An Apple a Day: Does it Keep the Doctor Away?

Research Paper Title

Association Between Apple Consumption and Physician Visits: Appealing the Conventional Wisdom That an Apple a Day Keeps the Doctor Away.

Importance

Fruit consumption is believed to have beneficial health effects, and some claim, “An apple a day keeps the doctor away.”

Objective

To examine the relationship between eating an apple a day and keeping the doctor away.

Design, Setting, and Participants

A cross-sectional study of a nationally representative sample of the non-institutionalised US adult population. A total of 8728 adults 18 years and older from the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey completed a 24-hour dietary recall questionnaire and reported that the quantity of food they ate was reflective of their usual daily diet.

Exposures

Daily apple eaters (consuming the equivalent of at least 1 small apple daily, or 149 g of raw apple) vs non–apple eaters, based on the reported quantity of whole apple consumed during the 24-hour dietary recall period.

Main Outcomes and Measures

The primary outcome measure was success at “keeping the doctor away,” measured as no more than 1 visit (self-reported) to a physician during the past year; secondary outcomes included successful avoidance of other health care services (i.e. no overnight hospital stays, visits to a mental health professional, or prescription medications).

Results

Of 8399 eligible study participants who completed the dietary recall questionnaire, we identified 753 adult apple eaters (9.0%) – those who typically consume at least 1 small apple per day. Compared with the 7646 non-apple eaters (91.0%), apple eaters had higher educational attainment, were more likely to be from a racial or ethnic minority, and were less likely to smoke (P < .001 for each comparison). Apple eaters were more likely, in the crude analysis, to keep the doctor (and prescription medications) away: 39.0% of apple eaters avoided physician visits vs 33.9% of non-apple eaters (P = .03). After adjusting for sociodemographic and health-related characteristics, however, the association was no longer statistically significant (OR, 1.19; 95% CI, 0.93-1.53; P = .15). In the adjusted analysis, apple eaters also remained marginally more successful at avoiding prescription medications (odds ratio, 1.27; 95% CI, 1.00-1.63). There were no differences seen in overnight hospital stay or mental health visits.

Conclusions and Relevance

Evidence does not support that an apple a day keeps the doctor away; however, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications.

Reference

Davis, M.A., Bynum, J.P.W. & Sirovich, B.E. (2015) Association Between Apple Consumption and Physician Visits: Appealing the Conventional Wisdom That an Apple a Day Keeps the Doctor Away. JAMA Internal Medicine. Published online March 30, 2015. doi:10.1001/jamainternmed.2014.5466.

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