Public Health Nutrition

Research paper

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

Miguel Á Martínez-Gonzáleza1 c1, Carmen de la Fuente-Arrillagaa1, Cristina López-del-Burgoa1, Zenaida Vázquez-Ruiza1, Silvia Benitoa1 and Miguel Ruiz-Canelaa1

a1 Department of Preventive Medicine and Public Health, Medical School and Clinic, University of Navarra, Irunlarrea 1, 31080 Pamplona, Navarra, Spain


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.

(Received May 13 2011)

(Accepted September 07 2011)

(Online publication December 13 2011)


c1 Corresponding author: Email