Estimated Global, Regional, and National Cardiovascular Disease Burdens Related to Fruit and Vegetable Consumption: An Analysis from the Global Dietary Database (FS01-01-19).

Inadequate fruit and vegetable intake contributes to cardiovascular diseases (CVD), 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 burdens of CVD attributable to fruit and vegetable consumption using the largest standardized global dietary database currently available. National intakes of fruit and vegetables (including legumes) were estimated using a Bayesian hierarchical model using individual-level intake data from nationally and sub-nationally representative diet surveys and country-level availability data (266 surveys representing 1630,069 individuals from 113 of 187 countries─ 82% of the world’s population). The effects of fruits and vegetables on coronary heart disease (CHD) and stroke mortality, collectively referred to as CVD mortality, were derived from the most recent meta-analyses of prospective cohorts. Disease specific mortality data were obtained from the Global Burden of Diseases study. A comparative risk assessment framework was used to estimate the proportional attributable fraction (PAF) and number of disease-specific deaths. In 2010, suboptimal intakes of fruit were estimated to result in 521,395 (95% uncertainty interval [UI] 498,254–542,808) CHD deaths (PAF: 7.5%; 7.2–7.8%) and 1255,978 (1187,716–1325,879) stroke deaths (PAF: 21.7%; 20.5–22.9%) globally per year. Suboptimal intakes of vegetables were estimated to result in 809,425 (783,362–836,687) CHD deaths (PAF: 11.6%; 11.3–12.0%) and 210,849 (196,297–226,577) stroke deaths (PAF: 3.6%; 3.4–3.9%). The proportion of CVD deaths from suboptimal fruit and vegetable intake was higher in males and younger adults. Among the 20 most populous countries, China (541,564; 482,709–608,314; PAF: 20.3%) had the largest absolute CVD deaths from suboptimal fruit intake and India (199,364; 176,961–222,688; PAF: 11.6%) from vegetables. Results for the global burden of fruits and vegetables on CVD in 1990 and 2015 will be presented at the meeting. Suboptimal fruit and vegetable intake each contribute to significant CVD mortality, demonstrating a pressing need for public health and policy priorities to increase intake. Gates Foundation.