Global cancer trends present an apparent contradiction. Between 1990 and 2021, the age-standardized incidence rate increased, while mortality and disability-adjusted life-year rates declined. These changes suggest progress in reducing fatal and disabling outcomes, but they also conceal substantial differences between countries, regions and population groups.
A new study published in Nutrire examines one part of this complex picture: the cancer burden attributable to low fruit and vegetable intake. The authors analyzed Global Burden of Disease 2021 estimates covering 204 countries and territories, 21 regions and five levels of the Socio-demographic Index. Their analysis spans 1990 to 2021 and includes projections of global cancer trends through 2035.
The global figures indicate considerable declines in both dietary risk categories. Cancer mortality attributable to low vegetable intake fell from 1.89 to 0.66 deaths per 100,000 people between 1990 and 2021. The corresponding rate for low fruit intake decreased from 1.30 to 0.77. By 2021, low fruit intake had become the slightly larger of the two contributors to cancer mortality and DALYs at the global level. The study assesses these risks separately, so their estimates should not be added together as a combined dietary effect.
Progress was far from uniform
The burden associated with low fruit intake was especially high in Southern Sub-Saharan Africa and South Asia, while that associated with low vegetable intake was concentrated mainly in Sub-Saharan Africa. Improvements were also less consistent in lower socio-demographic Index (SDI) settings. For example, the cancer disability-adjusted life-year (DALY) rate attributable to low vegetable intake remained relatively high in the low SDI group, declining from 47.54 to 37.33 per 100,000, compared with a decrease from 59.05 to 7.56 in the high-middle-SDI group. Several regional estimates for low vegetable intake had wide uncertainty intervals crossing zero and therefore require cautious interpretation.
The differences extend across age and sex. Diet-attributable cancer burden increased markedly with age, and global mortality and DALY rates associated with both dietary risks were higher among males than females. These patterns support a more differentiated view of nutrition-sensitive cancer prevention, one that considers age, sex, geography and socioeconomic context rather than relying on a single global profile.
The authors project broadly stable global cancer incidence through 2035, alongside continued declines in mortality and DALY rates. These are model-based trajectories rather than precise forecasts. The study is ecological and relies on Global Burden of Diseases-modeled estimates, so it cannot establish that a person’s fruit or vegetable intake caused an individual cancer outcome. It nevertheless shows where diet-attributable burden remains comparatively high and why improving access to affordable, healthy foods should form part of broader cancer-control strategies.