title: Fruit consumption and physical activity in relation to all-cause and cardiovascular mortality among 70,000 Chinese adults with pre-existing vascular disease.
abstract: OBJECTIVE
  To assess the associations of fresh fruit consumption and total physical activity with all-cause and cardiovascular mortality among Chinese adults who have been diagnosed with cardiovascular disease (CVD) or hypertension.
  
  
  METHODS
  During 2004-08, the China Kadoorie Biobank study recruited 70,047 adults, aged 30-79 years, with physician-diagnosed stroke or transient ischaemic attack, ischemic heart disease, or hypertension. Information on diet and physical activity was collected using an interviewer-administered electronic questionnaire. Cox regression was used to yield hazard ratios (HRs) for the independent and joint associations of fresh fruit consumption and total physical activity with mortality.
  
  
  RESULTS
  At baseline, 32.9% of participants consumed fresh fruit regularly (i.e. >3 days/week) and the mean total physical activity were 15.8 (SD = 11.8) MET-hr/day. During ~7-years follow-up, 6569 deaths occurred with 3563 from CVD. Compared to participants with <1 day/week fruit consumption, regular consumers had HR (95% CI) of 0.84 (0.79-0.89) for all-cause mortality and 0.79 (0.73-0.86) for CVD mortality. The HRs for the top vs bottom tertile of physical activity were 0.68 (0.64-0.72) and 0.65 (0.60-0.71), respectively, with no clear evidence of reverse causality. After correcting for regression dilution, each 100 g/day usual consumption of fresh fruit or 10 MET-hr/day usual levels of physical activity was associated with 23-29% lower mortality. The combination of regular fruit consumption with top 3rd of physical activity (>16.53 MET-hr/day) was associated with about 40% lower mortality.
  
  
  CONCLUSIONS
  Among Chinese adults with pre-existing vascular disease, higher physical activity and fruit consumption were both independently and jointly associated with lower mortality.
authors.affiliation: School of Public Health, Shandong University, Jinan, Shandong, China.|Qingdao Center for Disease Prevention and Control, Qingdao, Shandong, China.
authors.forename: Xiaocao
authors.initials: X
authors.lastname: Tian
authors.affiliation: Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Huaidong
authors.identifier: http://orcid.org/0000-0002-9814-0049
authors.initials: H
authors.lastname: Du
authors.affiliation: Dept. of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China.|Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Derrick
authors.initials: D
authors.lastname: Bennett
authors.affiliation: Qingdao Center for Disease Prevention and Control, Qingdao, Shandong, China.
authors.forename: Ruqin
authors.initials: R
authors.lastname: Gao
authors.affiliation: Qingdao Center for Disease Prevention and Control, Qingdao, Shandong, China.
authors.forename: Shanpeng
authors.initials: S
authors.lastname: Li
authors.affiliation: Qingdao Center for Disease Prevention and Control, Qingdao, Shandong, China.
authors.forename: Shaojie
authors.initials: S
authors.lastname: Wang
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Bian
authors.affiliation: Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Ling
authors.initials: L
authors.lastname: Yang
authors.affiliation: Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.|Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Chen
authors.affiliation: China National Center for Food Safety Risk Assessment, Beijing, China.
authors.forename: Junshi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Suzhou CDC, Suzhou, Jiangsu Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Meilan CDC, Haikou, Hainan Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Weng
authors.affiliation: Qingdao Center for Disease Prevention and Control, Qingdao, Shandong, China.
authors.forename: Zengchang
authors.initials: Z
authors.lastname: Pang
authors.affiliation: School of Public Health, Shandong University, Jinan, Shandong, China.
authors.forename: Baofa
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D004032:Diet; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies