Meta-analysis of Fruit and Vegetable Sources and Cardiovascular Outcomes

Fruit and vegetables are a cornerstone of healthy dietary patterns and dietary guidelines worldwide. The supporting evidence, however, is largely derived from observational studies of protective associations with cardiovascular disease (CVD) in health-conscious populations or from randomized trials of the effect of specific fruit or vegetable derived nutrients on CVD risk factors. A growing body of literature has influenced a shift away from a focus on single nutrients to a focus on whole foods and dietary patterns. To what extent fruit and vegetables should contribute to dietary patterns for cardiovascular health and whether specific types of fruit or vegetables should be recommended is unclear. Although previous systematic reviews and meta-analyses have elucidated the association between the intake of total and some specific fruit and vegetables with cardiovascular outcomes, a comprehensive synthesis comparing the certainty of the evidence for the different types of fruit and vegetables in relation to a range of cardiovascular outcomes has yet to be completed. We propose to conduct a systematic review and meta-analysis of the available prospective cohort studies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the association between different types of fruit and vegetables and different cardiovascular outcomes that include CVD, coronary heart disease \[CHD\], and stroke incidence and mortality.