title: Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies.
abstract: OBJECTIVE
  To examine and quantify the potential dose-response relation between fruit and vegetable consumption and risk of all cause, cardiovascular, and cancer mortality.
  
  
  METHODS
  Medline, Embase, and the Cochrane library searched up to 30 August 2013 without language restrictions. Reference lists of retrieved articles.
  
  
  METHODS
  Prospective cohort studies that reported risk estimates for all cause, cardiovascular, and cancer mortality by levels of fruit and vegetable consumption.
  
  
  RESULTS
  Random effects models were used to calculate pooled hazard ratios and 95% confidence intervals and to incorporate variation between studies. The linear and non-linear dose-response relations were evaluated with data from categories of fruit and vegetable consumption in each study.
  
  
  RESULTS
  Sixteen prospective cohort studies were eligible in this meta-analysis. During follow-up periods ranging from 4.6 to 26 years there were 56,423 deaths (11,512 from cardiovascular disease and 16,817 from cancer) among 833,234 participants. Higher consumption of fruit and vegetables was significantly associated with a lower risk of all cause mortality. Pooled hazard ratios of all cause mortality were 0.95 (95% confidence interval 0.92 to 0.98) for an increment of one serving a day of fruit and vegetables (P=0.001), 0.94 (0.90 to 0.98) for fruit (P=0.002), and 0.95 (0.92 to 0.99) for vegetables (P=0.006). There was a threshold around five servings of fruit and vegetables a day, after which the risk of all cause mortality did not reduce further. A significant inverse association was observed for cardiovascular mortality (hazard ratio for each additional serving a day of fruit and vegetables 0.96, 95% confidence interval 0.92 to 0.99), while higher consumption of fruit and vegetables was not appreciably associated with risk of cancer mortality.
  
  
  CONCLUSIONS
  This meta-analysis provides further evidence that a higher consumption of fruit and vegetables is associated with a lower risk of all cause mortality, particularly cardiovascular mortality.
authors: Department of Maternal and Child Health Care, School of Public Health, Shandong University, Jinan, China Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Xia
authors: X
authors: Wang
authors: Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Yingying
authors: Y
authors: Ouyang
authors: Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Jun
authors: J
authors: Liu
authors: Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Minmin
authors: M
authors: Zhu
authors: Department of Cardiovascular Sciences, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.
authors: Gang
authors: G
authors: Zhao
authors: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA nhbfh@channing.harvard.edu wei.bao@nih.gov.
authors: Wei
authors: W
authors: Bao
authors: Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA nhbfh@channing.harvard.edu wei.bao@nih.gov.
authors: Frank B
authors: FB
authors: Hu
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004032:Diet / Q000706:statistics & numerical data*; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014675:Vegetables