Abstract
Low fruit and vegetable consumption is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published. This study presents data on the prevalence of low fruit and vegetable intake for 52 countries and for various sociodemographic groups and settings across these countries. Data from 196,373 adult participants from 52 countries taking part in the World Health Survey (2002-2003) were analyzed in the summer of 2008. Low fruit and vegetable consumption was defined according to the WHO guidelines of a minimum of five servings of fruits and/or vegetables daily.
Generated Summary
This research, published in the American Journal of Preventive Medicine, presents findings from the World Health Survey (WHS) conducted in 52 countries between 2002 and 2003. The study aimed to assess the prevalence of low fruit and vegetable consumption across various sociodemographic groups and settings. The WHS employed a cross-sectional design, surveying 196,373 adults. Low fruit and vegetable consumption was defined according to the WHO guidelines of a minimum of five servings of fruits and/or vegetables daily. Data analysis included age standardization, weighting, and the use of multivariable Poisson regression analyses to examine associations with gender, age, urbanicity, and income. The study provides a comprehensive global assessment of low fruit and vegetable intake, offering baseline data for policymakers to develop interventions to address chronic diseases.
Key Findings & Statistics
- The prevalence of low fruit and vegetable consumption ranged from 36.6% (Ghana) to 99.2% (Pakistan) for men, and from 38.0% (Ghana) to 99.3% (Pakistan) for women.
- Overall, 77.6% of men and 78.4% of women consumed less than the recommended five daily servings of fruits and vegetables.
- Significant differences in the likelihood of low fruit and vegetable intake between men and women were found in 15 countries.
- The percentage of men in the sample was 44.5%, with the lowest percentage in Latvia (33.4%) and the highest in Côte d’Ivoire (57.5%).
- Mean age ranged from 34.7 years (Ethiopia) to 52.1 years (Croatia).
- The percentage of urban-dwelling respondents ranged from 13.7% (Nepal) to 91.9% (Russian Federation).
- In 2000, 2.7 million deaths (4.9%) and 26.7 million disability-adjusted life years (DALYs; 1.8%) were attributable to low fruit and vegetable intake globally.
- 31% of ischemic heart disease, 20% of esophageal cancer, 19% of ischemic stroke, 19% of gastric cancer, and 12% of lung cancer worldwide could be prevented by increasing dietary intake of fruits and vegetables.
- The WHO panel recommended an individual intake of at least 400g of fruits and vegetables a day—the equivalent of five servings of 80g each.
- The overall module response was 86.8%. Country response to the nutrition module ranged from 25.7% (Brazil) to 100% (Morocco).
- Women had a higher risk of low fruit and vegetable consumption than men in five countries: Comoros, Dominican Republic, Guatemala, Morocco, and Paraguay.
- Women had lower risk in ten countries: Czech Republic, Estonia, Hungary, Slovakia, Slovenia, Spain, Swaziland, Ukraine, Uruguay, and Vietnam.
- The oldest age stratum had a higher risk of low fruit and vegetable consumption than one or more younger strata in 28 countries.
- The poorest income quintile had the highest prevalence of low fruit and vegetable consumption (81.6%), and the richest quintile had the lowest prevalence (73.4%).
- In 33 countries, there were differences between the richest quintile and one or more poorer quintiles.
Other Important Findings
- Low fruit and vegetable consumption is an important risk factor for chronic diseases.
- The study found significant differences in low fruit and vegetable intake between men and women in various countries.
- The prevalence of low fruit and vegetable consumption tended to increase with age and decrease with income.
- Urbanicity was not consistently associated with low fruit and vegetable consumption, but differences were significant in some countries.
- The income gradient in fruit and vegetable consumption was observed, with the poorest quintile having the highest prevalence of low consumption.
- The study highlighted the need for interventions to address the global chronic disease epidemic.
- The ranking of country prevalence values within WHO regions was relatively consistent for men and women.
- The African region displayed the greatest heterogeneity in low fruit and vegetable consumption.
Limitations Noted in the Document
- The study’s reliance on self-reported data is subject to recall bias, although this was minimized by using questions about recent intake.
- The study may not provide reliable estimates of usual intake due to day-to-day variations.
- Comparisons with other studies are limited by differences in questionnaires, age groups, definitions of low consumption, and the inclusion of high-income vs. low- and middle-income countries.
- The time period of data collection varied across countries.
Conclusion
The study emphasizes the critical role of low fruit and vegetable consumption as a significant risk factor for chronic diseases globally. The data reveal considerable variability in consumption patterns across countries, highlighting the need for tailored interventions. The study underscores the importance of addressing the social determinants of health, such as income and urbanicity, which influence consumption. The observed income gradient suggests that strategies to make fruits and vegetables more affordable could improve consumption rates, especially for low-income families. The study supports the WHO’s recommendations for increased fruit and vegetable intake and emphasizes the need for public health actions at national and international levels, including education, policy changes, and the promotion of equitable access to healthy foods. The global patterns of obesity and fruit and vegetable consumption, along with country-specific variations, should be considered for effective interventions to reduce the burden of chronic disease. The findings provide valuable baseline data for policymakers and health organizations to develop and implement targeted strategies to improve fruit and vegetable consumption worldwide. The study suggests that effective strategies should focus on the importance of consuming at least five servings of fruits and vegetables daily.