| 36) Takachi R (2008) | The Japan Public Health Center-based Prospective Study (JPHC). | 77,891 subjects (35,909 men 41,982 and women) aged 45-74.
(Japan) | 5.8
(1995-1998 to 2002) | 1,386 (227 myocardial infarction, 1,159 stroke) | Risk of cardiovascular disease | Fruits (defined as: mandarins, oranges, and 100% orange juice, papaya, apples, persimmons, strawberries, grapes, melons, watermelons, peaches, pears, kiwi fruit, pineapple, bananas, and 100% apple juice) |
CVD risk stratified by gender
Men & Women
(1,386 cases) | Men
(830 cases) | Women
(556 cases) |
HR = 0.81 (0.67-0.97; P = 0.01) for the highest vs lowest quartile of consumption (Not defined).
Amount specific data (quartiles):
Q1: HR = 1.
Q2: HR = 0.94 (0.81-1.09).
Q3: HR = 0.83 (0.70-0.98).
Q4: HR = 0.81 (0.67-0.97).
HR for the highest vs lowest decile of consumption:
HR = 0.81 (0.61-1.08; P = 0.01). |
HR = 0.83 (0.64-1.07; P = 0.11) for the highest vs lowest quartile of consumption (Not defined).
Amount specific data (quartiles):
Q1: HR = 1.
Q2: HR = 0.92 (0.77-1.10).
Q3: HR = 0.88 (0.71-1.08).
Q4: HR = 0.83 (0.64-1.07). |
HR = 0.77 (0.58-1.02; P = 0.04) for the highest vs lowest quartile of consumption (Not defined).
Amount specific data (quartiles):
Q1: HR = 1.
Q2: HR = 0.96 (0.72-1.27).
Q3: >HR = 0.76 (0.57-1.01).
Q4: HR = 0.77 (0.58-1.02).> |
CVD risk stratified by smoking status
Ever smoker
(649 cases) | Nonsmoker
(689 cases) |
HR = 0.84 (0.63-1.13; P = 0.25) for the highest vs lowest quartile of consumption (Not defined).
Amount specific data (quartiles):
Q1: HR = 1.
Q2: HR = 0.94 (0.77-1.15).
Q3: HR = 0.93 (0.74-1.17).
Q4: HR = 0.84 (0.63-1.13).
HR for men only = 0.87 (0.64-1.19; P = 0.39). |
HR = 0.76 (0.60-0.97; P = 0.02) for the highest vs lowest quartile of consumption (Not defined).
Amount specific data (quartiles):
Q1: HR = 1.
Q2: HR = 0.93 (0.74-1.17).
Q3: HR = 0.75 (0.59-0.95).
Q4: HR = 0.76 (0.60-0.97).
HR for men only = 0.74 (0.45-1.20; P = 0.13)
For both men and women, CVD incidence was lower in nonsmokers than ever smokers, and the inverse association between fruit intake and risk was more remarkable among nonsmokers than ever smokers. |
Stratified analyses by cohort (cohort I or II), BMI, age, and alcohol intake (< 150 vs > or = 150 g ethanol/wk) showed similar results. | age, public health center area, BMI, physical activity, smoking, alcohol, energy, screening examination, medication, and daily vitamin supplement use. |
| 21) Liu S (2000) | The Women's Health Study. | 39,876 female health professionals.
(USA) | 5
(1993-1999) | All cases: 418.
Excluding women with self-reported disease: 110. | Cardiovascular disease risk | All fruit (apple, pear, orange, grapefruit, peach, banana, strawberry, blueberry, cantaloupe, raisin, prune, and fruit juices) |
| All women: | Excluding women with self-reported diabetes, history of hypertension, or history of high cholesterol at baseline: |
RR = 0.96 (0.70-1.33; P = 0.69) for the highest vs lowest quintile of consumption.
Amount specific data (median servings/d):
0.6: RR = 1.
1.3: RR = 0.73 (0.52-1.01).
1.9: RR = 0.70 (0.50-0.99).
2.6: RR = 0.91 (0.66-1.26).
3.9: RR = 0.96 (0.70-1.33).
|
RR = 0.57 (0.30-1.09; P = 0.15) for the highest vs lowest quintile of consumption.
Amount specific data (median servings/d):
0.6: RR = 1.
1.3: RR = 0.71 (0.39-1.26).
1.9: RR = 0.67 (0.37-1.23).
2.6: RR = 0.79 (0.44-1.42).
3.8: RR = 0.57 (0.30-1.09).
|
Age, smoking, exercise, alcohol use, postmenopausal hormone use, BMI, multivitamin use, vitamin C supplement use, history of diabetes, history of hypertension, history of cholesterol, and parental history of MI. |
| 20) Cox BD. (2000) | The British Health and Lifestyle Survey (HALS). | 1,422 men, and 1,826 women aged 35-75. | 7
(1984-85 to 1991-92) | 205? men, and 187? women | Cardiovascular disease risk | Fruit (not defined) |
Men
| Fruit in winter | Fruit in summer |
OR = 0.98 (0.87-1.09; P = 0.705) per frequency category of increasing consumption.
Amount specific data:
Never: OR = 1.
< 1 day/wk: OR = 0.54.
1-2 days/wk: OR = 0.72.
3-6 days/wk: OR = 0.83.
Daily: OR = 0.69. |
OR = 1.03 (0.91-1.16; P = 0.634) per frequency category of increasing consumption.
Amount specific data:
Never: OR = 1.
< 1 day/wk: OR = 0.54.
1-2 days/wk: OR = 0.77.
3-6 days/wk: OR = 0.67.
Daily: OR = 0.81. |
Women
| Fruit in winter | Fruit in summer |
OR = 0.84 (0.74-0.94; P = 0.004) per frequency category of increasing consumption.
Amount specific data:
Never: OR = 1.
< 1 day/wk: OR = 0.95.
1-2 days/wk: OR = 0.75.
3-6 days/wk: OR = 0.69.
Daily: OR = 0.52. |
OR = 0.85 (0.74-0.97; P = 0.014) per frequency category of increasing consumption.
Amount specific data:
Never: OR = 1.
< 1 day/wk: OR = 0.39.
1-2 days/wk: OR = 0.85.
3-6 days/wk: OR = 0.57.
Daily: OR = 0.43. |
Age, smoking and socioeconomic group. |
| 10) Joshipura KJ (2009) | The Nurses' Health Study
&
The Health Professional's Follow-up Study | 70,870 women aged 38-63, and 38,918 men aged 40-75. Subjects were without cancer, diabetes or CVD. | Men: 14 (1986-2000).
Women: 16 (1984-2000) | 2,040? men, and
1,852? women | Ischaemic CVD incidence (fatal and non-fatal MI and ischaemic stroke) | Total fruits (not defined) |
Highest vs lowest quintile of consumption.
Stratified by energy from carbohydrate intake:
| < 40% | 40-55% | > 55% |
Men: RR = 1.08
Women: RR = 1.14
Men & women: RR = 1.11 (0.78-1.58)
|
Men: RR = 0.76
Women: RR = 0.86
Men & women: RR = 0.81 (0.70-0.94; P = < 0.05)
|
Men: RR = 1.19
Women: RR = 1.30
Men & women: RR = 1.25 (0.87-1.78)
|
Per increment of 3 servings/d.
Stratified by energy from carbohydrate intake:
| < 40% | 40-55% | > 55% |
Men: RR = 0.76
Women: RR = 1.03
Men & women: RR = 0.88 (0.66-1.18; P = 0.42)
|
Men: RR = 0.89
Women: RR = 0.90
Men & women: RR = 0.90 (0.80-1.01; P = 0.07)
|
Men: RR = 0.96
Women: RR = 0.89
Men & women: RR = 0.93 (0.76-1.13; P = 0.46)
|
Effect modification: All associations were generally attenuated among the multivitamin supplement users (data not shown).Total energy, whole grains, age, smoking, alcohol, BMI, multivitamin and vitamin E supplement use, aspirin use, physical activity, family history of MI, history of hypertension, hypercholesterolaemia and incident diabetes, and menopausal status and hormone replacement therapy. |
| 10) Hung HC. (2004) | The Nurses' Health Study
&
The Health Professionals' Follow-up Study. | 71,910 women (aged 30-55) and
37,725 men (aged 40-75).
(USA) | 14
(1984-1998)
(women), and
12
(1986-1998)
(men) | 1964? women, and
1670? men.
1314 never smokers, 1513 past smokers, and 988 current smokers.
1625 non-vitamin supplement users, and 1444 vitamin supplement users. | Cardiovascular disease risk | All fruit (raisins or grapes, prunes, bananas, cantaloupes, watermelon, fresh apples or pears, oranges, grapefruit, strawberries, blueberries, peaches, apricots or plums, blackberries, cherries, currants, dates, fruit cocktail, guavas, honeydew melon, kiwi fruit, lemons, limes, mangoes, crenshaw melon, nectarines, persimmons, pineapple, plantains, pomegranates, quince, raspberries, tangerines, applesauce and dried apples, figs, papaya) |
Stratified by sex:
| Men + women | Men | Women |
| A significant inverse association: RR = 0.87 (0.80-0.94; No P-value). |
RR = 0.85 (No 95% CI; No P-value). |
RR = 0.88 (No 95% CI; No P-value). |
Stratified by smoking status (men and women combined):
| Never | Past | Current |
| RR = 0.94 (0.81-1.08; No P-value). | RR = 0.86 (0.76-0.99; No P-value). | RR = 0.78 (0.65-0.93; No P-value). |
Stratified by multivitamin use (men and women combined):
| Non-vitamin use | Multivitamin use |
| RR = 0.88 (0.77-1.01; No P-value). | RR = 0.89 (0.78-1.02; No P-value). |
All RRs are for an increment of 3 servings/day.Total calorie intake, age, smoking status, alcohol use, body mass index, multivitamin and vitamin E supplement use, physical activity, family history of myocardial infarction, family history of colon cancer, personal history of hypertension, personal history of hypercholesterolemia, personal history of diabetes, and (for women only) family history of breast cancer, menopausal status, and use of hormone replacement therapy. |
| 10) McCullough ML. (2000) | The Health Professionals Follow-up Study. | 38,622 men aged 40-75.
(USA) | 8
(1986-1994) | 1,092? | Cardiovascular disease risk (fatal and nonfatal myocardial infarction and stroke) | Fruit | A reduced risk: RR for a 5-point increase (representing more servings) = 0.87 (0.77-0.98; No P-value).
Highest (10 points) vs lowest tertile (0 points) = 3.2-4 vs 0 servings/d respectively. | Each component of the healthy food index was added individually into the multivariate model, adjusting for age, smoking, body mass index, alcohol intake, physical activity, diagnosis of hypertension or hypercholesterolemia at baseline, total energy intake, multivitamin use, vitamin E use, and time period. |
Cardiovascular disease mortality:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 37) Nagura J (2009) | The JACC Study | 25,206 men and 34,279 women aged 40-79, and without a history of CHD, stroke, or cancer.
(Japan) | 12.7
(1989-2003) | 2,243 | Total CVD mortality | Fruit (citrus fruits, other fruits, and fresh fruit juice in summer) |
HR = 0.77 (0.67-0.88; P = < 0.001) for the highest vs lowest quartile of consumption.
Amount specific data (servings per week):
0.9: HR = 1.
2.3: HR = 0.90 (0.80-1.00).
3.9: HR = 0.89 (0.79-0.99).
5.9: HR = 0.77 (0.67-0.88).
The association did not vary by sex (no data shown). | Sex, age, BMI, smoking status, alcohol intake, hours of walking, hours of sleep, education years, perceived mental stress, cholesterol intake, SFA intake, n-3 fatty acids intake, sodium intake, vegetables intake, bean intake and histories of hypertension and diabetes. |
| 33) Chang-Claude J (2005) | The German Vegetarian Study | 1,724 vegetarians and health conscious persons. | 21
(1978-1999) | 219? | Circulatory disease mortality | Fruits (not defined) | Frequency of consumption did not show an appreciable effect on mortality (no data shown). | Age, gender, smoking, level of activity, alcohol consumption, vegetarianism, BMI, and education. |
| 26) Nöthlings U (2008) | The EPIC Study. | 10,449 participants - aged 35 to 70- with self-reported diabetes mellitus.
(10 European Countries) | 9
(1992-2000 to 2007) | 517? | CVD mortality | Fruit (not defined) | RR = 0.90 (0.81-0.99) for an increase of 80 g/d. | Stratified on age.
Adusted for sex, smoking status, self-reported heart attack at baseline, self-reported hypertension at baseline, self-reported cancer at baseline, waist-to-hip ratio, insulin treatment, age at diabetes diagnosis, energy intake, alcohol intake. |
| 24) Nakamura K (2008) | The Takayama Study. | 13,355 men and 15,724 women aged ≥ 35.
(Japan) | 7
(1992-1999) | 200 men, and 184 women | CVD mortality | Total fruit (orange, grapefruit, melon, banana, kiwi, mandarin orange, peach, watermelon, apple, pear, Japanese persimmon, and strawberry) |
| Men: | Women: |
HR = 1.16 (0.77-1.74; P = 0.61) for the highest vs lowest quartile of consumption.
Amount specific data in servings/d (g/d):
0.3 (24.1): HR = 1.
0.7 (62.2): HR = 1.09 (0.73-1.62).
1.3 (110.6): HR = 0.90 (0.58-1.38).
2.6 (211.7): HR = 1.16 (0.77-1.74).
|
HR = 0.99 (0.66-1.50; P = 0.48) for the highest vs lowest quartile of consumption.
Amount specific data in servings/d (g/d):
0.4 (35.7): HR = 1.
0.9 (77.0): HR = 0.99 (0.65-1.50).
1.5 (122.5): HR = 0.74 (0.47-1.18).
2.7 (213.6): HR = 0.99 (0.66-1.50).
|
The serving size was determined as 80 g.
Age, total energy, marital status, years of education, BMI, smoking status, alcohol intake, exercise, history of hypertension or diabetes mellitus, menopausal status, total protein, saturated fat, and sodium intake. |
| 12) Appleby PN. (2002) | The Health Food Shoppers Study. | 10,741 subjects, aged 16-89 (4,325 men, 6,416 women. 8,675 non-smokers).
(UK) | 1973-79 to 1997 | 1,202 (591 men, and 611 women. 981 non-smokers) | Mortality from circulatory diseases | Fresh fruit (not defined) |
| All subjects | Men | Women | Non-smokers |
RR = 0.83 (0.73-0.96; P = < 0.01).
After additional adjustment for wholemeal bread, nuts/dried fruit, raw vegetable salads, and bran cereals: RR = 0.89 (0.77-1.03; No P-value). | RR = 0.95 (0.79-1.14; No P-value). | RR = 0.70 (0.58-0.86; P = < 0.01). | RR = 0.80 (0.69-0.94; P = < 0.01). |
RRs are for daily consumption vs less frequent consumption.Age at recruitment, sex, and smoking. |
| 2) Vollset SE (1983) | No cohort name. | 16,713 Norwegian postal dietary survery respondents. | 11.5
(1967-?) | 438? | CVD mortality | Fruits and berries (not defined) | A negative association (no data shown). | Not defined, but possiby sex, age, region, and urbanisation. |
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