Fruit consumption and physical activity in relation to all-cause and cardiovascular mortality among 70,000 Chinese adults with pre-existing vascular disease

OBJECTIVES To assess the associations of fresh fruit consumption and total physical activity with all-cause and cardiovascular mortality among Chinese adults who have been diagnosed with cardiovascular disease (CVD) or hypertension. METHODS During 2004-08, the China Kadoorie Biobank study recruited 70,047 adults, aged 30-79 years, with physician-diagnosed stroke or transient ischaemic attack, ischemic heart disease, or hypertension. Information on diet and physical activity was collected using an interviewer-administered electronic questionnaire. Cox regression was used to yield hazard ratios (HRs) for the independent and joint associations of fresh fruit consumption and total physical activity with mortality. RESULTS At baseline, 32.9% of participants consumed fresh fruit regularly (i.e. >3 days/week) and the mean total physical activity were 15.8 (SD = 11.8) MET-hr/day. During ~7-years follow-up, 6569 deaths occurred with 3563 from CVD. Compared to participants with <1 day/week fruit consumption, regular consumers had HR (95% CI) of 0.84 (0.79-0.89) for all-cause mortality and 0.79 (0.73-0.86) for CVD mortality. The HRs for the top vs bottom tertile of physical activity were 0.68 (0.64-0.72) and 0.65 (0.60-0.71), respectively, with no clear evidence of reverse causality. After correcting for regression dilution, each 100 g/day usual consumption of fresh fruit or 10 MET-hr/day usual levels of physical activity was associated with 23-29% lower mortality. The combination of regular fruit consumption with top 3rd of physical activity (>16.53 MET-hr/day) was associated with about 40% lower mortality. CONCLUSION Among Chinese adults with pre-existing vascular disease, higher physical activity and fruit consumption were both independently and jointly associated with lower mortality.