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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 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]
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“Associations with all-cause mortality [ 2 , 3 ]”
From Increasing vegetable intakes: rationale and systematic review of published interventions (2016) · cites this paper as [2]
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“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]
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“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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“Inadequate consumption of fruit has been associated with the development of chronic health conditions such as type 2 diabetes, some cancers, cardiovascular disease and obesity (Dauchet et al., 2006; Oyebode et al., 2014; Van’t Veer et al., 2000; World Health Organization [WHO], 2003).”
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“In addition, an adequate consumption of fruits and vegetables is related to a lower incidence and prevention of Non-communicable Chronic Diseases such as cardiovascular diseases, type 2 diabetes, obesity, and the development of cancer [5-7].”
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“A national survey in England found robust evidence of lower mortality for higher FV intake of up to seven servings daily [3].”
BackgroundTropical Oral Disease: Analysing Barriers, Burden, Nutrition, Economic Impact, and Inequalities
Santosh, A. B. R., & Jones, T. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.729234 · Cited by 6
“Inadequate consumption of vegetables and fruits may contribute to the risk of oral cancer (23, 36, 37).”
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Szinay, D., Forbes, C., Busse, H., DeSmet, A., Smit, E. S., & König, L. M. (2022) · doi:10.31234/osf.io/cq24y · Cited by 6
Can social media be used to increase fruit and vegetable consumption? A pilot intervention study
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Bockarie, T., Shanker, A., Jalloh, M. B., Kamara, A. M., Odland, M. L., Wurie, H. R., Ansumana, R., Lamin, J. M., Witham, M. D., Oyebode, O. O., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-095825 · Cited by 10
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“Their medicinal properties have been linked to their potent antioxidant activities which reduce the risks of short life span, cardiovascular diseases, stroke, obesity, diabetes, neuronal dysfunction and cancer (Boffetta et al., 2010; Oyebode et al., 2014; Rolls et al., 2004).”
BackgroundZheng, G., Ran, S., Zhang, J., Qian, A. M., Hua, J., Wang, C., Vaughn, M. G., Tabet, M., & Lin, H. (2024) · European Journal of Nutrition · doi:10.1007/s00394-024-03362-6 · Cited by 5
“…that blood glucose may rapidly rise after excessive intake of fresh fruit, which can damage pancreatic β-cells and further increase nationally representative population in England have shown that fresh fruit intake is inversely associated with cardiovascular, cancer, and all-cause mortality [27].”
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“Evidence suggests that vegetable consumption may be associated with greater health benefits than fruit intake (Joshipura et al., 2001; Oyebode et al., 2014).”
BackgroundHorticulture in the UK: potential for meeting dietary guideline demands
Lang, T., & Schoen, V. (2016) · City Research Online (City University London) · Cited by 5
Increasing fruit and vegetable intake: where are we at and how do we reach recommendations?
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“Recent evidence suggests that a higher number of servings might increase health benefits even further((11)).”
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“Low intake of fruit and vegetables was defined as having fruit and vegetables twice a week or less [36].”
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“The impact of nutritional deficiencies, such as lower fruit and vegetable consumption, was highlighted by Oyebode et al.((80)) in an analysis of Health Survey for England data.”
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“…focused on the beneficial impact of an increase of fruit and vegetable consumption on CHD or CVD and reported a lower incidence, as well as lower mortality related to heart deficiencies (Joshipura et al. 2001; Bazzano et al. 2002; Dauchet et al. 2006; Oyebode et al. 2014; Miller et al. 2017).”
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“It is estimated that each additional portion of vegetables consumed can reduce all-cause risk of mortality by between 5% and 16% (Wang et al. 2014; Oyebode et al. 2014).”
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“Increased FV consumption with age is well recognised (Lee-Kwan et al. 2017; NHS Digital 2020; Oyebode et al. 2014).”
BackgroundA role for enjoyment for encouraging fruit consumption.
Appleton, K., & Adams, C. (2023) · Appetite · doi:10.1016/j.appet.2023.106609 · Cited by 6
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“High dietary glycemic load has also been associated with increased risk of recurrence and mortality in survivors, as was high intake of red and processed meat [125, 126].”
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Nutritional Profile of Vegetables and Its Significance in Human Health
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Metadata
- 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 (medical) › 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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