Quantity and Variety in Fruit and Vegetable Intake and Cardiovascular Disease (CVD) Risk: The Women's Health Initiative (WHI)

Epidemiological data have shown a protective effect of fruit and vegetable (FV) intake on CVD. Consequently, dietary guidelines recommend increasing FV intake and, most recently, have also suggested increasing variety. We examined the independent roles of quantity and variety in FV in relation to incident CVD among 88,249 women in the WHI. Diet was assessed at baseline using a validated FFQ. Variety was defined as the number of FV consumed in the past 3 months. Potatoes, starchy vegetables, and fruit juice were not included. During 18 years of follow‐up, we documented 5672 incident CVD cases. In multivariable analyses, after adjusting for dietary and non dietary covariates, those with the highest FV intake (median=3.9 servings/d) had a 12% lower CVD risk (95% CI 4%‐20%) compared to those with the least intake (median =1 serving/d). Higher fruit intake was associated with 34% (95% CI 19%‐48%) lower coronary heart disease risk while higher vegetable intake was associated with a 15% (95% CI 3%‐25%) lower stroke risk. Conversely, quantity‐adjusted variety was not associated with CVD (HR=0.97, 95% CI 0.86‐1.10). Our data suggest that quantity, rather than variety, in FV intake is associated with lower CVD risk. Policy efforts should continue to focus on increasing overall FV intake in the population. Supported by NIH, NHLBI, HHS grants/contracts HL60712, K01HL10880705, HHSN268201100‐046C/‐001C/‐002C/‐003C/‐004C and AHA grant 13POST14370012.