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

  • NUTRITIONAL EPIDEMIOLOGY
  • Published:
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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.

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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.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

    Max Leenders, Peter D. Siersema & H. Bas Bueno-de-Mesquita

  2. Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80177, 3508TD, Utrecht, The Netherlands

    Max Leenders

  3. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    Hendriek C. Boshuizen

  4. National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    Hendriek C. Boshuizen & H. Bas Bueno-de-Mesquita

  5. International Agency for Research on Cancer, Lyon, France

    Pietro Ferrari, Mattias Johansson & Idlir Licaj

  6. Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark

    Kim Overvad

  7. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

    Kim Overvad

  8. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anne Tjønneland & Anja Olsen

  9. Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health Team, Inserm, Villejuif, France

    Marie-Christine Boutron-Ruault, Laure Dossus & Laureen Dartois

  10. UMRS 1018, Paris Sud University, Villejuif, France

    Marie-Christine Boutron-Ruault, Laure Dossus & Laureen Dartois

  11. Institut Gustave Roussy, Villejuif, France

    Marie-Christine Boutron-Ruault, Laure Dossus & Laureen Dartois

  12. Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Rudolf Kaaks & Kuanrong Li

  13. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany

    Heiner Boeing & Manuela M. Bergmann

  14. Hellenic Health Foundation, Athens, Greece

    Antonia Trichopoulou & Dimitrios Trichopoulos

  15. Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece

    Antonia Trichopoulou & Pagona Lagiou

  16. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Pagona Lagiou & Dimitrios Trichopoulos

  17. Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece

    Pagona Lagiou & Dimitrios Trichopoulos

  18. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy

    Domenico Palli

  19. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Vittorio Krogh

  20. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    Salvatore Panico

  21. Cancer Registry and Histopathology Unit, ‘Civile - M.P. Arezzo’ Hospital, Asp Ragusa, Italy

    Rosario Tumino

  22. Human Genetics Foundation (HuGeF), Turin, Italy

    Paolo Vineis

  23. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Paolo Vineis, Petra H. M. Peeters, Marc J. Gunter, Neil Murphy, Elio Riboli & H. Bas Bueno-de-Mesquita

  24. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Petra H. M. Peeters

  25. Department of Research, Cancer Registry of Norway, Oslo, Norway

    Elisabete Weiderpass

  26. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Elisabete Weiderpass

  27. Samfundet Folkhälsan, Helsinki, Finland

    Elisabete Weiderpass

  28. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsö, Norway

    Elisabete Weiderpass, Dagrun Engeset & Tonje Braaten

  29. Public Health Directorate, Asturias, Spain

    Maria Luisa Redondo

  30. Unit of Nutrition, Environment and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain

    Antonio Agudo

  31. Escuela Andaluza de Salud Pública, Granada, Spain

    María-José Sánchez

  32. Instituto de Investigación Biosanitaria de Granada, Granada, Spain

    María-José Sánchez

  33. CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain

    María-José Sánchez, Pilar Amiano, José-María Huerta & Eva Ardanaz

  34. Public Health Division of Gipuzkoa, Research Institute of BioDonostia, San Sebastian, Spain

    Pilar Amiano

  35. Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain

    José-María Huerta

  36. Navarre Public Health Institute, Pamplona, Spain

    Eva Ardanaz

  37. Research Group in Nutritional Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden

    Isabel Drake

  38. Department of Clinical Sciences, Lund University, Malmö, Sweden

    Emily Sonestedt

  39. Department of Odontology, Umeå University, Umeå, Sweden

    Ingegerd Johansson

  40. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Anna Winkvist

  41. University of Cambridge, Cambridge, UK

    Kay-Tee Khaw

  42. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

    Nick J. Wareham

  43. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Timothy J. Key & Kathryn E. Bradbury

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  1. Max Leenders
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  38. Nick J. Wareham
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  43. Marc J. Gunter
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  44. Neil Murphy
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Correspondence to Max Leenders.

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Leenders, M., Boshuizen, H.C., Ferrari, P. et al. Fruit and vegetable intake and cause-specific mortality in the EPIC study. Eur J Epidemiol 29, 639–652 (2014). https://doi.org/10.1007/s10654-014-9945-9

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