Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data
Open accessAbstract
Background: Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England. Methods: Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years). Results: Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion). Conclusions: A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted.
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Other studies have shown a dose-response relationship between mental and physical health up to seven portions a day.
“other studies have shown a dose–response relationship between mental42 and physical health43 up to seven portions a day.”
From Major health-related behaviours and mental well-being in the general population: the Health Survey for England (2014) · cites this paper as [43]
High fruit and vegetable consumption is associated with lower all-cause mortality.
“Associations with all-cause mortality [ 2 , 3 ]”
From Increasing vegetable intakes: rationale and systematic review of published interventions (2016) · cites this paper as [2]
High fruit and vegetable consumption is associated with lower cardiovascular disease mortality, including coronary heart disease and stroke.
“mortality from cardiovascular disease [ 2 , 3 ], including coronary heart disease [ 4 ] and stroke [ 5 , 6 ], are well evidenced.”
From Increasing vegetable intakes: rationale and systematic review of published interventions (2016) · cites this paper as [2]
Observational studies demonstrate reduced risk of cardiovascular disease, type II diabetes, non-gallstone-related acute pancreatitis, various cancers, and cognitive decline with high vegetable-specific consumption.
“Observational studies demonstrate reduced risk of cardiovascular disease [ 2 ], type II diabetes [ 34 ], non-gallstone-related acute pancreatitis [ 33 ], various cancers [ 2 , 47 – 50 ] and cognitive decline [ 32 ].”
From Increasing vegetable intakes: rationale and systematic review of published interventions (2016) · cites this paper as [2]
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Morais, R. M. S. C., Morais, A. M. M. B., Dammak, I., Bonilla, J., Sobral, P. J. D. A., Laguerre, J., Afonso, M. J., & Ramalhosa, E. (2018) · Journal of Food Quality · doi:10.1155/2018/1739636 · Cited by 81 · see citing works
Does the importance of dietary costs for fruit and vegetable intake vary by socioeconomic position?
Mackenbach, J. D., Brage, S., Forouhi, N. G., Griffin, S. J., Wareham, N. J., & Monsivais, P. (2015) · British Journal Of Nutrition · doi:10.1017/s0007114515003025 · Cited by 80 · see citing works
“Three dietary cost variables were used for analysis: (1) crude dietary cost, (2) dietary cost per 8·4 MJ and (3) energy-adjusted dietary costs.”
BackgroundMethodFruit and Vegetable Intake and Risk of Hip Fracture: A Cohort Study of Swedish Men and Women
Byberg, L., Bellavia, A., Orsini, N., Wolk, A., & Michaëlsson, K. (2014) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2384 · Cited by 79 · see citing works
“We have previously observed a similar doseresponse relation withmortality,((2)) whichwas also the conclusion of a meta-analysis,((7)) whereas a recent study set in England found that even higher intakes seemed additionally beneficial to lower mortality rates.((56)) Homeostatic regulation of micronutrient”
Boehm, J. K., Soo, J., Zevon, E. S., Chen, Y., Kim, E. S., & Kubzansky, L. D. (2018) · Health Psychology · doi:10.1037/hea0000643 · Cited by 76 · see citing works
Vinther, J. L., Conklin, A., Wareham, N. J., & Monsivais, P. (2016) · Social Science & Medicine · doi:10.1016/j.socscimed.2016.04.004 · Cited by 74 · see citing works
Szinay, D., Forbes, C. C., Busse, H., DeSmet, A., Smit, E. S., & König, L. M. (2023) · Obesity Reviews · doi:10.1111/obr.13542 · Cited by 71 · see citing works
Kongsbak, I., Skov, L. R., Nielsen, B. K., Ahlmann, F. K., Schaldemose, H., Atkinson, L., Wichmann, M., & Pérez-Cueto, F. J. A. (2015) · Food Quality and Preference · doi:10.1016/j.foodqual.2015.12.006 · Cited by 72 · see citing works
Okuda, N., Miura, K., Okayama, A., Okamura, T., Abbott, R. D., Nishi, N., Fujiyoshi, A., Kita, Y., Nakamura, Y., Miyagawa, N., et al. (2015) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2014.276 · Cited by 74 · see citing works
Celli, G. B., Khattab, R. Y., Ghanem, A., & Brooks, M. S. (2015) · Food Chemistry · doi:10.1016/j.foodchem.2015.08.012 · Cited by 71 · see citing works
Kuntz, S., Asseburg, H., Dold, S., Römpp, A., Fröhling, B., Kunz, C., & Rudloff, S. (2015) · Food & Function · doi:10.1039/c4fo00755g · Cited by 70 · see citing works
Chapman, K. E., Goldsbury, D. E., Watson, W. L., Havill, M. A., Wellard‐Cole, L., Hughes, C., Bauman, A. E., & Allman-Farinelli, M. A. (2017) · Appetite · doi:10.1016/j.appet.2017.02.043 · Cited by 69 · see citing works
Nour, M. M., Rouf, A. S., & Allman-Farinelli, M. A. (2017) · Appetite · doi:10.1016/j.appet.2017.10.016 · Cited by 70 · see citing works
Okop, K., Ndayi, K., Tsolekile, L. P., Sanders, D. M., & Puoane, T. R. (2019) · BMC Public Health · doi:10.1186/s12889-019-7254-7 · Cited by 70 · see citing works
“An increased proportion of fruits and vegetable consumption is also linked to a decrease in all-cause mortality [11].”
BackgroundThe fruit and vegetable intake of young Australian adults: a population perspective
Nour, M. M., Sui, Z., Grech, A. L., Rangan, A., McGeechan, K., & Allman-Farinelli, M. A. (2017) · Public Health Nutrition · doi:10.1017/s1368980017001124 · Cited by 67 · see citing works
“and vegetable intake in reducing the risk of cancer, CVD and all-cause mortality((70)), promoting increased intake in this young generation may reduce the future burden of”
BackgroundChai, S. C., Davis, K., Wright, R. S., Kuczmarski, M. F., & Zhang, Z. (2018) · Food & Function · doi:10.1039/c8fo00468d · Cited by 68 · see citing works
Hjartåker, A., Knudsen, M. D., Tretli, S., & Weiderpass, E. (2014) · European Journal of Nutrition · doi:10.1007/s00394-014-0741-9 · Cited by 66 · see citing works
Dietary nitrate and blood pressure: evolution of a new nutrient?
Ashworth, A., & Bescós, R. (2017) · Nutrition Research Reviews · doi:10.1017/s0954422417000063 · Cited by 65 · see citing works
“Oyebode et al. suggest that the current UK ‘5-a-day’ message could be amended to specifically advise on numbers of portions of vegetables (90) .”
BackgroundIncreasing trends in obesity prevalence from 2013 to 2019 and associated factors in Brazil
Ferreira, A. P. D. S., Szwarcwald, C. L., Damacena, G. N., & Júnior, P. R. B. D. S. (2021) · Revista Brasileira de Epidemiologia · doi:10.1590/1980-549720210009.supl.2 · Cited by 66 · see citing works
Weight-Related Dietary Behaviors in Young Adults
Allman-Farinelli, M. A., Partridge, S. R., & Roy, R. (2016) · Current Obesity Reports · doi:10.1007/s13679-016-0189-8 · Cited by 63 · see citing works
Appleton, K. M., Dinnella, C., Spinelli, S., Morizet, D., Saulais, L., Hemingway, A., Monteleone, E., Depezay, L., Pérez-Cueto, F. J. A., & Hartwell, H. J. (2019) · Food Quality and Preference · doi:10.1016/j.foodqual.2019.02.007 · Cited by 62 · see citing works
Green leafy vegetable and lutein intake and multiple health outcomes
Li, N., Wu, X., Zhuang, W., Xia, L., Chen, Y., Wang, Y., Wu, C., Rao, Z., Du, L., Zhao, R., et al. (2021) · Food Chemistry · doi:10.1016/j.foodchem.2021.130145 · Cited by 57 · see citing works
Lee, J., & Allen, J. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00672-x · Cited by 56 · see citing works
Storm, V., Dörenkämper, J., Reinwand, D. A., Wienert, J., de Vries, H., & Lippke, S. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5147 · Cited by 56 · see citing works
“Sufficient fruit and vegetable consumption is also recommended because it reduces the risk of further cardiovascular issues, such as coronary heart disease [10,11] and ischemic heart disease [12], cardiac mortality [13], and overall mortality [11].”
Recent Insights Into Health Benefits of Carotenoids
Cooperstone, J. L., & Schwartz, S. J. (2016) · Elsevier eBooks · doi:10.1016/b978-0-08-100371-8.00020-8 · Cited by 56 · see citing works
Evans, R., Norman, P. E., & Webb, T. L. (2017) · Appetite · doi:10.1016/j.appet.2017.05.022 · Cited by 57 · see citing works
Are ‘fruits and vegetables’ intake really what they seem in India?
Minocha, S., Thomas, T. S., & Kurpad, A. V. (2018) · European Journal of Clinical Nutrition · doi:10.1038/s41430-018-0094-1 · Cited by 56 · see citing works
Food, microbiome and colorectal cancer
Niederreiter, L., Adolph, T. E., & Tilg, H. (2018) · Digestive and Liver Disease · doi:10.1016/j.dld.2018.03.030 · Cited by 56 · see citing works
The Potential of Introduction of Asian Vegetables in Europe
Hong, J., & Gruda, N. S. (2020) · Horticulturae · doi:10.3390/horticulturae6030038 · Cited by 55 · see citing works
“WHO recommended daily consumption of a minimum 400 g of fruits and vegetables to prevent chronic diseases in 1990 [43].”
BackgroundInfluentialBrookie, K. L., Mainvil, L. A., Carr, A. C., Vissers, M. C. M., & Conner, T. S. (2016) · Appetite · doi:10.1016/j.appet.2016.09.015 · Cited by 55 · see citing works
Du, H., Li, L., Bennett, D., Yang, L., Yu, C., Key, T. J., Bian, Z., Chen, Y., Walters, R. G., Millwood, I. Y., et al. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyx042 · Cited by 54 · see citing works
“consumed raw in China, maximizing its potential health benefits.(16,32) Second, the associations of fruit consumption with disease risks may be stronger in populations with low levels of consumption,(5) and the average level of fruit consumption in our study population is much lower than that in most Western populatio…”
BackgroundAppleton, K., Dinnella, C., Spinelli, S., Morizet, D., Saulais, L., Hemingway, A., Monteleone, E., Depezay, L., Perez-Cueto, F., & Hartwell, H. (2017) · Nutrients · doi:10.3390/nu9090923 · Cited by 53 · see citing works
“impact including cardiovascular disease [1,2], stroke [1,3], type 2 diabetes [4,5], some cancers [1,3,6–8], and dementia and cognitive decline [9,10].”
BackgroundMummah, S. A., Mathur, M., King, A. C., Gardner, C. D., & Sutton, S. (2016) · JMIR mhealth and uhealth · doi:10.2196/mhealth.5146 · Cited by 52 · see citing works
“Greater consumption of vegetables and fruits is associated with reduced risks of cardiovascular disease, stroke, cancer, and all-cause mortality [1-8].”
Shivappa, N., Harris, H. R., Wolk, A., & Hébert, J. R. (2015) · European Journal of Nutrition · doi:10.1007/s00394-015-1005-z · Cited by 51 · see citing works
“In support of our findings, previous work in the SMC examining diet and mortality, have shown significant inverse associations between anti-inflammatory food parameters such as fruits and vegetables [72], which is consistent with results from other studies such as ARIC [73], 2001–2008 Health Surveys for England [74],…”
ResultPulz, I. S., Martins, P., Feldman, C. H., & Veiros, M. B. (2016) · Perspectives in Public Health · doi:10.1177/1757913916636414 · Cited by 51 · see citing works
Does exposure to socially endorsed food images on social media influence food intake?
Hawkins, L. K., Farrow, C. V., & Thomas, J. M. (2021) · Appetite · doi:10.1016/j.appet.2021.105424 · Cited by 57 · see citing works
García‐Pérez, I., Posma, J. M., Chambers, E. S., Nicholson, J. K., Mathers, J. C., Beckmann, M., Draper, J., Holmes, E. C., & Frost, G. S. (2016) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.5b05878 · Cited by 48 · see citing works
Wilson, D. R., Driller, M. W., Johnston, B., & Gill, N. (2020) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2020.11.007 · Cited by 48 · see citing works
“An inverse association between fruit and vegetable intake and mortality has been reported, with benefits observed in up to 7 daily portions.(30) Sufficient PA is defined as the achievement of 150 min/week or more of moderate-to-vigorous PA (MVPA), or 75 min/week or more of vigorous PA, or an accumulative equivalent co…”
Indigenous vegetables worldwide: their importance and future development
Keatinge, J. D. H., Wang, J.-F., Dinssa, F. F., Ebert, A. W., Hughes, J., Stoilova, T., Nenguwo, N., Dhillon, N. P. S., Easdown, W. J., Mavlyanova, R., et al. (2015) · Acta Horticulturae · doi:10.17660/actahortic.2015.1102.1 · Cited by 48 · see citing works
Górska-Warsewicz, H., Rejman, K., Kaczorowska, J., & Laskowski, W. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063217 · Cited by 51 · see citing works
“Relevant governmental campaigns have been launched to promote greater fruit and vegetable consumption, such as “5 a Day” in England, France, Germany, and many other European countries, “Fruit and Veggies—More Matters” in the US, which recommended eating different numbers of servings of fruits and vegetables depending…”
BackgroundCorley, J., Kyle, J. A. M., Starr, J. M., McNeill, G., & Deary, I. J. (2015) · British Journal Of Nutrition · doi:10.1017/s000711451500210x · Cited by 46 · see citing works
Nutrición y salud cardiovascular
Berciano, S., & Ordovás, J. M. (2014) · Revista Española de Cardiología · doi:10.1016/j.recesp.2014.05.003 · Cited by 44 · see citing works
Side Streams of Broccoli Leaves: A Climate Smart and Healthy Food Ingredient
Berndtsson, E., Andersson, R., Johansson, E., & Olsson, M. E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17072406 · Cited by 44 · see citing works
“Human health benefits from diets being rich in fruits and vegetables have been verified in a range of studies, and is partly due to an association with a reduction in cardiovascular disease and cancer mortality [1].”
Backgroundda Cunha, M. D. S. B., & Arruda, S. F. (2017) · Nutrients · doi:10.3390/nu9111243 · Cited by 43 · see citing works
“The consumption of dietary sources of phytochemical compounds seems to attenuate oxidative damages and inflammatory status [12,15,25], promoting health benefits and preventing cell senescence [14,26,27].”
BackgroundA “green” diet-based approach to cardiovascular health? Is inorganic nitrate the answer?
Rathod, K. S., Velmurugan, S., & Ahluwalia, A. (2016) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201500313 · Cited by 42 · see citing works
Lamb, M. J. E., Griffin, S. J., Sharp, S. J., & Cooper, A. (2016) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2016.180 · Cited by 42 · see citing works
Nekitsing, C., Blundell-Birtill, P., Cockroft, J. E., Fildes, A., & Hetherington, M. M. (2019) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2019.05.017 · Cited by 42 · see citing works
“Eating vegetables confers a greater protective health benefit than eating fruits.(7) Also, most vegetables are low in energy density and naturally occurring sugars compared to fruits.”
BackgroundSurvivorship: Nutrition and Weight Management, Version 2.2014
Denlinger, C. S., Ligibel, J. A., Are, M., Baker, K. S., Demark‐Wahnefried, W., Dizon, D. S., Friedman, D. L., Goldman, M. E., Jones, L. W., King, A. A., et al. (2014) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2014.0137 · Cited by 40 · see citing works
Health Benefits of Fruits and Vegetables: Review from Sub-Saharan Africa
Amao, I. O. (2018) · InTech eBooks · doi:10.5772/intechopen.74472 · Cited by 39 · see citing works
“Benefits obtainable from consumption of fruits and vegetables are greater life span [13], improved mental health [14], better cardiovascular health [15], reduced risks of some cancers [16] and weight management [17], among others.”
Ranabhat, C. L., Park, M.-B., & Kim, C.-B. (2019) · Nutrients · doi:10.3390/nu12020459 · Cited by 38 · see citing works
“By observing country-level data from FAO, we have found co-variants such as red meat, alcohol, vegetable fruits, and calories [2,4,55].”
BackgroundDietary Patterns and All-Cause Mortality: A Systematic Review
Boushey, C. J., Ard, J. D., Bazzano, L., Heymsfield, S. B., Mayer‐Davis, E. J., Sabaté, J., Snetselaar, L. G., Horn, L. V., Schneeman, B. O., English, L., et al. (2020) · doi:10.52570/nesr.dgac2020.sr0108 · Cited by 41 · see citing works
- Authors
- Oyebode, O., Gordon-Dseagu, V., Walker, A., & Mindell, J. S.
- Affiliations
- University College London (GB)
- Corresponding author
- Oyebode, Oyinlola
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2014-03-31
- Volume
- 68
- Issue
- 9
- Pages
- 856-862
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC4145465
- OpenAlex
- W2158916521
- Cited by
- 437
- References
- 32
- Citations by year
- 2026: 5 · 2025: 20 · 2024: 24 · 2023: 18 · 2022: 36 · 2021: 48 · 2020: 36 · 2019: 40 · 2018: 43 · 2017: 48 · 2016: 52 · 2015: 48 · 2014: 18
- FWCI
- 55.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of Epidemiology & Community Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Diabetes UK (08/0003752)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- fruit and vegetable intake, all-cause mortality, cancer mortality, cardiovascular mortality, dietary recommendations, vegetables, salads, Health Survey for England
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cause of Death, England, Feeding Behavior, Female, Fruit, Health Surveys, Humans, Male, Middle Aged, Neoplasms, Risk Factors, Vegetables
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