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The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease

Kaumudi J. Joshipura, ScD; Frank B. Hu, MD; JoAnn E. Manson, MD; Meir J. Stampfer, MD; Eric B. Rimm, ScD; Frank E. Speizer, MD; Graham Colditz, MD; Alberto Ascherio, MD; Bernard Rosner, PhD; Donna Spiegelman, ScD; and Walter C. Willett, MD
[+] Article and Author Information

From Harvard School of Public Health, Harvard School of Dental Medicine, Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.


Grant Support: By grants HL34595, HL35464 and CA40356, CA55075, and DE12102 from the National Institute of Health and by the Office of Dietary Supplements and the Florida Department of Citrus.

Acknowledgments: The authors thank the participants of the Health Professionals' Follow-up Study and the Nurses' Health Study for their continued cooperation and participation; Al Wing, Mira Kaufman, Karen Corsano, and Marcia Goetsch for computer assistance; Jill Arnold, Betsy Frost-Hawes, Kerry Demers, Mitzi Wolff, Gary Chase, and Barbara Egan for assistance in the compilation of data; and Laura Sampson for maintaining the food composition tables.

Requests for Single Reprints: Kaumudi J. Joshipura, ScD, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston MA 02115.

Current Author Addresses: Drs. Joshipura, Hu, Manson, Stampfer, Rimm, Speizer, Colditz, Ascherio, Rosner, Speigelman, and Willett: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.

Author Contributions: Conception and design: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, E.B. Rimm, F.E. Speizer, G. Colditz, A. Ascherio, W.C. Willett.

Analysis and interpretation of the data: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, E.B. Rimm, A. Ascherio, B. Rosner, D. Spiegelman, W.C. Willett.

Drafting of the article: K.J. Joshipura, F.B. Hu, W.C. Willett.

Critical revision of the article for important intellectual content: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, E.B. Rimm, A. Ascherio, B. Rosner, D. Spiegelman, W.C. Willett.

Final approval of the article: K.J. Joshipura, F.B. Hu, J.E. Manson, M.J. Stampfer, F.E. Speizer, G. Colditz, A. Ascherio, D. Spiegelman, W.C. Willett.

Provision of study materials or patients: M.J. Stampfer, E.B. Rimm, F.E. Speizer, G. Colditz.

Statistical expertise: K.J. Joshipura, B. Rosner, D. Spiegelman, W.C. Willett.

Obtaining of funding: K.J. Joshipura, J.E. Manson, E.B. Rimm, F.E. Speizer, G. Colditz, W.C. Willett.

Administrative, technical, or logistic support: K.J. Joshipura, E.B. Rimm, F.E. Speizer, G. Colditz, W.C. Willett.

Collection and assembly of data: M.J. Stampfer, E.B. Rimm, F.E. Speizer, G. Colditz, D. Spiegelman, W.C. Willett.


Ann Intern Med. 2001;134(12):1106-1114. doi:10.7326/0003-4819-134-12-200106190-00010
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In several studies, many nutrients in fruits and vegetables, such as dietary fiber, potassium, and antioxidants, have been associated with reduced risk for cardiovascular disease (15). However, as reviewed elsewhere (6), most prospective studies that have specifically examined intake of fruits and vegetables in relation to risk for cardiovascular disease have been small, and their results have been inconsistent. Dietary assessments were often crude and available only at baseline, and few studies have examined the effects of specific types of vegetables or fruits. In a recent report (7), we evaluated the association between fruit and vegetable intake and risk for ischemic stroke. We found that persons in the highest quintile of fruit and vegetable intake had a relative risk of 0.69 (95% CI, 0.52 to 0.92) compared with the lowest quintile of intake; moreover, a 1-serving/d increase in fruit or vegetable intake was associated with a 6% lower risk for ischemic stroke, after controlling for standard cardiovascular risk factors. In the current study, we sought to evaluate the association between intake of overall and specific fruits and vegetables and incidence of coronary heart disease.

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Figure.
Total intake of fruits and vegetables and multivariate relative risk for coronary heart disease.PP

Data are for men and women combined and are adjusted for age (5-year categories), smoking status (never, former, or current [1–14, 15–24, or >24 cigarettes/d]), alcohol intake (7 categories in men and 5 categories in women), family history of myocardial infarction (age < 60 years in men and < 65 years in women), body mass index (quintiles), vitamin supplement use, vitamin E use, physical activity, aspirin use, 2-year follow-up period, presence of hypertension, presence of hypercholesterolemia, total daily caloric intake, and postmenopausal hormone use (among women). Fewer than 3 servings/d is the referent group. The trend in decreasing coronary heart disease risk with increasing fruit and vegetable intake, using a single continuous variable for the median intake in each quintile of the composite item and pooled across cohorts, is significant (  = 0.01). Error bars represent 95% CIs. for trend = 0.01.

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Summary for Patients

Eating Fruits and Vegetables Helps Prevent Coronary Heart Disease

The summary below is from the full report titled “The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease.” It is in the 19 June 2001 issue of Annals of Internal Medicine (volume 134, pages 1106-1114). The authors are KJ Joshipura, FB Hu, JE Manson, MJ Stampfer, EB Rimm, FE Speizer, G Colditz, A Ascherio, B Rosner, D Spiegelman, and WC Willett.

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