International Journal of Epidemiology, Vol 26, 1-13, Copyright © 1997 by International Epidemiological Association
AR Ness and JW Powles
BACKGROUND: Increased interest in the potential cardio-protective effects
of fruit and vegetables is currently unsupported by systematic reviews of
the reported associations of these foods with risk. METHOD: All ecological,
case-control, cohort studies and unconfounded trials in humans were
eligible for inclusion. Eligible outcomes were symptomatic coronary heart
disease, stroke and total circulatory disease. Only studies of diet that
reported on fresh fruit and vegetables or a nutrient which could serve as a
proxy (reversing the usual direction of inference) were included. MEDLINE
(1966-1995) and EMBASE (1980-1995) were searched using the terms
cerebrovascular disorder, coronary heart disease, fruit(s) and vegetable(s)
as keywords. Personal bibliographies, books and reviews were also searched,
as were citations in located reports. RESULTS: For coronary heart disease
nine of ten ecological studies, two of three case-control studies and six
of 16 cohort studies found a significant protective association with
consumption of fruit and vegetables or surrogate nutrients. For stroke
three of five ecological studies, none (of one) case-control study and six
of eight cohort studies found a significant protective association with
consumption of fruit and vegetables or surrogate nutrients. For total
circulatory disease, one of two cohort studies reported a significant
protective association. No attempt was made to arrive at a summary measure
of the association because of the differences in study type, study quality
and the different exposure measures used. CONCLUSIONS: Although null
findings may be underreported the results are consistent with a strong
protective effect of fruit and vegetables for stroke and a weaker
protective effect on coronary heart disease. Greater use of food-based
hypotheses and analyses, would complement existing nutrient-based analyses
and help guide the search for underlying causes.
ARTICLES
Fruit and vegetables, and cardiovascular disease: a review
Institute of Public Health, University Forvie Site, Cambridge, UK.
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