Associations of vegetable and fruit consumption with all-cause and cause-specific mortality in the Japanese population: the Japan multi-institutional collaborative cohort study

Cohort studies in Western countries have shown positive long-term benefits of vegetable and fruit consumption in relation to mortality. However, specific characteristics of Asian dietary patterns may modify these associations, and previous studies have limitations. In the Japan Multi-Institutional Collaborative Cohort Study, we followed mortality in 34,523 men and 46,888 women. We used a validated food frequency questionnaire to assess these participants’ vegetable and fruit intakes. We estimated the hazard ratio by sex for all-cause and cause-specific mortality according to quintiles (Q1–Q5) of vegetable and fruit intakes and adjusted for covariates. We identified 3340 deaths during the follow-up (mean follow-up, 10.7 years). Vegetable intake was significantly and inversely associated with all-cause mortality (multivariable-adjusted hazard ratio [95% confidence interval]: 0.91 [0.79–1.04] for Q2, 0.84 [0.73–0.96] for Q3, 0.89 [0.78–1.02] for Q4, and 0.83 [0.73–0.95] for Q5; all compared with Q1) and cardiovascular disease mortality (multivariable-adjusted hazard ratio [95% confidence interval]: 0.75 [0.53–1.07] for Q2, 0.58 [0.40–0.84] for Q3, 0.47 [0.32–0.70] for Q4, and 0.63 [0.44–0.90] for Q5). We observed no significant associations between vegetable intake and cancer mortality. We also found no significant associations of vegetable intake in women or fruit intake in both men and women with all-cause mortality, cancer, cardiovascular disease, and other-cause mortality, except for an inverse association of fruit intake with cardiovascular disease mortality in men < 60 years old, and a negative correlation of vegetable intake with other-cause mortality in women with carbohydrate or rice intake less than the median. Men with higher vegetable intake had a lower risk of all-cause and cardiovascular disease mortality in our Japanese cohort.