Chronic non-communicable diseases (NCDs) are the leading causes of death and disability worldwide and are increasing rapidly in most regions. Meanwhile, the traditional plant-based diet in many countries is being replaced by a diet rich in animal fats and sugar and low in fibre. An analysis of international data helps to clarify the link between these two trends.

The degree of protection given by fruit and vegetables against cardiovascular disease and cancers is unclear. Researchers from the London School of Hygiene and Tropical Medicine analysed data from the updated World Health Organisation (WHO) Global Burden of Disease (GBD) project, which included fruit and vegetable consumption as one of 26 risk factors. They found that consumption is highest in Western Europe and parts of Australasia, and lowest in North America, the Former Soviet Union, parts of South-East Asia and eastern and southern Africa. Consumption varies by age, with children and the elderly generally having eating less than middle-aged adults.

The analysis also showed that:

• Inadequate consumption of fruit and vegetables is estimated to cause up to 2.635 million deaths per year worldwide.
• Increasing individual intake by up to 600g per day could reduce the total worldwide burden of disease by 1.8 percent.
• This compares with 1.3 percent for physical inactivity, 2.3 percent for overweight and obesity, 2.8 percent for high cholesterol and 4.1 percent for tobacco use.
• The increased intake would reduce the burden of ischaemic heart disease and ischaemic stroke by 31 percent and 19 percent, respectively.
• For stomach, oesophageal, lung and colorectal cancer, the potential reductions are 19, 20, 12 and two percent, respectively.

The researchers warn that the impact of fruit and vegetable consumption on disease risk may vary depending on the type and combination eaten, the frequency, and changes in intake during a lifetime. It is also unclear whether the benefit of eating more fruit and vegetables is linear or whether there is a minimum threshold intake required.

Despite the limitations of the GBD study, it provides information on the impact of 26 risk factors, obtained using uniform methods, for all world regions. It can be used to stimulate decision-makers to think about a wider range of health determinants when developing public policy. In particular, they should consider:

• placing nutrition much higher on the policy agenda addressing the increasing rates of NCDs worldwide
• promoting an increase in fruit and vegetable intake to 400-500g per day (as in ‘5-a-day’ campaigns in some countries) as a minimum goal
• tackling competing pressures such as marketing of fast food
• looking beyond individual behaviour change, aiming to enhance people’s ability to eat healthy diets through action on agriculture, food labelling, nutritional claims, advertising, nutrition programmes and food taxation
• supporting the joint Fruit and Vegetable Promotion Initiative of the WHO and the UN Food and Agriculture Organisation (FAO), which advocates the development and implementation of national policies that are sustainable, comprehensive and engage all sectors.

Source(s):
‘The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet’, Bulletin of the World Health Organization 83: 100-108, by K. Lock, J. Pomerleau, L. Causer, D. Altmann and M. McKee, 2005 Full document.

Funded by: Department of Health of England

id21 Research Highlight: 9 May 2005

Further Information:
Karen Lock
European Centre on Health of Societies in Transition
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Contact the contributor: karen.lock@lshtm.ac.uk

European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, UK

Other related links:
World Health Organisation's (WHO) global strategy on diet, physical activity and health: promoting fruit and vegetable consumption around the world

'Pass the leafy vegetables, please'

'Freedom to grow: are children bigger in South Africa’s new democracy?'

'Improving family nutrition'

'Globalisation-driven dietary change: implications for India’s food supply system'

'Weighting game: economic development and nutritional status in China'

'Wealth = health? Nutrition's double whammy in Asia'