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What to know about cardiorespiratory endurance

Cardiorespiratory endurance is an indication of a person's overall physical health. Cardiorespiratory endurance tests monitor how well the heart, lungs, and muscles perform during moderate to high-intensity exercise.

Increasing cardiorespiratory endurance improves oxygen uptake in the lungs and heart and can help a person sustain physical activity for longer.

Other names for cardiorespiratory endurance include cardiovascular fitness, cardiovascular endurance, and cardiorespiratory fitness.

In this article, we discuss what cardiorespiratory endurance is, how a person can measure it, and why it is important. We also look at how to improve cardiorespiratory endurance, including some examples of exercises.

What is it? Woman jumping rope to improve cardiorespiratory endurance
Jumping rope can improve cardiorespiratory endurance.

Cardiorespiratory endurance measures how well the body performs during long periods of exercise. A person with high cardiorespiratory endurance can sustain high-intensity activities over an extended period without getting tired.

Measuring a person's cardiorespiratory endurance involves examining how well their body takes in and utilizes oxygen.

When a person inhales, their lungs fill up with air and some of the oxygen it contains passes into the bloodstream. This oxygen-rich blood then travels to the heart, which circulates it around the body to the tissues and organs that need it.

The muscles require an adequate supply of oxygen and other nutrients to work properly during high-intensity or extended periods of exercise. If the muscles do not get enough nutrients, waste products begin to accumulate and cause fatigue.

A person's level of cardiorespiratory endurance can directly affect their physical performance.

Thank you for supporting Medical News Today How is it measured? Tests that measure cardiorespiratory endurance include: Metabolic equivalents Metabolic equivalents (METs) refers to the ratio between the energy expended during physical activity and the energy expended while at rest. Finding a person's MET involves measuring how much oxygen their body uses at rest. Maximum oxygen uptake Maximum oxygen uptake (VO2 max) test determines the maximum amount of oxygen the body is capable of using during high-intensity activities, such as sprinting or biking. The VO2 max test typically involves running on a treadmill or pedaling on a stationary bike as fast as possible. During the test, the person wears a chest strap or other body attachment that records their heart rate and a face mask that measures oxygen consumption. Why is it important? Cardiorespiratory endurance indicates a person's level of aerobic health and physical fitness. This information can benefit everyone, not just professional athletes. Having a high cardiorespiratory endurance generally means that a person can perform high-intensity exercise for longer. People trying to lose weight may want to focus on increasing their cardiorespiratory endurance because doing higher-intensity aerobic activities can help a person burn more calories. Scientific research also suggests some other potential health benefits from having an improved cardiorespiratory endurance. For example: A 2017 study suggests that people with higher cardiorespiratory endurance are less likely to develop high blood pressure than those with a lower cardiorespiratory endurance. In a 2015 study, researchers found a positive correlation between cardiorespiratory endurance levels and multitask performance among adults aged between 59 and 80 years. Improving cardiorespiratory endurance may decrease the risk of coronary heart disease and all-cause mortality, according to a 2015 study. How to improve it People can improve their cardiorespiratory endurance through regular exercise. The authors of a 2019 study reported that resistance training, endurance training, and high-intensity interval training led to improvements in cardiorespiratory endurance and muscular strength among adults who were aged 40–65 years old and who were not previously physically active. A 2017 study investigated the effectiveness of a 12-week cross-circuit training program in students who were overweight and had intellectual disabilities. The researchers found participants who followed the training program had an improved exercise endurance, muscle strength, and body mass index. The following exercises can help improve cardiorespiratory endurance, build muscle, and burn calories. People can perform these physical activities at home or add them to their gym routine. Try doing these exercises in sets of 10–15 repetitions, or as many repetitions as possible for 1 minute with a 20-second break in between sets. Jumping jacks: Jumping jacks gif

Start by standing upright with legs together and arms at the sides of the body. Jump up. While in the air, open the legs to spread the feet wide apart and raise the arms overhead. While landing, bring the feet and arms back to the starting position. Burpees: Burpees gif

Begin standing with the feet shoulder-width apart. Bend the knees and place the hands on the floor in front to come down into a squat position. Jump the legs out behind to get into the push-up position, shifting the body's weight onto the hands. Jump the feet back into the squat position. Jump up into the air with arms raised above the head. Land back in the squat position. Mountain climbers (running planks): Mountain climbers (running planks) gif

Start in the plank position, aligning the shoulders over the wrists and keeping the legs straight. Keep the back flat and the head aligned with the spine. Engage the core muscles. Bring the right knee towards the chest. Switch legs by returning the right leg to the starting position and bringing the left knee towards the chest. This completes one repetition. Side-shuffle touches: Start in a standing position with the feet shoulder-width apart and the arms down by the sides. Bend the knees and squat down. Shuffle a shoulder-width to the right and then touch the floor outside the right foot with the fingertips of the right hand. Shuffle a shoulder-width to the left and then touch the floor outside the left foot with the fingertips of the left hand. This is one repetition. Other exercises that can help improve cardiorespiratory fitness include: running power walking swimming dancing jump rope high-intensity sports, such as basketball and soccer Summary Cardiorespiratory endurance is a measure of how well the heart, lungs, and muscles perform during moderate to high-intensity physical activity. Getting regular physical activity, especially aerobic exercise, can improve cardiorespiratory endurance. Aerobic exercises can help promote heart and lung health and improve how well the body circulates and utilizes oxygen.
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What to expect during a physical exam

A physical exam, or a physical, is a routine test wherein a healthcare professional inspects, feels, or listens to different parts a person's body. Other names for a physical include a complete physical exam, a routine physical, and a checkup.

A doctor or nurse may recommend a physical to:

check for possible diseases or medical conditions check for medical issues that may become a problem later on keep track of any changes in a person's physical health determine whether a person needs further tests

In this article, we discuss what to expect during a routine physical exam. We also cover some specific types of physical exam.

What to expect Doctor performs physical examination on patient with stethoscope.
A healthcare professional may listen to the chest during a physical exam.

Healthcare professionals typically carry out a physical exam in their office or in a dedicated room in a medical clinic or hospital.

It is important for the doctor or nurse to make sure that a person feels comfortable during a physical exam. The American Medical Association require clinics to provide a chaperone on request and to allow people to bring a friend or relative into the examination room with them.

Usually, the healthcare professional will also take a medical history before moving onto the physical exam. A medical history is a record of the person's current symptoms as well as any risk factors and previous medical issues that might be relevant.

The doctor or nurse may ask about:

past and current diseases or medical conditions previous operations or medical procedures past immunizations any medicines, vitamins, minerals, and herbal remedies that the person is currently taking current signs and symptoms lifestyle information, such as diet and exercise habits, the use of tobacco and alcohol, and sexual and reproductive history family history of health conditions or diseases

Exactly what the physical examination entails will depend on the reason for the test, but in general it can include:

height and weight measurements nose, mouth, throat, and ear examination with a torch or scope feeling for the pulse in the person's neck, groin, or feet checking the body's reflexes listening to the heart and lungs with a stethoscope measuring blood pressure using a sphygmomanometer feeling the lymph nodes in the neck, underarms, or groin feeling the abdomen to check for abnormalities

For babies and young children, a physical exam may include:

asking questions about their development and growth measuring the circumference of their head checking their fine motor development, such as by asking them to pick up small items or tie their shoelaces checking their gross motor development, which can include asking them to walk, climb stairs, or jump looking in the mouth, eyes, and ears listening to the chest checking the health of the genitals tapping on the knees to check reflexes examining the feet

Sometimes, people undergo physical examinations to check for a particular issue or health condition. In these cases, the healthcare professional may carry out specific tests in addition to or instead of those above. We discuss some of these specific tests below.

Thank you for supporting Medical News Today Skin exam Doctors recommend regular skin exams to look for suspicious growths, moles, or other changes that may be a sign of skin cancer. These exams are particularly important for people with risk factors for skin cancer, such as those with a family history of the condition. A doctor may include a skin exam as part of a routine checkup. The exam will typically involve the doctor checking the person's skin from head to toe. Clinical breast exam A healthcare professional may recommend a clinical breast exam to check for abnormalities in and around the breast area. During this exam, they will use the pads of their fingers to check the entire breast, including the underarm and collarbone area. If they spot a lump, they will note its size, shape, and texture and check whether it moves easily. This is because lumps that are soft, smooth, round, and movable tend to be noncancerous cysts. The doctor will usually then recommend further diagnostic tests. Pap test and pelvic exam A doctor has a discussion with a patient.
A Pap test is one physical exam a female might undergo. During a pelvic exam, a healthcare professional will examine the female reproductive organs to check for any gynecological problems. They may also perform a Pap test to check for signs of cervical cancer. Doctors usually recommend that females have their first pelvic exam when they turn 21 years old or if they experience any of the following symptoms: unexplained pain in the lower stomach or around the vulva vaginal discharge that itches, burns, or smells unpleasant bleeding from the vagina that lasts longer than 10 days missed periods severe menstrual cramps During the appointment, the doctor will usually ask the person about their periods and sexual activity. They will then ask the person to take off their underwear and lie on the table with their feet in stirrups and a sheet covering their stomach and legs. The healthcare professional will visually inspect the area outside of the vagina before moving on to the speculum exam. A speculum is a small plastic or metal instrument. They will insert it into the vagina and then gently open it so that they can see the vaginal canal and cervix. For the Pap test part of the examination, the doctor will use a plastic stick to collect a sample of cells from the inside of the cervix. They will then send this sample to a laboratory for analysis. Learn more about Pap tests here. Digital rectal exam Healthcare professionals commonly use a digital rectum exam to check for signs of prostate cancer in males. They may recommend the exam for people at higher risk of prostate cancer or those who experience any of the following symptoms: bleeding from the rectum a change in bowel habits blood in the semen or urine pain when ejaculating urination difficulties A digital rectal exam only takes a few minutes. It is not usually painful, but it may be uncomfortable. The doctor will ask the person to take off their pants and underwear before giving them a gown or cloth to wrap around themselves. The person will then either stand and bend forward at the waist or lie on their side in the fetal position on an exam table. The healthcare professional will then gently insert a gloved and lubricated finger into the rectum to inspect the prostate for its size and the presence of any bumps, soft or hard spots, and other abnormalities. They will also examine the wall of the lower colon, or rectum. Learn more about these types of test here. Thank you for supporting Medical News Today Summary Physical exams are a routine part of healthcare. Doctors and nurses use them to check on a person's general health, look for potential medical issues, and monitor specific signs. If a doctor suspects an underlying health condition, they will usually recommend further diagnostic testing. They will usually do everything they can to help people feel as comfortable as possible during physical exams. Anyone who has any concerns about undergoing a physical exam should speak to their doctor.
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Hundreds of current medical practices may be ineffective

"Medical reversal" is a term that defines instances in which new and improved clinical trials show that current medical practices are ineffective or misguided. New research reveals that there are currently almost 400 medical reversals.
doctor checking medical record, looking concerned
A new meta-analysis finds that almost 400 medical practices may not be effective.

Medical reversals occur when new clinical research shows that a certain medical practice does not, in fact, work or it does more harm than good.

These new studies are superior to their predecessors because of things like better controls, better study design, or larger sample size.

Medical reversals often concern medications but they can also affect surgical procedures.

For instance, more than a decade ago, researchers and healthcare professionals realized that stenting procedures did not work for renal artery stenosis and that routine stenting should not be used to treat stable coronary disease.

Now, a new meta-analysis of 3,000 studies identifies almost 400 cases of medical reversals. The review appears in the journal eLife.

Diana Herrera-Perez, a research assistant at the Knight Cancer Institute at Oregon Health & Science University (OHSU), in Portland, is the lead author of the new analysis.

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Analysis finds 396 medical reversals

Referring to well-known endeavors to assess the validity of clinical practices, such as the Cochrane reviews, Herrera-Perez says, "We wanted to build on these and other efforts to provide a larger and more comprehensive list for clinicians and researchers to guide practice as they care for patients more effectively and economically."

To do so, she and colleagues examined over 3,000 randomized controlled trials published in three prestigious medical journals over the last 15 years: The Journal of the American Medical Association (JAMA), The Lancet, and The New England Journal of Medicine (NEJM).

The analysis discovered 396 medical reversals: 154 of them in JAMA, 129 in NEJM, and 113 in The Lancet.

Researchers carried out most of these studies (92%) in high-income countries, while 8% were performed in low- or middle-income countries, including China, India, Malaysia, Ghana, Tanzania, and Ethiopia.

Most of the medical reversals occurred in the fields of cardiovascular disease (20%), public health and preventive medicine (12%), and critical care (11%).

Specifically, the most common interventions involved medications (33%), procedures (20%), vitamins and supplements (13%), devices (9%), and system interventions (8%).

Main takeaways from the results

The study's senior author, Dr. Vinay Prasad, a hematologist-oncologist and associate professor at the OHSU Knight Cancer Institute, comments on the findings.

"There are a number of lessons that we can take away from our set of results, including the importance of conducting [randomized controlled trials] for both novel and established practices," he says.

"Once an ineffective practice is established, it may be difficult to convince practitioners to abandon its use. By aiming to test novel treatments rigorously before they become widespread, we can reduce the number of reversals in practice and prevent unnecessary harm to patients."

Dr. Vinay Prasad

He adds, "We hope our broad results may serve as a starting point for researchers, policymakers, and payers who wish to have a list of practices that likely offer no net benefit to use in future work."

Dr. Prasad cautions that the review has some limitations, such as the small number of journals it includes and the limited expertise of the reviewers.

To overcome such limitations, co-lead study author Alyson Haslam, Ph.D., who is also affiliated with the OHSU Knight Cancer Institute, calls for experts from various fields to critically assess the medical reversals identified in the analysis.

She says, "Taken together, we hope our findings will help push medical professionals to evaluate their own practices critically and demand high-quality research before adopting a new practice in [the] future, especially for those that are more expensive and/or aggressive than the current standard of care."

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What are the perks and problems of being a night owl?

In the collective imagination, night owls are free, creative spirits. Yet studies have shown that people who are more active at night face greater health risks. Do night owls experience more benefits or risks due to their rhythms? This Spotlight feature tackles this and related questions.
three silhouettes in the moonlight
What health risks do night owls face, and why? And should they strive to turn into morning larks?

If, like Bram Stoker's famous character Dracula from the 1897 novel of the same title, you are most active when the moon is up and tend to go into hiding at sunrise, then you might not be a vampire, but you probably qualify as a night person or night owl.

Literature often romanticizes night owls. The fact that they keep unusual hours, and that they are most productive in the evenings or even at night can make them seem mysterious — both appealing and somewhat frightening.

"There is a romance about all who are abroad in the black hours, and with something of a thrill we try to guess their business," wrote Robert Louis Stevenson in Travels with a Donkey in the Cévennes (1879), his account of hiking in the French mountains.

Despite the romantic, mysterious image that books and movies might portray about night owls, many studies warn that people who frequently stay up until the early hours of the morning are placing their health and well-being at risk.

For instance, a 2018 study analyzing the relationship between bedtime habits and health in 433,268 adults found that night owls are more at risk of developing diabetes, and 10% more likely to die prematurely when compared with individuals who identified as morning people.

While few studies have analyzed what percentage of people among the world's populations are night owls, the research that does exist on this topic seems to suggest that a significant number of people do their best work in the evenings.

A study from 2011, which focused on college students in Saudi Arabia, and worked with 540 male and 219 female participants, all aged between 18–32, found that 26.9% of the study participants were "evening types," who performed better later in the day. The study's authors also add that research conducted in Western countries indicates that an even higher number of college students qualify as night owls in Western societies.

Given the high number of people who are naturally inclined to go to bed late and wake up late, it is essential to understand what impact their rhythms may have on their health, and why. In more general terms, research about individual body clocks and sleep-wake patterns can help us build a healthier and happier society.

In this Spotlight feature, we look at what makes a night owl a night owl, what other types there are, and how and why being a night or evening person impacts various aspects of health and well-being.

Circadian rhythms and chronotypes

"The morning was a wretched time of day for him. [...] On no morning of his life had he ever been in good spirits nor done any good before midday, nor ever had a happy idea, nor devised any pleasure for himself or others. By degrees during the afternoon he warmed and became alive, and only towards evening, on his good days, was he productive, active and sometimes, aglow with joy."

person sleeping
'The morning is a wretched time of day...' for night owls.

Thus goes the description, of Harry, a character in Herman Hesse's novel Steppenwolf, which first appeared in English in 1929. It is a good match for the daily patterns of night owls, who tend to be sluggish and unproductive in the mornings and become alert in the evenings.

But who is a night owl? To answer that question, we must first talk about body clocks. All humans — and other animals — have internal regulating mechanisms, or "body clocks," which allow a person to adapt to natural day or night cycles, "telling" them when to eat, rehydrate, have sex, and sleep.

As Dr. Roberto Manfredini — an expert in chronobiology and cardiovascular medicine from the University of Ferrara in Italy — and colleagues explain, "[t]he daily time-keeping system is called 'circadian' from the Latin 'circa diem,' which means 'approximately a day,' deriving from duration of a cycle of earth rotation."

However, not everyone's circadian rhythms coincide. Some people feel the most refreshed early in the morning, but feel like they're falling asleep by 9:00 p.m., and people who are most active in the evenings and have trouble waking up in the morning.

As you've surely guessed by now, these are the so-called morning larks and night owls, respectively or, in more scientific terms, "morning types" and "evening types."

"The degree of morningness or eveningness is one of the most important aspects of individual differences in circadian rhythms, a phenotype known as chronotype," write the authors of a 2017 study featured in the journal Chronobiology International.

To find out whether a person is a morning type or an evening type, researchers typically use a test called the Horne-Ostberg Morningness-Eveningness Questionnaire, which assesses subjective preferences for activities throughout a 24-hour cycle.

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More than 2 chronotypes?

The Morningness-Eveningness Questionnaire does not only distinguish between larks and owls; there is also a third option on this scale, namely the intermediate types, people who do not fully qualify either as morning or evening individuals. The "intermediate types," in fact, might be more widespread than either larks or owls.

person facing wall simulating a clock
There are more than just morning and evening people. A new study has also identified 'afternoon people' and 'nappers.'

"I'm a night owl and a morning bird. Generally, I'm fine both ends. I basically just don't get that much sleep," one person told Medical News Today.

Although most people fall in between the extremes of "morningness" and "eveningness," as a society, we don't have any terms to describe these other chronotypes. Or, more correctly, we didn't have any words until now.

This year, a team of researchers from Belgium and Russia studied intermediate types in more detail, characterized them, and gave them names based on those characteristics.

The new study paper — published online ahead of print in the journal Personality and Individual Differences — identifies two additional chronotypes: "afternoon types" and "nappers."

"[M]orning types," the researchers write in their paper, are the "least sleepy in the morning and most sleepy in the beginning of the night while the opposite trend [is associated with] evening types."

In addition, they explain, "[t]hose who might be named 'afternoon types' [are] least sleepy after the middle of the day and [...] more sleepy not only in the early morning but also at midnight, whereas those who might be named 'napper types' [follow an] op-posite pattern characterized by 'afternoon dip' in combination with lower sleepiness levels both prior and after this dip."

Night owls: An endangered species?

woman reading in bed at night
Night owls are more at risk of diabetes and poor mental health.

But in a context in which the constructs of our global society accommodate morning lark habits — where "the early bird catches the worm" — it is night owls whose health is usually most at risk.

"[The] mismatch between a person's biological time and social time — which most of us have experienced in the form of jet lag — is a common issue for night owls trying to follow a normal working day," notes Elise Facer-Childs, Ph.D.

Formerly affiliated with the University of Birmingham in the United Kingdom, Facer-Childs currently works at Monash University in Melbourne, Australia.

In a study published earlier this year, Facer-Childs and colleagues found that night owls experience something akin to jet lag every day. More precisely, connectivity was lower in certain brain regions of night owls than it was in morning larks.

Essentially, this meant that evening types had shorter attention spans, slower reactions, and less energy than morning people.

An international review published in Advances in Nutrition in 2018 found that adults who fared better in the evenings were more at risk of developing heart disease, as well as type 2 diabetes.

Its authors argue that "this may be potentially due to the poorer eating behavior and diet" in night owls.

Research from 2017 also shows that night owls are more likely to receive a diagnosis of obesity, which is a significant risk factor for conditions such as diabetes and cancer. This study's authors also suggest that "evening types" may have an increased cardiovascular risk.

Finally, some studies suggest that night owls have an increased risk of depression when compared with morning larks.

Should owls turn into larks?

However, most researchers seem to agree that a great deal of these poor outcomes for physical health and mental well-being in the case of night owls may be because they are expected to function and be productive following a morning lark template, which does not suit them.

smart watch
Researchers are still debating whether or not it would be helpful for night owls to adjust their natural rhythms.

"A typical day might last from 9:00 a.m. to 5:00 p.m., but for a night owl, this could result in diminished performance during the morning, lower brain connectivity in regions linked to consciousness, and increased daytime sleepiness," notes Facer-Childs

"If, as a society, we could be more flexible about how we manage time, we could go a long way towards maximizing productivity and minimizing health risks," she adds.

At the same time, though, in a newly published study, Facer-Childs and team suggest that night owls might benefit by switching up their routine a little, by going to bed a couple of hours earlier than usual, and waking up a few hours earlier, too.

"We wanted to see if there were simple things people could do at home to solve this issue," says another one of the recent study's authors, Andrew Bagshaw, Ph.D.

The question of whether night owls should modify their rhythms to try and become "morning people," or whether workplaces should strive to accommodate the different needs of individuals remains highly contentious.

Some people have indeed found that adjusting their routines so that they would become more active in the morning has actually helped them in the long run.

One person told MNT: "I used to be a night owl, and I converted. I used to stay up until 1:00 or 2:00 in the morning and then struggle to get to work on time. Then I decided I wanted to be a writer, so I forced myself to get up early to write before I went to work. Slowly, I converted myself into a morning person."

He also added that now he has become more productive and he does not regret the switch.

Not a black and white issue

Other readers, however, take issue with the idea that night owls should shift their schedules to fit the 9 to 5 regime. "I think where workplaces can offer more flexible hours they should," someone else told us, adding:

"Of course that's not possible in every industry, and there may be key events that most of the workforce need to be working at the same time for, but increasingly it feels like people could work 12 to 8 rather than 9 to 5 and it really wouldn't affect output in any way — bar making them more productive."

"If anything, it's actually economically illiterate not to offer this as you have a whole host of people working way below their maximum potential, which morality aside is simply bad business," the same person asserted.

And night owls do have their advantages, which researchers also acknowledge. One study from 1999 argues that "early to bed, early to rise will likely make you anything but wise," finding that night owls score better on intelligence tests than morning larks.

Furthermore, perhaps unsurprisingly, a more recent study from 2012 found that men who are evening types were able to find more sexual partners, compared with peers who identified as morning people.

But perhaps the solution to the "night owl versus morning lark problem" is not black and white, and a measure of change has to come both from society at large, and from individuals, as they "try on" different daily rhythms and find the ones that bring the best results for health.

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Low fruit and vegetable intake may account for millions of deaths

Findings from a new study suggest that inadequate consumption of fruits and vegetables may be a major factor in heart disease death.
very few vegetables on a plate
Not eating enough fruits or vegetables may have dire consequences for cardiovascular health.

Fruits and vegetables are rich in vitamins, fiber, potassium, magnesium, and antioxidants.

A diet that includes fruits and vegetables can lower blood pressure, reduce the risk of heart disease and cancer, and improve digestive health.

Previous research — part of the Harvard-based Nurses' Health Study and Health Professionals Follow-up Study — confirmed that a diet containing lots of fruits and vegetables can even lower the risk of heart disease and stroke.

After analyzing these results and combining them with findings from other studies, researchers estimated that the risk of heart disease is 20% lower among individuals who eat more than five servings of fruits and vegetables per day, compared with those who eat fewer than three servings per day.

The United States Department of Agriculture recommend that adults eat at least 1.5 to 2 cups per day of fruit and 2–3 cups per day of vegetables. According to another study by the Centers for Disease Control and Prevention (CDC), only around 1 in 10 adults meet these guidelines.

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The global impact of inadequate nutrition

Now, a new study — the results of which the researchers presented at Nutrition 2019, the American Society for Nutrition annual meeting in Baltimore, MD — suggests that a low fruit intake can cause 1 in 7 deaths from heart disease, and that a low vegetable intake can cause 1 in 12 deaths from heart disease.

Analyzing data from 2010, researchers found that low fruit consumption resulted in almost 2 million deaths from cardiovascular disease, while low vegetable intake resulted in 1 million deaths. The global impact was more significant in countries with a low average consumption of fruits and vegetables.

The data suggest that low fruit consumption results in more than 1 million deaths from stroke and more than 500,000 deaths from heart disease worldwide every year, while low vegetable intake results in about 200,000 deaths from stroke and more than 800,000 deaths from heart disease per year.

"Our findings indicate the need for population-based efforts to increase fruit and vegetable consumption throughout the world," says study co-author Victoria Miller, a postdoctoral researcher at the Friedman School of Nutrition Science and Policy at Tufts University in Medford, MA.

Tracking death toll by region, age, and sex

The researchers tracked the death toll by region, age, and sex using diet surveys and food availability data of 113 countries. They combined these with data on causes of death in each country and data on the cardiovascular risk linked to low fruit and vegetable intake.

The findings showed that fruit intake was lower in South Asia, East Asia, and Sub-Saharan Africa, while vegetable consumption was lower in Central Asia and Oceania. Countries in these regions have low average fruit and vegetable intakes and high rates of deaths from heart disease and stroke.

When the researchers analyzed the impact of inadequate fruit and vegetable consumption by age and sex, they found that the biggest impact was among young adults and males. Miller adds that females tend to eat more fruits and vegetables.

"These findings indicate a need to expand the focus to increasing availability and consumption of protective foods like fruits, vegetables, and legumes — a positive message with tremendous potential for improving global health."

Senior study author Dariush Mozaffarian, Friedman School of Nutrition Science and Policy

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