Incorporating healthy dietary changes in addition to an increase in fruit and vegetable intake further improves the status of cardiovascular disease risk factors: A systematic review, meta-regression, and meta-analysis of randomized controlled trials

Context Fruit and vegetable (FV) intake has been associated with a reduced risk of cardiovascular disease (CVD). Beyond increasing FV intake, the incorporation of other healthy dietary changes may help to further attenuate CVD risk. Objective A systematic review and meta-analysis was conducted to determine the effect of increasing FV intake to > 3 servings daily as well as incorporating other healthy dietary changes on classical CVD risk factors through a systematic review, meta-regression, and meta-analysis of randomized controlled trials. Data Sources The following databases were searched: PubMed, CINAHL Plus with Full Text, Medline (ProQuest), and Cochrane Library. Data Extraction 82, 24, and 10 articles were selected for the systematic review, meta-regression, and meta-analysis, respectively. Data Analysis Meta-regression analysis showed a dose-dependent response between the number of FV servings consumed in each intervention group and the blood triglyceride change value. Pooled weighted mean differences from the meta-analysis suggested that increasing FV intake to > 3 servings daily contributes to significant decreases in triglyceride (−0.10 mmol/L; 95%CI, −0.18 to −0.01) and diastolic blood pressure (−1.99 mmHg; 95%CI, −2.28 to −1.70) as well as marginal decreases in total cholesterol and low-density lipoprotein cholesterol. While improvements were observed in the triglyceride and high-density lipoprotein cholesterol response following the incorporation of other healthy dietary changes, no additional cardiovascular benefits were observed when FV intake was increased from > 3 to > 5 servings daily. Conclusion Increasing FV intake to > 3 servings daily improves CVD risk factors, most distinctly triglyceride, especially when complemented with other healthy dietary changes.