Abstract
ObjectivesTo assess the associations of fresh fruit consumption and total physical activity with all-cause and cardiovascular mortality among Chinese adults who have been diagnosed with cardiovascular disease (CVD) or hypertension.MethodsDuring 2004–08, the China Kadoorie Biobank study recruited 70,047 adults, aged 30–79 years, with physician-diagnosed stroke or transient ischaemic attack, ischemic heart disease, or hypertension. Information on diet and physical activity was collected using an interviewer-administered electronic questionnaire. Cox regression was used to yield hazard ratios (HRs) for the independent and joint associations of fresh fruit consumption and total physical activity with mortality.ResultsAt baseline, 32.9% of participants consumed fresh fruit regularly (i.e. >3 days/week) and the mean total physical activity were 15.8 (SD = 11.8) MET-hr/day. During ~7-years follow-up, 6569 deaths occurred with 3563 from CVD. Compared to participants with <1 day/week fruit consumption, regular consumers had HR (95% CI) of 0.84 (0.79–0.89) for all-cause mortality and 0.79 (0.73–0.86) for CVD mortality. The HRs for the top vs bottom tertile of physical activity were 0.68 (0.64–0.72) and 0.65 (0.60–0.71), respectively, with no clear evidence of reverse causality. After correcting for regression dilution, each 100 g/day usual consumption of fresh fruit or 10 MET-hr/day usual levels of physical activity was associated with 23–29% lower mortality. The combination of regular fruit consumption with top 3rd of physical activity (>16.53 MET-hr/day) was associated with about 40% lower mortality.ConclusionAmong Chinese adults with pre-existing vascular disease, higher physical activity and fruit consumption were both independently and jointly associated with lower mortality.
Highlights
Despite the progressive decline in age-standardised adult mortality over the last half century, cardiovascular disease (CVD) remains a major cause of death worldwide [1]
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
The combination of regular fruit consumption with top 3rd of physical activity (>16.53 MET-hr/day) was associated with about 40% lower mortality
Summary
Despite the progressive decline in age-standardised adult mortality over the last half century, cardiovascular disease (CVD) remains a major cause of death worldwide [1]. Current guidelines for secondary CVD prevention generally recommend a healthy lifestyle, a diet rich in fresh fruit and vegetables and regular physical activity [2, 3]. Such recommendations, are mainly based on data either from studies in general population who were largely free of CVD at the start of the study [4, 5] or from relatively short-term rehabilitation trials [6,7,8]. There is currently insufficient high quality data showing the long-term effects of fresh fruit consumption and physical activity on mortality among individuals with pre-existing CVD, or hypertension. Well-performed large-scale population-based prospective cohort studies can help to assess the potential long-term health impacts of diet and physical activity among people with pre-existing vascular disease [10, 11]
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