Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data

Unhealthy behavior clustering and mental health status in United States college students

Objective: Examine the association of health risk behavior clusters with mental health status among US college students. Participants: 105,781 US college students who completed the Spring 2011 National College Health Assessment. Methods: We utilized the latent class analysis to determine clustering of health risk behaviors (alcohol binge drinking, cigarette/marijuana use, insufficient physical activity, and fruit/vegetable consumption), and chi-square and ANOVA analyses to examine associations between the class membership and mental health (mental health diagnoses, psychological symptoms, and self-injurious thoughts/behaviors). Results: Three classes were identified with differing rates of binge drinking, substance use, and insufficient physical activity but similar rates of insufficient fruit/vegetable consumption. Students classified with the highest rates of binge drinking and cigarette/marijuana use had the highest rates across all mental health variables compared to other classes. Conclusions: Students who reported engaging in multiple health risk behaviors, especially high alcohol and cigarette/marijuana use, were also more likely to report poorer mental health.

Plant Foods, Antioxidant Biomarkers, and the Risk of Cardiovascular Disease, Cancer, and Mortality: A Review of the Evidence

Although a high intake of plant foods such as fruits, vegetables, whole grains, nuts, and legumes has been recommended for chronic disease prevention, it has been unclear what is the optimal amount of intake of these foods and whether specific subtypes are particularly beneficial. The evidence from several recently published meta-analyses on plant foods and antioxidants and various health outcomes is reviewed as well as more recently published studies. In meta-analyses of prospective studies, inverse associations were observed between intake of fruits, vegetables, whole grains, and nuts and the risk of coronary artery disease, stroke, cardiovascular disease overall, total cancer, and all-cause mortality. The strongest reductions in risk were observed at an intake of 800 g/d for fruits and vegetables, 225 g/d for whole grains, and 15-20 g/d for nuts, respectively. Whole-grain and nut consumption was also inversely associated with mortality from respiratory disease, infections, and diabetes. Stronger and more linear inverse associations were observed between blood concentrations of antioxidants (vitamin C, carotenoids, vitamin E) and cardiovascular disease, cancer, and all-cause mortality than for dietary intake. Most studies that have since been published have been consistent with these results; however, further studies are needed on subtypes of plant foods and less common causes of death. These results strongly support dietary recommendations to increase intake of plant foods, and suggest optimal intakes for chronic disease prevention may be ∼800 g/d for intakes of fruits and vegetables, 225 g/d for whole grains, and 15-20 g/d for nuts. Diets high in plant foods could potentially prevent several million premature deaths each year if adopted globally.

Life cycle environmental impacts of fruits consumption in the UK

Fruits are indispensable for a balanced and healthy diet. However, their environmental impacts remain largely unknown. Using a life cycle approach, this work estimates for the first time the impacts of fruits consumed in the UK. What makes the UK a particularly interesting case is that only 7% of fruits are produced domestically, with the rest imported, largely (70%) from outside of Europe. In total, 21 types of fruit and 46 fresh and processed products produced in the UK and abroad are considered to estimate the impacts at both the product and the national levels. The findings at the product level suggest that melons have the lowest and mangoes and avocados the highest impacts as a significant portion of the last two is air-freighted. Processing leads to high impacts of fruit juices, dried and frozen products. Storage has a considerable contribution to the impacts for fruits stored over a long period, such as apples. Packaging used for canned fruits and juices is also a significant contributor to the impacts. Taking the annual consumption into account, the whole UK fruit sector generates 7.9 Mt CO₂ eq. and consumes 94 PJ of primary energy. This is equivalent to 4% of the annual GHG emissions and 9% of energy demand of the whole UK food sector. Moreover, fruits require 0.35 Mha of agricultural land and 315 Mm³ eq. of water per year. Oranges, bananas and apples are responsible for more than half of the impacts at the national level as they account for 64% of the total fruit consumption in the UK. It is expected that the results of this study will be of interest to different supply chain actors, including farmers, food processors and consumers, aiding them in reducing the environmental impacts of fruits.

Environmental impacts of vegetables consumption in the UK

A healthy diet depends on the daily intake of vegetables. Yet, their environmental impacts along the full supply chains are scarcely known. Therefore, this paper provides for the first time a comprehensive evaluation of the life cycle environmental impacts of vegetables consumed in UK. The impacts are assessed for 56 fresh and processed products produced domestically and imported from abroad, considering both the product and sectoral levels. At the product level, taking into account the market mix of fresh and processed vegetables for each vegetable type sold in the UK, asparagus has the highest per-kg impacts across most of the 19 impact categories considered, while cabbage, celery and Brussels sprouts are generally environmentally most sustainable. At the sectoral level, the annual consumption of 10.8 t of vegetables generates 20.3 Mt CO₂ eq., consumes 260.7 PJ of primary energy and depletes 253 Mt eq. of water. The majority of the impacts are caused by potatoes since they account for 56% of the total amount of vegetables consumed, with crisps and frozen chips contributing most to the total impacts. Importing vegetables grown in unheated greenhouses in Europe has a lower impact than UK vegetables cultivated in heated greenhouses, despite the transportation. The impacts of air-freighted fresh vegetables are around five times higher than of those produced domestically. Even processed products have lower impacts than fresh air-freighted produce. Packaging also contributes significantly to the impacts, in particular glass jars and metal cans used for processed vegetables. Other significant hotspots are open display cabinets at the retailer and cooking of vegetables at home. The results of this study will be useful for food manufacturers, retailers and consumers, helping to identify improvement opportunities along vegetables supply chains.

Fruit and Vegetable Consumption and Potential Moderators Associated with All-Cause Mortality in a Representative Sample of Spanish Older Adults

This study sought to determine the association between levels of fruit and vegetable consumption and time to death, and to explore potential moderators. We analyzed a nationally-representative sample of 1699 older adults aged 65+ who were followed up for a period of 6 years. Participants were classified into low (≤3 servings day), medium (4), or high (≥5) consumption using tertiles. Unadjusted and adjusted cox proportional hazard regression models (by age, gender, cohabiting, education, multimorbidity, smoking, physical activity, alcohol consumption, and obesity) were calculated. The majority of participants (65.7%) did not meet the recommendation of five servings per day. High fruit and vegetable intake increased by 27% the probability of surviving among older adults with two chronic conditions, compared to those who consumed ≤3 servings per day (HR = 0.38, 95%CI = 0.21-0.69). However, this beneficial effect was not found for people with none, one chronic condition or three or more, indicating that this protective effect might not be sufficient for more severe cases of multimorbidity. Given a common co-occurrence of two non-communicable diseases in the elderly and the low frequency of fruit and vegetable consumption in this population, interventions to promote consuming five or more servings per day could have a significant positive impact on reducing mortality.

Low intake of commonly available fruits and vegetables in socio-economically disadvantaged communities of South Africa: influence of affordability and sugary drinks intake

BACKGROUND

Consumption of fruits and vegetables reduces the risk of obesity, diabetes, cancer, cardiovascular mortality and all-cause mortality. The study assessed the pattern of intake and the factors that influence daily intake of commonly available fruits and vegetables in economically disadvantaged South African communities.

METHODS

This is a cross-sectional study nested on an ongoing longitudinal study in South Africa. Two communities (a rural and urban) of low socio-economic status were purposely selected from two of the nine provinces. A sample of 535 participants aged 30-75 years was randomly selected from the longitudinal cohort of 1220; 411 (78%) women. Data were collected using validated food frequency and structured interviewer-administered questionnaires. Descriptive and multivariate regression analysis were undertaken.

RESULTS

A higher proportion of participants in the urban township compared to their rural community counterparts had purchased fruits (93% vs. 51%) and vegetables (62% vs. 56%) either daily or weekly. Only 37.8% of the participants consumed at least two portions of commonly available fruits and vegetables daily, with no differences in the two communities. Daily/weekly purchase of sugar sweetened beverages (SSBs) was associated with daily intake of fruits and vegetables (p = 0.014). Controlling for age and gender, analysis showed that those who spent R1000 (USD71.4) and more on groceries monthly compared to those who spent less, and those who travelled with a personal vehicle to purchase groceries (compared to those who took public transport) were respectively 1.6 times (AOR, 95% CI: 1.05-2.44; p = 0.030) and 2.1 times (AOR, 95% CI: 1.06-4.09; p = 0.003) more likely to consume at least two or more portions of fruits and vegetables daily. Those who purchased SSBs daily or weekly were less likely (AOR, 95% CI: 0.54, 0.36-0.81, p = 0.007) to consume two or more portions of fruits and vegetables daily. The average household monthly income was very low (only 2.6% of households earned R5000 (US$357.1); and education level, attitude towards fruits and vegetables and owning a refrigerator had no significant association with fruits and vegetable daily intake.

CONCLUSION

These findings indicate that affordability and frequency of purchase of sugary drinks can influence daily intake of fruits and vegetables in resource-limited communities.

Grocery store tour education programme promotes fruit and vegetable consumption

Objective:

To examine the effectiveness of the Produce for Better Health Foundation grocery store tour programme as a nutrition education tool for changing consumers’ intention to consume various forms of fruits and vegetables (F&V).

Design:

Cross-sectional study.

Setting:

Ten grocery stores in a city in the Southeast USA.

Participants:

A total of 147 grocery shoppers in Alabama, who participated in a grocery store tour, completed a retrospective pre-/post-survey using the Theory of Planned Behaviour.

Results:

Results from independent-samples t tests indicated that mean values of attitude, subjective norm and perceived control were significantly increased after store tours (P < 0·01). Participants’ intentions to consume various types of F&V (fresh, dried, canned, juice and frozen), especially dried F&V, increased significantly after store tours. Results from structural equation modelling indicated that before store tours attitude (γ = 0·48, P < 0·01) was the most significant predictor of intention to consume F&V, followed by perceived behavioural control (γ = 0·24, P = 0·02) and subjective norm (γ = 0·21, P = 0·03). After store tours, attitude (γ = 0·51, P < 0·01) and perceived behavioural control (γ = 0·44, P < 0·01) were still strong predictors of intention to consume F&V, while subjective norm became an insignificant predictor of intention.

Conclusions:

Findings revealed positive changes in study participants’ attitude, subjective norm, perceived behavioural control and their intentions to consume various forms of F&V, which suggest potential benefits of providing grocery store tours as a tool to promote consumers’ F&V intake.

Fruit and Vegetable Prescriptions for Pediatric Patients Living in Flint, Michigan: A Cross-Sectional Study of Food Security and Dietary Patterns at Baseline

Though fruit and vegetable consumption is essential for disease prevention and health maintenance, intake among children fails to meet dietary recommendations. Limited access to and the affordability of fresh produce, particularly among low-income youth, are barriers to adequate intake. To address these challenges, researchers and pediatricians in Flint, Michigan, expanded a successful fruit and vegetable prescription program that provides one $15 prescription for fresh fruits and vegetables to every child at every office visit. Vendors include the downtown farmers' market and a local mobile market. This study describes baseline characteristics, dietary patterns, food access, and food security among 261 caregiver-child dyads enrolled August 2018-March 2019. The child-reported mean daily intake of vegetables (0.72 cups ± 0.77), dairy products (1.33 cups ± 1.22), and whole grains (0.51 ounces ± 0.49) were well below recommendations. Furthermore, 53% of children and 49% of caregivers who completed the food security module indicated low or very low food security. However, there were no statistically significant differences in the child consumption of fruits and vegetables between households that reported high versus low food security (p > 0.05). Results validate and raise deep concerns about poor dietary patterns and food insecurity issues facing Flint children, many of whom continue to battle with an ongoing drinking water crisis. Additional poverty-mitigating efforts, such as fruit and vegetable prescription programs, are necessary to address these gaps.

Using repeated visual exposure, rewards and modelling in a mobile application to increase vegetable acceptance in children

Children are not consuming the recommended amounts of fruit and vegetables. Repeated visual exposure, modelling, and rewards have been shown to be effective at increasing vegetable acceptance in young children. The aim of this study was to assess the effectiveness of an evidence-based mobile application (Vegetable Maths Masters) which builds on these principles to increase children's liking and acceptance of vegetables. Seventy-four children (37 male, 37 female) aged 3-6 years old were randomised to play with either the vegetable app or a similar control app that did not include any foods. Children played their allocated game for 10 min. Liking and acceptance of the vegetables used in Vegetable Maths Masters (carrot and sweetcorn) and other vegetables which were not used in the game (yellow pepper and tomato) were measured pre- and post-play in both groups. Parents provided data about their child's food fussiness and previous exposure to the foods being used. Children who played with the Vegetable Maths Masters app consumed significantly more vegetables after playing with the app and reported significant increases in their liking of vegetables, relative to the control group. The effect of the Vegetable Maths Masters app on the change in consumption of vegetables was mediated by the change in liking of vegetables. These findings suggest that evidence-based mobile apps can provide an effective tool for increasing children's liking and consumption of vegetables in the short-term. Further work is now required to establish whether these effects are maintained over time.

Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries

Objectives

To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries.

Methods

Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years.

Results

Varying by country, upward levelling reduced inequalities in DFLE by 0.1–1.1 years (1–10%) in males, and by 0.0–1.3 years (0–18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6–15%), and between 0.1 years and 1.8 years for females (3–20%).

Conclusions

Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE.

Electronic supplementary material

The online version of this article (10.1007/s00038-019-01253-w) contains supplementary material, which is available to authorized users.

Associations between Health Behaviors and Factors on Markers of Healthy Psychological and Physiological Functioning: a Daily Diary Study

Background

Cross-sectional and experimental knowledge highlight the contribution of various health-promoting behaviors, such as physical activity, regular sleep, and healthy nutrition to mental and physical health. Beyond these well-studied lifestyle behaviors, music listening and perceived respect in social interactions are just recently proposed everyday life experiences, which may act as health-promoting factors.

Purpose

This study tested the simultaneous contribution of several health-promoting behaviors and factors and examined listening to music and positive social interaction by means of perceived respect as new potentially preventive and health-promoting behaviors and factors using an ambulatory assessment design.

Methods

Seventy-seven young healthy adults (38 women, 23.9 ± 4.5 years) completed surveys on their psychological state (i.e., mood, stress, and fatigue) five times a day for four consecutive days. A saliva sample was collected with each data entry to explore the physiological stress markers salivary cortisol, alpha-amylase, and flow rate as further outcome variables. As predictors, perceived respect, self-reported physical activity, the sleep’s restfulness, daily coffee, alcohol, vegetable/fruit consumption, and music listening behavior were recorded.

Results

Overall, restful sleep, mean daily perceived respect, and listening to music were most clearly associated with more positive psychological states, that is, better mood and lower fatigue and perceived stress. Associations with daily alcohol, coffee, and vegetable/fruit consumption appeared rather minor. While perceived respect scores were associated with lower daily cortisol output, coffee consumption was positively related to daily cortisol and alpha-amylase. Self-reported physical activity was unrelated to either outcome measure.

Conclusions

These findings provide important insights regarding potential resources of health (i.e., music and respect), their covariation, and which psycho-physiological mechanisms may underlie the links between health factors and well-being. Findings also have implications for the development of interventions aiming to increase resilience and foster health. Here, strategies for improving sleep quality, the use of music, and approaches that emphasize mutual respect and appreciation appear useful additions.

Young Adults' Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study

Background

Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement.

Objective

This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake.

Methods

A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 × 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts.

Results

Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed.

Conclusions

As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery.

Fruits and Vegetables Versus Vegetables and Fruits: Rhyme and Reason for Word Order in Health Messages

Both vegetable and fruit consumption contribute to wellness and disease prevention. Most dietary health messages promote both together and position the word "fruits" before "vegetables." We examined the word order of the commonly used phrase "fruits and vegetables" through linguistics, psychology, botany, nutrition, health outcomes, and current US intake to determine if the common word order best presents these two foods in health messaging. By comparing the 10 most commonly consumed vegetables versus fruits, we found that vegetables scored higher on the Aggregate Nutrient Density Index and contained fewer calories and more fiber than fruits. Among the "nutrients of public concern" listed in the 2015 Dietary Guidelines for Americans, we determined that vegetables are better sources of these nutrients than fruits, although fruits scored higher in antioxidant content. In observational cohort studies, vegetable and fruit consumption was found to be associated with decreased mortality. Finally, daily intakes of both vegetables and fruits are lower than recommended, but the discrepancy is larger for vegetables-especially among children-suggesting a greater imperative to promote vegetables. For these reasons, future health messages promoting both together should intentionally put "vegetables" first to promote intake and emphasize their importance regarding contribution to health.

Effects of Tart Cherry Juice on Biomarkers of Inflammation and Oxidative Stress in Older Adults

Inflammation and oxidative stress are important factors in the development of cardiovascular disease and atherosclerosis. The findings of our previous study suggest that 12 weeks consumption of tart cherry juice lowers the levels of systolic blood pressure (BP) and low-density lipoprotein (LDL) cholesterol in older adults. The present study investigated the effects of tart cherry juice on blood biomarkers of inflammation and oxidative stress. In this randomized-controlled clinical trial, a total of 37 men and women between the ages of 65⁻80 were randomly assigned to consume 480 mL of tart cherry juice or control drink daily for 12 weeks. Several blood biomarkers of inflammation and oxidative stress were assessed at baseline and after 12 weeks intervention. After the 12 weeks intervention, tart cherry juice significantly increased the plasma levels of DNA repair activity of 8-oxoguanine glycosylase (p < 0.0001) and lowered (p = 0.03) the mean c-reactive protein (CRP) level compared to the control group. There was a significant group effect observed for plasma CRP (p = 0.03) and malondialdehyde (MDA) (p = 0.03), and a borderline significant group effect observed for plasma oxidized low-density lipoprotein (OxLDL) (p = 0.07). Within group analysis showed that the plasma levels of CRP, MDA, and OxLDL decreased numerically by 25%, 3%, and 11%, respectively after 12 weeks of tart cherry juice consumption compared with corresponding baseline values. The present study suggests that the ability of tart cherry juice to reduce systolic BP and LDL cholesterol, in part, may be due to its anti-oxidative and anti-inflammatory properties. Larger and longer follow-up studies are needed to confirm these findings.

The Associations of Fruit and Vegetable Intakes with Burden of Diseases: A Systematic Review of Meta-Analyses

BACKGROUND

Low fruit and vegetable intakes are recognized risk factors for noncommunicable diseases. This systematic review summarizes published meta-analyses of global burden of diseases attributable to low fruit and vegetable intakes, and the best relative risk estimates.

METHODS

A published novel assessment process combining Cochrane Review measures, Assessing the Methodological Quality of Systematic Reviews checklist, and Newcastle-Ottawa Quality Assessment Scale was employed.

RESULTS

Sixty-four reports investigating 98 risk-disease pairs were included in the systematic review. Fifty-six pairs from 39 reports were assessed as statistically significant, involving 29 burden of diseases. Dose responses were identified for 31 negative and two positive associations. High against low intake relative risks were identified for 22 negative and one positive association. The highest identified linear dose response for each 100 g/day increase in fruit intakes was 0.56 (95% CI 0.42 to 0.74) for esophageal cancer, followed by 0.72 (95% CI 0.59 to 0.87) for mouth, pharynx, and larynx cancer; nonlinear dose response for the first 100 g/day of fruit intakes were 0.86 (95% CI 0.84 to 0.88) for stroke, followed by 0.89 (95% CI 0.88 to 0.90) for all-cause mortality. The highest identified linear dose response for each 100 g/day increase in vegetable intakes was 0.88 (95% CI 0.80 to 0.95) for renal cell cancer, followed by 0.89 (95% CI 0.84 to 0.95) for non-Hodgkin lymphoma; nonlinear dose responses for the first 100 g/day of vegetable intake were 0.86 (95% CI 0.84 to 0.89) for coronary heart disease, followed by 0.87 (95% CI 0.84 to 0.90) for all-cause mortality. For nonlinear associations, clear increases in protective associations were observed with the first 200 g/day of intakes, whereas little further increase or even decrease in protective associations were reported beyond 300 g/day intakes. Canned fruit intakes were positively associated with all-cause and cardiovascular disease mortality, and pickled vegetable intakes were positively associated with stomach cancer.

CONCLUSIONS

This systematic review supports existing recommendations for fruit and vegetable intakes. Current comparative risk assessments might significantly underestimate the protective associations of fruit and vegetable intakes.

Factors associated with the consumption of fi ve daily servings of fruits and vegetables by students

ABSTRACT Objective To evaluate and associate the frequency of consumption of five daily servings of fruits and vegetables with socioeconomic and demographic factors of students in the city of Santa Cruz do Sul, Brazil. Methods A cross-sectional study with a sample stratified by clusters of 1,578 students aged 7 to 17 in the city of Santa Cruz do Sul (Rio Grande do Sul state), Brazil. Volunteers were asked whether they consumed five daily servings of fruits and vegetables. This consumption was classified as irregular or regular. Data regarding gender, age, socioeconomic status, domicile area, and information on the nutritional status of students were also collected. The prevalence ratio was calculated with a significance level of p<0.05. Results The consumption of at least five servings of fruits and vegetables per day was reported by 40.6% of students. The irregular consumption of fruits and vegetables was higher among students aged 10-12 (69.7%, p<0.001), boys (60.9%, p<0.001), and urban area residents (61.8%, p<0.001). There were no significant differences between the consumption of fruits and vegetables and the students’ socioeconomic status (p=0.094), nor with their nutritional status (p=0.999). Conclusion The students presented an irregular consumption of fruits and vegetables in relation to the recommendations of five servings per day. However, age and domicile area, which were significantly associated with the consumption of fruits and vegetables, were not associated with their socioeconomic and nutritional status.

Prevalência e fatores associados da obesidade na população brasileira: estudo com dados aferidos da Pesquisa Nacional de Saúde, 2013

RESUMO: Introdução: A prevalência de obesidade está aumentando em um ritmo alarmante em muitos países. Uma alimentação não saudável e o sedentarismo são os principais fatores de risco para a obesidade. O objetivo deste artigo foi estudar a prevalência e identificar fatores associados à obesidade na população adulta brasileira com base nos dados coletados na Pesquisa Nacional de Saúde, 2013. Método: Amostra de 59.402 indivíduos adultos, excluindo-se as mulheres grávidas. O índice de massa corporal foi calculado por meio das aferições de peso e estatura. A obesidade foi definida por índice de massa corporal ≥ 30 kg/m2. Utilizaram-se modelos de regressão logística para identificar os fatores associados à obesidade. Resultados: As prevalências de obesidade foram de 16,8% para homens e 24,4% para mulheres. Idade avançada (a partir dos 50 anos), nível de instrução baixo (sem instrução ou ensino fundamental incompleto), raça/cor preta e viver com companheiro foram fatores de risco à obesidade. A atividade física no lazer e o hábito de assistir mais de 4 horas de televisão por dia mostraram associações significativas para ambos os sexos. Quanto à morbidade referida, em pessoas obesas, as chances de ter o diagnóstico de hipertensão, diabetes ou de alguma doença crônica não transmissível foram maiores. Homens e mulheres obesos tiveram a pressão arterial sistólica significativamente aumentada. Conclusão: Os achados enfatizam a importância de políticas públicas para a prevenção da obesidade e para a promoção de hábitos saudáveis na sociedade brasileira.

Longitudinal associations between psychological well-being and the consumption of fruits and vegetables

BACKGROUND

Psychological well-being is associated with longevity and reduced risk of disease, but possible mechanisms are understudied. Health behaviors like eating fruits and vegetables may link psychological well-being with better health; however, most evidence is cross-sectional.

PURPOSE

This study investigated psychological well-being's longitudinal association with fruit and vegetable consumption across as many as 7 years.

METHOD

Participants were 6,565 older adults from the English Longitudinal Study of Ageing, which includes men and women aged 50 years or older. Psychological well-being was assessed with 17 items from the Control, Autonomy, Satisfaction, Pleasure Scale. Fruit and vegetable consumption was initially assessed during 2006-2007 and then approximately every 2 years through 2012-2013. Covariates included sociodemographic factors, health status, and other health behaviors.

RESULTS

Mixed linear models showed that higher baseline levels of psychological well-being were associated with more fruit and vegetable consumption at baseline (β = 0.05, 95% confidence interval [CI] [0.02, 0.08]) and that fruit and vegetable consumption declined across time (β = -0.01, 95% CI [-0.02, -0.004]). Psychological well-being interacted significantly with time such that individuals with higher baseline psychological well-being had slower declines in fruit and vegetable consumption (β = 0.01, 95% CI [0.01, 0.02]). Among individuals who initially met recommendations to consume 5 or more servings of fruits and vegetables (N = 1,719), higher baseline psychological well-being was associated with 11% reduced risk of falling below recommended levels during follow-up (hazard ratio = 0.89, 95% CI [0.83, 0.95]).

CONCLUSIONS

Findings suggest that psychological well-being may be a precursor to healthy behaviors such as eating a diet rich in fruits and vegetables. (PsycINFO Database Record

The hypolipidemic effects of Tamarindus indica fruit pulp extract in normal and diet-induced hypercholesterolemic hamsters are associated with altered levels of serum proteins

The hypolipidemic effects of Tamarindus indica fruit pulp extract (Ti-FPE) have been earlier reported but the underlying molecular mechanisms are still uncertain. In this study, hamsters fed with Ti-FPE, both in the absence and presence of high-cholesterol diet, were shown to have significantly reduced levels of serum triglyceride, LDL-C and total cholesterol. The Ti-FPE-fed non-hypercholesterolemic hamsters also showed significant enhanced levels of serum apolipoprotein A1, antithrombin III, transferrin and vitamin D binding protein. In diet-induced hypercholesterolemic hamsters, apolipoprotein A1, antithrombin III and transferrin, which were relatively low in levels, became significantly enhanced when the hamsters were fed with Ti-FPE. These Ti-FPE-fed hypercholesterolemic hamsters also showed significant higher levels of serum vitamin D binding protein. When the different treated groups of hamsters were analyzed for the levels of the four serum proteins by ELISA, similar altered abundance were detected. Ingenuity Pathway Analysis of the Ti-FPE modulated serum proteins singled out "Lipid metabolism, molecular transport, small molecule biochemistry" as the top network. Our results suggest that the hypolipidemic effects of Ti-FPE are associated with alterations of serum proteins that are known to be cardioprotective and involved in the metabolism of lipids. The MS data have been deposited to the ProteomeXchange Consortium with the dataset identifier PXD010232.

Impact of tart cherry juice on systolic blood pressure and low-density lipoprotein cholesterol in older adults: a randomized controlled trial

Hypertension and dyslipidemia are major risk factors for cardiovascular disease (CVD). Common treatments for high blood pressure (BP) and dyslipidemia include medications, but there is question as to whether natural sources may be adequate to reduce CVD risk factors. We examined the effects of tart cherry juice on lipid profiles, BP, glucose, insulin, and homeostatic model assessment-insulin resistance (HOMA-IR) in older adults. In this randomized-controlled clinical trial, 17 men and 20 women between the ages of 65-80 years were randomly assigned to consume 480 ml of tart cherry juice or control drink daily for 12 weeks. Control beverages were matched for energy and sugar content. Outcome variables were assessed at baseline and after 12 weeks of tart cherry juice or control drink. Systolic BP and low-density lipoprotein cholesterol (LDL) exhibited treatment × time interaction effects. At the end of the study, participants in the tart cherry group had lower levels of LDL cholesterol (difference of -20.6 with P = 0.001) and total cholesterol (difference of -19.11 with P = 0.01), and higher levels of glucose (difference of 7.94 with P = 0.001), triglycerides (difference of 6.66 with P = 0.01) and BMI (difference of 1.06 with P = 0.02) than in the control group. Neither tart cherry juice nor control significantly altered body weight, high-density lipoprotein cholesterol, diastolic BP, insulin and HOMA-IR. Our findings show that tart cherry juice can lower the levels of systolic BP and LDL cholesterol. However, larger and longer follow-up studies are needed to further assess cardio-protective effects of tart cherry juice.

Choice architecture modifies fruit and vegetable purchasing in a university campus grocery store: time series modelling of a natural experiment

Background

In developed countries, adolescent and young adult diets have been found to be nutritionally poor. The aim of this study was to examine whether a choice architecture intervention, re-arrangement of produce within a grocery store to increase the accessibility of fruit and vegetables, affected purchasing behaviour on a university campus.

Methods

A database of daily sales data from January 2012 to July 2017 was obtained from a campus grocery store. Two changes to the layout were made during this time period. In January 2015, fruit and vegetables were moved from the back of the store, furthest from the entrance, to the aisle closest to the entrance and an entrance-facing display increasing their accessibility. In April 2016, the entrance-facing display of fruit and vegetables was replaced with a chiller cabinet so that fruit and vegetables remained more accessible than during the baseline period, but less accessible than in the period immediately previously. A retrospective interrupted time series analysis using dynamic regression was used to model the data and to examine the effect of the store re-arrangements on purchasing. All analyses were carried out both for sales-by-quantity and for sales-by-money.

Results

The first shop re-arrangement which made fruit and vegetables more prominent, increased the percentage of total sales that were fruit and vegetables, when analysed by either items purchased or money spent. The second rearrangement also had a positive effect on the percentage of total sales that were fruit and vegetables compared to baseline, however this was not significant at the 5% level. Over the five year period, the percentage of sales that were fruit and vegetables declined both in terms of items purchased, and money spent.

Conclusions

Increasing accessibility of fruit and vegetables in a grocery store is a feasible way to improve the diet of students in tertiary education. There is evidence of declining fruit and vegetable consumption among the studied population, which should be further investigated.

Electronic supplementary material

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Repeated exposure and conditioning strategies for increasing vegetable liking and intake: systematic review and meta-analyses of the published literature

Background

Vegetable intakes are typically lower than recommended for health. Although repeated exposure has been advocated to increase vegetable liking and consumption, no combination of the evidence yet provides a measure of benefit from repeated exposure or alternative conditioning strategies.

Objective

This work aimed to identify and synthesize the current evidence for the use of repeated exposure and conditioning strategies for increasing vegetable liking and consumption.

Design

Three academic databases were searched over all years of records using prespecified search terms. Published data from all suitable articles were tabulated in relation to 3 research questions and combined via meta-analyses.

Results

Forty-three articles detailing 117 comparisons investigating the use of repeated exposure and conditioning strategies for increasing liking and intakes of vegetables were found. Our analyses demonstrate: 1) increased liking and intakes of the exposed vegetable after repeated exposure compared with no exposure; 2) increased liking for the exposed vegetable after conditioning compared with repeated exposure, increased intakes after the use of rewards, and some suggestion of decreased intakes after flavor-nutrient conditioning; and 3) increased liking and intakes of a novel vegetable after repeated exposure to a variety of other vegetables compared with no exposure or repeated exposure to one other vegetable. Effect sizes, however, are small, and limited evidence suggests long-term benefits. Our analyses, furthermore, are limited by limitations in study design, compliance, and/or reporting.

Conclusions

Based on our findings, we recommend the use of repeated exposure to one and a variety of vegetables, and the use of rewards, for increasing vegetable liking and consumption. Confirmation from further large, well-conducted studies that use realistic scenarios, however, is also required. This study was registered at PROSPERO as CRD42017056919.

Obesity Prevention Behaviors in Asian Indian Adolescent Girls: A Pilot Study

PURPOSE

The purpose of this pilot study was to evaluate obesity prevention behaviors of Asian Indian adolescent females and determine the relationship of these behaviors to cardiovascular risk factors.

DESIGN AND METHODS

A purposive sample of twenty females, 14-18 years of age, was enrolled. Body mass index, percent body fat, waist circumference, and blood pressure were measured to assess cardiovascular risk. Measures of obesity prevention behaviors were physical activity, dietary and sleeping behaviors. To quantify engagement in physical activity, participants wore an accelerometer. The dietary intake was assessed using the web based SuperTracker. Pittsburgh Sleep Quality Index was used to assess sleep behaviors. For data analysis, descriptive statistics was used for demographic characteristics. Correlations were calculated to evaluate the relationship between cardiovascular risk factors and obesity prevention behaviors.

RESULTS

The majority of the adolescents did not meet recommended physical activity levels. Most reported unhealthy eating behaviors with higher saturated fat intake correlating with higher percent body fat. The cardiovascular risk measures fell below normative values. However, more time spent in sedentary behaviors was related to higher systolic blood pressure, while poor sleep quality was associated with higher diastolic blood pressure and greater BMI.

CONCLUSIONS

The findings support the unhealthy patterns of physical activity, dietary and sleep behaviors in Asian Adolescent girls and the need for promoting healthy behaviors in this at risk population.

PRACTICE IMPLICATIONS

The study findings provide a basis for education on healthy behaviors and development of culturally appropriate interventions to prevent obesity.

Antioxidant activity and mechanism of commercial Rama Forte persimmon fruits (Diospyros kaki)

This study aimed to characterize the antioxidant properties of Rama Forte persimmon, a tannin-rich fruit variety produced in Brazil. Extracts prepared with lyophilized pulps from fruits obtained in local markets were analyzed individually to evaluate the extent of antioxidant protection and investigate the antioxidant mechanism. Iron-mediated hydroxylation of 5,5-dimethyl-1-pirrolidine-N-oxide, determined by electron paramagnetic resonance (EPR), and oxidative degradation of 2-deoxyribose (2-DR) were inhibited by fruit extracts in a dose-dependent manner. There was a considerable individual variability in inhibition of 2-DR degradation by individual fruits. Higher protection of 2-DR degradation (by the extracts) was observed in Fe(III)-citrate/ascorbate in comparison with Fe(III)-EDTA/ascorbate system; however, antioxidant effectiveness of fruit extracts was not diminished by increasing EDTA concentration by 10-fold. Other competition experiments using the 2-DR assay (varying pre-incubation time and 2-DR concentration) indicated that protection comes mainly from free radical scavenging, rather that metal chelation antioxidant activity. Persimmon extracts prevented iron-mediated lipid peroxidation in rat liver homogenates, which correlated significantly with the inhibition of 2-DR oxidation. Finally, sugar content of individual fruits correlated inversely with inhibition of 2-DR degradation, which could indicate that maturation decreases soluble antioxidant concentration or efficiency. In conclusion, lipid peroxidation, 2-DR and EPR experiments indicated that extracts from commercial fruits showed mainly radical-scavenger activity and relevant antioxidant activity.

Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES

This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.

Time to address the double inequality of differences in dietary intake between Scotland and England

Geographical disparities in health outcomes have been evident across the UK for decades. Recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences is limited. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. A period of 12 years of UK food purchase data (2001-2012) were pooled and used to estimate household-level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than in England (e.g. fruit and vegetables 267 g/d; 99 % CI 259, 274 v. 298 g/d; 99 % CI 296, 301), P<0·001). Similarly, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower-income groups (e.g. red and processed meat consumption in the lowest-income quintile was 65 g/d; 99 % CI 61, 69 in Scotland v. 58 g/day; 99 % CI 57, 60 in England, P<0·001, but similar in the highest-income quintile (58 g/d; 99 % CI 54, 61 v. 59 g/d; 99 % CI 58, 60, respectively). A poorer diet in Scotland compared with England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries.

Food, microbiome and colorectal cancer

You are what you eat. This adage has been confirmed by many studies demonstrating the high impact of nutrition on risk of cardiovascular diseases, many malignancies and other diseases. Dietary factors are of major relevance in the evolution of colorectal carcinoma. Various aspects are involved in colorectal carcinoma pathogenesis including genetics, lifestyle, age, chronic inflammation and others. It has only recently been recognized that the gut microbiota might reflect an important missing link in the interaction between diet and subsequent colorectal carcinoma development. Dietary factors are a major confounding factor affecting the composition of the intestinal microbiota. Several preclinical and clinical studies have recently suggested a role for the intestinal microbiota in potentially initiating and driving colorectal carcinoma. Therefore it is increasingly acknowledged that dietary factors might favor carcinogenesis via manipulation of the gut microbiota via potential outgrowth of certain bacterial populations, such as Fusobacterium nucleatum, Escherichia coli or Bacteroides fragilis. Excitingly, recent large clinical studies also highlighted a role for the gut microbiota and in particular Akkermansia muciniphila in tumor response toward chemotherapeutic agents and immune checkpoint inhibitors. This review will concentrate on the role of dietary factors in affecting the microbiota and implications in colorectal carcinoma.

Misperceived norms and personal sugar-sweetened beverage consumption and fruit and vegetable intake among students in the United States

Perceptions of peer food and beverage consumption norms may predict personal consumption. Yet actual peer norms may be misperceived. Data were collected from adolescents in grades 6-12 (n = 5841) in 13 schools across six regionally diverse states via an anonymous online survey. The male and female averages for the number of sugar-sweetened beverages (SSBs) personally consumed per day were significantly lower than average perceptions of the typical number of SSBs consumed by peers. Inversely, the male and female averages for the number of fruit and vegetable (FV) servings personally consumed per day were significantly higher than average perceptions of typical FVs consumed by peers. Among the majority of male and female grade cohorts, the median SSB consumption was 1 drink per day and the median FV intake was 3 servings per day. Regression analyses found a strong relationship between personal consumption and perceived peer norms about male and female consumption (β  = 0.56, p < .001 for perceived male norm among male students and β  = 0.52, p < .001 for perceived female norm among female students about SSB consumption, for example), adjusting for sociodemographic characteristics and actual consumption norms. Overall, 65% and 67% of students overestimated average SSB consumption among males and females in their grade cohort, respectively, while less than 5% underestimated these norms. In addition, 49% and 52% of students underestimated average FV intake among males and females in their grade cohort, respectively, while only about 25-30% overestimated the norm. There was little difference in male and female students' estimations of peer norms. Unhealthy misperceptions of SSB norms and FV norms existed across all student categories and grade cohorts, which may contribute to unhealthy personal dietary patterns.

5-a-day fruit and vegetable food product labels: reduced fruit and vegetable consumption following an exaggerated compared to a modest label

BACKGROUND

Food product labels based on the WHO 5-a-day fruit and vegetable (FV) message are becoming increasingly common, but these labels may impact negatively on complementary or subsequent FV consumption. This study aimed to investigate the impact of a '3 of your 5-a-day' versus a '1 of your 5-a-day' smoothie product label on subsequent FV consumption.

METHODS

Using an acute experimental design, 194 participants (90 males, 104 females) were randomised to consume a smoothie labelled as either '3 of your 5-a-day' (N = 97) or '1 of your 5-a-day' (N = 97) in full, following a usual breakfast. Subsequent FV consumption was measured for the rest of the day using 24-h recall. Usual FV consumption was also assessed via 24-h recall for the day before the study.

RESULTS

Regression analyses revealed a significantly lower subsequent FV consumption following smoothies displaying the '3 of your 5-a-day' label compared to the '1 of your 5-a-day' label (Beta = - 0.15, p = 0.04). Secondary analyses revealed these effects to be driven mainly by changes to consumption in usual high FV consumers, in females and in vegetable as opposed to fruit consumption.

CONCLUSIONS

These findings demonstrate a role for label information in food intake, and the potential negative impacts of an exaggerated food product label on healthy food consumption and healthy dietary profiles.

Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years

BACKGROUND

Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important.

OBJECTIVE

To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years.

DESIGN

The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included.

RESULTS

30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked.

CONCLUSIONS

Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).

Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis

Background

Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work.

Objective

The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet.

Methods

The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%).

Results

The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers.

Conclusions

This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field.

Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center

Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P ≤ 0.05). Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.

Clusters of health behaviours in Queensland adults are associated with different socio-demographic characteristics

Background

The co-occurrence of unhealthy lifestyles, calls for interventions that target multiple health behaviours. This study investigates the clustering of health behaviours and examines demographic differences between each cluster.

Methods

In total, 934 adults from Queensland, Australia completed a cross-sectional survey assessing multiple health behaviours. A two-step hierarchical cluster analysis using multiple iterations identified the optimal number of clusters and the subset of distinguishing health behaviour variables. Univariate analyses of variance and chi-squared tests assessed difference in health behaviours by socio-demographic factors and clusters.

Results

Three clusters were identified: the ‘lower risk’ cluster (n = 436) reported the healthiest profile and met all public health guidelines. The ‘elevated risk’ cluster (n = 105) reported a range of unhealthy behaviours such as excessive alcohol consumption, sitting time, fast-food consumption, smoking, inactivity and a lack of fruit and vegetables. The ‘moderate risk behaviour’ cluster (n = 393) demonstrated some unhealthy behaviours with low physical activity levels and poor dietary outcomes. The ‘elevated risk’ cluster were significantly younger and more socio-economically disadvantaged than both the ‘lower and moderate risk’ clusters.

Discussion

Younger people who live in more deprived areas were largely within the ‘elevated risk’ cluster and represent an important population for MHBC interventions given their wide range of unhealthy behaviours.

Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014

Background

Healthy Start (HS) is a UK government programme, introduced in 2006, providing vouchers to pregnant women or families with children aged <4 who are in receipt of certain benefits. Vouchers can be exchanged for fruit and vegetables (F&V), milk or infant formula. We sought to identify any association between HS and F&V intake.

Methods

We analysed repeated cross-sectional data from the Health Survey for England. Study participants were classified into one of four groups: one HS-eligible group and three control groups, meeting only the income or demographic or no eligibility criterion. Outcome measures were mean F&V intake and the proportions of participants consuming ≥3 and ≥1 portion/day. Outcomes were compared across the four groups over four time periods: 2001–2003, 2004–2006, 2007–2009 and 2010–2014. Regression analyses examined whether F&V intake among HS-eligible participants had a significantly different rate of change from those in the control groups.

Results

The change in mean F&V consumption over time was similar in HS-eligible adults and children to that of the control groups. Likewise, the change in odds of consuming ≥3 or ≥1 portion of F&V/day over time was similar among HS-eligible participants and control groups.

Conclusion

This study found that during the period 2001–2003 to 2010–2014, F&V consumption among adults and children in households deemed eligible for HS changed similarly to that of other adults and children. Potential explanations include that vouchers may have been spent on milk or infant formula, or that vouchers helped protect F&V consumption in low-income households.

Developing Healthy Food Preferences in Preschool Children Through Taste Exposure, Sensory Learning, and Nutrition Education

PURPOSE OF REVIEW

The present review was undertaken in order to summarize and evaluate recent research investigating taste exposure, sensory learning, and nutrition education interventions for promoting vegetable intake in preschool children.

RECENT FINDINGS

Overall, taste exposure interventions yielded the best outcomes for increasing vegetable intake in early childhood. Evidence from sensory learning strategies such as visual exposure and experiential learning also show some success. While nutrition education remains the most common approach used in preschool settings, additional elements are needed to strengthen the educational program for increasing vegetable intake. There is a substantial gap in the evidence base to promote vegetable intake in food fussy children. The present review reveals the relative importance of different intervention strategies for promoting vegetable intake. To strengthen intervention effects for improving vegetable intake in preschool children, future research could consider integrating taste exposure and sensory learning strategies with nutrition education within the preschool curriculum.

Are 'fruits and vegetables' intake really what they seem in India?

BACKGROUND/OBJECTIVES

Fruits and vegetables are integral parts of a healthy diet. This study evaluated the quantity and diversity of the fruit and vegetable intake in India, with a focus on its distribution across sectors and wealth quintiles.

SUBJECTS/METHODS

A secondary data analysis on the nation-wide NSSO Household Consumer Expenditure Survey 2011-2012 was performed to estimate the amount (g/capita/day) and diversity of household intake of fruits and vegetables in the rural and the urban sectors of India. Using the expenditure data, households in both the sectors were further divided into wealth quintiles and differences in the diversity of intake was evaluated across these quintiles separately for each sector.

RESULTS

The per capita household vegetable and fruit intake was found to be 145 and 15 g, respectively, for rural India, and 155 and 29 g for urban India. A significant portion of this intake came from energy-dense food items; potatoes and bananas for vegetable and fruit intake respectively. Further, while wealth marginally improved the diversity in vegetable intake, no such trend was observed in fruit intake.

CONCLUSIONS

Given the high proportion of energy-dense fruits and vegetables in the Indian total intake, the focus should be on improving the diversity of vegetables, as well as on increasing the intake and diversity of fruits.

Functional Dehydrated Foods for Health Preservation

The market of functional foods has experienced a huge growth in the last decades due to the increased consumers’ awareness in a healthy lifestyle. Dried fruits constitute good snacks, in alternative to salty or sweet ones, and food ingredients due to their taste and nutritional/health benefits. Bioactive molecules are interesting sources to develop functional foods, as they play a major role in improving the health status and minimizing disease risks. The bioactive compounds most widely discussed in literature are presented in this review, for example, polyphenols, phytosterols, and prebiotics. Different technologies to dry bioproducts for producing functional foods or ingredients are presented. New drying techniques for the preservation of bioactive compounds are proposed, focusing more specifically on dielectric drying. A discussion on the techniques that can be used to optimize drying processes is performed. An overview on dehydrated plant based foods with probiotics is provided. The microorganisms used, impregnation procedures, drying methods, and evaluated parameters are presented and discussed. The principal bioactive compounds responsible for nutritional and health benefits of plant derived dried food products—fruits and vegetables, fruits and vegetables by-products, grains, nuts, and algae—are presented. Phytochemical losses occurring during pretreatments and/or drying processes are also discussed.

A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study

Background

Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits.

Purpose

These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality.

Methods

Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support.

Results

Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption.

Conclusions

These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships.

Regulatory/modulatory effect of prune essence concentrate on intestinal function and blood lipids

CONTEXT

Prunus domestica Linn (Rosaceae) has been considered a functional food, owing to its various pharmacological activities, including antioxidant, anti-inflammatory, antidiabetic and anticancer.

OBJECTIVE

This placebo-controlled, randomized study was framed to check the beneficial activity of prune essence concentrates (PEC) in corroboration with intestinal function and lipid profile in mildly hypercholesterolemic subjects.

MATERIALS AND METHODS

Sixty healthy mild hypercholesterolemic subjects were randomly chosen and segregated into three groups as placebo (consume 50 mL of simulated prune drink), PEC I (consume 50 mL of PEC/day) and PEC II (consume 100 mL of PEC/day) for 4 weeks with 2 weeks of follow-up without PEC consumption.

RESULTS

Intake of PEC (I and II) for 4 weeks substantially ameliorated (p < 0.05) the colony number of Bifidobacterium spp. (1.18- and 1.19-fold) and Lactobacillus spp. (1.07- and 1.16-fold), but markedly lowered (p < 0.05) the colony number of Clostridium perfringens (5.97 and 8.35%) and Escherichia coli (6.25 and 9.38%). Meanwhile, the total cholesterol (TC; 5.90 and 6.99%) levels and LDL-c (6.68 and 6.53%) were significantly reduced (p < 0.05), but no change in other lipid parameters. Whereas, the antioxidant capacity was also concomitantly elevated (p < 0.05) upon administration with PEC.

DISCUSSION AND CONCLUSION

Overall, the results suggest that the use of PEC may positively regulate the intestinal microflora and thereby effectively lower the TC levels and thus act as a hypocholesterolemic agent.

Tucum-do-Cerrado (Bactris setosa Mart.) May Promote Anti-Aging Effect by Upregulating SIRT1-Nrf2 Pathway and Attenuating Oxidative Stress and Inflammation

Aging may be related to oxidative damage accumulation and a low-grade inflammation, both responses are modulated by iron and phytochemicals. This study investigated the effect of tucum-do-cerrado (Bactris setosa Mart.) consumption on the expression of sirtuins (SIRT 1 and 3) and senescence marker protein-30 (SMP30), and on the redox and inflammatory responses, in adult rats supplemented or not with dietary iron. Male Wistar rats were treated for 12 weeks with: control diet (CT); iron enriched-diet (+Fe); control diet + 15% tucum-do-cerrado (Tuc); or iron enriched-diet + 15% tucum-do-cerrado (Tuc + Fe). Iron supplementation (+Fe) increased liver, spleen and intestine iron levels, transferrin saturation, serum iron, serum TNF-α and IL-6 levels, hepatic carbonyl content and and superoxide dismutase (SOD) activity, hepatic Nrf2 protein and Nqo1 mRNA levels and decreased the renal Sirt1 mRNA levels in relation to CT group. Tucum-do-cerrado consumption (Tuc) increased hepatic SOD activity, Nrf2 and SIRT1 mRNA and protein contents, and Nqo1 mRNA levels, while it decreased the renal SOD activity compared with the CT diet. The consumption of tucum-do-cerrado associated with the iron-enriched diet (Tuc + Fe) increased the iron levels in tissues and serum transferrin saturation, compared to the CT diet, while promoting a decrease in hepatic carbonyl and renal malondialdehyde levels, marginally reducing serum IL-6 levels, and increasing hepatic SIRT1 protein content, renal Sirt1 and hepatic Nrf2 mRNA levels, compared to the +Fe group. None of the treatments altered Smp30 mRNA levels. The results suggest that tucum-do-cerrado consumption might promote an anti-aging effect by increasing SIRT1 expression, which may enhance Nrf2 mRNA and protein levels and its downstream pathway, which in turn decrease oxidative damage to proteins and the levels of inflammatory cytokines (IL-6 and TNF-α), induced by iron excess.