Global Vegetable Intake and Supply Compared to Recommendations: A Systematic Review

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

BACKGROUND

Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines.

METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme.

RESULTS

Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT).

CONCLUSIONS

Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.

Vegetable, but Not Potato, Intake Is Associated With a Lower Risk of Type 2 Diabetes in the Danish Diet, Cancer and Health Cohort

OBJECTIVE

To examine the relationship between intake of vegetables/potatoes and incident type 2 diabetes (T2D) and explore whether the relationship between vegetable intake and incident T2D is mediated by baseline BMI.

RESEARCH DESIGN AND METHODS

Cross-sectional associations between exposure (baseline intake of total vegetables, vegetable subgroups, and potatoes) and baseline BMI were assessed by multivariable-adjusted linear regression models. Associations between exposure and incident T2D were examined by multivariable-adjusted Cox proportional hazards models. Mediation by BMI was quantified through exploration of natural direct and indirect effects.

RESULTS

Among 54,793 participants in the Danish Diet, Cancer and Health cohort, 7,695 cases of T2D were recorded during a median follow-up of 16.3 years. Participants in the highest total vegetable intake quintile (median 319 g/day) had a 0.35 kg/m2 (95% CI -0.46, -0.24) lower BMI and a 21% (95% CI 16, 26%) lower risk of incident T2D after multivariable adjustment compared with those in the lowest quintile (median 67 g/day). Baseline BMI mediated ∼21% of the association between vegetable intake and incident T2D. Participants in the highest compared with the lowest (median 256 vs. 52 g/day) potato intake quintile had a 9% (95% CI 2, 16%) higher risk of T2D after multivariable adjustment, with no association found after accounting for underlying dietary pattern. Of the vegetable subclasses, higher intake of green leafy and cruciferous vegetables was associated with a statistically significantly lower risk of T2D.

CONCLUSIONS

The findings provide evidence that a higher vegetable, but not potato, intake might help mitigate T2D risk, partly by reducing BMI.

The association of specific types of vegetables consumption with 10-year type II diabetes risk: Findings from the ATTICA cohort study

BACKGROUND

The present study aimed to investigate the association between vegetable consumption, in total as well as per type/category, and 10-year type-2 diabetes mellitus (T2DM) incidence.

METHODS

The ATTICA study was conducted during 2001-2012 in 3042 apparently healthy adults living in Athens area, Greece. A detailed biochemical, clinical, and lifestyle evaluation was performed; vegetable consumption (total, per type) was evaluated through a validated semi-quantitative food frequency questionnaire. After excluding those with no complete information of diabetes status or those lost at the 10-year follow-up, data from 1485 participants were used for the current analysis.

RESULTS

After adjusting for several participants' characteristics, including overall dietary habits, it was observed that participants consuming at least 4 servings/day of vegetables had a 0.42-times lower risk of developing T2DM (hazard ratio [HR] = 0.42; 95% confidence interval [CI] = 0.29-0.61); the benefits of consumption were greater in women (HR = 0.29; 95% CI = 0.16-0.53) compared to men (HR = 0.56; 95% CI = 0.34-0.92). Only 33% of the sample consumed vegetables 4 servings/day. The most significant associations were observed for allium vegetables in women and for red/orange/yellow vegetables, as well as for legumes in men.

CONCLUSIONS

The intake of at least 4 servings/day of vegetables was associated with a considerably reduced risk of T2DM, independently of other dietary habits; underlying the need for further elaboration of current dietary recommendations at the population level.

Worldwide associations of fruit and vegetable supply with blood pressure from 1975 to 2015: an ecological study

Low fruit and vegetable consumption is a major modifiable risk factor for raised blood pressure (BP), but it is unknown how heterogeneity in national supply has contributed to BP trends. To address this, we characterised supply trends from 1975 to 2015 and whether it met WHO recommendations. We then examined associations with three metrics: systolic, diastolic and raised BP. We used ecological data on fruit and vegetable supply and on BP for 159 countries. We examined trends in fruit and vegetable supply from 1975 to 2015 by country and World Bank income region. Multivariable linear regression was used to examine cross-sectional associations with BP. Global fruit and vegetable supply increased from 1975 to 2015, but with heterogeneous national and regional trends. While WHO recommendations were met globally, this target was not met in almost half the countries, of which many were low-income countries. Significant associations between combined fruit and vegetable supply and raised BP were observed. Over the past four decades, combined fruit and vegetable supply has been consistently and strongly associated with lower prevalence of raised BP globally. However, the heterogeneous regional trends in fruit and vegetable supply underpin the need for international organisations and individual governments to introduce or strengthen policies for increased fruit and vegetable supply to reduce the burden of non-communicable diseases at national and global levels.

China Requires a Sustainable Transition of Vegetable Supply from Area-Dependent to Yield-Dependent and Decreased Vegetable Loss and Waste

China, the largest country in vegetable supply, faces a transition to sustainable vegetable production to counteract resource waste and environmental pollution. However, there are knowledge gaps on the main constraints and how to achieve sustainable vegetable supply. Herein, we integrated the vegetable production and supply data in China, compared its current status with five horticulture-developed countries US, the Netherlands, Greece, Japan and South Korea, using data from the Food and Agriculture Organization (FAO) and National Bureau of Statistics of China, and predicted the vegetable supply in 2030 and 2050 by a model prediction. The vegetable supply in China increased from 592 g capita-1 d-1 in 1995 to 1262 g capita-1 d-1 in 2018 and will keep constant in 2030 and 2050. Compared to the five countries, the greater vegetable supply is primarily achieved by higher harvested areas rather than higher yield. However, it is predicted that the harvested areas will decrease by 13.6% and 24.7% in 2030 and 2050. Instead, steady increases in vegetable yield by 11.8% and 28.3% are predicted for this period. The high vegetable supply and greater vegetable preference indicated by the high vegetable-to-meat production ratio cannot guarantee recommended vegetable intake, potentially due to the high rate of vegetable loss and waste. Under the scenarios of decreased vegetable loss and waste, the harvested area will decrease by 37.3-67.2% in 2030 and 2050. This study points out that the sustainable transition of Chinese vegetable supply can be realized by enhancing yield and limiting vegetable loss and waste instead of expanding the harvested area.

Review of influence of critical operation conditions on by-product/intermediate formation during thermal destruction of PFAS in solid/biosolids

Poly- and perfluoroalkyl substances (PFAS) are a large group of synthetic organofluorine compounds. Over 4700 PFAS compounds have been produced and used in our daily life since the 1940s. PFAS have received considerable interest because of their toxicity, environmental persistence, bioaccumulation and wide existence in the environment. Various treatment methods have been developed to overcome these issues. Thermal treatment such as combustion and pyrolysis/gasification have been employed to treat PFAS contaminated solids and soils. However, short-chain PFAS and/or volatile organic fluorine is produced and emitted via exhaust gas during the thermal treatment. Combustion can achieve complete mineralisation of PFAS at large scale operation using temperatures >1000 °C. Pyrolysis has been used in treatment of biosolids and has demonstrated that it could remove PFAS completely from the generated biochar by evaporation and degradation. Although pyrolysis partially degrades PFAS to short-chain fluorine containing organics in the syngas, it could not efficiently mineralise PFAS. Combustion of PFAS containing syngas at 1000 °C can achieve complete mineralisation of PFAS. Furthermore, the by-product of mineralisation, HF, should also be monitored due to its low regulated atmospheric discharge values. Alkali scrubbing is normally required to lower the HF concentration in the exhaust gas to acceptable discharge concentrations.

Valorization of Vegetable Waste from Leek, Lettuce, and Artichoke to Produce Highly Concentrated Lignocellulose Micro- and Nanofibril Suspensions

Vegetable supply in the world is more than double than vegetable intake, which supposes a significant waste of vegetables, in addition to the agricultural residues produced. As sensitive food products, the reasons for this waste vary from the use of only a part of the vegetable due to its different properties to the product appearance and market image. An alternative high-added-value application for these wastes rich in cellulose could be the reduction in size to produce lignocellulose micro- and nanofibrils (LCMNF). In this sense, a direct treatment of greengrocery waste (leek, lettuce, and artichoke) to produce LCMNFs without the extraction of cellulose has been studied, obtaining highly concentrated suspensions, without using chemicals. After drying the wastes, these suspensions were produced by milling and blending at high shear followed by several passes in the high-pressure homogenizer (up to six passes). The presence of more extractives and shorter fiber lengths allowed the obtention of 5-5.5% leek LCMNF suspensions and 3.5-4% lettuce LCMNF suspensions, whereas for artichoke, only suspensions of under 1% were obtained. The main novelty of the work was the obtention of a high concentration of micro- and nanofiber suspension from the total waste without any pretreatment. These high concentrations are not obtained from other raw materials (wood or annual plants) due to the clogging of the homogenizer, requiring the dilution of the sample up to 1% or the use of chemical pretreatments.

Changes in terms of risks/benefits of shifting diets towards healthier and more sustainable dietary models

Food production and therefore human diet are identified as important sources of environmental impact. Unhealthy and unsustainable diets with high intake of meat and low intake of plant-based products are predominant worldwide. On the other hand, a balance between health and sustainability is necessary, since diets that are environmentally sustainable could lack essential macro- and micronutrients and result in nutrient deficiencies, non-communicable diseases and malnutrition. The aim of this project was to investigate the nutritional adequacy and environmental impact of adults' diet by comparing current dietary habits and new alternative dietary scenarios. First, a systematic review was conducted following PRISMA guidelines to assess the environmental impact of current diets and sustainable dietary scenarios such as vegan, vegetarian, pescatarian, omnivorous and optimised dietary patterns worldwide. In the second part of the project, an optimisation study was conducted, based on a multi-objective optimisation approach, with the purpose of creating the optimal diet based on nutritional and environmental constraints for the adult Italian population. The dietary scenarios of the optimised models were developed in accordance with the Italian food-based dietary guidelines. Food consumption data was extracted from the INHES study and used as baseline diet. A clear evaluation of the current environmental impact because of diet and potential sustainable dietary scenarios globally is challenging. Finally, national food-based guidelines should be adjusted by suggesting healthy and sustainable dietary recommendations in line with traditional eating habits and local food availability in order the desirable dietary shifts towards sustainability to be feasible.

Uncovering the diversity and contents of gene cassettes in class 1 integrons from the endophytes of raw vegetables

Rapid spread of antibiotic resistance genes (ARGs) in pathogens is threatening human health. Integrons allow bacteria to integrate and express foreign genes, facilitating horizontal transfer of ARGs in environments. Consumption of raw vegetables represents a pathway for human exposure to environmental ARGs. However, few studies have focused on integron-associated ARGs in the endophytes of raw vegetables. Here, based on the approach of qPCR and clone library, we quantified the abundance of integrase genes and analyzed the diversity and contents of resistance gene cassettes in class 1 integrons from the endophytes of six common raw vegetables. The results revealed that integrase genes for class 1 integron were most prevalent compared with class 2 and class 3 integron integrase genes (1-2 order magnitude, P < 0.05). The cucumber endophytes harbored a higher absolute abundance of integrase genes than other vegetables, while the highest bacterial abundance was detected in cabbage and cucumber endophytes. Thirty-two unique resistance gene cassettes were detected, the majority of which were associated with the genes encoding resistance to beta-lactam and aminoglycoside. Antibiotic resistance gene cassettes accounted for 52.5 % of the functionally annotated gene cassettes, and bla_TEM-157 and aadA2 were the most frequently detected resistance cassettes. Additionally, carrot endophytes harbored the highest proportion of antibiotic resistance gene cassettes in the class 1 integrons. Collectively, these results provide an in-depth view of acquired resistance genes by integrons in the raw vegetable endophytes and highlight the potential health risk of the transmission of ARGs via the food chain.

Seasonality and nutrition-sensitive farming in rural Northern Ghana

In rural sub-Saharan Africa, where malnutrition in all its forms is rife, the greatest gap between the availability of foods and the foods needed for a nutritious diet are faced during the ‘hunger season’. We investigated what rural households in Northern Ghana would need to grow to ensure year-round availability of a nutrient adequate diet or the income required to fulfil their dietary needs. We applied linear programming to model different scenarios and interventions. Our results provide three major insights. First, considering seasonality is crucial in nutrition-sensitive farming. Ensuring a nutritious diet year-round requires enhanced availability of vegetables and fruits throughout the year. Second, although staple crops do not provide the full range of essential nutrients, increasing their yields allows for a reduction of field size, freeing up space for the production of other foods belonging to a nutritious diet, such as vegetables. Third, small farms are unable to produce sufficient food to cover their needs. They depend on income both from agriculture and other sources, and the availability of types of foods on markets to meet their dietary needs. Our study shows the value of modelling the range of dietary effects from agricultural interventions in a specific context, using a local feasible nutritious diet as a starting point and taking seasonality into account.

Upcycled foods: A nudge toward nutrition

One of the aims of the United Nations Sustainable Development Goals (SDG) is to end hunger and ensure access by all people to safe, nutritious, and sufficient food all year round. An obvious synergy exists between the second SDG “Zero Hunger” and SDG target 12.3 which focuses on halving food waste and reducing food losses. In addition to helping improve global food security, reducing food waste provides financial and environmental benefits. Upcycling food is a technical solution for food waste reduction that retains the nutritional and financial value of food by-products. However, many of the upcycled foods produced are discretionary foods such as biscuits, crackers, and other snack food that are not part of a healthy dietary pattern, and should only be eaten sometimes in small amounts. Given the importance of ensuring a sustainable healthy diet, this paper discusses opportunities for upcycled food manufacturers to produce more nutritious products.

Dietary polyglycosylated anthocyanins, the smart option? A comprehensive review on their health benefits and technological applications

Over the years, anthocyanins have emerged as one of the most enthralling groups of natural phenolic compounds and more than 700 distinct structures have already been identified, illustrating the exceptional variety spread in nature. The interest raised around anthocyanins goes way beyond their visually appealing colors and their acknowledged structural and biological properties have fueled intensive research toward their application in different contexts. However, the high susceptibility of monoglycosylated anthocyanins to degradation under certain external conditions might compromise their application. In that regard, polyglycosylated anthocyanins (PGA) might offer an alternative to overcome this issue, owing to their peculiar structure and consequent less predisposition to degradation. The most recent scientific and technological findings concerning PGA and their food sources are thoroughly described and discussed in this comprehensive review. Different issues, including their physical-chemical characteristics, consumption, bioavailability, and biological relevance in the context of different pathologies, are covered in detail, along with the most relevant prospective technological applications. Due to their complex structure and acyl groups, most of the PGA exhibit an overall higher stability than the monoglycosylated ones. Their versatility allows them to act in a wide range of pathologies, either by acting directly in molecular pathways or by modulating the disease environment attributing an added value to their food sources. Their recent usage for technological applications has also been particularly successful in different industry fields including food and smart packaging or in solar energy production systems. Altogether, this review aims to put into perspective the current state and future research on PGA and their food sources.

Are Organic Certified Carrots Richer in Health-Promoting Phenolics and Carotenoids than the Conventionally Grown Ones?

The aim of the present study was to determine the concentrations of polyphenols and carotenoids by means of HPLC/UV-Vis in certified organic and non-organic carrots (Daucus carota L.) of two cultivars (Flacoro and Nantejska). The analyzed carrot root samples contained, on average, 4.29 ± 0.83 mg/100g f.w. of carotenoids (mainly β-carotene) and 9.09 ± 2.97 mg/100g f.w. of polyphenols, including 4.44 ± 1.42 mg/100g f.w. of phenolic acids and 4.65 ± 1.96 mg/100g f.w. of flavonoids. Significant effects of the production system on the carotenoids (total) and β-carotene concentration were found, with higher concentrations of these compounds generally identified in conventionally cultivated roots (4.67 ± 0.88 mg/100g f.w.) vs. organically grown ones (4.08 ± 0.74 mg/100g f.w.). There was a noticeable inter-sample (inter-farm) variation in the concentration of polyphenols in carrot roots. Despite a general trend towards higher concentrations of these compounds in the organic carrots (9.33 ± 3.17 mg/100g f.w.) vs. conventional carrots (8.64 ± 2.58 mg/100g f.w.), and in those of Nantejska (9.60 ± 2.87 mg/100g f.w.) vs. Flacoro (8.46 ± 3.02 mg/100g f.w.) cultivar, no consistent, statistically significant impact of the production system and/or cultivar on the level of these bioactive compounds was identified. More efforts should be encouraged to ensure that organic crops reaching the market consistently contain the expected high levels of health-promoting bioactive compounds, which could be brought through their shelf-life and all processing steps, in order to meet consumers’ expectations and provide the expected health benefits.

Vegetables for Healthy Diets in Low- and Middle-Income Countries: A Scoping Review of the Food Systems Literature

BACKGROUND

Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches.

METHODS

This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps.

RESULTS

We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is also a research gap on the impacts of different policy and practice interventions (13% of articles) to enable greater vegetable consumption.

CONCLUSIONS

Food system studies necessarily drew on multiple disciplines, methods and metrics to describe, analyze, and diagnose parts of the system. More work is needed across disciplines, across contexts, and across the food system, including understanding interventions and trade-offs, and impacts and change for diets particularly of marginalized population groups. Filling these gaps in knowledge is necessary in order to work toward healthy vegetable-rich diets for everyone everywhere.

Folate Deficiency Increased Lipid Accumulation and Leptin Production of Adipocytes

Imbalanced dietary habits are closely associated with poor micronutrients status and the development of obesity. Previous studies have shown that serum folate level is decreased in obese individuals. However, whether folate deficiency could result in adiposity is still unclear. The aim of this study was to investigate the effects of dietary folate on lipid accumulation and leptin production using both in vivo and in vitro studies. Male C57BL/6 mice were fed with a diet with (f1) or without (f0) folate in a high-fat (HF) diet containing high-sucrose (HFS-f1, HFS-f0) for 4.5-5 months in Experiment 1, or an HF diet (HF-f1, HF-f0) for 12 months in Experiment 2, or an HF diet containing high-fructose (HFF-f1, HFF-f0) for 12 months in Experiment 3, compared with the normal-fat (NF-f1, NF-f0) diet, respectively. The serum levels of folate and leptin, white adipose tissue (WAT), size of adipocytes, hepatic contents of triglyceride (TG), and cholesterol were measured. In vitro study, TG contents, proinflammatory cytokines, leptin, and expressions of hypoxia-inducible factor (HIF)-1α and lipogenesis-related genes of 3T3-L1 adipocytes cultured with (f1) or without (f0) folate were assayed. The results showed that folate deficiency together with a high-fat diet (HFS-f0, HF-f0, HFF-f0) had higher WAT mass, adipocyte size, serum leptin level, and hepatic TG compared to those of the folate-sufficient groups (HFS-f1, HF-f1, and HFF-f1). Folate deficiency with a high-fat high -sucrose or -fructose diet (HFS-f0, HFF-f0) significantly increased the body weight of the mice. Increased intracellular TG, leptin, monocyte chemotactic protein (MCP)-1 and interleukin (IL)-6 levels, and the expression of Hif1α and lipogenesis-related genes Cebpα, Cebpβ, Acc1, Fasn, and Fabp4 were also detected in folate-deficient 3T3-L1 adipocytes. Our results suggested that folate deficiency increased lipid accumulation and leptin production of adipocytes, and thus, inadequate folate status might be one of the risk factors for adiposity.

Modifiable risk factors in adults with and without prior cardiovascular disease: findings from the Indonesian National Basic Health Research

Backgrounds

The majority of risk factors for cardiovascular diseases (CVDs) are modifiable. Continuous monitoring and control of these factors could significantly reduce the risk of CVDs-related morbidity and mortality. This study estimated the prevalence of modifiable risk factors in Indonesia and its co-occurence of multiple risk factors stratified by prior CVDs diagnosis status and sex.

Methods

Adult participants (> 15 years, N = 36,329, 57% women) with median age of 40 years were selected from a nationwide Indonesian cross-sectional study called Basic Health Research or Riset Kesehatan Dasar (Riskesdas) conducted in 2018. Thirteen risk factors were identified from the study, including smoking, a high-risk diet, inadequate fruit and vegetable consumption, a low physical activity level, the presence of mental-emotional disorders, obesity, a high waist circumference (WC), a high waist-to-height ratio (WtHR), hypertension, diabetes, a high total cholesterol level, a high low-density lipoprotein (LDL) cholesterol level, and a low high-density lipoprotein (HDL) cholesterol level. Age-adjusted prevalence ratios stratified by CVDs status and sex were calculated using Poisson regression with the robust covariance estimator.

Results

CVDs were found in 3% of the study population. Risk factor prevalence in the overall population ranged from 5.7 to 96.5% for diabetes and inadequate fruit and vegetable consumption respectively. Smoking, a high-risk food diet, and a low HDL cholesterol level were more prevalent in men, whereas a low physical activity level, the presence of mental-emotional disorders, obesity, a high WC, a high WtHR, hypertension, diabetes, a high total cholesterol level, and a high LDL cholesterol level were more prevalent in women. Approximately 22% of men and 18% of women had at least 4 risk factors, and these proportions were higher in participants with prior CVDs diagnosis.

Conclusions

There is a high prevalence of modifiable risk factors in the Indonesian adult population. Sex, age, and the presence of CVD are major determinants of the variations in risk factors. The presence of multiple risk factors, which are often inter-related, requires a comprehensive approach through health promotion, lifestyle modification and patient education.

Long-term association of vegetable and fruit intake with risk of dementia in Japanese older adults: the Hisayama study

Background

Several prospective Western studies have reported an inverse association of vegetable and fruit intake with dementia risk. However, there is limited epidemiologic evidence in Asians. This study investigated the association of intakes of vegetables, fruits, and their nutrients on the risk of incident dementia and its subtypes in a Japanese community.

Methods

A total of 1071 participants (452 men and 619 women) aged ≥60 years without dementia at baseline were prospectively followed up for 24 years. Intakes of vegetables, fruits, and nutrients were evaluated using a 70-item semiquantitative food frequency questionnaire at baseline and were categorized into quartiles separately by gender. The outcome measure was the development of dementia and its subtypes—namely, Alzheimer’s disease (AD) and vascular dementia (VaD). The risk estimates of incident dementia were computed using a Cox proportional hazards model.

Results

During the long-term follow-up period, 464 subjects developed dementia, of whom 286 had AD and 144 had VaD. Higher vegetable intake was associated gradually with lower risk of developing dementia and AD (both P-trend < 0.05), but not VaD, after adjusting for confounders. Subjects allocated the highest quartile of vegetable intake had 27 and 31% lower risk of dementia and AD, respectively, than those with the lowest quartile. The risk of dementia decreased significantly with higher intakes of vitamin A, riboflavin, vitamin C, magnesium, calcium, and potassium (all P-trend < 0.05). Subjects with higher total dietary fiber intake tended to be at decreased risk for total dementia (P-trend = 0.07). Meanwhile, there were no significant associations between fruit intake and the risk of dementia and its subtypes.

Conclusion

Higher intakes of vegetables and their constituent nutrients were associated with a lower risk of dementia in Japanese older adults. A diet rich in vegetables may be beneficial in reducing the dementia risk in Asians.

The prevalence and distribution of health risk factors in airline pilots: a cross-sectional comparison with the general population

OBJECTIVE

To explore the prevalence and distribution of health risk factors in airline pilots and compare these with the general population.

METHODS

Health risk measures: age, sex, weight, height, body mass index (BMI), blood pressure, sleep, physical activity (PA) and fruit and vegetable intake (FV) were analysed to determine the prevalence and distribution of health risk.

RESULTS

Obesity prevalence and BMI was lower in pilots (p=<0.001, -17.5%, d=-0.41, and p=<0.05, -1.8, d=-0.37, respectively), yet overall overweight and obesity prevalence did not differ between groups (p=0.20). No difference was observed between groups for hypertension (p=0.79, h=-0.01), yet a higher proportion of pilots were 'at risk' for hypertension (p=<0.001, h=-0.34). The general population had longer sleep duration (p=<0.001, d=0.12), achieved more total PA minutes (p=<0.001, d=0.75), and had a higher prevalence of positive self-rated health (p=<0.001, h=0.31). More pilots achieved >5 servings of FV daily (p=0.002, h=0.16).

CONCLUSION

Pilots had lower obesity prevalence, higher FV, yet lower positive self-health ratings and total PA minutes, and shorter sleep duration overall.

IMPLICATIONS FOR PUBLIC HEALTH

The results indicate notable health risk factor prevalence in airline pilots and the general population. Based on present findings, aviation health researchers should further examine targeted, cost-effective intervention methods for promoting healthy bodyweight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of licence, medical incapacity, and to support flight safety.

The role of holistic nutritional properties of diets in the assessment of food system and dietary sustainability

Advancing sustainable diets for nutrition security and sustainable development necessitates clear nutrition metrics for measuring nutritional quality of diets. Food composition, nutrient requirements, and dietary intake are among the most common nutrition metrics used in the current assessment of sustainable diets. Broadly, most studies in the area classify animal-source foods (ASF) as having a substantially higher environmental footprint in comparison to plant-source foods (PSF). As a result, much of the current dietary advice promulgates diets containing higher proportions of PSF. However, this generalization is misleading since most of these studies do not distinguish between the gross and bioavailable nutrient fractions in mixed human diets. The bioavailability of essential nutrients including β-carotene, vitamin B-12, iron, zinc, calcium, and indispensable amino acids varies greatly across different diets. The failure to consider bioavailability in sustainability measurements undermines the complementary role that ASF play in achieving nutrition security in vulnerable populations. This article critically reviews the scientific evidence on the holistic nutritional quality of diets and identifies methodological problems that exist in the way the nutritional quality of diets is measured. Finally, we discuss the importance of developing nutrient bioavailability as a requisite nutrition metric to contextualize the environmental impacts of different diets.

Classification tree analysis for an intersectionality-informed identification of population groups with non-daily vegetable intake

BACKGROUND

Daily vegetable intake is considered an important behavioural health resource associated with improved immune function and lower incidence of non-communicable disease. Analyses of population-based data show that being female and having a high educational status is most strongly associated with increased vegetable intake. In contrast, men and individuals with a low educational status seem to be most affected by non-daily vegetable intake (non-DVI). From an intersectionality perspective, health inequalities are seen as a consequence of an unequal balance of power such as persisting gender inequality. Unravelling intersections of socially driven aspects underlying inequalities might be achieved by not relying exclusively on the male/female binary, but by considering different facets of gender roles as well. This study aims to analyse possible interactions of sex/gender or sex/gender related aspects with a variety of different socio-cultural, socio-demographic and socio-economic variables with regard to non-DVI as the health-related outcome.

METHOD

Comparative classification tree analyses with classification and regression tree (CART) and conditional inference tree (CIT) as quantitative, non-parametric, exploratory methods for the detection of subgroups with high prevalence of non-DVI were performed. Complete-case analyses (n = 19,512) were based on cross-sectional data from a National Health Telephone Interview Survey conducted in Germany.

RESULTS

The CART-algorithm constructed overall smaller trees when compared to CIT, but the subgroups detected by CART were also detected by CIT. The most strongly differentiating factor for non-DVI, when not considering any further sex/gender related aspects, was the male/female binary with a non-DVI prevalence of 61.7% in men and 42.7% in women. However, the inclusion of further sex/gender related aspects revealed a more heterogenous distribution of non-DVI across the sample, bringing gendered differences in main earner status and being a blue-collar worker to the foreground. In blue-collar workers who do not live with a partner on whom they can rely on financially, the non-DVI prevalence was 69.6% in men and 57.4% in women respectively.

CONCLUSIONS

Public health monitoring and reporting with an intersectionality-informed and gender-equitable perspective might benefit from an integration of further sex/gender related aspects into quantitative analyses in order to detect population subgroups most affected by non-DVI.

The inside story of fruits; exploring the truth behind conventional theories

BACKGROUND AND AIMS

Consumption of fruits and vegetables are important to prevent several diet related diseases. Many dietary guidelines including world health organization (WHO) recommend at least two fruits per day. Our aim here is to highlight theoretical deficiencies in the field of nutritional science that would possibly cause misinterpretations to assess the fruit intake worldwide.

METHODS

Information regarding fruits and vegetables serving sizes were obtained from WHO, National Health Service UK, American Heart Association and the United States Department of Agriculture (USDA). Nutritional compositions of fruits were collected from the USDA, FoodData Central database.

RESULTS

Three main problems causing misinterpretations to the measurement of global fruit intake were identified. First, the absence of a clear definition to classify a fruit; second, lacking a scientific justification for the nutritional composition of servings of fruits; and thirdly, absence of a standard amount or size for a serving of fruits. Since the carbohydrates are the main nutrient in the fruits, it was suggested to determine the serving size according to the 15 g.

CONCLUSIONS

Nutrition experts and other reputed international organizations must focus their attention on scientifically backed definitions and serving size estimations of fruits.

Bioactive Compounds, Sugars, and Sensory Attributes of Organic and Conventionally Produced Courgette (Cucurbita pepo)

Organic agriculture is considered one of the elements of sustainable food production and consumption, mainly due to its limited impact on the natural environment. At the same time, the quality features of organically produced foods, especially sensory attributes and health promoting values, are important factors determining consumers’ interest, and therefore play a key role in the organic sector’s development. The aim of this study was to investigate the sensory characteristics and concentrations of sugars and selected health-promoting bioactive compounds of organic courgette compared to conventionally grown courgette. In addition, untargeted metabolomic analysis of the courgette fruits was performed. The results of this study did not show a significant effect of the horticultural system (organic vs. conventional) on the concentrations of vitamin C, carotenoids, and chlorophylls in the courgette fruits. However, the fruits from the organic systems were significantly richer in sugars when compared to the conventionally cultivated ones (p = 0.038). Moreover, the organic fruits fertilized with manure contained significantly higher amounts of polyphenols, including gallic acid (p = 0.016), chlorogenic acid (p = 0.012), ferulic acid (p = 0.019), and quercetin-3-O-rutinoside (p = 0.020) compared to the conventional fruits. The untargeted analysis detected features significantly differentiating courgette fruits depending on the cultivar and horticultural system. Some significant differences in sensory values were also identified between fruits representing the two cultivars and coming from the horticultural systems compared in the study. Conventional courgettes were characterized by the most intensive peel color and aquosity, but at the same time were the least hard and firm compared to the fruits from the two organic systems. There was also a trend towards higher overall quality of the organically grown fruits. The presented study shows that the organic and conventional courgette fruits differ in a number of quality features which can influence consumers’ health and purchasing choices.

Twenty-year trends in vegetable consumption by preparation method and eating location for Korean population from 1998 to 2017

Vegetables are an important source for the essential vitamins and minerals that are necessary for optimal health. This research investigated changes in vegetable intake over time in the Korean population from 1998 to 2017, focusing on preparation methods of vegetables and location of consumption. This cross-sectional study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) that was established in 1998 to assess the health and nutritional status of the South Korean population. This research utilised information from 1998 to 2017 which is the extent of all available KNHANES data. Vegetable consumption was grouped, according to preparation methods and common eating locations. Both crude and age-standardised means of vegetable intake were derived via a 24-h dietary recall. All participants who completed a 24-h dietary recall survey were selected for the analyses. This included 109 220 individuals (49 069 men and 60 151 women) over the course of 20 years of the KNHANES. Total vegetable intake decreased over time (Pfor trends < 0·001), specifically, steamed and salted vegetables (Pfor trends < 0·001). In contrast, Koreans consumed noticeably more raw vegetables from 1998 to 2017 (Pfor trends < 0·001). Vegetable intake at home significantly declined (Pfor trends < 0·001), while that eaten at restaurants or outside the home increased greatly (Pfor trends < 0·001). Over 20 years, Koreans have ingested decreasing amounts of vegetables, but the intake of raw vegetables has escalated. However, the location of vegetable consumption has changed, with an increase at both restaurants and outside the home (approximately 70·0 %).

How supportive is the global food supply of food-based dietary guidelines? A descriptive time series analysis of food supply alignment from 1961 to 2013

BACKGROUND

FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved over time. The aim of this study was to determine to what extent the global food supply aligns with FBDGs, and to examine historical trends.

METHODS

Descriptive time series analysis of food supply alignment (FSA), 1961-2013. FSA was characterised as a ratio dividing country-level food supply data by FBDG across four food groups: fruit and vegetables (FV); sugar (SU); fish and seafood (FS); and red and processed meat (RP). FBDG data was collected from guidance produced by international bodies, and from countries with published FBDGs. The food supply was estimated using yearly FAOSTAT data. A population-weighted average of this ratio was created for all countries included in the analysis, and stratified by region and country income.

FINDINGS

FBDGs from 89 countries were included. Of those, 80% had country guidelines for FV, 34% for SU, 44% for FS, and 21% for RP. FSA (1.0 = perfect alignment) based on global guidelines showed a higher supply than recommended for FV (1.2), SU (1.2) and RP (1.1). FSA based on country guidelines showed a lower supply than recommended for FV (0.9) and a higher supply than recommended for SU (2.3), RP (2.3) and FS (1.4). FSA also showed substantial differences in levels and trends across region and country income.

INTERPRETATION

As of 2013, food supplies were not aligned with national and international FBDGs and misalignment persisted across five decades with subtantial variation in trends based on geography and country income. The long running nature of these trends suggest that the transition toward sustainable and healthful food systems represent a signifiant global challange. Additionally, acknowledging the degree of misalignment between macro-level structural factors, such as the composition of the food supply, in relation to national or global food policy aims may further aid efforts for population level adherence.

Determinants of Fruits and Vegetables Consumption among In-School Adolescents in Ghana

Background: Fruit and vegetable consumption is an important source of nutrients for healthy growth and development, as well as a protective factor against chronic non-communicable diseases. Paucity of data exists on adolescents’ fruit and vegetable consumption in Ghana. This study, therefore, sought to determine the prevalence and correlates of fruit and vegetable consumption among in-school adolescents in Ghana. Methods: Data for this study were extracted from the 2012 Global School-Based Health Survey. A cross-sectional analysis on 2786 in-school adolescents from junior and senior high schools was conducted. Descriptive analyses using frequencies and percentages were used to present the results on the prevalence of fruit and vegetable consumption. Multivariable binomial regression analysis was performed to determine the association between fruit and vegetable consumption and explanatory variables. The results of the regression analyses were presented using adjusted odds ratio (aOR) with their respective confidence intervals (CIs). Statistical significance was set at p < 0.05. Results: The prevalence of adequate fruits, adequate vegetables, and adequate fruit and vegetable consumption were 35.7%, 26.8%, and 27.8%, respectively. In-school male adolescents had lower odds of adequate fruit and vegetable consumption compared to female adolescents (aOR = 0.64, 95%CI = 0.51–0.82). Adolescents in senior high schools (aOR = 0.36, 95%CI = 0.22–0.61) were less likely to consume adequate fruits and vegetables compared to those in junior high schools. The odds of adequate fruit and vegetable consumption were higher among adolescents who consumed soft drinks (aOR = 3.29, 95%CI = 2.42–4.46), fast foods (aOR = 1.42, 95%CI = 1.13–1.77), and those who had sedentary behavior (aOR = 1.38, 95%CI = 1.07–1.77). Conclusions: The findings revealed that fruit and vegetable consumption among Ghanaian adolescents is relatively low. Sex of adolescents, grade, soft drink intake, fast food consumption, and sedentary behavior were factors associated with adequate fruit and vegetable consumption. Health promotion interventions to scale up fruit and vegetable consumption should pay attention to the factors identified in this study.

Transformation of Inferior Tomato into Preservative: Fermentation by Multi-Bacteriocin Producing Lactobacillus paracasei WX322

Loss and waste of postharvest vegetables are the main challenges facing the world’s vegetable supply. In this study, an innovative method of value-added transformation was provided: production of bacteriocin from vegetable waste, and then its application to preservation of vegetables. Antibacterial activity to soft rot pathogen Pectobacterium cartovorum (Pcb BZA12) indicated that tomato performed best in the nutrition supply for bacteriocin production among 12 tested vegetables. Moreover, the antibacterial activity was from Lactobacillus paracasei WX322, not components of vegetables. During a fermentation period of 10 days in tomato juice, L. paracasei WX322 grew well and antibacterial activity reached the maximum on the tenth day. Thermostability and proteinase sensitivity of the bacteriocin from tomato juice were the same with that from Man-Rogosa-Sharpe broth. Scanning electron microscope images indicated that the bacteriocin from tomato juice caused great damage to Pcb BZA12. At the same time, the bacteriocin from tomato juice significantly reduced the rotten rate of Chinese cabbage from 100% ± 0% to 20% ± 8.16% on the third day during storage. The rotten rate decrease of cucumber, tomato, and green bean was 100% ± 0% to 0% ± 0%, 70% ± 14.14% to 13.33% ± 9.43%, and 76.67% ± 4.71% to 26.67% ± 4.71%, respectively. Bacteriocin treatment did not reduce the rotten rate of balsam pear, but alleviated its symptoms.

The Lack of Association between Plant-Based Dietary Pattern and Breast Cancer: a Hospital-Based Case-Control Study

Our purpose was to assess the association between plant-based dietary patterns and breast cancer (BrCa) among Iranian women. This hospital-based case-control study included 150 newly diagnosed BrCa cases and 150 age-matched controls from the Cancer Research Center, Imam Khomeini hospital, Iran. Three indices of a plant-based diet were first calculated: plant-based diet index (PDI), the healthy PDI (hPDI), and the unhealthy PDI (uPDI). In the overall PDI, all plant foods scored positively. In hPDI and uPDI, healthy and less healthy plant foods scored positive, respectively. The adjusted odds ratio (OR) in the highest adherence of PDI was 1.00 (95% confidence interval [CI], 0.55-1.83). In hPDI, 0.89 (95% CI, 0.49-1.62); in uPDI, 1.80 (95% CI, 0.95-3.42). The adjusted OR after subgroup analysis for body mass index (BMI) was as follow, BMI > 25: 0.77(95% CI, 0.37-1.61) comparing highest with the lowest tertile of PDI, 0.91(95% CI, 0.44-1.89) comparing highest with the lowest tertile of hPDI and this value for uPDI was 2.04 (95% CI, 0.91-4.56). BMI < 25: OR for top tertile of PDI was 1.82 (95% CI, 0.48-6.93), top tertile of hPDI was 1.47 (95% CI, 0.35-6.22) and top tertile of uPDI was 2.29 (95% CI, 0.54-9.70). Our results revealed no significant association between none of the PDIs and the chance of BrCa in Iranian women. Continued and expanded research, evaluated by different methods and BrCa is urgently needed to build the foundation for future progress in evidence-based public health efforts.

Africa’s evolving vegetable seed sector: status, policy options and lessons from Asia

Fostering better access to more nutritious foods across sub-Saharan Africa will be critical to ending hunger and malnutrition. In Asia, vegetable production and consumption have grown rapidly since the 1990s and the development of a dynamic vegetable seed industry, led by the private sector, played a pivotal role in this process. The availability of locally-bred and adapted varieties facilitated the rapid expansion of production and increased the supply of affordable vegetables to consumers. In contrast, the vegetable seed sector in sub-Saharan Africa has been slow to develop and has received little attention in the development agenda. Drawing from Asia’s experience, this paper outlines a four-point strategy to accelerate the vegetable seed sector in sub-Saharan Africa. First, there is a need to strengthen the technical capacity of African seed companies to allow them to develop varieties that are well-adapted to local conditions and consumer preferences. Second, seed regulations, originally designed with food grains in mind, should be reviewed and revised to facilitate domestic vegetable breeding research and seed production. Third, more farmer extension is needed to exploit improved varieties together with good management practices. Fourth, vegetable marketing systems should be strengthened to reduce risks to farmers and traders. Investment in these four areas will help energize private sector investment in the vegetable seed sector. Asian experience suggests that investment in locally adapted vegetable varieties is a critical step in improving productivity, availability and ultimately consumption of nutritious vegetables.

Prevalence and correlates of excess body weight in university students

abstract – This study aimed to identify the prevalence of excess body weight in university students from a representative state in Brazil's southern region and establish associations with the demographic, university environment, and health behavior correlates. A random sample of 5,310 university students answered an online questionnaire with demographic, university environment, and eight health behavior data. Excess body weight was identified using the body mass index (BMI ≥ 25 kg/m2). The data were processed using bivariate analysis and hierarchical multiple regression. The overall prevalence of excess body weight exposure was equivalent to 39.1% [35.7-42.6], with significantly different rates between gender, age, and marital status. Likewise, housing type and study year showed significant associations with excess body weight. Among health behavior indicators, with control of all other variables involved in the model, depressive symptoms (p = 0.031), high stress (p = 0.045), sleep duration < 6 hours/night (p < 0.001), moderate-vigorous physical activity < 150 min/week (p = 0.022) and fruit/vegetable consumption < 5 servings per day (p < 0.001) were independently associated with the outcome. However, tobacco use, binge drinking, and prescription drug misuse did not remain in the adjusted multivariate model. In conclusion, the findings emphasize the importance of proposing and implementing multifaceted preventive intervention actions to prevent health outcomes related to excess body weight, once since significant associations with modifiable factors have been identified.