A Global and Some National Perspectives on the Current Evidence of Interventions on Fruit and Vegetable Intake in Low-, Middle-, and High-Income Countries.

The relationship between Fruit and vegetable intake and frailty: Data from NHANES 2007–2018

Diet, nutrition and cancer: public, media and scientific confusion

Substantial scientific evidence firmly advocates consumption of vegetables and fruits for maintenance of overall health and protection against chronic diseases, such as obesity. However, prevalence of fruit and vegetable intake among adolescents in Malaysia remains low, whereas the data on factors associated with vegetable and fruit intake among adolescents were limited. This study aims to determine the prevalence of fruit and vegetable intake and the factors that influence the Malaysian adolescents' consumption of fruits and vegetables. A cross-sectional study was conducted from November 2021 to August 2022 by distribution of an online validated questionnaire on various platforms to recruit school-going adolescents aged 13 to 17 years old (Form 1-5) in Selangor. Respondents were screened and data of eligible participants were included as subjects. Descriptive statistics, chi square analysis, and generalized linear model with Poisson-loglinear distribution and the robust estimator were employed for data analysis. A total of 277 adolescents participated in this study. Overall, low prevalence of adequate vegetable consumption was observed (23.5%). Of the participants surveyed, 14.8% of adolescents with thinness, 25.2% and 15.0% of adolescents with overweight and obesity, and 27.1% of normal-weight adolescents met the recommended daily intake (>3 servings), whereas 64.1% of adolescents with overweight and obesity and 65% of normal-weight participants consumed at least two servings of fruits a day. The findings revealed significant association between BMI-for-age (X 2 (1, N = 277) = 5.236, p = 0.022) and adolescent fruit intake. On the other hand, overweight and obese adolescents reporting positive intention (PR: 1.146, 95% CI: 1.002, 1.310, p = 0.047) and parental allowance (PR: 1.125, 95% CI: 1.011, 1.252, p = 0.030) were observed to have 14.6% and 12.5% higher prevalence of fruit consumption, respectively, while availability at home (PR: 0.849, 95% CI: 0.731, 0.987, p = 0.033) showed significantly lower prevalence of fruit intake with more reports of home availability. The study suggests that personal, social-environmental, and physical-environmental factors influence vegetable and fruit intake among adolescents, particularly fruit intake consumption behaviors among overweight and obese adolescent population in Selangor. The enunciation of these intake correlates could potentially be incorporated in future development of intervention strategies to effectively promote fruit and vegetable intake.

Fruit, Vegetables, and Folate: Cultivating the Evidence for Cancer Prevention

Eating Pattern Analyses: The Whole Is More than the Sum of Its Parts

Resemblance of dietary intakes of snacks, sweets, fruit, and vegetables among mother–child dyads from low income families

Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study

The first aim of this study was to investigate the stability of the Fruit Test and Vegetable Test over time and whether the Fruit Test and Vegetable Test are capable of measuring fruit and vegetable intake with consistency. Second, the study aimed to examine criterion (concurrent) validity of the Fruit Test and Vegetable Test by testing their agreement with 7-day food diary-derived measures of fruit and vegetable intake. In total 58 adults (31% male, mean age = 30.0±12.09y) completed the Flemish Fruit and Vegetable test by indicating the frequency of days that they ate fruit and vegetables and the number of portions during the past week. Validity was tested by using a 7-day food diary as a golden standard. Adults were asked to register their fruit and vegetable intake daily in a diary during one week. Spearman correlations were measured to compare total intake reported in the Fruit and Vegetable Test and in the 7-day diary. Agreement plots were used to illustrate absolute agreement. Test-retest reliability was evaluated by having participants completing the Fruit Test and Vegetable Test twice. The Fruit Test (ICC = 0.81) and Vegetable Test (ICC = 0.78) showed excellent and substantial reliability. The Fruit Test (ρ = 0.73) and Vegetable Test showed good validity. Agreement plots showed modest variability in differences between vegetable and fruit intake as measured by the Vegetable and Fruit Test and the 7-day food diary. Also a small underestimation of fruit intake in the Fruit test and vegetable intake in the Vegetable test against the 7-day food diary was shown. Based on the results, it is suggested to include portion size pictures and consumption of mixed vegetables to prevent underestimation. To prevent overestimation, it is concluded to add a moderate number of representative fruit and vegetable items, questions on portion size, household sizes with sufficient detail and food items highly tailored to the dietary behaviors and local food items of the population surveyed. The questionnaires can easily be adapted for the use in other diets (e.g. Asian diet), but reliability and validity should then be examined again. Also, validity remains to be tested in other population groups (i.e. low socio economic status groups, other age groups).

Depression is the largest global contributor to non-fatal disease burden(1). A growing body of evidence suggests that dietary behaviours, such as higher fruit and vegetable intake, may be protective against the risk of depression(2). However, this evidence is primarily from high-income countries, despite over 80% of the burden of depression being experienced in low- and middle-income countries(1). There are also limited studies to date focusing on older adults. The aim of this study was to prospectively examine the associations between baseline fruit and vegetable intake and incidence of depression in adults aged 45-years and older from 10 cohorts across six continents, including four cohorts from low and middle-income countries. The association between baseline fruit and vegetable intake and incident depression over a 3–6-year follow-up period was examined using Cox proportional hazard regression after controlling for a range of potential confounders. Participants were 7771 community-based adults aged 45+ years from 10 diverse cohorts. All cohorts were members of the Cohort Studies of Memory in an International Consortium collaboration(3). Fruit intake (excluding juice) and vegetable intake was collected using either a comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated depression measures, and depression was defined as a score greater than or equal to a validated cut-off. Prior to analysis all data were harmonised. Analysis was performed by cohort and then cohort results were combined using meta-analysis. Subgroup analysis was performed by sex, age (45 – 64 versus 65+ years) and income level of country (high income countries versus low- and middle-income countries). There were 1537 incident cases of depression over 32,420 person-years of follow-up. Mean daily intakes of fruit were 1.7 ± 1.5 serves and vegetables 1.9 ± 1.4. serves. We found no association between fruit and vegetable intakes and risk of incident depression in any of the analyses, and this was consistent across the subgroup analyses. The low intake of fruit and vegetables of participants, diverse measures used across the different cohorts, and modest sample size of our study compared with prior studies in the literature, may have prevented an association being detected. Further investigation using standardised measures in larger cohorts of older adults from low- to middle-income countries is needed. Future research should consider the potential relationship between different types of fruits and vegetables and depression.

OBJECTIVE: Thhis study aimed to investigate the reason why people choose to consume less vegetable and fruit through examining how the stage of change and psycho-social parameters relate to vegetable and fruit intake.
 
 METHODS: We carried out a cross-sectional study in 4 regions of Japan in which 2308 individuals (1012 men and 1296 women) aged 18 years or older who completed the questionnaires were included in the study.
 
 RESULTS: The results showed 56% of the participants were in the precontemplation stage (not thinking about consuming recommended amount of fruit and vegetable) and their average amounts of vegetable and fruit intake were far below the level of current recommendations, and subjects in the precontemplation stage showed lower scores of attitude and self efficacy. Men were more likely to be in precontemplation (67.7%) and less likely to be in action/maintenance stage (7.9%) than women (46.9%, 12.1%, respectively) (p < 0.001). We also observed the scores of attitude (p = 0.06) and self-efficacy (p < 0.01) rose as the stage went up from the precontemplation to action/maintenance for increasing vegetable and fruit intake. Moreover, a linear trend was found toward higher vegetable (p < 0.05) and fruit (p = 0.121) intake from precontemplation to action/maintenance stage.
 
 CONCLUSION: The present evidence suggests more attention should be focused on strategy for perceptions of personal need for recommended amount of vegetable and fruit intake for those who are in the precontemplation stage. Moreover, effective programs on enhancement of self-efficacy and attitude toward vegetable and fruit consumption are needed for increasing the vegetable and fruit intake.

BackgroundLifestyle behaviors during the periconception period contribute to achievement of a successful pregnancy. Assessment of attitudes and practices toward these modifiable behaviors can aid in identifying gaps in unhealthy lifestyle behaviors with impact on intervention effectiveness.ObjectiveThis study investigates the effectiveness of coaching by the eHealth program Smarter Pregnancy during the periconception period on improvement of attitudes and practices toward fruit and vegetable intake and smoking in women attempting pregnancy through assisted reproductive technology (ART) or natural conception.MethodsWomen attempting pregnancy through ART (n=1060) or natural conception (n=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching for 24 weeks, whereas the control group conceived through ART and did not receive coaching. Attitudes and practices at baseline and follow-up periods were obtained from self-administered online questionnaire provided by the program. Attitudes were assessed in women with unhealthy behaviors as their intention to increase their fruit and vegetable intake and to quit smoking using a yes/no question. Outcomes on practices, suggesting effectiveness, included daily fruit (pieces) and vegetable (grams) intake, and if women smoked (yes/no). Changes in attitudes and practices were compared at 12 and 24 weeks with baseline between the ART intervention and ART control groups, and within the intervention groups between ART and natural conception. Changes in practices at 12 and 24 weeks were also compared with baseline between women with negative attitude and positive attitude within the intervention groups: ART and natural conception. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices.ResultsThe ART intervention group showed higher vegetable intake and lower odds for negative attitudes toward vegetable intake after 12 weeks (βadj=25.72 g, P<.001; adjusted odds ratio [ORadj] 0.24, P<.001) and 24 weeks of coaching (βadj=23.84 g, P<.001; ORadj 0.28, P<.001) compared with ART controls. No statistically significant effect was observed on attitudes and practices toward fruit intake (12 weeks: P=.16 and .08, respectively; 24 weeks: P=.16 and .08, respectively) and smoking behavior (12 weeks: P=.87; 24 weeks: P=.92). No difference was observed for the studied attitudes and practices between the ART intervention and natural conception intervention groups. Women with persistent negative attitude toward fruit and vegetable intake at week 12 showed lower fruit and vegetable intake at week 24 compared with women with positive attitude (βadj=–.49, P<.001; βadj=–30.07, P<.001, respectively).ConclusionsThe eHealth Smarter Pregnancy program may improve vegetable intake–related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. Despite small changes, this study demonstrates again that Smarter Pregnancy can be used to improve vegetable intake, which can complemented by blended care that combines face-to-face and online care to also improve fruit intake and smoking behavior.

Region-specific nutritious, environmentally friendly, and affordable diets in India

We used an ecological approach to determine the correlation between vegetable, fruit and salt intakes, refrigerator use, and gastric cancer mortality in Korean population. Information on fruit and vegetable intakes per capita from the National Health and Nutrition Survey, death certificate data from the National Statistical office, refrigerator per household data from Korean Statistical Information Service, and salt/sodium intake data from a cross-sectional survey were utilized. Correlation coefficients were calculated between vegetable and fruit intakes, refrigerator per household, and gastric cancer mortality and between salt and sodium intakes, and gastric cancer mortality and incidence in the four areas. With 5, 10, and 15years lag time, refrigerator usage and fruit intake were negatively associated with gastric cancer mortality (p<0.01), but vegetable intake was not associated with gastric cancer mortality. When estimates of salt/sodium intake evaluated by 24-h urine collection in four areas of Korea were compared to the gastric cancer mortality and incidence in these regions, positive correlation was shown between salt/sodium intake, and gastric cancer incidence and mortality. Negative associations between refrigerator use, fruit intake, and gastric cancer mortality and positive associations between salt/sodium intake and gastric cancer mortality and incidence were suggested.

Fruit and Vegetable Intake in Adults with Sickle Cell Disease

BackgroundAfrican Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans.ObjectiveThis study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change.MethodsThis study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression.ResultsParticipants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively).ConclusionsOur findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans.