Incorporating healthy dietary changes in addition to an increase in fruit and vegetable intake further improves the status of cardiovascular disease risk factors: A systematic review, meta-regression, and meta-analysis of randomized controlled trials

Abstract

Context: Fruit and vegetable (FV) intake has been associated with a reduced risk of cardiovascular disease (CVD). Beyond increasing FV intake, the incorporation of other healthy dietary changes may help to further attenuate CVD risk.

Objective: A systematic review and meta-analysis was conducted to determine the effect of increasing FV intake to > 3 servings daily as well as incorporating other healthy dietary changes on classical CVD risk factors through a systematic review, meta-regression, and meta-analysis of randomized controlled trials.

Data sources: The following databases were searched: PubMed, CINAHL Plus with Full Text, Medline (ProQuest), and Cochrane Library.

Data extraction: 82, 24, and 10 articles were selected for the systematic review, meta-regression, and meta-analysis, respectively.

Data analysis: Meta-regression analysis showed a dose-dependent response between the number of FV servings consumed in each intervention group and the blood triglyceride change value. Pooled weighted mean differences from the meta-analysis suggested that increasing FV intake to > 3 servings daily contributes to significant decreases in triglyceride (-0.10 mmol/L; 95%CI, -0.18 to -0.01) and diastolic blood pressure (-1.99 mmHg; 95%CI, -2.28 to -1.70) as well as marginal decreases in total cholesterol and low-density lipoprotein cholesterol. While improvements were observed in the triglyceride and high-density lipoprotein cholesterol response following the incorporation of other healthy dietary changes, no additional cardiovascular benefits were observed when FV intake was increased from > 3 to > 5 servings daily.

Conclusion: Increasing FV intake to > 3 servings daily improves CVD risk factors, most distinctly triglyceride, especially when complemented with other healthy dietary changes.

Keywords: blood pressure; cholesterol; fruit; healthy diet; inflammation; lipoproteins; oxidative stress; triglycerides; vegetable.