Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa.
S Afr Med J. 2022 Sep 30;112(8b):617-626. doi: 10.7196/SAMJ.2022.v112i8b.16486.
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.
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.
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.
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).
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.
水果和蔬菜摄入量低与各种非传染性疾病的风险增加有关，包括心血管疾病、糖尿病和癌症等主要死因和致残原因。南非（SA）人口的水果和蔬菜摄入量低，且平均摄入量远低于国际推荐阈值。
估算 2000 年、2006 年和 2012 年 SA 因水果和蔬菜摄入量低而导致的疾病负担，按性别和年龄组划分。
我们遵循世界卫生组织和全球疾病负担研究的比较风险评估方法。基于国家和地方调查估计的水果和蔬菜摄入量以及基于当前文献的健康结果的相对风险，计算了人群归因分数，并将其应用于第二次南非国家疾病负担研究（SANBD2）的负担估计值。结果指标包括缺血性心脏病、中风、2 型糖尿病和五类癌症导致的死亡和残疾调整生命年（DALY）损失。
2000 年至 2012 年期间，SA 成年人口（≥25 岁）的水果平均摄入量下降了 7%，从 48.5 克/天（95%置信区间[95%UI] 46.6-50.5）降至 45.2 克/天（95%UI 42.7-47.6）。蔬菜摄入量下降了 25%，从 146.9 克/天（95%UI 142.3-151.8）降至 110.5 克/天（95%UI 105.9-115.0）。2012 年，这些消费模式估计导致 26423 人死亡（95%UI 24368-28006），占 SA 所有死亡人数的 5.0%（95%UI 4.6-5.3%），并导致 514823 人失去健康生命年（95%UI 473508-544803）或所有 DALY 的 2.5%（95%UI 2.3-2.6%）。心血管疾病占归因负担的最大比例，有 83%的死亡和 84%的 DALY。男性的年龄标准化死亡率（145.1 人/100000；95%UI 127.9-156.2）高于女性（108.0 人/100000；95%UI 96.2-118.1）；在两性中，死亡率均低于 2000 年观察到的水平（分别下降 9%和 12%）。
尽管自 2000 年以来观察到标准化死亡率总体下降，但 SA 因水果和蔬菜摄入不足而导致的疾病负担绝对值仍令人严重关切。需要通过立法和政策支持的有效干预措施来扭转大多数年龄组中观察到的消费下降趋势，并遏制相关负担。
