Impact of Fruit and Fruit Juice on Death and Disease Incidence: A Sex‐Specific Longitudinal Analysis of 18 603 Adults

Abstract

Background The health benefits of fruits are well established, but fruit juice has been more controversial. Fruit and juice are often ingested with other foods, which prompted our investigation to determine whether fruit consumed as juice may negate the beneficial effects of consuming whole fruit in people with cardiovascular disease. Methods and Results We retrospectively analyzed data from a population‐based study in Australia (the 45 and Up Study) linked with hospitalization and mortality data up to September 2018. Kaplan‐Meier survival estimates and Cox proportional hazards models were used to examine effects of fruit, fruit juice, and the combination of fruit and fruit juice in relation to death and disease incidence among men and women living with cardiovascular disease. A total of 7308 deaths occurred among 18 603 participants diagnosed with cardiovascular disease over a 13‐year follow‐up. After multivariable adjustment, inadequate fruit intake (hazard ratio [HR], 1.12 [95% CI, 1.01–1.24]) and high fruit juice intake (HR, 1.26 [95% CI, 1.12–1.41]) predicted all‐cause mortality in women. Also, high fruit juice intake plus either adequate fruit intake (HR, 1.18 [95% CI, 1.02–1.37]) or inadequate fruit intake (HR, 1.43 [95% CI, 1.21–1.69]) predicted mortality in women. No relationships were found in men after multivariable adjustments. Also, we found no prognostic value for fruit and fruit juice intake on disease incidence. Conclusions In adults with cardiovascular disease, we found that fruit juice (in combination with adequate or inadequate fruit intake) predicted mortality in women but not in men. These effects became less clear when focusing on disease incidence.