Cardiovascular disease (CVD) mortality rates are considerably higher in countries of Central and Eastern Europe (CEE) and Former Soviet Union (FSU) compared to Western Europe (WE). Differences in diet quality between the two regions - fruit and vegetable consumption in particular - has been one of the proposed explanations for this health gap. The lack of internationally comparable, individual level dietary data in Europe is a well-known problem in public health nutrition.
Denes Stefler and Martin Bobak at Department of Epidemiology and Public Health of University College London aimed to answer the question whether cross-national studies with comparable individual-level dietary data reveal any systematic differences in fruit and vegetable consumption between populations in CEE and FSU compared to WE.
Studies were identified by electronic search of MEDLINE, EMBASE and Web of Science databases from inception to September 2014, and hand search. Studies which reported data on fruit, vegetable consumption or carotene and vitamin C intake or tissue concentrations of adult participants from both CEE/FSU and WE countries were considered for inclusion. Quality of the included studies was assessed by a modified STROBE statement. Power calculation was performed to determine the statistical significance of the comparison results.
From review work twenty-two studies resulted to meet the inclusion criteria. Fruit consumption was found to be consistently lower in CEE/FSU participants compared to Western Europeans. Results on vegetable intake were less unambiguous. Antioxidant studies indicated lower concentration of beta-carotene in CEE/FSU subjects, but the results for vitamin C were not consistent.
Scientists conclude that this systematic review supports previous data that people in CEE/FSU countries consume less fruit than Western Europeans, and that the difference in vegetable intake is probably less clear-cut. Since inadequate consumption of fruit is suggested as a modifiable risk factor for CVD, the difference in fruit intake may contribute to the gap in CVD mortality rates between the two regions.
