Fruit and vegetable intake in minority ethnic groups in the UK: analysis from ‘Understanding Society’ and UK Biobank

The UK population is ageing and becoming more ethnically diverse(1). Nutrition is a key modifiable determinant of healthy ageing but there is little published data of dietary patterns in ethnic minority groups. The reasons for poor dietary habits of older adults from ethnic minority groups could be attributed to cost of living, language barriers, age, availability of traditional foods(2). As part of a larger research study to improve nutritional health in older adults (TANGERINE: nuTritional heAlth aNd aGeing in oldER ethnIc miNoritiEs), the aim of this study was to investigate vegetable intake in different older ethnic groups compared with a white (British) reference population.We used food frequency questionnaire (FFQ) data drawn from Wave 2 (2010-2012) and Wave 13 (2021-2022) of Understanding Society, a UK household panel survey(3). We calculated the proportions of vegetable intake by ethnic group for each wave, weighted for population representativeness, and used (weighted) logistic regression for intake (everyday vs less than every day) to adjust for potential confounders. Data from the WHO food insecurity questionnaire in wave 13 was used to evaluate the ethnic group differences in food insecurity.The percentage vegetable intake at least every day was reduced between Waves 2 and 13 in all ethnic groups. At both Waves all ethnic groups, except Indian ethnicity have lower vegetable intakes than white (British) reference group. The age and sex adjusted odds ratios (OR) (95% confidence intervals) at Wave 2 were 0.60 (0.51, 0.71) for Caribbean, 0.67 (0.56, 0.79) for African, 0.36 (0.28, 0.44) for Pakistani, 0.78 (0.62, 0.98) for Bangladeshi and 1.10 (0.94, 1.28) for Indian. The differences could be largely explained by lower income and greater area deprivation for Bangladeshi, less so for Caribbean, African and Pakistani groups. Results were similar for Wave 13. All ethnic groups, except Indian had higher odds of greater food insecurity than the white (British) reference group, largely attributed to income and area deprivation, for example, the OR for Pakistani group compared with white (British) reference group decreased from 1.74 (1.18, 2.56) to 1.05 (0.70, 1.58). However, for the African group, the OR remained greater than white reference population at 2.55 (1.73, 3.76) even after accounting for socioeconomic position.The findings suggest differences in vegetable intake between different ethnic groups which have been maintained between 2010-2012 and 2021-2022 and may be explained to some extent by socioeconomic disadvantage. Whilst we used cross-sectional analyses of self-reported data, there remains a need for further large-scale studies using longitudinal and experimental designs in older ethnic groups considering socioeconomic position, recognising the importance of heterogeneity and the need to analyse ethnic groups individually, rather than as a group for measurements of dietary intake.

Relationships Between Food Security, Fruit and Vegetable Availability, and Fruit and Vegetable Intake in Elementary Children and Their Parents.

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

To investigate the effects of providing free fruit and snack vegetables at a university on students' fruit intake, snack vegetable intake and total vegetable intake. Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university's main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires. A Dutch university of applied science. Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students. Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions. Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes.

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.

Using the National Health and Nutrition Examination Survey (NHANES) 1999–2000 and 2001–2002 age, gender, ethnicity, poverty level, BMI, and food security status were examined as determinants of low fruit and vegetable intake in U.S. children ages 2–18 years (n=6,863). Significant differences in total mean daily fruit intake were found with regards to food security status and gender. Males in households determined food insecure without hunger had significantly lower mean fruit intakes (1.17 ¡Ó .093) than males in households fully food secure and marginally food secure (1.44 ¡Ó .066 and 1.54 ¡Ó .147, respectively) (p „T.024). Females living in households determined food insecure with hunger had significantly lower mean fruit intakes (.885 „b .126) than females living in households fully food secure, marginally food secure, and food insecure without hunger (1.39¡Ó. 064, 1.31¡Ó.127, 1.47 ¡Ó .128, respectively) (p „T .007). Total fruit consumption also differs significantly among ethnicities for school age children. Mexican American children have significantly higher mean daily fruit intakes (1.7 ¡Ó .08) than non-Hispanic white and other Hispanic children (1.3 ¡Ó .09, 1.1 ¡Ó .21, respectively). Mean daily vegetable consumption differs for white potato and deep yellow vegetables among gender, age, and ethnicity, specifically non-Hispanic black children. This study shows differences in total mean vegetable and fruit intakes among age categories and gender in conjunction with poverty status, ethnicity or food security status.

Fruit and Vegetable Intake in Adults with Sickle Cell Disease

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

To investigate the ways in which food insecurity, food acquisition behaviors, and perceived and objective food access influence fruit and vegetable intakes among rural Georgians. A population-based survey was merged with USDA's Food Access Research Atlas, and multilevel modeling was used to determine individual-level (eg, food insecurity, food acquisition behaviors, perceived access) and environmental-level (eg, census tract food access) predictors of fruit and vegetable intakes. Twenty-four rural census tracts in 6 counties in Georgia, USA. One thousand four hundred and seventy-four adults. Residing in a low food access census tract was not associated with fruit or vegetable intake. Food insecurity had negative effects on both fruit and vegetable intakes. Perceived access to fresh fruits and vegetables was positively associated with fruit intake, and obtaining fresh fruits and vegetables from community or home gardens was positively associated with both fruit and vegetable intakes. Findings are unique from previous research on census tract-level fruit and vegetable determinants, underscoring the need for a better understanding of influences on fruit and vegetable intakes among rural populations. Interventions to increase fruit and vegetable consumption in rural areas should prioritize food security.

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.

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