Eating fresh fruit decreased the risk of cardiovascular disease in Chinese adults: The China Kadoorie Biobank Study

1. Higher consumption of fresh fruit was independently associated with lower risk of cardiovascular disease (CVD) in Chinese adults. 

Evidence Rating Level: 2 (Good)

Study Rundown: CVD represents a substantial cause of morbidity and mortality in low- and middle-income countries, such as China. Adverse changes in lifestyle, diet and tobacco use play a significant role in this statistic – in particular, the dietary risk of low fresh fruit intake. Studies that have evaluated this risk factor have often conflated consumption of fresh and processed fruit, and lack data on the relationship between fruit intake and specific subtypes of cardiovascular disease. In this prospective cohort study, researchers attempted to evaluate the association between fresh fruit intake and major cardiovascular events by subtype across ten regions in China. Researchers found that respondents who consumed more fresh fruit tended to have lower systolic blood pressures, blood glucose levels, and a reduced risk of CVD which coronary events, ischemic stroke and hemorrhagic stroke. This study did not collect data on processed fruit, on the premise that it has low rates of consumption in China, and did not collect data on the type of fruit consumed, or the direct amount of fruit consumed.

Click to read the study in NEJM

Relevant Reading: China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up

In-Depth [prospective cohort]: In this study, researchers evaluated 512,891 adults aged 30-79 (mean age of 50.5 years; 59% female) without prior CVD between 2004-2008 in ten geographically defined regions in China (5 urban and 5 rural) for fruit consumption, among other lifestyle metrics. Researchers collected baseline survey data on lifestyle habits and demographics, physical measurements and blood glucose. The dietary survey inquired about consumption of fruit within the past 12 months and categorized participants into the following groups: Daily, 3-6 days/week, 1-3 days/week, monthly or never. With regards to fresh fruit intake, 18% reported daily intake, 9.4% reported intake 4-6 days/week, 6.3% reported no or rare consumption. Overall, participants who consumed fresh fruit more frequently tended to be female, urban-dwelling, younger and have higher income and education level.

Across a 3.2 million person-years follow-up, there were 5173 deaths from CVD, 2551 major coronary events, 14,579 ischemic strokes and 3523 hemorrhagic strokes. The risk for all of these events were significantly and inversely related to the level of fruit consumption (p<0.001 for trend, all comparisons). Specifically, the adjusted HRs for daily fruit intake were 0.60 (95%[CI]= -0.054-0.67) for CV death, 0.66 (95%[CI]=0.58-0.75), for major coronary events, 0.75 (95% [CI]=0.72-0.79) for ischemic stroke and 0.64 (95%[CI]=0.56-0.74) for hemorrhagic stroke. This risk tended to hold constant across the 10 different regions and within various subgroups of participants by baseline characteristics. The HR for CV death for participants falling into the nondaily versus daily fruit consumption groups was 1.30 (95%[CI]=1.17-1.46). 

Image: PD

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