Intake of fruit, vegetables and pulses, and all-cause, cardiovascular and cancer mortality: Results from a population-based prospective study

Abstract

Objectives: The aim of this study was to explore the association of fruit, vegetable, and pulses consumption with all-cause, cardiovascular, and cancer mortality. Study design: This prospective study included 66,933 individuals from three Spanish health surveys linked to the national death registry up to December 2022. Methods: Adjusted Poisson regression models were used to analyze the data, categorizing fruit, vegetable and pulses intake according to Spanish dietary recommendations and using splines to examine non-linear relationships. Results: No clear association was found between pulses intake and mortality. Consuming fruits and vegetables ≥2 times/day reduced all-cause mortality risk by 20 % (95%CI = 10%-29 %) and 17 % (95%CI = 7%-26 %) respectively, compared with <3 times/week. Combined intake of fruits and vegetables from 1 to 1.99 to ≥5 times/day showed reductions in all-cause and CVD mortality ranging from 16 % (95%CI = 5%-26 %) to 30 % (95%CI = 20%-39 %), and from 25 % (95%CI = 5%-41 %) to 35 % (95%CI = 14%-50 %), respectively, compared with <1 time/day. No additional benefits against all-cause and CVD mortality for intakes of fruits over 2-3 times/day, but gradual reductions in mortality risk for vegetable intake of 2-5 times/day were observed. Combined intake showed protection up to intakes of 10 times/day, notably for CVD mortality. Associations were similar but weaker for cancer mortality. Conclusions: This study suggests that significant benefits of fruits and, specially, vegetables intake might go beyond the recommended five servings a day. Confirmation of these results could lead to specific dietary recommendations to prevent chronic diseases.