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Background
In Western populations, a higher level of fruit consumption has been associated with a lower risk of cardiovascular disease, but little is known about such associations in China, where the consumption level is low and rates of stroke are high.Methods
Between 2004 and 2008, we recruited 512,891 adults, 30 to 79 years of age, from 10 diverse localities in China. During 3.2 million person-years of follow-up, 5173 deaths from cardiovascular disease, 2551 incident major coronary events (fatal or nonfatal), 14,579 ischemic strokes, and 3523 intracerebral hemorrhages were recorded among the 451,665 participants who did not have a history of cardiovascular disease or antihypertensive treatments at baseline. Cox regression yielded adjusted hazard ratios relating fresh fruit consumption to disease rates.Results
Overall, 18.0% of participants reported consuming fresh fruit daily. As compared with participants who never or rarely consumed fresh fruit (the “nonconsumption” category), 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]) (P<0.001 for trend for both comparisons). The adjusted hazard ratios for daily consumption versus nonconsumption were 0.60 (95% confidence interval [CI], 0.54 to 0.67) for cardiovascular death, and 0.66 (95% CI, 0.58 to 0.75), 0.75 (95% CI, 0.72 to 0.79), and 0.64 (95% CI, 0.56 to 0.74), respectively, for incident major coronary events, ischemic stroke, and hemorrhagic stroke. There was a strong log-linear dose–response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics.Conclusions
Among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary and nondietary factors, with significantly lower risks of major cardiovascular diseases. (Funded by the Wellcome Trust and others.)
Supported
by grants from the Wellcome Trust, the Kadoorie Charitable Foundation,
and the Chinese National Natural Science Foundation (81390541), with
core funding provided by the British Heart Foundation, the Medical
Research Council, and Cancer Research UK to the Clinical Trial Service
Unit and Epidemiological Studies Unit, University of Oxford.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
We thank the study participants and project staff, the Chinese Center for Disease Control and Prevention (China CDC) and its regional offices for access to death and disease registries, Prof. Yuna He from the National Institute for Nutrition and Food Safety, China CDC, for sharing unpublished information about current levels of fruit intake in China, and the Chinese National Health Insurance Scheme for providing data.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
We thank the study participants and project staff, the Chinese Center for Disease Control and Prevention (China CDC) and its regional offices for access to death and disease registries, Prof. Yuna He from the National Institute for Nutrition and Food Safety, China CDC, for sharing unpublished information about current levels of fruit intake in China, and the Chinese National Health Insurance Scheme for providing data.
Source Information
From the Clinical Trial Service Unit and the Epidemiological Studies Unit (H.D., D.B., P.S., H.G., Y.C., L.Y., R.C., R.P., Z.C.) and the Cancer Epidemiology Unit (T.J.K.), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center (L.L.), the Chinese Academy of Medical Sciences (L.L., Y.G., Z.B.), and the China National Center for Food Safety Risk Assessment ( J.C.), Beijing, Hainan Center for Disease Control (CDC), Haikou (S.W.), Qingdao CDC, Qingdao (R.D.), and Heilongjiang CDC, Harbin (H.S.) — all in China.Address reprint requests to Dr. Du at the Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Old Rd. Campus, Oxford OX3 7LF, United Kingdom, or at huaidong.du@ctsu.ox.ac.uk; or to Prof. Li at the Department of Epidemiology and Biostatistics, Peking University, Beijing 100191, China, or at lmlee@vip.163.com.
A
complete list of the members of the steering committee and
collaborative group of the China Kadoorie Biobank is provided in the Supplementary Appendix, available at NEJM.org.
