Fruit and vegetable intake and cause-specific mortality in the EPIC study

European Journal of Epidemiology, Springer Nature, ISSN 1573-7284

Volume 29, 9, 2014

DOI:10.1007/s10654-014-9945-9, Dimensions: pub.1034911309, PMID: 25154553,



  1. (1) Utrecht University, grid.5477.1
  2. (2) University Medical Center Utrecht, grid.7692.a
  3. (3) Wageningen University & Research, grid.4818.5
  4. (4) National Institute for Public Health and the Environment, grid.31147.30
  5. (5) International Agency For Research On Cancer, grid.17703.32
  6. (6) Aalborg Hospital, grid.27530.33, North Denmark Region
  7. (7) Aarhus University, grid.7048.b, AU
  8. (8) Danish Cancer Society, grid.417390.8
  9. (9) Centre for research in epidemiology and population health, grid.463845.8
  10. (10) Institut Gustave Roussy, grid.14925.3b
  11. (11) UMRS 1018, Paris Sud University, Villejuif, France
  12. (12) German Cancer Research Center, grid.7497.d
  13. (13) German Institute of Human Nutrition, grid.418213.d
  14. (14) National and Kapodistrian University of Athens, grid.5216.0
  15. (15) Hellenic Health Foundation, grid.424637.0
  16. (16) Academy of Athens, grid.417593.d
  17. (17) Harvard University, grid.38142.3c
  18. (18) Istituto per lo Studio e la Prevenzione Oncologica, grid.417623.5
  19. (19) Fondazione IRCCS Istituto Nazionale dei Tumori, grid.417893.0
  20. (20) University of Naples Federico II, grid.4691.a
  21. (21) Cancer Registry and Histopathology Unit, ‘Civile - M.P. Arezzo’ Hospital, Asp Ragusa, Italy
  22. (22) Human Genetics Foundation, grid.428948.b
  23. (23) Imperial College London, grid.7445.2
  24. (24) Cancer Registry of Norway, grid.418941.1
  25. (25) Folkhälsans Forskningscentrum, grid.428673.c
  26. (26) Karolinska Institute, grid.4714.6
  27. (27) The Arctic University of Norway, grid.10919.30
  28. (28) Public Health Directorate, Asturias, Spain
  29. (29) Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
  30. (30) Andalusian School of Public Health, grid.413740.5
  31. (31) Instituto de Investigación Biosanitaria, grid.507088.2
  32. (32) CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
  33. (33) Public Health Division of Gipuzkoa, Research Institute of BioDonostia, San Sebastian, Spain
  34. (34) Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
  35. (35) Instituto de Salud Pública de Navarra, grid.419126.9
  36. (36) Lund University, grid.4514.4
  37. (37) Umeå University, grid.12650.30
  38. (38) University of Gothenburg, grid.8761.8
  39. (39) University of Cambridge, grid.5335.0
  40. (40) University of Oxford, grid.4991.5


Consumption of fruits and vegetables is associated with a lower overall mortality. The aim of this study was to identify causes of death through which this association is established. More than 450,000 participants from the European Prospective Investigation into Cancer and Nutrition study were included, of which 25,682 were reported deceased after 13 years of follow-up. Information on lifestyle, diet and vital status was collected through questionnaires and population registries. Hazard ratios (HR) with 95% confidence intervals (95% CI) for death from specific causes were calculated from Cox regression models, adjusted for potential confounders. Participants reporting consumption of more than 569 g/day of fruits and vegetables had lower risks of death from diseases of the circulatory (HR for upper fourth 0.85, 95% CI 0.77-0.93), respiratory (HR for upper fourth 0.73, 95% CI 0.59-0.91) and digestive system (HR for upper fourth 0.60, 95% CI 0.46-0.79) when compared with participants consuming less than 249 g/day. In contrast, a positive association with death from diseases of the nervous system was observed. Inverse associations were generally observed for vegetable, but not for fruit consumption. Associations were more pronounced for raw vegetable consumption, when compared with cooked vegetable consumption. Raw vegetable consumption was additionally inversely associated with death from neoplasms and mental and behavioral disorders. The lower risk of death associated with a higher consumption of fruits and vegetables may be derived from inverse associations with diseases of the circulatory, respiratory and digestive system, and may depend on the preparation of vegetables and lifestyle factors.


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Times Cited: 36

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