CoChat
Sign Up
Cited by 1,327Nutritional Studies and DietPhytochemicals and Antioxidant ActivitiesCardiovascular Health and Risk Factors

Fruit and vegetable intake and risk of major chronic disease

Open access
Hung, H.-C., Joshipura, K. J., Jiang, R., Hu, F. B., Hunter, D., Smith-Warner, S. A., Colditz, G. A., Rosner, B. +2 more·2004·JNCI Journal of the National Cancer Institute
DOI 10.1093/jnci/djh296
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Studies of fruit and vegetable consumption in relation to overall health are limited. We evaluated the relationship between fruit and vegetable intake and the incidence of cardiovascular disease and cancer and of deaths from other causes in two prospective cohorts. METHODS: A total of 71 910 female participants in the Nurses' Health study and 37,725 male participants in the Health Professionals' Follow-up Study who were free of major chronic disease completed baseline semiquantitative food-frequency questionnaires in 1984 and 1986, respectively. Dietary information was updated in 1986, 1990, and 1994 for women and in 1990 and 1994 for men. Participants were followed up for incidence of cardiovascular disease, cancer, or death through May 1998 (women) and January 1998 (men). Multivariable-adjusted relative risks were calculated with Cox proportional hazards analysis. RESULTS: We ascertained 9329 events (1964 cardiovascular, 6584 cancer, and 781 other deaths) in women and 4957 events (1670 cardiovascular diseases, 2500 cancers, and 787 other deaths) in men during follow-up. For men and women combined, participants in the highest quintile of total fruit and vegetable intake had a relative risk for major chronic disease of 0.95 (95% confidence interval [CI] = 0.89 to 1.01) times that of those in the lowest. Total fruit and vegetable intake was inversely associated with risk of cardiovascular disease but not with overall cancer incidence, with relative risk for an increment of five servings daily of 0.88 (95% CI = 0.81 to 0.95) for cardiovascular disease and 1.00 (95% CI = 0.95 to 1.05) for cancer. Of the food groups analyzed, green leafy vegetable intake showed the strongest inverse association with major chronic disease and cardiovascular disease. For an increment of one serving per day of green leafy vegetables, relative risks were 0.95 (95% CI = 0.92 to 0.99) for major chronic disease and 0.89 (95% CI = 0.83 to 0.96) for cardiovascular disease. CONCLUSIONS: Increased fruit and vegetable consumption was associated with a modest although not statistically significant reduction in the development of major chronic disease. The benefits appeared to be primarily for cardiovascular disease and not for cancer.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/jnci/djh296

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A diet rich in vegetables, which contain high concentrations of inorganic NO3-, significantly protects against coronary heart disease and stroke.

    “Conversely, a diet rich in vegetables, which contain high concentrations of inorganic NO3-, significantly protects against both coronary heart disease and stroke [16], [2], [20].”

    From Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans (2018) · cites this paper as [16]

    The Results report a statistically significant inverse association between vegetable intake and cardiovascular disease, and the Ascertainment of Outcomes section defines that outcome to include myocardial infarction and stroke (page numbers unavailable). The paper does not report separate protective effects for coronary heart disease and stroke, assess inorganic nitrate, or establish that vegetable intake causes the lower risk. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Major epidemiological studies have consistently identified that vegetable- and fruit-rich diets improve every major risk factor for PH and CVD, including blood pressure, ischemic stroke, ischemic heart disease, obesity, insulin resistance and diabetes, and metabolic syndrome.

    “Major epidemiological studies have consistently identified that vegetable- and fruit-rich diets improve every major risk factor for PH and CVD, including blood pressure[361,363,364], ischemic stroke[365], ischemic heart disease[366], obesity, insulin resistance and diabetes[367], and metabolic syndrome[365,366,368,369].”

    From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [366]

  • A number of epidemiological studies have shown preventive effects of fruits and vegetables on coronary heart disease.

    “On the other hand, a number of epidemiological studies have shown the preventive effects of fruits and vegetables on coronary heart disease [3,4,5,6,106].”

    From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [106]

  • The DASH diet is not widely advised in the UK.

    “but it is not widely advised in the UK (36) .”

    From High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women (2015) · cites this paper as [36]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. [3]3. Heimendinger J, Chapelsky D. The National 5 A Day for Better Health Program. Adv Exp Med Biol 1996;401:199 -206.
  2. [22]22. Smith-Warner SA, Giovannucci E. Fruit and vegetable intake and cancer. In: Nutritional oncology. Boston (MA): Academic Press; 1999.
  3. [28]28. Willett W. Nutritional epidemiology. 2nd ed. New York (NY): Oxford University Press; 1998.
  4. [33]33. Walker AE, Robins M, Weinfeld FD. The National Survey of Stroke. Clinical findings. Stroke 1981;12:I13-44.

Cited by

Sorted by citations

Related

Authors
Hung, H.-C., Joshipura, K. J., Jiang, R., Hu, F. B., Hunter, D., Smith-Warner, S. A., Colditz, G. A., Rosner, B., Spiegelman, D., & Willett, W. C.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Hung, H.-C.
ORCID
Venue
JNCI Journal of the National Cancer Institute
Publisher
Oxford University Press (OUP)
Published
2004-11-02
Volume
96
Issue
21
Pages
1577-1584
ISSN
  • 0027-8874 (ISSN-L)
  • 1460-2105
DOI
10.1093/jnci/djh296
OpenAlex
W2168775710
Cited by
1,327
References
51
Citations by year
2026: 14 · 2025: 27 · 2024: 22 · 2023: 28 · 2022: 34 · 2021: 55 · 2020: 70 · 2019: 43 · 2018: 68 · 2017: 89 · 2016: 75 · 2015: 80 · 2014: 109 · 2013: 79 · 2012: 90
FWCI
56.96
Type
journal article
Language
en
Open access
Locations
  • JNCI Journal of the National Cancer Institute (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Heart, Lung, and Blood Institute (HL-34595, R01HL035464, HL35464, R01HL034595)
  • National Cancer Institute (CA-87969, CA-55075, P01CA087969)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
fruit and vegetable intake, dietary fiber, cardiovascular disease, cancer incidence, mortality, leafy vegetables, Nurses' Health Study, Health Professionals Follow-up Study, prospective cohort, chronic disease risk, cardiovascular disease prevention, mortality prevention, cancer screening utilization
MeSH terms
Adult, Aged, Analysis of Variance, Cardiovascular Diseases, Cause of Death, Chronic Disease, Diet Surveys, Feeding Behavior, Female, Follow-Up Studies, Fruit, Health Personnel, Humans, Male, Middle Aged, Neoplasms, Prospective Studies, Surveys and Questionnaires, Research Design, Risk Factors, United States, Vegetables, Confounding Factors, Epidemiologic, Incidence, Confidence Intervals, Proportional Hazards Models, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review