Cited by 597Nutritional Studies and DietNutrition, Health and Food BehaviorNutrition, Health, and Society Studies

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Global Variability in Fruit and Vegetable Consumption

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Hall, Justin N., Moore, Spencer, Harper, Sam B., Lynch, John W.·2009·American Journal of Preventive Medicine

DOI 10.1016/j.amepre.2009.01.029

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Abstract

Background Low fruit and vegetable consumption is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published. This study presents data on the prevalence of low fruit and vegetable intake for 52 countries and for various sociodemographic groups and settings across these countries.Methods Data from 196,373 adult participants from 52 countries taking part in the World Health Survey (2002-2003) were analyzed in the summer of 2008. Low fruit and vegetable consumption was defined according to the WHO guidelines of a minimum of five servings of fruits and/or vegetables daily.Results Low fruit and vegetable consumption prevalence ranged from 36.6% (Ghana) to 99.2% (Pakistan) for men and from 38.0% (Ghana) to 99.3% (Pakistan) for women. Significant differences in the likelihood of low fruit and vegetable intake between men and women were found in 15 countries. The prevalence of low fruit and vegetable consumption tended to increase with age and decrease with income. Although urbanicity was not associated overall with low fruit and vegetable consumption, urban and rural differences were significant for 11 countries.Conclusions Overall, 77.6% of men and 78.4% of women from the 52 mainly low- and middle-income countries consumed less than the minimum recommended five daily servings of fruits and vegetables. Baseline global information on low fruit and vegetable consumption obtained in this study can help policymakers worldwide establish interventions for addressing the global chronic disease epidemic.

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Background
Correlates of healthy fruit and vegetable diet in students in low, middle and high income countries
Peltzer, K., & Pengpid, S. (2014) · International Journal of Public Health · doi:10.1007/s00038-014-0631-1 · Cited by 95
“Fruit and vegetable consumption was assessed with two questions, ‘‘How many servings of fruit do you eat on a typical day?’’ and ‘‘How many servings of vegetables do you eat on a typical day?’’ (One standard serving = 80 g) (Hall et al. 2009).”
Background
Fruits and vegetables: measuring intake and encouraging increased consumption
Woodside, J. V., Young, I. S., & McKinley, M. C. (2013) · Proceedings of The Nutrition Society · doi:10.1017/s0029665112003059 · Cited by 90
“A more recent study by Hall et al.((103)) confirmed a low intake of FV worldwide.”
MethodResultInfluential
Association between depression and fruit and vegetable consumption among adults in South Asia
Bishwajit, G., O’Leary, D. P., Ghosh, S., Yaya, S., Tang, S., & Zhanchun, F. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1198-1 · Cited by 95
“A multi-country study reported 74% lower than recommended level of F&V consumption among adult population in India [20].”
Background
The Effect of Increasing Fruit and Vegetable Consumption on Overall Diet: A Systematic Review and Meta-analysis
Fulton, S. L., McKinley, M. C., Young, I. S., Cardwell, C. R., & Woodside, J. V. (2014) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2012.727917 · Cited by 96
“It was estimated that, in 2000, low consumption of FV was accountable for 4.9% of deaths worldwide (Hall et al., 2009).”
BackgroundInfluential
Antioxidant Effectiveness of Vegetable Powders on the Lipid and Protein Oxidative Stability of Cooked Turkey Meat Patties: Implications for Health
Duthie, G. G., Campbell, F., Bestwick, C. S., Stephen, S., & Russell, W. R. (2013) · Nutrients · doi:10.3390/nu5041241 · Cited by 87
“Despite numerous health promoting campaigns, consumption of fruit and vegetables remains sub-optimum, 78% of populations in low and middle-income countries consuming less than the minimum recommended five daily servings [34].”
Background
Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors
Morgan, E. H., Schoonees, A., Sriram, U., Faure, M. C., & Seguin‐Fowler, R. A. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012547.pub2 · Cited by 94
Fruit and vegetable intake and associated factors in older adults in South Africa
Peltzer, K., & Phaswana-Mafuya, N. R. (2012) · Global Health Action · doi:10.3402/gha.v5i0.18668 · Cited by 83
“However, this was also found in an adult survey in South Africa (4).”
BackgroundResultInfluential
A comprehensive review of the policy and programmatic response to chronic non-communicable disease in Ghana.
Bosu, W. K. (2012) · Europe PMC (PubMed Central) · Cited by 81
Dietary and circulating vitamin C, vitamin E, β-carotene and risk of total cardiovascular mortality: a systematic review and dose–response meta-analysis of prospective observational studies
Jayedi, A., Rashidy‐Pour, A., Parohan, M., Zargar, M. S., & Shab‐Bidar, S. (2019) · Public Health Nutrition · doi:10.1017/s1368980018003725 · Cited by 83
“defined as less than a minimum of five servings of fruits and/or vegetables daily, was about 78%((82)).”
Background
Hypertension and overweight/obesity in Ghanaians and Nigerians living in West Africa and industrialized countries
Commodore-Mensah, Y. Y., Samuel, L. J., Himmelfarb, C. D., & Agyemang, C. O. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000061 · Cited by 88
“Overweight/obesity in Ghanaians and Nigerians residing in Africa All studies except one [43] in this review utilized international criteria for BMI classification [28,50], with normal weight defined as a BMI of 18.”
Meat, fruit, and vegetable consumption in sub-Saharan Africa: a systematic review and meta-regression analysis
Mensah, D., Nunes, A. R., Bockarie, T., Lillywhite, R., & Oyebode, O. O. (2020) · Nutrition Reviews · doi:10.1093/nutrit/nuaa032 · Cited by 84
Living Wages Around the World
Anker, R., & Anker, M. (2017) · Edward Elgar Publishing eBooks · doi:10.4337/9781786431462 · Cited by 78
Prevalence of hypertension and associated cardiovascular risk factors in Central India
Bhadoria, A. S., Kasar, P. K., Toppo, N. A., Bhadoria, P., Pradhan, S., & Kabirpanthi, V. (2014) · Journal of Family and Community Medicine · doi:10.4103/2230-8229.128775 · Cited by 78
“31 Journal of Family and Community Medicine | April 2014 | Vol 21 | Issue 1 • Estimated per capita salt consumption was quantifi ed by 24-h dietary recall method for three consecutive days and an average was calculated[13] • Type of diet was categorized as vegetarian and nonvegetarian • Fruit and vegetable intake was…”
Prevalence of overweight/obesity and central obesity and its associated factors among a sample of university students in India
Pengpid, S., & Peltzer, K. (2014) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2013.12.003 · Cited by 80
Association Between Body Mass index and Prevalence of Multimorbidity in Low-and Middle-income Countries: A Cross-Sectional Study
Agrawal, S., & Agrawal, P. K. (2016) · International Journal of Medicine and Public Health · doi:10.5530/ijmedph.2016.2.5 · Cited by 74
Fruit and Vegetable Intake and Body Mass Index in a Large Sample of Middle-Aged Australian Men and Women
Charlton, K. E., Kowal, P. R., Soriano, M. M., Williams, S., Banks, E., Vo, K., & Byles, J. (2014) · Nutrients · doi:10.3390/nu6062305 · Cited by 73
“4% of women from mainly low- and middle-income countries consumed less than five servings of fruits and vegetables [32].”
Background
Exploring perceptions and beliefs about the cost of fruit and vegetables and whether they are barriers to higher consumption
Chapman, K. E., Goldsbury, D. E., Watson, W. L., Havill, M. A., Wellard‐Cole, L., Hughes, C., Bauman, A. E., & Allman-Farinelli, M. A. (2017) · Appetite · doi:10.1016/j.appet.2017.02.043 · Cited by 69
Low intake of commonly available fruits and vegetables in socio-economically disadvantaged communities of South Africa: influence of affordability and sugary drinks intake
Okop, K., Ndayi, K., Tsolekile, L. P., Sanders, D. M., & Puoane, T. R. (2019) · BMC Public Health · doi:10.1186/s12889-019-7254-7 · Cited by 85
“A systematic review and meta-analysis have also reported that consumption of acceptable healthier food (example, fruits and vegetables) in many studies are commonly associated with higher costs, disproportionally high in low-income settings [16, 17] In many developing countries, inadequate consumption of fruits and ve…”
Background
Dietary adequacy of Inuit in the Canadian Arctic
Hopping, B. N., Mead, E. L., Erber, E., Sheehy, C. M., Roache, C., & Sharma, S. (2010) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2010.01099.x · Cited by 67
“Although not a prominent part of the traditional Inuit diet, fruit and vegetables may be protective against chronic disease development (Hall et al., 2009).”
The fruit and vegetable intake of young Australian adults: a population perspective
Nour, M. M., Sui, Z., Grech, A. L., Rangan, A., McGeechan, K., & Allman-Farinelli, M. A. (2017) · Public Health Nutrition · doi:10.1017/s1368980017001124 · Cited by 67
Prevalence of cardiovascular disease risk factors: A community-based cross-sectional study in a peri-urban community of Kathmandu, Nepal
Dhungana, R. R., Thapa, P., Devkota, S. P., Banik, P. C., Gurung, Y., Mumu, S. J., Sayami, A., & Ali, L. (2018) · Indian Heart Journal · doi:10.1016/j.ihj.2018.03.003 · Cited by 66
“that of low- and middle-income countries.(46) One of our studies conducted in rural Nepal indicated that dependency over seasonal production, insufficient supply and comparatively high price of fruit and vegetables adversely affected on their intake.”
Background
Associations of vegetable and fruit consumption with metabolic syndrome. A meta-analysis of observational studies
Zhang, Y., & Zhang, D. (2018) · Public Health Nutrition · doi:10.1017/s1368980018000381 · Cited by 70
“A survey report, which was based on a sample extracted from fifty-two low- and middle-income countries, showed that 77·6% of men and 78·4% of women had daily fruit and vegetable intake lower than 400g (the minimum intake recommended by the WHO)((9)).”
BackgroundInfluential
Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review
Kaur, S. (2022) · Nutrition Research Reviews · doi:10.1017/s0954422422000166 · Cited by 76
Flavonoid intake from vegetables and fruits is inversely associated with colorectal cancer risk: a case–control study in China
Xu, M., Chen, Y., Huang, J., Fang, Y., Huang, W., Yan, B., Lu, M.-S., Pan, Z.-Z., & Zhang, C. (2016) · British Journal Of Nutrition · doi:10.1017/s0007114516003196 · Cited by 65
“The typical Chinese diet is known to be high in plant-origin foods((25)).”
Background
Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis
López‐Bueno, R., Núñez‐Cortés, R., Calatayud, J., Salazar‐Méndez, J., Petermann-Rocha, F. E., López‐Gil, J. F., & Cruz, B. D. P. (2023) · Cardiovascular Research · doi:10.1093/cvr/cvad176 · Cited by 70
“100 However, owing to the well-spread sample used in this study, which comprised 70 countries, our estimations may provide reliable information on the status of this cardiovascular risk factor for children and young adults together (i.e. 2–25 years), although the prevalence of this risk factor may…”
Background
Risk factors for noncommunicable chronic diseases in women in China: surveillance efforts
Yichong, L., Wang, L., Jiang, Y., Zhang, M., & Wang, L. (2013) · Bulletin of the World Health Organization · doi:10.2471/blt.13.117549 · Cited by 63
Augmenting fruit and vegetable consumption by an online intervention: Psychological mechanisms
Keller, J., Motter, S., Motter, M., & Schwarzer, R. (2017) · Appetite · doi:10.1016/j.appet.2017.09.019 · Cited by 62
Sociodemographic predictors of multiple non-communicable disease risk factors among older adults in South Africa
Phaswana-Mafuya, N. R., Peltzer, K., Chirinda, W., Musekiwa, A., & Kose, Z. (2013) · Global Health Action · doi:10.3402/gha.v6i0.20680 · Cited by 61
Colourful = healthy? Exploring meal colour variety and its relation to food consumption
König, L. M., & Renner, B. (2017) · Food Quality and Preference · doi:10.1016/j.foodqual.2017.10.011 · Cited by 61
“As most people consume too little fruit and vegetables (Hall, Moore, Harper, & Lynch, 2009) and too much sugar, the need for public health initiatives to facilitate healthier diets is high (World Health Organization., 2007).”
Low consumption of fruits and vegetables among adults in Uganda: findings from a countrywide cross-sectional survey
Kabwama, S. N., Bahendeka, S., Wesonga, R., Mutungi, G. N., & Guwatudde, D. (2019) · Archives of Public Health · doi:10.1186/s13690-019-0332-6 · Cited by 67
“Due to their low caloric content and high fiber and nutrient density, the recommended level of consumption of fruits and/ or vegetables is a minimum of 5 servings per day [4, 11, 12].”
Background
Fruits and vegetables consumption and associated factors among in-school adolescents in seven African countries
Peltzer, K., & Pengpid, S. (2010) · International Journal of Public Health · doi:10.1007/s00038-010-0194-8 · Cited by 60
“In terms of mean daily servings of fruits and/or vegetables Tanzanian school children had the highest (4.3) followed by Zambian (3.4), Botswana (3.3), Kenyan (3.0), Swaziland (2.8), Ugandan (2.7) and Senegalese (2.6) school children.”
Influential
Barriers to Treatment and Control of Hypertension among Hypertensive Participants: A Community-Based Cross-sectional Mixed Method Study in Municipalities of Kathmandu, Nepal
Devkota, S. P., Dhungana, R. R., Pandey, A. R., Bista, B., Panthi, S., Thakur, K. K., & Gajurel, R. M. (2016) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2016.00026 · Cited by 60
“Sufficient Fruit and Vegetables Intake Intake of at least 400 g of fruit and vegetables in a day was regarded as sufficient (27).”
Background
Fruit and vegetable biodiversity for nutritionally diverse diets: Challenges, opportunities, and knowledge gaps
Harris, J., van Zonneveld, M., Achigan-Dako, E. G., Bajwa, B. E., Brouwer, I. D., Choudhury, D., de Jager, I., Piters, B. D. S., Dulloo, E., Guarino, L., et al. (2022) · Global Food Security · doi:10.1016/j.gfs.2022.100618 · Cited by 63
Associations of consumption of fruits and vegetables during pregnancy with infant birth weight or small for gestational age births: a systematic review of the literature
Murphy, M., Stettler, N., Reiss, R., & Smith, K. (2014) · International Journal of Women s Health · doi:10.2147/ijwh.s67130 · Cited by 59
Associations of physical partner violence and sexual violence victimization on health risk behaviours and mental health among university students from 25 countries
Pengpid, S., & Peltzer, K. (2020) · BMC Public Health · doi:10.1186/s12889-020-09064-y · Cited by 64
“Fruit and vegetable intake was measured with two questions, 1) “How many servings [80 grams] of fruit do you eat on a typical day?” and 2)“How many servings [80 g] of vegetables do you eat on a typical day?” [44].”
Method
Global and National Socioeconomic Disparities in Obesity, Overweight, and Underweight Status
Moore, S., Hall, J. N., Harper, S. B., & Lynch, J. W. (2010) · Journal of Obesity · doi:10.1155/2010/514674 · Cited by 57
Global assessment of select phytonutrient intakes by level of fruit and vegetable consumption
Murphy, M. M., Barraj, L. M., Spungen, J. H., Herman, D. R., & Randolph, R. K. (2014) · British Journal Of Nutrition · doi:10.1017/s0007114514001937 · Cited by 56
“Fruit and vegetable intakes worldwide are lower than recommended levels (20,21) , consequently the diets of many individuals may be lacking in essential nutrients as well as phytonutrients typical of a diet rich in a variety of fruits and vegetables.”
Background
Patterns of fruit and vegetable consumption among Iranian adults: a SuRFNCD-2007 study
Esteghamati, A., Noshad, S., Nazeri, A., Khalilzadeh, O., Khalili, M., & Nakhjavani, M. (2011) · British Journal Of Nutrition · doi:10.1017/s0007114511005393 · Cited by 56
“men and 81·3 for women) and the United Arab Emirates (77·8 for men and 74·5 for women), and higher than its eastern neighbour Pakistan (99·2 for men and 99·3 for women)((15)).”
BackgroundResultInfluential
Social distribution of diabetes, hypertension and related risk factors in Barbados: a cross-sectional study
Howitt, C., Hambleton, I. R., Rose, A., Hennis, A. J. M., Samuels, T. A., George, K. S., & Unwin, N. C. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008869 · Cited by 60
Are ‘fruits and vegetables’ intake really what they seem in India?
Minocha, S., Thomas, T. S., & Kurpad, A. V. (2018) · European Journal of Clinical Nutrition · doi:10.1038/s41430-018-0094-1 · Cited by 56
Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work
Noorwali, E. A., Hardie, L. J., & Cade, J. E. (2019) · Nutrients · doi:10.3390/nu11061382 · Cited by 58
“Despite these recommendations, FV consumption remains below the recommended levels and below the WHO recommendations in many countries [37,43,44].”
Background
Consumption of fruits and vegetables among adolescents: a multi-national comparison of eleven countries in the Eastern Mediterranean Region
Ani, M. F. A., Al-Subhi, L., & Bose, S. (2016) · British Journal Of Nutrition · doi:10.1017/s0007114515005371 · Cited by 55
“The adverse relationship between F&V intake and age has been shown to start from early adolescence((38)) and may persist into late adolescence and adulthood((1,14,39)).”
Background

Authors: Hall, J. N., Moore, S., Harper, S. B., & Lynch, J. W.
Affiliations: Queen's University (CA)
McGill University (CA)
University of South Australia (AU)
Corresponding author: Moore, Spencer
ORCID: Hall, Justin N.
Moore, Spencer
Harper, Sam B.
Lynch, John W.
Venue: American Journal of Preventive Medicine
Publisher: Elsevier BV
Published: 2009-05
Volume: 36
Issue: 5
Pages: 402-409.e5
ISSN: 0749-3797 (ISSN-L)
DOI: 10.1016/j.amepre.2009.01.029
OpenAlex: W2060303123
Cited by: 597
References: 41
Citations by year: 2026: 15 · 2025: 21 · 2024: 27 · 2023: 42 · 2022: 41 · 2021: 52 · 2020: 47 · 2019: 35 · 2018: 48 · 2017: 48 · 2016: 39 · 2015: 43 · 2014: 53 · 2013: 27 · 2012: 28
FWCI: 19.74
Type: journal article
Language: en
Open access: green
research.wur.nl
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: American Journal of Preventive Medicine (publishedVersion)
PubMed (publishedVersion)
Socio-Environmental Systems Modeling (acceptedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Explore Bristol Research (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: U.S. Public Health Service (263-MQ-611198)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
Keywords: fruit and vegetable intake, prevalence, sociodemographic differences, sex differences, age differences, income, urban-rural differences, low- and middle-income countries, chronic disease prevention, dietary guidelines, World Health Survey
MeSH terms: Adolescent, Adult, Aged, Cross-Sectional Studies, Diet, Female, Fruit, Humans, Male, Middle Aged, Vegetables, Global Health, Prevalence, Nutrition Policy

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Global Variability in Fruit and Vegetable Consumption

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