Insufficient fruit intake is an important dietary risk factor for various chronic diseases such as cardiovascular diseases and metabolic disorders. This study aims to analyze the disease burden attributable to insufficient fruit intake in China from 1990 to 2023 and its changing trends, and to identify priority intervention populations by combining the dietary structure and socioeconomic characteristics of residents, so as to provide evidence for precision nutrition policies.

A cross-sectional design was adopted in this study. Based on the GBD 2023 database, the data on mortality and disability-adjusted life years (DALYs) attributable to inadequate fruit intake in China were collected. Joinpoint regression was used to calculate the average annual percent change (AAPC) and its 95% confidence interval (CI). The population attributable fraction (PAF) method was employed to quantify the contribution of inadequate fruit intake to 9 categories of diseases. Age-stratified attributable analysis was performed for hypertensive heart disease, which had the highest PAF, and the Bayesian age-period-cohort (BAPC) model was used to predict disease burden trends from 2023 to 2033.

From 1990 to 2023, except aortic aneurysm decreased significantly, the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life-year rate (ASDR) for diseases attributable to inadequate fruit intake significantly decreased (P<0.05). Tuberculosis showed the largest decline (ASMR: AAPC=-8.50%, 95%CI: -8.58% to -8.39%; ASDR: AAPC=-8.08%, 95%CI: -8.16% to -7.99%). Aortic aneurysm was the only disease showing an upward trend ASMR: AAPC=0.56%, 95%CI: 0.45% to 0.67%; ASDR: AAPC=0.77%, 95%CI: 0.67% to 0.88%; P<0.05). Joinpoint analysis revealed that most diseases declined rapidly from 2017 to 2020 but generally rebounded slightly from 2020 to 2023. Hypertensive heart disease imposed the heaviest burden, with its PAF for deaths and DALYs ranking first, showing a downward trend but with a younger-age tendency (attributable proportion of deaths decreased from 38.15% to 28.79%, and attributable proportion of DALYs decreased from 39.77% to 30.27%). The BAPC model predicted that its ASMR and ASDR would continue to decline from 2023 to 2033 [ASMR decreasing from 7.57/100000 (95%PI: 7.52 to 7.62) to 5.81/100000 (95%PI: 0.06 to 11.57), a decrease of 23.25%; ASDR decreasing from 133.31/100000 (95%PI: 133.10 to 133.52) to 110.06/100000 (95%PI: 12.11 to 208.01), a decrease of 17.44%].

The burden of most diseases has significantly decreased, indicating the effectiveness of nutrition intervention policies. However, the trend turning point from 2020 to 2023 reveals remaining weak links in residents’ nutrition security during major public health events. Males and patients with hypertensive heart disease bear a heavier burden and require focused attention in dietary interventions.

In primary health services, “fruit intake screening and guidance” can be incorporated into routine health management to provide personalized dietary plans for residents, with emphasis on guiding young people to develop fruit consumption habits of “adequate quantity and diversity”. Meanwhile, it is recommended that the government establish a basic nutrition emergency security plan to ensure fruit accessibility and dietary support for residents during major public health events.