Global Burden and Trends of Cardiovascular Disease Attributable to Low Vegetable Intake: A GBD 1990–2021 Analysis and Projection to 2035

Global Burden and Trends of Cardiovascular Disease Attributable to Low Vegetable Intake: A GBD 1990–2021 Analysis and Projection to 2035 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Global Burden and Trends of Cardiovascular Disease Attributable to Low Vegetable Intake: A GBD 1990–2021 Analysis and Projection to 2035 JingYang Liu, TianXin Dong, ShiTong Wang, XinXin Li, YongHuai Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8349669/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Mar, 2026 Read the published version in npj Science of Food → Version 1 posted 9 You are reading this latest preprint version Abstract ​​ Background : Cardiovascular disease (CVD) remains among the leading causes of death and disability worldwide. Dietary patterns are modifiable determinants of CVD, and a diet low in vegetables is a pervasive nutritional risk factor whose independent contribution to the global CVD burden has not been fully quantified. Objective: This study aimed to systematically assess the global, regional, and national burden of CVD attributable to a diet low in vegetables from 1990 to 2021 and to forecast future trends up to 2035 using comprehensive data from the Global Burden of Disease (GBD) 2021 study. ​​ Methods : We extracted data on CVD attributable to low vegetable intake from the GBD 2021 database. Age-standardized mortality rates (ASMR) and estimated annual percentage changes were calculated to describe temporal trends. Bayesian age–period–cohort models were applied to predict future trajectories through 2035. Analyses were stratified by sex, age group, CVD subtype, and sociodemographic index (SDI) quintile. ​​ Results : From 1990 to 2021, the global ASMR for CVD attributable to insufficient vegetable intake continued to decline. However, the absolute number of deaths increased. The burden was highest in regions with low to moderate SDI, particularly in South Asia. Men and adults aged ≥ 55 years accounted for the greatest number of deaths. Notably, hypertensive heart disease has surpassed stroke and ischemic heart disease as the leading cause of CVD mortality linked to low vegetable intake. Projections indicate that the global ASMR will continue to decline slowly until 2035. ​​ Conclusions : Although age-standardized CVD mortality attributable to low vegetable intake has declined globally over the past three decades, the absolute burden continues to rise due to demographic shifts. This underscores the urgent need for targeted dietary interventions and public health policies that promote vegetable consumption, particularly among older adults, men, and populations in low- and middle-SDI regions. Health sciences/Cardiology Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors cardiovascular diseases vegetables global burden of disease dietary risk bayesian forecasting Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Published Journal Publication published 14 Mar, 2026 Read the published version in npj Science of Food → Version 1 posted Editorial decision: Revision requested 18 Jan, 2026 Reviews received at journal 14 Jan, 2026 Reviews received at journal 10 Jan, 2026 Reviewers agreed at journal 27 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers invited by journal 15 Dec, 2025 Editor assigned by journal 15 Dec, 2025 Submission checks completed at journal 15 Dec, 2025 First submitted to journal 12 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8349669","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":561464480,"identity":"afffdec5-39d1-42ed-9456-31aa2091761b","order_by":0,"name":"JingYang Liu","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"prefix":"","firstName":"JingYang","middleName":"","lastName":"Liu","suffix":""},{"id":561464482,"identity":"e654238e-0ac6-48f0-8b05-949f65bbe1a9","order_by":1,"name":"TianXin Dong","email":"","orcid":"","institution":"China Medical 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2035","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-science-of-food","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjscifood","sideBox":"Learn more about [npj Science of Food](http://www.nature.com/npjscifood/)","snPcode":"41538","submissionUrl":"https://submission.springernature.com/new-submission/41538/3","title":"npj Science of Food","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular diseases, vegetables, global burden of disease, dietary risk, bayesian forecasting","lastPublishedDoi":"10.21203/rs.3.rs-8349669/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8349669/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e​​\u003cstrong\u003eBackground\u003c/strong\u003e: Cardiovascular disease (CVD) remains among the leading causes of death and disability worldwide. Dietary patterns are modifiable determinants of CVD, and a diet low in vegetables is a pervasive nutritional risk factor whose independent contribution to the global CVD burden has not been fully quantified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to systematically assess the global, regional, and national burden of CVD attributable to a diet low in vegetables from 1990 to 2021 and to forecast future trends up to 2035 using comprehensive data from the Global Burden of Disease (GBD) 2021 study.\u003c/p\u003e\n\u003cp\u003e​​\u003cstrong\u003eMethods\u003c/strong\u003e: We extracted data on CVD attributable to low vegetable intake from the GBD 2021 database. Age-standardized mortality rates (ASMR) and estimated annual percentage changes were calculated to describe temporal trends. Bayesian age–period–cohort models were applied to predict future trajectories through 2035. Analyses were stratified by sex, age group, CVD subtype, and sociodemographic index (SDI) quintile.\u003c/p\u003e\n\u003cp\u003e​​\u003cstrong\u003eResults\u003c/strong\u003e: From 1990 to 2021, the global ASMR for CVD attributable to insufficient vegetable intake continued to decline. However, the absolute number of deaths increased. The burden was highest in regions with low to moderate SDI, particularly in South Asia. Men and adults aged ≥ 55 years accounted for the greatest number of deaths. Notably, hypertensive heart disease has surpassed stroke and ischemic heart disease as the leading cause of CVD mortality linked to low vegetable intake. Projections indicate that the global ASMR will continue to decline slowly until 2035.\u003c/p\u003e\n\u003cp\u003e​​\u003cstrong\u003eConclusions\u003c/strong\u003e: Although age-standardized CVD mortality attributable to low vegetable intake has declined globally over the past three decades, the absolute burden continues to rise due to demographic shifts. This underscores the urgent need for targeted dietary interventions and public health policies that promote vegetable consumption, particularly among older adults, men, and populations in low- and middle-SDI regions.\u003c/p\u003e","manuscriptTitle":"Global Burden and Trends of Cardiovascular Disease Attributable to Low Vegetable Intake: A GBD 1990–2021 Analysis and Projection to 2035","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-19 00:28:58","doi":"10.21203/rs.3.rs-8349669/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-18T16:05:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-14T16:54:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T03:26:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147541716263534152510039330941540126752","date":"2025-12-27T20:32:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221675556480443828120514555701121569877","date":"2025-12-17T02:01:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-15T15:12:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-15T12:46:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-15T12:43:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Science of Food","date":"2025-12-13T02:31:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-science-of-food","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjscifood","sideBox":"Learn more about [npj Science of Food](http://www.nature.com/npjscifood/)","snPcode":"41538","submissionUrl":"https://submission.springernature.com/new-submission/41538/3","title":"npj Science of Food","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6c157a85-20b4-4cd9-831f-023f4233d3de","owner":[],"postedDate":"December 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":59782858,"name":"Health sciences/Cardiology"},{"id":59782859,"name":"Health sciences/Diseases"},{"id":59782860,"name":"Health sciences/Health care"},{"id":59782861,"name":"Health sciences/Medical research"},{"id":59782862,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-03-16T16:14:49+00:00","versionOfRecord":{"articleIdentity":"rs-8349669","link":"https://doi.org/10.1038/s41538-026-00797-5","journal":{"identity":"npj-science-of-food","isVorOnly":false,"title":"npj Science of Food"},"publishedOn":"2026-03-14 15:58:56","publishedOnDateReadable":"March 14th, 2026"},"versionCreatedAt":"2025-12-19 00:28:58","video":"","vorDoi":"10.1038/s41538-026-00797-5","vorDoiUrl":"https://doi.org/10.1038/s41538-026-00797-5","workflowStages":[]},"version":"v1","identity":"rs-8349669","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8349669","identity":"rs-8349669","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}