[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.211.213.149. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Original Investigation
May 2015

Association Between Apple Consumption and Physician VisitsAppealing the Conventional Wisdom That an Apple a Day Keeps the Doctor Away

Author Affiliations
  • 1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
  • 2Division of Systems Leadership and Effectiveness Science, University of Michigan School of Nursing, Ann Arbor
  • 3Veteran Affairs Medical Center Outcomes Group, White River Junction, Vermont
JAMA Intern Med. 2015;175(5):777-783. doi:10.1001/jamainternmed.2014.5466
Abstract

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 noninstitutionalized 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 (ie, 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.

×