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European Journal of Epidemiology

, Volume 29, Issue 9, pp 639–652 | Cite as

Fruit and vegetable intake and cause-specific mortality in the EPIC study

  • Max LeendersEmail author
  • Hendriek C. Boshuizen
  • Pietro Ferrari
  • Peter D. Siersema
  • Kim Overvad
  • Anne Tjønneland
  • Anja Olsen
  • Marie-Christine Boutron-Ruault
  • Laure Dossus
  • Laureen Dartois
  • Rudolf Kaaks
  • Kuanrong Li
  • Heiner Boeing
  • Manuela M. Bergmann
  • Antonia Trichopoulou
  • Pagona Lagiou
  • Dimitrios Trichopoulos
  • Domenico Palli
  • Vittorio Krogh
  • Salvatore Panico
  • Rosario Tumino
  • Paolo Vineis
  • Petra H. M. Peeters
  • Elisabete Weiderpass
  • Dagrun Engeset
  • Tonje Braaten
  • Maria Luisa Redondo
  • Antonio Agudo
  • María-José Sánchez
  • Pilar Amiano
  • José-María Huerta
  • Eva Ardanaz
  • Isabel Drake
  • Emily Sonestedt
  • Ingegerd Johansson
  • Anna Winkvist
  • Kay-Tee Khaw
  • Nick J. Wareham
  • Timothy J. Key
  • Kathryn E. Bradbury
  • Mattias Johansson
  • Idlir Licaj
  • Marc J. Gunter
  • Neil Murphy
  • Elio Riboli
  • H. Bas Bueno-de-Mesquita
NUTRITIONAL EPIDEMIOLOGY

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.

Keywords

Fruits and vegetables Mortality Nutrition Cancer Cardiovascular disease Respiratory disease 

Notes

Acknowledgments

This work was supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer (coordination of EPIC). The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); Ministry of Health and Social Solidarity, Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC) and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch Zorg Onderzoek Nederland (ZON), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health. (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (Nº 6236) and Navarra, Instituto de Salud Carlos III - Redes Telemáticas de Investigación Cooperativa en Salud (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and Wellcome Trust (United Kingdom). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10654_2014_9945_MOESM1_ESM.docx (106 kb)
Supplementary material 1 (DOCX 106 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Max Leenders
    • 1
    • 2
    Email author
  • Hendriek C. Boshuizen
    • 3
    • 4
  • Pietro Ferrari
    • 5
  • Peter D. Siersema
    • 1
  • Kim Overvad
    • 6
    • 7
  • Anne Tjønneland
    • 8
  • Anja Olsen
    • 8
  • Marie-Christine Boutron-Ruault
    • 9
    • 10
    • 11
  • Laure Dossus
    • 9
    • 10
    • 11
  • Laureen Dartois
    • 9
    • 10
    • 11
  • Rudolf Kaaks
    • 12
  • Kuanrong Li
    • 12
  • Heiner Boeing
    • 13
  • Manuela M. Bergmann
    • 13
  • Antonia Trichopoulou
    • 14
    • 15
  • Pagona Lagiou
    • 15
    • 16
    • 17
  • Dimitrios Trichopoulos
    • 14
    • 16
    • 17
  • Domenico Palli
    • 18
  • Vittorio Krogh
    • 19
  • Salvatore Panico
    • 20
  • Rosario Tumino
    • 21
  • Paolo Vineis
    • 22
    • 23
  • Petra H. M. Peeters
    • 23
    • 24
  • Elisabete Weiderpass
    • 25
    • 26
    • 27
    • 28
  • Dagrun Engeset
    • 28
  • Tonje Braaten
    • 28
  • Maria Luisa Redondo
    • 29
  • Antonio Agudo
    • 30
  • María-José Sánchez
    • 31
    • 32
    • 33
  • Pilar Amiano
    • 33
    • 34
  • José-María Huerta
    • 33
    • 35
  • Eva Ardanaz
    • 33
    • 36
  • Isabel Drake
    • 37
  • Emily Sonestedt
    • 38
  • Ingegerd Johansson
    • 39
  • Anna Winkvist
    • 40
  • Kay-Tee Khaw
    • 41
  • Nick J. Wareham
    • 42
  • Timothy J. Key
    • 43
  • Kathryn E. Bradbury
    • 43
  • Mattias Johansson
    • 5
  • Idlir Licaj
    • 5
  • Marc J. Gunter
    • 23
  • Neil Murphy
    • 23
  • Elio Riboli
    • 23
  • H. Bas Bueno-de-Mesquita
    • 1
    • 4
    • 23
  1. 1.Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands
  3. 3.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  4. 4.National Institute of Public Health and the Environment (RIVM)BilthovenThe Netherlands
  5. 5.International Agency for Research on CancerLyonFrance
  6. 6.Section for Epidemiology, Department of Public HealthAarhus UniversityAarhusDenmark
  7. 7.Department of CardiologyAalborg University HospitalAalborgDenmark
  8. 8.Danish Cancer Society Research CenterCopenhagenDenmark
  9. 9.Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health TeamInsermVillejuifFrance
  10. 10.UMRS 1018Paris Sud UniversityVillejuifFrance
  11. 11.Institut Gustave RoussyVillejuifFrance
  12. 12.Department of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
  13. 13.Department of EpidemiologyGerman Institute of Human Nutrition Potsdam-RehbrückeNuthetalGermany
  14. 14.Hellenic Health FoundationAthensGreece
  15. 15.Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition PoliciesUniversity of Athens Medical SchoolAthensGreece
  16. 16.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  17. 17.Bureau of Epidemiologic ResearchAcademy of AthensAthensGreece
  18. 18.Molecular and Nutritional Epidemiology UnitCancer Research and Prevention Institute – ISPOFlorenceItaly
  19. 19.Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  20. 20.Department of Clinical and Experimental MedicineFederico II UniversityNaplesItaly
  21. 21.Cancer Registry and Histopathology Unit‘Civile - M.P. Arezzo’ HospitalAsp RagusaItaly
  22. 22.Human Genetics Foundation (HuGeF)TurinItaly
  23. 23.Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
  24. 24.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  25. 25.Department of ResearchCancer Registry of NorwayOsloNorway
  26. 26.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  27. 27.Samfundet FolkhälsanHelsinkiFinland
  28. 28.Department of Community Medicine, Faculty of Health SciencesUiT The Arctic University of NorwayTromsöNorway
  29. 29.Public Health DirectorateAsturiasSpain
  30. 30.Unit of Nutrition, Environment and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELLL’Hospitalet de LlobregatBarcelonaSpain
  31. 31.Escuela Andaluza de Salud PúblicaGranadaSpain
  32. 32.Instituto de Investigación Biosanitaria de GranadaGranadaSpain
  33. 33.CIBER Epidemiology and Public Health CIBERESPMadridSpain
  34. 34.Public Health Division of GipuzkoaResearch Institute of BioDonostiaSan SebastianSpain
  35. 35.Department of EpidemiologyMurcia Regional Health CouncilMurciaSpain
  36. 36.Navarre Public Health InstitutePamplonaSpain
  37. 37.Research Group in Nutritional Epidemiology, Department of Clinical Sciences in MalmöLund UniversityMalmöSweden
  38. 38.Department of Clinical SciencesLund UniversityMalmöSweden
  39. 39.Department of OdontologyUmeå UniversityUmeåSweden
  40. 40.Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  41. 41.University of CambridgeCambridgeUK
  42. 42.MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
  43. 43.Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK

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