Linus Pauling Institute at Oregon State University
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Linus Pauling Institute
Micronutrient Research for Optimum Health
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Fruits and Vegetables
Summary • Dietary patterns characterized by high intakes of fruits and vegetables are consistently associated with significant reductions in cardiovascular disease risk. (More Information) • Although prospective cohort studies provide weak support for an association between total fruit and vegetable consumption and cancer risk, they provide some evidence that high intakes of certain classes of fruits or vegetables are associated with reduced risk of individual cancers. (More Information) • The results of epidemiological and controlled clinical trials suggest that diets rich in fruits and vegetables can help prevent bone loss. (More Information) • The results of prospective cohort studies suggest that high intakes of vitamin C and carotenoid-rich fruits and vegetables may be associated with decreased risk of age-related eye diseases, such as macular degeneration or cataracts. (More Information) • Many organizations, including the Centers for Disease Control and Prevention, recommend eating a variety of fruits and vegetables daily; the recommended serving number depends on total caloric intake, which is governed by age, gender, body composition, and physical activity level. (More Information) Introduction Despite all of the controversy surrounding the optimal components of a healthy diet, there is little disagreement among scientists regarding the importance of fruits and vegetables. The results of numerous epidemiological studies and recent clinical trials provide consistent evidence that diets rich in fruits and vegetables can reduce the risk of chronic disease (1). On the other hand, evidence that very high doses of individual micronutrients or phytochemicals found in fruits and vegetables can do the same is inconsistent and relatively weak. Fruits and vegetables contain thousands of biologically active phytochemicals that are likely to interact in a number of ways to prevent disease and promote health (2). Fruits and vegetables are rich in antioxidants, which help protect the body from oxidative damage induced by pro-oxidants. The best way to take advantage of these complex interactions is to eat a variety of fruits and vegetables. Disease Prevention Cardiovascular Disease Dietary patterns characterized by relatively high intakes of fruits and vegetables are consistently associated with significant reductions in the risk of coronary heart disease (CHD) and stroke. A
for information about serving size. in the case of fruits and vegetables. supplementation of individual micronutrients or phytochemicals has not generally resulted in significantly decreased incidence of cardiovascular events in randomized controlled trials. After eight weeks. For more information on the DASH eating plan. 459 people with and without high blood pressure were randomly assigned to one of three diets: 1) a typical American diet that provided about 3 servings/day of fruits and vegetables and 1 serving/day of a low-fat dairy product. Adding more fruits and vegetables to a sensible diet is one potential way to lower blood pressure.000 men and women participating in the Health Professionals' Follow-up Study and the Nurses’ Health Study. In a cohort of almost 10. go to the National Heart. However. the benefit of the whole may be greater than the sum of its parts.000 adults in the United States.oregonstate. In a meta-analysis that included nine cohort studies.edu/infocenter/foods/fruitveg/
. In the same cohort. the risk of ischemic stroke (stroke caused by a reduction in blood flow to part of the brain) was 30% lower in those who consumed at least five servings of fruits and vegetables daily than in those who consumed less than three servings daily (5). In a metaanalysis of eight studies examining fruit and vegetable intake. and Blood Institute Web site. or 3) a combination diet (now called the DASH diet) that provided 9 servings/day of fruits and vegetables and 3 servings/day of low-fat dairy products (10). 2) a fruit and vegetable diet that provided 8 servings/day of fruits and vegetables and 1 serving/day of a low-fat dairy product. the blood pressures of those on the fruit and vegetable diet (8 servings/day) were significantly lower than those on the typical American diet. please see Examples of One Serving of Fruits or Vegetables below) had a risk of myocardial infarction (MI) that was approximately 15% lower than those in the 10th percentile of intake (3). Among more than 126. when compared to those who consumed less than three servings daily (8). In a metaanalysis designed to estimate the global burden of disease attributable to low fruit and vegetable consumption. Three recent meta-analyses have examined fruit and vegetable consumption and risk of CHD or stroke. an additional daily serving of fruit and vegetables was associated with a 4% decreased risk for CHD (6). fiber. potassium. those who consumed eight or more servings of fruits and vegetables daily had a risk of developing CHD over the next 8-14 years that was 20% lower than those who consumed less than three servings daily (4). found that individuals who consumed more than five daily servings of fruit and vegetables experienced a 17% reduction in risk of CHD compared to those who consumed less than three servings daily (7). type 2 diabetes mellitus (DM) is associated with increased risk of cardiovascular disease—the leading cause of death in type 2 diabetics (12). respectively. the results of a small number of studies suggest that higher intakes of fruits and vegetables are associated with improved blood glucose control and lower risk of developing type 2 DM. Lung. individuals who consumed three to five daily servings or more than five daily servings had an 11% or 26% reduction in risk of stroke. In the Dietary Approaches to Stop Hypertension (DASH) study. epidemiologists concluded that increasing individual fruit and vegetable consumption (excluding potatoes) up to 600 g/day (about 7 servings/day) could decrease the risk of CHD by 31% and the risk of ischemic stroke by 19% (1). the risk of developing type 2 DM over the next 20 years was approximately 20% lower in those who reported consuming at least five daily servings of fruits and vegetables compared to those who reported
http://lpi. folate. Another meta-analysis. including vitamin C. while blood pressures of those on the combination (DASH) diet (9 servings/day of fruits and vegetables) were lower still. High blood pressure (hypertension) increases the risk of heart disease and stroke (9). Type 2 Diabetes Mellitus In addition to other complications. and various phytochemicals (11). eating one extra serving of fruits or vegetables daily would decrease one’s risk of CHD by about 4% and decrease risk of ischemic stroke by 6%. Although the evidence for a beneficial effect of a diet rich in fruits and vegetables on diabetes is not as consistent as it is for heart disease.Linus Pauling Institute at Oregon State University
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meta-analysis that combined the results of 11 prospective cohort studies found that people in the 90th percentile of fruit and vegetable intake (about 5 servings/day or more. A number of compounds may contribute to the cardioprotective effects of fruits and vegetables. Based on the results of Health Professionals' Followup Study and the Nurses’ Health Study. Thus. which examined 12 separate studies.
which might otherwise be mobilized to maintain normal pH.oregonstate. However.S. Case-control studies. In another prospective cohort study that followed more than 40. those with higher fruit and vegetable intakes had significantly lower levels of glycosylated hemoglobin (HbA1c). The current U. which collect information on the diets of large cohorts of healthy people and follow the development of disease in the cohort over time (45). Cancer The results of numerous case-control studies indicate that eating a diet rich in fruits and vegetables decreases the risk of developing a number of different types of cancer. total fruit and vegetable intake was not associated with risk for diabetes. although further analysis revealed that intake of fruit or green leafy vegetables was individually associated with a modest reduction in risk of diabetes (16). in which the past diets of people diagnosed with a particular type of cancer are compared to the diets of people without cancer. higher fruit and vegetable intakes were associated with significantly less decline in BMD at the hip in elderly men but not elderly women (50). The results of some of these studies were the foundation for the National Cancer Institute’s “5 a Day” program. Fruits & Veggies-More Matters™. Fruits and vegetables are rich in precursors to bicarbonate ions. women for an average of nine years. government campaign.000 individuals followed for 12 years (15). in a cross-sectional study of more than 6. and rectum) and lung (19-21). a measure of long-term blood glucose control (18). stomach. In contrast to the results of case-control studies. has replaced the "5 a Day" program.edu/infocenter/foods/fruitveg/
. In men.000 U. In a study that followed BMD over four years. Possible compounds in fruits and vegetables that may enhance glucose control include fiber and magnesium. Increased consumption of fruits and vegetables reduces the net acid content of the diet and may preserve calcium in bones. the results of a recent placebocontrolled trial in 276 postmenopausal women suggest that supplementing the diet with alkali. many recent prospective cohort studies have found little or no association between total fruit and vegetable intake and the risk of various cancers (22-44). higher intakes of cruciferous vegetables have been associated with significant reductions in the risk of bladder cancer (47) as well as prostate cancer (48). esophagus. either through supplemental potassium citrate or an additional 300 g/day of fruits and vegetables. which serve to buffer acids in the body. When the quantity of bicarbonate ions is insufficient to maintain normal pH. Although prospective cohort studies provide weak support for an association between total fruit and vegetable consumption and cancer risk.000 nondiabetic adults in the UK. they provide some evidence that high intakes of certain classes of fruits or vegetables are associated with reduced risk of individual cancers.S. particularly cancers of the digestive tract (oropharynx.346 women participating in the Nurses' Health Study. Results
http://lpi. Osteoporosis Several cross-sectional studies have reported that higher intakes of fruits and vegetables are associated with significantly higher bone mineral density (BMD) and lower levels of bone resorption (loss) in men and women (50-53). colon. the body is capable of mobilizing alkaline calcium salts from bone in order to neutralize acids consumed in the diet and generated by metabolism (54). but higher intakes of green leafy and yellow vegetables were associated with significant reductions in the risk of type 2 DM in overweight women (14). did not increase BMD or blunt the age-associated bone loss over a two-year period (55).Linus Pauling Institute at Oregon State University
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consuming none (13). Higher fruit and vegetable intakes were weakly associated with a reduced risk of diabetes in a cohort of more than 20. Higher intakes of fruits have been associated with modest but significant reductions in lung cancer risk in a pooled analysis of eight prospective cohort studies (28) and with reductions in risk of bladder cancer in some studies (46). which was aimed at increasing the fruit and vegetable consumption of the American public to a minimum of five servings daily. However. fruit and vegetable intake was not associated with the risk of developing type 2 DM in the entire cohort. are more susceptible to bias in the selection of participants and dietary recall than prospective cohort studies. and higher intakes of tomato products have been linked with significant reductions in risk of prostate cancer (49). In a cohort of 71. There are several possible explanations for this discrepancy. A systematic review and meta-analysis of five cohort studies found that fruit and vegetable intake was not associated with type 2 diabetes (17).
such as dark green. In two case-control studies. The reasons for the beneficial association between fruit intake and lung health are not yet known. especially those rich in lutein and zeaxanthin.5 oz) increase in daily fruit consumption was associated with a 24% decrease in the risk of death from COPD (71). are associated with higher forced expiratory volume (FEV1) values. Macular Degeneration Degeneration of the macula. Although smoking is by far the most important risk factor for COPD. providing support for the antioxidant hypothesis. particularly bone resorption. especially apple intakes.500 middle-aged Welsh men. those who ate at least five apples weekly had significantly slower declines in lung function than those who did not eat apples over a 5-year period (69).Linus Pauling Institute at Oregon State University
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from the DASH study support a beneficial link between fruit and vegetable intake and bone health. scientists are currently investigating the possibility that antioxidants found in fruits. indicative of better lung function (68-70). Age-Related Eye Diseases Cataracts Cataracts are thought to be caused by oxidative damage of proteins in the eye’s lens induced by long-term exposure to UV light. more strongly. increasing fruit and vegetable intakes from about 3 to 9 servings daily decreased urinary calcium loss by almost 50 mg/day (10) and lowered biochemical markers of bone turnover. especially carotenoid and vitamin C-rich fruits and vegetables. those who consumed three or more servings of fruits daily had a risk of developing agerelated macular degeneration over the next 12-18 years that was 36% lower than those who consumed less than 1. high intakes of both broccoli and spinach were associated with fewer cataract extractions (57). vegetable intake was not associated with the risk of macular degeneration in this cohort.917 European men followed over 20 years. including serum levels of C-terminal telopeptide of type 1 collagen (56). two chronic lung diseases that are characterized by airway obstruction. combined lutein and zeaxanthin intake was not associated with prevalence of intermediate AMD in a cohort of women aged 50-79 years (66). In a study of 2. In a study of 2. Interestingly. Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease (COPD) is a term that includes emphysema and chronic bronchitis. the results of epidemiological studies and controlled clinical trials suggest that a diet rich in fruits and vegetables can help prevent bone loss.edu/infocenter/foods/fruitveg/
.5 servings (65). high intakes of carotenoid-rich vegetables. further analysis of the data revealed that women younger than 75 years with stable intakes of lutein and zeaxanthin had a 43% lower risk of developing intermediate AMD (66). although the specific mechanisms are not known with certainty. Taken together. The results of several large prospective cohort studies suggest that diets rich in fruits and vegetables.oregonstate. Higher fruit and vegetable intake was inversely associated with risk of COPD in a small case-control study of male cigarette smokers (72). The resulting cloudiness and discoloration of the lens leads to vision loss that becomes more severe with age. each 100 g (3. health professionals. In a more recent study. In a prospective cohort study of more than 118. leafy vegetables. were associated with a significantly lower risk of developing age-related macular degeneration (AMD) (63. such as vitamin C or flavonoids. Because oxidative stress is thought to play a role in the etiology of chronic obstructive lung disease. However. Lutein and zeaxanthin are carotenoids that are found in relatively high concentrations in the retina.S. is the leading cause of blindness in people over the age of 65 in the United States (61). with fruit intakes and COPD risk (67).000 men and women. are associated with decreased incidence and severity of cataracts (57-60). In a study of male U. The results of several epidemiological studies in Europe indicate that higher fruit intakes. 64). the center of the retina.
http://lpi. these carotenoids may play a role in preventing damage to the retina caused by light or oxidants (62). In addition to decreasing blood pressure. the results of several epidemiological studies suggest beneficial associations between vegetable and. could play a protective role.
Moreover. and whole grains was associated with a 25-50% reduction in COPD risk in large cohorts of men (73) and women (74). fiber-rich. such as cruciferous vegetables. blue. The Linus Pauling Institute's Prescription for Health states that potatoes should not be included in the daily tally of fruit and vegetable intake. The table below provides some examples of a single serving of fruits or vegetables. certain groups of fruits and vegetables. More studies are needed to determine whether fruit and vegetable consumption is protective against neurodegenerative diseases. consumption of a variety of different fruits and vegetables is recommended. In both cases. Additionally. and activity level (78). cured and red meats. while 1. including the Centers for Disease Control and Prevention.S. when compared to a Western dietary pattern (refined grains. French fries.600 kcal/d. Neurodegenerative Disease Although it is not yet clear whether a diet rich in fruits and vegetables will decrease the risk of neurodegenerative diseases like Alzheimer’s disease and Parkinson’s disease in humans.oregonstate. including dark green. government. red. a prospective study that followed 1. and desserts). whole fruits are recommended over high-sugar fruit juices. recent studies in animal models of these diseases suggest that diets rich in fruits like blueberries (75) or tomatoes may be protective (76). Daily consumption of 2 cups (4 servings) of fruit and 2½ cups (5 servings) of vegetables are recommended for people who consume 2.edu/infocenter/foods/fruitveg/
. Examples of One Serving of Fruits or Vegetables • • • • • • • • 6 fluid ounces of fruit or vegetable juice (¾ of a cup) 1 medium sized apple or orange 1 small banana 1 cup of raw salad greens ½ cup of cooked vegetables (about the size of a baseball) ½ cup of chopped fruit or vegetables ½ cup of cooked peas or beans ¼ cup of dried fruit (about the size of a golf ball)
Some Potentially Beneficial Compounds in Fruits and Vegetables
Folate Vitamin A Vitamin C
Magnesium Potassium Selenium
Carotenoids Chlorophylls Fiber
http://lpi.000 kcal/d. but they are tied to caloric intake and not to age or gender (79). the recommended serving number depends on age. as well as legumes (peas and beans). Intake Recommendations Many agencies within the U. fish. vegetables. and garlic.Linus Pauling Institute at Oregon State University
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Interestingly. sex. Interestingly. and purple fruits and vegetables. may provide specific health benefits (see the article on Cruciferous Vegetables).5 cups of fruit and (3 servings) and 2 cups (4 servings) of vegetables are recommended for people who consume 1. The 2005 Dietary Guidelines for Americans are similar with respect to fruit and vegetable intake recommendations.3 years found that regular consumption of fruit and vegetable juices was associated with a decreased risk of developing Alzheimer's disease (77). a prudent dietary pattern that emphasized fruits.836 older Japanese Americans for an average of 6. yellow. recommend eating a variety of fruits and vegetables daily. onions. orange.
The information is made available with the understanding that the author and publisher are not providing medical. Linus Pauling Institute Oregon State University Reviewed in May 2009 by: Kaumudi Joshipura. Drake.edu/infocenter/foods/fruitveg/
.D. or nutritional counseling services on this site. Sc. Ph. precautions. It is not intended as medical advice for individual problems.D. Professor of Epidemiology Harvard School of Public Health Associate Professor Harvard School of Dental Medicine Last updated 4/7/2010 Copyright 2003-2012 Linus Pauling Institute Disclaimer The Linus Pauling Institute Micronutrient Information Center provides scientific information on health aspects of micronutrients and phytochemicals for the general public. Liability for individual actions or omissions based upon the contents of this site is expressly disclaimed. Ph. The information should not be used in place of a consultation with a competent health care or nutrition professional. psychological.Linus Pauling Institute at Oregon State University
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Vitamin E Vitamin K
Flavonoids Indole-3-Carbinol Isoflavones Isothiocyanates Lignans Phytosterols
References Written in December 2005 by: Jane Higdon.
http://lpi.oregonstate. Linus Pauling Institute Oregon State University Updated in May 2009 by: Victoria J. actions.D. The information on micronutrients and phytochemicals contained on this Web site does not cover all possible uses. and interactions. side effects.