Fruit and Vegetable 

• People who eat more fruits and vegetables have a lower risk of developing and dying from cardiovascular disease (CVD), cancer, and diabetes.^1-6

• Low consumption of fruits and vegetables, however, is common throughout the world. It was estimated that inadequate consumption of fruits and vegetables could have accounted for 2.6 million deaths worldwide in the year 2000. ^{5, 7}

• WHO and many international organizations recommend a minimum intake of 400-500g or five servings (5 servings x 80g) of fruits and vegetables per day to reduce the risk of chronic diseases.^{5, 7}

• According to a new study of more than 300,000 people from eight different countries, those who consumed at least eight portions of fruit and vegetables a day compared to those who ate fewer than three portions a day had a 22% lower risk of dying from coronary artery disease (CAD).⁸

• The average daily intake of fruits and vegetables was five portions. People in Greece, Italy, and Spain ate more fruits and vegetables and people in Sweden ate less fruits and vegetables than the average.⁸ 

• Asian Indians have lower prevalence of daily fruit and vegetable intake (27% vs. 45% for rest of the world).⁹

• Fruits and vegetables are rich in a myriad of nutrients and phytochemicals, including fiber, B vitamins, vitamin C, antioxidants, potassium, and flavonoids that promote cardiovascular health. Phytochemicals are bioactive non-nutrient plant compounds linked to reduced risk of CVD.¹⁰ Functional aspects of fruits and vegetables, such as their low dietary glycemic load and energy density, may  play a significant role (Figure 061).¹¹

• People who consume more fruits and vegetables often have lower prevalence of important risk factors for CVD, including high blood pressure, obesity, diabetes and low levels of homocysteine.¹² In the Nurses Health Study, each increase of one serving per day in the intake of fruits and vegetables was associated with 4% lower CAD risk. Those who had the highest intake had a 20% lower risk.¹³ This is in sharp contrast to increased risk from antioxidant supplements.¹⁴

• The biologic mechanisms whereby fruits and vegetables may exert their beneficial effects are multiple. Many nutrients, antioxidants, and phytochemicals in fruits and vegetables, including fiber, potassium, magnesium, and folate, could be independently or jointly responsible for the apparent reduction in CVD risk. The antioxidant value of 100 g of apple is equivalent to 1500 mg of vitamin C.¹⁵

• A high intake of fruits and vegetables have been shown to increase concentration of plasma carotenoids and vitamin C, both of which have antioxidant properties.⁵ Functional aspects of fruits and vegetables, such as their low dietary glycemic load and energy density may also play a significant role.

• Reduction in cholesterol and triglycerides has also been reported with liberal consumption of local fruits and vegetables.¹⁶

• Another benefit is the reduction of blood pressure. Fruits and vegetables that are rich in anthocyanins—such as blueberries, strawberries, and blood oranges—may help prevent the development of high blood pressure.  Blueberries are a rich source of anthocyanins, and consumption of this food was associated with a 10% reduction in blood pressure.¹⁷

• Similar benefits have been obtained and observed with other foods with red or blue pigments that contain anthocyanins, such as black currants, raspberries, or eggplants, we would have seen the same effects according to researchers.¹⁷

• When your arteries are stiff, your heart has to pump harder to move blood around the body. Overtime, the increased force can damage the artery walls and weaken the heart muscle, setting the stage for heart attack, stroke, and other cardiovascular problems later in life. ¹⁸

• Researchers in Finland tracked the diet and health habits of 1622 children for 27 years. Children who eat higher amounts of fruits and vegetables have a lower risk of stiff arteries in adulthood. ¹⁸ Low consumption of fruits and vegetables has also been related to arterial stiffness in young adulthood, a potential indicator of high blood pressure and CVD.¹⁸

• To get the most nutritional benefit from your fruit and vegetable choices, select from a broad variety of items. On a weekly basis, make sure to include: Dark green vegetables (spinach, broccoli, kale); yellow and orange vegetables (carrots, yams, squash); peas and bean; starchy vegetables (corn, potatoes); and whole fruits (instead of juice).

• One of the most commonly eaten vegetables is French fried potatoes. Although technically a vegetable, this food offers little nutrition and is usually laden with fat.

• Large scale dietary trials for the primary and/or secondary prevention of CVD and diabetes are unlikely to be undertaken in the foreseeable future. Nonetheless, available data suggests that it may be prudent to adopt a diet low in fats, and one rich in fresh fruits and vegetables, for the prevention of diabetes. Given the great potential for benefits already known, greater efforts and resources are needed to support dietary changes that encourage increased fruit and vegetable intake.

Sources

1. Steffen LM, Jacobs DR, Jr., Stevens J, Shahar E, Carithers T, Folsom AR. Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr. Sep 2003;78(3):383-390.

2. Kromhout D, Menotti A, Kesteloot H, Sans S. Prevention of coronary heart disease by diet and lifestyle: evidence from prospective cross-cultural, cohort, and intervention studies. Circulation. 2002;105(7):893-898.

3. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. Jan 28 2006;367(9507):320-326.

4. D’Elia L, Barba G, Cappuccio FP, Strazzullo P. Potassium intake, stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol. Mar 8 2011;57(10):1210-1219.

5. Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229.

6. van’t Veer P, Jansen MC, Klerk M, Kok FJ. Fruits and vegetables in the prevention of cancer and cardiovascular disease. Public Health Nutr. Mar 2000;3(1):103-107.

7. WHO. Prevention of cardiovacular disease. World Health Organization, Genewa Switzerland2007.

8. Crowe FL, Roddam AW, Key TJ, et al. Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study. Eur Heart J. Jan 18 2011.

9. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. Sep 11 2004;364(9438):937-952.

10. Enas EA. Indian diet and cardiovascular disease: An update. In: Chatterjee SS, ed. Update in Cardiology Hyderabad: Cardiology Society of India.; 2007.

11. Bazzano LA, Serdula MK, Liu S. Dietary intake of fruits and vegetables and risk of cardiovascular disease. Curr Atheroscler Rep. Nov 2003;5(6):492-499.

12. Bazzano LA, Serdula MK, Liu S. Dietary intake of fruits and vegetables and risk of cardiovascular disease. Curr Atheroscler Rep. Nov 2003;5(6):492-499.

13. Joshipura KJ, Hu FB, Manson JE, et al. The effect of fruit and vegetable intake on risk for coronary heart disease. Annals of internal medicine. 2001;134(12):1106-1114.

14. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. Jama. Feb 28 2007;297(8):842-857.

15. Liu  RH. Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. Am J Clin Nutr. Sep 2003;78(3 Suppl):517S-520S.

16. Adebawo O, Salau B, Ezima E, et al. Fruits and vegetables moderate lipid cardiovascular risk factor in hypertensive patients. Lipids Health Dis. 2006;5:14.

17. Cassidy A, O’Reilly EJ, Kay C, et al. Habitual intake of flavonoid subclasses and incident hypertension in adults. Am J Clin Nutr. Feb 2011;93(2):338-347.

18. Aatola H, Koivistoinen T, Hutri-Kahonen N, et al. Lifetime Fruit and Vegetable Consumption and Arterial Pulse Wave Velocity in Adulthood: The Cardiovascular Risk in Young Finns Study. Circulation. Nov 29 2010.