Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Int J Epidemiol. 2017 Jun 1;46(3):1029-1056. doi: 10.1093/ije/dyw319.
Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations.
PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included.
For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90-0.94, I 2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal.
Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.
水果和蔬菜摄入量与心血管疾病、癌症和全因死亡率风险之间的剂量反应关系的强度和形状仍存在疑问，特定类型的水果和蔬菜的影响也存在疑问。我们进行了系统回顾和荟萃分析以阐明这些关联。
检索了 PubMed 和 Embase 数据库，检索时间截至 2016 年 9 月 29 日。纳入了水果和蔬菜摄入量与心血管疾病、总癌症和全因死亡率相关的前瞻性研究。使用随机效应模型计算了每个 200 克/天的汇总相对风险（RR），并估计了全球死亡率负担；共纳入了 95 项研究（142 篇文献）。
对于水果和蔬菜的综合摄入量，每天 200 克的 RR 分别为冠心病 0.92（95%CI：0.90-0.94，I 2 = 0%，n = 15）、中风 0.84（95%CI：0.76-0.92，I 2 = 73%，n = 10）、心血管疾病 0.92（95%CI：0.90-0.95，I 2 = 31%，n = 13）、总癌症 0.97（95%CI：0.95-0.99，I 2 = 49%，n = 12）和全因死亡率 0.90（95%CI：0.87-0.93，I 2 = 83%，n = 15）。单独分析水果和蔬菜时也观察到类似的关联。除癌症（600 克/天）外，所有结果的风险降低都可观察到高达 800 克/天。摄入苹果和梨、柑橘类水果、绿叶蔬菜、十字花科蔬菜和沙拉与心血管疾病和全因死亡率呈负相关，摄入绿黄色蔬菜和十字花科蔬菜与总癌症风险呈负相关。如果观察到的关联是因果关系，那么 2013 年全球估计有 560 万和 780 万例过早死亡可归因于水果和蔬菜摄入量低于 500 克/天和 800 克/天。
水果和蔬菜的摄入量与降低心血管疾病、癌症和全因死亡率的风险有关。这些结果支持公共卫生建议，即增加水果和蔬菜的摄入量以预防心血管疾病、癌症和过早死亡。
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