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. 2022 Oct;28(10):2066-2074.
doi: 10.1038/s41591-022-01970-5. Epub 2022 Oct 10.

Health effects associated with vegetable consumption: a Burden of Proof study

Jeffrey D Stanaway  1   2 , Ashkan Afshin  3   4 , Charlie Ashbaugh  3 , Catherine Bisignano  3 , Michael Brauer  3   4   5 , Giannina Ferrara  3 , Vanessa Garcia  3 , Demewoz Haile  3 , Simon I Hay  3   4 , Jiawei He  3   4 , Vincent Iannucci  3 , Haley Lescinsky  3 , Erin C Mullany  3 , Marie C Parent  3 , Audrey L Serfes  3 , Reed J D Sorensen  3 , Aleksandr Y Aravkin  3   6 , Peng Zheng  3   4 , Christopher J L Murray  3   4
Affiliations

Health effects associated with vegetable consumption: a Burden of Proof study

Jeffrey D Stanaway et al. Nat Med. 2022 Oct.

Abstract

Previous research suggests a protective effect of vegetable consumption against chronic disease, but the quality of evidence underlying those findings remains uncertain. We applied a Bayesian meta-regression tool to estimate the mean risk function and quantify the quality of evidence for associations between vegetable consumption and ischemic heart disease (IHD), ischemic stroke, hemorrhagic stroke, type 2 diabetes and esophageal cancer. Increasing from no vegetable consumption to the theoretical minimum risk exposure level (306-372 g daily) was associated with a 23.2% decline (95% uncertainty interval, including between-study heterogeneity: 16.4-29.4) in ischemic stroke risk; a 22.9% (13.6-31.3) decline in IHD risk; a 15.9% (1.7-28.1) decline in hemorrhagic stroke risk; a 28.5% (-0.02-51.4) decline in esophageal cancer risk; and a 26.1% (-3.6-48.3) decline in type 2 diabetes risk. We found statistically significant protective effects of vegetable consumption for ischemic stroke (three stars), IHD (two stars), hemorrhagic stroke (two stars) and esophageal cancer (two stars). Including between-study heterogeneity, we did not detect a significant association with type 2 diabetes, corresponding to a one-star rating. Although current evidence supports increased efforts and policies to promote vegetable consumption, remaining uncertainties suggest the need for continued research.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Vegetable consumption and ischemic stroke.
a, log RR. b, RR function. c, A modified funnel plot showing the residuals (relative to zero) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Fig. 2
Fig. 2. Vegetable consumption and IHD.
a, log RR function. b, RR function. c, A modified funnel plot showing the residuals (relative to zero) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Fig. 3
Fig. 3. Vegetable consumption and hemorrhagic stroke.
a, log RR function. b, RR function. c, A modified funnel plot showing the residuals (relative to zero) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Fig. 4
Fig. 4. Vegetable consumption and esophageal cancer.
a, log RR function. b, RR function. c, A modified funnel plot showing the residuals (relative to zero) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Fig. 5
Fig. 5. Vegetable consumption and type 2 diabetes.
a, log RR function. b, RR function. c, A modified funnel plot showing the residuals (relative to zero) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Extended Data Fig. 1
Extended Data Fig. 1. PRISMA flow diagram of vegetable consumption and stroke subtypes (ischemic stroke and hemorrhagic stroke).
The PRISMA flow diagram covering the data seeking approach for vegetable consumption and stroke subtypes (ischemic stroke and hemorrhagic stroke). Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 2
Extended Data Fig. 2. PRISMA flow diagram of vegetable consumption and IHD.
The PRISMA flow diagram covering the data seeking approach for vegetable consumption and IHD. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 3
Extended Data Fig. 3. PRISMA flow diagram of vegetable consumption and esophageal cancer.
The PRISMA flow diagram covering the data seeking approach for vegetable consumption and esophageal cancer. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 4
Extended Data Fig. 4. PRISMA flow diagram of vegetable consumption and type 2 diabetes.
The PRISMA flow diagram covering the data seeking approach for vegetable consumption and type 2 diabetes. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
See this image and copyright information in PMC

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