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The global burden of disease attributable to suboptimal fruit and vegetable intake, 1990-2021: a systematic analysis of the global burden of disease study.
BMC Med. 2025 Aug 05; 23(1):456.BM

Abstract

BACKGROUND

Suboptimal fruit and vegetable intake remains a significant global public health concern. This study aimed to estimate the global intake and the disease burden attributable to suboptimal fruit and vegetable intake.

METHODS

In this Global Burden of Disease (GBD) Study 2021, we evaluated the number, age-standardized rates (ASRs), and estimated annual percentage changes (EAPCs) in deaths and disability-adjusted life years (DALYs) attributable to suboptimal fruit and vegetable intake among adults aged over 25 years, across 21 regions and 204 countries and territories, from 1990 to 2021.

RESULTS

In 2021, the global average intake of fruit and vegetable was 121.8 g/day and 212.6 g/day, respectively, far below the optimal intake range (fruit: 340-350 g/day, vegetable: 306-372 g/day). Suboptimal consumption contributed to 1.7 million (95% uncertainty interval [UI] 0.8 to 2.5, fruit) and 0.9 million (95% UI 0.5 to 1.2, vegetable) deaths globally, with cardiovascular diseases accounting for 83.7% (ASR 16.80/100,000) and 79.3% (ASR 8.22/100,000) of mortality attributable to suboptimal fruit and vegetable intake, respectively. Between 1990 and 2021, age-standardized mortality rates decreased by 35% (95%UI 28% to 40%) for fruit and 45% (95% UI 38% to 50%) for vegetables. The global disease burden attributable to suboptimal fruit and vegetable intake was inversely associated with sociodemographic index (SDI) and human development index (HDI). Over three decades, the difference in fruit (52.0 vs. 84.4 g/day) and vegetable (125.5 vs. 158.5 g/day) intake between higher (high, high-middle, middle) and lower (low-middle, low) SDI regions increased by 62.3% and 26.3%, respectively. Meanwhile, disparities in disease burden also increased, as higher SDI regions experienced greater reductions in age-standardized mortality due to suboptimal fruit (- 47.0% vs. - 17.7%) and vegetable (- 58.8% vs. - 26.8%) intake, highlighting widening health inequities linked to developmental disparities.

CONCLUSIONS

Suboptimal fruit and vegetable intake continues to contribute to a substantial and unequal global disease burden. Reducing this burden should be a global priority, particularly in regions with low SDI and HDI.

Links

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Authors+Show Affiliations

Xu X
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Yan P
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Chen W
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Wei W
Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Thomson B
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA. Stanford University School of Medicine, Stanford, CA, USA.
Ruan S
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Cao Z
State Key Lab of Intelligent Technologies and Systems, Beijing National Research Center for Information Science and Technology, Department of Automation, Tsinghua University, Beijing, China.
Ou C
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Geldsetzer P
Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA. Chan Zuckerberg Biohub, San Francisco, CA, USA.
Han T
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Wang J
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Chen S
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. simiao.chen@uni-heidelberg.de. Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany. simiao.chen@uni-heidelberg.de.
Li J
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. lijn2008@126.com. Key Laboratory of Gut Microbiome and Translational Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. lijn2008@126.com.

MeSH

HumansFruitVegetablesGlobal Burden of DiseaseAdultMaleFemaleMiddle AgedAgedDietDisability-Adjusted Life YearsGlobal Health

Pub Type(s)

Journal Article

Language

eng

PubMed ID

40764991

Citation

Xu, Xiang, et al. "The Global Burden of Disease Attributable to Suboptimal Fruit and Vegetable Intake, 1990-2021: a Systematic Analysis of the Global Burden of Disease Study." BMC Medicine, vol. 23, no. 1, 2025, p. 456.
Xu X, Yan P, Chen W, et al. The global burden of disease attributable to suboptimal fruit and vegetable intake, 1990-2021: a systematic analysis of the global burden of disease study. BMC Med. 2025;23(1):456.
Xu, X., Yan, P., Chen, W., Wei, W., Thomson, B., Ruan, S., Cao, Z., Ou, C., Geldsetzer, P., Han, T., Wang, J., Chen, S., & Li, J. (2025). The global burden of disease attributable to suboptimal fruit and vegetable intake, 1990-2021: a systematic analysis of the global burden of disease study. BMC Medicine, 23(1), 456. https://doi.org/10.1186/s12916-025-04275-9
Xu X, et al. The Global Burden of Disease Attributable to Suboptimal Fruit and Vegetable Intake, 1990-2021: a Systematic Analysis of the Global Burden of Disease Study. BMC Med. 2025 Aug 5;23(1):456. PubMed PMID: 40764991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The global burden of disease attributable to suboptimal fruit and vegetable intake, 1990-2021: a systematic analysis of the global burden of disease study. AU - Xu,Xiang, AU - Yan,Pengguang, AU - Chen,Wenjin, AU - Wei,Wei, AU - Thomson,Blake, AU - Ruan,Shuaizhi, AU - Cao,Zhong, AU - Ou,Chengzhu, AU - Geldsetzer,Pascal, AU - Han,Taotao, AU - Wang,Jing, AU - Chen,Simiao, AU - Li,Jingnan, Y1 - 2025/08/05/ PY - 2025/1/22/received PY - 2025/7/14/accepted PY - 2025/8/6/medline PY - 2025/8/6/pubmed PY - 2025/8/6/entrez PY - 2025/8/5/pmc-release KW - Disease burden KW - Global burden of disease study 2021 KW - Suboptimal fruit and vegetable intake SP - 456 EP - 456 JF - BMC medicine JO - BMC Med VL - 23 IS - 1 N2 - BACKGROUND: Suboptimal fruit and vegetable intake remains a significant global public health concern. This study aimed to estimate the global intake and the disease burden attributable to suboptimal fruit and vegetable intake. METHODS: In this Global Burden of Disease (GBD) Study 2021, we evaluated the number, age-standardized rates (ASRs), and estimated annual percentage changes (EAPCs) in deaths and disability-adjusted life years (DALYs) attributable to suboptimal fruit and vegetable intake among adults aged over 25 years, across 21 regions and 204 countries and territories, from 1990 to 2021. RESULTS: In 2021, the global average intake of fruit and vegetable was 121.8 g/day and 212.6 g/day, respectively, far below the optimal intake range (fruit: 340-350 g/day, vegetable: 306-372 g/day). Suboptimal consumption contributed to 1.7 million (95% uncertainty interval [UI] 0.8 to 2.5, fruit) and 0.9 million (95% UI 0.5 to 1.2, vegetable) deaths globally, with cardiovascular diseases accounting for 83.7% (ASR 16.80/100,000) and 79.3% (ASR 8.22/100,000) of mortality attributable to suboptimal fruit and vegetable intake, respectively. Between 1990 and 2021, age-standardized mortality rates decreased by 35% (95%UI 28% to 40%) for fruit and 45% (95% UI 38% to 50%) for vegetables. The global disease burden attributable to suboptimal fruit and vegetable intake was inversely associated with sociodemographic index (SDI) and human development index (HDI). Over three decades, the difference in fruit (52.0 vs. 84.4 g/day) and vegetable (125.5 vs. 158.5 g/day) intake between higher (high, high-middle, middle) and lower (low-middle, low) SDI regions increased by 62.3% and 26.3%, respectively. Meanwhile, disparities in disease burden also increased, as higher SDI regions experienced greater reductions in age-standardized mortality due to suboptimal fruit (- 47.0% vs. - 17.7%) and vegetable (- 58.8% vs. - 26.8%) intake, highlighting widening health inequities linked to developmental disparities. CONCLUSIONS: Suboptimal fruit and vegetable intake continues to contribute to a substantial and unequal global disease burden. Reducing this burden should be a global priority, particularly in regions with low SDI and HDI. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/40764991/full_citation DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓4 ↑38]

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