Educational attainment and differences in fruit and vegetable consumption among middle-aged adults in the Korean National Health and Nutrition Examination Survey IV

We investigated whether socioeconomic differences affect fruit and vegetable (FV) consumption with respect to total intake and intake of various FV subgroups. Our study included 6667 adults aged 40-64 years who completed a dietary survey in the fourth Korean NHANES (2007-2009). FV intake was estimated from 24-hour recalls and food frequency questionnaires. Differences in FV consumption related to educational attainment were analyzed according to different nutritional categories of FV. Both men and women in the low-education group had the lowest intake of total FV and total fruits, and women also had the lowest intake of total vegetables. Also lowest in this group was consumption of mushrooms and vegetables (excluding kimchi) among men, and cruciferous and allium vegetables (excluding Chinese cabbage and radish) among women, while kimchi consumption was the highest in this group. Additionally, an association between educational level and intake of citrus fruits was evident among men. Adults in the low-education group consumed less carotene-rich FV, red fruit and/or vegetables, and dark-green leafy vegetables, fewer total vegetable dishes, and fewer types of fruit than in other groups. Men in this group had the lowest intake of yellow/orange fruit and/or vegetables, and women consumed the least folate-rich FV. There is a clear association between educational attainment and FV intake with regard to total intake, and to specific nutrients, bioactive compounds, colors, and variety.     

Association of fruit and vegetable intake with dietary fat intake

We examined the relation of fruit and vegetable intake with dietary fat intake under conditions in which individuals consume recommended number of portions of dairy, meat and grain foods, using 24-hour dietary recall data from the NHANES II of 1976–80. Only recalls that included at least 2 servings each of dairy foods and meat and 4 servings of grains, but variable servings of fruits and vegetables (ranging from 0 to 2 or more) were examined, yielding a total of 9 food group patterns (possible combinations of food group servings) as reported by 1,490 respondents. In patterns ranging from 0 to 2 servings each of fruits and vegetables, the mean percent of energy as fat varied from 39% to 36%. We observed a slight trend for decreasing energy from fat with increasing number of fruit-but not vegetable-servings. Consumption of fruits and vegetables was not associated with selection of lower-fat foods in the meat, dairy or grain groups. The percent of daily fat contributed by the miscellaneous food group (containing visible fats, sweeteners, and baked products with a high fat or sugar content) increased with increasing vegetable-but not fruit-servings. These results suggest that without conscious effort to reduce fat intake, an increase in fruit and vegetable intake may have a relatively minor impact on reduction of dietary fat.     

Relationship between total fruit and vegetable intake and self-reported knee pain in older adults

Objectives

Knee pain is one of the most common symptoms of knee osteoarthritis (OA) that affects the quality of life in the older adults, and identifying the contributing factors of knee pain is important. We hypothesized that higher fruit and vegetable consumption might be associated with the severity of knee pain lower prevalence of severe knee pain by affecting pain perception in the knee joint. Therefore, we investigated the relationship between self-reported knee pain and the consumption of fruits vegetables, carotenoids and vitamin C and self-reported knee pain.

Design

Nationally representative cross sectional study.

Setting

2010-2011 rounds of the Korean National Health and Nutrition Examination Survey.

Participants

A total of 6588 subjects aged ≥50 years were participated.

Methods

Severity of knee pain was estimated using a 10-point numeric rating scale (NRS). Daily intake of fruits, vegetables, and vitamins were estimated using data from 24-hour recalls and food frequency questionnaires.

Results

The NRS scores of knee pain decreased significantly with increasing fruit and vegetable intake quartiles. A multivariate logistic regression analysis showed that the fourth quartile of vegetable and fruit consumption was associated with decreased prevalence of severe knee pain (OR 0.59, 95% CI 0.48-0.73) compared with first quartile of vegetable and fruit consumption; however, carotenoids and vitamin C consumption was not associated with the severity of knee pain.

Conclusions

In conclusion, severe knee pain was independently associated with fruit and vegetable consumption. Our findings suggest that intake of whole fruits and vegetables may help improve knee pain in older adults.

     

Food prices and fruit and vegetable consumption among young American adults

Multivariate negative binomial count models were estimated to examine associations between young adults’ fruit and vegetable (FV) consumption and the prices of FV, other food at home grocery items, and fast food and the availability of restaurants and food stores. This study used the 2002 wave of data collected from US young adults aged 18–23 years in the 1997 National Longitudinal Survey of Youth merged by geocode identifiers with food prices and restaurant and food store availability. The results showed that higher levels of FV consumption were associated with lower FV prices (price elasticity of −0.32) and that this own-price effect was robust to the inclusion of other food prices and food outlet availability. Lower income and lower educated young adults and those with lower educated mothers and middle-income parents were found to be most price sensitive. No statistically significant cross-price effects on FV consumption were found with other grocery food (meat, dairy and bread) prices or fast food prices. Fiscal policy instruments such as FV subsidies may help to increase FV intake, particularly among young adults of lower socioeconomic status.     

Factors associated with fruit and vegetable consumption among adults

Background: The higher consumption of fruit and vegetables is considered to be an indicator of healthy eating and the protective effects of fruit and vegetable (FV) consumption for noncommunicable diseases have been investigated extensively. The present study aimed to investigate the association between fruit and vegetable intake (FVI), health behaviours and socio‐demographic factors among adult Canadians. Methods: This analysis was based on the information from the Canadian Community Health Survey, Cycle 3.1. Daily intake of fruit and vegetables from a total number of 15 512 apparently healthy individuals, aged 18–64 years, were assessed using a structured questionnaire, which included 20 questions on the frequency of consumption of different types of fruit and vegetables. Multiple logistic regression models were used to determine the association between FVI and some socio‐economic factors and lifestyle behaviour among adult Canadians. Results: In total 77% of Canadian adults consumed fruit and vegetables less than five times per day. Females were more likely to consume more fruit [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.75–2.4], vegetables (OR 1.95; 95% CI 1.65–2.29) and FV (OR 2.52; 95% CI 2.20–2.90) than males. Single/never married individuals, individuals with higher levels of education, never smokers, former drinkers and older people reported more consumption of fruit and vegetables than others. Conclusions: The results obtained in the present study indicate an association between FVI and some socio‐economic and healthy lifestyle behaviours, and that a substantial gap exists between the recommended level and the actual intake of the FV among the Canadian population. Because a higher intake of FV improves public health, it is imperative to tailor nutrition education at the individual and community levels in Canadian populations.     

Overweight and average-weight children equally responsive to "Kids Choice Program" to increase fruit and vegetable consumption

Secondary analyses were conducted for children participating in the school-based Kids Choice Program [Hendy, H. M., Williams, K., & Camise, T. (2005). "Kids Choice" school lunch program increases children's fruit and vegetable acceptance. Appetite, 45, 250-263.] to examine whether fruit and vegetable consumption and preference ratings by overweight and average-weight children within the original sample were equally responsive to the program. The Kids Choice Program produced increased fruit and vegetable consumption by both overweight and average-weight children that lasted throughout the month-long program, while avoiding "over-justification" drops in later fruit and vegetable preference ratings. We believe that the Kids Choice Program shows promise for encouraging overweight children to improve nutrition and weight management behaviors while in their everyday peer environment.     

Association between fruit and vegetable intake and risk for glioma: A meta-analysis

ObjectiveEpidemiologic studies evaluating the association between the intake of vegetables and fruit and the risk for glioma have produced inconsistent results. Therefore, the aim of this study was to test the hypothesis that higher vegetable and fruit intake may have a protective effect on risk for glioma.MethodsPertinent studies were identified by a search in PubMed, Web of Knowledge, and Wan Fang Med Online up to January 2014. Random-effect model was used to combine study-specific results. Publication bias was estimated using Begg's funnel plot and Egger's regression asymmetry test.ResultsFifteen studies involving 5562 cases focusing on vegetable intake and 17 studies involving 3994 cases of fruit intake compared with the risk for glioma were included in this meta-analysis. The combined relative risk (RR) of glioma associated with vegetable intake was 0.775 (95% confidence interval [CI], 0.688–0.872) overall, and the association for subgroup analysis by study design, sources of control, ethnicity, and number of cases was consistent with overall data. For fruit intake and glioma risk, significant protective associations were found in an Asian population (RR, 0.573; 95% CI, 0.346–0.947), but not in a white population. No publication bias was found.ConclusionsThis analysis indicated that intake of vegetables might have a protective effect on glioma. The intake of fruit might have a protective effect on glioma in the Asian population; however, the results need to be confirmed.     

Perceptions of fruit and vegetable dietary guidelines among Australian young adults

Aim: Regular consumption of fruit and vegetables has been associated with a decreased risk of a number of chronic diseases. An appropriate level of knowledge is important to successfully adhere to the dietary guidelines for eating fruit and vegetables. However, there is little research about the level of knowledge that young adults have about fruit and vegetable consumption. The current study aimed to investigate the recall and understanding of Australian dietary guidelines, food product and serving size knowledge in a population of young adults. Methods: One hundred and six undergraduate students completed online questionnaires regarding (1) knowledge of dietary recommendations; (2) knowledge of serving size information; and (3) foods that could be included as part of fruit and vegetable intake. Results: The results showed that the sample had significant knowledge gaps in all three areas. Approximately half (54%) of participants correctly reported the recommended daily intake of fruit and vegetables, the majority were not able to correctly report serving sizes (correct responses were 30–61%) and were not able to identify all ingredients from a recipe that counted towards fruit and vegetable intake. Conclusions: Past interventions have not tended to focus on the fruit and vegetable knowledge, or behaviours, of Australian young adults. On the basis of findings from this study, it appears that more work is needed to develop messages to effectively target this important group.     

蔬菜水果食用频率与慢性阻塞性肺疾病的相关性

目的 探讨中国城乡居民蔬菜和水果食用频率与慢性阻塞性肺疾病(COPD)的关系.方法 2007年在全国疾病监测系统的161个监测点中,采用多阶段按比例分层随机抽样的方法,抽取了48 974名15～69岁居民作为调查对象,采用标准化问卷调查收集相关信息,比较不同蔬菜食用频率(<4、4～5、6～7 d/周)和水果食用频率(<2、2～4、5～7 d/周)的自报COPD患病风险.结果 蔬菜食用频率为6～7和<4 d/周者分别占89.9%(44 019/48 974)和4.6%(2262/48 974),水果食用频率为5～7和<2 d/周者分别占30.8%(15 072/48 974)和31.5%(15 432/48 974).自报COPD患病率为2.9%(1412/48 974).调整了年龄、性别、城乡、被动吸烟和COPD家族史后,与水果食用频率较低(<2 d/周)的人群相比,水果食用频率较高的人群(5～7 d/周)患COPD的风险降低(在不吸烟者中,OR=0.80,95%CI:0.66～0.98;在吸烟者中,OR=0.80,95%CI:0.64～0.99).在不吸烟者中,高蔬菜食用频率(6～7 d/周)者患COPD风险较低(OR=0.65,95%CI:0.48～0.89).结论 食用蔬菜和水果可能对COPD有保护性作用.

Abstract：

Objective To explore the association between frequency of fruit and vegetable intake and chronic obstructive pulmonary disease(COPD).Methods In 2007,48 974 Chinese residents aged 15-69 years were selected as study participants by multistage stratified proportionate to size random sampling from the 161 sites of Disease Surveillance Points System.Standardized questionnaires were used to collect relevant information to compare the risk for self-reported physician diagnosed COPD between different frequency groups for fruit(<2,2-4,5-7 d/week) and vegetable(<4,4-5,6-7 d/week) intake.Results The proportion of vegetable intake was 89.9%(44 019/48 974) and 4.6%(2262/48 974) for individuals with frequency of 6-7 and <4 d/week respectively.The proportion of fruit intake was 30.8%(15 072/48 974) and 31.5%(15 432/48 974) for individuals with frequency of 5-7 and <2 d/week respectively.The prevalence of self-reported COPD was 2.9%(1412/48 974).After adjusting for age,sex,urban/rural areas,passive smoking exposure and family history,the risk of COPD decreased among those with high frequency(5-7 d/week) of fruit intake( OR=0.80,95%CI:0.66-0.98 for never smokers; OR=0.80,95%CI:0.64-0.99 for ever smokers),compared to subjects with low frequency of fruit intake(<2 d/week).Among never smokers, those with high frequency of vegetable intake(6-7 d/w) had a low risk of developing COPD (OR=0.65,95%CI:0.48-0.89).Conclusion There were beneficial effects of fruit and vegetable intake on COPD.     

The use of inappropriate feeding practices by rural parents and their effect on preschoolers' fruit and vegetable preferences and intake

ObjectiveTo describe the frequency of inappropriate feeding practices used by parents of preschoolers and the impact on a child’s preference for and intake of fruits and vegetables (FV).DesignCross-sectional analysis of baseline data from a telephone interview.SettingA community-based program in rural southeastern Missouri.Participants1555 rural parents participating in the High 5 for Kids project. The mean age of parents was 28.9 years, the mean age for children was 38.0 months, and 52.1% of children were male.Variables MeasuredDemographic characteristics; intake and preferences for FV; inappropriate child feeding practices.AnalysisInappropriate feeding practices, preferences for and intake of FV were examined using Kruskal-Wallis tests and Spearman’s correlations. Logistic regression was used to assess the relationships between FV intake and preference and inappropriate feeding practices.ResultsAn increasing number of inappropriate feeding practices negatively impacted FV preference of children but positively impacted FV intake.Conclusions and ImplicationsThis study documents the public health need to develop programs that guide and advise rural parents on information about how children develop patterns of intake, and how to foster children’s preferences and acceptance of healthful food.     

Validity of a questionnaire to assess fruit and vegetable intake in adults

OBJECTIVE: To validate a method for assessing fruit and vegetable intake among adults in a population of low intake. The method assesses mean intake and ranks individuals by their usual intake. DESIGN: A precoded fruit and vegetable Questionnaire included a 24-h recall and a food frequency. The participants filled in the Questionnaire, a week later they started a 7-day food record, 1-day weighed record and 6 days using household measures. SUBJECTS: Following advertisements 40 participants were recruited, 36 returned food records(mean age=37 years). RESULTS: No difference was observed between the average intake yielded by the 24-h recall and that from the 1-day weighed food record of fruits or vegetables. Correlation coefficients between results from the food frequency questionnaire and the 7-day food records were 0.45 (P=0.007) for vegetables, 0.63 (P<0.001) for fruits and 0.73 (P<0.001) for fruits and vegetables combined. Cross-classification into quartiles showed that the proportion of participants in the same or the adjacent quartile of the intake distribution were 94% for fruit intake and 80% for vegetable intake. Registered intake of fruits and vegetables was higher the first 4 days of the record than the last 3 days (P=0.002). The 4-day food record correlated with the food frequency questionnaire in similar manner as the 7-day record. CONCLUSION: The present study indicates that the precoded 24-h recall may be valuable tool for measuring average intake of fruits and vegetables among adults in a population of low intake. Moreover, the food frequency questionnaire was valid for ranking individuals according to their usual intake. A 4-day food record might be sufficient when validating food frequency questionnaires for fruits and vegetables.     

Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention

Objective

To examine the effects of a multi-component, theory-based, 2.5-year intervention on children's fruit and vegetable consumption, preferences, knowledge and body mass index.

Methods

Four inner city elementary schools in the Northeastern United States were randomized to an intervention (n = 149) or control group (n = 148) in 2005. Fruit and vegetable consumption during school lunch (measured by plate waste), preferences, and knowledge, as well as body mass index, were assessed five times across 3.5 years (pre-intervention, spring 2006, 2007, 2008 and 2009). Hierarchical linear modeling was used to analyze program outcomes.

Results

At the first post-test assessment, children in the experimental group ate 0.28 more servings/lunch of fruit and vegetable relative to children in the control group and changes in fruit and vegetable consumption were found in each year throughout the program. However, this effect declined steadily across time so that by the delayed one-year follow-up period there was no difference between the groups in fruit and vegetable consumption. There were persistent intervention effects on children's knowledge. There were no effects on fruit and vegetable preferences and body mass index throughout the study.

Conclusion

Although there was initial fruit and vegetable behavior change, annual measurements indicated a gradual decay of behavioral effects. These data have implications for the design of school-based fruit and vegetable interventions.     

Affective associations mediate the influence of cost–benefit beliefs on fruit and vegetable consumption

Consumption of fruits and vegetables is far lower than recommended. The behavioral affective associations model posits that affective associations influence behavior and mediate the influence of perceived benefits and barriers on behavioral choices. The purpose of this study was to test the model's predictions about the influence of affective associations and benefits/barriers on fruit and vegetable consumption. Community adults (N = 446) reported perceived benefits and barriers to fruit and vegetable consumption, affective associations with fruits and vegetables, and current fruit and vegetable intake. Affective associations predicted behavior and mediated the influence of benefits and barriers on behavior, supporting predictions made by the behavioral affective associations model. This highlights the need to incorporate affective factors in decision-making models and intervention strategies.     

Low-income young adults report increased variety in fruit and vegetable intake after a stage-tailored intervention

The objective of this study was to determine if a fruit and vegetable (FV) intervention, previously demonstrated to increase amount of FV per day, also increased the variety consumed. Variety in FV intake was assessed using a 26-item FV (12 fruit and 14 vegetable) food frequency questionnaire on 1255 low-income adults, with ages from 18 to 24 years (control = 684 vs experimental = 571), after completion of a stage-tailored intervention to increase FV intakes. The food frequency questionnaire was administered at 12 months to assess how often and how much participants ate of each item over the previous year. Variety was defined as the number of different types of fruits and vegetables consumed. At completion, the experimental group vs the control group had significantly greater variety in number of fruit items (9.5 ± 0.1 vs 9.1 ± 0.1, P ≤ .001) and vegetable items (11.5 ± 0.1 vs 11.2 ± 0.1, P < .01) as well as greater total intake of fruits (2.73 ± 0.09 vs 2.33 ± 0.11 cups, P < .01) and vegetables (1.87 ± 0.10 vs 1.62 ± 0.01 cups, P ≤ .001) and a greater consumption of the categories of seasonal fruits (P < .05), juices (P < .01), and high-β-carotene vegetables (P ≤ .001). This is one of the first studies to document an increase in FV variety as a result of an educational intervention for low-income young adults.     

"Kids Choice" school lunch program increases children's fruit and vegetable acceptance

The "Kids Choice" school lunch program used token reinforcement, food choice, and peer participation to increase children's fruit and vegetable consumption without later drops in food preference sometimes found in past research and often called 'overjustification effects.' Participants included 188 school children (92 boys, 96 girls; mean age = 8.0; 95% Caucasian). After four baseline meals, children were randomly assigned for 12 meals to receive token reinforcement for eating either fruits or vegetables. Observers recorded fruit and vegetable consumption and provided token reinforcement by punching holes into nametags each day children ate their assigned foods, then once a week children could trade these tokens for small prizes. Fruit and vegetable preference ratings were gathered with child interviews during baseline, and during follow-up conditions two weeks and seven months after the token reinforcement program. Consumption increased for fruit and for vegetables and the increases lasted throughout reinforcement conditions. Two weeks after the program, preference ratings showed increases for fruit and for vegetables. Seven months later, fruit and vegetable preferences had returned to baseline levels, suggesting the need for an ongoing school lunch program to keep preferences high, but also showing no signs of "overjustification effects" from the token reinforcement used in the "Kids Choice" school lunch program.     

Differences in fruit and vegetable exposure and preferences among adolescents receiving free fruit and vegetable snacks at school

Low fruit and vegetable (FV) intakes are associated with excess body weight. The United States Department of Agriculture sponsors a Free Fruit and Vegetable Program in schools whereby students receive free FV snacks daily. This study assessed whether the program improved student exposure to and preferences for FV in a Houston high school in 2006–2007. Anonymous, post-intervention only FV exposure and preference surveys were completed by 2000 intervention school students and 1600 students in a comparison school during May, 2007. Differences in FV exposure and preferences were assessed, as well as differences in preferences between those students who tasted the item for the first time at school compared to those who had tasted the item before. The comparison school average scores for prior FV exposure and vegetable preferences were significantly higher than the intervention school scores. Intervention school students who had tasted the item previously reported significantly higher preferences than students who had tasted it for the first time at school. Access to the Free Fruit and Vegetable Program did not appear to improve high school student reported FV exposure and preferences. Future research should investigate the connection between food exposure, preferences and consumption in adolescents.     

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.