Sunday, December 05, 2021

Article Index

1.0 Health Trends

Cardio-vascular diseases (CVD) made up 16.7 million, or 29.2% of total global deaths according to World Health Report 2003 (WHO, 2003).  By 2010, CVD will be the leading cause of death in developing countries (WHO, 2007).  At least 20 million people survive heart attacks and strokes every year; many require continuing costly clinical care (WHO, 2007).  CVD is still Australia's greatest health problem. It kills more people than any other disease (accounting for 47 637 deaths in 2004) and affected 3.5 million Australians in 2004-05 (Australian Institute for Health and Welfare, 2006).  

Around 1 million Australian are estimated to have diabetes (Australian Government).  It is predicted that diabetes to soon to become the biggest global epidemic in history (Thompson, 2007).  Similar illness and disease patterns (obesity, type 2 diabetes, heart disease), currently experienced in developed countries, are now emerging in developing Asian countries (American Heart Association, 2007; Baylor College of medicine,; Medical News Today, 2006).  In 2002-03, Australian spent about $A10 billion on pharmaceuticals and $A70 billion on health (10% of GDP) (Australian Government).

In 2004, Australians spent $A1.8 billion on complementary medicines and therapies (Thompson, 2007). The global supplements and herbal medicine industry is growing at a rate of 10% per annum and is currently valued at $US 200 billion (Nutrition Business Journal, 2007).  It is expected to reach $US5 trillion by the year 2050 (Thompson, 2007).

Besides the benefits to human wellness and productivity, insufficient fruit and vegetable intake is estimated to cause some 2.7 million deaths each year and belongs to the top 10 risk factors contributing to mortality (Ezzati et al., 2002).  The World Cancer Research Fund has noted that consumption of at least five servings of fruit or vegetables a day was associated with about a 50% reduced risk of cancer; the cancer-preventative effects were dose dependent (www.wcrf).

2.0 Fruits And Health Benefits - Causality In Disease Prevention

The evidence on the health and medicinal benefits of custard apple presented in the following sections must be evaluated in terms of the strength of evidence or proof in prevention and intervention programs to show causal relationships.  This evidence is classified into four categories (WHO, 2003):

  • Insufficient evidence
  • Possible evidence
  • Probable evidence
  • Convincing evidence

There are various levels of testing to establish proof; these are outlined below in increasing order of sophistication and validity:

  • Observational studies (e.g. epidemiological, anecdotal, folk medicines etc.)
  • In vitro (test tube) testing using human cell lines
  • In vivo animal studies (tests on rats, rabbits etc.)
  • Human clinical trials (the best are randomised, double blind, placebo-controlled (RDBPC) experiments)

Human clinical trials are expensive and may cost several hundred thousand dollars to conduct.  Both in vitro (laboratory) and in vivo (live organism) testing has been conducted for custard apple, the latter on a limited scale.  There has been limited human clinical testing mainly on the anti-cancer properties of the closely related Annonaceous species Asimina triloba (

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