Fresh fruit consumption and all-cause and cause-specific mortality: findings from the China Kadoorie Biobank.

Huaidong Du,Xianzhi Li,Junshi Chen,Yijun Li,Liming Li,Yiping Chen,Ling Yang,Yu Guo,Zhengming Chen,Xue Zhou,Derrick Bennett,Rory Collins,Junzheng Wang,Le Fang,Richárd Pető ,Robin G Walters ,Timothy J Key ,Iona Y Millwood ,Bin Zheng

doi:10.1093/ije/dyx042

Abstract

BackgroundHigher fruit consumption is associated with lower risk of cardiovascular disease (CVD). Substantial uncertainties remain, however, about the associations of fruit consumption with all-cause mortality and mortality from subtypes of CVD and major non-vascular diseases, especially in China.MethodsIn 2004–08, the nationwide China Kadoorie Biobank Study recruited > 0.5 million adults aged 30–79 years from 10 diverse localities in China. Fresh fruit consumption was estimated using an interviewer-administered electronic questionnaire, and mortality data were collected from death registries. Among the 462 342 participants who were free of major chronic diseases at baseline, 17 894 deaths were recorded during ∼ 7 years of follow-up. Cox regression yielded adjusted rate ratios (RRs) for all-cause and cause-specific mortality associated with fruit consumption.ResultsAt baseline, 28% of participants reported consuming fruit ≥ 4 days/week (regular consumers) and 6% reported never/rarely consuming fruit (non-consumers). Compared with non-consumers, regular consumers had 27% [RR = 0.73, 95% confidence interval (CI) 0.70–0.76] lower all-cause mortality, 34% lower CVD mortality (n = 6166; RR = 0.66, 0.61–0.71), 17% lower cancer mortality (n = 6796; RR = 0.83, 0.78–0.89) and 42% lower mortality from chronic obstructive pulmonary disease (COPD) (n = 1119; RR = 0.58, 0.47–0.71). For each of the above, there was an approximately log-linear dose-response relationship with amount consumed. For mortality from site-specific cancers, fruit consumption was inversely associated with digestive tract cancer (n = 2265; RR = 0.72, 0.64–0.81), particularly oesophageal cancer (n = 801; RR = 0.65, 0.50–0.83), but not with cancer of lung or liver.ConclusionsAmong Chinese adults, higher fresh fruit consumption was associated with significantly lower mortality from several major vascular and non-vascular diseases. Given the current low population level of fruit consumption, substantial health benefits could be gained from increased fruit consumption in China.

Highlights

In China, adult mortality has been decreasing in the past several decades, driven mainly by reductions in several major chronic non-communicable diseases such as chronic obstructive pulmonary disease (COPD), haemorrhagic stroke and certain cancers.[1]
There was no association observed between fruit consumption and mortality from traffic accidents. This large prospective study in China showed that fresh fruit consumption is associated with significantly lower overall mortality and mortality from a range of cardiovascular and non-cardiovascular diseases
There was a clear dose-response relationship with amount consumed and the associations appeared to be similar in men and women and in other subgroups of participants

Summary

Introduction

In China, adult mortality has been decreasing in the past several decades, driven mainly by reductions in several major chronic non-communicable diseases such as chronic obstructive pulmonary disease (COPD), haemorrhagic stroke and certain cancers (e.g. oesophageal and stomach cancer).[1] These decreasing mortality trends are due to many social, dietary, occupational and health care changes, and may well continue (except perhaps in male smokers2), if there are further favourable changes in diet and other main causes of chronic diseases at the population level.[1]. In Western populations, the association of fruit consumption with cardiovascular disease (CVD) mortality is relatively well established,[5] substantial uncertainty remains about its associations with certain CVD subtypes (e.g. haemorrhagic stroke) and with other common chronic diseases (e.g. COPD and cancer). Substantial uncertainties remain, about the associations of fruit consumption with all-cause mortality and mortality from subtypes of CVD and major non-vascular diseases, especially in China.

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Results

Conclusion