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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Diet and Respiratory Health in Children from 11 Latin American Countries: Evidence from ISAAC Phase III
and the ISAAC Phase III Latin America Group, Cepeda, A. M., Thawer, S. G., Boyle, R. J., Villalba, S., Jaller, R., Tapias, E., Segura, A. M., Rodrigo Villegas, R., & Garcia-Larsen, V. (2017) · Lung · doi:10.1007/s00408-017-0044-z · Cited by 31
“Worldwide variations in frequency of consumption of fruits and vegetables were reported for the first time in 2009 for adults from 52 countries, showing that lower income countries also have difficulties adhering to these recommendations [17].”
Background
Contrasting Effects of Short-Term Mediterranean and Vegan Diets on Microvascular Function and Cholesterol in Younger Adults: A Comparative Pilot Study
Rogerson, D., Maçãs, D., Milner, M., Liu, Y., & Klonizakis, M. (2018) · Nutrients · doi:10.3390/nu10121897 · Cited by 36
“However, few appear to achieve recommended intakes [5], necessitating strategies to foster this important behaviour change.”
Background
Global variability in diabetes mellitus and its association with body weight and primary healthcare support in 49 low‐ and middle‐income developing countries
Liu, L., Yin, X., & Morrissey, S. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03549.x · Cited by 30
Physical activity, nutrition and behavior change in Latin America: a systematic review
Barboza, C. F., Monteiro, S. M. D. R., Barradas, S. C., Sarmiento, O. L., Ríos, A. P., Varela, A. R., Mahecha, M. P., & Pratt, M. (2013) · Global Health Promotion · doi:10.1177/1757975913502240 · Cited by 33
Underestimation of weight and its associated factors in overweight and obese university students from 21 low, middle and emerging economy countries
Peltzer, K., & Pengpid, S. (2014) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2014.08.004 · Cited by 29
Motivational theater to increase consumption of vegetable dishes by preschool children
Nicklas, T. A., Lopez, S., Liu, Y., Saab, R., & Reiher, R. H. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0468-0 · Cited by 30
Probabilistic quantitative microbial risk assessment model of norovirus from wastewater irrigated vegetables in Ghana using genome copies and fecal indicator ratio conversion for estimating exposure dose
Owusu-Ansah, E. D.-G. J., Sampson, A., Amponsah, S. K., Abaidoo, R. C., Dalsgaard, A., & Hald, T. (2017) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2017.05.168 · Cited by 29
Alcohol consumption and fruits and vegetable intake among older adults in Ghana: a cross-sectional survey based on WHO-SAGE Wave 2 data
Tachi, K., Tetteh, J., Yawson, A. E., Agyei-Nkansah, A. A., & Archampong, T. N. A. (2020) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2020-000102 · Cited by 29
Vegetables for Healthy Diets in Low- and Middle-Income Countries: A Scoping Review of the Food Systems Literature
Harris, J., Tan, W., Raneri, J. E., Schreinemachers, P., & Herforth, A. (2022) · Food and Nutrition Bulletin · doi:10.1177/03795721211068652 · Cited by 29
Fruit and Vegetable Purchasing Patterns and Preferences in South Delhi
Finzer, L. E., Ajay, V. S., Ali, M. K., Shivashankar, R., Goenka, S., Sharma, P., Pillai, D., Khandelwal, S., Tandon, N., Reddy, K. S., et al. (2013) · Ecology of Food and Nutrition · doi:10.1080/03670244.2012.705757 · Cited by 30
“Factors such as income, age, and education have all been associated with FV intake in other countries (Darmon and Drenowski 2008; Ball, Crawford, and Mishra 2006; Subar et al. 1995; Nayga 1995; Hall et al. 2009; Thorne-Lyman et al. 2010).”
Background
Prevalence, clustering and sociodemographic distributions of non-communicable disease risk factors in Nepalese adolescents: secondary analysis of a nationwide school survey
Dhungana, R. R., Bista, B., Pandey, A. R., & de Courten, M. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028263 · Cited by 29
“Likewise, eating fruit and vegetable for five and more times per day was regarded as sufficient intake.(25) Overweight and obesity definitions correspond to the WHO criteria of +1 SD and +2 SD from the median for body mass index (BMI), respectively.”
Background
Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji
O’Meara, L., Williams, S. L., Hickes, D., & Brown, P. H. (2019) · Nutrients · doi:10.3390/nu11071629 · Cited by 30
“Globally, nutrition-related noncommunicable diseases (NCDs) account for more than 36 million deaths each year and almost 80% of these deaths occur in low- and middle-income countries [1].”
BackgroundInfluential
Intraclass correlation and design effect in BMI, physical activity and diet: a cross-sectional study of 56 countries
Masood, M., & Reidpath, D. D. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-008173 · Cited by 28
“Diet was operationalised as the number of serves of fruit and vegetable (FVI) in a typical day, using two questions on average FVI per day.(12) Data on MET were missing for Australia, Finland, France, Ireland, Latvia, Portugal and Sweden.”
Method
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/s0007114516003810 · Cited by 28
“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) .”
The global disease burden attributable to a diet low in fibre in 204 countries and territories from 1990 to 2019
Zhuo, M., Chen, Z., Zhong, M., Liu, Y.-M., Lei, F., Qin, J., Sun, T., Yang, C., Chen, M., Song, X., et al. (2022) · Public Health Nutrition · doi:10.1017/s1368980022001987 · Cited by 30
“In addition, data from fifty-two countries showed that urban areas with increasing income levels consume more fruits and vegetables(36).”
Background
Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women
Skreden, M., Bere, E. T., Sagedal, L. R., Vistad, I., & Øverby, N. C. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1291-y · Cited by 28
“A low intake of FV may be explained by a variety of factors such as cost [19], availability, familiarity, and time for preparation [37–39].”
Background
Health messages to promote fruit and vegetable consumption at different stages: A match-mismatch design
Godinho, C. A., Alvarez, M.-J., Lima, M., & Schwarzer, R. (2015) · Psychology and Health · doi:10.1080/08870446.2015.1054827 · Cited by 26
“Despite all the benefits of a diet rich in fruit and vegetables, for many people, their consumption is still below the recommended 400 grams (approximately 5 portions) a day (Hall et al., 2009).”
Background
Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia
Kassa, A., & Woldesemayat, E. M. (2019) · International Journal of Chronic Diseases · doi:10.1155/2019/2509242 · Cited by 27
Explaining inequalities in fruit and vegetable intake in Europe: The role of capabilities, opportunities and motivations
Craveiro, D., Marques, S., Zvěřinová, I., Máca, V., Ščasný, M., Chiabai, A., Suárez, C., Martínez-Juárez, P., de Jalón, S. G., Quiroga, S., et al. (2021) · Appetite · doi:10.1016/j.appet.2021.105283 · Cited by 27
Low Daily Intake of Fruits and Vegetables in Rural and Urban Bangladesh: Influence of Socioeconomic and Demographic Factors, Social Food Beliefs and Behavioural Practices
Mustafa, S., Haque, C. E., & Baksi, S. (2021) · Nutrients · doi:10.3390/nu13082808 · Cited by 27
“Different social, cultural and geographic factors, as well as variations in lifestyle, habits, nutritional knowledge or cooking styles may also affect the level of consumption [28], and these were not addressed in the present study.”
Background
Intake of ultra-processed food, dietary diversity and the risk of nutritional inadequacy among adults in India
Mediratta, S., Ghosh, S., & Mathur, P. (2023) · Public Health Nutrition · doi:10.1017/s1368980023002112 · Cited by 26
“The sample size for males and females was calculated separately with a CI of 95 % and confidence limits set at 5 %.”
Method
FRUIT AND VEGETABLE CONSUMPTION AMONG STUDENTS OF TERTIARY INSTITUTIONS IN OYO STATE
L.A., L. A. S., & Adeoye, I. B. (2014) · Russian Journal of Agricultural and Socio-Economic Sciences · doi:10.18551/rjoas.2014-06.01 · Cited by 26
Do Trees on Farms Improve Household Well-Being? Evidence From National Panel Data in Uganda
Miller, D. C., Muñoz, J. C., Rasmussen, L. V., & Zezza, A. (2020) · Frontiers in Forests and Global Change · doi:10.3389/ffgc.2020.00101 · Cited by 26
Importance of data preparation when analysing written responses to open-ended questions: an empirical assessment and comparison with manual coding
Jaeger, S., & Rasmussen, M. (2021) · Food Quality and Preference · doi:10.1016/j.foodqual.2021.104270 · Cited by 17
Barrier analysis for adequate daily fruit and vegetable consumption among low-income residents of Hanoi, Vietnam and Ibadan, Nigeria
Filippo, A. D., Meldrum, G., Samuel, F. O., Tuyết, T., Kennedy, G., Adeyemi, O., Phuong, N., Wertheim‐Heck, S., Talsma, E. F., Shittu, O. O., et al. (2021) · Global Food Security · doi:10.1016/j.gfs.2021.100586 · Cited by 26
Vegetable and Fruit Intake Variety and Cardiovascular Health and Mortality: A Systematic Review and Meta-Analysis of Observational Studies
Nishi, S. K., Khoury, N., Valle‐Hita, C., Zurbau, A., Salas‐Salvadó, J., & Babió, N. (2023) · Nutrients · doi:10.3390/nu15234913 · Cited by 31
“This is of importance as globally, 78% of individuals do not meet the World Health Organization (WHO) recommendations for ﬁve daily servings of fruits and vegetables [59].”
Background
Education and WHO Recommendations for Fruit and Vegetable Intake Are Associated with Better Cognitive Function in a Disadvantaged Brazilian Elderly Population: A Population-Based Cross-Sectional Study
Pastor‐Valero, M., Viebig, R. F., Menezes, P. R., Simon, A. D. S., Vallada, H., & Scazufca, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0094042 · Cited by 28
“18 years old showed daily intakes $ 400 g/day of fruit and vegetables [30].”
Background
Stages of change to increase fruit and vegetable intake and its relationships with fruit and vegetable intake and related psychosocial factors
Yen, W. C., Shariff, Z. M., Kandiah, M., & Taib, M. N. M. (2014) · Nutrition Research and Practice · doi:10.4162/nrp.2014.8.3.297 · Cited by 26
“Despite the recommendations, a high proportion of the world’s populations do not consume adequate amount of fruits and vegetables [2-4].”
Background
Fruit and vegetable consumption in Vietnam, and the use of a ‘standard serving’ size to measure intake
Bui, T. V., Blizzard, C. L., Luong, K. N., Truong, N. L. V., Bao, T. Q., Otáhal, P., Srikanth, V. K., Nelson, M. R., Au, T. B., Ha, S. T., et al. (2016) · British Journal Of Nutrition · doi:10.1017/s0007114516001690 · Cited by 26
“Two simple questions on fruit and vegetable consumption were used in the World Health Survey(3), and four simple questions were included in the ‘WHO STEPwise approach to surveillance of non-communicable diseases (NCD)’ (STEPS) questionnaire to collect information on the number of standard servings of fruit and vegetab…”
BackgroundMethodResultInfluential
Sociodemographic Determinants of Low Fruit and Vegetable Consumption Among Bangladeshi Adults: Results From WHO-STEPS Survey 2010
Karim, M. N., Zaman, M. M., Rahman, M. M., Chowdhury, M. A. J., Ahsan, H., Hassan, M. M., Karim, S. R., Hossain, M. Z., & Billah, B. (2017) · Asia Pacific Journal of Public Health · doi:10.1177/1010539517699059 · Cited by 28
Can Reduced Intake Associated with Downsizing a High Energy Dense Meal Item be Offset by Increased Vegetable Variety in 3–5-year-old Children?
Carstairs, S. A., Caton, S. J., Blundell-Birtill, P., Rolls, B. J., Hetherington, M. M., & Cecil, J. E. (2018) · Nutrients · doi:10.3390/nu10121879 · Cited by 25
“Variety has been used to facilitate vegetable intake in children [27], which is an important observation given the low vegetable intakes evident globally [28].”
Mother’s Fruit Preferences and Consumption Support Similar Attitudes and Behaviors in Their Children
Groele, B., Głąbska, D., Gutkowska, K., & Guzek, D. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15122833 · Cited by 25
“4% of women had a lower intake of fruits and vegetables than the minimum recommended level [18].”
Background
Nature's bountiful gift to humankind
Krishnaswamy, K., & Gayathri, R. (2018) · The Indian Journal of Medical Research · doi:10.4103/ijmr.ijmr_1780_18 · Cited by 28
Nutrient and phytochemical composition of two varieties of Monkey kola (Cola parchycarpa and Cola lepidota): An underutilised fruit
Ene‐Obong, H. N., Okudu, H. O., & Asumugha, U. V. (2014) · Food Chemistry · doi:10.1016/j.foodchem.2014.11.045 · Cited by 25
Fruit and vegetable consumption in the former Soviet Union: the role of individual- and community-level factors
Goryakin, Y., Rocco, L., Suhrcke, M., Roberts, B., & McKee, M. (2015) · Public Health Nutrition · doi:10.1017/s1368980015000105 · Cited by 25
“Surveys were nationally representative and conducted among adult respondents (aged ≥18 years) in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine.”
BackgroundInfluential
Dietary consumption and happiness and depression among university students: A cross-national survey
Peltzer, K., & Pengpid, S. (2017) · Journal of Psychology in Africa · doi:10.1080/14330237.2017.1347761 · Cited by 26
The Association of Dietary Behaviors and Physical Activity Levels with General and Central Obesity among ASEAN University Students
Peltzer, K., & Pengpid, S. (2017) · AIMS Public Health · doi:10.3934/publichealth.2017.3.301 · Cited by 25
“Dietary behavior variables: Fruit and vegetable (FV) 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) [21].”
Method

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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