The ADA Disorders of Lipid Metabolism workgroup concurs with the following statement and grade from the USDA Nutrition Evidence Library (NEL):

Consistent evidence suggests at least a moderate inverse relationship between vegetable and fruit consumption with myocardial infarction and stroke, with significantly larger, positive effects noted above five servings of vegetables and fruits per day.

Notwithstanding prior work on dietary patterns that emphasize vegetables and fruits, insufficient evidence published since 2004 is available to assess the independent relationship between vegetable and fruit intake and blood pressure or serum cholesterol.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

• Detail
• Quality Rating Summary
  For a summary of the Quality Rating results, click here.
• Worksheets
  • Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr. 2006 Oct;136(10):2588-93.
  • Dauchet L, Amouyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: A meta-analysis of cohort studies. Neurology. 2005 Oct 25; 65(8): 1,193-1,197.
  • Galeone C, Tavani A, Pelucchi C, Negri E, La Vecchia C. Allium vegetable intake and risk of acute myocardial infarction in Italy. Eur J Nutr. 2009 Mar;48(2):120-3. Epub 2009 Jan 13.  
  • Genkinger JM, Platz EA, Hoffman SC, Comstock GW, Helzlsouer KJ. Fruit, vegetable, and antioxidant intake and all-cause, cancer, and cardiovascular disease mortality in a community-dwelling population in Washington County, Maryland. Am J Epidemiol. 2004; 160(12): 1223-1233.
  • He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: Meta-analysis of cohort studies. Lancet. 2006 Jan 28; 367 (9,507): 320-326.
  • He FJ, Nowson CA, Lucas M, MacGregor GA. Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: Meta-analysis of cohort studies. J Hum Hypertens. 2007 Sep; 21(9): 717-728.
  • Hung HC, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA, Colditz GA, Rosner B, Spiegelman D, Willett WC. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst. 2004 Nov 3; 96 (21): 1,577-1,584.
  • Joshipura KJ, Hung HC, Li TY, Hu FB, Rimm EB, Stampfer MJ, Colditz G, Willett WC. Intakes of fruits, vegetables and carbohydrate and the risk of CVD. Public Health Nutr. 2009 Jan; 12(1): 115-121.
  • Kelley DS, Rasooly R, Jacob RA, Kader AA, Mackey BE. Consumption of Bing sweet cherries lowers circulating concentrations of inflammation markers in healthy men and women. J Nutr. 2006 Apr;136(4):981-6.
  • Mirmiran P, Noori N, Zavareh MB, Azizi F. Fruit and vegetable consumption and risk factors for cardiovascular disease. Metabolism. 2009 Apr; 58 (4): 460-468.
  • Nakamura K, Nagata C, Oba S, Takatsuka N, Shimizu H. Fruit and vegetable intake and mortality from cardiovascular disease are inversely associated in Japanese women but not in men. J Nutr. 2008 Jun;138(6):1129-34.
  • Nikolic M, Nikic D, Petrovic B. Fruit and vegetable intake and the risk for developing coronary heart disease. Cent Eur J Public Health. 2008 Mar; 16(1): 17-20.
  • Nuñez-Cordoba JM, Alonso A, Beunza JJ, Palma S, Gomez-Gracia E, Martinez-Gonzalez MA. Role of vegetables and fruits in Mediterranean diets to prevent hypertension. Eur J Clin Nutr. 2009 May; 63 (5): 605-612.
  • Radhika G, Sudha V, Mohan Sathya R, Ganesan A, Mohan V. Association of fruit and vegetable intake with cardiovascular risk factors in urban south Indians. Br J Nutr. 2008 Feb;99(2):398-405. Epub 2007 Aug 3.
  • Takachi R, Inoue M, Ishihara J, Kurahashi N, Iwasaki M, Sasazuki S, Iso H, Tsubono Y, Tsugane S; JPHC Study Group. Fruit and vegetable intake and risk of total cancer and cardiovascular disease: Japan Public Health Center-Based Prospective Study. Am J Epidemiol. 2008 ;167(1):59-70.
  • Tucker KL, Hallfrisch J, Qiao N, Muller D, Andres R, Fleg JL; Baltimore Longitudinal Study of Aging. The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging. J Nutr. 2005 Mar;135(3):556-61.
  • Utsugi MT, Ohkubo T, Kikuya M, Kurimoto A, Sato RI, Suzuki K, Metoki H, Hara A, Tsubono Y, Imai Y. Fruit and vegetable consumption and the risk of hypertension determined by self measurement of blood pressure at home: the Ohasama study. Hypertens Res. 2008 Jul;31(7):1435-43.
  • Wang YF, Yancy WS Jr, Yu D, Champagne C, Appel LJ, Lin PH. The relationship between dietary protein intake and blood pressure: Results from the PREMIER study. J Hum Hypertens. 2008 Nov; 22 (11): 745-754.