Article

Have Americans Increased Their Fruit and Vegetable Intake?. The Trends Between 1988 and 2002

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Abstract

Previous research indicates that few Americans meet the United States Department of Agriculture (USDA) guidelines for fruit and vegetable consumption, and that adequate fruit and vegetable consumption may decrease the risk for chronic disease. Twenty-four-hour dietary recall data from NHANES III, 1988-1994 (n=14,997) and NHANES 1999-2002 (n=8910) were used to assess adult (equal to or more than 18 years) trends in daily fruit and vegetable consumption (number of servings and types). In 1988-1994, an estimated 27% of adults met the USDA guidelines for fruit (equal to or more than two servings) and 35% met the guidelines for vegetables (equal to or more than three servings). In 1999-2002, 28% and 32% of adults met fruit and vegetable guidelines, respectively. There was a significant decrease in vegetable consumption over time (p=0.026). Only 11% met USDA guidelines for both fruits and vegetables in 1988-1994 and 1999-2002, indicating no change in consumption (p=0.963). In both data sets, non-Hispanic blacks were less likely to meet USDA guidelines compared to non-Hispanic whites (p<0.05). Higher income and greater education were significantly associated with meeting the guidelines in both data sets (p<0.05). Despite the initiation of a national fruit and vegetable campaign in 1991, the findings indicated that Americans' fruit and vegetable consumption did not increase in 1999-2002, and only a small proportion met the related dietary recommendations. Greater public health efforts and approaches are needed to promote healthy eating in the United States.

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... The subjects consuming five or more servings of vegetables and fruits a day, as recommended by the United States Department of Agriculture (USDA) guidelines based on the National Health and Nutrition Examination Survey (NHANES) data, was reported to be about 23.6% [34]. However, a study conducted on the 5 servings of vegetables and fruits per day (80 g/serving) in all ages using KNHANES in 2008 reported that the rate of satisfactory intake increased with age: 13.5% in subjects aged [13][14][15][16][17][18]19.1% in those aged 24.0% aged 49-59, and 25.4% aged 60 or older, which was similar to our result of 24.6% in 2008 [16]. ...
... Regardless of the increase in family size, fruit and vegetable intake tended to increase in all subjects over the past 20 years. This shows a similar trend to the results of previous studies [34]. However, the WHO/WCRF guidelines for plant food intake were still less than half of the subjects. ...
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The study aimed to examine the 20-year trends in fruit and non-starch/unsalted vegetable intake among the Korean elderly aged 65 years or older based on the Korea National Health and Nutrition Examination Survey (KNHANES) data. A total of 3722 elderly citizens aged 65 years or older who participated in the dietary survey (24-h recall of dietary intake) of the 1998, 2008, and 2018 NHANES were selected as the subjects of this study. Fruit and non-starchy/unsalted vegetable intake increased by approximately 86.53 g over the past 20 years, from 268.27 g in 1998 to 355.8 g in 2018. In particular, 65–74-year-olds had an increased intake by approximately 130.38 g over the past 20 years, from 277.34 g in 1998 to 407.72 g in 2018. In addition, snacks intake significantly increased over the past 20 years (p for trend < 0.001). Intake according to daily meal cooking location increased by approximately 130 g over the past 20 years, from 64.50 g in 1998 to 123.39 g in 2008, and to 198.01 g in 2018. The annual proportion of the total elderly population who meet the amount of vegetable food intake recommended by the World Health Organization (WHO)/World Cancer Research Fund (WCRF) (400 g or more fruits and non-starchy vegetables) increased by approximately 11.28%p (percentage points) over the past 20 years, from 21.78% in 1998 to 24.63% in 2008, and to 33.06% in 2018. The results of this study suggest that more fundamental measures are required to increase the fruit and non-starchy vegetable intake among the elderly. Furthermore, it is thought that the results of this study can be used as basic data in establishing dietary policy. In addition, it is thought that it can be used in developing nutrition education and dietary guidelines for enhancing fruit and vegetable intake.
... With the rising incomes and resultant change in diets from vegetable based, it is anticipated that health challenges such as cardiovascular diseases, diabetes and cancer will continue to increase (Davies and Doyle, 2015;NFNC, 2009;Pomerleau et al., 2004). The decline in consumption of fresh fruits and vegetables is a worldwide phenomenon (Casagrande et al., 2007;Hampwaye et al., 2016;Pomerleau et al., 2004). This decline when coupled to a diet largely rich in calories and energy has been associated with malnourished or obese populations (Hoffman et al., 2017(Hoffman et al., , 2018. ...
... Consumption of vegetables and fruits can be improved by introducing and popularising 'novel' commodities or under-utilised plants (Casagrande et al., 2007;Pomerleau, et al., 2004). Indigenous plants provide a cheaper and affordable source of nutrients and can play a critical role especially among the low-income brackets of the population (Williams and Huq, 2002;Davies, 2015;NFNC, 2009, Weller et al., 2015. ...
Article
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Studies were conducted to determine variability in leaf nutritive contents associated with leaf phenological maturity and genotype among local Zambian roselle (Hibiscus sabdariffa) landraces. A split-plot design was used with leaf maturity as the main plot, genotype as the subplot and 4 replications. Four local landraces ZM 5729, ZM 5738, ZM 5748 and ZM 6839 from Western and Southern provinces of Zambia were compared. Leaves were harvested at three plant maturity stages: immature (7-11 weeks old), mature (12-15 weeks old) and senescence (more than 16 weeks old). Crude protein, carbohydrates, fat, fibre, oxalate, alkaloid and vitamin C contents were analysed. There were highly significant interactions among genotypes and maturity for macro-nutrient, anti-nutrient and vitamin C contents. Ash content increased with advance of maturity. Crude protein was highest in the immature phase and declined slightly in the mature phase. Crude fat was lowest in the immature stage and increased to a maximum in the mature stage. Crude fibre increased with maturity, by about 215 % from the immature to the senescence stage. For the two anti-nutrients, alkaloids increased with age from 1.58 % in immature to 4.17 % in senescent stage; and oxalates followed a reverse pattern, decreasing with age. Vitamin C followed a trend that showed moderate levels in the immature phase, which increased by about 20 % in the mature stage and thereafter declined by about 70 %. Vitamin C increased with increases in fat and carbohydrate contents but was reduced with fibre content. Ash increased with alkaloid contents but was reduced with oxalate content. The study demonstrated the variability in nutritional, anti-nutrient and vitamin C contents among local roselle genotypes as they mature. These changes have an important bearing on the nutritional quality of the vegetable related to when leaves are harvested.
... Dietary patterns differ across ethnic groups, with fruits and vegetables comprising different percentages of the total energy intake (18) . Studies in the United States have reported differences in self-reported fruit and vegetable consumption across ethnic groups (19) and lower adherence to recommended intake in ethnic minorities compared to the Caucasian majority population (20) . In addition, a metaanalysis showed a different self-reported fruit and vegetable intake across eight countries but no significant association with T2D (7) . ...
... The observed ethnic differences confirm previous selfreported differences in fruit and vegetable intakes across different ethnic groups (19,20) and in the population under study (28) . Previous studies performed in the United States have included comparisons with ethnic groups such as Hispanics and African Americans (21)(22)(23) . ...
Article
Objective Studies have reported an inverse association between a diet rich in fruits and vegetables and type 2 diabetes (T2D), but data on high-risk ethnic minority groups is limited. We investigated whether serum carotenoids, as biomarkers for fruit and vegetable intake, mediate ethnic differences in the prevalence of T2D. Design Age-adjusted serum carotenoid concentrations were compared using ANCOVA. A cross-sectional analysis was performed using Cox regression to estimate prevalence ratios (PR) and their 95 % CI of the association between serum carotenoid concentrations and T2D. To study whether serum carotenoids potentially mediate the differences in the prevalence of T2D across ethnic groups, we compared PR of the model including known risk factors and the model additionally adjusted for serum carotenoid concentrations using the Dutch group as reference. Setting A study among six ethnic groups living in Amsterdam, the Netherlands. Participants Data on 204 Dutch, 203 South Asian Surinamese, 204 African Surinamese, 203 Turkish and 200 Moroccan-origin participants from the Healthy Life in an Urban Setting (HELIUS) study were used. Results Serum carotenoid concentrations differed across ethnic groups. After adjusting for confounders, the serum concentrations of total carotenoids (PR 0·67, 95 % CI 0·54, 0·84), α-carotene (PR 0·57, 95 % CI 0·42, 0·77), β-carotene (PR 0·45, 95 % CI 0·32, 0·63) and β-cryptoxanthin (PR 0·73, 95 % CI 0·58, 0·92) were inversely associated with T2D. Despite the associations, serum carotenoids did not mediate the ethnic differences in the prevalence of T2D. Conclusions The limited contribution of serum carotenoids to ethnic differences in T2D suggests that a focus on increasing fruit and vegetable intake alone will not likely eliminate ethnic differences in T2D prevalence.
... The consumption of fresh fruits and vegetables in Zambia is low particularly among the high income households (Hichaambwa et al., 2009). This low and declining consumption of fruits and vegetables is not unique to Zambia but a worldwide phenomenon (Casagrande et al., 2007;Pomerleau et al., 2004). An added complication is the declining nutritional content in new crop varieties that has been observed as plant breeders attempt to improve agronomic characteristics of crops (Simon, 2014). ...
... Growing awareness of health-promoting effects of vegetables and fruits has rekindled interest in novel or underutilised foods (Casagrande et al., 2007;Pomerleau et al., 2004). Indigenous plants provide a cheaper and affordable source of nutrients and can play a critical role especially among the low income households (Hichaambwa et al., 2009). ...
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p>An experiment was conducted to determine the effects of shade on plant development, macronutrient and secondary metabolites in roselle ( Hibiscus sabdariffa ). Three roselle accessions (ZM 5729, ZM 5738 and ZM ZM5748) acquired from the Zambia National Plant Genetic Resource Centre were used and shade was imposed by intercropping roselle with maize ( Zea mays ). A Split plot design with shade as main plot and genotype as split- plot was used. Nutritional and development parameters were monitored. At 14 weeks shaded plants had about a three-fold decrease in branches numbers compared to unshaded ones. Plant height was higher in unshaded treatments (120 cm) compared to shaded (83 cm). Plant height of ZM 5738 was significantly higher than the other two accessions. Shading reduced dry matter accumulation by almost 75 % across genotypes with about 20 g per plant in shaded treatments and 73 g in unshaded treatments. Nutrient reductions were highest in fat (60.6 %), fibre (48.4 %), protein (37.8 %), and lowest in ash (27.3 %). In terms of strength of partitioning the pattern was: branches ˃ leaves ˃ roots ˃ squares ˃ flowers. The carbohydrate content increased with shading (10.6 %). Vitamin C content was higher in unshaded treatments in comparison with shaded conditions. ZM 5738 had the highest content followed by ZM 5748 and ZM 5729 had the least content. Oxalates which are an anti- nutrition factor increased with shade. The findings showed that there is significant variation among genotypes and in future selections can be made to choose the most productive genotypes. Int. J. Agril. Res. Innov. & Tech. 8 (1): 7-13, June, 2018</p
... 60,61 NHANES data from 1999 to 2002 indicate a small but significant (P ¼ 0.03) decrease in mean daily intake, with only 33% of adults consuming at least 3 servings of vegetables per day. 61 Other populationbased studies confirm that vegetable intake stalled and then decreased in the late 1990s. Data from the Behavioral Risk Factor Surveillance System from 1990 to 1994 are consistent with the NHANES data from the early 1990s, ie, the percentage of US adults meeting the guideline of 5 servings of fruits and vegetables per day increased from 19% in 1990 to 22% in 1994, but then increased to only 23% in 1996. ...
... 77 Higher income and education are associated with higher intakes of reduced or nonfat milk, lean meats, and whole grains and with consumption of at least 5 servings of fruits and vegetables per day, while low socioeconomic status is associated with higher consumption of refined grains and added fats. 40,61,77 Low educational status is associated with low earning potential, low purchasing power, and food insecurity. 40 The prevalence of food insecurity has remained stable, at just over 14%, since the beginning of the 21st century. ...
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The negative health effects of inadequate magnesium intake are well established, but the extent of the problem of deficiency warrants further exploration. This review explores the dietary factors, such as changes in agricultural practices and dietary patterns, that affect magnesium consumption over time and examines the current adequacy of magnesium intake among adults in the United States. Large, cross-sectional, population-based data sets confirm over half the adult population in the United States does not consume adequate amounts of magnesium, although recent population-based studies show a steady and consistent recovery in magnesium consumption over the last several decades. Because there is no simple, rapid, accurate test to determine whole-body magnesium status, continued monitoring of magnesium consumption is essential to determine whether the trend of increasing magnesium consumption will continue. In the meantime, since the clinical consequences of inadequate magnesium status are well established, there are few reasons not to encourage increased magnesium intake in adults, especially since magnesium is found in healthy foods that should be consumed more often and there are no reported cases of hypermagnesemia from food alone.
... Growth stunting is a gradual process that occurs in response to chronic biological assault, including malnutrition and infectious diseases, during periods of linear bone growth. Up to date consumption data on fruit and vegetables is difficult to find but generally it is recommended that two servings of fruits and three servings of vegetables per day are required daily (Casagrande et al., 2007). The National Food and Nutrition Commission survey of 2009 showed the following; the overall stunting in Zambia was 49.7 % with subsequent surveys showing only minor decline. ...
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This review focused on horticultural development as a key economic subsector sector. Although practiced by more than 60 % of the population, agriculture and horticulture largely remain small scale in Zambia. Partly due to the relatively high income generation potential of commodities, the horticultural sector holds immense potential to make significant contribution to the poverty reduction. It has been estimated that since 1960, worldwide demand for fresh produce has more than doubled compared to a 20 % increase in demand for cereals. However, in Africa per capita supply of fresh produce has been declining since 1970. The key challenge therefore remains how to expand horticultural production in a manner that is sustainable and beneficial to all players throughout the food system. A vision of ‘An efficient and dynamic horticulture sector responsive to changing needs of society’ is advanced. This article reviews the emergence of horticulture sub sector contributing significantly to the agricultural GDP and poverty reduction, outlines its limitations and explores options for improving the sector. While the traditional biotic and abiotic approaches are the primary focus (improved research and development to drive production, and reduce postharvest losses), emerging challenges such as globalization, and climate change are considered. The findings suggest poor production technologies, limited crop varietal choices, high postharvest loses and inadequate marketing infrastructure and low smallholder participation horticultural markets contributing to overall poor sector performance. To achieve sustained and environmentally safe horticultural performance there is need to establish effective linkages, networks and partnerships among different players throughout the horticulture value and supply chains, both from private and public sectors.
... Adults living below the poverty threshold are significantly less likely to meet daily intake recommendations for fruits and vegetables (Grimm et al. 2012). Race and education are also predictive of healthy eating, with non-Hispanic Blacks and adults who did not graduate from high school exhibiting the lowest levels of fruit and vegetable consumption (Casagrande et al. 2007;Kirkpatrick et al. 2012). Access and cost have been held up as the most impactful explanations for associations between income, race, and eating habits that pose risks to personal health (Pirog et al. 2014;Treuhaft and Karpyn 2010). ...
Article
The market for local food has grown considerably over the course of thirty years. At the same time, even robust local food systems may reproduce injustices that have long marred corporatized food systems. In this paper, we explore the relationship of environmental justice to local food systems by asking two questions. First, are farmers markets (FMs) more likely to be found in wealthier, whiter communities? Second, are FMs providing people who are not members of socially privileged groups with an opportunity to buy food grown in accordance with organic principles? Drawing on survey data from FMs in New Jersey, we find that, although community demographics are strongly associated with FM location, social privilege is not associated with where organic farmers sell produce, once the lens of analysis is narrowed to just communities with an FM. But although food grown without agricultural chemicals is widely available at FMs in the study area, organic farmers who accept payment via WIC or SNAP are not more likely to sell at FMs in lower-income communities, and fewer organic farmers than non-organic farmers accept payment via WIC or SNAP. The presence of organic farmers at FMs in a wide range of communities suggests that expanding access to locally sourced fruits and vegetables may be able to play a small but not insignificant role in reducing exposure to agricultural chemicals. However, organic food would be more accessible at FMs in low-income communities if more organic farmers participated in nutrition assistance programmes like WIC and SNAP.
... Rakhra et al., 2020), and whilst dietary guidelines do emphasise on limiting the intake of such foods, research indicates that this is normally not the case (e.g. Park et al., 2012), especially amongst those who have obesity (Te Morenga et al., 2013). In fact, despite the WHO recommendation of consuming a minimum of five portions of fruit and vegetables a day (WHO, 2003), studies have suggested that people often consume significantly less (Casagrande et al., 2007;Hall et al., 2009;Sachdeva et al., 2013). Focusing on limiting the consumption of foods high in fat and sugar, whilst also encouraging the intake of fruit and vegetables is important for weight regulation and obesity prevention (Akers et al., 2012;de Oliveira Otto et al., 2018). ...
Article
Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.
... Research has shown that young adults consume high amounts of fast food and soda or sugar-sweetened beverages and low amounts of fruits and vegetables [1][2][3][4][5][6]. For the purpose of this study, we define soda or sugarsweetened beverages and fast food as unhealthy foods, and fruits and vegetables as healthy foods. ...
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Objectives This study explores the relationship between young women’s consumption of healthy and unhealthy food and depression and examines the moderating effect of their employment status on the relationship. Methods The National Longitudinal Survey of Youth 79 for Children and Young Adults (NLSY79 CY) was used for this study. The final sample included a total of 1524 young women aged from 18 to 35 years. Multiple Linear Regression was conducted to answer the research questions. Results Fast food consumption was related to higher levels of depression among young women while fruit intake was associated with lower levels of depression. Employment status moderated the relationship between young women’s fruit consumption and depression. Conclusions Young women are encouraged to consume more fruit and less fast food in order to ameliorate depression. Programs that target young women’s mental health should consider addressing their nutritional needs, through, for example, vouchers for fresh, nutritious foods; nutrition or cooking education; or having a certified nutrition specialist on staff.
... However, a review of F&V policies and initiatives across countries could help to explain the changes and guide future strategies to increase F&V intake among adolescents. According to the studies of Casagrande et al., (2007) and Larson et al., (2007) the United States population is not meeting the recommended levels of F&V consumption. There is no statistically significant increase in F&V intake among adults between the years 1988-1994 and 1999-2002. ...
Research
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Fruits and vegetables (henceforth referred to as F&V) are very good sources of vitamins, minerals, antioxidants, and dietary fibre. Adequate consumption of F&V is one of the most cost-effective measures to alleviate micronutrient deficiencies and could help to reduce a wide range of diseases. Therefore, the consumption of F&V is encouraged as part of a healthy diet which will lead to lower personal and social health costs. According to medical recommendations, an adult needs a minimum of 400 grams of varying F&V each day to lead a healthy life. However, Sri Lanka's per capita consumption of F&V remains far below the required average daily intake. Due to the diverse nature of socio-economic status, the patterns and decisions in F&V intake may vary from household to household (henceforth referred to as HH). Understanding this behavior is important in decision making along with the F&V supply chain as well as in implementing nutrition policies. Hence, the focus of this study is identifying F&V consumption patterns, contributory factors for consumption, and barriers and potential to increase F&V intake at HH level in Sri Lanka with special attention to the urban, rural, and estate sectors. Multistage Random Sampling Method was employed and 443 HHs representing the urban, rural, and estate sectors were surveyed using a structured questionnaire. Descriptive analysis was conducted to examine the F&V purchasing behaviour of HHs. The F&V intake was measured according to the National Food Guidelines presented by the Ministry of Health of Sri Lanka, and Food and Agriculture Organization guidelines. The Simpson Index Analysis was used to calculate F&V consumption diversity across HHs. The factors which influence HH F&V consumption were examined using a Regression Analysis. An Exploratory Factor Analysis was used to identify factors that influence the potentials and barriers to F&V consumption. Urban HHs spend more than twice the amount that rural and estate HHs spend on F&V. The budget share of F&V varies across the three sectors showing values of 0.42, 0.32, and 0.29 among urban, rural, and estate dwellers respectively. The vegetable budget share is higher than the fruit budget share in all three sectors indicating higher spending for vegetables in comparison to fruits. In the period from 2002 to 2016, there is an increasing trend in fruit budget shares in urban HHs over time and a declining trend in the rural sector. There is no significant change in fruit budget shares in the estate sector during this period. Urban HHs show a declining trend in the vegetable budget share over time in the same period, while the rural and estate sectors showed an upward trend. However, the percentage of the food budget spent on F&V is generally small in all three sectors, ranging from 1.9 percent to 10 percent. A majority of the urban (69%), estate (69%), and rural (56%) HHs totally depend on outsources for obtaining F&V, while only four percent of the rural sector and one percent of estate HHs fully depend on home gardens to obtain F&V. Most of the HHs in the urban sector are inclined to use supermarkets to obtain F&V while the rural sector HHs prefer home gardens and the local market (pola). Estate HHs mostly prefer the local market and roadside vendors. A majority of the respondents (99%) did not have problems with the availability of F&V at markets. However, there was a keen interest in buying fresh F&V rather than packed or processed ones. Quality and freshness were the most important attributes that come under F&V purchasing, followed by price, safety, and seasonality which were ranked under important attributes. The per capita fruit consumption was estimated and it varied across urban (187.78 g/day/person), rural (151.51 g/day/person) and estate (43.34g/day/person) HHs. The per capita vegetable consumption was reported as 180.55 g/day/person in the urban sector, 165.89 g/day/person in the rural sector, and 108.38 g/day/person in the estates. The Simpson Index Analysis revealed that diversity of F&V intake varies among HHs and the highest diversity is in urban (0.65) HHs, followed by rural (0.58), and estate (0.32). In addition, the consumption of vegetables (urban- 0.63, rural- 0.56, estate- 0.28) is more diversified than the consumption of fruits (urban-0.31, rural- 0.19, estate-0.025). However, quantity, as well as the diversity of F&V intake, is very low in estate HHs in comparison to the urban and rural sectors. According to the Multiple Linear Regression Analysis, HH size, gender, education level of the HH head, number of children, food habits, dwelling in an urban area, and access to the F&V market have a significant effect on HH expenditure on F&V over other expenditures. The results of the Exploratory Factor Analysis revealed eight factors that impact potentials and constraints in F&V consumption. They are, “the willingness to change”, “choice of F&V”, “awareness of recommendations”, “liking”, “health consciousness”, “difficulties,” “ease” and “perceived quality of F&V”. All together, these factors explained 70 percent of the total variation. Most of the respondents were aware of the nutritional benefits of F&V. However, the majority of respondents (75%) in the survey were not aware of the National Food Guidelines, quantity, variety of intake, and terms like serving and serving sizes. Perception of chemical usage in fruit ripening, poor taste, and high prices were the most important factors which hindered HH fruit consumption. Awareness about the nutritional benefits of F&V, quality of the products, availability at home gardens, reasonable price, and seasonal availability were reported as motives for F&V intake. The majority of the respondents (97%) highly perceived that the F&V they purchased are not very safe and believed that they are contaminated with pesticide residues. This belief negatively affected the F&V consumption and purchasing decisions of a majority of HHs (74%). Most of the respondents (60%) were aware of organic F&V. However, non-availability, doubt about the product guarantee, lack of promotion, and unclear declarations of the organic status were the major barriers for reducing purchase of organic F&V. According to the sector of residence, socio-economic status, and the F&V consumption patterns of HHs varied, which suggests that actors in the supply chain of F&V should find the most suitable markets for their products across three sectors. The nutrition policies should place more emphasis on promoting F&V consumption, making people aware of the importance of a diversified F&V intake, and promoting v better attitudes towards healthy diets. Estate sector HHs, in particular, should be specifically targeted in such strategies as they have the least F&V intakes in accordance with dietary recommendations. Assurance of quality and safety of F&V available at the market is essential and market inspections and legislation procedures should be strengthened and regulated. It is recommended that scientific research is done to assess the residual effects of pesticide use and that people are made aware of this information to prevent misconceptions. There is a potentially viable market for safe F&V and national legislation for reputable organic certification will lead to greater trust in organic F&V. Moreover, investments in F&V research aimed at reducing production costs and enhancing food safety could greatly benefit population health by helping to lower the price of F&V making them more accessible to the populations that need them.
... Consuming high levels of fruit and vegetables is linked to significant reductions in conditions such as obesity and heart disease (Dubowitz et al., 2007;Ettienne-Gittens et al., 2013). Although reports show that most U.S. adults do not consume an adequate amount of fruit and vegetables (Gary et al., 2004), African Americans and groups of lower socioeconomic status are less likely to consume a fruit and vegetable-rich diet (Casagrande et al., 2007, Ettienne-Gittens et al., 2013. The current minimum recommended daily allowances for adults range from 2.5 to 3 cups of vegetables and 1.5 to 2 cups of fruit, depending on age, sex and physical activity (United States Department of Agriculture, 2010). ...
Article
Cardiovascular disease is a concern nationwide and disproportionately impacts African Americans residing in the American South. However, this condition can be assuaged by consuming a diet of fruits and vegetables. Utilizing the social ecological model, this study explored the community, interpersonal, and intrapersonal factors that predict fruit and vegetable consumption in Hopkinsville, Kentucky, a small rural city which possesses one of the largest populations of African Americans in the state. Using data from social transect walks and a formative research survey (N=174), this study also sought to discover the best methods to communicate with Hopkinsvillians to improve their diets. Results show that despite some barriers (i.e., cost of quality foods, perceived lack of access to fresh food stores), Hopkinsvillians tend to view fruit and vegetable consumption positively. In addition, family and friends provide interpersonal support to those wanting to eat healthier. The study reveals that communicators must consider all levels of the social ecological model to produce effective health messages.
... It has been estimated that only 9% to 13% of U.S. adults meet the recommended vegetable intakes [1,2]. Meanwhile, racial and ethnic disparities in overall health and fruit and vegetable consumption have been well documented [3][4][5]. In the U.S., people identifying as Black have lower rates of vegetable consumption and poorer nutritional quality compared to their White counterparts [6,7]. ...
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With the majority of U.S. adults not meeting recommended vegetable intakes and well-documented racial and ethnic disparities in fruit and vegetable consumption, various approaches to increase vegetable consumption have been implemented. Gardening is one approach that has been associated with increased vegetable consumption in various subpopulations; however, limited national data exist examining this relationship. Since vegetable acquisition is a necessary antecedent to increased vegetable consumption, this study examines if garden access is associated with vegetable acquisition among adults in a nationally representative sample of U.S. households. Data come from the National Food Acquisition and Purchasing Survey (FAPS), a survey of 4826 US households. Descriptive analysis and modified Poisson regressions were performed to examine associations between household garden access and vegetable acquisition amongst the total population and by race. Results indicate that for foods for at-home consumption, respondents with their own garden had a 30% greater prevalence (PR: 1.30, 95% CI: 1.01, 1.64) of acquiring enough vegetables to meet USDA recommendations compared to respondents in households without access to any gardens. Among Black respondents, those with access to their own garden had over two times increased prevalence (PR: 2.35, 95% CI: 1.10, 5.01) of acquiring enough vegetables to meet recommended consumption amounts, compared to Black respondents without any access to a garden. No relationships between garden access and vegetable acquisition were observed for White or Asian respondents. This information may contribute to the body of evidence on strategies for increasing vegetable consumption among U.S. adults.
... In contrats, Ngo-Metzger et al. reported differences in different races (25). Since cost itself is an obstacle to choosing a healthy diet, including fruits and vegetables, income is considered as a positive determinant of a healthy diet (26). ...
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Background: Diabetes is one of the most common chronic and non-communicable metabolic diseases and one of the major public health problems. Lifestyle and diet are remarkable factors in controlling diabetes. Objectives: This study aimed to determine the level of knowledge and stages of nutritional behavior change in diabetic patients. Methods: In this descriptive-analytical study, a simple random sampling method was used to select 330 diabetic patients covered by comprehensive health service centers in Ghayenat city, South Khorasan Province, Iran. The research instrument addressed the participants’ demographic information, knowledge, and stages of nutritional behavior change in diabetic patients. The ordinal logistic regression was used to examine factors affecting behavior change. In this regard, the significance level was set to be P < 0.05. Results: The participants’ mean age was 57.86 ± 11.72 years, and 63.7% of the patients were female. The mean score of knowledge was 15.73 ± 2.61, and 52.8, 16.9, 8.9, 11.3, and 10.1 percent of the participants were in the maintenance, action, preparation, contemplation, and pre-contemplation stages. The ordinal Logistic regression model revealed that the main factors affecting behavior change were knowledge, level of income, and a family member with diabetes (P < 0.05). Conclusions: Given that about two-thirds of diabetic patients take no training course on diabetes, that above forty percent of these individuals have no proper knowledge about the disease, and that half of the patients are in the pre-maintenance stages of behavior change, holding a training course is of paramount importance for patients.
... Demand for fruits and vegetables is important because most U.S. consumers do not consume the recommended amounts (Lee-Kwan et al., 2017). Low consumption of fruits and vegetables has persisted despite decades of public programs promoting healthier diets (Casagrande et al., 2007;Lin et al., 2016). Even modest increases in fruit and vegetable consumption from current low levels could lead to significant reductions in incidence of cardiovascular disease, cancers, and all-cause mortality (Aune et al., 2017). ...
Article
Many recent efforts by econometricians have focused on supervised machine learning techniques to aid in empirical studies using experimental data. By contrast, this article explores the merits of unsupervised machine learning algorithms for informing ex ante policy design using observational data. We examine the extent to which groups of consumers with differing responses to economic incentives can be identified in a context of fruit and vegetable demand. Two classes of nonparametric algorithms—revealed preference and unsupervised machine learning—are compared for segmenting households in the National Consumer Panel. Nonlinear almost‐ideal demand models are estimated for all segments to determine which methods group households into segments with different expenditure and price elasticities. In‐sample comparisons and out‐of‐sample prediction results indicate methods using price‐quantity data alone—without demographic, geographic, or other variables—perform better at segmenting households into groups with sizeable differences in price and expenditure responsiveness. These segmentation results suggest considerable heterogeneity in household purchasing behavior of fruits and vegetables.
... On one side, fruit and vegetables products are sold at a relatively high operating margin, as can be seen by comparing its contribution to retailers' turnover and profits (Payne et al., 2014). On the other hand, these products not only contribute to weight loss, but also bring health benefits (Casagrande, Wang, Anderson, & Gary, 2007). Moreover, fruit and vegetables is not the ideal setting for developing price promotions, and price lever is not best suited to support the department's sell-out (Talukdar & Lindsey, 2013). ...
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The World Health Organization (WHO) suggests people to eat at least five portion of fruits and vegetables a day, but the level of consumption of this category is far from been reached. Considering that the majority of food purchases occurs in grocery context, increasingly in e-commerce channels, understanding how retailers could improve food choice, both in physical and digital stores, is paramount to healthier living. This paper aims to understand which are the most effective retail marketing’ levers in stimulating impulse buying in fruits and vegetables category, therefore in promoting healthier shopping behavior. Since fruit and vegetable is known for its healthy vocation and its role in differentiating and enhancing the perceived image of retailers, this category is the ideal place to host nutritional marketing initiatives. We used a quantitative survey method to explore shoppers’ behaviour in an online setting, focusing on fruit and vegetables’ category. Respondents were exposed to nine marketing stimuli, according to different communication contents (price versus non price). All the data was considered for linear regression analysis. Our results show that the pre-shopping preparation has an effect on purchasing behaviour, limiting its impulsiveness. Furthermore, price levers and communication levers influence the intention to buy impulse in the online channel, with the latter more effective than the other ones. Therefore, as this process takes place in the digital context, marketing efforts need to focus on dimensions that increase the propensity to make impulse purchases online: communicative and price stimuli.
... For instance, Nour et al. [67] reported that young people aged from 18 to 24 years old reported less variety in the consumption of vegetables than people aged between 25 and 34. Moreover, older people are more likely to achieve the recommended daily consumption of fruit and vegetables than young people [68]. Interestingly, the literature shows that young people with lower diet quality scores were more likely to report depressive symptoms [69,70]. ...
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The role of diet quality in depression is an emerging research area and it appears that diet quality could be an important modifying factor. The aims of this study were to report the prevalence of diet quality among individuals with and without a self-reported diagnosis of depression aged from 16 to 64 years old in Spain, to analyze the time trends of the frequency of food consumption and diet quality from 2011 to 2017 in individuals with a self-reported diagnosis of depression, and to explore the associations between poor/improvable diet quality and sociodemographic, lifestyle, and health-related factors. A nationwide cross-sectional study was conducted in 42,280 participants with and without a self-reported diagnosis of depression who had participated in the 2011/2012 and 2017 Spanish National Health Surveys and the 2014 European Health Survey in Spain. A logistic regression analysis was performed to identify the variables associated with diet quality. The overall prevalence of diet quality among depressive and non-depressive individuals revealed 65.71% and 70.27% were in need of improvement, respectively. Moreover, having a poor or improvable diet quality is associated with male gender, people aged 16–24 years old and 25–44 years old, separated or divorced, and also in smokers.
... Yet, the amount of decline was not large (6·5 %), and vegetables remain an important component of the Korean diet. In comparison, vegetable intake for adults decreased in the USA in the 1988-2002 time period (16) , as well as in Hong Kong from 2004 to 2016 (for ages 45-64 years old) (17) . However, the decrease from 289·1 to 270·3 g/d in Korea is still greater in this research than the ≥240 g/d estimated globally (18) . ...
Article
Vegetables are an important source for the essential vitamins and minerals that are necessary for optimal health. This research investigated changes in vegetable intake over time in the Korean population from 1998 to 2017, focusing on preparation methods of vegetables and location of consumption. This cross-sectional study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) that was established in 1998 to assess the health and nutritional status of the South Korean population. This research utilized information from 1998 to 2017 which is the extent of all available KNHANES data. Vegetable consumption was grouped, according to preparation methods and common eating locations. Both crude and age-standardized means of vegetable intake were derived via a 24-hour dietary recall. All participants who completed a 24-hour dietary recall survey were selected for the analyses. This included 109,220 individuals (49,069 men and 60,151 women) over the course of 20 years of the KNHANES. Total vegetable intake decreased over time ( p for trends <0.001), specifically, steamed and salted vegetables ( p for trends <0.001). In contrast, Koreans consumed noticeably more raw vegetables from 1998 to 2017 ( p for trends <0.001). Vegetable intake at home significantly declined ( p for trends <0.001), while that eaten at restaurants or outside the home increased greatly ( p for trends <0.001). Over 20 years, Koreans have ingested decreasing amounts of vegetables, but the intake of raw vegetables has escalated. However, the location of vegetable consumption has changed, with an increase at both restaurants and outside the home (≍ 70.0%).
... Racial and ethnic minority groups, defined here as Black or African American, Hispanic, Asian, and Native American, have been traditionally underrepresented in clinical trials and epidemiologic studies focused on diet. This is despite ethnic minorities having diet-related disparities, including poorer diet [26] and disproportionate burden for health conditions that are related to diet including cardiovascular disease [27], high blood pressure [28], type 2 diabetes [29], and some cancers [30,31]. The rationale for why ethnic minorities need more representation in research that aims to capture nutrient intake is clear. ...
Article
Polyunsaturated fatty acids (PUFAs) play an important role in human health, influencing chronic disease and mortality. Food Frequency Questionnaires (FFQs) are widely used to assess self-reported diet, but they can be subject to a variety of errors. Accordingly, an accurate assessment of diet is crucial in nutrition research. This study examined the association between a widely-used self-report measure of PUFAs (Diet History Questionnaire- II: DHQ-II) with the proportion of PUFA in red blood cell (RBC) membranes, and examined whether this rela-tionship was moderated by race/ethnicity. In a racially and ethnically diverse sample of 132 female participants (Mage =21.97±3.98, range 18 to 42 years), bivariate correlations and linear regression analyses demonstrated associations between DHQ-II and proportion of nutrients in RBCs for omega-3 fatty acids EPA (r =0.39, ß =0.38, p <.01), DHA (r =0.48, ß =0.47, p <.01), and EPA+DHA (r =0.51, β =0.49, p <.01). No associations were found for omega-3 fatty acid ALA or omega-6 fatty acids LA or ARA. DHQ-II and RBC associations for EPA, DHA, and EPA+DHA were moderated by race/ethnicity, controlling for age. Self-report of EPA was most consistent with RBC proportions for Caucasian individuals, and less consistent for Black/African American individuals. Self- reports of DHA and EPA+DHA were most consistent with RBC proportions for Caucasian individuals, and less consistent for Black/African American individuals and Hispanic/Latina individuals, although still statistically significant. No associations were detected for Hispanic/Latina individuals (for EPA only), Asian/Pacific Islanders or individuals of mixed/other descent. The present study found that when compared to PUFA biomarkers, the DHQ-II did not assess PUFAs consistently across all racial/ethnic groups in this sample of women. Further research is needed to determine what factors contribute to weak or lacking correlations between reported fat intake and corresponding values in RBCs, including but not limited to recall errors, underestimations of fatty acids in food composition databases, insufficient DHQ-II assessment of fatty acids in general and from particular cultures, and genetic differences in fat metabolism
... 11 Despite intensive public educational campaigns, surveys showed that 70% of U.S. people do not reach vegetable intake of the USDA rec-ommendation, and surprisingly 25% of people do not eat vegetable at all. 12 There are several reasons for low vegetable intake, such as economic burden, lack of knowledge of the benefits of vegetable intake, low availability of fresh products, taste preference, and limited cooking time and skills. Therefore eating vegetables every day is not easy for many people. ...
Article
Background and objectives: Our aim was to evaluate the effect of consuming tomato juice before carbohydrate on postprandial glucose concentrations in healthy women. Methods and study design: In this randomized controlled cross-over study, 25 healthy women (age 21.6±3.8 years, HbA1c 5.3±0.2 %, mean±SD) consumed either 200 g of tomato juice, tomato, or water (control) at 30 min before consuming 200 g of boiled white rice at 9:00 and consumed identical lunch at 13:00 for 3 days. The blood glucose concentrations were measured by selfmonitoring blood glucose at 0, 30, 45, 60, 90, 150, and 210 min pre- and post-breakfast, and at 0, 30, 60, 120, 150, and 180 min pre- and post-lunch. The concentration of postprandial glucose, incremental glucose peak (IGP), and incremental area under the curve for glucose after the test meals were compared among 3 days. Results: Incremental blood glucose concentrations at 60 min (2.32±0.16 vs 2.97±0.19 mmol/L, p<0.05, mean±SEM), 90 min (2.36±0.23 vs 3.23±0.24 mmol/L, p<0.01), and IGP (2.77±0.19 vs 3.68±0.22 mmol/L, p<0.001) in consuming tomato juice 30 min before carbohydrate were all significantly lower than those of water, while IGP of consuming tomato was tended to be lower than that of water (2.82±0.19 mmolL, p=0.023). No significant difference was observed in glycaemic parameters after consuming lunch among 3 days. Conclusions: Consuming tomato juice half hour before carbohydrate ameliorates the postprandial blood glucose concentrations, although total amounts of energy and carbohydrate of tomato juice are higher than those of water.
... Government agencies have traditionally tried to counter the negative effects of unhealthy eating patterns by creating awareness through health education programmes (e.g., Feunekes et al. 2020). These informative campaigns may make people aware of the constituents of a healthy eating pattern, but such cognitive interventions are unlikely to counterbalance the everlasting, continuing stream of persuasive advertising and product offerings that companies present them with (Snyder 2007;Stark Casagrande et al. 2007). Approaches that directly address emotional responses or attempt to target specific types of behaviours are likely to be more effective (Cadario and Chandon 2020). ...
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What makes food design different from other types of industrial product design? Based on over twenty years of professional design practice and food experience research, the authors present a variety of insights – clustered in five overarching themes – that provide an invaluable view on the specifics of the food realm for practicing designers in this field. First of all, foods are based on materials that used to be alive, which makes them highly perishable. Before the widespread introduction of mass transportations systems, foods were usually produced and consumed in the same region. But food technologists continuously try to improve the ways to preserve foods and invest in packaging that protects them in order to increase shelf life and to make them more widely available, while consumers seem to demand more and more freshness. The second challenge is presented by the need to make the food system more sustainable, addressing agricultural production and its impact on biological diversity and the quality of the living environment and also focusing on the amount of waste generated in terms of food or its packaging material. Third, the food people eat is absorbed and transformed into the building blocks of their bodies. Food fulfils a basic human need, and thus, there is a challenge to provide people access to the right amount of safe and nutritious food, in order to keep them healthy. Fourth, food is a source of sensory stimulation that enriches people’s lives. This provides a new sensory spectrum to design for – including flavour and mouthfeel – and it challenges designers to trigger appetite, rather than aesthetics. The fifth challenge addresses preparation practices and the associated cultural differences. Because food stuffs can be prepared in multiple ways, many different products can be created, varying from raw to highly processed, and addressing multiple consumer needs, eating occasions and market segments. These five themes provide interesting challenges for designers that should be tackled in order to provide a healthy and sustainable future for the next generations on this planet.
... indicates that African-Americans suffer disproportionately in comparison to Whites in terms of disease incidence and mineral deficiencies related to nutrition (Wang and Chen, 2011;Kirkpatrick et al., 2012). For example, data from the National Health and Nutrition Examination Survey (NHANES) III (1999III ( -2002 found that African Americans were 43% less likely than Whites to meet USDA fruit and vegetable guidelines (Casagrande et al., 2007). According to the Centers for Disease Control and Centers for Disease Control Prevention. ...
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Historically, African-American farmers faced a long and challenging struggle to own land and operate independently. In recent years, several factors, including unfair policy legislation, institutionalized racism, the mechanization of agriculture, and increases in agricultural technology have exacerbated land loss and decreases in farm ownership. Currently, African-American farmers are vastly underrepresented, comprising just 2% of the nation's farmers, 0.5% of farmland and 0.2% of total agricultural sales. As a site for inquiry, this topic has been examined across many academic sub-disciplines, however, the literature has not yet explored how the erasure of the African-American farmer influences the conversation about broader diet-related health disparities in the U.S. This overlooked perspective represents a novel approach to rethinking public health interventions and may improve methods for communicating messages about healthy eating to the African American community. In this essay, we extend (Dutta, 2008) the Culture-Centered Approach (CCA) to foreground the lived experiences and perspectives of a small cohort of African-American farmers (n = 12) living in the U.S. Mid-South as an entry point to address this underexamined area of research and inform future methodological directions of study. Two key themes emerged from the thematic analysis: (1) erasure of the African-American farming tradition and land loss; and (2) solutions to change. Drawing on the understanding that systematic land loss in the African-American community has contributed to wealth disparities between African-Americans and Whites, we argue that the erasure of the African-American farming tradition within mainstream discourses has created communication inequities that disenfranchise the African-American community and may contribute to broader health inequities in food system. Our findings may offer important insights into the methodological development of more effective health campaigns within these communities.
... For example, the national 5-A-Day-For-Better-Health fruits and vegetables campaign presented people with information about the pros and cons of health behaviors, attempting to motivate them to change. The campaign successfully increased people's knowledge about what they should do to be healthy, but had limited effect on eating habits [38,39]. Another example comes from highly controlled studies designed to change habits using incentives. ...
... An Australian survey also found low income households were more likely not to have eaten F&Vs the previous day, while high income households eat a greater variety of F&Vs and would like to increase their consumption (Giskes, Turrell, Patterson & Newman, 2002) 20 . Those with higher incomes are also more likely to meet the guidelines for F&V intake (e.g., Blanck et al., 2007;Casagrande, Wang, Anderson & Gary, 2007). Low income therefore appears to be a risk factor for an inadequate level of F&V consumption. ...
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Available at https://www.researchgate.net/publication/333203921_Fruit_and_vegetable_intake_among_men_in_New_Zealand_An_evaluation_and_extension_of_a_stage_and_continuous_model_of_dietary_behaviour
... To increase awareness and promote consumption of F&Vs, the five-a-day national campaign was launched in 1991. Despite significant efforts and funding, F&V consumption was not significantly impacted (Casagrande et al. 2007). However, some successes were observed with programs targeting specific food environments. ...
Article
The Dietary Guidelines for Americans (DGA) recommend the consumption of whole grains, fruits, and vegetables as part of a healthy diet. However, current consumption patterns suggest that most Americans are not meeting these recommendations. The challenge remains to align the DGA guidance with the food environment and consumers’ expectations for product quality, availability, and affordability. Currently, processed foods play an increasingly important role in American diets. Often characterized as unhealthy, processed foods are contributors to both food and nutritional security. When the alignment of processing strategies with DGA principles exists, achieving DGA goals is more likely, regardless of processing level. In this review, select processing strategies for whole grains, fruits, and vegetables are described to show how DGA principles can guide processing efforts to create healthier products. Although whole grains, supported by industry-wide innovation and guidance, have had some success with consumers, improving intake of fruit and vegetable products remains a challenge. Closing consumption gaps requires new innovations and products aligned with consumer preferences and DGA principles.
... These findings may be utilized to help improve school lunch vegetable consumption in this demographic in whom vegetable intake is far below national recommendations. 60 This identification of specific factors supporting or hindering vegetable intake among high-school students is important, given that most previous interventions focused on increasing vegetable consumption have been conducted in younger children. [61][62][63] Furthermore, few studies have examined use of spices/herbs for this goal, 43 and to the authors' knowledge, this is the first study to explore taste and other sensory-related factors as they relate specifically to attitudes about school lunch vegetable intake among an urban, economicallyunderserved adolescent study sample. ...
... According to the U.S. Behavioral Risk Factor Surveillance Survey (BRFSS) [237], only 21.3% of African Americans consume fruits and vegetables 5 times per day, the lowest of any U.S. ethnoracial group. Similarly, in the third National Health and Nutrition Examination Survey, NHANES (1999NHANES ( -2002, non-Hispanic African Americans were 43% less likely than nHWs to meet fruit and vegetable guidelines [238]. These racial disparities differ by geographic region. ...
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Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise "state-of-the-science" report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.
... This potential of advertising to change consumers' patterns of consumption should extend to healthy food. The continuing decline in fruit and vegetable intake ( Casagrande et al., 2007), however, casts doubt on the success of current healthy food campaigns. This failure raises questions about how advertisements for healthy and unhealthy foods differ. ...
... These findings may be utilized to help improve school lunch vegetable consumption in this demographic in whom vegetable intake is far below national recommendations. 60 This identification of specific factors supporting or hindering vegetable intake among high-school students is important, given that most previous interventions focused on increasing vegetable consumption have been conducted in younger children. [61][62][63] Furthermore, few studies have examined use of spices/herbs for this goal, 43 and to the authors' knowledge, this is the first study to explore taste and other sensory-related factors as they relate specifically to attitudes about school lunch vegetable intake among an urban, economicallyunderserved adolescent study sample. ...
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Objective: We identified factors impacting school lunch vegetable consumption among underserved urban adolescents. Methods: Overall, 26 adolescents completed questionnaires to determine perceptions and preferences of school lunch vegetables and spices/herbs. Sixteen adolescents participated in monadic sequential sensory evaluations to compare taste, appearance, texture, and smell acceptance for plain school lunch vegetable recipes versus otherwise identical recipes with spices/herbs. Paired preference ratings determined preferred recipes. Results: Preparation method and taste were common reasons for not eating school vegetables. Recommendations included modifying flavor, appearance and preparation. Black pepper and curry were self-reported favorite spices/herbs and garlic-based recipes were preferred over plain in sensory evaluations for peas, black beans/corn, and cauliflower-carrot-broccoli blend. Conclusions: Enhancing vegetables with spices/herbs is a novel approach to increase school lunch vegetable consumption among underserved urban adolescents.
... Despite their many health benefits (Dauchet, Amouyel, Hercberg, & Dallongeville, 2006;Doyle et al., 2006;Health, U. D. o., & Services, H, 2017;Organization, W. H, 2017;Rock & Demark-Wahnefried, 2002), most Americans consume fewer servings of fruits and vegetables (FVs) than recommended (Casagrande, Wang, Anderson, & Gary, 2007; Centers for Disease, C., & Prevention, 2007). FV consumption is influenced by a milieu of psychological, social, and structural factors, including individual choices and the beliefs that inform them (Elmubarak, Bromfield, & Bovell-Benjamin, 2005;Glanz, Basil, Maibach, Goldberg, & Snyder, 1998). ...
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Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < -0.31, ps <.001, than women, bs < -0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.
...  Felnőtt lakosság kevesebb, mint harmada fogyaszt megfelelő mennyiségű gyümölcsöt (napi legalább 2), és az emberek kevesebb, mint negyede megfelelő mennyiségű zöldséget (napi legalább 3) [2,3].  A hozzáadott cukor aránya a napi energia-bevitelben 1978 és 2002 között 13%-ról 17%-ra emelkedett [4,5]. ...
... While, Joint FAO/WHO Expert Consultation on diet, nutrition and the prevention of chronic diseases recommends to consume minimum 400g of F&V per day excluding potatoes and other starchy tubers ( Agudo et al., 2002;Bihan et al., 2010;Johnson et al., 1998), the literature has emphasized that people consume far less than the recommended amount of F&V in the US (Robinson, 2008), Australia (Ding et al., 2014), and European Union (EU) countries (FLB, 2012), in South Pacific island countries (FAO, 2015). A very low percentage of people in the world reached this target (e.g., 20-30% in the US (Casagrande, Wang, Anderson, & Gary, 2007), 43% in France ( Castetbon et al., 2009), 4% adults aged between 18 and 34 years in Australia ( Ding et al., 2014). While the per capita daily consumptions of F&V in the world were 171 g and 324 g in 2002, in a decade, they reached respectively 213 g and 385 g in 2013 (FAO, 2016). ...
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In this study, we have identified the effects of socio-demographic and economic factors of household heads and households on monthly expenditures of fresh and frozen fruit and vegetable in Turkey using the bivariate Tobit model. The results show that both the probability and monthly spending levels of household fruit and vegetable consumption increase with increasing in age of household heads, educational levels of household heads, married household heads, household income, and the number of adults in a family, while male-headed households, working household heads, the households that receive in-kind help from the government or private sector, and the use of internet at home decrease both the likelihood and spending levels of fruit and vegetable consumption in Turkey. The results in the study may contribute to the stakeholders to identify and implement effective marketing strategies and also develop more effective policies for the government to improve nutritional levels for certain dwellings for which the government include them in the certain state-initiated benefit program.
Article
Background: There is growing evidence that an addictive-eating phenotype may exist. There is significant debate regarding whether highly processed foods (HPFs; foods with refined carbohydrates and/or added fats) are addictive. The lack of scientifically grounded criteria to evaluate the addictive nature of HPFs has hindered the resolution of this debate. Analysis: The most recent scientific debate regarding a substance's addictive potential centered around tobacco. In 1988, the Surgeon General issued a report identifying tobacco products as addictive based on three primary scientific criteria: their ability to (1) cause highly controlled or compulsive use, (2) cause psychoactive (i.e. mood-altering) effects via their effect on the brain and (3) reinforce behavior. Scientific advances have now identified the ability of tobacco products to (4) trigger strong urges or craving as another important indicator of addictive potential. Here, we propose that these four criteria provide scientifically valid benchmarks that can be used to evaluate the addictiveness of HPFs. Then, we review the evidence regarding whether HPFs meet each criterion. Finally, we consider the implications of labeling HPFs as addictive. Conclusion: Highly processed foods (HPFs) can meet the criteria to be labeled as addictive substances using the standards set for tobacco products. The addictive potential of HPFs may be a key factor contributing to the high public health costs associated with a food environment dominated by cheap, accessible and heavily marketed HPFs.
Article
The racial and ethnic disparities in diet-related chronic diseases are major concerns. This systematic review examines the extent to which diet-induced changes in health outcomes such as cardiometabolic, inflammation, cancer, bone health, kidney function outcomes etc., have been reported and discussed by race or ethnicity in randomized trials with 2 or more diet arms that recruited both minority and non-Hispanic White groups. Databases i.e., PubMed, Cochrane library and Web of Science were searched up to August 2021. Thirty-four studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group vs. non-Hispanic Whites were included in the systematic review (PROSPERO registration number: CRD42021229256). Acute trials and those with one diet arm that accounted for race or ethnicity in their analyses, and studies that focused on a single racial or ethnic group were discussed separately. Most studies were conducted in Black vs. White adults testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black adults compared to Whites particularly on DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability. Overall risk of bias was low. With emerging precision nutrition initiatives that aim to optimize metabolic responses in population subgroups through tailored approaches, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing health disparities. Factors that help explain variability in responses such as socioecological context should be included and adequately powered. Given the racial and ethnic disparities in chronic diseases, studying the adoption, maintenance, and effectiveness of dietary interventions on health outcomes among different groups is critical for developing approaches that can mitigate diet-related health disparities.
Article
Background: Food shopping frequency may be an important modifiable factor related to increasing fruit and vegetable (FV) intake. Because of mixed findings of individual studies of shopping frequency, a systematic review is needed to examine findings across studies and store types. Objective: To conduct a systematic review of articles examining the relationship between frequency of food shopping and FV intake including examination of participation in federal nutrition assistance programs on FV intake, if reported. Methods: A search, guided by the Preferred Reported Items for Systematic Reviews and Metanalyses, using terms related to FV consumption and food shopping across 4 online databases, was conducted. Studies conducted in the US and published through October, 2020, included adults, and had a cross-sectional, longitudinal, cohort, or randomized study design were eligible for inclusion. Results: Twenty-four articles were included. The majority of studies found at least 1 positive finding between the frequency of food shopping and FV intake, indicating that as the frequency of food shopping increased, FV intake increased. In studies with 100% participation in government/federal nutrition assistance programs, participation was associated with FV intake. Studies that included participation as a subset found participation not associated with FV intake. Implications for future research and practice: The frequency of shopping may be modifiable to increase FV intake. Experimental research is needed to test the directionality and causality of the relationship. Federal nutrition assistance programs may be a logical place to test the relationship through the adjustment of fund disbursements.
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Applying effective learning strategies during self-study is important to build long-term knowledge. However, students rarely use such strategies, because they lack metacognitive knowledge and believe they are too effortful. To facilitate students use of these so-called desirable difficulties during self-study, we developed the Study Smart program, an intervention geared toward creating awareness of, reflection on, and practice with effective learning strategies. Based on a three-year design and implementation process, we share the problems we encountered and illustrate with student testimonials. Moreover, we reflect on future steps to be taken in research and practice. Among them is the need to debunk nave theories about learning strategies in students and teachers and to support the behavior change needed to develop effective study habits by implementing effective learning strategies in teaching and providing follow-up reflection sessions.
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Objective. This cross-sectional study examined associations between adolescent dietary behaviors and family/home environments with parent-adolescent dyadic analysis. Methods. Secondary data were analyzed for adolescents and their parents who participated in the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Relationships between adolescent and parent intake of convenience/fast-food, fruits/vegetables, and sugar, as well as family/community and mealtime environments, were examined using Pearson’s correlations, 2-sample t tests, analysis of variance, and general linear model analyses. Results. Among this nationwide parent-adolescent dyad sample (N = 1890), a moderate relationship between parent and adolescent consumption of convenience/fast-foods ( r = 0.426) and fruits/vegetables ( r = 0.416) was found. Adolescent convenience/fast-foods intake differed by sex, neighborhood socioeconomic status, meals eaten with family, and meals eaten in front of the TV ( P < .001 for all) as well as race/ethnicity ( P = .004). Adolescent fruit/vegetable intake differed by home location ( P = .029), school location ( P = .032), meals eaten together with family, meals eaten in front of the TV, and body mass index category ( P < .001 for all). Generalized linear models revealed multiple predictors of adolescent dietary behaviors. Conclusion. Findings suggest dynamic relationships between adolescent and parent dietary cancer risk factors and adolescent fruit/vegetable consumption disparities by multiple environmental factors. Interventions targeting adolescent-parent dyads may help reduce cancer risk associated with diet.
Article
Objective To examine Black emerging adult women's (ages 18-29) intention to meet the recommended daily intake of fruits and vegetables using the Theory of Planned Behavior (TPB). Participants: Black emerging adult women (BEAW; N = 100). Methods: A cross-sectional survey design. Results: Hierarchical regression analyses revealed that in Model 1, attitudes (p<.0001) and subjective norms (p<.05) were significant predictors of intentions to meet the recommended daily intake of fruits and vegetables. In Model 2, attitudes (p=.0001) and perceived behavioral control (p<.0001) were revealed to be significant predictors of intentions. The change in R squared from Model 1 (R2=.304) and Model 2 (R2=.559), was 0.255 (F = 40.08, p<.0001) with the addition of perceived behavioral control to the second model. Conclusion: The TPB may be a suitable framework to assess factors associated with fruit and vegetable intentions among BEAW. Interventions designed to increase fruit and vegetable intake in BEAW should prioritize modifying perceived behavioral control.
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This study explores the relationship between the consumption of healthy and unhealthy foods and depression among young adults and the moderating effect of gender on these relationships. The National Longitudinal Survey of Youth 1979 for Children and Young Adults (NLSY79 CY) was used. A total of 2983 young adults were selected for the final sample. Logistic Regression Analysis and Ordinary Linear Regression were conducted to examine the research questions. Young men were overall more likely than young women to engage in negative eating habits. The consumption of healthy foods, which included fruits and vegetables, had a significant inverse relationship with depression. An interaction effect was found, indicating that gender moderated the relationship between fruit consumption and depression among young adults. Young males need to be taught more about the importance of good eating habits. Eating more fruits and vegetables (healthy foods) is more important than avoiding fast food or soft drinks (unhealthy foods) for young adults’ mental health. The gender differences in the effect of fruit consumption implies that increased fruit consumption may be critical to reduce young females’ depression.
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The Dietary Approaches to Stop Hypertension (DASH) diet is an evidence-based dietary pattern that is effective in lowering blood pressure, improving lipids, and achieving weight control among individuals with hypertension. The blood pressure-lowering benefit of the DASH dietary pattern has been confirmed in many follow-up studies and a large meta-analysis. In addition, observational studies strongly suggest benefits of following the DASH diet in individuals with different health conditions including chronic kidney disease, prediabetes, diabetes, cardiovascular disease, and even cancer. Thus, this dietary pattern has been recommended for blood pressure management by the National Heart, Lung, and Blood Institute (NHLBI) and as a dietary guideline for all Americans 2 years and older by the National Academy of Sciences. Despite the strong evidence and governmental endorsement, implementation of the DASH dietary pattern in the United States has been challenging. This chapter summarizes evidence of health effects and challenges and potential strategies for implementation.
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A healthy diet is often unaffordable for low‐income individuals, so income‐lifting policies may play an important role in not only alleviating poverty but also in improving nutrition. We investigate if higher minimum wages can contribute to an improved diet by increasing consumption of fruits and vegetables. Exploiting recent minimum wage increases in the United States and using individual‐level data from the Behavioral Risk Factor Surveillance System we identify the causal effect of minimum wage changes on fruit and vegetable intake among low‐wage individuals in a triple‐differences framework. The estimated minimum wage elasticity of fruit and vegetable consumption equals 0.12. (JEL I12, I18, J38)
Article
Objective To examine the association between cooking frequency and Healthy Eating Index (HEI)-2015, overall and by income, among US adults. Design Cross-sectional analysis using multivariable linear regression models to examine the association between cooking frequency and total HEI-2015 score adjusted for sociodemographic variables, overall and stratified by income. Setting Nationally representative survey data from the USA. Participants Adults aged ≥20 years (with 2 d of 24 h dietary recall data) obtained from the 2007 to 2010 National Health and Nutrition Examination Survey ( n 8668). Results Compared with cooking dinner 0–2 times/week, greater cooking frequency was associated with higher HEI-2015 score overall (≥7 times/week: +3·57 points, P < 0·001), among lower-income adults (≥7 times/week: +2·55 points, P = 0·001) and among higher-income adults (≥7 times/week: +5·07 points, P < 0·001). Overall, total HEI-2015 score was higher among adults living in households where dinner was cooked ≥7 times/week (54·54 points) compared with adults living in households where dinner was cooked 0–2 times/week (50·57 points). In households in which dinner was cooked ≥7 times/week, total HEI-2015 score differed significantly based on income status (lower-income: 52·51 points; higher-income: 57·35 points; P = 0·003). Cooking frequency was associated with significant differences in HEI-2015 component scores, but associations varied by income. Conclusions More frequent cooking at home is associated with better diet quality overall and among lower- and higher-income adults, although the association between cooking and better diet quality is stronger among high-income adults. Strategies are needed to help lower-income Americans consume a healthy diet regardless of how frequently they cook at home.
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Diabetes and heart disease disproportionately burden African Americans, who tend to have worse nutritional intake than Whites. Many Black churches are influential institutions in the Black community, with potential to assist with promotion of healthy eating behaviors. The purpose of the current study was to use the Theory of Planned Behavior (TPB) to examine intention to eat a healthy diet and dietary behaviors among church-affiliated African Americans. It was hypothesized that TPB constructs would positively predict intention to eat a healthy diet and that intention to eat a healthy diet would be a predictor of fat and fruit and vegetable intake. It was also hypothesized that control beliefs would predict reduced fat intake and increased fruit and vegetable intake. Path analyses indicated behavioral, normative, and control beliefs were predictive of intention to eat a healthy diet. Intention to eat healthy was a significant predictor of dietary intake behaviors. These findings provide support for the use of the TPB in examining diet among church-affiliated African Americans. This study represents an opportunity to inform dietary interventions for the African American faith community.
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Toplumların gıda tüketimlerine yönelik tercihleri, aynı zamanda söz konusu toplumun sağlık düzeylerini de doğrudan etkileyen bir faktör olarak karşımıza çıkmaktadır. Nitekim sağlıksız beslenme alışkanlıkları başta obezite olmak üzere birçok hastalığa neden olmakta ve sonuç olarak toplum sağlığı bozulabilmektedir. Toplum sağlığının bozulması ise sağlık harcamalarında artış, sağlığın finansmanında sürdürülebilirlik ve sosyal güvenlik sistemi üzerinde çeşitli sorunlara yol açtığından, toplum sağlığını ilgilendiren çalışmalar önem arz etmektedir
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We examined associations of social support and loneliness with eating and activity among parent–adolescent dyads (N = 2968) using actor–partner interdependence modeling. Loneliness had several actor associations with health behaviors (adolescents: less physical activity [PA], p < .001, more sedentariness, p < .001; parents: less fruit/vegetable consumption [FVC], p = .029, more hedonic food consumption [HFC], p = .002, and sedentariness, p < .001), but only one dyadic association (adolescent loneliness with less parent FVC, p = .039). Visible support was associated with less HFC, p < .001, and sedentariness, p < .001, but less FVC, p = .008, among adolescents. Invisible support was associated with less HFC, p = .003, but also less PA, p = .028, among adolescents. Both support types were associated with less HFC among parents, p < .001, but invisible support was also associated with less FVC, p = .029, and PA, p = .012, and more sedentariness, p = .013, among parents. When examining health behavior among parents and adolescents, it may be important to consider social support (but perhaps not loneliness) at a dyadic level.
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Background Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. Methods This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2–5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers’ need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children’s diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. Discussion Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. Trial registration (# NCT02452645) ClinicalTrials.gov Trial registered on May 22, 2015. Electronic supplementary material The online version of this article (10.1186/s12889-019-6704-6) contains supplementary material, which is available to authorized users.
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Cooking is a basic life skill and promotes a more healthful diet. However, many young adults lack cooking confidence. Eleven focus groups with 71 total participants were conducted to understand perceptions of cooking education among high school students. Students who had taken cooking classes displayed cooking confidence, developed additional non‐cooking‐related skills, and valued the courses. Students believed cooking is a life skill, would like to learn more skills and about cultural cuisines, and thought cooking classes should be offered, but not required for all high school students. Family and Consumer Sciences teachers and school administrators could use the results in advocating for cooking classes.
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Objective: The association between social norms and dietary behaviors is well-documented, but few studies examine the role of race. The aim of this study was to determine the interrelationships among race, social norms, and dietary behaviors. Methods: We used data from the Healthy Friends Network Study (a pilot study of women attending a southern university). Dietary behaviors, social norms, and self-identified race were obtained. Results: African Americans had lower odds of daily vegetable (OR = 0.55, 95% CI = 0.38-0.79) and fruit consumption (OR = 0.45, 95% CI = 0.30-0.67), but no race difference in frequent consumption of fatty/fried/salty/sugary foods was observed in fully adjusted models. Proximal descriptive norms were associated with all dietary behaviors, but distal injunctive social norms were associated with lower odds of frequent unhealthy food consumption (OR = 0.10, 95% CI = 0.05-0.21). Race differences in family descriptive norms were found to mediate race differences in vegetable and fruit consumption by 7%-9%. However, race differences in friend and family injunctive norms mediated 20%-50% of the effects of race on frequent unhealthy food consumption. Conclusions: Proximal injunctive norms account for race differences in unhealthy food consumption. Future studies should further explicate the mechanisms and seek to utilize social norms in behavior change interventions.
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The number of days of food intake data needed to estimate the intake of 29 male (n = 13) and female (n = 16) adult subjects, individually and as a group, was determined for food energy and 18 nutrients. The food intake records were collected in a year-long study conducted by the U.S. Department of Agriculture's Beltsville Human Nutrition Research Center. Each individual's average intake of nutrients and standard deviation over the year were assumed to reflect his or her “usual” intake and day-to-day variability. Confidence intervals (P < 0.05) for each individual's usual intake were constructed, and from these the number of days of dietary records needed for estimated individual and group intake to be within 10% of usual intake was calculated. The results indicated that the number of days of food intake records needed to predict the usual nutrient intake of an individual varied substantially among individuals for the same nutrient and within individuals for different nutrients; e.g., food energy required the fewest days (averaging 31) and vitamin A the most (averaging 433). This was considerably higher than the number of days needed to estimate mean nutrient intake for this group, which ranged from 3 for food energy to 41 for vitamin A. Fewer days would be needed for larger groups.
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Objective: To examine the changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. Design: Prospective cohort study with 12 y of follow-up conducted in the Nurses' Health Study. Subjects: A total of 74,063 female nurses aged 38-63 y, who were free of cardiovascular disease, cancer, and diabetes at baseline in 1984. Measurements: Dietary information was collected using a validated food frequency questionnaire, and body weight and height were self-reported. Results: During the 12-y follow-up, participants tended to gain weight with aging, but those with the largest increase in fruit and vegetable intake had a 24% of lower risk of becoming obese (BMI> or =30 kg/m2) compared with those who had the largest decrease in intake after adjustment for age, physical activity, smoking, total energy intake, and other lifestyle variables (relative risk (RR), 0.76; 95% confidence interval (CI), 0.69-0.86; P for trend <0.0001). For major weight gain (> or =25 kg), women with the largest increase in intake of fruits and vegetables had a 28% lower risk compared to those in the other extreme group (RR, 0.72; 95% CI, 0.55-0.93; P=0.01). Similar results were observed for changes in intake of fruits and vegetables when analyzed separately. Conclusions: Our findings suggest that increasing intake of fruits and vegetables may reduce long-term risk of obesity and weight gain among middle-aged women.
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Twenty-four hour dietary recall data from the Second National Health and Nutrition Examination Survey (1976-80) were used to estimate the numbers of servings of fruit and vegetables consumed by Black and White adults, to examine the types of servings (e.g., potatoes, garden vegetables, fruit, and juice), and to estimate the mean intake of calories, fat, dietary fiber, and vitamins A and C by number of servings. An estimated 45 percent of the population had no servings of fruit or juice and 22 percent had no servings of a vegetable on the recall day. Only 27 percent consumed the three or more servings of vegetables and 29 percent had the two or more servings of fruit recommended by the US Departments of Agriculture and of Health and Human Services; 9 percent had both. Consumption was lower among Blacks than Whites. The choice of vegetables lacked variety. Diets including at least three servings of vegetables and two servings of fruit contained about 17 grams of dietary fiber. Although caloric and fat intake increased with increasing servings of fruit and vegetables, the percent of calories from fat remained relatively constant. Although these data are 10 years old, more recent surveys have shown similar results. The discrepancy between dietary guidelines and the actual diet suggests a need for extensive public education.
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The number of days of food intake data needed to estimate the intake of 29 male (n = 13) and female (n = 16) adult subjects, individually and as a group, was determined for food energy and 18 nutrients. The food intake records were collected in a year-long study conducted by the U.S. Department of Agriculture's Beltsville Human Nutrition Research Center. Each individual's average intake of nutrients and standard deviation over the year were assumed to reflect his or her "usual" intake and day-to-day variability. Confidence intervals (P less than 0.05) for each individual's usual intake were constructed, and from these the number of days of dietary records needed for estimated individual and group intake to be within 10% of usual intake was calculated. The results indicated that the number of days of food intake records needed to predict the usual nutrient intake of an individual varied substantially among individuals for the same nutrient and within individuals for different nutrients; e.g., food energy required the fewest days (averaging 31) and vitamin A the most (averaging 433). This was considerably higher than the number of days needed to estimate mean nutrient intake for this group, which ranged from 3 for food energy to 41 for vitamin A. Fewer days would be needed for larger groups.
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Desire for weight change and level of dietary consciousness may severely bias reported food intake in dietary surveys. We evaluated to what degree under- and overreporting of energy intake (EI) was related to lifestyle, sociodemographic variables, and attitudes about body weight and diet in a nationwide dietary survey. Data were gathered by a self-administered quantitative food-frequency questionnaire distributed to a representative sample of men and women aged 16-79 y in Norway, of whom 3144 subjects (63%) responded. Reported EI was related to estimated basal metabolic rate (BMR) based on self-reported body weight, age, and sex. An EI:BMR < 1.35 was considered to represent underreporting and an EI:BMR > or = 2.4 as overreporting of EI. Fewer men than women underreported EI (38% compared with 45%). The fraction of overreporters did not differ significantly between sexes (7% of the men compared with 5% of the women). A large proportion of underreporters was obese (9%) and wanted to reduce their weight (41%). Few overreporters were obese and 12% wanted to increase their weight. Underreporters consumed fewer foods rich in fat and sugar than did the other subjects. Multiple regression analysis showed that desire for weight change and physical activity score were significantly correlated with both EI and EI:BMR when adjusted for sociodemographic and lifestyle variables. Our findings indicated that attitudes about one's own body weight influenced reported EI. These attitudes are important in the interpretation of dietary data because many of the subjects (> 30%) wanted to change their body weight.
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This study examined trends in fruit and vegetable consumption among adults in 16 US states. Data from telephone surveys were used to stratify respondents by sociodemographic and health-related characteristics. The proportion of adults who consumed fruits and vegetables at least 5 times daily was 19%, 22%, and 23% in 1990, 1994, and 1996, respectively. While the proportion increased among those with active leisure-time physical activities and normal weight, it remained almost the same among inactive people and dropped among the obese. Progress in fruit and vegetable intake from 1990 to 1994 was encouraging, but it changed little between 1994 and 1996.
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To investigate whether self-reported frequency of fruit and vegetable consumption was associated with HbA(1C) levels in individuals not known to have diabetes, and what dietary and lifestyle factors might explain this association. Cross-sectional study. The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. A total of 2678 men and 3318 women (45-74 y) not known to have diabetes reported weekly consumption of fruit, green leafy vegetables and other vegetables. Among men, 274 (10.2%) reported seldom or never eating fruit and 127 (4.7%) seldom or never eating green leafy vegetables. Corresponding numbers in women were 157 (4.7%) and 92 (2.8%), respectively. Participants who reported never or seldom having both fruit and green leafy vegetables had higher mean (s.d.) HbA(1C) measurements (5.43% (0.71)) than those who reported more frequent consumption (5.34% (0.67); P=0.046). Differences by category of fruit or green leafy vegetable consumption were not substantially changed after adjustment for saturated fat, dietary fibre and plasma vitamin C. These findings support the hypothesis that high intake of fruit and green leafy vegetables may influence glucose metabolism independent of dietary fibre or vitamin C alone and that increased consumption may contribute to the prevention of diabetes.
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The prevalence of overweight and obesity has increased markedly in the last 2 decades in the United States. To update the US prevalence estimates of overweight in children and obesity in adults, using the most recent national data of height and weight measurements. As part of the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the US noninstitutionalized civilian population, both height and weight measurements were obtained from 4115 adults and 4018 children in 1999-2000 and from 4390 adults and 4258 children in 2001-2002. Prevalence of overweight (body mass index [BMI] > or =95th percentile of the sex-specific BMI-for-age growth chart) among children and prevalence of overweight (BMI, 25.0-29.9), obesity (BMI > or =30.0), and extreme obesity (BMI > or =40.0) among adults by sex, age, and racial/ethnic group. Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight. The NHANES results indicate continuing disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity. There is no indication that the prevalence of obesity among adults and overweight among children is decreasing. The high levels of overweight among children and obesity among adults remain a major public health concern.
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We examined trends in fruit and vegetable consumption in the United States. A 6-item food frequency questionnaire was used to assess consumption among 434 121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000. Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups. Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed.
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Studies of fruit and vegetable consumption in relation to overall health are limited. We evaluated the relationship between fruit and vegetable intake and the incidence of cardiovascular disease and cancer and of deaths from other causes in two prospective cohorts. A total of 71 910 female participants in the Nurses' Health study and 37,725 male participants in the Health Professionals' Follow-up Study who were free of major chronic disease completed baseline semiquantitative food-frequency questionnaires in 1984 and 1986, respectively. Dietary information was updated in 1986, 1990, and 1994 for women and in 1990 and 1994 for men. Participants were followed up for incidence of cardiovascular disease, cancer, or death through May 1998 (women) and January 1998 (men). Multivariable-adjusted relative risks were calculated with Cox proportional hazards analysis. We ascertained 9329 events (1964 cardiovascular, 6584 cancer, and 781 other deaths) in women and 4957 events (1670 cardiovascular diseases, 2500 cancers, and 787 other deaths) in men during follow-up. For men and women combined, participants in the highest quintile of total fruit and vegetable intake had a relative risk for major chronic disease of 0.95 (95% confidence interval [CI] = 0.89 to 1.01) times that of those in the lowest. Total fruit and vegetable intake was inversely associated with risk of cardiovascular disease but not with overall cancer incidence, with relative risk for an increment of five servings daily of 0.88 (95% CI = 0.81 to 0.95) for cardiovascular disease and 1.00 (95% CI = 0.95 to 1.05) for cancer. Of the food groups analyzed, green leafy vegetable intake showed the strongest inverse association with major chronic disease and cardiovascular disease. For an increment of one serving per day of green leafy vegetables, relative risks were 0.95 (95% CI = 0.92 to 0.99) for major chronic disease and 0.89 (95% CI = 0.83 to 0.96) for cardiovascular disease. Increased fruit and vegetable consumption was associated with a modest although not statistically significant reduction in the development of major chronic disease. The benefits appeared to be primarily for cardiovascular disease and not for cancer.
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African Americans experience high rates of obesity and other chronic diseases, which may be related, in part, to diet. However, little is known about dietary patterns in this population, particularly from population-based data sources. A cross-sectional analysis was conducted of 2,172 African-American adults in Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together). A baseline assessment was conducted using a multistaged population-based probability sample from Raleigh and Greensboro, NC. Daily fruit, vegetable and fat intake was evaluated using a modified version of the Block questionnaire, and then stratified results were analyzed by sociodemographic, health and behavior characteristics. STATA Survey commands were used to account for the complex survey design. Overall, a very small number of participants met national recommendations for > or = 2 servings of fruit (8%) and > or = 3 servings of vegetables (16%) per day. Many participants reported eating high-fat foods; the average daily fat intake was 86 g, and the average daily intake from saturated fat was 24 g. People with more education and higher incomes had a higher average daily fruit intake (all p < 0.05). The data suggest that participants' fruit, vegetable and fat intake deviated greatly from national guidelines; older people, women, participants with higher socioeconomic status and those who were physically active consumed healthier foods. These data may be useful in developing dietary and weight loss interventions for African Americans.
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To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institute's Health Habits and History Questionnaire. We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability. The LMD region of the USA. White and African American adult residents of the LMD. LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format. Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.
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Following national recommendations for physical activity, diet, and nonsmoking can reduce both incident and recurrent coronary heart disease. Prevalence data about combinations of behaviors are lacking. This study describes the prevalence of full adherence to national recommendations for physical activity, fruit and vegetable consumption, and nonsmoking among individuals with and without coronary heart disease and examines characteristics associated with full adherence. We performed a cross-sectional analysis of data from the 2000 Behavioral Risk Factor Surveillance System, a national population-based survey. We included respondents to the cardiovascular disease module and excluded individuals with poor physical health or activity limitations. Subjects were most adherent to smoking recommendations (approximately 80%) and less adherent to fruit and vegetable consumption and physical activity (approximately 20% for both). Only 5% of those without coronary heart disease and 7% of those with coronary heart disease were adherent to all three behaviors (P < .01). Among those without a history of coronary heart disease, female sex (odds ratio [OR] 1.47; 95% confidence interval [CI], 1.23-1.76), highest age quintile (OR 1.67; 95% CI, 1.28-2.19), more education (OR 2.48; 95% CI, 1.69-3.64), and more income (OR 1.19; 95% CI, 1.04-1.36) were associated with full adherence. Among those with coronary heart disease, mid-age quintile (OR 3.79; 95% CI, 1.35-10.68), good general health (OR 2.05; 95% CI, 1.07-3.94), and more income (OR 1.51; 95% CI, 1.06-2.16) were associated with full adherence. These data demonstrate the lack of a heart-healthy lifestyle among a sample of U.S. adults with and without coronary heart disease. Full adherence to combined behaviors is far below adherence to any of the individual behaviors.
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To determine low-income consumers' attitudes and behaviour towards fruit and vegetables, in particular issues of access to, affordability of and motivation to eat fruit and vegetables. Questionnaire survey mailed to homes owned by a large UK housing association. Participants were 680 low-income men and women, aged 17-100 years. Age, employment, gender, smoking and marital status all affected attitudes towards access, affordability and motivation to eat fruit and vegetables. Few (7%) participants experienced difficulty in visiting a supermarket at least once a week, despite nearly half having no access to a car for shopping. Fruit and vegetables were affordable to this low-income group in the amounts they habitually bought; purchasing additional fruits and vegetables was seen as prohibitively expensive. Less than 5% felt they had a problem with eating healthily and yet only 18% claimed to eat the recommended 5 or more portions of fruit and vegetables every day. Supported by research, current UK Government policy is driven by the belief that low-income groups have difficulties in access to and affordability of fruit and vegetables. Findings from this particular group suggest that, of the three potential barriers, access and affordability were only a small part of the 'problem' surrounding low fruit and vegetable consumption. Thus, other possible determinants of greater consequence need to be identified. We suggest focusing attention on motivation to eat fruit and vegetables, since no dietary improvement can be achieved if people do not recognise there is a problem.
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We developed a food guidance system to assist healthy Americans in making food choices for good health. The system differs from commonly used food guides in that it provides guidance for a total rather than a foundation diet. A framework of food groups—illustrated in the Food Wheel—is supplemented by additional information about food energy, total fat, fatty acids, sodium, sweeteners, and cholesterol. Goals for this system were based on the Dietary Guidelines, the 1980 Recommended Dietary Allowances, and usability considerations. These goals were restated as specific objectives based on a review of current concepts in nutrition science, recommendations by various scientific groups, and food consumption practices of the population. The first part of this article presents the rationale for the objectives and development of the food guidance system. The second part details the results of the research conducted to develop and evaluate the system. Expected levels of nutrients provided by diets selected according to system recommendations and expected levels of food energy, fat, fatty acids, cholesterol, sweeteners, and sodium are presented. The food guidance system provides the basis for the food guidance presented in the American Red Cross nutrition course, “Better Eating for Better Health”, and in “Dietary Guidelines and Your Diet”, a series of bulletins developed by USDA to help consumers use the Dietary Guidelines.
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A population-based incident case-control study of lung cancer in white males was conducted during 1980-1981 in six high-risk areas in New Jersey. Interviews were completed for 763 cases and 900 controls. To assess whether dietary intake of carotenoids, preformed retinol, or total vitamin A influences the risk of lung cancer, the authors asked the respondents about the usual frequency of consumption, approximately four years earlier, of 44 food items which provide 83% of the vitamin A in the US diet and about the use of vitamin supplements. The men in the lowest quartile of carotenoid intake had a relative risk of 1.3 compared with those in the highest quartile after adjusting for smoking. No increase in risk was associated with low consumption of retinol or total vitamin A. Intake of vegetables, dark green vegetables, and dark yellow-orange vegetables showed stronger associations than did the carotenoid index; the smoking-adjusted risks of those in the lowest quartiles of consumption of these food groups reached relative risks of 1.4-1.5 compared with the risks of those in the highest quartiles. The protective effect of vegetables was limited to current and recent cigarette smokers; the smoking-adjusted relative risks for low consumers reached 1.7, 1.8, and 2.2 compared with the risks for high consumers for vegetables, dark green vegetables, and dark yellow-orange vegetables, respectively. The reduction in risk with vegetable intake was most apparent for squamous cell carcinomas, but it extended to adenocarcinomas and most other cell types when only current and recent smokers were analyzed. This protection among current and recent smokers is consistent with the model that vegetable intake prevents a late-stage event of carcinogenesis. Consumption of dark yellow-orange vegetables was consistently more predictive of reduced risk than consumption of any other food group or the total carotenoid index, possibly because of the high content of beta-carotene relative to other carotenoids in this particular food group.
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"We all witness, in advertising and on supermarket shelves, the fierce competition for our food dollars. In this engrossing exposé, Marion Nestle goes behind the scenes to reveal how the competition really works and how it affects our health. The abundance of food in the United States--enough calories to meet the needs of every man, woman, and child twice over--has a downside. Our over-efficient food industry must do everything possible to persuade people to eat more--more food, more often, and in larger portions--no matter what it does to waistlines or well-being. Like manufacturing cigarettes or building weapons, making food is big business. Food companies in 2000 generated nearly $900 billion in sales. They have stakeholders to please, shareholders to satisfy, and government regulations to deal with. It is nevertheless shocking to learn precisely how food companies lobby officials, co-opt experts, and expand sales by marketing to children, members of minority groups, and people in developing countries. We learn that the food industry plays politics as well as or better than other industries, not least because so much of its activity takes place outside the public view. Editor of the 1988 Surgeon General's Report on Nutrition and Health, Nestle is uniquely qualified to lead us through the maze of food industry interests and influences. She vividly illustrates food politics in action: watered-down government dietary advice, schools pushing soft drinks, diet supplements promoted as if they were First Amendment rights. When it comes to the mass production and consumption of food, strategic decisions are driven by economics--not science, not common sense, and certainly not health. No wonder most of us are thoroughly confused about what to eat to stay healthy. An accessible and balanced account, Food Politics will forever change the way we respond to food industry marketing practices. By explaining how much the food industry influences government nutrition policies and how cleverly it links its interests to those of nutrition experts, this path-breaking book helps us understand more clearly than ever before what we eat and why." © 2002, 2007, 2013 by The Regents of the University of California.
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Background: 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables. The Seattle 5 a Day worksite investigators designed and evaluated an intervention, organized on stages of behavioral change, to increase worksitewide fruit and vegetable consumption. Methods: We recruited 28 worksites with cafeterias and randomized 14 to intervention and 14 to control. The intervention addressed both changes in the work environment and individual level behavior change. In each worksite, an employee advisory board, with study interventionist assistance, implemented the program. By surveying cross-sectional samples of 125 employees per worksite, we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline. Unobtrusive site-level indicators including plate observation and cafeteria checklist were also used. Results: The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites, with an intervention effect of 0.3 daily serving (P < 0.05). Other measures of fruit and vegetable consumption, including unobtrusive indicators, supported the effectiveness of the intervention. Conclusions: This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias. There was a significant differential increase in fruit and vegetable consumption in the intervention worksites. This kind of worksite intervention can achieve important health benefits on a population basis, because of its potential to reach large numbers of people.
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OBJECTIVE To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses. RESULTS Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level (P < 0.05). An independent inverse association with the past intake of vitamin C was observed (P < 0.05). These associations were independent of changes in the intake of fat and vitamin C during the 20-year follow-up. An increase in the consumption of vegetables and legumes, potatoes, and fish during the 20-year follow-up was inversely related with 2-h glucose level (P < 0.05). CONCLUSIONS Although the regression coefficients were in general not very large, these results indicate that a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and NIDDM. Foods such as fish, potatoes, vegetables, and legumes may have a protective effect. In addition, the observed inverse association between vitamin C and glucose intolerance suggests that antioxidants may also play a role in the development of derangements in glucose metabolism.
Article
To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM). At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses. Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level (P < 0.05). An independent inverse association with the past intake of vitamin C was observed (P < 0.05). These associations were independent of changes in the intake of fat and vitamin C during the 20-year follow-up. An increase in the consumption of vegetables and legumes, potatoes, and fish during the 20-year follow-up was inversely related with 2-h glucose level (P < 0.05). Although the regression coefficients were in general not very large, these results indicate that a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and NIDDM. Foods such as fish, potatoes, vegetables, and legumes may have a protective effect. In addition, the observed inverse association between vitamin C and glucose intolerance suggests that antioxidants may also play a role in the development of derangements in glucose metabolism.
Article
Dietary guidelines posit an association between diet and cancer. Different cancer mortality rates among whites, blacks, and Hispanics may be related to differences in diet. Food frequency data from the 1987 National Health Interview Survey on 20,143 adults were used to estimate the percentage of adults, by gender and race/ethnicity, who consume some 59 foods six or more times per year, median number of servings for consumers, and frequency of consumption of skin on poultry and fat on red meat. On the basis of percent consumption of these foods, women appear to have a more diverse diet than men. Women eat more fruits and vegetables, less meat, and fewer high-fat foods and drink fewer alcoholic beverages. Whites eat a more varied diet than blacks and Hispanics; blacks eat more fried and high-fat food; consumption of high-fat foods is lowest among Hispanics. Public health messages, especially those aimed at cancer prevention, should be targeted at increasing the overall consumption of fruits and vegetables, decreasing consumption of high-fat foods, especially among white and black men, and increasing consumption of those healthful foods already consumed by particular race/ethnicity groups.
Article
Dietary factors may contribute to the increased cancer risk of blacks. As a first step to explore this hypothesis, we examined food frequency data obtained by interview with 1,976 adults (881 blacks and 1,095 whites) randomly selected from three areas of the United States. The a priori hypothesis was that blacks were more likely to consume diets low in fruits and vegetables and/or high in fat, particularly saturated fat. Contrary to expectation, blacks were more frequent consumers of fruits and vegetables considered to be protective against cancer (e.g., citrus fruits, cruciferous vegetables, and vegetables rich in vitamins A and C). Intake of both total and saturated fat was slightly lower among blacks than whites. This analysis does not rule out a role for these dietary factors in the etiology of cancer but indicates that ascribing the excess cancer risk among blacks to their frequency of fruit and vegetable consumption or intake of fat per se is inadequate. This suggests that alternative dietary explanations for the racial disparity in cancer risk should be pursued in future studies.
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Food-pattern analysis provides a way to examine diets in a multidimensional context. This study examined the diets of 8181 adults in the 1989-1991 Continuing Survey of Food Intakes by Individuals and evaluated whether they met the federal recommendations for each of five food groups. The sample was partitioned among 32 different food-intake patterns, six of which represented 44% of the population. Nutrient profiles associated with each of the patterns indicated that failure to meet one or more of the food-group recommendations was associated with nutrient inadequacy, macronutrient imbalance, or both. A reexamination of the data to account for low energy reporters did not alter these findings. The pattern of meeting all five of the food-group recommendations was among the least common, accounting for only 1% of adults' intakes.
Article
To examine food intake trends in the US population, cross-sectional nationally representative food intake data were obtained from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements. In each of these years, approximately 10,000 respondents completed methodologically consistent food frequency questionnaires containing the same 57 food items. Between 1987 and 1992, the proportion of Americans consuming high-fat foods, including fried fish, fried chicken, bacon, eggs, whole milk, and butter, decreased. The proportion of Americans drinking alcoholic beverages also decreased: fewer drank wine and hard liquor in 1992. The proportion of fruit and vegetable consumers remained stable over time. These results are similar to those obtained from more detailed national surveys. National guidelines urge Americans to avoid intake of high-fat foods, increase consumption of fruits and vegetables, and practice moderation when drinking alcoholic beverages to prevent cancer and other chronic diseases. The direction of Americans' apparent changes in food usage between 1987 and 1992, evaluated using limited data from food frequency questionnaires, suggests greater behavioral changes in the direction of guidelines recommending avoidance of foods that may increase the risk of cancer than in the direction of guidelines recommending increased consumption of foods that may confer protection.
Article
As cancer gains on heart disease as the leading cause of death, there is increased urgency to improve the current diet that contributes to 35 percent of cancer deaths. Lacking have been consensus about the strength of the science base, political will, resources, and conceptualization about what can be done in communities to change dietary behaviors. Over the past 10 years, the 5 A Day for Better Health Program has emerged as the major population-based initiative for nutrition and cancer prevention. The 5 A Day Program is a national theory-based program that approaches Americans with a simple, positive message: eat five or more servings of fruit and vegetables daily as part of a low-fat, high-fiber diet. This article describes the elements and theories woven into the national 5 A Day Program, provides a description of the important components of the program, and outlines the issues that will face dietary change initiatives in the future.
Article
This cross-sectional study was undertaken to investigate the association between the reported frequency of consumption of vegetables and fruits, the choice of staple carbohydrate, and glucose intolerance. One thousand one hundred twenty-two subjects aged 40-64 years in a population-based study underwent an oral glucose tolerance test, and their food consumption was assessed using a food-frequency questionnaire. The crude prevalence of undiagnosed non-insulin-dependent diabetes mellitus (NIDDM) was 4.5%, and that of impaired glucose tolerance (IGT) 16.8%. The age-standardized prevalence rates were 2.3 and 11.2%, respectively. Frequent consumption of vegetables throughout the year was inversely associated with the risk of having NIDDM (odds ratio [OR] = 0.16; 95% confidence interval [CI] = 0.04-0.69). This association was maintained after adjustment for age, gender, and family history. Vegetable consumption during the summer months had a much weaker inverse association with the risk of having NIDDM that failed to reach statistical significance. A nonsignificant inverse association between frequent consumption of fruits and NIDDM was observed. Frequent self-reported pasta and rice consumption was associated with a reduction in the risk of having IGT and NIDDM. (OR = 0.62, 95% CI = 0.44-0.87, and OR = 0.51, 95% CI = 0.27-0.99, respectively) but this relationship was not independent of age. Whether these associations reflect specific effects of particular nutrients or are a reflection of the patterning of lifestyle factors remains to be determined.
Article
To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. Women (n = 891) aged 20-45 y who enrolled in the Pound of Prevention study. Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. Twenty-one percent of the sample reported eating > or = 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of fiber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.
Article
Adequate fruit and vegetable intake may lower the risk of several chronic diseases, but little is known about how it affects the risk of diabetes mellitus. We examined whether fruit and vegetable consumption was associated with diabetes incidence in a cohort of U. S. adults aged 25-74 years who were followed for about 20 years. In the analytic sample of 9,665 participants, 1,018 developed diabetes mellitus. The mean daily intake of fruits and vegetables as well as the percentage of participants consuming five or more fruits and vegetables per day was lower among persons who developed diabetes than among persons who remained free of this disease (P < 0.001). After adjustments for age, race or ethnicity, cigarette smoking, systolic blood pressure, use of antihypertensive medication, serum cholesterol concentration, body mass index, recreational exercise, nonrecreational exercise, and alcohol consumption, the hazard ratio for participants consuming five or more servings of fruits and vegetables per day compared with those consuming none was 0.73 (95% confidence interval (CI), 0.54-0.98) for all participants, 0.54 (95% CI, 0.36-0.81) for women, and 1.09 (95% CI, 0.63-1.87) for men. Adding education to the model changed the hazard ratios to 0.79 (95% CI, 0.59-1.06) for all participants, 0.61 (95% CI, 0.42-0.88) for women, and 1.14 (95% CI, 0.67-1.93) for men. Fruit and vegetable intake may be inversely associated with diabetes incidence particularly among women. Education may explain partly this association.
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To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables. Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses. United States. A total of 2605 adults who were 18 years and older. Awareness of the "5 A Day for Better Health" program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption. Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit. Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.
Article
Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals' diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation. Names and addresses of places to buy food in Mississippi, North Carolina, Maryland, and Minnesota were obtained from respective departments of health and agriculture. Addresses were geocoded to census tracts. Median house values were used to estimate neighborhood wealth, while the proportion of black residents was used to measure neighborhood racial segregation. Compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are 3 times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods (prevalence ratio [PR]=0.3, 95% confidence interval [CI]=0.1-0.6). Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods (PR=4.3, 95% CI=1.5-12.5). Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.