Promoting consumption of fruit and vegetables for better health. Have campaigns delivered on the goals?

Increasing Children's Vegetable Consumption: Translating a Review of the Evidence Base to Develop Best Practice Guidelines

Introduction

Dietary guidelines worldwide emphasize the importance of consuming vegetables as part of a healthy diet. Despite this, translating this information into messages for consumers that change behavior has been difficult. There have been population-level social marketing campaigns as well as several smaller campaigns directed specifically toward children, which have demonstrated small increases in consumption. However, achieving meaningful and sustained increases in children's vegetable consumption remains a challenge. This article describes the process of synthesizing the published literature and translating these findings to inform the development of 7 best practice guidelines to increase children's vegetable intake.

Methods

The first step in this process was a systematic review of scientific literature to identify the components of interventions that were associated with successfully increasing vegetable intake. The synthesis of effective intervention components was guided by the Behavior Change Wheel. These scientific findings were translated to guidelines for best practice. This process involved a team of nutrition and behavioral researchers and nutrition practitioners translating the science into actionable advice that could be adopted by a range of stakeholders. The 6 selected stakeholders included long daycare centers, after-hours school care providers, primary schools, industry groups and growers, researchers, and government policy makers. Stakeholders were involved in the development process through surveys and interviews to understand their requirements for resources to support adoption of the best practice guidelines within each setting and within the context of existing practice.

Results

The guidelines center on coordination of effort, with a focus on components such as planning, environmental restructuring, barrier reduction, feedback, and monitoring. In consultation with key stakeholders, a range of resources were developed for each setting to support the implementation of best practice, with the aim of achieving meaningful increases in intake. The resources and tools have been made available at http://www.vegkit.com.au.

Conclusions

The translation of knowledge into practice is not traditionally included as part of the research process. Therefore, combining the process of reviewing the science and translating the evidence to stakeholder resources to influence practice in 1 research study is novel, and the study could be used to guide future research translation activities within and beyond the field of public health nutrition.

Biofilm-forming Ability of Bacillus thuringiensis Strains from Biopesticides on Polystyrene and their Attachment on Spinach

Bacillus thuringiensis-based commercial products as a biopesticide have been used for more than 60 years in agriculture. However, as one of the species in B. cereus group, B. thuringiensis has been considered as an emerging hazard with the potential to cause food toxico-infections. The present study aimed to evaluate the biofilm-forming ability of B. thuringiensis biopesticide strains and their attachment on spinach, compared to foodborne B. cereus strains. Biofilm formations of tested strains were found to be strain-specific and affected by the nutrient conditions more than the incubation time. Nutrient starvation conditions generally reduced the biofilm formation of tested B. thuringiensis and B. cereus strains, particularly B. thuringiensis ABTS-1857 strain was found as the nonbiofilm former in starvation conditions. It is worth mentioning that B. thuringiensis SA-11 strain showed stronger biofilm-forming ability with more air-liquid interface biofilm than the other two B. thuringiensis biopesticide strains, but no such higher attachment of B. thuringiensis SA-11 to spinach was observed. These results indicate that B. thuringiensis SA-11 strain can enter the food processing lines by the attachment on spinach leaves, and it has the potential to form biofilms throughout the processing lines or the production environment when sufficient nutrients are available. However, more biofilm tests of B. thuringiensis biopesticide strains in the vegetable production chain should be performed. The dry formulation of commercial B. thuringiensis biopesticides enhanced their adhesion on spinach leaves, whereas the strength of adhesion was not improved by the formulation. In addition, 1-2 log reductions of spores after the intensive washing of spinach leaves in the lab were detected. However, the log reduction due to the actual washing done by the food processing companies in large-volume washing baths or by consumers at home would be limited and less than this lab simulation.

Using Novel Multimethod Evaluation Approaches to Understand Complex Food System Interventions: Insights from a Supply Chain Intervention Intended to Improve Nutrition

Background

A "food system" approach to improve diet quality by intervening within areas such as food supply chains is gaining prominence. However, evidence of such interventions' impact, and understanding of appropriate methods to evaluate them, is lacking.

Objectives

We present an impact evaluation of an intervention that aimed to increase consumption of nutritious foods by supporting food-producing firms in Kenya. In doing so, we demonstrate how multiple methods, including those from other disciplines, can be used to evaluate a complex food systems intervention.

Methods

Four methods focused on food-producing firms and their management, including a survey of intervention participants (n = 83 individuals), a "laboratory-in-the-field" experiment (n = 83 individuals), baseline/endline data on firm performance (n = 71 firms), and semistructured interviews (n = 19 firms). Three methods focused on consumers in neighborhoods targeted by a supported firm: a randomized field experiment tested effects of making a supported product exhaustively available on consumers' purchases and consumption (n = 1295 consumers); 3 discrete choice experiments (n = 1295 consumers) tested factors influencing consumers' willingness to pay for foods with relevant characteristics.

Results

Among firms, we saw suggestive evidence of increased networking and business relationships, while laboratory-in-the-field experiments indicated the intervention might foster cooperation among participants. Qualitative interviews suggested that the intervention enabled firms to increase production, improve management, increase revenues, and lower costs. Baseline/endline data confirmed a positive effect only on the launch of new products and hiring workers. In the field experiment, consumption of the supported product increased in areas where it was made available relative to a control group, but this did not increase overall consumption of the food type or dietary diversity.

Conclusions

Results showed positive signs of the intervention improving firm-level outcomes but limited impact on consumers' diet quality. The evaluation also demonstrates how diverse methods can be used to evaluate complex interventions.

Humanistic Health Management and Cancer: Associations of Psychology, Nutrition, and Exercise with Cancer Progression and Pathogenesis

The incidence rate of cancer is increasing year by year due to the aging of the population, unhealthy living, and eating habits. At present, surgery and medication are still the main treatments for cancer, without paying attention to the impact of individual differences in health management on cancer. However, increasing evidence suggests that individual psychological status, dietary habits, and exercise frequency are closely related to the risk and prognosis of cancer. The reminder to humanity is that the medical concept of the unified treatment plan is insufficient in cancer treatment, and a personalized treatment plan may become a breakthrough point. On this basis, the concept of "Humanistic Health Management" (HHM) is proposed. This concept is a healthcare plan that focuses on self-health management, providing an accurate and comprehensive evaluation of individual lifestyle habits, psychology, and health status, and developing personalized and targeted comprehensive cancer prevention and treatment plans. This review will provide a detailed explanation of the relationship between psychological status, dietary, and exercise habits, and the regulatory mechanisms of cancer. Intended to emphasize the importance of HHM concept in cancer prevention and better prognostic efficacy, providing new ideas for the new generation of cancer treatment.

Socio-demographic and cross-country differences in attention to sustainable certifications and changes in food consumption

Food labeling can influence, sometimes facilitate, changes in consumer diets to support environmental sustainability and in response to climate change. However, a significant impediment to this dietary shift may arise from the consumers' tendency to underestimate the environmental impact of their food choices and from their limited knowledge about sustainable certifications. These aspects are influenced by the characteristics and geographical affiliations of individuals. In such a context, the aim of this research has been to identify the main factors that drive the food purchasing frequency and the changes in food consumption associated with consumers' concerns about climate change and interest in sustainable food certifications by comparing different food products and countries (Italy, France, Germany, Denmark, the USA, and China). A cross-country survey was conducted on 6500 consumers of various food products. The obtained mean scores were then compared, using generalized linear mixed-effect models, to evaluate the associations between the consumers' food purchasing frequency, the importance of sustainable certifications, and changes in food consumption due to climate change concerns. Much of the variation in food consumption, purchasing behaviors, and interest in sustainable certifications was found to depend on such factors as age, gender, and country of origin. Indeed, Chinese consumers exhibited a heightened interest in sustainable food certifications, yet their consumption scores for all food products overall were higher. Conversely, adult and elderly Danish consumers demonstrated a decrease in the consumption of cheeses, meat, fruits, and vegetables, and their interest scores in all sustainable food certifications were lower. Despite the challenges posed by various consumers' interests and minimal changes in food consumption patterns, our findings suggest that sustainable certifications present a promising avenue for straightforward interventions to promote the adoption of sustainable diets and to address climate change.

Australians' willingness to change their discretionary food intake: findings from the CSIRO junk food analyser

Introduction

Overconsumption of energy dense, nutrient poor foods and beverages is a major problem globally. This study describes what and how Australian adults consume and are willing to change their intake in terms of discretionary food and beverage categories.

Methods

Cross-sectional data were collected via the CSIRO Junk Food Analyser. This online tool contains short questions on discretionary food and beverage consumption, and items relating to stage of and willingness and strategies to reduce discretionary food and beverage intake. Analyses focussed on describing discretionary intake, adherence to guidelines and the prediction of willingness to change discretionary food intake amongst those exceeding guidelines.

Results

In 2021, 41,109 Australian adults completed the CSIRO Junk Food Analyser. Participants were mostly female (73.1%) and aged 31-70 years (78.9%). Most participants exceeded dietary guidelines for discretionary food and beverage intake (67.4%, 27,694/41,109) with 40% reporting actively trying to reduce intake. Most people exceeding guidelines did so in categories of alcohol (39.3%) and cakes and biscuits (21.0%). Yet, willingness to change intake was lowest for alcohol (median, IQR of 3, 2:4 out of 5). Almost half of the participants were willing to try 'having a few days off per week' (46.0%), while only 13.4% were willing to try to 'eliminate' their highest ranked category.

Discussion

Australian adults are willing to reduce their discretionary food and beverage intake, but simply targeting the foods and beverages consumed most may not be the best place to start. Messages encouraging days off frequently consumed discretionary foods and beverages may be well received.

Meta-analysis of the prevalence of norovirus and hepatitis a virus in berries

Norovirus (NoV) and hepatitis A virus (HAV) stand as the predominant agents associated with viral foodborne infections. Outbreaks have been documented to be caused by various types of food items, including fresh and/or frozen berries. Comprehensive data concerning crucial viral pathogens in berries remain limited and are not currently available in aggregate form. Consequently, the present study aimed to compile the existing information regarding the prevalence of NoV and HAV in this matrix. Records of foodborne viruses were systematically extracted from database repositories up to December 2022, adhering to PRISMA standards and were subjected to a multilevel random effect meta-analysis model to determine the mean occurrence rate of NoV and HAV. A high heterogeneity across studies was observed (I2 = 82 %), reflecting variations in the prevalence of sampling locations, years, berry types, and sample conditions, among other potential contributing factors. The prevalence of NoV and HAV in berries was calculated at 2.12 % (95 % CI 1.74-2.59 %), and no statistically differences were observed among the viral types or genogroup categories. However, it is important to clarify that this estimate should be taken with caution given the high heterogeneity. There was no discernible correlation between viral prevalence and any particular berry type. However, there was a temporal correlation observed with the year of sampling, revealing a significantly decreasing trend throughout the study period. A significant influence of the sample condition (fresh or frozen) was observed in relation to the prevalence of NoV GII and HAV. Overall higher viral prevalences were identified in berries originating from African countries as compared to those sourced from other continents. It was also noted that the prevalence of NoV GI was significantly higher in samples collected directly from farms compared to those obtained from retailers. The outcomes of this comprehensive meta-analysis propose that while viral contamination of berries is diminishing in more recent times, the prevalence remains substantial in certain African countries, having a significant risk for foodborne infections. It is imperative to implement intervention strategies in these regions to enhance product safety.

Can social media be used to increase fruit and vegetable consumption? A pilot intervention study

Background

Exposure to social norms about fruit and vegetable intake has been shown to increase individuals' consumption of these foods. Further, exposure to socially endorsed 'healthy' food posts can increase consumption of low energy-dense (LED), relative to high energy-dense (HED) foods. The current pilot study aimed to investigate whether exposure to healthy eating (vs. control) social media accounts can shift normative perceptions about what others eat, eating intentions and self-reported food consumption.

Methods

In a 2 (condition) × 2 (type of food consumed) mixed factorial design, 52 male and female students were asked to follow either healthy eating (intervention) or interior design (control) Instagram accounts over a two-week period. Baseline and post-intervention measures assessed normative perceptions of Instagram users' consumption of fruit and vegetables (LED foods), and energy dense snacks and sugar sweetened beverages (HED foods). Participants' intentions to consume, and self-reported consumption of these foods, were also measured.

Results

There were no significant changes in perceptions about what others eat, or participants' own eating intentions (ps > 0.05). However, the intervention increased participants' self-reported consumption of LED foods by 1.37 servings (per day) and decreased consumption of HED foods by 0.81 items (per day), compared to the control condition (ps < 0.05).

Conclusions

This novel pilot study demonstrates that a social norm-based social media intervention can successfully encourage healthier eating, with a large effect after two weeks. Certain social media platforms may therefore provide a viable tool for nudging healthy eating. Future work will aim to replicate these findings in a larger and more diverse sample.

Green Onion (Allium fistulosum): An Aromatic Vegetable Crop Esteemed for Food, Nutritional and Therapeutic Significance

In recent years, there has been a shift towards a greater demand for more nutritious and healthier foods, emphasizing the role of diets in human well-being. Edible Alliums, including common onions, garlic, chives and green onions, are staples in diverse cuisines worldwide and are valued specifically for their culinary versatility, distinct flavors and nutritional and medicinal properties. Green onions are widely cultivated and traded as a spicy vegetable. The mild, onion-like flavor makes the crop a pleasant addition to various dishes, serving as a staple ingredient in many world cuisines, particularly in Eastern Asian countries such as China, Japan and the Republic of Korea. The green pseudostems, leaves and non-developed bulbs of green onions are utilized in salads, stir-fries, garnishes and a myriad of culinary preparations. Additionally, green onions have a rich historical background in traditional medicine and diets, capturing the attention of chefs and the general public. The status of the crop as an important food, its culinary diversity and its nutraceutical and therapeutic value make it a subject of great interest in research. Therefore, the present review has examined the distribution, culinary, nutritional and therapeutic significance of green onions, highlighting the health benefits derived from the consumption of diets with this aromatic vegetable crop as a constituent.

Analysing the potential impacts of three interventions on fruit and vegetable consumption in urban Kenya using participatory systems modelling

OBJECTIVE

This study uses participatory modelling with stakeholders to assess the potential impacts of three interventions intended to increase fruit and vegetable (F&V) consumption in urban Kenya.

DESIGN

A participatory process using Group Model Building (GMB) developed a conceptual model of the determinants of vegetable consumption. A subsequent quantitative System Dynamics model using data from primary and secondary sources simulated vegetable consumption from 2020 to 2024 under three proposed interventions suggested by stakeholders: increasing consumer awareness, reducing post-harvest losses and increasing farm yields. Model analyses assumed mean parameter values and assessed uncertainty using 200 simulations with randomised parameter values.

SETTING

The research was implemented in Nairobi, Kenya with simulation analyses of mean per capita consumption in this location.

PARTICIPANTS

Workshops convened diverse F&V value chain stakeholders (farmers, government officials, NGO staff and technical experts) to develop the conceptual model, data inputs and intervention scenarios.

RESULTS

Increasing consumer awareness was simulated to increase vegetable consumption by relatively modest amounts by 2024 (5 g/person/d from a base of 131 g/person/d) under mean assumed value of value chain response parameters. Reducing perishability was simulated to reduce consumption due to the higher costs required to reduce losses. Increasing farm yields was simulated to have the largest impact on consumption at assumed parameter values (about 40 g/person/d) but would have a negative impact on farm profits, which could undermine efforts to implement this intervention.

CONCLUSIONS

The combination of GMB and simulation modelling informed intervention priorities for an important public health nutrition issue.

Sixteen-year trends in fruit consumption and related socioeconomic inequalities among adolescents in Western European countries

PURPOSE

To investigate time trends in daily fruit consumption among Western European adolescents and in related socioeconomic inequalities.

METHODS

We used nationally representative data from 18 countries participating in five rounds (2002 to 2018) of the cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey (n = 458,973). The questionnaire, standardised across countries and rounds, was self-administered at school by 11-, 13- and 15-year-old adolescents. Daily fruit consumption was assessed using a short food frequency questionnaire (sFFQ). Socioeconomic inequalities were measured using the Family Affluence Scale (FAS). Multilevel logistic regressions were applied to study linear time trends in daily fruit consumption, overall, by country and by FAS.

RESULTS

Between 2002 and 2018, daily fruit consumption increased in 10 countries (OR range, 1.04 to 1.13, p < 0.05) and decreased in 3 (OR range 0.96 to 0.98, p < 0.05). In all survey years combined, prevalence of daily fruit consumption was significantly higher among high FAS groups (42.6%) compared to medium (36.1%) and low FAS groups (31.7%; all countries: p < 0.001). Between 2002 and 2018, socioeconomic inequalities in fruit consumption increased in Austria, Germany, Italy, Netherlands, Scotland, Sweden, and Switzerland. Only in Norway FAS inequalities decreased while the prevalence increased.

CONCLUSION

The prevalence of daily fruit consumption generally increased among adolescents between 2002 and 2018 in Western European countries, yet socioeconomic inequalities increased in some countries. Public health interventions should continue to promote fruit consumption with special attention to lower socioeconomic groups.

Determinants of Consumption of Vegetables among the Spanish Population: A Cross-Sectional Study

The consumption of vegetables is one of the fundamentals of a healthy diet. The purposes of the present study were to describe the frequency of consumption of vegetables in the general Spanish population and to explore the relations between the consumption of vegetables and sex, age, cohabitation circumstances, educational level, and body mass index (BMI).

METHODS

An analytical cross-sectional study was accomplished based on data from the European Health Survey in Spain (2020).

RESULTS

A total of 20,745 (52.1% women) subjects with a median age of 54 years old were included. Only 2.8% of them ate vegetables at least three times a day. The adjusted generalized linear model showed that being a woman increased the odds of consuming vegetables at least three times a day by 1.666 times (p < 0.001). Not cohabiting as a couple decreased the odds by 0.783 (p < 0.001). Having studied at a university increased the odds by 1.812 times (p < 0.001) and possessing a certificate of higher education by 1.408 (p = 0.030). Being overweight decreased the odds by 0.924 (p = 0.006). For every additional year of age, the odds of consuming vegetables at least three times a day increased by 1.3% (p < 0.001).

CONCLUSIONS

The vast majority of the general Spanish population did not consume an optimal amount of vegetables. Women, people with higher levels of education, and older individuals reported having a more frequent intake of vegetables. Not cohabiting as a couple and being overweight were related to a less frequent intake of vegetables.

California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Be Better social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours

OBJECTIVE

Evaluation of California Department of Public Health's three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign.

DESIGN

Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours.

SETTING

CalFresh Healthy Living (California's SNAP-Ed).

PARTICIPANTS

Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated.

RESULTS

Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0·1 to 0·7).

CONCLUSIONS

The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.

Anthocyanins as Immunomodulatory Dietary Supplements: A Nutraceutical Perspective and Micro-/Nano-Strategies for Enhanced Bioavailability

Anthocyanins (ACNs) have attracted considerable attention for their potential to modulate the immune system. Research has revealed their antioxidant and anti-inflammatory properties, which play a crucial role in immune regulation by influencing key immune cells, such as lymphocytes, macrophages, and dendritic cells. Moreover, ACNs contribute towards maintaining a balance between proinflammatory and anti-inflammatory cytokines, thus promoting immune health. Beyond their direct effects on immune cells, ACNs significantly impact gut health and the microbiota, essential factors in immune regulation. Emerging evidence suggests that they positively influence the composition of the gut microbiome, enhancing their immunomodulatory effects. Furthermore, these compounds synergize with other bioactive substances, such as vitamins and minerals, further enhancing their potential as immune-supporting dietary supplements. However, detailed clinical studies must fully validate these findings and determine safe dosages across varied populations. Incorporating these natural compounds into functional foods or supplements could revolutionize the management of immune-related conditions. Personalized nutrition and healthcare strategies may be developed to enhance overall well-being and immune resilience by fully understanding the mechanisms underlying the actions of their components. Recent advancements in delivery methods have focused on improving the bioavailability and effectiveness of ACNs, providing promising avenues for future applications.

The CENTS program: promoting healthy eating by addressing perceived barriers

OBJECTIVE

Nutrition interventions addressing barriers to healthy eating can mitigate concerns regarding poor diet and obesity among college students. Aimed at reducing healthy eating perceived barriers, this investigation employed two mindset change intervention studies.

DESIGN

First, a nutrition improvement program called CENTS (Cost of Eating Nutritiously during Time as a Student) that disseminated specific information and utilized experiential activities for mindset change was developed and pilot tested using a pre/post study design. Second, using a similar pre/post method, the CENTS program was evaluated in a quasi-experimental design.

MAIN OUTCOME MEASURES

We examined perceived barriers to healthy eating (e.g. too costly, too much time), fruit and vegetable consumption, and other variables related to healthy eating (e.g. cost estimates, diet attitudes, self-efficacy, sugary foods consumption).

RESULTS

Results demonstrated some improvement in many outcomes between the two studies. Most noteworthy, the two major perceived barriers of healthy eating (i.e. too expensive, too much time to prepare) dramatically reduced and cost appraisal accuracy improved. Moreover, some attitudes to eat healthy improved and some unhealthy dietary behaviors reduced.

CONCLUSION

Using mindset change techniques to address perceived barriers to healthy eating, interventions can promote healthy eating and discourage unhealthy dietary habits among college students.

Global burden of non-communicable chronic diseases associated with a diet low in fruits from 1990 to 2019

Background

The aim of this study was to assess the global burden of disease from non-communicable chronic diseases (NCD) due to diet low in fruits from 1990 to 2019.

Methods

Based on data from the Global Burden of Disease (GBD) 2019, the global burden of disease due to diet low in fruits was analyzed for each country or region, disaggregated by disease type, age, sex, and year. The number of deaths and disability-adjusted life years (DALYs), population attributable fraction (PAF), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were calculated, and the average annual percentage change (AAPC) was calculated to describe trends in ASMR and ASDR from 1990 to 2019.

Results

From 1990 to 2019, the number of deaths and DALYs due to diet low in fruits increased by 31.5 and 27.4%, respectively. Among the tertiary diseases, ischemic heart disease, stroke, and diabetes and kidney disease were the top three contributors to the global increase in deaths and DALYs. However, both ASMR and ASDR showed a decreasing trend. The fastest decline in ASMR and ASDR was in stroke, with AAPC of -2.13 (95% CI: -2.22, -2.05, p < 0.05) and -0.56 (95% CI: -0.62, -0.51, p < 0.05), respectively. For GBD regions, high PAF occurred mainly in South Asia, Oceania, and sub-Saharan Africa. Age-specific PAF for stroke and ischemic heart disease death attributable to diet low in fruits was significantly negatively associated with age. Diet low in fruits related ASMR and ASDR showed an M-shaped relationship with the socio-demographic index (SDI), but with an overall decreasing trend.

Conclusion

The number of deaths and DALYs due to diet low in fruits continues to increase. Therefore, early nutritional interventions should be implemented by the relevant authorities to reduce the burden of diseases caused by diet low in fruits.

Digital behaviour change interventions to increase vegetable intake in adults: a systematic review

BACKGROUND

Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness.

METHODS

A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials.

RESULTS

Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain.

CONCLUSION

Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.

South African consumerattitudesunderlyingthechoicetoconsumegamemeat

Currently little is known about the South African game meat consumer market or the underlying attributes driving the choice to consume game meat, limiting the game meat industry's market positioning, growth and ultimately its contribution to food security and economic growth. The study explored attitudes of 1081 consumers through an online survey and structural equation modelling, to determine which game meat attributes were the strongest predictors of the choice to consume game meat. Health benefits and production ethics have the strongest direct relationship with the choice to consume game meat. Availability indicated a moderate and price a weak direct relationship whereas safety had no significant relationship with the choice to consume game meat. Future game meat marketing campaigns may need to emphasise health benefits and production ethics of game meat to stimulate the consumer market in South Africa. The findings from this study will benefit the game meat industry and advance SDG 2 to improve food security and address zero hunger in South Africa. Implementing the recommendations from this study may change consumers' approach to game meat which will also bring about economic change in South Africa.

A home gardening intervention to improve vegetable consumption among urban poor children: A study protocol for randomised controlled trial

Background: One of the key importance of vegetable consumption is to obtain sufficient micronutrients, dietary fibre, and for the prevention of childhood obesity. Most Malaysian children did not meet the recommended intake of vegetable consumption, and this is especially vulnerable among the urban poor population due to food insecurity. Efforts are needed to promote vegetable consumption that fall short of the recommended intake level. Aim: This trial aims to examine the effectiveness of the "GrowEat" project, as a nutrition intervention programme integrated with home gardening activities to improve vegetable consumption among urban poor children in Kuala Lumpur, Malaysia. Methods: This is a single-blinded parallel two-arm cluster randomised controlled trial (RCT) that include 134 children. Two zones in Kuala Lumpur will be randomly selected, and three low-cost housing flats from each zone will be selected as the intervention and control groups respectively. The trial is designed based on the social cognitive theory (SCT). Children from the intervention group (n = 67) will attend a 12-week programme, which consists of home garden-based activities, gardening and nutrition education session. Assessment will be conducted for both groups at three time points: baseline, post-intervention and follow-up phase at 3 months after the intervention. Conclusion: We anticipate positive changes in vegetable consumption and its related factors after the implementation of the "GrowEat" project. The current intervention may also serve as a model and can be extended to other urban poor population for similar interventions in the future to improve vegetable consumption, agriculture and nutrition awareness.

Revisiting fruit and vegetable determinants: Evidence from Latin America

Introduction

In the past decade, the public health discussion regarding fruit and vegetable (FV) consumption has been dominated by economic and physical accessibility.

Methods

Using an online survey in four Latin American countries, we applied a set of tobit models to compare the determinants of desirable and current consumption of FV levels for satisfied and unsatisfied respondents.

Results

We found that, even when consuming less than five FV portions a day, most of the respondents were satisfied with their current FV consumption level. Satisfied respondents consumed significantly more FV than unsatisfied ones. In general, the desirable and current consumption of FV levels were associated with different sets of determinants, while years of education were relevant in both cases. Finally, in a hypothetical case where unsatisfied respondents would not face any physical or economic access restrictions, unsatisfied respondents would not reach the goal of five FV portions a day.

Discussion

Assuming that physical and economic access improved, this would automatically increase FV to reach the five-a-day recommendation may be inaccurate in some cases. We also need to take mental access into account. We may ask how to improve the desirable level of FVs and then how to close the gap between the current and desirable FV levels.

The Nutrition Transition and the Double Burden of Malnutrition in Sub-Saharan African Countries: How Do These Countries Compare with the Recommended LANCET COMMISSION Global Diet?

BACKGROUND

Over the last two decades, many sub-Saharan African (SSA) countries have undergone dietary and nutrition transitions fuelled by rapid urbanisation, economic development, and globalisation. The aim of the current study was to examine outcomes of the nutrition transition and the epidemiologic transition in SSA countries in terms of food intake, health, and socioeconomic and development factors.

METHODS

Food balance sheet data-specifically, per capita energy intake per day and per capita gram intake per day-from the CountrySTAT framework of the Food and Agricultural Organization (FAO) were analysed for major food commodities. Additionally, selected health and development indicators supplied by UNICEF, the WHO and the World Bank were analysed.

RESULTS

Four dietary patterns emerged. The diet of the southern African/island cluster (South Africa, Mauritius, Eswatini, Namibia, Cabo Verde, and the outlier Seychelles) resembles a Westernised diet, with median values high on sugar/sweeteners, alcohol, meat, animal fats, eggs, and dairy. On the other hand, the diet of countries in the other three clusters appears to be more traditional, with countries in the desert/semi-arid cluster consuming more cereals and pulses/tree nuts, countries in the tropical coastal cluster consuming more fish and vegetable oils, and countries in the equatorial cluster consuming more starchy roots and fruit and vegetables. The resulting median values of health indicators also indicate a higher prevalence of non-communicable diseases in the southern African/island cluster, whereas stunting and anaemia are higher in the other three clusters.

CONCLUSIONS

SSA countries are in different stages of the nutrition transition. By superimposing clusters generated using macronutrient intake values on a map of the climatic regions in Africa, one can clearly see the importance of climate on the availability of food and food intake patterns. Climate change presents a great challenge to healthy eating, as the link between climate regions and diets is illustrated.

Effect of microfluidization on quality characteristics of sapodilla (Manilkara achras L.) juice

Various oxidative enzymes account for the quality degradation of sapodilla (Manilkara achras L.) juice and need to be inactivated through emerging and continuous green pressure processing technology. In this study, pressurization of sapodilla juice was attempted via microfluidization (MF) at pressure range of 10,000-30,000 pound per square inch (psi) with 1-3 passes or cycles. The impact of microfluidization on the activity of polyphenol oxidase (PPO), peroxidase (POD), color, total soluble solid (TSS), viscosity, serum cloudiness along with particle size, and microbial load of sapodilla juice was assessed. Results showed that microfluidization (MF) decreased the residual PPO activity from 100 to 80.78 % and POD activity from 100 to 40.57%. However, TSS (18.81-19.01 %), viscosity (2.64-2.06 cP), serum cloudiness (2.19-1.22 %) and total color change (3.19-18.54) was also significantly affected. Most of these changes were observed due to particle size (PS) reduction that varied from 65.19 to 8.13 μm. Microfluidized juice revealed color improvement at particular MF pressure and pass due to enzyme inactivation. Moreover, lowest microbial load (2.89 Log CFU/ mL) was found at 30,000 psi/3 pass of MF as compared to control sample (unprocessed juice) (7.57 Log CFU/ mL). Consequently, MF can be potential candidate in processing of juices against spoilage.

Exposure to (Poly)phenol Metabolites after a Fruit and Vegetable Supplement Intake: A Double-Blind, Cross-Over, Randomized Trial

Dietary (poly)phenol intake derived from the daily consumption of five portions of fruits and vegetables could protect against the development of non-communicable diseases. However, the general population does not meet the recommended intake. Supplementation with (poly)phenol-rich ingredients, within a varied and balanced diet, could help in filling this nutritional gap. This study aimed to validate the proof-of-concept of a (poly)phenolic supplementation developed to enhance the daily consumption of potentially bioactive compounds. Oxxynea^® is a (poly)phenol-rich ingredient developed to provide the quantity and the variety corresponding to five-a-day fruit and vegetable consumption. In this double-blind, randomized cross-over study, 10 participants were supplemented with 450 mg of a (poly)phenol-based supplement or a placebo. Pharmacokinetics and urinary excretion profiles were measured for 24 and 48 h, respectively, using UPHLC-MS/MS analysis. The pharmacokinetic profile displayed a triphasic absorption, indicating peaks of circulating metabolites at 1.75 ± 0.25 h, 4.50 ± 0.34 h, 9.50 ± 0.33 h and an average T_max (time of maximal plasma concentration) of 6.90 ± 0.96 h. Similarly, the urinary profile showed maximum metabolite excretion at 3-6 h, 6-10 h and 14-24 h after supplement consumption. Compared to individual metabolites belonging to different (poly)phenolic subfamilies, the total circulating and excreted metabolites showed a reduced coefficient of variation (CV 38%). The overall bioavailability estimated was 27.4 ± 3.4%. Oxxynea^® supplementation may provide a sustained exposure to several (poly)phenolic metabolites and catabolites and reduces the inter-individual variation that could arise from supplementing only one class of (poly)phenol.

Implication of knowledge, lifestyle and self-efficacy in the prevention of cardiovascular diseases' risk factors among the urban elderly

Background: Cardiovascular disease (CVD) is preventable by effectively managing its risk factors. Such risk factors (smoking, unhealthy eating habits, sedentary lifestyles, etc.) are judged to reflect an individual's self-efficacy, lifestyle modification, and CVD knowledge. Objectives: To evaluate the relationship between lifestyle practices, self-efficacy, and knowledge of CVDs risk factors among the elderly. Methods: A descriptive cross-sectional study was conducted on 424 randomly individuals whose age is ≥60 years. A questionnaire-based survey was administered on the self-efficacy rate, lifestyle practices, and respondents' knowledge of CVDs risk factors. Respondents with a score of ≤50%, 51%-74.99%, and ≥75% were classified as having low, medium, or high self-efficacy. Similarly, the same score was used to classify poor, fair, or good lifestyle; and low, average, or high knowledge. Data were analysed using Statistical Package for Social Sciences, while association among variables was determined using chi-square. Results: Few respondents were involved in physical exercise (1.7%), cigarette smoking (4.5%), regular soft drinks (18.2%), and alcohol consumption (13.2%). Many respondents used excess salt during cooking (92.7%) or ate outside their homes (64.6%). 58.5%, 30.0%, and 11.6% of the respondents had fair, good, and poor lifestyle practices. 11.3%, 58.7%, and 30.0% had low, medium, and high self-efficacy scores. A total of 45.3%, 35.4%, and 19.3% had low, average, and high knowledge. Knowledge and self-efficacy scores were significantly different (P  =  0.001). Conclusion: High self-efficacy and its significant relationship with knowledge could mean that CVD risk factors can be checked if the elderly have a proper lifestyle, positive attitudes, and nutrition education.

Healthy Choices Catch On: Data-informed Evolution of a Social Marketing Campaign

OBJECTIVE

Describe how a multiyear, mixed-methods evaluation informed the evolution of a healthy eating and physical activity social marketing campaign.

DESIGN

Focus groups, A/B survey to test messages and images, telephone interviews (2019) with local programmers, and an annual outcome survey.

SETTING

Statewide through multiple channels: billboards, transit signs, social media, website, and program resources like banners and posters.

PARTICIPANTS

Supplemental Nutrition Assistance Program-Education eligible adults, focusing on mothers and caregivers.

INTERVENTION(S)

Healthy Choices Catch On originally launched in 2006 and has since evolved.

MAIN OUTCOME MEASURE(S)

Fruit and vegetable consumption, physical activity, and campaign recall.

ANALYSIS

Univariate descriptive statistics and multivariate, weighted linear regression modeling. Interview transcriptions were analyzed for common themes.

RESULTS

The multiyear evaluation demonstrated a steady increase in campaign exposure from 2013 to 2017, followed by a decline when new messages and images were introduced in 2018 and 2020. People with greater exposure to messages were more likely to eat more fruits and vegetables and be physically active.

CONCLUSIONS AND IMPLICATIONS

Using a combination of evaluation methods can help inform campaign design and evolution while also demonstrating reach and impact.

Integrated metabolomics of "big six" Escherichia coli on pea sprouts to organic acid treatments

Naturally occurring organic acids (OAs) have demonstrated satisfactory effects in inhibiting common pathogens on fresh produce; however, their effectiveness on "big six" Escherichia coli serotypes, comprised of E. coli O26:H11, O45:H2, O103:H11, O111, O121:H19 and O145, remained unaddressed. Regarding this, using nuclear magnetic resonance (NMR) spectroscopy and ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS), the sanitising efficacy and the underlying antimicrobial mechanisms of 10-min treatments with 0.2 mol/L ascorbic acid (AA), citric acid (CA) and malic acid (MA) against the "big six" strains on pea sprouts were thoroughly investigated in this study. Despite the varying antimicrobial efficacy (AA: 0.12-0.99, CA: 0.36-1.72, MA: 0.75-3.28 log CFU/g reductions), the three OAs induced consistent metabolic changes in the E. coli strains, particularly in the metabolism of membrane lipids, nucleotide derivatives and amino acids. Comparing all strains, the most OA-resistant strain, O26 (0.36-1.12 log CFU/g reductions), had the largest total amino acids accumulated to resist osmotic stress; its ulteriorly suppressed cell activity further strengthened its endurance. In contrast, the lowest OA-resistance of O121 (0.99-3.28 log CFU/g reductions) might be explained by the depletion of putrescine, an oxidative stress regulator. Overall, the study sheds light on the effectiveness of a dual-platform metabolomics investigation in elucidating the metabolic responses of "big six" E. coli to OAs. The manifested antimicrobial effects of OAs, especially MA, together with the underlying metabolic perturbations detected in the "big six" strains, provided scientific basis for applying OA treatments to future fresh produce sanitisation.

How to Measure Organic Fruit Consumer Behavior: A Systematic Review

This review article seeks to systematically identify appropriate ways to measure the consumption behavior of organic fruits. The systematic review of the literature was performed according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the eligibility criteria were declared through the PICOS (population, interventions, comparators, outcomes, and study) tool based on 277 article records scientiometrically identified in both the Journal Citation Report databases from Web of Science. The literature review stages determined a reduced set of articles that presented valid and reliable measurement scales that covered determinant constructs in organic fruit consumer behavior (OFCB). The measurement scale with the best results reported within the screened articles covered the constructs related to health, fear, environment, effort, and economy, allowing it to serve as a reference instrument in further studies on food consumer behavior.

A Comparison of Dietary Patterns and Factors Influencing Food Choice among Ethnic Groups Living in One Locality: A Systematic Review

Globally, the number of minority ethnic groups in high-income countries is increasing. However, despite this demographic change, most national food consumption surveys are not representative of ethnically diverse populations. In consequence, many ethnic minorities' dietary intakes are underreported, meaning that accurate analysis of food intake and nutrient status among these groups is not possible. This systematic review aims to address these gaps and understand differences in dietary intakes and influencers of dietary habits of ethnic groups worldwide. A systematic search was conducted through three databases (Pubmed, Web of Science and Scopus) and manual searches, generating n = 56,647 results. A final search of these databases was completed on 13 September 2021, resulting in a total of 49 studies being included in this review. Overall, food group intakes-particularly fruit, vegetable and fish intake-and diet quality scores were seen to differ between ethnicities. Overall Black/African American groups were reported to be among the poorest consumers of fruit and vegetables, whilst Asian groups achieved high diet quality scores due to higher fish intakes and lower fat intakes compared to other groups. Limited data investigated how nutrient intakes, dietary and meal patterns compared between groups, meaning that not all aspects of dietary intake could be compared. Socioeconomic status and food availability appeared to be associated with food choice of ethnic groups, however, confounding factors should be considered more closely. Future work should focus on comparing nutrient intakes and meal patterns between ethnicities and investigate potential targeted interventions which may support adherence to food-based dietary guidelines by all ethnic groups.

Viruses Infecting Trees and Herbs That Produce Edible Fleshy Fruits with a Prominent Value in the Global Market: An Evolutionary Perspective

Trees and herbs that produce fruits represent the most valuable agricultural food commodities in the world. However, the yield of these crops is not fully achieved due to biotic factors such as bacteria, fungi, and viruses. Viruses are capable of causing alterations in plant growth and development, thereby impacting the yield of their hosts significantly. In this work, we first compiled the world's most comprehensive list of known edible fruits that fits our definition. Then, plant viruses infecting those trees and herbs that produce fruits with commercial importance in the global market were identified. The identified plant viruses belong to 30 families, most of them containing single-stranded RNA genomes. Importantly, we show the overall picture of the host range for some virus families following an evolutionary approach. Further, the current knowledge about plant-virus interactions, focusing on the main disorders they cause, as well as yield losses, is summarized. Additionally, since accurate diagnosis methods are of pivotal importance for viral diseases control, the current and emerging technologies for the detection of these plant pathogens are described. Finally, the most promising strategies employed to control viral diseases in the field are presented, focusing on solutions that are long-lasting.

Behavioural change box? Applying the COM-B model to understand behavioural triggers that support consumption of fruits and vegetable among subscribers of a fruit and vegetable box scheme

OBJECTIVE

To understand the key mechanisms that support healthy dietary habits promoted by fruit and vegetable (F&V) box schemes, testing relevant behaviour change triggers identified under the COM-B model in an evaluation research study of a Portuguese F&V box scheme (PROVE).

DESIGN

Correlation study with a post-test-only non-equivalent group design based on survey data. The mechanisms underpinning the differences between subscribers and non-subscribers are operationalised as mediation effects. Data availability, theoretical relevance and empirical validation supported the selection and testing of four potential mediators for the effects of subscribing to the box scheme on F&V consumption. These estimations derive from the coefficients of a structural equation model combined with the product coefficient approach and Sobel test.

SETTING

The study is part of a wider evaluation study on the impact of the PROVE box scheme on sustainability, health and equity.

PARTICIPANTS

A sample of PROVE box subscribers (n 294) was compared with a matched subsample of non-subscribers (n 571) in a nationally representative survey.

RESULTS

Subscribing to the PROVE box correlates with an increased probability of eating at least five portions of F&V, irrespective of differences in age, education and perceived economic difficulties. Diet quality perceptions, and more robustly, the strength of meal habits and household availability were identified as relevant mediators.

CONCLUSIONS

The subscription to an F&V box scheme is connected with proximal context that enables the consumption of F&V by ensuring more readily available F&V and better situational conditions associated with healthier meal habits.

Preservatives from food-For food: Pea protein hydrolysate as a novel bio-preservative against Escherichia coli O157:H7 on a lettuce leaf

Fresh-cut fruits and vegetables are becoming particularly popular as healthy fast-food options; however, they present challenges such as accelerated rates of decay and increased risk for contamination when compared to whole produce. Given that food safety must remain paramount for producers and manufacturers, research into novel, natural food preservation solutions which can help to ensure food safety and protect against spoilage is on the rise. In this work, we investigated the potential of using a novel protein hydrolysate, produced by the enzymatic hydrolysis of Pisum sativum (PSH), as a novel bio-preservative and its abilities to reduce populations of Escherichia coli O157:H7 after inoculation on a lettuce leaf. While unhydrolyzed P. sativum proteins show no antimicrobial activity, once digested, and purified, the enzymatically released peptides induced in vitro bactericidal effects on the foodborne pathogen at 8 mg/ml. When applied on an infected lettuce leaf, the PSH significantly reduced the number of bacteria recovered after 2 hr of treatment. PSH may be preferred over other preservation strategies based on its natural, inexpensive, sustainable source, environmentally friendly process, nontoxic nature, good batch to batch consistency, and ability to significantly reduce counts of E. coli both in vitro and in a lettuce leaf.

Food on the Move: The Impact of Implied Motion in Pictures on Food Perceptions through Anticipated Pleasure of Consumption

To tackle obesity, upgrading the image of healthy food is increasingly relevant. Rather than focusing on long-term benefits, an effective way to promote healthy food consumption through visual advertising is to increase its pleasure perception. We investigate whether implied motion, a popular trend in food pictures, affects food perceptions through anticipated consumption pleasure. Prior research shows that motion affects food perceptions, but these studies focused on limited food categories, using experiments with a single food stimulus, and mainly showing unhealthy food effects. Therefore, we aim to (1) replicate prior findings on the effects of food in motion on appeal, tastiness, healthiness, and freshness perceptions; (2) examine whether these effects differ for healthy and unhealthy food; and (3) investigate whether anticipated pleasure of consumption drives the effects of implied motion on food perceptions. Three between-subjects experiments (N = 626) reveal no evidence for the effectiveness of motion (vs. no motion) across a large variety of food products. We further show no differential effects for healthy versus unhealthy foods. Moreover, implied motion does not increase appeal or taste perceptions through anticipated pleasure. Considering the current replication crisis, these findings provide more nuanced insights into the effectiveness of motion in visual food advertising.

Exploring Pathways of Socioeconomic Inequity in Vegetable Expenditure Among Consumers Participating in a Grocery Loyalty Program in Quebec, Canada, 2015-2017

Vegetable consumption remains consistently low despite supportive policy and investments across the world. Vegetables are available in great variety, ranging in their processing level, availability, cost, and arguably, nutritional value. A retrospective longitudinal study was conducted in Quebec, Canada to explore pathways of socioeconomic inequity in vegetable expenditure. Data was obtained for consumers who participated in a grocery loyalty program from 2015 to 2017 and linked to the 2016 Canadian census. Vegetable expenditure share (%) was examined as a fraction of the overall food basket and segmented by processing level. Panel random effects and tobit models were used overall and to estimate the stratified analysis by median income split. Consumers allocated 8.35% of their total food expenditure to vegetables, which was mostly allocated to non-processed fresh (6.88%). Vegetable expenditure share was the highest in early winter and lowest in late summer. In the stratified analysis, the low-income group exhibited less seasonal variation, allocated less to fresh vegetables, and spent more on canned and frozen compared to the high-income group. Measures of socioeconomic status were all significant drivers of overall vegetable consumption. Consumers with high post-secondary education in the low-income group spent 2% more on vegetables than those with low education. The complexity of observed expenditure patterns points to a need for more specific vegetable consumption guidelines that include provisions by processing level. Implications for education, marketing, intersectional policies, and the role of government are discussed. Governments can scale present efforts and catalyze health-promoting investments across local, state, national, and global food systems.

Awareness and outcomes of the fruits and veggies (FNV) campaign to promote fruit and vegetable consumption among targeted audiences in California and Virginia: a cross-sectional study

Background

In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to apply a unique industry-inspired marketing approach to promote fruit and vegetable sales and intake to moms and teens in two US pilot markets: Fresno, California and Hampton Roads, Virginia. The aims of this cross-sectional study were to: 1) assess brand awareness and fruit- and vegetable-related outcomes among FNV Campaign target audiences in the California and Virginia market locations; and 2) examine whether reported awareness of the FNV Campaign was associated with differences in fruit- and vegetable-related cognitive and behavioral outcomes.

Methods

Data for this cross-sectional study were collected using an online survey administered to a non-probability convenience sample (n = 1604; February–July 2017) of youth aged 14–20 years (n = 744) and moms aged 21–36 years (n = 860) in the two pilot markets. Descriptive statistics were computed and outcomes compared between unaware and aware respondents, controlling for sociodemographic covariates. Multivariate analysis of covariance (MANCOVA) was conducted to assess whether fruit- and vegetable-related attitude, belief, and encouragement outcomes differed by FNV Campaign awareness; logistic regression was used to examine associations between FNV brand awareness and dichotomous variables (fruit- and vegetable-related behavioral intentions, trying new fruits and vegetables); and ANCOVA was used to assess associations with daily fruit and vegetable intake frequency.

Results

Approximately 20% (n = 315/1604) of respondents reported awareness of the FNV Campaign. Youth that reported awareness of the FNV Campaign (n = 167, 22.4%) had higher intentions to buy (p = 0.003) and eat (p = 0.009) fruits and vegetables than unaware respondents. Mothers that reported awareness of the FNV Campaign (n = 148, 17.2%) reported greater encouragement for friends and family to eat fruits and vegetables (p = 0.013) and were approximately 1.5 times more likely to report trying a new fruit or vegetable (p = 0.04) than mothers unaware of the Campaign. Daily fruit and vegetable intake frequency did not differ by Campaign awareness.

Conclusions

FNV Campaign awareness was associated with limited but positive short- and intermediate-term cognitive and behavioral outcomes among target audience respondents. These findings can inform future research to enhance understanding and improve the FNV Campaign as it is expanded to new markets nationwide.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11055-6.

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.

Does exposure to socially endorsed food images on social media influence food intake?

Social norms can influence the consumption of high and low energy-dense (HED/LED) snack foods. Such norms could be communicated via social media, however, there is little experimental research investigating this possibility. This laboratory study aimed to investigate the acute effect of socially endorsed social media posts on participants' eating behaviour. Healthy women students (n = 169; mean age = 20.9; mean BMI = 23.3) were assigned to either a HED, LED or control condition, where they viewed three types of images (HED foods, LED foods and interior design as control), but only one type was socially endorsed (e.g. in the control condition, only interior design images were socially endorsed). Participants completed questionnaires and were also provided a snack buffet of grapes and cookies. One-way ANOVA revealed a significant main effect of condition on participants' relative consumption of grapes (percentage of grapes consumed out of total food intake), for both grams and calories consumed (both ps < .05). Follow-up t-tests revealed that participants consumed a larger proportion of grapes (grams and calories) in the LED condition vs HED condition (all ps < .05), and a larger proportion of calories from grapes in the LED compared to control condition (p < .05). These findings suggest that exposure to socially endorsed images of LED food on social media could nudge people to consume more of, and derive more calories from these foods in place of HED foods. Further research is required to examine the potential application of these findings.

Explaining inequalities in fruit and vegetable intake in Europe: The role of capabilities, opportunities and motivations

People who do not eat enough fruit and vegetables (F&V) have incremental health risks. Most Europeans do not comply with health recommendations relating to F&V consumption and this is especially true for those with lower-level education, which reinforces structural inequalities in health and wellbeing among Europeans. This study investigated the role of key behavioural triggers - capabilities, opportunities and motivation (in the COM-B model) - as pathways for educational differentials in F&V intake in Europe. A cross-sectional survey-based study was conducted in five European countries differing widely in their consumption habits, wealth, and climatic conditions. A structural equation model was designed to study how capabilities (diet perceived knowledge, health purchase criteria), opportunities (financial availability, social norms), and motivations (health value, habits strength) affect educational inequalities in the intake of F&V (5 portions a day) as mediators. Multi-group comparisons assessed country differences. People with higher levels of education were more likely to eat the recommended diet, i.e., at least 5 portions of F&V a day. Countries in the sample vary significantly in the percentage of people complying with the recommendation, but not significantly in terms of relative education differentials. The educational gap in the intake of F&V is mainly explained by education differentials in financial availability, diet knowledge, and habits in inserting F&V in main meals. Policies targeting dietary inequalities should address behavioural triggers affecting dietary intake, for example by subsidising F&V, developing targeted dietary awareness campaigns, or by intervening in mass catering contexts to facilitate the implementation of healthy habits.

Assessment of microbial risk during Australian industrial practices for Escherichia coli O157:H7 in fresh cut-cos lettuce: A stochastic quantitative approach

Escherichia coli O157:H7 risk associated with the consumption of fresh cut-cos lettuce during Australian industrial practices was assessed. A probabilistic risk assessment model was developed and implemented in the @Risk software by using the Monte Carlo simulation technique with 1,000,000 iterations. Australian preharvest practices yielded predicted annual mean E. coli O157:H7 levels from 0.2 to -3.4 log CFU/g and prevalence values ranged from 2 to 6.4%. While exclusion of solar radiation from the baseline model yielded a significant increase in concentration of E. coli O157:H7 (-5.2 -log fold), drip irrigation usage, exclusion of manure amended soil and rainfall reduced E. coli O157:H7 levels by 7.4, 6.5, and 4.3-log fold, respectively. The microbial quality of irrigation water and irrigation type both had a significant effect on E. coli O157:H7 concentrations at harvest (p < 0.05). The probability of illness due to consumption of E. coli O157:H7 contaminated fresh cut-cos lettuce when water washing interventions were introduced into the processing module, was reduced by 1.4-2.7-log fold (p < 0.05). This study provides a robust basis for assessment of risk associated with E. coli O157:H7 contamination on fresh cut-cos lettuce for industrial practices and will assist the leafy green industry and food safety authorities in Australia to identify potential risk management strategies.

Perceived environmental supports for fruit and vegetable consumption among older adults in the US

BACKGROUND

The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur.

AIM

To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption.

METHODS

Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption.

RESULTS

The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables.

CONCLUSION

Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Factors Associated with an Unhealthy Lifestyle among Adults in Riyadh City, Saudi Arabia

BACKGROUND

Unhealthy lifestyles are a global concern. This study measured the prevalence and factors associated with an unhealthy lifestyle in Riyadh city, Saudi Arabia.

METHODS

An interview-based, cross-sectional study was conducted with 968 males and 2029 females, aged 30-75 years, covering 18 primary health care centers in Riyadh. Multivariate logistic regression analyses were conducted to identify the significant determinants associated with an unhealthy lifestyle.

RESULTS

Overall, men were 1.49 (1.28, 1.74) times at higher risk of an unhealthy lifestyle compared to women. Men reporting unhealthy lifestyle were 2.1 (1.3, 3.4) and 1.5 (1.0, 2.6) times more likely than men with healthy lifestyle to cite not enjoying physical activity, lack of social support, and not having enough information about a healthy diet [1.5 (1.0, 2.0)], whereas those ≥ 45 years age group were 30 times less likely to report unhealthy lifestyle [0.7 (0.5, 0.9)]. In contrast, in women aged ≥ 45 years [1.3 (1.1, 1.7)], lack of motivation [1.3 (1.1, 1.7)], feeling conscious while exercising [2.0 (1.4, 2.9)], not enjoying healthy food [1.6 (1.3, 2.1)], and no family support to prepare healthy food [1.4 (1.1, 1.8)] were significantly associated with an unhealthy lifestyle.

CONCLUSIONS

In a Saudi sample, younger men and older women are at higher risk of an unhealthy lifestyle. In addition to self-motivation, combined strategies to promote physical activity and healthy eating are required to improve lifestyle.

Understanding the Variation within a Dietary Guideline Index Score to Identify the Priority Food Group Targets for Improving Diet Quality across Population Subgroups

Globally, population dietary intakes fall below the guideline recommendations and large-scale interventions have had modest success in improving diet quality. To inform the development of more targeted approaches, this study analysed the variations in self-reported data from an online survey of Australian adults collected between 2015 and 2020, to identify common combinations of low scoring components within a dietary guideline index. A low score was defined as meeting less than half the guideline recommendations (a score <50 out of 100). Among 230,575 adults, a single component analysis showed that 79.5% had a low score for discretionary choices, 72.2% for healthy fats and 70.8% for dairy. The combinations approach showed 83.0% of individuals had two to five low scoring components, with men, younger adults aged 18-30 years and individuals with obesity (BMI ≥ 30) more likely to have five or more. The most common dietary pattern combination included low scores for discretionary choices, dairy and healthy fats. There was a considerable but systematic variation in the low scoring components within the dietary patterns, suggesting that interventions with the flexibility to address particular combinations of key food groups across subgroups could be an effective and resource efficient way to improve diet quality in the population.

The Big Three Health Behaviors and Mental Health and Well-Being Among Young Adults: A Cross-Sectional Investigation of Sleep, Exercise, and Diet

BACKGROUND

Sleep, physical activity, and diet have been associated with mental health and well-being individually in young adults. However, which of these "big three" health behaviors most strongly predicts mental health and well-being, and their higher-order relationships in predictive models, is less known. This study investigated the differential and higher-order associations between sleep, physical activity, and dietary factors as predictors of mental health and well-being in young adults.

METHOD

In a cross-sectional survey design, 1,111 young adults (28.4% men) ages 18-25 from New Zealand and the United States answered an online survey measuring typical sleep quantity and quality; physical activity; and consumption of raw and processed fruit and vegetables, fast food, sweets, and soda, along with extensive covariates (including demographics, socioeconomic status, body mass index, alcohol use, smoking, and health conditions) and the outcome measures of depressive symptoms [measured by the Center for Epidemiological Depression Scale (CES-D)] and well-being (measured by the Flourishing Scale).

RESULTS

Controlling for covariates, sleep quality was the strongest predictor of depressive symptoms and well-being, followed by sleep quantity and physical activity. Only one dietary factor-raw fruit and vegetable consumption-predicted greater well-being but not depressive symptoms when controlling for covariates. There were some higher-order interactions among health behaviors in predicting the outcomes, but these did not survive cross-validation.

CONCLUSION

Sleep quality is an important predictor of mental health and well-being in young adults, whereas physical activity and diet are secondary but still significant factors. Although strictly correlational, these patterns suggest that future interventions could prioritize sleep quality to maximize mental health and well-being in young adults.