An estimated one in seven cardiovascular deaths could be attributed to not eating enough fruits, while one in 12 cardiovascular deaths could be attributed to not eating enough vegetables, according to the preliminary findings of a new study.
The research findings, which reveal that inadequate fruit and vegetable consumption may account for millions of deaths from heart disease and strokes each year, were presented at Nutrition 2019, the American Society for Nutrition annual meeting, held in Baltimore.
Cardiovascular disease (CVD) is the number one cause of death in the United States and worldwide, said the researchers.
"Inadequate fruit and vegetable intake contribute to cardiovascular diseases, and the impacts of fruits and vegetables on CVD risk worldwide has not been well established by country, age, and sex. Our objective was to derive comprehensive and accurate estimates of the burden of CVD attributable to fruit and vegetable consumption using the largest standardized global dietary database currently available," said the research team from the Friedman School of Nutrition Science and Policy at Tufts University.
Results for the global burden of fruits and vegetables on cardiovascular diseases showed that low fruit intake resulted in nearly 1.8 million cardiovascular deaths in 2010, while low vegetable intake resulted in 1 million deaths.
Overall, the toll of suboptimal fruit intake was almost double that of vegetables. The impacts were most acute in countries with the lowest average intakes of fruits and vegetables, said a EurekAlert release.
Based on dietary guidelines and studies of cardiovascular risk factors, the researchers defined optimal fruit intake as 300 grams per day, equivalent to roughly two small apples.
Optimal intake of vegetables, including legumes, was described as 400 grams per day, equivalent to about three cups of raw carrots. The work is part of the Global Dietary Database project funded by the Bill & Melinda Gates Foundation.
"Fruits and vegetables are a modifiable component of the diet that can impact preventable deaths globally. Our findings indicate the need for population-based efforts to increase fruit and vegetable consumption throughout the world," said lead study author Victoria Miller, a postdoctoral researcher at the Friedman School of Nutrition Science and Policy at Tufts University, in the release.
According to the World Health Organization (WHO), reduced fruit and vegetable consumption is linked to poor health and increased risk of noncommunicable diseases (NCDs). The WHO says that an estimated 3.9 million deaths worldwide were attributable to inadequate fruit and vegetable consumption in 2017.
"Including fruits and vegetables as part of the daily diet may reduce the risk of some NCDs, including cardiovascular diseases and certain types of cancer. More limited evidence suggests that when consumed as part of a healthy diet low in fat, sugars, and salt/sodium, fruits and vegetables may also help to prevent weight gain and reduce the risk of obesity, an independent risk-factor for NCDs," says WHO.
According to a study on “Global, regional and national consumption of major food groups in 1990 and 2010”, published in BMJ in 2015, suboptimal diet is now the single leading preventable cause of NCDs, making food-based research a top priority for public health. The BMJ study had concluded that, globally, mean intakes of ‘healthful’ food, including fruits, vegetables, nuts/seeds, whole grains and fish were substantially below optimal intakes.
For the current study, the researchers estimated average national intakes of fruit and vegetables from diet surveys and food availability data representing 113 countries (approximately 82% of the world's population). They then combined this information with data on causes of death in each country and data on the cardiovascular risk associated with low fruit and vegetable consumption.
Based on data from 2010, suboptimal intakes of fruit were estimated to result in 521,395 coronary heart disease (CHD) deaths, and 1,255,978 stroke deaths globally every year. Suboptimal intakes of vegetables were estimated to result in 809,425 coronary heart disease deaths and 210,849 stroke deaths, findings reveal.
In the US, suboptimal vegetable intake may account for 82,000 cardiovascular deaths while suboptimal fruit intake accounted for 57,000 deaths, said the research team. The findings further show that among the 20 most populous countries, China had the largest absolute CVD deaths from suboptimal fruit intake and India from vegetables.
"The impact of inadequate fruit and vegetable intake was greatest in countries with the lowest fruit and vegetable consumption. Countries in South Asia, East Asia, and Sub-Saharan Africa had low fruit intake and high rates of associated stroke deaths. Countries in Central Asia and Oceania had low vegetable intake and high rates of associated coronary heart disease," said the release.
The researchers said that by age-group, the proportion of CVD deaths from suboptimal fruit and vegetable intake was higher in younger adults. By gender, the proportion of coronary heart disease deaths from suboptimal fruit and vegetable consumption was higher in males, found the research team.
"Global nutrition priorities have traditionally focused on providing sufficient calories, vitamin supplementation, and reducing additives like salt and sugar. These findings indicate a need to expand the focus to increasing availability and consumption of protective foods like fruits, vegetables, and legumes - a positive message with tremendous potential for improving global health," said senior study author Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University, in the release.