Pure fruit juice and fruit consumption and the risk of CVD: the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study

Dietary guidelines for pure fruit juice consumption differ between countries, regarding the question whether pure fruit juice is an acceptable alternative for fruit. Currently, little is known about pure fruit juice consumption and the risk of CVD. In this prospective cohort study, we studied the association of pure fruit juice and fruit consumption with the incidence of fatal and non-fatal CVD, CHD and stroke and investigated the differences in association with pure fruit juice consumption between low and high fruit consumers. A validated FFQ was used to estimate dietary intake of 34 560 participants (26 center dot 0 % men and 74 center dot 0 % women) aged 20-69 years from the European Prospective Investigation into Cancer and Nutrition-Netherlands study. Adjusted hazard ratios (HR) were estimated using Cox regression after average follow-up of 14 center dot 6 years. Compared with no consumption, pure fruit juice consumption up to 7 glasses/week - but not consumption of >= 8 glasses - was significantly associated with reduced risk of CVD and CHD, with HR from 0 center dot 83 (95 % CI 0 center dot 73, 0 center dot 95) to 0 center dot 88 (95 % CI 0 center dot 80, 0 center dot 97). Consumption of 1-4 and 4-8 glasses/week was significantly associated with lower risk of stroke with HR of 0 center dot 80 (95 % CI 0 center dot 64, 0 center dot 99) and 0 center dot 76 (95 % CI 0 center dot 61, 0 center dot 94), respectively. Associations did not differ considerably between low and high fruit consumers. The highest three quintiles of fruit consumption (>= 121 g/d) were significantly associated with lower incidence of CVD, with HR of 0 center dot 87 (95 % CI 0 center dot 78, 0 center dot 97) and 0 center dot 88 (95 % CI 0 center dot 80, 0 center dot 98). In conclusion, although we observed favourable associations of moderate pure fruit juice consumption with CVD, for now consumption of whole fruit should be preferred because the evidence of the health benefits of fruit is more conclusive.