An apple a day won't keep the doctor away but maybe the pharmacist

The apple has come to symbolize health and healthy habits. But can apple consumption be associated with reduced health care use because patients who eat them might visit doctors less?

Matthew A. Davis, D.C., M.P.H., Ph.D., of the University of Michigan School of Nursing, Ann Arbor, and coauthors analyzed data from the National Health and Nutrition Examination Survey (2007-2008 and 2009-2010) to find out.

The authors compared daily apple eaters (those who consumed at least 1 small apple per day or 149 grams of raw apple) with non-apple eaters. Of the 8,399 survey participants who completed a dietary recall questionnaire, 753 (9 percent) were apple eaters and 7,646 (91 percent) were non-apple eaters. Apple eaters had higher educational attainment, were more likely to be from a racial or ethnic minority, and were less likely to smoke. The authors measured "keeping the doctor away" as no more than one self-reported visit to a physician during the past year.

There was no statistically significant difference between apple eaters and non-apple eaters when it came to keeping the doctor away when sociodemographic and health-related characteristics were taken into account. However, apple eaters had marginally higher odds of avoiding prescription medications, according to the results. The authors found no difference between apple eaters and non-apple eaters when measuring the likelihood of avoiding an overnight hospital stay or a visit to a mental health professional.

"Our findings suggest that the promotion of apple consumption may have limited benefit in reducing national health care spending. In the age of evidence-based assertions, however, there may be merit to saying 'An apple a day keeps the pharmacist away,'" the study concludes.

This study was one of several lighthearted but real papers in the April Fool Days issue of JAMA Internal Medicine.