Skip to main content
Knowledge4Policy
KNOWLEDGE FOR POLICY

Health Promotion and Disease Prevention Knowledge Gateway

A reference point for public health policy makers with reliable, independent and up-to date information on topics related to promotion of health and well-being.

Page | Last updated: 26 Oct 2023

Fruit and Vegetables

F&V intake is associated with a reduction in the risk of non-communicable diseases like cardiovascular disease, Type 2 diabetes mellitus and some types of cancer.

Botanical definitions of vegetables, and fruit as a subcategory, refer to any kind of plant, without consideration for edibility. For nutrition purposes however, the term vegetable in general refers to a plant cultivated for its edible part(s), or refers to the edible parts of a plant ( IARC Handbook ); these include the stems and stalks, roots, tubers, bulbs, leaves, flowers and fruits. Fruit are, by this definition, a subgroup of vegetables consisting of the seeds and surrounding pulpy tissues. What constitutes a fruit or a vegetable varies, depending on their traditional uses in different countries and cultural practices ( IARC Handbook ). Reference to fruit and vegetables (F&V) often excludes cereal grains, nuts, seeds, tea leaves, coffee beans, cacao beans, herbs and spices. Table 1 provides examples of fruit and vegetable-related definitions.

Table 1: Examples of fruit and vegetable-related definitions 

The macronutrient composition of F&V differs substantially. Even within the same fruit or vegetable it can vary according to many factors, such as the type of cultivar, the plant growing conditions (e.g. soil composition, climate, fertilizer use), post-harvest handling, distribution and storage conditions as well as the ripeness of the final produce. In general, F&V have a high fibre and water content and they are a good source of micronutrients such as vitamins (in particular vitamins C and E, provitamin A and folate) and minerals (e.g. potassium, magnesium, phosphorus and calcium). Legumes, roots and tubers have a higher energy density in comparison to fruit and leafy vegetables. Legumes also have high protein content and are a good source of iron. Nuts have high energy density due to their high fat content, mainly in the form of unsaturated fatty acids. F&V also contain a variety of phytochemicals, as reported in Table 2.

Food processing – such as juicing, canning, freezing or cooking – can have an impact on F&V nutritional value. Commercial canning and freezing appear to have little effect but may result in minimal losses of some micronutrients (e.g. vitamin C and folic acid); often F&V cultivars used for canning are different from those sold fresh and this may be reflected in their composition too (e.g. higher levels of carotenoids in canned vs fresh tomatoes) ( Rickman JC, et al ). Other food processing techniques such as juicing result in changes to the energy density and loss of dietary fibre; drying of F&V removes water and also results in an increase in energy density ( IARC Handbook )

Table 2: Phytochemicals and the fruits and vegetables where they can be found 

According to major food and health-related organizations – and as described in Table 3 - F&V intake is associated with a reduction in the risk of non-communicable diseases like cardiovascular disease (CVD), Type 2 diabetes mellitus (T2DM) and some types of cancer as well as improved bone health and reduced likelihood of unhealthy weight gain.

Table 3: Health effects related to fruit and vegetables intake by food and health-related organisations 

Table 4 showcases recommendations for F&V intake.

Table 4: Dietary recommendations for fruit and vegetable intake as by food and health-related organisations 

Average F&V intake data for different age groups in European countries are presented in Table 5.  The intake data -unless differently specified- has been extracted from the European Food Safety Authority (EFSA) Comprehensive Food Consumption database ( EFSA database ). According to EFSA – and as reported in the 2009 European Nutrition and Health Report ( ENHR 2009 ) – daily intake of F&V varies broadly across different countries and between population groups. Despite the different methodologies used for the assessment of food intake in the surveys, it is possible to conclude that, with few exceptions, EU citizens fail to consume the recommended 400 grams a day of F&V.

Table 5: Overview of fruit and vegetable intake in European countries 

The European Health Interview Survey (EHIS) (Eurostat 2016 (pdf)) reports that, on average, more than a third of the EU adults (defined as older than 15 years) does not consume any F&V on a daily basis whereas 51.4% consume between 1 and 4 portions of F&V per day; only 14.1% of the EU adults consume 5 portions (equivalent to 400g) of F&V per day as recommended by most food based dietary guidelines (Food-Based Dietary Guidelines page).

Data from a 2013-2014 European children survey ( WHO 2016b (pdf) ) suggest that, on average, less than half of the children ate fruit on a daily basis, with even less frequent intakes observed in the age groups of 13- and 15-year olds. Data for vegetable consumption patterns are similar to those for fruit.

The Global Burden of Disease study ( GBD Study 2019 ) estimated that in EU Member States in 2019, diets low in fruit and vegetables were among the leading dietary risk factors, being accountable for approx. 73 000 and 41 000 deaths respectively (GBD Tool 2019). In addition, diets low in fruit were accountable for approx. 1.5 million Disability-Adjusted Life Years (DALYs), while diets low in vegetables accounted for approx. 600 000 DALYs. Values for individual EU Member States in 2019 can be seen in the map below. The GBD study defines diets low in fruits as average daily consumption of less than 310-340 grams of fruits (fresh, frozen, cooked, canned, or dried, excluding fruit juices and salted or pickled fruits), and diets low in vegetables as average daily consumption of less than 280-320 grams of vegetables (fresh, frozen, cooked, canned or dried vegetables excluding legumes and salted or pickled vegetables, juices, nuts and seeds, and starchy vegetables such as potatoes or corn).

View visualisation: DALYs and data table - diet low in fruit 

View visualisation: Mortality map and data table - diet low in fruit 

View visualisation: DALYs and data table - diet low in vegetables 

View visualisation: Mortality map and data table - diet low in vegetables 

These data are confirmed by other studies; a recent meta-analysis ( Wang X., et al 2014 ) of observational studies conducted in Europe, North America and Asia found that higher consumption of F&V is associated with a reduced risk of mortality from all causes, and from CVD in particular. All-cause mortality decreased by 5% for each additional serving a day of F&V (6% for fruit and 5% for vegetables) with a threshold of around five servings a day, after which the risk of death did not decrease further. Similarly, the European Prospective Investigation into Cancer and Nutrition (EPIC) study reported that participants consuming more than 569 g per day of fruit and vegetables had respectively 15%, 27% and 40% lower risk of circulatory, respiratory and digestive system mortality when compared with participants consuming less than 249 g per day ( Leenders M.,et al 2014 ).  

Inequalities and fruits and vegetables intake

There is evidence to suggest that those with lower income and education levels consume less F&V (Eurostat 2016 (pdf), GBD Study 2016, WHO 2014b (pdf) ) . A more detailed discussion on fruit and vegetables consumption and inequalities can be found in the Inequalities in Diet and Physical Activity Patterns in this series.

Two recent nutrition-related European action plans, the EU Action Plan on Childhood Obesity 2014-2020 (EU 2014 (pdf)) and the WHO European Food and Nutrition Action Plan 2015–2020 ( WHO 2015 (pdf) ) offer, among others, detailed recommendations regarding specific policy actions to increase availability and intake of F&V in Europe. These are summarised in Table 6. In both documents (but in particular in the EU Action Plan on Childhood Obesity), special attention has been given to school children. In addition, both documents highlight the need to focus on low socio-economic and other vulnerable population groups.

Table 6: Policy recommendations to address fruit and vegetable intake 

The European Commission has also compiled series of effective school-based interventions to increase F&V intake consumption in children. These school-based actions, separated into education, environment and parental are tried and tested interventions that have shown to increase F&V consumption in children and are described in 'How to promote fruit and vegetable consumption in schools: a toolkit' (JRC 2016).

Several European countries have implemented policies to increase fruit and vegetable consumption in children as well as adults. Examples of such policies are detailed in table 7.

Table 7: Implemented policies to address fruit and vegetable intake 

References

Overview of the references to this brief