5 a Day for a Longer Life

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Want to reduce your chance of dying early? Put your plants on.

A new study published in Circulation finds more reasons for the “5 a day” fruit and vegetable recommendation. Eating 2 servings of fruit and 3 servings of vegetables each day may help reduce the risk of death from CVD, cancer, and respiratory disease.

According to Dong D. Wang, MD, ScD, an epidemiologist, nutritionist, and faculty member at both Harvard Medical School and Brigham and Women’s Hospital, consumers may get mixed messages about how much produce they need to eat to reduce their risk of disease. They may also get mixed messages about what foods to eat or avoid. For example, the American Heart Association advises 4 to 5 servings of fruits and vegetables per day, while MyPlate's recommendations vary based on a variety of factors, including age, gender, and physical activity levels.

Scientists evaluated over 66,500 women from the Nurse’s Health Study from 1984 to 2014 and over 42,000 men from the Health Professionals Follow Up study using the same time frame. None of the participants had CVD, cancer, or diabetes at baseline. Diet was assessed using a semiquantitative food frequency questionnaire updated from baseline every 2 to 4 years. A dose response meta-analysis that used data from the current study and 24 additional prospective studies was also included. 

Why Fruits and Vegetables?

A nonlinear, inverse relationship between fruit and vegetable intake and overall mortality was observed. The researchers note that consuming more than 5 fruits and vegetables per day did not appear to add additional benefit in reducing mortality. Total mortality did not decline further with fruit servings above 2 per day versus 0.5 servings per day and 3 servings per day for vegetables versus 1.5 servings. 

When compared to only 2 servings of fruit or vegetables per day, consuming 2 fruit servings and 3 vegetable servings was shown to reduce mortality related to CVD, cancer, and respiratory disease. The authors of the study note that eating this amount of produce is likely achievable for most people. Chang does note that not all fruits and vegetables are created equal. For example, broccoli and kale would carry more nutritional value than potatoes. Whole fruit offers more benefits than fruit juice. Etc, etc, etc.

The link between fruit and vegetable consumption and overall mortality was observable across age, smoking, BMI, and elevated lipids. Scientists also noted similar results in a dose-response meta-analysis with nearly 1,900,000 subjects. 

Advice from the American Heart Association is similar. The AHA suggests making at least half of your plate fruits and vegetables at each meal. Anne Thorndike, MD, MPH, chair of the AHA’s nutrition committee and associate professor of medicine at Harvard Medical School agrees. “This research provides strong evidence for the lifelong benefits of eating fruits and vegetables and suggests a goal amount to consume daily for ideal health. Fruits and vegetables are naturally packaged sources of nutrients that can be included in most meals and snacks, and they are essential for keeping our hearts and bodies healthy.”

Retraining Our Taste Buds

Naveed Sattar Md, PhD, a cardiovascular and medical sciences professor at the University of Glasgow and Nita Forouhi, PhD, a program leader and MRC investigator in nutritional epidemiology at the University of Cambridge wrote an editorial in Circulation suggesting that health professionals can teach people about simple changes in their diets. The most impact comes from nudging those who eat few fruits or vegetables to diets with even moderate fruit and vegetable intake. Just as we use repeated exposure with children to train their palates, the same can be done in adults to boost fruit and vegetable intake.

The editorial authors believe that in the post-COVID world, increasing fruit and vegetable intake is important to focus on, especially since healthy eating patterns and other health behaviors took a back seat during the lockdown. Below are some tips to encourage more fruits and vegetables in your clients’ diets:

  • Add chopped peppers, onions, spinach, or zucchini to scrambled eggs or omelets. 
  • Use fresh, frozen, or dried fruit in oatmeal at breakfast.
  • Add spinach or kale to fruit smoothies.
  • Try shaved Brussels sprouts and kale in salads.
  • Include fresh or frozen fruit as a snack with string cheese or Greek yogurt
  • Roast broccoli or cauliflower as a side dish.
  • Use wilting produce in soups or sauces to reduce food waste.
  • Keep veggie sticks on hand to enjoy with hummus or peanut butter.
  • Enjoy seasonal fruit with your favorite cheese for dessert.
  • Toss asparagus, peppers, onions, or squash on the grill when the weather gets warm!

By Lisa Andrews, MEd, RD, LD


  1. Dong D. Wang Yanping Li Shilpa N. Bhupathiraju Bernard A. Rosner Qi Sun, Edward L. Giovannucci, Eric B. Rimm. JoAnn E. Manson, Walter C. Willett, Meir J. Stampfer and Frank B. Hu. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies 1 Mar 2021 https://doi.org/10.1161/CIRCULATIONAHA.120.048996 Circulation.
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