title: Low consumption of fruit and vegetables and risk of chronic disease: a review of the epidemiological evidence and temporal trends among Spanish graduates.
abstract: OBJECTIVE
  To review the evidence on the association between fruit and vegetable (F&V) consumption and risk of chronic disease, and to assess trends in the prevalence of low F&V consumption.
  
  
  METHODS
  Systematic review and cross-sectional analyses of a Mediterranean cohort.
  
  
  METHODS
  The Seguimiento University of Navarra (SUN) project (Spanish dynamic cohort of graduates).
  
  
  METHODS
  A systematic review of prospective studies aimed to assess the relationship between fruit and/or vegetables consumption and chronic disease incidence was conducted. We also assessed 18 457 university graduates (59·4 % women; mean age = 39 (sd 12) years) enrolled in a dynamic cohort with permanently open recruitment. Baseline data were collected between 1999 and 2010 using a validated 136-item FFQ. Four definitions for low F&V consumption were used (<400 g/d, <200 g/4184 kJ (1000 kcal) per d, ≤2 servings/d and ≤1 serving/d). Multivariate-adjusted cross-sectional associations between the prevalence of low F&V consumption and the year of recruitment were estimated.
  
  
  RESULTS
  The systematic review found that a high F&V consumption is inversely associated with CVD incidence and mortality. This association is not so clear for cancer. Inconsistent findings have been reported for diabetes. In all, 13 % of participants in the SUN cohort did not meet the goal of consuming at least 400 g/d of F&V and 2·1 % of them did not reach >1 serving/d. Between 1999 and 2010 the consumption of F&V significantly increased.
  
  
  CONCLUSIONS
  Even among health-conscious university graduates, low F&V consumption is fairly prevalent. Although the temporal trends suggest an improvement, preventive strategies addressed to increase F&V consumption are needed.
authors.affiliation: Department of Preventive Medicine and Public Health, Medical School and Clinic, University of Navarra, Irunlarrea 1, 31080 Pamplona, Navarra, Spain. mamartinez@unav.es
authors.forename: Miguel Á
authors.initials: MÁ
authors.lastname: Martínez-González
authors.forename: Carmen
authors.initials: C
authors.lastname: de la Fuente-Arrillaga
authors.forename: Cristina
authors.initials: C
authors.lastname: López-Del-Burgo
authors.forename: Zenaida
authors.initials: Z
authors.lastname: Vázquez-Ruiz
authors.forename: Silvia
authors.initials: S
authors.lastname: Benito
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D038441:Diet, Mediterranean; D005260:Female; D005638:Fruit; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D014675:Vegetables