Fruit and vegetable intake and the risk of cataract in women1–3
William G Christen, Simin Liu, Debra A Schaumberg, and Julie E Buring

KEY WORDS
Cataract, cataract extraction, fruit and vegetables, prospective cohort, Women’s Health Study

study used prospective data to examine cataract in relation tototal fruit and vegetable intake (11).
We analyzed data from a large, prospective cohort of US
female health professionals to assess the association of total fruitand vegetable intake with the risk of subsequent cataract. Because cigarette smoking is an established risk factor for cataract
and an important source of oxidative stress (14 –17), we also
examined a priori whether the observed associations were modified by smoking status at baseline.
SUBJECTS AND METHODS

Subjects
The Women’s Health Study (WHS) is an ongoing randomized, double-blind, placebo-controlled trial of low-dose aspirin
and vitamin E in the primary prevention of cardiovascular disease and cancer among 39 876 apparently healthy female healthprofessionals aged 욷45 y (18). Detailed information on fruit andvegetable intake was provided by 39 127 (98%) of the randomly
assigned participants, who completed a 131-item validated semiquantitative food-frequency questionnaire (SFFQ) at baseline in
1993 (19). For this analysis we excluded participants who reported total energy intake쏝600 kcal/d or 쏜3500 kcal/d, or who
had 쏜70 blanks on the SFFQ. Of the remainder, 35 724 participants had no diagnosis of cataract at baseline and were included.
This study was conducted according to the ethical guidelines ofBrigham and Women’s Hospital.

INTRODUCTION

Assessment of fruit and vegetable intake

Basic science and animal research studies support a role foroxidative mechanisms in the etiology of cataract (1, 2). Thus,
observational epidemiologic studies of dietary factors in cataract
have focused on the amount of antioxidant nutrients contained in
the diet. The most common approaches have been to examine theintake of specific nutrients or the serum concentrations of nutrients or biomarkers of fruit and vegetable intake. The results ofthese studies have been mixed. Whereas most studies report an
inverse association between cataract and one or more antioxidant
nutrients, the data for individual nutrients across studies havebeen inconsistent (2– 4).
An alternative approach is to examine the development ofcataract in relation to specific foods or food groups, such as total
fruit and vegetable intake. This approach enables an assessmentof the combined effects of antioxidant nutrients together with theeffects of other components of the diet, such as other micronutrients, phytochemicals, and fiber. Several studies have examined the association of cataract with foods (5–13), but only one

All participants were requested to complete an SFFQ that
included 29 vegetable items and 15 fruit items. For each fruit orvegetable, a standard unit or portion size was specified and participants were asked how often, on average, during the previous
year they had consumed that amount. Nine responses were possible, which ranged from “never” to “욷6 times/d.” Responses to
1

From the Division of Preventive Medicine, Department of Medicine,
Brigham and Women’s Hospital (WGC, SL, DAS, and JEB) and the Department of Ambulatory Care and Prevention (JEB), Harvard Medical School,
Boston, MA, and the Department of Nutrition, the Harvard School of Public
Health, Boston, MA (SL)2Supported by research grants CA 47988, HL 43851, and EY 06633 fromthe National Institutes of Health.
3
Reprints not available. Address correspondence to WG Christen, 900
Commonwealth Avenue East, Boston, MA 02215-1204. E-mail: wchristen@rics.bwh.harvard.edu.
Received October 6, 2004.
Accepted for publication February 11, 2005.

Am J Clin Nutr 2005;81:1417–22. Printed in USA. © 2005 American Society for Clinical Nutrition

1417

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ABSTRACT
Background: Prospective data on cataract in relation to total fruitand vegetable intake are limited.
Objective: We aimed to examine whether higher fruit and vegetableintake reduces the risk of cataract and cataract extraction in a large,
prospective cohort of women.
Design: Fruit and vegetable intake was assessed at baseline in 1993
among 39 876 female health professionals with the use of a validated, semiquantitative food-frequency questionnaire. A total of
35 724 of these women were free of a diagnosis of cataract at baseline and were followed for incident cataract and cataract extraction.
Cataract was defined as an incident, age-related lens opacity responsible for a reduction in best-corrected visual acuity to 20/30 or worse,
based on self-report confirmed by medical record review. Individuals, rather than eyes, were the unit of analysis.
Results: During an average of 10 y of follow-up, 2067 cataracts and1315 cataract extractions were confirmed. Compared with women in
the lowest quintile of fruit and vegetable intake, women with higher
intakes had modest 10 –15% reduced risks of cataract (P for trend 쏝0.05). For cataract extraction, no significant inverse trend was observed (P for trend ҃ 0.12).
Conclusion: These prospective data suggest that high intake of fruitand vegetables may have a modest protective effect on cataract.
Am
J Clin Nutr 2005;81:1417–22.

1418

CHRISTEN ET AL

the individual food items were converted to average daily intakesof each fruit and vegetable item for each subject, and the average
daily intakes of individual fruit and vegetables were summed tocompute total fruit and vegetable intake (19). In similar populations, the SFFQ was shown to have high validity as a measure oflong-term average dietary intakes (20).
Other covariates

Ascertainment and definition of endpoints
Information on the occurrence of any relevant events, including cataract, was collected on annual questionnaires. After thereport of a cataract diagnosis or extraction, the subjects wererequested to provide written consent and to identify the treating
ophthalmologist or optometrist. The ophthalmologists and optometrists were contacted by mail and requested to complete acataract questionnaire to supply information about the presenceof lens opacities, date of diagnosis, visual acuity loss, cataract
extraction, other ocular abnormalities that could explain visualacuity loss, cataract type, and etiology (including age-related,traumatic, congenital, inflammatory, or surgery- or steroidinduced). As an alternative to completing the questionnaire, theophthalmologists and optometrists were given the option ofproviding the relevant medical records. Medical record information was obtained for 쏜91% of the participants who reported a cataract.
Endpoints were incident cataract and extraction of incident
cataract. An incident cataract was defined as a self-report of acataract that was confirmed by medical record review to havebeen first diagnosed after randomization, to be age-related inorigin, and to be responsible for a decrease in best-correctedvisual acuity to 20/30 or worse. In the presence of alternate ocularpathology, a lens opacity was considered a cataract if, in the
judgment of the ophthalmologist or optometrist, the opacity wasof sufficient severity to reduce visual acuity to 20/30 or worse
when considered alone. Extraction was defined as the surgicalremoval of an incident cataract. Women who developed a nonage-related cataract or a cataract that did not reduce visual acuity
to 20/30 or worse were included in the analyses as noncases.
Data analysis
Individuals, rather than eyes, were the unit of analysis becauseeyes were not examined independently, and participants wereclassified according to the status of the worse eye based on
disease severity. Participants contributed person-years offollow-up until the time of diagnosis of cataract or censoring

RESULTSThe reported mean (앐SD) daily intake of fruit and vegetables
at baseline was 6.0 앐 3.3 total servings, including 2.1 앐 1.4
servings of fruit and 3.9 앐 2.4 servings of vegetables. The median intake of fruit and vegetables ranged from 2.6 servings/d inthe lowest quintile to 10 servings/d in the highest quintile. The
distribution at baseline of possible risk factors for cataract according to quintiles of fruit and vegetable intake is shown in
Table 1. Women with a high fruit and vegetable intake wereolder and were less likely to be current smokers. They also
exercised more, had higher caloric intakes, and were more likely
be postmenopausal, to use postmenopausal hormones, to use
multivitamin supplements and supplements of vitamin C, and toreport having had an eye exam in the past 2 y.
During an average of 10 y of follow-up, 2067 cases of incident
cataract and 1315 cases of cataract extraction were confirmed.
Compared with women in the lowest quintile of fruit and vegetable intake, women in quintiles 2–5 had only mildly reduced(앒10%) risks of cataract in an age- and treatment-adjusted analysis, and the test of linear trend across quintiles was not statistically significant (P for trend ҃ 0.10) (Table 2). After adjustment
for other potential confounders, RR estimates were loweredslightly, and the test of trend was significant (P for trend 쏝 0.05).
Analyses that separately examined the intake of all fruit or all
vegetables similarly indicated a reduced risk of cataract of 앒10%for women in the highest, compared with women in the lowest,
quintile of intake; however, there was no significant trend acrossquintiles (Table 2). The data for cataract extraction also indicatedthat women with higher intake of fruit and vegetables had RRsslightly 쏝1.0, but there was no statistically significant trend of
decreasing risk across increasing quintiles of intake (Table 3).
The relation of fruit and vegetable intake to the risks of cataract
and cataract extraction was not significantly modified by smoking

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Information on possible risk factors for cataract was collectedon the WHS baseline questionnaire. Information included age (iny), height and weight (expressed as body mass index; in kg/m2),
smoking status (never, past, or current), alcohol use (rarely ornever, 1–3 drinks/mo, 1– 6 drinks/wk, or 욷1 drink/d), frequencyof exercise (rarely or never, 쏝1 times/wk, 1–3 times/wk, or 욷4times/wk), parental history of myocardial infarction at age 쏝60
y (no or yes), history of hypertension (no or yes), history of
diabetes (no or yes), history of hypercholesterolemia (no or yes),menopause status (no or yes), postmenopausal hormone use(never, past, current), multivitamin use (no or yes), use of vitamin
C supplements (no or yes), and history of an eye exam in the past
2 y (no or yes).

(death or February 2004, whichever came first). Fruit and vegetable intake was considered as a categorical variable (in quintiles), and we computed incidence rates of cataract by dividing
the number of incident cases by person-years of follow-up ineach quintile of fruit and vegetable intake. Estimates of relativerisk (RR) were computed as the rate of cataract in a specificquintile of intake divided by the corresponding rate in the lowest
quintile (reference). Crude RR estimates were obtained by adjusting for age (in y) and randomized treatment assignment in
Cox proportional hazards regression models (21). Multivariate
RRs were obtained by further adjusting for smoking, alcohol use,
history of diabetes, history of hypertension, history of hypercholesterolemia, body mass index, physical activity, parental historyof myocardial infarction, menopause status, postmenopausal
hormone use, use of multivitamins or vitamin C supplements,
total energy intake, and history of an eye exam in the past 2 y. For
each RR, two-sided P values and 95% CIs were calculated (22).
Tests of linear trend across increasing quintiles of fruit and vegetable intake were conducted by assigning the medians of intakes
in quintiles (servings/d) treated as a continuous variable.
We also analyzed subgroup data according to baseline smoking status (current or noncurrent). Tests of interaction were performed to evaluate the statistical significance of any modifying
effect of baseline smoking status on the association of fruit andvegetable intake with cataract. Data were analyzed with SAS(version 8; SAS Institute Inc, Cary, NC).

1419

FRUIT AND VEGETABLES AND CATARACTTABLE 1Baseline characteristics according to quintiles of fruit and vegetable intake in the Women’s Health Study1
Quintile of fruit intake

Median intake (servings/d)

Quintile of vegetable intake

1

2

3

4

5

P for

1

2

3

4

5

P for

(n ҃ 7165)(n ҃ 7131)(n ҃ 7156)(n ҃ 7128)(n ҃ 7144)

trend2(n ҃ 7150)(n ҃ 7145)(n ҃ 7142)(n ҃ 7150)(n ҃ 7137)

trend2

0.6

1.3

1.9

2.6

3.8

1.5

2.5

3.4

4.5

6.8

쏝0.001Age (%)

쏝0.001

45–54 y

72.6

67.5

62.4

59.0

55.4

68.3

66.0

62.3

61.3

59.0

55–64 y

23.4

27.0

30.5

31.9

33.4

25.7

28.1

30.2

30.4

31.8

65–74 y

3.9

5.4

6.9

8.6

10.6

5.8

5.7

7.2

8.0

8.7

욷75 y

0.1

0.2

0.2

0.5

0.6

0.2

0.3

0.3

0.3

54.0 앐 6.3

54.6 앐 6.6

53.5 앐 6.2

54.1 앐 6.5

54.3 앐 6.6

Average age (y)52.5 앐 5.73 53.3 앐 6.1

55.3 앐 7.0 쏝0.001 53.2 앐 6.2

0.5
54.6 앐 6.7 쏝0.001

쏝0.001

Cigarette smoking (%)

쏝0.001

41.9

48.1

51.9

54.8

58.6

50.1

51.5

51.3

50.9

51.5

Past

33.6

36.8

37.2

36.9

34.4

32.4

34.3

36.2

37.2

38.7

Current

24.5

15.1

10.9

8.3

7.0

17.5

14.2

12.4

11.9

9.8

Alcohol use (%)

쏝0.0010.005

욷1 drink/d

11.4

11.1

10.3

9.5

8.9

7.9

9.1

10.8

11.5

11.8

1–6 drinks/wk

28.5

30.8

33.0

34.1

34.0

26.4

31.6

33.6

34.9

33.9

1–3 drinks/mo

12.7

13.2

14.1

13.4

13.1

13.7

14.2

13.5

12.4

12.8

Rarely or never

47.5

44.9

42.5

43.0

44.1

51.9

45.0

42.2

41.3

41.6

쏝0.001

Physical exercise (%)
욷4 times/wk

6.2

8.7

쏝0.001

10.6

12.1

15.8

7.4

8.9

10.2

11.4

15.5
36.6

1–3 times/wk

23.6

28.9

32.8

35.4

36.9

25.5

28.4

32.3

34.8

쏝1 time/wk

20.4

21.1

20.6

20.1

18.5

19.2

20.4

20.4

21.2

19.6

Rarely or never

49.8

41.4

36.0

32.4

28.8

48.0

42.3

37.2

32.7

28.3

51.8

49.6

47.9

47.1

46.7

51.3

49.5

47.9

47.6

46.6

쏝0.001

Postmenopausal hormone use (%)
Never쏝0.001

Past only

9.8

9.3

9.0

9.2

10.3

9.2

9.2

9.4

10.0

9.8

Current

38.4

41.1

43.2

43.7

43.1

39.5

41.3

42.7

42.4

43.6

Never

14.1

12.8

12.4

11.8

12.8

14.5

12.1

12.3

12.2

12.8

Past only

61.9

59.6

58.3

55.7

54.6

57.4

59.0

58.2

58.5

57.1

Current

24.0

27.6

29.2

32.5

32.6

28.0

28.9

29.5

29.3

30.2

6.8

8.9

9.1

10.3

12.1

8.4

8.9

9.4

9.8

10.6

쏝0.001

Multivitamin use (%)

Current use of vitamin C

쏝0.001

쏝0.001

쏝0.001

supplements (%)
Mean energy intake (kcal)

1432 앐 484 1579 앐 472 1707 앐 468 1832 앐 482 2094 앐 518 쏝0.001 1379 앐 440 1589 앐 452 1707 앐 461 1859 앐 479 2110 앐 536 쏝0.001

BMI (kg/m2)

26.4 앐 5.4

26.2 앐 5.0

26.1 앐 4.9

25.7 앐 4.8

24.8

23.6

24.7

23.8

History of hypertension (%)4

25.6 앐 4.8 쏝0.001 26.1 앐 5.2
26.3

0.057

24.3

26.1 앐 5.1

25.8 앐 4.9

25.9 앐 4.9

26.1 앐 5.1

0.11

23.9

24.0

24.4

26.6

0.002
0.02

History of diabetes (%)

2.4

2.3

2.1

2.1

2.5

0.94

2.1

2.3

2.0

2.1

2.9

History of high cholesterol (%)5

28.1

28.3

28.4

28.9

29.7

0.023

28.5

28.3

29.0

28.4

29.2

0.41

Postmenopausal (%)

45.8

48.6

53.2

55.5

58.0

쏝0.001

48.9

49.9

52.5

54.0

55.8

쏝0.001

Family history of myocardial

14.0

13.7

12.7

12.6

12.4

0.001

13.4

13.2

12.9

12.8

13.1

0.51

79.0

81.4

82.4

83.7

83.6

쏝0.001

79.6

81.3

82.0

83.5

83.7

쏝0.001

infarction (%)
Eye exam in past 2 y (%)
1

Fruit was defined as a composite score of all the fruit items on the questionnaire, including apple, pear, orange, grapefruit, peach, banana, strawberry, blueberry, cantaloupe, raisin, prune,

and fruit juices. Vegetable was defined as a composite score of all the vegetable items on the questionnaire, including cruciferous vegetables, dark-yellow vegetables, tomatoes, green leafy
vegetables, legumes, corn, mixed vegetables, celery, eggplant, mushroom, and beet.
2

Based on a test of linear trend. For categorical variables, linear trend was assessed with the Jonckheere-Terpstra test.

3x៮ 앐 SD (all such values).

4

Hypertension was defined as a reported systolic blood pressure of 욷140 mm Hg, a diastolic blood pressure of 욷90 mm Hg, or a history of treatment for high blood pressure.

5

High cholesterol was defined as a reported high cholesterol, a reported blood cholesterol concentration of 욷240 mg/dL, or a history of treatment with cholesterol-lowering medication.

status at baseline (P for interaction 쏜 0.20). In a comparison of
extreme quintiles, the RR of cataract was 0.71 (95% CI: 0.44, 1.16;
P for trend ҃ 0.07) and the RR of cataract extraction was 0.68 (95%
CI: 0.37, 1.24; P for trend ҃ 0.09) in current smokers. In noncurrent
smokers, the RR of cataract was 0.84 (95% CI: 0.69, 1.02; P for
trend ҃ 0.18) and the RR of cataract extraction was 0.89 (95% CI:
0.70, 1.14; P for trend ҃ 0.39).

DISCUSSION

These prospective data, from female health professionals followed for an average of 10 y, indicated that 쏜3.4 servings/d of fruitand vegetables is associated with modest 10 –15% reduced risks ofcataract and cataract extraction. The apparent modest relation did
not change significantly after adjustment for smoking and other

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Never

1420

CHRISTEN ET AL

TABLE 2
Relative risk (and 95% CI) of cataract according to quintiles of fruit and vegetable intake in the Women’s Health Study
Quintile of intake
2

3

4

5

P for
trend

2.6
360
7145
1.00
1.00

4.1
374
7145
0.94 (0.81, 1.08)
0.93 (0.80, 1.09)

5.4
414
7145
0.90 (0.79, 1.04)
0.89 (0.76, 1.04)

7.0
447
7145
0.91 (0.79, 1.04)
0.87 (0.74, 1.03)

10.0
472
7144
0.88 (0.77, 1.01)
0.83 (0.70, 0.99)

0.10
0.048

0.6
341
7165
1.00
1.00

1.3
359
7131
0.91 (0.79, 1.06)
0.95 (0.80, 1.11)

1.9
419
7156
0.95 (0.82, 1.10)
1.00 (0.85, 1.18)

2.6
459
7128
0.92 (0.80, 1.06)
0.97 (0.83, 1.14)

3.8
489
7144
0.87 (0.75, 1.00)
0.89 (0.75, 1.06)

0.07
0.19

1.5
384
7150
1.00
1.00

2.5
375
7145
0.93 (0.81, 1.07)
0.94 (0.81, 1.10)

3.4
427
7142
0.95 (0.83, 1.09)
0.96 (0.83, 1.12)

4.5
428
7150
0.93 (0.81, 1.07)
0.94 (0.80, 1.10)

6.8
453
7137
0.91 (0.80, 1.05)
0.88 (0.74, 1.04)

0.28
0.15

1

Referent category.
Adjusted for age, randomized treatment assignment, smoking, alcohol use, history of diabetes, history of hypertension, history of hypercholesterolemia,
BMI, physical activity, parental history of myocardial infarction, menopausal status, postmenopausal hormone use, use of multivitamins or vitamin C
supplements, total energy intake, and history of an eye exam in the past 2 y in Cox proportional hazards regression models.
2

possible risk factors for cataract. Among the subgroup of women
who were current smokers at baseline, the inverse association of
cataract with fruit and vegetable intake appeared to be slightly stronger, although the interaction with smoking was not statistically significant when tested in multivariate models.

Several possible limitations of the study need to be considered.
Misclassification of fruit and vegetable intake is always a major
concern in any epidemiologic study of diet. In the WHS, information on fruit and vegetable intake was reported through aself-administered SFFQ collected at baseline. Because of the

TABLE 3
Relative risk (and 95% CI) of cataract extraction according to quintiles of fruit and vegetable intake in the Women’s Health Study
Quintile of intake

All fruit and vegetables
Median intake (servings/d)
Cases of cataract extractionnAge- and treatment-adjusted risk
Multivariate-adjusted risk2
All fruit
Median intake (servings/d)
Cases of cataract extractionnAge- and treatment-adjusted risk
Multivariate-adjusted risk2
All vegetables
Median intake (servings/d)
Cases of cataract extractionnAge- and treatment-adjusted risk
Multivariate-adjusted risk2
1

11

2

3

4

5

P for
trend

2.6
221
7145
1.00
1.00

4.1
238
7145
0.97 (0.81, 1.17)
1.00 (0.82, 1.22)

5.4
272
7145
0.97 (0.81, 1.16)
0.98 (0.81, 1.20)

7.0
290
7145
0.95 (0.80, 1.14)
0.94 (0.77, 1.15)

10.0
294
7144
0.88 (0.74, 1.05)
0.86 (0.69, 1.08)

0.14
0.12

0.6
214
7165
1.00
1.00

1.3
222
7131
0.90 (0.75, 1.09)
0.94 (0.77, 1.16)

1.9
275
7156
0.99 (0.83, 1.18)
1.07 (0.88, 1.31)

2.6
295
7128
0.94 (0.78, 1.12)
0.98 (0.80, 1.20)

3.8
309
7144
0.86 (0.72, 1.03)
0.90 (0.73, 1.12)

0.12
0.33

1.5
234
7150
1.00
1.00

2.5
228
7145
0.93 (0.77, 1.11)
0.98 (0.80, 1.20)

3.4
292
7142
1.06 (0.90, 1.26)
1.14 (0.95, 1.38)

4.5
282
7150
1.00 (0.84, 1.20)
1.04 (0.86, 1.27)

6.8
279
7137
0.92 (0.77, 1.09)
0.91 (0.73, 1.13)

0.42
0.31

Referent category.
Adjusted for age, randomized treatment assignment, smoking, alcohol use, history of diabetes, history of hypertension, history of hypercholesterolemia,
BMI, physical activity, parental history of myocardial infarction, menopausal status, postmenopausal hormone use, use of multivitamins or vitamin C
supplements, total energy intake, and history of an eye exam in the past 2 y in Cox proportional hazards regression models.
2

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All fruit and vegetables
Median intake (servings/d)
Cases of cataractnAge- and treatment-adjusted risk
Multivariate-adjusted risk2
All fruit
Median intake (servings/d)
Cases of cataractnAge- and treatment-adjusted risk
Multivariate-adjusted risk2
All vegetables
Median intake (servings/d)
Cases of cataractnAge- and treatment-adjusted risk
Multivariate-adjusted risk2

11

FRUIT AND VEGETABLES AND CATARACT

servings) quintiles: 0.97 (95% CI: 0.65,1.46); P for trend ҃ 0.90]
in analyses adjusted for age, pack-years of smoking, and heavy
alcohol use (7). Prospective data in that cohort, based on 5 y offollow-up during which 246 incident nuclear cataracts were identified, indicated no significant reduction in risk of cataract for
those with high intake of vegetables (OR for the comparison ofhigh and low quintiles: 0.7; 95% CI: 0.4, 1.2; P for trend ҃ 0.39),
and a possible elevated risk of cataract for those with high intakeof fruit (OR: 1.8; 95% CI: 1.0, 3.3; P for trend ҃ 0.07) after
adjustment for age, energy intake, and pack-years of smoking(11). Separate results for men and women were not provided inthat analysis. The results of our study, which is the largest toreport on the category of all fruit and vegetable intake, suggest
only a small overall benefit, if any, on cataract for women who
consume 쏜3.4 servings/d of fruit and vegetables.
We found no evidence to indicate that the association of fruitand vegetable intake with the risk of cataract was significantly
modified by baseline smoking status. Cigarette smoking is anestablished risk factor for cataract (14 –17), and available evidence supports a direct deleterious effect of smoking on thehuman lens (23–27). In addition, cigarette smoking is known todecrease plasma concentrations of ascorbate and, perhaps, lutein/zeaxanthin (28 –32). Thus, cigarette smoking may indirectly
aid cataract formation by lowering the plasma concentrations of
nutrients that are important to the maintenance of lens transparency. Consumption of a diet rich in fruit and vegetables could, atleast in theory, partially offset this effect of smoking on plasma
nutrients. Results of other studies that examined antioxidant nutrients and cataract have not been consistent on this point: somesuggest a stronger association in smokers (11, 33, 34) and otherssuggest a stronger association in nonsmokers (6, 9, 10).
In conclusion, these prospective data from a large cohort ofwell-nourished female health professionals indicate that a higher
intake of fruit and vegetables was associated with only a slightly
reduced risk of cataract. Additional observational studies in thisand other cohorts and ongoing trials of dietary supplements may
yet identify specific components of the diet that markedly reduce
cataract formation. In the meantime, the possible beneficial effects of fruit and vegetables on the risk of many chronic diseases,
including cataract, have a strong biological basis and warrant thecontinued recommendation to increase total intakes of fruit andvegetables.
We acknowledge the crucial contributions of the entire staff of the Women’s Health Study, under the leadership of David Gordon, as well as Susan
Burt, Mary Breen, Marilyn Chown, Lisa Fields-Johnson, Georgina Friedenberg, Inge Judge, Jean MacFadyen, Geneva McNair, David Potter, Claire
Ridge, and Harriet Samuelson. We are also indebted to the dedicated participants of the Women’s Health Study.
WGC participated in the data collection, data analysis, and writing of thefirst draft of the manuscript. JEB participated in the study design. JEB, SL,
and DAS participated in the data analysis. All authors participated in thewriting of the manuscript. None of the authors had any conflicts of interest.

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0.43,1.09); P for trend ҃ 0.07] but not in women [OR for thecomparison of high (median: 5.3 servings) and low (median: 2.9

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