Estimating the burden of disease attributable to a diet low in fruit and vegetables in South Africa for 2000, 2006 and 2012

Abstract


 
 
 
 Background. Low intake of fruit and vegetables is associated with an increased risk of various non-communicable diseases, including major causes of death and disability such as cardiovascular disease, diabetes mellitus and cancers. Diets low in fruit and vegetables are prevalent in the South African (SA) population, and average intake is well below the internationally recommended threshold.
 Objectives. To estimate the burden of disease attributable to a diet low in fruit and vegetables by sex and age group in SA for the years 2000, 2006 and 2012.
 Methods. We followed World Health Organization and Global Burden of Disease Study comparative risk assessment methodology. Population attributable fractions – calculated from fruit and vegetable intake estimated from national and local surveys and relative risks for health outcomes based on the current literature – were applied to the burden estimates from the second South African National Burden of Disease Study (SANBD2). Outcome measures included deaths and disability-adjusted life years (DALYs) lost from ischaemic heart disease, stroke, type 2 diabetes, and five categories of cancers.
 Results. Between 2000 and 2012, the average intake of fruit of the SA adult population (≥25 years) declined by 7%, from 48.5 g/d (95% uncertainty interval (UI) 46.6 - 50.5) to 45.2 g/d (95% UI 42.7 - 47.6). Vegetable intake declined by 25%, from 146.9 g/d (95% UI 142.3 - 151.8) to 110.5 g/d (95% UI 105.9 - 115.0). In 2012, these consumption patterns are estimated to have caused 26 423 deaths (95% UI 24 368 - 28 006), amounting to 5.0% (95% UI 4.6 - 5.3%) of all deaths in SA, and the loss of 514 823 (95% UI 473 508 - 544 803) healthy life years or 2.5% (95% UI 2.3 - 2.6%) of all DALYs. Cardiovascular disease comprised the largest proportion of the attributable burden, with 83% of deaths and 84% of DALYs. Age-standardised death rates were higher for males (145.1 deaths per 100 000; 95% UI 127.9 - 156.2) than for females (108.0 deaths per 100 000; 95% UI 96.2 - 118.1); in both sexes, rates were lower than those observed in 2000 (–9% and –12%, respectively).
 Conclusion. Despite the overall reduction in standardised death rates observed since 2000, the absolute burden of disease attributable to inadequate intake of fruit and vegetables in SA remains of significant concern. Effective interventions supported by legislation and policy are needed to reverse the declining trends in consumption observed in most age categories and to curb the associated burden.
 
 
 

Overview

“…To address these limitations, for the majority of risk factors (high systolic blood pressure, tobacco smoking, high fasting plasma glucose, alcohol use, high BMI, low fruit and vegetable intake, high LDL cholesterol, high sodium intake, iron deficiency) we adopted a meta-regression approach to the estimation of the parameters of the exposure distribution within each subgroup (age, sex and, for some risk factors, population group, province or urban/rural). [19][20][21][22][23][24][25][26][27] The modelling and estimation details varied across risk factorsdepending on the characteristics of the exposure and the available data -but in all cases the procedure involved two separate steps. In the first step, we used all available microdata and applied standard estimation methods (weighted estimators with robust standard error) to recover age, sex and survey-specific estimates of the parameters of interest (e.g.…”

“…The detailed evaluation of each risk factor and the quantification of the resultant attributable burden [19][20][21][22][23][24][25][26][27][31][32][33][34][35][36] revealed insights into trends. Key observations for each risk factor are summarised in Table 3.…”

“…11, 16 Low fruit and vegetable intake [24] • Between 2000 and 2012 the average intake of fruit and vegetables in the SA population (>25 years) decreased by 7% and 25%, respectively. The number of deaths and DALYs attributable to low fruit consumption increased by 7.3% and 8%, respectively.…”

“…Effective interventions supported by legislation and policy are needed to reverse the declining trends in fruit and vegetable consumption observed in most age categories. [24] August 2022 Vol. 112, No.…”

Consumer Profiles of Sustainable Fruit and Vegetable Consumption in the European Union

“…The Food and Agriculture Organization (FAO) of the United Nations [5] says that up to 3.9 million lives could be saved each year if the consumption of fruit and vegetables were sufficient. It is estimated that the lack of fruit and vegetables in the human diet or their low consumption may lead to an increased risk of chronic diseases, metabolic deterioration, as well as regulatory and digestive problems [6][7][8][9][10][11][12][13][14]. The reasons for this phenomenon include unsustainable consumer behaviour, lack of sufficient knowledge about the benefits of fruit and vegetable consumption [15][16][17][18], perception of fruit as luxury goods [5], and price movements for this category of products (changes dictated by, for example, weather conditions or economic crises) [19][20][21][22][23].…”