Nearly 60% of the people in low-income countries, including India, cannot afford the recommended daily intake of fruits and vegetables, research published in the British medical journal Lancet has concluded.
Most nutritional guidelines recommend the consumption of at least two servings of fruits and three servings of vegetables per day. However, according to the study, a large proportion of individuals do not meet these targets. Data shows that consumption of fruit and vegetables is low worldwide, particularly in low-income countries, and lower the average income of a country, the lower the average consumption of fruits and vegetables.
The study is based on responses received from 147,938 adults aged 35-70 years in 18 countries between January 1, 2003 and December 31, 2013. The responses of 143,000 individuals were considered as the rest did not report “plausible energy intake” in the range of 500-5,000 kilo calories per day.
The countries were divided into four categories based on their income levels. The low-income countries include Bangladesh, India, Pakistan and Zimbabwe. The four lower-middle income countries include China, Colombia, Iran and Occupied Palestinian Territory. Upper-middle income countries are Argentina, Brazil, Chile, Malaysia, Poland, Turkey and South Africa and the three high income countries are Canada, Sweden and United Arab Emirates.
Data shows that in low-income countries, the average consumption of fruits and vegetables per day is nearly half of what it is in high income countries. For the bottom three income-group countries, consumption levels are lower than the required number of servings.
Also, in low-income countries, the average consumption of fruits (0.8 servings) is much lower than that of vegetables (1.48). The study also claims that the variety of vegetables and fruits that are available for sale is greatest in high-income countries, intermediate in upper-middle income countries, lower in lower-middle income countries and lowest in lower-income countries.
A strong, inverse relation exists between gross national income and the average proportion of total household income spent on food. In low-income countries, including India, individuals spend nearly 62% of their income on food, well above the average of 42.4%. In high-income countries on the other hand, about 13% of the income is spent on food.
People in poorer countries also spend a much larger proportion of their income on fruits and vegetables.
At the absolute cost, vegetables are cheapest in low-income countries while fruits are the most expensive. However, according to the study, the cost of one serving of vegetables relative to income per household member is more than 19 times higher in low-income countries than in high-income countries, and the relative cost of one serving of fruit is 50 times higher.
Unsurprisingly, low-income countries have the highest share of population that cannot afford the required servings of fruits and vegetables. According to the study, worldwide, 1·7 million annual deaths are estimated to be associated with low fruit and vegetable intake.
Hunger and under-nutrition remain highly prevalent in many low-income and medium-income countries and nutrition strategies in these countries often prioritise meeting the minimum energy intake over diet quality.
Increased cost of fruits and vegetables relative to household income is associated with reduced consumption, highlighting the need for policies that expand affordability and availability of these foods, which might improve the diet quality of many populations, especially in lower and lower-middle income countries.