Encouraging the consumption of fruit and vegetables by older Australians: an experiential study

OBJECTIVE: To explore perceptions of dietary recommendations for fruit and vegetables, and barriers and opportunities for increasing consumption. DESIGN: Qualitative study with an experiential component. SETTING: Older adults' households. PARTICIPANTS: Six focus groups with 38 Australian adults aged 50 to 64 years who reported low vegetable consumption. INTERVENTION: Week 1: focus group including demonstration of recommended fruit and vegetable servings; week 2: delivery of a week's supply of fruit and vegetables and recipes; week 3: follow-up focus group. VARIABLES MEASURED: Perceptions of a healthful diet, fruit and vegetable recommendations, barriers to consumption, and reactions to the food delivery and recipes. ANALYSIS: Qualitative, thematic analysis. RESULTS: Participants were unfamiliar with serving recommendations. Barriers to consumption were as follows: perceptions that vegetables are eaten only with evening meals, preference for eating meat, believing that recommended quantities were too big, and a lack of preparation time. The delivery had a positive impact on some (especially low fruit consumers), for whom the availability of appealing fruit served as a prompt for consumption. CONCLUSIONS AND IMPLICATIONS: Possible strategies for enabling consumers to achieve adequate fruit and vegetable consumption are education about the recommended number and size of servings and distribution of fruit and vegetables relative to meat and carbohydrates, encouragement to spread fruit and vegetable consumption over the day, and promoting the appealing sensory attributes of fruit and vegetables.     

生命早期喂养模式对学龄前儿童蔬菜和水果摄入的影响

目的 了解婴儿期母乳喂养持续时间和纯母乳喂养对学龄前期儿童蔬菜和水果摄入的影响,为婴幼儿喂养指导提供更为有力的科学依据。方法 使用已经进行的儿童肥胖研究的基线调查数据进行分析,数据为通过问卷调查的方式了解儿童婴儿期喂养基本情况和儿童膳食现状,使用Logistic回归模型对可能关联进行验证。结果 在1 189名调查儿童婴儿期,纯母乳喂养持续超过6个月的占17.1%,母乳喂养持续时间超过12个月的占9.6%。纯母乳喂养持续6个月以上的儿童在学龄前期超重肥胖发生率明显低于纯母乳喂养持续时间<6个月的儿童(2.2% &3.7%,P<0.05)。学龄前儿童摄入每周≥6次的水果和蔬菜的频率比例分别为87.5%及67.7%。婴儿期持续母乳喂养12个月及以上儿童在学龄前期摄入蔬菜频率高于母乳喂养持续时间<12个月的儿童(OR=1.251; 95%CI1.115~2.563),纯母乳喂养≥6个月的儿童较纯母乳喂养时间<6个月的儿童在学龄前期摄入蔬菜的频率高,两者存在统计学关联(OR=1.015;95%CI1.002~1.105)。母乳喂养模式与学龄前期儿童摄入水果频率差异无统计学意义(OR=0.882;95%CI0.412~1.514) &(OR=0.657;95%CI0.442~1.019)。结论 长期母乳喂养及纯母乳喂养与学龄前期儿童蔬菜摄入量存在正向关联,但与学龄前期儿童水果摄入无任何关联。生命早期科学喂养方式对于儿童生命后期营养习惯的形成乃至对营养发育的影响都十分重要的,因而社会和家庭对于母乳喂养的认识和支持也需进一步深入和提高。     

Critical review: vegetables and fruit in the prevention of chronic diseases

Background

Vegetables and fruit provide a significant part of human nutrition, as they are important sources of nutrients, dietary fibre, and phytochemicals. However, it is uncertain whether the risk of certain chronic diseases can be reduced by increased consumption of vegetables or fruit by the general public, and what strength of evidence has to be allocated to such an association.

Methods

Therefore, a comprehensive analysis of the studies available in the literature and the respective study results has been performed and evaluated regarding obesity, type 2 diabetes mellitus, hypertension, coronary heart disease (CHD), stroke, cancer, chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, eye diseases, and dementia. For judgement, the strength of evidence for a risk association, the level of evidence, and the number of studies were considered, the quality of the studies and their estimated relevance based on study design and size.

Results

For hypertension, CHD, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, COPD, and RA indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For IBD, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

Conclusions

This critical review on the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health. Therefore, from a scientific point of view, national campaigns to increase vegetable and fruit consumption are justified. The promotion of vegetable and fruit consumption by nutrition and health policies is a preferable strategy to decrease the burden of several chronic diseases in Western societies.     

Socioeconomic differences in the consumption of vegetables, fruit and fruit juices. The influence of psychosocial factors

BACKGROUND: The aim was to investigate whether social network and social support factors can explain socioeconomic differences in the risk of consuming low amounts of vegetables, fruit and fruit juices. METHODS: The Malm? Diet and Cancer Study was a prospective cohort study. The present cross-sectional study examined data from a subpopulation of 11,837 individuals that completed baseline examinations in 1992-1994. Dietary habits were assessed using a modified diet history method, and socioeconomic and social network factors were measured with a structured questionnaire. Low consumption was defined as the lowest consumption quartile for vegetables and fruit, while fruit juice consumption was dichotomized to separate users from non-users. RESULTS: Socioeconomic differences were most pronounced regarding the consumption of vegetables and fruit juices. For both sexes, unskilled manual workers had a twice as high risk of low vegetable and fruit juice consumption as higher non-manual employees. No socioeconomic differences in fruit consumption were observed for men, and only moderate differences for women with a higher consumption in higher socioeconomic groups. When the psychosocial variables were introduced in the multivariate model, social participation moderately reduced the socioeconomic differences in vegetable consumption, and the female socioeconomic differences in fruit consumption, but had no effect on the socioeconomic differences in fruit juice consumption. The other psychosocial variables had no effect on the socioeconomic differences. CONCLUSION: Considerable socioeconomic differences in vegetable, fruit and fruit juice consumption were observed. Social participation seemed to be a strong determinant for these food choices. However, this effect was largely independent of the socioeconomic differences.     

Longitudinal observation of an HIV prevention community planning group (CPG)

HIV prevention community planning groups were formed to increase stakeholder participation and develop evidence-based comprehensive HIV prevention plans. To date, it is not well understood what factors affect group behavior as the planning group prepares for data-informed decision making. In this observational case study, the authors videotaped 18 meetings of a community planning group (CPG) to observe how a group's behavior changes over time in response to modifications in its structure and function. Discussions on authority and conflict were common, particularly during presentations on prioritized populations and interventions. Changes in the frequency of data-informed discussions were not statistically significant. Observed group conflict may have been an unintended consequence of efforts to improve equity. The authors suggest that formal and informal mechanisms to manage conflict and agreed-on procedures for decision making should be incorporated into the technical assistance offered to CPGs. Future studies should address whether data-informed decisions increase once contentious issues are resolved.     

Childhood consumption of fruit and vegetables across England: a study of 2306 6-7-year-olds in 2007

The School Fruit and Vegetable Scheme (SFVS) provides children in government-run schools in England with a free piece of fruit or a vegetable each school day for the first 3 years of school. The present study examines the impact of the SFVS, in terms of its contribution towards the total daily intake of fruit and vegetables by children across England. Quantitative dietary data were collected from 2306 children in their third year of school, from 128 schools, using a 24 h food diary. The data were examined at different spatial scales, and variations in the impact of the scheme across areas with different socio-economic characteristics were analysed using a deprivation index and a geodemographic classification. The uptake of the SFVS and the total intake of fruit and vegetables by children varied across different parts of England. Participation in the SFVS was positively associated with fruit and vegetable consumption. That is, in any one area, those children who participated in the SFVS consumed more fruit and vegetables. However, children living in deprived areas still consumed less fruit and vegetables than children living in more advantaged areas: the mean daily frequency of fruit and vegetables consumed, and rates of consumption of fruit or vegetables five times or more per d, decreased as deprivation increased (r - 0.860; P = 0.001; r - 0.842; P = 0.002). So the SFVS does not eliminate the socio-economic gradient in fruit and vegetable consumption, but it does help to increase fruit and vegetable consumption in deprived (and affluent) areas.     

Self-efficacy and consumption of fruit and vegetables: validation of a summated scale.

PURPOSE: To develop and validate a scale to assess self-efficacy for increasing fruit and vegetable consumption, and to assess the ability of the scale to discriminate individuals at different stages of readiness to change. METHODS: Data were collected using a combination of self-administered mail questionnaires and phone interviews from a sample of 1200 Chinese Singaporeans randomly selected from residential phone listings. Principal-components analysis was conducted with half the sample, and model fit was measured using structural modeling procedures on the other half. Analyses of variance were used to determine whether self-efficacy differed across the stages of change. SETTING: Data were collected as part of a larger study investigating factors influencing consumption of fruit, vegetables, and cereal foods. MEASURES: Fruit and vegetable intake was measured using a validated seven-item food frequency questionnaire. Subjects were assigned to stages using a phone-administered staging algorithm. Self-efficacy items were scored on a five-point Likert scale from very confident to not at all confident. RESULTS: Principal-components analysis revealed a two-factor structure that was highly stable across two split-half samples and gender, and accounted for 57% of the variance in self-efficacy. The two factors demonstrated good internal consistency (Cronbach's alpha = 0.77 and 0.89), with loadings ranging from 0.59 to 0.86 (mean = 0.70). Confirmatory factor analysis demonstrated good model fit (goodness-of-fit index = 0.99), with all parameters significant. Scores on the scale were significantly higher among subjects assigned to maintenance than among those assigned to precontemplation, contemplation, and preparation. CONCLUSIONS: Results of this study provide preliminary evidence for the utility of the scale to guide development and monitoring of community programs and therapeutic interventions.     

Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia

Objective: This study examined trends in the price of healthy and less‐healthy foods from 1989 to 2007 using the Australian Consumer Price Index (CPI). Methods: CPI food expenditure classes were classified as ‘core’ or ‘non‐core’. Trends in the CPI were analysed to examine the rise in prices of core compared with non‐core foods. Results: On average, the CPI for core foods has risen at a slightly higher, though not statistically significant, rate than non‐core foods. Furthermore, selected groupings reveal interesting patterns. ‘Bread’ has risen in price significantly more than ‘cakes and biscuits’, and ‘milk’ has risen in price significantly more than ‘soft drinks, waters and juices’. Conclusions and implications: This investigation of food price trends reveals notable differences between core and non‐core foods. This should be investigated further to determine the extent to which this contributes to the higher prevalence of diet‐related diseases in low socio‐economic groups.     

Increasing pre-school children's consumption of fruit and vegetables. A modelling and rewards intervention

Using a repeated measures design, in a nursery setting, a modelling and rewards intervention targeted preschool children's consumption of 8 fruit and 8 vegetables (presented as 4 different food sets, each comprising 2 fruit and 2 vegetables). During the 16-day Baseline 1, and subsequent baselines, the children received a different food set daily, first at snacktime and again at lunchtime; consumption of these foods was not rewarded. In the 32-day fruit intervention phase, Food Set 2 and Food Set 3 were presented on alternate days; rewards were presented only at snacktime, and only for consumption of the fruit components. Following Baseline 2 and Baseline 3, the intervention targeted snack consumption of the vegetable components of Food Sets 1 and 4. Finally, Baseline 4, and 6-month Follow up were conducted. The interventions produced large and significant increases in target fruit and vegetable consumption with smaller, but significant, increases for the paired, opposite category, non-target foods. Immediately after each intervention, increases based on within-category generalisation were also evident. All increases generalised strongly to the no-rewards lunchtime context. Contrary to theories predicting response decrements, the increases in preschoolers' fruit and vegetable consumption were maintained at Follow up, six months after rewards were withdrawn.     

A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables

OBJECTIVE: To evaluate the differences in the consumption of fruit and vegetables between groups with different socio-economic status (SES) in the adult population of European countries. DESIGN: A systematic review of published and unpublished surveys of food habits conducted between 1985 and 1999 in 15 European countries. Educational level and occupational status were used as indicators of SES. A pooled estimate of the mean difference between the highest and the lowest level of education and occupation was calculated separately for men and women, using DerSimonian and Laird's random effects model. SETTING: The inclusion criteria of studies were: use of a validated method for assessing intake at the individual level; selection of a nationwide sample or a representative sample of a region; and providing the mean and standard deviation of overall fruit and vegetable consumption for each level of education or occupation, and separately for men and women. SUBJECTS: Participants in the individual surveys had to be adults (18-85 y). RESULTS: Eleven studies from seven countries met the criteria for being included in the meta-analysis. A higher SES was associated with a greater consumption of both fruit and vegetables. The pooled estimate of the difference in the intake of fruit was 24.3 g/person/day (95% confidence interval (CI) 14.0-34.7) between men in the highest level of education and those in the lowest level of education. Similarly, this difference was 33.6 g/person/day for women (95% CI 22.5-44.8). The differences regarding vegetables were 17.0 g/person/day (95% CI 8.6-25.5) for men and 13.4 g/person/day (95% CI 7.1-19.7) for women. The results were in the same direction when occupation instead of education was used as an indicator of SES. CONCLUSIONS: Although we cannot exclude over-reporting of intake by those with highest SES, it is unlikely that this potential bias could fully explain the differences we have found. Our results suggest that an unhealthier nutrition pattern may exist among adults belonging to lower socio-economic levels in Europe. SPONSORSHIP: The present study was supported by the European Union's FAIR programme (FAIR-97-3096).     

Occurrence of patulin in fruit and vegetables

In different varieties of apples and pears suffering from brown rot, patulin was found in about 50 p. 100 of samples investigated (about 120). Patulin levels as high as 1 g/kg rotten material were found 2-3 days after the fruit was removed from the cold store where it had been stored for 5 months. A significant diffusion into the healthy plant tissue was not observed in apples, but in peaches, tomatoes and pears. Vegetable products with natural patulin content: apples, pears, peaches, apricots, bananas, pine apples, grapes. After inoculation with Penicillium expansum, P. urticae or Byssochlamys nivea, patulin was also found in greengages, strawberries, honeydew melons, red and green paprika, tomatoes, cucumbers and carrots. The artificial infection failed in celeriac, kohlrabi, cauliflower, red cabbage, radish, horseradish, onions, squash (zuccini), potatoes and egg plants. The author further investigated the patulin synthesis as a function of the temperature as well as its oxygen requirement in various mold species and strains.     

Consumption of, and factors influencing consumption of, fruit and vegetables among elderly Chinese people

ObjectiveThere is substantial evidence that the low intake of fruit and vegetables (FV) is a major risk factor for many nutrition-related non-communicable diseases. The purpose of our study was to assess FV consumption and the variables that influence FV consumption among Chinese people age 60 and older.MethodsTwenty-four-hour dietary recall data from the 1991, 1993, 1997, 2000, 2004, 2006, and 2009 China Health and Nutrition Surveys were used to collect the FV intake and sociodemographic variables examined in this article. Data were analyzed using t tests, χ² tests, and logistic regression.ResultsBetween 1991 and 2009, elderly Chinese adults experienced an improvement in dietary FV intake. The FV consumption increased from 325.7 g/d in 1991 to 379.0 g/d in 2009. During this 18-y period, the proportion of daily consumers increased from 11.0% to 32.5% for fruit and remained over 95% for vegetables. Age, gender, educational attainment, community, activity level, marital status, and drinking were significantly associated with FV consumption.ConclusionThe findings of this study indicated that FV intake among elderly adults in China was lower than the minimum of 400 g/d recommended by the World Health Organization. Greater public health efforts and approaches are needed to promote FV consumption in elderly Chinese adults.     

Intake of fruit and vegetables and risk of stroke: an overview

PURPOSE OF REVIEW: This review presents recent scientific advances in understanding the role of fruit and vegetables in lowering stroke risk, based on epidemiological and clinical studies. RECENT FINDINGS: Recent studies indicate that high dietary intake of fruit and vegetables is associated with reduced risk of stroke and other cardiovascular outcomes. Both observational studies and interventional trials have consistently shown this inverse relationship. Multiple mechanisms may underlie the apparent beneficial effect. SUMMARY: Public health policy should promote increased dietary intake of fruit and vegetables, as this may have a substantial positive effect on stroke prevention.