In modern nations the importance of consuming fruits and vegetables in order to prevent cardiovascular diseases has been studied extensively. However the same does not hold truth for the rest of the nations until the “Prospective Urban Rural Epidemiology” (PURE) study, a prospective cohort study that involved 135,335 participants aged 35 to 70 years without cardiovascular disease in 18 low, middle and high income countries. Dietary guidelines recommend a minimum of 400g/day of fruits and vegetables but it has not been truly achieved on a global basis due to the cost limitations.

Victoria Miller et al. enrolled participants between January 2003 and March 2103 that responded to standardised questionnaires about socio-economic, lifestyle, personal health and family histories. They studied outcomes like major events related to cardiovascular disease (myocardial infarction, stroke, heart failure) and mortality rates produced by those conditions. Cox models were created to study the association with fruit and vegetables consumption. Potatoes and other tubers, fruit-vegetable juices were excluded; the legumes were beans, black beans, lentils, peas, chickpeas and black-eyed peas.

The authors wrote: “during a median 7.4 years (5.5-9.3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex and centre…Higher fruit, vegetable, and legume consumption was associated with lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375-500 g/day)”

The researchers also found that participants that consumed more fruits, vegetables and legumes had higher education, higher levels of physical activity, lower rates of smoking, and higher energy, meat consumption and were more likely to live in urban areas. There was an 11% lower risk of major cardiovascular disease for the highest fruit intake category compared with the lowest category intake; there was a minimum benefit from a higher vegetable input. The authors hypothesized that given that vegetables can be consumed raw or cooked, the latter might have degraded nutrient contents.

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