Low consumption of fruit and vegetables and risk of chronic disease: a review of the epidemiological evidence and temporal trends among Spanish graduates

Public Health Nutr. 2011 Dec;14(12A):2309-15. doi: 10.1017/S1368980011002564.


Objective: To review the evidence on the association between fruit and vegetable (F&V) consumption and risk of chronic disease, and to assess trends in the prevalence of low F&V consumption.

Design: Systematic review and cross-sectional analyses of a Mediterranean cohort.

Setting: The Seguimiento University of Navarra (SUN) project (Spanish dynamic cohort of graduates).

Subjects: A systematic review of prospective studies aimed to assess the relationship between fruit and/or vegetables consumption and chronic disease incidence was conducted. We also assessed 18 457 university graduates (59·4 % women; mean age = 39 (sd 12) years) enrolled in a dynamic cohort with permanently open recruitment. Baseline data were collected between 1999 and 2010 using a validated 136-item FFQ. Four definitions for low F&V consumption were used (<400 g/d, <200 g/4184 kJ (1000 kcal) per d, ≤2 servings/d and ≤1 serving/d). Multivariate-adjusted cross-sectional associations between the prevalence of low F&V consumption and the year of recruitment were estimated.

Results: The systematic review found that a high F&V consumption is inversely associated with CVD incidence and mortality. This association is not so clear for cancer. Inconsistent findings have been reported for diabetes. In all, 13 % of participants in the SUN cohort did not meet the goal of consuming at least 400 g/d of F&V and 2·1 % of them did not reach >1 serving/d. Between 1999 and 2010 the consumption of F&V significantly increased.

Conclusions: Even among health-conscious university graduates, low F&V consumption is fairly prevalent. Although the temporal trends suggest an improvement, preventive strategies addressed to increase F&V consumption are needed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Cardiovascular Diseases / epidemiology
  • Chronic Disease / epidemiology*
  • Cohort Studies
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diet, Mediterranean*
  • Female
  • Fruit*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Neoplasms / epidemiology
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology
  • Students / psychology
  • Students / statistics & numerical data
  • Vegetables*