Quantifying health effects of a low consumption of fruits and vegetables

The health benefits of a diet rich in Fruits and Vegetables (F&V) are well recognized. F&V consumption has been associated with decreased risks of several chronic diseases, such as cardiovascular diseases, diabetes, obesity, and certain types of cancer. Most evidence comes from large cohort studies like the European Prospective Investigation into Cancer and nutrition (EPIC1). This study observed, for example, a protective effect of F&V consumption on a variety of cancers and weight gain2-4. However, it is not clear how high the consumption of F&V should be in order to achieve relevant reductions in health risk. Nevertheless, recommendations for the consumption of F&V have been issued by most national and international health agencies. As a population-wide intake goal, the WHO recommends the consumption of a minimum of 400 grams of F&V a day5. The Dutch National Food Consumption Survey among young adults (19-30 years) showed that none of the participants consumed at least 200 grams of vegetables and only 8% of the men and 7% of the women consumed 200 grams of fruits per day (including nuts and seeds). When F&V were combined, only 3% of men and 1% of women reached the recommended consumption of 400 grams a day6.

The health effects of not consuming the recommended intake of F&V can be quantified by model simulations, in which the actual consumption (current scenario) can be compared with the recommended scenario. This has been calculated for The Netherlands7. For vegetable consumption, the life expectancy of newborns is 0.41 years shorter for the current low consumption in comparison with the recommended situation (Table 1). In addition, 34,000 deaths and 0.5 billion euros (net present value) of health care costs in the next 20 years are attributable to the lower vegetable consumption if the current low consumption of vegetables is continued. For fruit consumption, the numbers are even larger: the life expectancy of newborns is 0.47 years shorter and the current low consumption of fruits will result in 60,000 deaths and 1.9 billion euros (net present value) in health care costs over the next 20 years. It should be kept in mind that these numbers are based on models using certain conditions and assumptions and depend on the quality of the input data. Recent and detailed data on F&V consumption from national food consumption surveys are essential to maintain the accuracy of the models. In addition, relative risks linking F&V consumption to chronic diseases should be based on (meta-analyses of) large (international) cohort studies or intervention studies.

The health loss due to not consuming the recommended intake of F&V is considerable and the potential health gain of a healthy diet is about two orders of magnitude larger than that attributable to food that is unsafe due to health-threatening substances (Table 2)8. In other words, much greater health gains can be made through encouraging a healthy diet than through further improving food safety.

The largest effects on public health are expected from Policy geared towards an integrated strategy, in which both the supply side as well as the consumer environment is addressed. As such, a major challenge for the authorities, the food industry, the scientific community and the consumer lies ahead. This challenge may be tackled by joint programming, in which science and technology join forces to contribute more to large social themes, such as a healthy diet for a healthy life. In the Netherlands an integrated approach is already taking place: the Ministry of Health, Welfare and Sport, the Ministry of Agriculture, Nature and Food Quality, and the Food and Consumer Product Safety Authority have aligned the programming of their research in the area of food, nutrition and health.

  1. The European EPIC investigation. http://epic.iarc.fr/
  2. van Duijnhoven FJ et al. Am J Clin Nutr 2009; 89(5):1441-52.
  3. Büchner FL et al. Cancer Causes Control 2010; 21(3):357-71.
  4. Buijsse B et al. Am J Clin Nutr 2009; 90(1):202-9.
  5. World Health Organization. Diet, nutrition and the prevention of chronic diseases – Report of the joint WHO/FAO expert consultation. 2003; WHO Technical Report Series, No. 916 (TRS 916) http://www.who.int/dietphysicalactivity/publications/trs916/en/index.html
  6. Hulshof KFAM et al. Bilthoven: RIVM, 2004; RIVM rapport 350030002/2004. http://www.rivm.nl/bibliotheek/rapporten/350030002.html
  7. Büchner FL et al. Bilthoven: RIVM, 2007; RIVM rapport 350080001/2007. http://www.rivm.nl/bibliotheek/rapporten/350080001.html
  8. Kreijl C et al. 2006; RIVM report 270555009 http://www.rivm.nl/bibliotheek/rapporten/270555009.html