2 - Status and recent trends in fresh-cut fruits and vegetables

Recent research does not show an association between fruit and vegetable consumption and bladder cancer risk. None of these studies looked at the variety in fruit and vegetable consumption, which may capture different aspects of fruit and vegetable consumption. We investigated whether the quantity and the variety in vegetable and fruit consumption are associated with bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition study. Data on usual food consumption and complete follow-up for cancer occurrence was available for 478,533 participants, who were recruited in 10 European countries. A calibration study was conducted in an 8% representative subsample. After a mean follow-up of 8.7 years, 1015 participants were diagnosed with bladder cancer. Diet Diversity Scores (DDSs) were used to quantify the variety in fruit and/or vegetable consumption by counting the number of different fruit and vegetable products eaten at least every two weeks. Multivariable Cox proportional hazard models were used to assess the effect of fruit and vegetable consumption and DDSs on the risk of bladder cancer. Increments of 100 gram/day in fruit and vegetable consumption did not affect bladder cancer risk (calibrated hazard ratio (HR) 0.98; 95%CI: 0.95–1.01). A slightly stronger, although statistically non-significant, inverse association was observed among never smokers (calibrated HR=0.92; 95%CI: 0.79–1.06 with increments of 100 g/day). Unexpectedly, more variety in fruit and vegetable products consumed increased bladder cancer risk (HR=1.30 95%CI=1.00–1.69 comparing the highest with the lowest tertile; p-trend=0.05), which was strongest among never smokers (HR=1.72; 95%CI: 1.00–2.97). Continuous risk estimates did not reach statistical significance (HR for whole cohort 1.02 (95%CI 0.99–1.06 per 2 products increment); HR in never smokers 1.04 (95%CI 0.98–1.11 per 2 products increment)). The quantity and variety of fruit or vegetable consumption separately were not associated with bladder cancer risk. We conclude that in EPIC quantity and variety of vegetable and fruit consumption is not associated with bladder cancer risk. Increased categorical risks for variety in vegetables and fruits without statistical significant findings in the continuous analyses may be due to chance. Our results provide further evidence that fruit and vegetable consumption does not strongly alter bladder cancer risk. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B103.

Research on the relationship between cancer risk and fruit and vegetable consumption is primarily focused on the quantity of consumption. However, simply looking at the quantity of fruit and vegetable consumption or at one specific component of fruits and vegetables might not fully capture the mechanism(s) responsible for a lower cancer risk. Looking at the diversity of fruit and vegetable consumption, reflecting an intake of many different bioactive compounds present in fruit and vegetables, may complement the research on fruit and vegetable consumption and cancer risk. We have previously linked the variety in fruit and vegetable consumption, as measured by diet diversity scores (DDS), to lung and bladder cancer risk in the European Prospective Investigation into Nutrition and Cancer (EPIC). We found no relation between the DDS and bladder cancer risk and a reduced lung cancer risk with increased variety in vegetable consumption. In this current study we evaluated whether the DDS indeed captures a mixed intake of bioactive compounds by comparing the DDS to plasma concentrations of six carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin). Within the cross-sectional study of the EPIC (including 3,089 subjects), we calculated four different DDS based on dietary questionnaires: one represents diversity in vegetable and fruit consumption, two represent diversity in vegetable consumption and one represents diversity in fruit consumption. Plasma carotenoids samples (200 μl) were analyzed by reversed-phase high-performance liquid chromatography (HPLC; HPLC-1100 system, Hewlett Packard). To standardize the six plasma carotenoids, concentrations were re-scaled using a rank difference method; higher values represent larger and lower values represent smaller intra-individual variation in the concentrations of the six plasma carotenoids. Conceptually, the rank difference score should be inversely correlated with the DDS. Correlation coefficients between the DDS and the rank difference score were calculated for the full study population and stratified by subgroups of potential effect modifiers. Complete data on the DDS and plasma levels of carotenoids were available for 2,675 participants. The correlation coefficient (r) between the diversity in vegetable and fruit consumption and the rank difference score was −0.13. Diversity in vegetable consumption was not correlated to the rank difference score. The strongest, although still weak, correlation was found between the diversity in fruit consumption and the rank difference score (r=-0.19). Correlations were somewhat stronger for fasting samples, in women, and in Southern Europe. The diet diversity scores show only weak correlations with rescaled plasma levels of six carotenoids. This might suggest that either questionnaire information or one measurement of plasma carotenoid levels or both cannot fully capture variety in fruit and vegetable consumption. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B7.

Poor consumption of fruits and vegetables is associated with an increased risk of non-communicable diseases, micronutrient deficiency, and undernutrition. Fruit and vegetable consumption is generally low worldwide, particularly in rural regions of many low- and middle-income countries. This study aimed to determine the prevalence and determinants of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya using the most recent Kenya Demographic and Health Survey. A cross-sectional study was employed using data from the most recent nationally representative KDHS 2022. A weighted sample of 2,965 children aged between 6 to 23 months who were living with their mother was included in the study. Data extracted from the KDHS 2022 data sets were cleaned, recoded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel logistic regression was used to determine the factors associated with the dependent variable. Finally, variables with a p-value less than 0.05 were declared statistically significant. The proportion of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya was 45.50% (95% CI: 43.71%–47.30%). Factors like maternal education [AOR = 0.59; 95% CI (0.37, 0.93)], maternal occupation [AOR = 0.60; 95% CI (0.47, 0.76)], media exposure [AOR = 0.59; 95% CI (0.43, 0.80)], wealth index [AOR = 0.68; 95% CI (0.49, 0.95)], place of delivery [AOR = 0.69; 95% CI (0.51, 0.94)], number of ANC visits [AOR = 1.30; 95% CI (1.05, 1.62)], child’s age [AOR = 0.30; 95% CI (0.21, 0.41)], community media exposure [AOR = 0.30; 95% CI (0.21, 0.41)], community literacy [AOR = 0.29; 95% CI (0.20, 0.43)], and community poverty [AOR = 1.46; 95% CI (1.04, 2.05)] were significantly associated with zero vegetable or fruit consumption. Conclusion: The proportion of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya was high. Zero vegetable or fruit consumption was significantly associated with maternal education, maternal occupation, media exposure, wealth index, place of delivery, number of ANC visits, child’s age, community media exposure, community literacy, and community poverty. Giving attention to jobless, media-non-exposed mothers, poor wealth status, who gave birth at home, who had no formal education, attended < 4 ANC visits, and children aged 6 to 8 months is recommended.What is Known:• Dietary recommendations for fruit and vegetable consumption were not met by many children in low and middle-income countries.What is New:• The proportion of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya was high.

Life-Course Events and Experiences: Association with Fruit and Vegetable Consumption in 3 Ethnic Groups

The Third School Nutrition Dietary Assessment Study: Summary and Implications

The increased risk of non-communicable diseases is still a problem in Indonesia, one of which is the lack of fruit and vegetable consumption. Available data show that although fruits and vegetables have a protective effect, the average consumption of fruits and vegetables is still below the recommended intake, especially in adolescents. This study aims to determine the description of fruit and vegetable consumption and to determine the factors of food parenting practices and other factors related to fruit and vegetable consumption in students of SMAN 37 Jakarta. This study uses a quantitative method with a cross-sectional study design conducted on 160 students with a simple random sampling method. Data was collected by filling out questionnaires and food record forms independently by respondents who were monitored online from July-August 2022. The results showed that 88.8 percent of respondents still consumed less fruit and vegetables (&lt;400 grams/day). The bivariate results showed that there was a significant relationship between parents fruit and vegetable intake and fruit and vegetable consump-tion(p-value=0,000). It is recommended to provide nutrition education to adolescents and parents regarding knowledge related to the recommended consumption of fruits and vegetables, and the benefits and impacts of insufficient consumption of fruits and vegetables.

Background and Aim: Functional constipation is one of the most common health problems in older adults. Its development greatly depends on nutritional status in that a high fiber diet including fruits and vegetables can prevent or manage it. The present study aimed at assessing vegetable and fruit consumption among the elderly with functional constipation, based on the health belief model. Methods: This was a cross-sectional study conducted on 163 elderly people aged 60 and older, who referred to retirement houses located in Isfahan, Iran, in 2013. The Rome III diagnostic criteria were used for functional constipation screening. Moreover, a demographic questionnaire, a researcher-made questionnaire developed based on the constructs of the health belief model, and a researcher-made 24-hour fruit and vegetable consumption checklist were used for data collection. Data analysis was done using SPSS Software (V, 20.0) and by running independent sample t test, Pearson correlation analysis, one-way analysis of variance, and multiple linear regression analysis at a significance level of less than 0.05. Results: The mean of participants’ age was 70.04 ± 6.41, while the means of their fruit consumption and vegetable consumption were 1.61 ± 0.73 and 1.31 ± 0.87 servings daily, respectively. Almost 44.2% of the participants consumed less than 2 servings of fruits and 55.8% consumed less than 2 servings of vegetables daily. Fruit and vegetable consumption was directly correlated with perceived susceptibility, perceived severity, perceived self-efficacy, perceived benefits, and knowledge and was inversely correlated with perceived barriers (P < 0.001). Moreover, perceived severity, perceived self-efficacy, perceived benefits, and knowledge explained 58% of the total variance of fruit consumption, while perceived self-efficacy, and perceived benefits, and knowledge explained 65.7% of the total variance of vegetable consumption. The most important cues to fruit and vegetable consumption were television (57.7%) and family and relatives (46%). Conclusions: This study revealed that the elderly with functional constipation consume inadequate amount of fruits and vegetables and the health belief model is a significant predictor of fruit and vegetable consumption among the elderly. Educational interventions based on the health belief model can be helpful in promoting the consumption of fruit and vegetable consumption in the elderly.

According to the World Health Organization in 2019, for a citizen of Belarus, the probability of death (aged 30 to 70 years) from any of the four major non-communicable diseases (NCDs) is 23.8 %. Developing interventions to prevent chronic NCDs requires evidence to characterize the prevalence of behavioral risk factors. The contribution of insufficient daily consumption of vegetables and fruits to premature mortality from chronic NCDs is 12.9 %, and to the loss of healthy years of life – 6.9 %. It is of scientific interest to study the characteristics of the consumption of vegetables and fruits as alimentary risk factors in an urbanized environment. In the Republic of Belarus, the state preventive project “Healthy cities and towns” has been implemented in 2012 and in 2024 the project unites 379 settlements. Aim. to assess the prevalence of consumption of vegetables and fruits as risk factors for the development of chronic NCDs in residents of settlements participating in the implementation of the state preventive project “Healthy cities and towns”. Material and methods. The work was carried out within the framework of the initiative research “To develop an algorithm for assessing the effectiveness of the state preventive project” Healthy cities and towns. “ The material for the study was the data of a sociological study on the prevalence of behavioral risk factors for the development of NCDs in the population aged 18–69 years, conducted in 6 regional centers from 6 regions of the Republic of Belarus, implementing the state preventive project “Healthy cities and towns” for at least 4 years (n = 1608). Results. A sufficient level of daily consumption of vegetables and fruits is noted in 30.35 %. Daily in the diet there are vegetables in 43.12 %, fruits - in 35.95 % of the population. Every seventh adult practically does not eat vegetables (14.37 %) or consumes them 1–2 times a week, and every sixth (15.86 %) - fruits. The frequency of daily consumption of vegetables and fruits is higher among women. With age, there is an increase in the frequency of daily consumption of vegetables and fruits from 28.69 % and 19.92 % among people 18–30 years old to 47.24 % and 40.71 % at 51–69 years old. Statistically significant differences in the consumption of fruits and vegetables were established depending on the duration of the implementation of the state preventive project “Healthy cities and towns.” Conclusion. The results of the study indicate that higher population activity in the consumption of vegetables and fruits is associated with female gender and older age and significantly differs depending on the region.

The study was designed to understand the relationship between school gardens and student’s self-efficacy and its effect on weekly intake of fruits and vegetables. The survey used two Ugandan secondary schools; one having a well-established school garden with all students having equal opportunities to participate in the growing, harvesting and consumptions of fruits and vegetables, another not. The study followed a cross-sectional study design employing quantitative research methods. The target population comprised of late adolescents 18-22 years attending the two-selected secondary school; one in Kampala and another in Luwero districts. The school in Luwero district engaged students in gardening activities while the school in Kampala did not. Self-administered structured questionnaire was given to students to answer questions in line with the specific objectives. Data was analyzed by using Mann Whitney U test, Pearson Rank Correlation, Odds ratio and test of proportion. The mean ages of the girls and boys in the school exposed to gardening activities were 19.10±1.4 and 19.2±2.86 respectively while those for students in the unexposed school were 18.62±1.21 and 19.11±1.29 respectively. The study had more males (56.3%) than females (43.7%). Neither group met the World Health Organization (WHO), Food and Agricultural Organization (FAO) and United States Department of Agriculture (USDA) recommendation of ≥35 servings per week (≥5 servings per day) for both fruits and vegetables consumption. However, the exposed students had more weekly servings of fruits and vegetables (P&gt;0.05) and had higher self-efficacy towards dietary intake of fruits and vegetables (P=0.007). School garden based intervention can significantly improve student’s self-efficacy towards fruit &amp; vegetable dietary intake increasing the weekly consumption of fruits and vegetables. The findings of the study will inform policy makers on the role of school gardens in enhancing fruit and vegetable intake by in-school adolescents as they develop the Uganda’s school health policy.

Evaluation of the Use of a Self-service Fruit and Vegetable Bar on the Consumption and Plate Waste

To analyze the consumption of fruits and vegetables of Chinese adults. Data were collected from 2010-2012 China National Nutrition and Health Surveillance. Information on fruits and vegetables consumption was collected by using the 24 h recall method for 3 consecutive days. Using the multi-stage stratified cluster randomization sampling method. The participants selected were more than 18 years old of 150 counties from 31 provinces in China. Age and sex standardization was performed based on the China 2009 population published by National Statistics Bureau. The average consumption of vegetables or fruits after weight adjustment for complex sampling was reported to analyze the consumption of fruits and vegetables of Chinese adults (x ± Sx). The average daily consumptions of vegetables and fruits for Chinese residents were (255 ± 6) and (36 ± 3)g/d, respectively. The total consumptions of fruits and vegetables were (291 ± 7)g/d, (295 ± 8)g/d for male, (286 ± 7)g/d for female. Rates on intake of vegetables in Chinese adults during the three survey days were 99.0%-99.8%.Rates on intake of fruits of urban and rural residents were 36.9%-51.5% and 21.3%-30.3%,respectively.The proportion of people whose total amount of vegetables and fruits intake reached 400 g/d were 24%-28% and 13%-23% in urban and rural areas, respectively. In urban and rural areas, the proportion of adults whose consumption reached Chinese dietary guidelines recommended level were 22%-26% and 14%-19% in vegetables, 2%-5% and 1%-2% in fruit, respectively. The consumptions of vegetables and fruits were inadequate in Chinese adults.

Chapter 6 - Barriers and Facilitating Factors Affecting Fruit and Vegetable Consumption

Background: Dietary factors, such as vegetable, fruit, and red meat consumption, have varying effects on the disease burden of diabetes, the world’s third leading health concern. This study aims to evaluate the global impact of vegetable/fruit/red meat consumption on disease burdens. Methods: Diabetes disease burden, vegetable/fruit/red meat consumption, and covariates data were obtained from the Global Burden of Disease Study (GBD) 2021, Food and Agriculture Organization (FAO), and WHO, respectively, and matched by country/region and year. Global vector maps assessed the status of diabetes disease burden and the consumption of three dietary factors in 2021, and their trends from 2010 to 2021 were illustrated through local regression curves. Generalized additive mixed models (GAMMs) were used to analyze relationships, with weights assigned based on log-transformed values relative to the mean population of each country. Results: A comprehensive dataset spanning 2010–2021, encompassing 175 countries/regions, was successfully matched and utilized in the analysis. In 2021, Oceania had the highest diabetes burden, whereas East Asia had a lower one. Globally, the disease burden increased from 2010 to 2021, accompanied by rising per capita vegetable and fruit consumption but declining red meat consumption. Vegetable consumption was inversely correlated with the age-standardized incidence rate (ASIR) and exhibited a “J-shaped” curve with the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year (DALY) rate (ASDR) (nadir at approximately 80 kcal/capita/day (kcal/cap/day). Fruit consumption had a “U-shaped” relationship with ASDR (nadir at approximately 100 kcal/cap/day). Red meat consumption was negatively correlated to ASIR and had a “U-shaped” relationship with ASMR and ASDR (nadir at 200 kcal/cap/day). Conclusions: The global diabetes disease burden is heavy, and dietary consumption varies widely. Vegetable-related risks differ between diabetics and non-diabetics. Proper fruit consumption decreases ASDR. Moderate red meat increases can reduce the disease burden, but excessive consumption increases ASMR and ASDR.

Screen Time is Related to Dietary Intake in Children at 24-Months-of-Age

Recent research does not show an association between fruit and vegetable consumption and bladder cancer risk. None of these studies investigated variety in fruit and vegetable consumption, which may capture different aspects of consumption. We investigated whether a varied consumption of vegetables and fruits is associated with bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Detailed data on food consumption and complete follow-up for cancer incidence were available for 452,185 participants, who were recruited from ten European countries. After a mean follow-up of 8.7 years, 874 participants were diagnosed with bladder cancer. Diet diversity scores (DDSs) were used to quantify the variety in fruit and vegetable consumption. Multivariable Cox proportional hazard models were used to assess the effect of the DDSs on bladder cancer risk. There was no evidence of a statistically significant association between bladder cancer risk and any of the DDSs when these scores were considered as continuous covariates. However, the hazard ratio (HR) for the highest tertile of the DDS for combined fruit and vegetable consumption was marginally significant compared to the lowest (HR = 1.30, 95% confidence interval: 1.00-1.69, p-trend = 0.05). In EPIC, there is no clear association between a varied fruit and vegetable consumption and bladder cancer risk. This finding provides further evidence for the absence of any strong association between fruit and vegetable consumption as measured by a food frequency questionnaire and bladder cancer risk.