Fruit And Vegetable Servings Research Articles

Socioeconomic and household framework influences in school-aged children's eating habits: Understanding the parental roles

Maternal influences on children's diet have been widely studied, while paternal and household frameworks require further research. This study aimed to evaluate how individual, socioeconomic and household characteristics at birth and 7 years (y) impact children's fruit and vegetable (FV) and energy-dense foods (EDF) intake at 10y, distinguishing maternal and paternal effects. The sample included 2750 children evaluated at 7 and 10y in the Portuguese birth cohort Generation XXI. The children's food intake was assessed through a Food Frequency Questionnaire at both ages, where 4 food groups were defined: FV, ‘Sweet foods’, ‘Salty snacks’, and ‘Soft drinks’. The associations between food intake at 7y, parents' and children's characteristics, and food intake at 10y were evaluated via binary logistic regression models. Offspring of older mothers with higher age and education, who live with siblings and had higher family income were likelier to have 5 servings of FV daily at 10y. Children eating 5 portions/day of FV at 7y had higher odds of keeping this pattern at 10y. Higher maternal age and education, and father's education decreased the odds of having soft drinks daily at 10y. Higher family income was linked with lower odds of weekly salty snacks and daily sweet foods at 10y. In conclusion, parental education, maternal age, living with siblings, and higher family income influenced children's FV and EDF intake at 10y. Mothers' effects appear to impact children's food intake more than fathers'.

Magnitude of fruit and vegetable consumption and its associated factors among patients with type 2 diabetes mellitus (T2DM) attending health services at selected health centers in Yeka subcity, Addis Ababa: a cross-sectional study

ObjectiveTo assess the fruit and vegetable (FV) consumption, and associated factors among patients with type 2 diabetes mellitus (T2DM) attending health services at selected health centres.MethodsInstitution-based cross-sectional study design was...

Skin Carotenoids Measured by Reflection Spectroscopy Correlate With Dietary Carotenoid Intake in Racially and Ethnically Diverse US Toddlers From Houston, Texas

BackgroundMethods to objectively assess fruit and vegetable (FV) intake in young children are needed in order to support rigorous assessments of policies and interventions. Noninvasive skin carotenoid concentration measurements may provide a rapid assessment of toddler carotenoid and carotenoid-rich FV intake. ObjectiveThe aim of this study was to evaluate the relationship between pressure-mediated reflection spectroscopy-measured skin carotenoid score (SCS) with proxy-reported carotenoid and FV intake in racially and ethnically diverse US toddlers. DesignThis study was a secondary analysis of data obtained from a randomized controlled 10-week study of the effect of an interactive healthy playgroup intervention vs classroom parent education on the diet and physical activity of toddlers. This study collected skin carotenoid and 1-week dietary intake using a 31-item semi-quantitative food frequency questionnaire analyzed by the Nutrient Data System for Research nutrient database. The current study determined dietary predictors of toddler SCS. Participants/settingParticipants were racially and ethnically diverse US toddlers (12 to 36 months) and adult guardian dyads (n = 50) recruited from the community in Houston, TX from fall 2018 to spring 2019. Main outcome measuresAt baseline and 10 to 12 weeks after baseline, SCS was measured by means of pressure-mediated reflection spectroscopy (Veggie Meter, Longevity Link Corporation), guardians reported toddler diet using a food frequency questionnaire, and carotenoid intake was estimated from the food frequency questionnaire responses using a nutrient database. Statistical analysisThe relationship between toddler SCS and intake of total and individual carotenoid species and FV servings was tested using generalized linear mixed models, controlling for body mass index-for-age percentiles, group assignment, and age. ResultsSCS was positively and significantly predicted by estimated intakes of total carotenoids (P = .002), β-carotene (P ≤ .001), and lutein and zeaxanthin (P = .003). Reported intakes of α-carotene, β-cryptoxanthin, and lycopene were not predictors of SCS. SCS was predicted by estimated total FV intake (P = .047) and vegetable intake (P = .006), but not fruit intake (P = .580). ConclusionsThese results showed that reported dietary carotenoid intake is a significant predictor of SCS in an ethnically and racially diverse population of US toddlers. Toddler skin carotenoid measurement holds promise as a rapid, objective, noninvasive biomarker of dietary carotenoid intake.

KNOWLEDGE LEVEL OF FRUIT-VEGETABLE AND CONSUMPTION DURING PANDEMIC COVID-19 AND ITS IMPACT ON CONSTIPATION AMONG TEENAGERS IN SMAN 1 DEPOK

Fruit and vegetable (FV) consumption among teenagers in Indonesia is still relatively low. Based on Indonesia Basic Health Survey in 2018, 96.4 percent of teenagers have a low intake of FV and this can increase the risk of constipation. The purpose of this study was to assess the level of knowledge and FV consumption pattern and the impact on constipation at SMAN 1 Depok. The research design was cross-sectional with 206 high school students as subjects taken by proportional random sampling. Data was collected through an online questionnaire and tested statistically with Chi-square and Fisher-exact tests. The proportion of teenagers with a good level of knowledge is only 8.3 percent, while the others are moderate (55.8%) and not-good (35.9%). The average amount of FV consumption was 132.4±96.5 grams/day and 95.1 percent consumed less than the recommended amount. The average fiber intake was 6±2.5 grams/day, lower than the recommendation. It was found that 29.6 percent of teenagers were constipated. There was a significant relationship between FV consumption and FV accessibility (p=0,016), as well as constipation with gender (p=0,021) and fluid intake (p=0,027). Almost all teenagers have low consumption of FV and fiber intake and gender were found to be the dominant factor in constipation. It is recommended for the school to carry out continuous socialization for the students and parents about balanced nutrition, especially the importance of consuming 3 – 5 servings of FV a day

P060 Impact of a Produce Prescription Program on Shopping Habits and Fruit and Vegetable Consumption Among New Yorkers With Hypertension

<h3>Background</h3> Consuming a diet rich in fruits and vegetables (FV) can reduce the risk of cardiovascular disease. However, the cost of FV is a barrier to consumption for many New Yorkers. From 2017-2021, the New York City (NYC) Department of Health's Pharmacy to Farm Prescriptions program provided coupons redeemable for FV at farmers markets to New Yorkers with hypertension and SNAP benefits. <h3>Objective</h3> To assess changes in FV consumption and farmers markets shopping behaviors. <h3>Study Design, Setting, Participants</h3> Eligible participants were recruited at 19 participating NYC pharmacies. Participants received monthly prescriptions to purchase $30 worth of fresh FV from NYC farmers markets. At enrollment and each subsequent visit to the pharmacy for a prescription, participants were encouraged to complete a self-administered survey about FV consumption and farmers market shopping behaviors. <h3>Measurable Outcome/Analysis</h3> Total daily servings of FV were calculated and compared at enrollment and at the last completed survey using the Wilcoxon signed-rank test. McNemar tests were used to compare changes in shopping behaviors. <h3>Results</h3> A total of 1,019 participants (59% Hispanic, 18% Black, 11% Asian 8% White, and 4% Other race) completed at least one follow-up survey with responses for all FV consumption questions. The median time from enrollment to last survey was 264 days (range, 20-1,383 days). Daily FV consumption remained unchanged from enrollment to last survey (median change: -0.03 servings, IQR: -1.01­-1.00 servings, <i>P =</i> 0.767). The percent of participants that reported shopping at farmers markets at least once a month increased (83% at last survey vs. 33% at enrollment, <i>P =</i> <0.001). Most participants (81%) reported buying more FV at farmers markets since joining the program. <h3>Conclusions</h3> Among participants, there was a significant increase in shopping frequency and FV purchases at farmers markets. However, this did not translate to increases in reported FV consumption. More research is needed to assess the long-term impacts and sustainability of produce prescription programs. <h3>Funding</h3> USDA

Comparison of Fruit and Vegetable Prices between Farmers' Markets and Supermarkets: Implications for Fruit and Vegetable Incentive Programs for Food Assistance Program Participants.

This cross-sectional study was part of a larger evaluation of a fruit and vegetable (FV) incentive program for Supplemental Nutrition Assistance Program (SNAP) participants in California. We examined the price differences in FV to explore whether these could help explain a previously observed lack of effect of the incentive program on FV consumption. Differences by type (organic/no-spray or conventional), among a convenience sample of farmers’ markets (n = 11) and nearby supermarkets (n = 7), were assessed using Wilcoxon rank-sum tests adjusting for clustering by market. We calculated the cost of market baskets comprising recommended FV servings for a household using median prices to consider the implications of FV price differences for SNAP shoppers who use financial incentives for FV. We found that farmers’ markets primarily offered organic FV while supermarkets primarily offered conventionally grown FV. Farmers’ market prices tended to be lower than supermarkets for organic FV but higher for conventional FV. Compared to supermarkets, the market basket composed only of organic FV cost USD 16.34 less at farmers’ markets, whereas a basket comprised of a mix of conventionally and organically grown FV cost USD 3.68 more. These differences warrant further exploration; FV price and type should be considered in studies aimed at understanding the impact of SNAP financial incentive programs.

Evaluating the Dissemination and Implementation of a Community Health Worker-Based Community Wide Campaign to Improve Fruit and Vegetable Intake and Physical Activity among Latinos along the U.S.-Mexico Border.

This study evaluated the dissemination and implementation of a culturally tailored community-wide campaign (CWC), Tu Salud ¡Si Cuenta! (TSSC), to augment fruit and vegetable (FV) consumption and physical activity (PA) engagement among low-income Latinos of Mexican descent living along the U.S.-Mexico Border in Texas. TSSC used longitudinal community health worker (CHW) home visits as a core vehicle to enact positive change across all socioecological levels to induce behavioral change. TSSC’s reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) was examined. A dietary questionnaire and the Godin-Shepherd Exercise Questionnaire measured program effectiveness on mean daily FV consumption and weekly PA engagement, respectively. Participants were classified based on CHW home visits into “low exposure” (2–3 visits) and “high exposure” (4–5 visits) groups. The TSSC program reached low-income Latinos (n = 5686) across twelve locations. TSSC demonstrated effectiveness as, compared to the low exposure group, the high exposure group had a greater FV intake (mean difference = +0.65 FV servings daily, 95% CI: 0.53–0.77) and an increased PA (mean difference = +185.6 MET-minutes weekly, 95% CI: 105.9–265.4) from baseline to the last follow-up on a multivariable linear regression analysis. Multivariable logistic regression revealed that the high exposure group had higher odds of meeting both FV guidelines (adjusted odds ratio (AOR) = 2.03, 95% CI: 1.65–2.47) and PA guidelines (AOR = 1.36, 95% CI: 1.10–1.68) at the last follow-up. The program had a 92.3% adoption rate, with 58.3% of adopting communities meeting implementation fidelity, and 91.7% of communities maintaining TSSC. TSSC improved FV consumption and PA engagement behaviors among low-income Latinos region wide. CHW delivery and implementation funding positively influenced reach, effectiveness, adoption, and maintenance, while lack of qualified CHWs negatively impacted fidelity.

Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes research Network (ECHORN) Cohort study

IntroductionStudies conducted in the US and other high-income countries show that the local food environment influences dietary intakes that are protective for cardiovascular health.However, few studies have examined this relationship in the Caribbean. This study aimed to determine whether perceptions of the local food environment were associated with fruit and vegetable (FV) intake in the Eastern Caribbean, where daily FV intake remains below recommended levels. MethodsCross-sectional analysis of Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) baseline data (2013–2016) from Barbados, Puerto Rico, Trinidad and Tobago, and US Virgin Islands was conducted in 2020. The National Cancer Institute Dietary Screener Questionnaire was adapted to measure daily servings of FV. Existing scales were used to assess participant perceptions of the food environment (availability, affordability, and quality). Chi-square tests and Poisson regression were used for analyses. ResultsParticipants reported eating one mean daily serving of FV. Mean daily intake was higher among those who perceived FV as usually/always affordable, available, and high quality. Multivariate results showed statistically significant associations between FV and affordability. Persons who perceived FV as affordable had 0.10 more daily servings of FV compared to those who reported FV as not always affordable (p = 0.02). Food insecurity modified the association between affordability and FV intake. ConclusionsThis study highlights the importance of affordability in consumption of FV in the Eastern Caribbean, and how this relationship may be modified by food insecurity.

On the association between risk attitude and fruit and vegetable consumption: insights from university students in Italy

As a novel contribution, this paper explores the possible association between individual risk attitudes and consumer fruit and vegetable (FV) intake. Inspired by the literature, the study also investigates the relationship between FV consumption frequency and health consciousness, perceived health benefits, trust, and attitude towards eating the recommended five-a-day FV portions. An ordered logit model is estimated on data collected through direct interviews among university students. The results show that risk aversion has a positive effect on consumer choice to eat the recommended number of FV servings, similar to the individual health consciousness and the perception of health benefits. The results pave the way for new research that aims to provide useful evidence for the implementation of new strategies to foster people’s FV intake in compliance with the five-a-day recommendation.

Level of Neighborhood Deprivation Predicts Fruit &amp; Vegetable and Sugar-Sweetened Beverage Intake in Children Aged 12–24 Months

Abstract Objectives The first USDA Dietary Guidelines for Americans for children under 2 were released in December, 2020, and recommend a diverse diet rich in fruits and vegetables (FV), whole grains and lean protein and avoidance of sugar-sweetened beverages (SSB). We analyzed data for children 12–24 months enrolled in the CDC-funded PREVAIL Cohort in Cincinnati, OH to assess adherence to FV and SSB recommendations by the socioeconomic position (SEP) of their neighborhoods. Methods Diet was assessed using a validated food frequency questionnaire and daily servings of FV and SSB were calculated. Home addresses were geocoded and merged with the Deprivation Index, a validated measure of census tract-level SEP, with residence then classified as being High SEP (least deprived), Low SEP (most deprived) or the middle quartiles of deprivation score. Comparisons of FV and SSB intake were made using logistic or Poisson regression and generalized estimating equations (GEE). Results Dietary data was available for N = 207 children from research visits at 12 (n = 155), 18 (n = 196), and 24 (n = 171) months. Residents in High SEP neighborhoods were 86% white with a median household income of ≥$50,000; residents of Low SEP neighborhoods were 86% Black with a median income of ≤$25,000. Children in High SEP consumed the most and those in Low SEP the least FV per day (mos. 12, 18, 24: High: 3.8, 3.8, 4.5; Low: 2.1, 2.7, 3.2; all P &amp;lt; 0.05). While only 16.8% of children consumed any SSB at month 12, Low SEP children were 13.4 times more likely to consume any SSB than High SEP (37.8% vs 4.4%, P = 0.001). At month 24, 27.4% of High SEP children consumed any SSB and 7.8% consumed SSB at least once daily compared to 58.4% and 27.8%, respectively, in Low SEP children (P &amp;lt; 0.05). In univariate GEE models, children in Low SEP neighborhoods averaged 1/3 fewer FV but 4.6-times more SSB (all P &amp;lt; 0.01) compared to children in High SEP neighborhoods. The middle quartiles of deprivation index were intermediate in their FV and SSB intake. Conclusions In the PREVAIL Cohort, children in more deprived neighborhoods consumed significantly fewer fruits and vegetables and more sugar-sweetened beverages than those in more affluent neighborhoods. Efforts to improve diet quality should focus on promoting and enabling healthy food and beverage consumption in low SEP neighborhoods. Funding Sources Centers for Disease Control and Prevention.

Family function and eating behaviours among Hispanic/Latino youth: results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth).

To elucidate mechanisms across family function, home environment and eating behaviours within sociocultural context among Hispanic youth. Two models tested via path analysis (youth fruit and vegetable (FV) consumption; empty energy consumption) using data from the Study of Latino Youth (2011-2013). Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA. Youth (8-16-year-olds), n 1466. Youth ate 2·4 servings of FV per d and received 27 % of total energy from empty energies. Perceiving higher acculturative stress was indirectly associated with lower FV consumption via a pathway of low family function and family support for FV (β = -0·013, P < 0·001) and via lower family closeness and family support (β = -0·004, P = 0·004). Being >12-year-olds was indirectly associated with lower FV consumption via lower family closeness and family support (β = -0·006, P < 0·001). Household food security was indirectly associated with greater FV consumption via family closeness and family support (β = 0·005, P = 0·003). In contrast, perceiving higher acculturative stress was indirectly associated with higher empty energy consumption (via family closeness and family support: β = 0·003, P = 0·028 and via low family function and low family support: β = 0·008, P = 0·05). Being older was associated with higher consumption of empty energies via family closeness (related to family support: β = 0·04, P = 0·016; parenting strategies for eating: β = 0·002, P = 0·049). Findings suggest pathways of influence across demographic and sociocultural context, family dynamics and home environment. The directionality of these associations needs confirmation using longitudinal data.

Incorporating healthy dietary changes in addition to an increase in fruit and vegetable intake further improves the status of cardiovascular disease risk factors: A systematic review, meta-regression, and meta-analysis of randomized controlled trials.

Fruit and vegetable (FV) intake has been associated with a reduced risk of cardiovascular disease (CVD). Beyond increasing FV intake, the incorporation of other healthy dietary changes may help to further attenuate CVD risk. A systematic review and meta-analysis was conducted to determine the effect of increasing FV intake to > 3 servings daily as well as incorporating other healthy dietary changes on classical CVD risk factors through a systematic review, meta-regression, and meta-analysis of randomized controlled trials. The following databases were searched: PubMed, CINAHL Plus with Full Text, Medline (ProQuest), and Cochrane Library. 82, 24, and 10 articles were selected for the systematic review, meta-regression, and meta-analysis, respectively. Meta-regression analysis showed a dose-dependent response between the number of FV servings consumed in each intervention group and the blood triglyceride change value. Pooled weighted mean differences from the meta-analysis suggested that increasing FV intake to > 3 servings daily contributes to significant decreases in triglyceride (-0.10 mmol/L; 95%CI, -0.18 to -0.01) and diastolic blood pressure (-1.99 mmHg; 95%CI, -2.28 to -1.70) as well as marginal decreases in total cholesterol and low-density lipoprotein cholesterol. While improvements were observed in the triglyceride and high-density lipoprotein cholesterol response following the incorporation of other healthy dietary changes, no additional cardiovascular benefits were observed when FV intake was increased from > 3 to > 5 servings daily. Increasing FV intake to > 3 servings daily improves CVD risk factors, most distinctly triglyceride, especially when complemented with other healthy dietary changes.

P74 Impact of the WV Kids Market Program on Children's Knowledge, Attitudes and Consumption of Fruits and Vegetables

Objective To evaluate the impact of the West Virginia (WV) Kids Market Program on children's knowledge, attitudes and consumption of fruits and vegetables (FV) using a parent survey. Use of Theory or Research Ninety percent of WV adults do not eat five servings of FV daily. Without positive parent role modeling and consistent home access, children are unlikely to develop preferences for FV, putting them at risk for obesity later in life. Repeated exposures and opportunities to taste in a positive environment are needed to encourage acceptance and consumption of FV by children. Target Audience The program targeted low income children of all ages at SNAP-Ed and EFNEP nutrition education sites and their parents. Program Description Each child received $4 vouchers to shop at a farmers market set up at their school, child care center or other youth-based program site. Children received nutrition education and were offered taste tests in conjunction with markets. Evaluation Methods A 12-question, parent survey was sent home with all children participating in the market. Paper surveys were entered in SurveyMonkey for analysis. A total of 724 were returned (32% response rate). Results Of those parents returning surveys, 91% said their child ate all the produce they purchased, 77% said their child was more excited about FV, 71% said their child talks about FV more and 78% said their child could identify more FV. Conclusions Parents reported changes in their child's knowledge, attitude and consumption of FV because of the program which are important factors in development of food preferences. This program offers a replicable model for nutrition education programs focused on increasing FV consumption and access in low income audiences. Funding None.

Pathways from Food Insecurity to Health Outcomes among California University Students.

The prevalence of food insecurity (FI) among college students is alarmingly high, yet the impact on student health has not been well investigated. The aim of the current study was to examine the simultaneous relationships between food insecurity and health-related outcomes including body mass index (BMI) and overall health in a college student population. Randomly sampled students in the University of California 10 campus system were invited to participate in an online survey in spring 2015. The analytic sample size was 8705 graduate and undergraduate students. Data were collected on FI in the past year, daily servings of fruits and vegetables (FV), number of days in the past week of enough sleep and moderate- to vigorous-intensity physical activity (MVPA), height and weight, self-rated health, and student characteristics. Using path analysis, mediated pathways between FI, BMI, and poor health were examined through FV intake, number of days of MVPA and enough sleep. Analyses controlled for student characteristics. Mean BMI was 23.6 kg/m2 (SD, 5.0), and average self-rated health was good. FI was directly and indirectly related to higher BMI and poor health through three pathways. First, FI was related to fewer days of enough sleep, which in turn was related to increased BMI and poor health. Second, FI was related to fewer days of MVPA, which in turn was related to increased BMI and poor health. Third, FI was related to fewer daily servings of FV, which in turn was related to poor health. FI is associated with poor health behaviors among college students, which may contribute to higher weight status and poor health. These findings highlight the importance of food security for a healthy college experience.

Abstract P216: Plant-Based Diets Are Associated With a Lower Risk of Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality

Introduction: Previous studies of plant-based diets and chronic diseases have limited generalizability because most have been conducted among vegetarians or Adventists who may have healthier lifestyles than the general population. Hypothesis: We hypothesized that plant-based diets are associated with lower risk of cardiovascular disease and all-cause mortality in a community-based US cohort. Methods: We used data from middle-aged adults (n=12,168) in the Atherosclerosis Risk in Communities (ARIC) study who were followed from 1987 to 2016. We classified participants’ diet using a plant-based diet index (PDI) and a provegetarian diet index. For the PDI, higher intakes of all plant foods were scored higher. For the provegetarian diet index, higher intakes of selected plant foods were scored higher. Higher intakes of animal foods were scored lower for both indices. We used Cox proportional hazards models to evaluate associations between plant-based diet indices and incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality, adjusting for several potential confounders. Results: On average, participants in the highest quintiles of PDI and provegetarian diet index consumed 4.8 servings of fruits and vegetables (FV) and 0.9 servings of red and processed meat per day. Participants in the lowest quintiles consumed 2.8 servings of FV and 1.5 servings of red and processed meat. Higher adherence to PDI was associated with 16% lower risk of cardiovascular disease, 31% lower risk of cardiovascular disease mortality, and 24% lower risk of all-cause mortality (all P -trend&lt;0.001, Table ). Similarly, higher adherence to provegetarian diet index was associated with a 15% lower risk of cardiovascular disease, 32% lower risk of cardiovascular disease mortality, and 18% lower risk of all-cause mortality (all P -trend&lt;0.001). Conclusions: Diets high in plant foods and low in animal foods were associated with lower risk of cardiovascular disease outcomes and all-cause mortality in a general population.

The Prevalence and Social Determinants of Fruit and Vegetable Consumption and Its Associations With Noncommunicable Diseases Risk Factors Among Adults in Laos.

The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption and its associations with noncommunicable diseases risk factors among adults in Laos. In a national cross-sectional survey in 2013, 2527 individuals (18-64 years old) responded to a questionnaire, and anthropometric and blood pressure measurements, and biochemistry tests were conducted. On average, participants had 0.99 servings of fruits a day and 1.33 servings of vegetables a day, a combined total of 2.32 servings of FAVs per day. Almost 1 in 5 respondents (18.9%) had 2 or more servings of fruit a day, 8.7% had 3 or more servings of vegetables a day, and 94.7% had less than 5 servings of FAV a day. In adjusted logistic analysis, being a Lao-Tai increased the odds of consuming 2 or more servings of fruits daily. Past month binge drinking decreased the odds of having 3 or more servings of vegetables daily. Higher education and urban residence decreased the odds of inadequate (<5 servings) FAV consumption. In adjusted linear regression analysis, increased FAV consumption was associated with higher body mass index scores. A high prevalence of inadequate FAV consumption was found. Interventions targeting identified modifiable risk factors, including lower education, general obesity, and binge drinking, may potentially increase FAV consumption in Laos.

Cafeteria assessment for elementary schools (CAFES): development, reliability testing, and predictive validity analysis

BackgroundStrategies to reduce childhood obesity and improve nutrition include creating school food environments that promote healthy eating. Despite well-documented health benefits of fruit and vegetable (FV) consumption, many U.S. school-aged children, especially low-income youth, fail to meet national dietary guidelines for FV intake. The Cafeteria Assessment for Elementary Schools (CAFES) was developed to quantify physical attributes of elementary school cafeteria environments associated with students’ selection and consumption of FV. CAFES procedures require observation of the cafeteria environment where preparation, serving, and eating occur; staff interviews; photography; and scoring.MethodsCAFES development included three phases. First, assessment items were identified via a literature review, expert panel review, and pilot testing. Second, reliability testing included calculating inter-item correlations, internal consistency (Kuder-Richardson-21 coefficients), and inter-rater reliability (percent agreement) based on data collected from 50 elementary schools in low-income communities and 3187 National School Lunch Program participants in four U.S. states. At least 43% of each participating school’s students qualified for free- or reduced-price meals. Third, FV servings and consumption data, obtained from lunch tray photography, and multi-level modeling were used to assess the predictive validity of CAFES.ResultsCAFES’ 198 items (grouped into 108 questions) capture four environmental scales: room (50 points), table/display (133 points), plate (4 points), and food (11 points). Internal consistency (KR-21) was 0.88 (overall), 0.80 (room), 0.72 (table), 0.83 (plate), and 0.58 (food). Room subscales include ambient environment, appearance, windows, layout/visibility, healthy signage, and kitchen/serving area. Table subscales include furniture, availability, display layout/presentation, serving method, and variety. Inter-rater reliability (percent agreement) of the final CAFES tool was 90%. Predictive validity analyses indicated that the total CAFES and four measurement scale scores were significantly associated with percentage consumed of FV served (p < .05).ConclusionsCAFES offers a practical and low-cost measurement tool for school staff, design and public health practitioners, and researchers to identify critical areas for intervention; suggest low- and no-cost intervention strategies; and contribute to guidelines for cafeteria design, food presentation and layout, and operations aimed at promoting healthy eating among elementary school students.

Yoga\u2019s potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study

BackgroundA regular yoga practice may have benefits for young adult health, however, there is limited evidence available to guide yoga interventions targeting weight-related health. The present study explored the relationship between participation in yoga, healthy eating behaviors and physical activity among young adults.MethodsThe present mixed-methods study used data collected as part of wave 4 of Project EAT (Eating and Activity in Teens and Young Adults), a population-based cohort study in Minneapolis-St. Paul, Minnesota. Young adults (n = 1820) completed the Project EAT survey and a food frequency questionnaire, and a subset who reported practicing yoga additionally participated in semi-structured interviews (n = 46). Analyses of survey data were used to examine cross-sectional associations between the frequency of yoga practice, dietary behaviors (servings of fruits and vegetables (FV), sugar-sweetened beverages (SSBs) and snack foods and frequency of fast food consumption), and moderate-to-vigorous physical activity (MVPA). Thematic analysis of interview discussions further explored yoga’s perceived influence on eating and activity behaviors among interview participants.ResultsRegular yoga practice was associated with more servings of FV, fewer servings of SSBs and snack foods, less frequent fast food consumption, and more hours of MVPA. Interviews revealed that yoga supported healthy eating through motivation to eat healthfully, greater mindfulness, management of emotional eating, more healthy food cravings, and the influence of the yoga community. Yoga supported physical activity through activity as part of yoga practice, motivation to do other forms of activity, increased capacity to be active, and by complementing an active lifestyle.ConclusionsYoung adult yoga practitioners reported healthier eating behaviors and higher levels of physical activity than non-practitioners. Yoga should be investigated as an intervention for young adult health promotion and healthy weight management.

The prevalence and social determinants of fruit and vegetable consumption among adults in Kenya: a cross-sectional national population-based survey, 2015

IntroductionLow fruit and vegetable consumption contributes significantly to the burden of disease. The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption among adults in a national survey in Kenya.MethodsA national cross-sectional study based on a stratified cluster random sampling was conducted in 2015. The total sample included 4479 individuals 18-69 years, (females = 60.0%; median age 38.0 years, Inter Quartile Range 23) from Kenya. Sociodemographics, health risk behaviour and anthropometric data were collected using the WHO-STEPS questionnaire.ResultsOn average, participants had 0.78 servings of fruits a day, 1.31 servings of vegetables a day, and 2.09 servings of FAV. Only 12.4% of respondents had two or more servings of fruit a day, 7.4% had three or more servings of vegetables a day and 94.0% had less than five servings of FAV a day. In adjusted logistic regression analysis, higher education (Odds Ratio=OR: 1.68, Confidence Interval = CI: 1.18, 2.39), greater wealth (OR: 1.61, CI: 1.04, 2.48), and being a Kikuyu (OR: 2.17, CI: 1.46, 3.23) or Luo (OR: 1.58, CI: 1.05, 2.37) were associated with two or more servings of fruits daily. Urban residence (OR: 0.44, CI: 0.23, 0.82) and being male (OR: 0.72, CI: 0.53, 0.98) decreased the odds, and older age (OR: 1.68, CI: 1.05, 2.69) and being Luo (OR: 2.84, CI: 1.53, 5.27) increased the odds of having three or more servings of vegetables daily. Being male (OR: 0.71, CI: 0.52, 0.99) and being Luo (OR: 0.40, CI: 0.23, 0.70) decreased the odds and urban residence (OR: 2.50, CI: 1.27, 4.96) increased the odds of inadequate (< five servings) FAV consumption.ConclusionA high prevalence of inadequate FAV consumption was found, and risk factors identified, such as being female, lower education, urban residence, and not being Luo, that may help in guiding strategies to increase FAV consumption.

WIC Cash Value Voucher Redemption Behavior in Jefferson County, Alabama, and Its Association With Fruit and Vegetable Consumption.

To examine cash value voucher (CVV) redemption behavior and its association with fruit and vegetable (FV) consumption among women who participate in the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Cross-sectional. Jefferson County, Alabama. Between October 2014 and January 2015, 300 women (mean age: 27.6 years; 66.8% non-Hispanic black; 45.1% obese) who participated in the Birmingham WIC program were surveyed. Self-reported information on demographics, produce shopping behaviors, and residential access to fresh produce retailers (eg, supermarkets and farmers markets) was examined. Fruit and vegetable intake was collected via the Block Fruit-Vegetable-Fiber screener. Participants who self-reported redeeming the WIC CVV in each of the 3 prior months were classified as regular redeemers. Multivariable-adjusted regression models were used to examine associations between variables of interest and regular WIC CVV redemption. There were 189 (63.0%) study participants classified as regular WIC CVV redeemers. Regular redeemers and other participants (ie, irregular redeemers and nonredeemers) were similar with respect to demographics. Regular redeemers were more likely to use grocery stores to purchase FVs ( P = .003) and consumed significantly more servings of FVs per day (β = .67; standard error = 0.24; P = .007). Regular WIC CVV redemption was associated with some produce shopping behaviors and increased FV consumption and among WIC participants in Jefferson County, Alabama.