Fruit and vegetable intakes, dietary antioxidant nutrients, and total mortality in Spanish adults: findings from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain).
BACKGROUND
Epidemiologic data suggest that persons with diets rich in fruit and vegetables are at a lower risk of several chronic diseases and mortality than are persons with diets poor in fruit and vegetables. Often, this effect is attributed to antioxidant micronutrients found in plant foods.


OBJECTIVE
We aimed to assess the relation of mortality to the consumption of fruit, vegetables, and other plant foods and to the dietary intake of vitamin C, vitamin E, and carotenoids.


METHODS
The study was a prospective study in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition. During 6.5 y of follow-up, 562 deaths occurred in 41 358 subjects aged 30-69 y. Proportional hazards regression analysis was used to assess the relation between dietary factors and total mortality.


RESULTS
After adjustment for age, sex, and several potential confounders, the hazard ratio for the highest versus the lowest quartile of consumption was 0.79 (95% CI: 0.62, 1.00; P for trend = 0.029) for fresh fruit, 0.72 (0.56, 0.91; P for trend = 0.006) for root vegetables, and 0.77 (0.60, 0.98; P for trend = 0.015) for fruiting vegetables (ie, vegetables that contain the "fruit" part of the plant, the seeds). The corresponding figures for antioxidant nutrients were 0.74 (0.58, 0.94; P for trend = 0.009) for vitamin C, 0.68 (0.53, 0.87; P for trend = 0.006) for provitamin A carotenoids, and 0.65 (0.51, 0.84; P for trend 0.001) for lycopene. The effect of vitamin C and provitamin A disappeared after adjustment for total antioxidant capacity in plant foods.


CONCLUSIONS
A high intake of fresh fruit, root vegetables, and fruiting vegetables is associated with reduced mortality, probably as a result of their high content of vitamin C, provitamin A carotenoids, and lycopene. Antioxidant capacity could partly explain the effect of ascorbic acid and provitamin A but not the association with lycopene.
Agudo
Antonio
A
Unit of Epidemiology, Catalan Institute of Oncology, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Spain. a.agudo@iconcologia.net
Cabrera
Laia
L
Amiano
Pilar
P
Ardanaz
Eva
E
Barricarte
Aurelio
A
Berenguer
Toni
T
Chirlaque
María D
MD
Dorronsoro
Miren
M
Jakszyn
Paula
P
Larrañaga
Nerea
N
Martínez
Carmen
C
Navarro
Carmen
C
Quirós
Jose R
JR
Sánchez
María J
MJ
Tormo
María J
MJ
González
Carlos A
CA
D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage*; D004032:Diet; D005260:Female; D005638:Fruit; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014675:Vegetables
D000975:Antioxidants