The findings are the most comprehensive to date having drawn conclusions from a 7-year study that included half a million adults living in China.
The country was selected as compared to countries like the UK or US where fresh fruit consumption is much lower.
Cardiovascular disease is a leading cause of premature death and disability worldwide and is responsible for more than 2 million deaths in Europe.
A low level of fruit consumption is a major risk factor for cardiovascular disease, accounting for an estimated 104 million disability-adjusted life-years worldwide in 2010.
Fresh fruit findings
A joint collaboration involving the University of Oxford and Chinese Academy of Medical Sciences enrolled 500,000 adults from 10 urban and rural localities across China.
The team were able to record and evaluate the health of these individuals by examining death records and electronic hospital records of illness spanning seven years.
Subjects were selected on the basis they did not have a history of cardiovascular disease or anti-hypertensive treatments prior to joining the study.
Findings reveal that a 100 g portion of fruit per day was associated with approximately one-third less of cardiovascular death. This link was similar across different study areas and in both men and women.
Overall, 18% of participants reported consuming fresh fruit daily. Compared with participants who never or rarely consumed fresh fruit, those who ate fresh fruit daily had lower systolic blood pressure (by 4.0 mm Hg) and blood glucose levels (by 0.5 mmol per liter [9.0 mg per deciliter]).
There was a particularly strong relationship between the incidence of each outcome and the amount of fresh fruit consumed.
These findings were similar across the 10 study regions and were significant even allowing for such factors like education, lower blood pressure, lower blood glucose, and not smoking.
“Our study focused on fresh fruit, which is universally consumed raw in China, perhaps maximising its potential benefits,” the study noted.
“Moreover, the average level of fruit consumption in the Chinese population is very low, and there is evidence that the association of fruit consumption with disease risks may be particularly strong at the low end of the range of intake (i.e., fewer than two servings per day).”
Previous findings
The link between fruit consumption and cardiovascular risk has been extensively researched for a good 30 years now.
However, previous studies have tended to involve a combination of fresh and processed fruit (frozen, dried, or canned fruit or fruit juice), with limited data specifically on fresh fruit.
Only one previous prospective study in China has shown an association between fresh fruit consumption and cardiovascular risk.
In that study, 130,000 adults were enrolled and roughly 1600 cardiovascular deaths during follow-up were recorded. The risk of cardiovascular death among people in the highest quintile of fruit consumption was about 30% lower than among those in the lowest quintile.
However, no overall association with the incidence of major coronary events was observed, perhaps in part because of the small number of such events (365).
Commenting on these latest findings, Victoria Taylor, senior dietitian at the British Heart Foundation (BHF), which helped fund the study said: “The results of this study support the current dietary recommendations in the UK to eat more fruit and vegetables.”
“While the five portions of fruit and vegetables a day recommendation has been in place for some time in the UK it’s one that we are still struggling to meet. On average we eat around four portions a day, with only around a third of adults getting their five-a-day.”
Source: New England Journal of Medicine
Published online ahead of print, DOI: 10.1056/NEJMoa1501451
“Fresh Fruit Consumption and Major Cardiovascular Disease in China.”
Authors: Huaidong Du et al.