Background: Questions remain about the strength and
shape of the dose response relationship
between fruit and vegetable intake and risk of card
iovascular disease, cancer and mortality,
and the effects of specific types of fruit and vege
tables. We conducted a systematic review
and meta analysis to clarify these questions.
Methods and Results: PubMed and Embase were searche
d up to 29
th
of September 2016.
Prospective studies of fruit and vegetable intake a
nd cardiovascular disease, total cancer and
all cause mortality were included. Summary RRs were
calculated using a random effects
model and the mortality burden globally was estimat
ed. Ninety five studies (142 publications)
were included. For fruits and vegetables combined,
the summary RR per 200 g/day was 0.92
(95% CI: 0.90 0.94, I
2
=0%, n=15) for coronary heart disease, 0.84 (95% CI
: 0.76 0.92,
I
2
=73%, n=10) for stroke, 0.92 (95% CI: 0.90 0.95, I
2
=31%, n=13) for cardiovascular disease,
0.97 (95% CI: 0.95 0.99, I
2
=49%, n=12) for total cancer, and 0.90 (95% CI: 0.8
7 0.93,
I
2
=83%, n=15) for all cause mortality. Similar associ
ations were observed for fruits and
vegetables separately. Reductions in risk were obse
rved up to 700 800 g/day for all outcomes
except cancer (600 g/day). Inverse associations wer
e observed between apples or pears, citrus
fruits, green leafy vegetables, cruciferous vegetab
les, and salads and cardiovascular disease
and mortality, and between green yellow vegetables
and cruciferous vegetables and total
cancer risk. An estimated 5.6 and 7.8 million prema
ture deaths worldwide in 2013 may be
attributable to a fruit and vegetable intake below
500 and 800 grams per day, respectively. Conclusion: Fruits and vegetable intakes were assoc
iated with reduced risk of cardiovascular
disease, cancer and mortality. These results suppor
ts public health recommendations to
increase fruit and vegetable intake for chronic dis
ease prevention.