title: Fruit and vegetable intake and cause-specific mortality in the EPIC study.
abstract: Consumption of fruits and vegetables is associated with a lower overall mortality. The aim of this study was to identify causes of death through which this association is established. More than 450,000 participants from the European Prospective Investigation into Cancer and Nutrition study were included, of which 25,682 were reported deceased after 13 years of follow-up. Information on lifestyle, diet and vital status was collected through questionnaires and population registries. Hazard ratios (HR) with 95% confidence intervals (95% CI) for death from specific causes were calculated from Cox regression models, adjusted for potential confounders. Participants reporting consumption of more than 569 g/day of fruits and vegetables had lower risks of death from diseases of the circulatory (HR for upper fourth 0.85, 95% CI 0.77-0.93), respiratory (HR for upper fourth 0.73, 95% CI 0.59-0.91) and digestive system (HR for upper fourth 0.60, 95% CI 0.46-0.79) when compared with participants consuming less than 249 g/day. In contrast, a positive association with death from diseases of the nervous system was observed. Inverse associations were generally observed for vegetable, but not for fruit consumption. Associations were more pronounced for raw vegetable consumption, when compared with cooked vegetable consumption. Raw vegetable consumption was additionally inversely associated with death from neoplasms and mental and behavioral disorders. The lower risk of death associated with a higher consumption of fruits and vegetables may be derived from inverse associations with diseases of the circulatory, respiratory and digestive system, and may depend on the preparation of vegetables and lifestyle factors.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands, m.b.leenders@uu.nl.
authors.forename: Max
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authors.lastname: Leenders
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: Pietro
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authors.lastname: Ferrari
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authors.lastname: Siersema
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authors.forename: Marie-Christine
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authors.lastname: Boutron-Ruault
authors.forename: Laure
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authors.lastname: Dossus
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authors.lastname: Dartois
authors.forename: Rudolf
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authors.forename: Kuanrong
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authors.forename: Heiner
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authors.forename: Manuela M
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authors.lastname: Bergmann
authors.forename: Antonia
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authors.lastname: Trichopoulou
authors.forename: Pagona
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authors.lastname: Lagiou
authors.forename: Dimitrios
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authors.lastname: Trichopoulos
authors.forename: Domenico
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authors.lastname: Palli
authors.forename: Vittorio
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authors.lastname: Krogh
authors.forename: Salvatore
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authors.lastname: Panico
authors.forename: Rosario
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authors.lastname: Tumino
authors.forename: Paolo
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authors.lastname: Vineis
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Elisabete
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authors.lastname: Weiderpass
authors.forename: Dagrun
authors.initials: D
authors.lastname: Engeset
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Redondo
authors.forename: Antonio
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authors.lastname: Agudo
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Pilar
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authors.lastname: Amiano
authors.forename: José-María
authors.initials: JM
authors.lastname: Huerta
authors.forename: Eva
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authors.lastname: Ardanaz
authors.forename: Isabel
authors.initials: I
authors.lastname: Drake
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Anna
authors.initials: A
authors.lastname: Winkvist
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Bradbury
authors.forename: Mattias
authors.initials: M
authors.lastname: Johansson
authors.forename: Idlir
authors.initials: I
authors.lastname: Licaj
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Gunter
authors.forename: Neil
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authors.lastname: Murphy
authors.forename: Elio
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authors.lastname: Riboli
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004032:Diet; D004034:Diet Surveys / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables