Fruit consumption and cardiometabolic risk in the PREDIMED-plus study: A cross-sectional analysis

Nutr Metab Cardiovasc Dis. 2021 Jun 7;31(6):1702-1713. doi: 10.1016/j.numecd.2021.02.007. Epub 2021 Feb 17.


Background and aims: Total fruit consumption is important for cardiovascular disease prevention, but also the variety and form in which is consumed. The aim of the study was to assess the associations between total fruit, subgroups of fruits based on their color and fruit juices consumption with different cardiometabolic parameters.

Methods and results: A total of 6633 elderly participants (aged 55-75 years) with metabolic syndrome from the PREDIMED-Plus study were included in this analysis. Fruit and fruit juice consumption was assessed using a food frequency questionnaire. Linear regression models were fitted to evaluate the association between exposure variables (total fruit, subgroups based on the color, and fruit juices) and different cardiometabolic risk factors. Individuals in the highest category of total fruit consumption (≥3 servings/d) had lower waist circumference (WC) (β = -1.04 cm; 95%CI:-1.81, -0.26), fasting glucose levels (β = -2.41 mg/dL; 95%CI(-4.19, -0.63) and LDL-cholesterol (β = -4.11 mg/dL; 95%CI:-6.93, -1.36), but, unexpectedly, higher systolic blood pressure (BP) (β = 1.84 mmHg; 95%CI: 0.37, 3.30) and diastolic BP (β = 1.69 mmHg; 95%CI:0.83, 2.56) when compared to those in the lowest category of consumption (<1 servings/d). Participants consuming ≥1 serving/day of total fruit juice had lower WC (β = -0.92 cm; 95%CI:-1.56, -0.27) and glucose levels (β = -1.59 mg/dL; 95%CI:-2.95, -0.23) than those consuming <1 serving/month. The associations with cardiometabolic risk factors differed according to the color of fruits.

Conclusion: Fruit consumption is associated with several cardiometabolic risk factors in Mediterranean elders with metabolic syndrome. The associations regarding BP levels could be attributed, at least partially, to reverse causality bias inherent to the cross-sectional design of the study.

Keywords: Cardiovascular diseases; Fruit juices; Fruits.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Blood Pressure
  • Body Mass Index
  • Cardiometabolic Risk Factors
  • Color
  • Cross-Sectional Studies
  • Diet, Healthy*
  • Female
  • Fruit and Vegetable Juices*
  • Fruit*
  • Humans
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / diagnosis
  • Metabolic Syndrome / diet therapy*
  • Metabolic Syndrome / physiopathology
  • Middle Aged
  • Nutritive Value
  • Protective Factors
  • Risk Assessment
  • Risk Reduction Behavior*
  • Spain
  • Waist Circumference


  • Biomarkers
  • Blood Glucose