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Recommendations Summary

HTN: Fruits and Vegetables 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  Fruits and Vegetables

  Advise the consumption of at least five to ten servings of fruits and vegetables per day, based on research reporting significant reductions in blood pressure after consumption of either the DASH dietary pattern or a diet rich in fruits and vegetables.

  Rating: Strong
  Imperative

  • Risks/Harms of Implementing This Recommendation

    None.

  • Conditions of Application

    No conditions specified.

  • Potential Costs Associated with Application

    None.

  • Recommendation Narrative

    • Five of six randomized controlled trials (Conlin et al, 2000; Moore et al, 2001; John et al, 2002; Nowson et al, 2004; Nowson et al, 2005) ranging from four weeks to six months report significant reductions in blood pressure after consumption of either the DASH dietary pattern (approximately ten servings of fruits and vegetables daily) or a diet rich in fruits and vegetables (five to ten servings daily).
    • One cohort study and two cross-sectional studies report an association between increased fruit and vegetable consumption and lowered blood pressure (Beitz et al, 2003; Alonso et al, 2004; Miura et al, 2004).

  • Recommendation Strength Rationale

    • Conclusion Statement is Grade I

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  What is the relationship between fruit and vegetable intake and blood pressure in healthy and hypertensive adults?

  • References

    Alonso A, de la Fuente C, Martín-Arnau AM, de Irala J, Martínez JA, Martínez-González MA. Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study.  Brit J Nutr. 2004;92:311-319.  
    
    Beitz R, Mensink GBM, Fischer B. Blood pressure and vitamin C and fruit and vegetable intake. Annals of Nutr & Metabolism. 2003; 47: 214-220.
    
    Broekmans WMR, Klopping-Ketelaars WAA, Kluft C, van den Berg H, Kok FJ, van Poppel G.  Fruit and vegetables and cardiovascular risk profile:  a diet controlled intervention study.  Eur J Clin Nutr 2001;55(8):636-642.
    
    Conlin PR, Chow D, Miller III ER, Svetkey LP, Lin PH, Harsha DW, Moore TJ, Sacks FM, Appel LJ, for the DASH Research Group.  The effect of dietary patterns on blood pressure control in hypertensive patients:  results from the Dietary Approaches to Stop Hypertension (DASH) trial.  Am J Hypertens 2000;13:949-955.
    
    John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW for the Oxford Fruit and Vegetable Study Group.  Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure:  a randomized controlled trial.  Lancet 2002;359(9322):1969-1974. 
    
    Miura K, Greenland P, Stamler J, Liu K, Daviglus ML, Nakagawa H.  Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004;159: 572-580.
    
    Moore TJ, Conlin PR, Ard J, Svetkey LP, for the DASH Collaborative Research Group.  DASH (Dietary Approaches to Stop Hypertension) diet is effective treatment for stage I isolated systolic hypertension.  Hypertension 2001;38:155-158.
    
    Nowson CA, Worsley A, Margerison C, Jorna MK, Frame AG, Torres SJ, Godfrey SJ. Blood pressure response to dietary modifications in free-living individuals.  J Nutr 2004;134:2322-2329.
    
    Nowson CA, Worsley A, Margerison C, Jorna MK, Godfrey SJ, Booth A. Blood pressure change with weight loss is affected by diet type in men. Am J Clin Nutr 2005;81:983-989.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N for the DASH Collaborative Research Group.  A clinical trial of the effects of dietary patterns on blood pressure.  N Engl J Med 1997;336(16):1117-24.