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Cited by 397Nutritional Studies and DietNutrition, Health and Food BehaviorObesity, Physical Activity, Diet

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Changes in Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for Up to 24 Years: Analysis from Three Prospective Cohort Studies

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Bertoia, Monica L., Mukamal, Kenneth J., Cahill, Leah E., Hou, Tao, Ludwig, David S., Mozaffarian, Dariush, Willett, Walter C., Hu, Frank B., Rimm, Eric B.·2015·PLOS Medicine
DOI 10.1371/journal.pmed.1001878PMC PMC4578962
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Abstract

BACKGROUND: Current dietary guidelines recommend eating a variety of fruits and vegetables. However, based on nutrient composition, some particular fruits and vegetables may be more or less beneficial for maintaining or achieving a healthy weight. We hypothesized that greater consumption of fruits and vegetables with a higher fiber content or lower glycemic load would be more strongly associated with a healthy weight. METHODS AND FINDINGS: We examined the association between change in intake of specific fruits and vegetables and change in weight in three large, prospective cohorts of 133,468 United States men and women. From 1986 to 2010, these associations were examined within multiple 4-y time intervals, adjusting for simultaneous changes in other lifestyle factors, including other aspects of diet, smoking status, and physical activity. Results were combined using a random effects meta-analysis. Increased intake of fruits was inversely associated with 4-y weight change: total fruits -0.53 lb per daily serving (95% CI -0.61, -0.44), berries -1.11 lb (95% CI -1.45, -0.78), and apples/pears -1.24 lb (95% CI -1.62, -0.86). Increased intake of several vegetables was also inversely associated with weight change: total vegetables -0.25 lb per daily serving (95% CI -0.35, -0.14), tofu/soy -2.47 lb (95% CI, -3.09 to -1.85 lb) and cauliflower -1.37 lb (95% CI -2.27, -0.47). On the other hand, increased intake of starchy vegetables, including corn, peas, and potatoes, was associated with weight gain. Vegetables having both higher fiber and lower glycemic load were more strongly inversely associated with weight change compared with lower-fiber, higher-glycemic-load vegetables (p < 0.0001). Despite the measurement of key confounders in our analyses, the potential for residual confounding cannot be ruled out, and although our food frequency questionnaire specified portion size, the assessment of diet using any method will have measurement error. CONCLUSIONS: Increased consumption of fruits and non-starchy vegetables is inversely associated with weight change, with important differences by type suggesting that other characteristics of these foods influence the magnitude of their association with weight change.

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Figures

Fig 1 Relationships between changes in total vegetable and total fruit intake and weight change over 4 y in three cohorts. Total vegetables: string beans, broccoli, cabbage/coleslaw, cauliflower, Brussels sprouts, carrots (raw, cooked, or juice), corn, peas, lima beans, mixed vegetables or vegetable soup, beans, lentils, celery, squash, eggplant, zucchini, yams, sweet potatoes, baked/boiled/mashed potatoes, spinach, kale, mustard or chard greens, iceberg or head lettuce, romaine or leaf lettuce, peppers, tomatoes, onions, tofu and soy (soy burger, soybeans, miso, or other soy protein). Total fruit (without juice): raisins, grapes, avocados, bananas, cantaloupe, watermelon, apples, pears, peaches (fresh or canned), apricots (fresh or canned), plums (fresh or canned), strawberries, blueberries, prunes, oranges, grapefruit (fresh or juice). Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 1 Relationships between changes in total vegetable and total fruit intake and weight change over 4 y in three cohorts. Total vegetables: string beans, broccoli, cabbage/coleslaw, cauliflower, Brussels sprouts, carrots (raw, cooked, or juice), corn, peas, lima beans, mixed vegetables or vegetable soup, beans, lentils, celery, squash, eggplant, zucchini, yams, sweet potatoes, baked/boiled/mashed potatoes, spinach, kale, mustard or chard greens, iceberg or head lettuce, romaine or leaf lettuce, peppers, tomatoes, onions, tofu and soy (soy burger, soybeans, miso, or other soy protein). Total fruit (without juice): raisins, grapes, avocados, bananas, cantaloupe, watermelon, apples, pears, peaches (fresh or canned), apricots (fresh or canned), plums (fresh or canned), strawberries, blueberries, prunes, oranges, grapefruit (fresh or juice). Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central
Fig 2 Relationships between changes in intake of classes of vegetables and fruits and weight change over 4 y in three cohorts. Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussels sprouts. Green leafy vegetables: kale, mustard or chard greens, spinach, head or romaine lettuce. Legumes: peas, lima beans, beans, lentils, tofu/soy. Berries: blueberries, strawberries. Melon: cantaloupe, watermelon. Citrus fruits: oranges, grapefruit (fresh or juice). Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 2 Relationships between changes in intake of classes of vegetables and fruits and weight change over 4 y in three cohorts. Cruciferous vegetables: broccoli, cauliflower, cabbage, Brussels sprouts. Green leafy vegetables: kale, mustard or chard greens, spinach, head or romaine lettuce. Legumes: peas, lima beans, beans, lentils, tofu/soy. Berries: blueberries, strawberries. Melon: cantaloupe, watermelon. Citrus fruits: oranges, grapefruit (fresh or juice). Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central
Fig 3 Relationships between changes in intake of specific fruits and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 3 Relationships between changes in intake of specific fruits and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central
Fig 4 Relationships between changes in intake of specific vegetables and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 4 Relationships between changes in intake of specific vegetables and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central
Fig 5 Relationships between changes in intake of specific vegetables and weight change over 4 y in three cohorts. *Includes baked/boiled/mashed white potatoes, sweet potatoes and yams; excludes french fries and potato chips. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 5 Relationships between changes in intake of specific vegetables and weight change over 4 y in three cohorts. *Includes baked/boiled/mashed white potatoes, sweet potatoes and yams; excludes french fries and potato chips. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central
Fig 6 Relationships between changes in intake of fruits and vegetables classified as either low or high fiber and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 6 Relationships between changes in intake of fruits and vegetables classified as either low or high fiber and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central
Fig 7 Relationships between changes in intake of fruits and vegetables classified as either high or low glycemic load (GL) and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.
Fig 7 Relationships between changes in intake of fruits and vegetables classified as either high or low glycemic load (GL) and weight change over 4 y in three cohorts. Adjusted for baseline age and BMI and change in the following lifestyle variables: smoking status, physical activity, hours of sitting or watching TV, hours of sleep, fried potatoes, juice, whole grains, refined grains, fried foods, nuts, whole-fat dairy, low-fat dairy, sugar-sweetened beverages, sweets, processed meats, non-processed meats, trans fat, alcohol, and seafood.CC BY · PubMed Central

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Metadata

Authors
Bertoia, M. L., Mukamal, K. J., Cahill, L. E., Hou, T., Ludwig, D. S., Mozaffarian, D., Willett, W. C., Hu, F. B., & Rimm, E. B.
Affiliations
  • Brigham and Women's Hospital (US)
  • Beth Israel Deaconess Medical Center (US)
  • Harvard University (US)
  • Boston Children's Hospital (US)
  • Tufts University (US)
Corresponding author
Bertoia, Monica L.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2015-09-22
Volume
12
Issue
9
Pages
e1001878
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1001878
PMC
PMC4578962
OpenAlex
W1915710460
Cited by
397
References
36
Citations by year
2026: 13 · 2025: 29 · 2024: 24 · 2023: 47 · 2022: 42 · 2021: 52 · 2020: 41 · 2019: 45 · 2018: 41 · 2017: 37 · 2016: 24 · 2015: 2
FWCI
37.18
Type
journal article
Language
en
Update notices
correction (2016-01-20)
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • U.S. Department of Agriculture
  • Brigham and Women's Hospital (R01 HL088521)
  • Amarin Corporation
  • National Institutes of Health (5r01ca049449-18, R01 CA49449, UM1-CA-176726, UM1-CA167552, CA176726, CA-167552, CA67262, CA 87969)
  • National Heart, Lung, and Blood Institute (R01HL035464, R01 HL35464, R01HL034594, R01HL088521)
  • National Cancer Institute (R01-CA49449, P01CA087969, R01‐CA049449, UM1CA176726, R01 CA67262, UM1CA167552, R01CA067262, [P01 CA87969)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24DK082730)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
fruits, vegetables, weight change, weight gain, dietary fiber, glycemic load, berries, cauliflower, starchy vegetables, potato, maize, pea, longitudinal dietary change, obesity prevention, healthy weight maintenance, prospective cohort, random-effects meta-analysis, residual confounding, sex differences, United States adults, physical activity
MeSH terms
Adult, Aged, Body Weight, Female, Fruit, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, United States, Vegetables

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