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

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

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

The aim of this study was to investigate whether the Western dietary guidelines on fruit and vegetable intake are associated with blood pressure parameters and hypertension among Vietnamese adults. Participants included 1384 women and 1049 men aged 18-69 years from the 2015 Vietnam national survey on risk factors of non-communicable diseases. Associations between dietary intake score based on the Dietary Approaches to Stop Hypertension (DASH) guidelines and World Health Organization recommendations on fruit and vegetable consumption and blood pressure parameters and hypertension were evaluated by multivariate regression analyses. Approximately 17.0% and 40.1% of participants met the respective definitions of hypertension according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline. Highest tertiles of DASH scores for fruit intake were significantly associated with increased blood pressure parameters, particularly in women. Hypertension was associated with DASH score for fruit intake with odds ratios and 95% confidence intervals for tertiles 2-3 versus tertile 1: 1.31 (0.98, 1.76) and 1.43 (1.05, 1.93) for JNC7; 1.26 (1.01, 1.58) and 1.31 (1.04, 1.66) for 2017 ACC/AHA guideline (all p-trend <0.05). No association with blood pressure parameters and hypertension was observed for DASH score for vegetable intake and meeting World Health Organization recommendations for fruit and vegetable intake. We found an unexpected positive association between DASH score for fruit intake and blood pressure parameters and hypertension among Vietnamese adults. More research is needed in this population to understand the relationship between vegetable and fruit intake with hypertension before a firm conclusion and recommendation are made.

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.

Adolescent Nutrition

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.&#x0D; &#x0D; 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.&#x0D; &#x0D; 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 &amp;lt; 0.001). We also observed the scores of attitude (p = 0.06) and self-efficacy (p &amp;lt; 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 &amp;lt; 0.05) and fruit (p = 0.121) intake from precontemplation to action/maintenance stage.&#x0D; &#x0D; 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.

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

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.

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.

Objective:This study investigated the association between fruit and vegetable intake and stomach cancer, with considering the impacts of Helicobacter pylori (H. pylori) infection and tobacco smoking. Methods:A case-control study featuring 80 male incident stomach-cancer cases and 146 male controls was conducted in a general hospital in Viet Nam. A semi-quantitative food frequency and demographic lifestyle questionnaire were used; and venous blood samples were collected to determine H. pylori status by IgG ELISA. The respective associations between fruit and vegetable intake and stomach cancer were examined using unconditional logistic regression analysis with adjustments for possible cofactors. Results:Fruit intake and stomach cancer showed a weak inverse association when this became non-significant after adjusting for H. pylori infection (OR = 0.50, 95%CI: 0.22–1.12, p trend = 0.094). Stratifying by H. pylori status returned a negative trend for fruit intake and stomach cancer among H. pylori-negative participants (OR = 0.21, 95%CI: 0.06–0.69, p trend = 0.010), but no significant interaction for H. pylori-positive participants (OR = 0.76, 95%CI: 0.21–2.68, p trend = 0.670). Vegetable intake and stomach cancer showed no association, regardless of H. pylori status. Compared to ever-smokers with low intake, never-smokers with high vegetable (OR = 0.25, 95% CI: 0.06–0.95) and fruit intake (OR = 0.20, 95%CI: 0.06–0.65) showed the lowest odds of stomach cancer. Conclusions:Fruit, but not vegetable, intake showed a weak inverse association with stomach cancer. H. pylori infection and tobacco-smoking status may influence the protective effects of fruit and vegetable intake on stomach cancer.

Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y

Simple screening tools to identify intake of fruit, vegetables and fat are necessary to design effective public health intervention strategies in order to increase intake of fruit and vegetable and to reduce fat intake. 108 men recorded their food intake for 14 days and filled in a 27-item food frequency questionnaire (FFQ) 1.5-2 months later. Estimates of fruit, vegetables and fat intake from the FFQ were compared with those from the weighed records. Mean intake of vegetables and fruit estimated from the diet records increased with increasing categories for frequency of intake assessed by the FFQ. Spearman correlation coefficient between frequency of intake of vegetables and fruit from the FFQ and amount of these food items estimated from the weighed records was 0.46 and 0.66, respectively. The ability of the FFQ to predict those having inadequate intake of fruits and vegetables based on weighed record data, was more than 90%. Almost 95% who reported use of fat spreads by the FFQ also reported this by the records. The correlation coefficient between the amount of fat used on bread from the two methods was 0.79. The correlation between fat intake estimated from both methods was 0.36 and for saturated fat intake the correlation was 0.38. The FFQ could be used to screen for low consumers of fruit, vegetable and fat spread in intervention programmes. However, the ability of the FFQ to identify persons with high (or low) intake of fat and saturated fat was not good.

Adolescents with type 1 diabetes (T1DM) must consider multiple factors in diet planning, including glycemic control and cardiovascular disease prevention, while ensuring adequate nutrition for growth. We examined diet composition, quality, and compliance for two dietary patterns - the traditional Dietary Approaches to Stop Hypertension (DASH) and a modified version of DASH in this population. Two feeding studies were conducted. First, adolescents with T1DM consumed their usual diet for 3 days followed by traditional DASH for 6 days. Next, DASH menus were adjusted to align with T1DM nutrition guidelines, and this modified DASH for Diabetes (DASH-D) was tested on a new group of adolescents with T1DM for 6 days, following 3 days of usual diet. Usual diet was measured via 24-hr dietary recalls. Dietary composition of DASH-D was compared to DASH and usual diet. Eighteen adolescents (9/group) participated. Compared to usual diet, intake of protein, fiber, fruit, vegetables, lean meats, and low-fat dairy were higher, while saturated fat and added sugar were lower, in DASH-D. Percent energy from fat was higher, and from carbohydrate lower, in DASH-D versus traditional DASH, with food group intake reflecting these patterns. Participants consumed 87% of foods provided for DASH, and 98% of foods provided for DASH-D. In both DASH iterations, participants met national guidelines for fat, saturated fat, fiber, and fruit/vegetable intake, while usual diet fell short of these recommendations. The novel DASH-D pattern meets guidelines and may be a viable option for achieving nutrition goals for adolescents with T1DM.

Vegetable and fruit intake in Australian adolescents: Trends over time and perceptions of consumption