Quantity and variety in fruit and vegetable intake and risk of coronary heart disease

Am J Clin Nutr. 2013 Dec;98(6):1514-23. doi: 10.3945/ajcn.113.066381. Epub 2013 Oct 2.


Background: Dietary guidelines recommend increasing fruit and vegetable intake and, most recently, have also suggested increasing variety.

Objective: We prospectively examined the independent roles of quantity and variety in fruit and vegetable intake in relation to incident coronary heart disease (CHD).

Design: We prospectively followed 71,141 women from the Nurses' Health Study (1984-2008) and 42,135 men from the Health Professionals Follow-Up Study (1986-2008) who were free of diabetes, cardiovascular diseases, and cancer at baseline. Diet was assessed by using a validated questionnaire and updated every 4 y. Variety was defined as the number of unique fruit and vegetables consumed at least once per week. Potatoes, legumes, and fruit juices were not included in our definition of fruit and vegetables.

Results: During follow-up, we documented 2582 CHD cases in women and 3607 cases in men. In multivariable analyses, after adjustment for dietary and nondietary covariates, those in the highest quintile of fruit and vegetable intake had a 17% lower risk (95% CI: 9%, 24%) of CHD. A higher consumption of citrus fruit, green leafy vegetables, and β-carotene- and vitamin C-rich fruit and vegetables was associated with a lower CHD risk. Conversely, quantity-adjusted variety was not associated with CHD.

Conclusions: Our data suggest that absolute quantity, rather than variety, in fruit and vegetable intake is associated with a significantly lower risk of CHD. Nevertheless, consumption of specific fruit and vegetable subgroups was associated with a lower CHD risk.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ascorbic Acid / administration & dosage
  • Ascorbic Acid / therapeutic use
  • Citrus / chemistry
  • Cohort Studies
  • Coronary Disease / epidemiology
  • Coronary Disease / etiology
  • Coronary Disease / prevention & control*
  • Diet* / adverse effects
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Fruit* / chemistry
  • Health Personnel
  • Humans
  • Male
  • Middle Aged
  • Nurses
  • Plant Leaves / chemistry
  • Prospective Studies
  • Risk Factors
  • United States / epidemiology
  • Vegetables* / chemistry
  • beta Carotene / administration & dosage
  • beta Carotene / therapeutic use


  • beta Carotene
  • Ascorbic Acid