Fruits and vegetables in the prevention of cancer and cardiovascular disease† | Public Health Nutrition | Cambridge Core (original) (raw)

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Objective

We quantified the public health benefit of fruits and vegetables on the prevention of cancer and cardiovascular disease (CVD), using currently available human data.

Design

We reviewed over 250 observational studies on cancer and CVD. Relative risks (RRs) for high versus low intake of fruits and vegetables were obtained. The preventable proportion of chronic diseases, i.e. the per cent of cases attributable to low consumption of fruits and vegetables, was estimated using three scenarios: best guess, optimistic (using stronger RRs) and conservative (using weaker RRs and eliminating the contribution of smoking and/or drinking). The preventable proportion was calculated for increasing average intake from the current 250 g day−1 to the recommended 400 g day among the general Dutch population.

Results

It is estimated that in the Netherlands cancer incidence could be reduced by 19% (12 000 cases annually, best guess), ranging from 6% (conservative) to 28% (optimistic). Cardiovascular deaths could be reduced by 16% (8000 deaths annually, best guess), ranging from 6% to 22%. Evidence is most abundant for gastrointestinal cancers, followed by hormone-related cancers, but limited for other sites and CVD.

Conclusions

Increasing consumption of fruits and vegetables carries a large public health potential. Population trials and biological mechanisms should eventually provide scientific proof of their efficacy. The available evidence is sufficient to justify public health education and promotion aimed at a substantial increase in the consumption of fruits and vegetables.

Type

Research Article

References

1Steinmetz, KA, Potter, JD. Vegetables, fruit, and cancer. I. Epidemiology Cancer Causes Control 1991; 2: 325–57.CrossRef Google Scholar PubMed

2Block, G, Patterson, B, Subar, A.Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence Nutr. Cancer 1992; 18: 1–29.CrossRef Google Scholar PubMed

3Margetts, BM, Thompson, R, Duffy, S on behalf of the Nutritional Epidemiology Working Group on Diet and Cancer. A Review of the Epidemiological Literature Linking Fruit and Vegetable Consumption to Risk of Cancer 1994.Google Scholar

4Ness, AR, Powles, JW. Fruit and vegetables, and cardiovascular disease: a review. Int. J. Epidemiol. 1997; 26: 1–13.CrossRef Google Scholar PubMed

5Steinmetz, KA, Potter, JD. Vegetables, fruit, and cancer. II. Mechanisms Cancer Causes Control 1991; 2: 427–42.CrossRef Google Scholar PubMed

6Greenwald, P, Kelloff, G. The role of chemoprevention in cancer control. In: Stewart, BW, McGregor, D, Kleihues, P, eds. Principles of Chemoprevention. IARC Scientific Publications No. 139. Lyon: International Agency for Research on Cancer, 1996; 13–22.Google Scholar

7Klerk, M, Jansen, MCJF, van't Veer, P, Kok, FJ. Fruits and Vegetables in Chronic Disease Prevention. Wageningen: Division of Human Nutrition and Epidemiology, 1998.Google Scholar

8Kistemake, C, Hulshof, KFAM, Aarnik, EJM. De Consumptie Van Groepen Voedingsmiddelen door Nederlandse Bevolkingsgroepen [food consumption in different segments of the Dutch population]. Voedselconsumptiepeiling 1992. TNO Report No. V93.414. Zeist: TNO, 1993.Google Scholar

9Tomatis, L, Cancer: Causes, Occurences and Control. Lyon: World Health Organization/International Agency for Research on Cancer, 1990.Google Scholar

10Jaarverslag, [annual report] 1993. Den Haag: Stichting Volksgezondheid en Roken, 1994.Google Scholar

11_Incidence of Cancer in the Netherlands, 1994_. Utrecht: Netherlands Cancer Registry, 1994.Google Scholar

12Doll, R, Peto, R.The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J. Natl. Cancer Inst. 1981;66: 1191–308.CrossRef Google Scholar PubMed