Global Progress, Unequal Gains: Diet and Cancer Burden

The effects of dietary risks are not distributed evenly. New research traces three decades of cancer burden associated with low fruit and vegetable intake and projects global trends through 2035.

Published in Healthcare & Nursing and Cancer

Global Progress, Unequal Gains: Diet and Cancer Burden
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Springer International Publishing
Springer International Publishing Springer International Publishing

Global inequalities in cancer burden attributable to low fruit and vegetable intake: an analysis of GBD 2021 data

Cancer burden remains uneven worldwide, and the contribution of insufficient fruit and vegetable intake to cancer outcomes requires updated assessment. Using Global Burden of Diseases, Injuries, and Risk Factors Study 2021 estimates, this ecological study evaluated total cancer burden and cancer mortality and disability-adjusted life-year (DALY) rates attributable to low fruit intake and low vegetable intake from 1990 to 2021 across 204 countries and territories, 21 GBD regions, and five Socio-demographic Index (SDI) quintiles. Bayesian age–period–cohort models were further used to project global trends through 2035. Globally, the age-standardized incidence rate increased from 252.85 to 275.16 per 100,000 population between 1990 and 2021, whereas the age-standardized mortality rate decreased from 147.67 to 115.81 and the age-standardized DALY rate decreased from 3956.14 to 2939.02 per 100,000 population. Higher-SDI settings generally showed higher incidence but greater reductions in mortality and DALY rates, while lower-SDI settings showed less consistent improvements. Low-vegetable-attributable cancer mortality declined from 1.89 to 0.66 per 100,000 population, whereas low-fruit-attributable mortality declined from 1.30 to 0.77; by 2021, low fruit intake became the slightly larger contributor. Diet-attributable burden was highest in parts of Sub-Saharan Africa and South Asia and was higher among males. Projections suggested stable incidence but continued declines in mortality and DALY rates through 2035. Low fruit intake and low vegetable intake remain distinct, modifiable contributors to cancer burden, supporting nutrition-sensitive cancer prevention strategies. Graphical abstract

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. 

Author's note: I used Microsoft Copilot to assist in creating this post.

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Nutrition
Life Sciences > Health Sciences > Health Care > Nutrition
Cancer Epidemiology
Life Sciences > Biological Sciences > Cancer Biology > Cancer Epidemiology
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