Fruits, berries, and vegetables and mortality - Cardiac Risk Factors

Despite the decrease in age-adjusted mortality from coronary heart disease (CHD) during the past 30 years, CHD is still the most common cause of death in Finland and many other industrialized countries. Intake of fruits, berries and vegetables may reduce cardiovascular disease (CVD) risk through the beneficial combination of antioxidants, fiber, potassium, magnesium, and other phytochemicals.

In the Seven Countries Study, the mortality rate in Eastern Finland was 10 times higher than in Crete in which the Mediterranean diet rich in plant foods and low in animal foods is consumed. Therefore, some Finnish researchers tested the hypothesis that a diet resembling the Mediterranean diet, that is, high in fruit, berry and vegetables, is associated with a decreased risk of all-cause, CVD- and non-CVD-related mortality in middle-aged Finnish men.

The subjects were Finnish men aged 42 to 60 years who were examined between 1984 and 1989 in the prospective Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. Four-day food intake records were used to assess dietary intakes. In this study, the intake of fruits, berries, and vegetables also included jams, nectars, and juices but did not include potatoes. Medical history, medications, family history of diseases, smoking, alcohol consumption and blood pressure were also assessed. The risk of all-cause and non-CVD-related deaths were studied in 2641 men and the risk of CVD-related death in 1950 men who had no history of CVD at baseline.

The daily intake of fruits, berries, and vegetables was 284 + 182 g. During a mean follow-up of 12.8 years, the occurrences of CVD death, non-CVD death as well as total mortality were the highest among men with the lowest consumption of fruits, berries, and vegetables. The intake of fruits, berries, and vegetables was 41% lower in men who died of CVD during the first five years of follow-up and 20% lower with the inclusion of all CVD-deaths during the whole follow-up period. After adjustment for the major CVD risk factors, the relative risk for men in the highest fifth of fruit, berry and vegetable intake for all-cause death, CVD-related and non-CVD related death was 0.66, 0.59 and 0.68, respectively, compared with men in the lowest fifth.

In the present study, the adjustment for nutritional factors (intake of energy adjusted vitamin C and E, beta carotene, lycopene, folate and fiber) attenuated the protective effect of intake of fruits, berries and vegetables against mortality; thus, these may be the main protective nutrients in these foods. The findings provide additional evidence that higher intakes of fruit and vegetables can prevent heart disease and mortality.

Tina H. Rissanen, Sari Voutilainen, Jyrki K. Virtanen, et al., Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. J. Nutr 133:199 -204 (January 2003) [Address correspondence to: Jukka T. Salonen, Department of Public Health and Gerneal Practice, University of Kuopio, Kuopio, Finland. E-mail: Jukka.Salonen@uku.fi]

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