New super study looks at role of fruit, vegetables and juices in lowering cardiovascular risk in 4 million adults

The saying ‘an apple a day keeps the doctor away’ is well known but is there any truth in it? There may be according to a major ‘super study’, published in the Journal of the American Heart Association¹, which found that not only apples – but orange juice, onions, carrots, broccoli and cabbage – are associated with lower risk of heart disease and stroke.

Scientists at the University of Toronto sifted through more than 80 unique cohort studies which, overall, followed up 4,031,896 individuals for an average of 11 years. During that time, more than 125,000 cardiovascular events e.g. strokes and heart attacks were recorded.

Author, Professor John Sievenpiper, commented: “Public health policies discourage the consumption of certain fruit sources such as 100 % fruit juice, dried fruit, and tropical fruits because of their sugar content and promote vegetables before fruit. However, we found that that different sources of fruit, including 100 % fruit juice, were associated with comparable cardiovascular disease risk reduction as that of vegetables.

“Public health guidance to limit the intake of certain fruit sources because of concerns related to their contribution to sugars may have unintended harm in preventing people from meeting fruit and vegetable targets for cardiovascular disease risk reduction”.

Looking at the detail, the study found that drinking 100 % fruit juice lowered the relative risk of dying from a stroke by 33 percent while eating fruit in general lowered risk by 13 percent. Vegetables cut the risk of stroke deaths by 6 percent. For heart disease mortality, fruit, vegetables and fruit juices were similarly associated with a relative risk reduction of around 13 – 14 percent.

According to the authors, the most important individual fruits and vegetables for lowering the risk of developing cardiovascular disease were citrus fruits, 100 % fruit juices, apples, allium vegetables (garlic, onion, leeks, chives), carrots, cruciferous vegetables (broccoli, cabbage, sprouts) and green leafy vegetables (kale, spinach, watercress).

Professor Sievenpiper concluded: “Higher intakes of fruits and/or vegetables are associated with improvements in all cardiovascular disease outcomes, with fruit associated with the largest risk reductions.

“Greater benefits may be seen for some fruits and vegetables supporting recommendations for emphasizing specific fruit and vegetable sources in dietary guidelines. No fruit and vegetable sources were adversely associated with cardiovascular disease, including fruit sources of concern, such as 100 % fruit juice and dried fruit”.

¹Zurbau A et al. (2020) Relation of different fruit and vegetable sources with incident cardiovascular outcomes: A systematic review and meta-analysis of prospective cohort studies. J Am Heart Assoc 9: e017728. DOI: 10.1161/JAHA.120.017728 https://www.ahajournals.org/doi/10.1161/JAHA.120.017728