Who eats 5 a day?: intake of fruits and vegetables among Norwegians in relation to gender and lifestyle

The effect of free school fruit on academic performance: a nationwide quasi-experiment

In past research, higher intake of fruit has been associated with better academic achievement. In Norway, the government required lower secondary schools to provide fruit to their pupils from 2007 to 2014. The present study assessed whether this policy improved academic performance. In addition to secondary schools, the policy covered schools with combined elementary and lower secondary education, but not ordinary elementary schools. This differentiation, in combination with administrative data on test scores before, during, and after the law was enforced, created a nationwide quasi-experiment. Population register data on parents' sociodemographic characteristics allowed for targeted analyses on a subsample of boys with low sociodemographic status. In analyses of 5th grade tests, the free fruit policy coincided with a slight decline in test scores among eligible compared to non-eligible pupils in the subsample (B = - 0.18, 95%CI[- 0.35, - 0.01]) and entire population (B = - 0.14, 95%CI[- 0.24, - 0.05]). Exploratory analyses of exam data in 10th grade yielded similar results, and sensitivity tests either failed to detect any effect or demonstrated a negative tendency. In a Western country with low levels of food insecurity, a policy that required schools to provide free fruit to pupils did not appear to improve academic performance.

Bilberry/red grape juice decreases plasma biomarkers of inflammation and tissue damage in aged men with subjective memory impairment -a randomized clinical trial

BACKGROUND

Few randomized clinical trials have explored the health effects of bilberries in humans. The aim was to test the effect of bilberry and red grape-juice consumption on visual memory, motor speed and dexterity as well as inflammatory and tissue damage biomarkers of plasma in aged men with subjective memory impairment.

METHODS

Nine-week double-blind, placebo-controlled, dietary intervention study of aged men (n = 60, age ≥ 67 years) with subjective memory impairment randomized to consume a 50/50 mix of bilberry/red grape-juice or an iso-caloric placebo juice. A selection of Cambridge Cognition Test Battery (CANTAB), Grooved Pegboard tests and blood-sampling for biomarker analysis were performed before and after the intervention.

RESULTS

Compared to placebo the selected memory and motor test scores were un-affected by the bilberry/red grape intervention. However, the plasma levels of tissue damage biomarkers decreased significantly more in the bilberry/red grape group. In particular lactate dehydrogenase (LDH) decreased from 362 U/L (median, baseline) to 346 U/L (median, post intervention) in the bilberry/red grape group. Also, several biomarkers of inflammation (EGF, IL6, IL9, IL10 and TNFα) decreased significantly more in the bilberry/red grape group. Furthermore, several plasma polyphenols; p-coumaric acid, hippuric acid, protocatechuic acid, 3HPAA and vanillic acid, increased significantly more in the bilberry/red grape group compared to placebo with the largest increase in p-coumaric acid with 116%; from 2.2 [1.0,5.5] to 4.7 [2.8,8.1] μM/L (median [95% CL]).

CONCLUSIONS

The results indicate that a nine-week bilberry/red grape juice intervention has no measurable effects on the selected memory scores in aged men experiencing memory problems but decreases the level of biomarkers of inflammation and tissue damage. Whether the dampening effects on inflammation and tissue damage biomarkers have relevance for neuroinflammatory brain pathology remains to be established.

TRIAL REGISTRATION

Registration number ( ClinicalTrials.gov : NCT00972972 ), September 9, 2009.

Variety in fruits and vegetables, diet quality and lifestyle in an older adult mediterranean population

BACKGROUND AND AIMS

Previous studies, mainly focused on quantity rather than variety, have shown beneficial associations between the amount of fruit and vegetable consumed, diet quality and healthy lifestyle. The aim is to evaluate the association between fruit and vegetable consumption, diet quality and lifestyle in an elderly Mediterranean population, considering both variety and the combination of quantity and variety (QV).

METHODS

A cross-sectional analysis of 6647 participants (51.6% of males) was conducted in the framework of the PREDIMED-Plus study. A variety score was created as the sum of vegetables and/or fruits consumed at least once per month using food frequency questionnaires. Dietary Reference Intakes (EAR and IA values) were used to estimate the prevalence of inadequate intake of dietary fiber and micronutrients. Logistic regression models were performed to examine the association between fruit and vegetable consumption and not meeting the DRIs, by tertiles of fruit and vegetable variety and QV categories.

RESULTS

Participants with higher fruit and vegetable variety score reported a significant higher intake of fiber, vitamins, minerals and flavonoids and were significantly more likely to be physically active and non-smoker. Besides, higher variety in fruit and vegetable consumption was associated with lower prevalence of having an inadequate intake of fiber [(0.13 (0.11-0.16)], two or more [(0.17 (0.14-0.21)], three or more [(0.15 (0.13-0.18)] and four or more [(0.11 (0.10-0.14)] micronutrients in our participants. Higher quantity and variety in fruit and vegetable consumption was associated with lower prevalence of having an inadequate intake of fiber [(0.05 (0.04-0.06)], two or more [(0.08 (0.06-0.10)], three or more [(0.08 (0.06-0.09)] and four or more [(0.06 (0.05-0.07)] micronutrients.

CONCLUSION

Greater variety in fruit and vegetable intake was associated with better nutrient adequacy, diet quality and healthier lifestyle in an elderly Mediterranean population.

Nutrition knowledge, attitudes, and practice towards breast cancer prevention among the female population of Iran University of medical science students

Diet plays a measurable role in breast cancer (BC) prevention. The aims of this study were to assess nutrition-related BC prevention Knowledge, attitudes and practice (KAP) of female university students and to examine the relationship between demographic characteristics of students and their KAP. We conducted a cross-sectional study among 500 female students from Iran University of Medical Science (IUMS). A pretested self-administered questionnaires were used to assess the participants' nutrition-related BC prevention KAP. A total of 500 students completed the survey. Students' knowledge with the mean score of 16.97, significantly varied by age (P= 0.03), the field of study (P= 0.001) and family history of BC (P= 0.01). The mean score of attitudes and practice toward nutrition-related BC prevention factors were 24.86 and 39.39, respectively. A significant relationship was observed between nutrition knowledge and attitude (r = 0.27, P < 0.001). Also, Nutrition-related attitudes were positively correlated with the BC prevention dietary practices (r = 0.23, P < 0.001). Nutrition KAP about BC prevention factors was found to be influenced by individual factors such as age, field of study, familial history of BC, job and residency status. Together, our findings confirm that increasing nutrition knowledge is not sufficient for dietary behavior change, but is necessary.

Happiness and health behaviors in South Korean adolescents: a cross-sectional study

OBJECTIVES:

We examined the associations between happiness and a wide range of health behaviors in South Korean adolescents.

METHODS:

Study data were derived from the ninth Korea Youth Risk Behavior Web-based Survey administered from June to July 2013. In addition to happiness levels, the questionnaire included items on sociodemographics and health-related lifestyle factors (smoking, drinking, eating breakfast, fruit and vegetable consumption, physical activity, sedentary behavior, and hours of sleep).

RESULTS:

The multivariate analysis revealed that higher levels of happiness were associated with not smoking or drinking, eating breakfast, eating fruits daily, vegetable consumption, participating in at least 60 minutes of physical activity a day, avoiding sedentary behavior, and hours of sleep. Additionally, sex differences were found in relationships between happiness and eating fruit daily, participation in physical activity, and sedentary behavior.

CONCLUSIONS:

These results encourage public health professionals to consider the psychological aspects of adolescent life in working to improve their health behaviors and outcomes.

Impact of childhood experience and adult well-being on eating preferences and behaviours

OBJECTIVES

To examine the relative contribution of childhood experience, measured by childhood violence and childhood happiness, and adult well-being on adult eating preferences and behaviours, independent of proximal factors such as current deprivation.

DESIGN

A cross-sectional, stratified, randomised sample survey using retrospective measures of childhood violence and happiness and self-reported measures of current well-being.

SETTING

The North West Region of England between September 2012 and March 2013.

PARTICIPANTS

Individuals aged 18-95-year-olds from randomly selected households (participation was successful for 90% of eligible households and 78% of the total visited addresses; n=11,243).

OUTCOMES

Dichotomised measures for preference of healthy foods or 'feel good' foods and low or high daily fruit and vegetable consumption.

RESULTS

After correcting for demographics, combined categories for childhood experience and dichotomised measures of adult well-being were found to be significantly related to adult food preferences and eating behaviours. Participants with unhappy and violent childhoods compared to those with happy and non-violent childhoods had adjusted ORs (95% CI, significance) of 2.67 (2.15 to 3.06, p<0.001) of having low daily fruit and vegetable intake (two or less portions) and 1.53 (1.29 to 1.81, p<0.001) of choosing 'feel good' foods over foods which were good for their long term health.

CONCLUSIONS

Daily intake of fruit and vegetables, linked to non-communicable diseases, and preference for 'feel good' foods, linked to obesity, are affected by childhood experience and adult well-being independent of demographic factors. Preventative interventions which support parent-child relationships and improve childhood experience are likely to reduce the development of poor dietary and other health-risk behaviours.

Consumer clusters in Denmark based on coarse vegetable intake frequency, explained by hedonics, socio-demographic, health and food lifestyle factors. A cross-sectional national survey

Vegetable intake seems to play a protective role against major lifestyle diseases. Despite this, the Danish population usually eats far less than the recommended daily intake. The present study focused on the intake of 17 coarse vegetables and the potential barriers limiting their intake. The present study drew upon a large Danish survey (n = 1079) to study the intake of coarse vegetables among Danish consumers. Four population clusters were identified based on their intake of 17 different coarse vegetables, and profiled according to hedonics, socio-demographic, health, and food lifestyle factors. The four clusters were characterized by a very low intake frequency of coarse vegetables ('low frequency'), a low intake frequency of coarse vegetables; but high intake frequency of carrots ('carrot eaters'), a moderate coarse vegetable intake frequency and high intake frequency of beetroot ('beetroot eaters'), and a high intake frequency of all coarse vegetables ('high frequency'). There was a relationship between reported liking and reported intake frequency for all tested vegetables. Preference for foods with a sweet, salty or bitter taste, in general, was also identified to be decisive for the reported vegetable intake, as these differed across the clusters. Each cluster had distinct socio-demographic, health and food lifestyle profiles. 'Low frequency' was characterized by uninvolved consumers with lack of interest in food, 'carrot eaters' vegetable intake was driven by health aspects, 'beetroot eaters' were characterized as traditional food consumers, and 'high frequency' were individuals with a strong food engagement and high vegetable liking. 'Low frequency' identified more barriers than other consumer clusters and specifically regarded low availability of pre-cut/prepared coarse vegetables on the market as a barrier. Across all clusters a low culinary knowledge was identified as the main barrier.

Socio-economic and behavioural determinants of fruit and vegetable intake in Moroccan women

OBJECTIVE

To estimate daily fruit and vegetable intakes and to investigate socio-economic and behavioural differences in fruit and vegetable consumption among urban Moroccan women.

DESIGN

A cross-sectional survey. Fruit and vegetable intake was measured with a single 24 h recall.

SETTINGS

A representative population-based survey conducted in the area of Rabat-Salé.

SUBJECTS

Women (n 894) of child-bearing age (20-49 years).

RESULTS

Mean fruit and vegetable intake was 331 g/d (155 g/d for fruit and 176 g/d for vegetables). Only one-third (32.1 %) of women consumed ≥ 400 g/d and half the sample (50.6 %) were considered as low consumers, i.e. <280 g/d. Women of higher economic status ate significantly more fruit (P<0.05) and more fruit and vegetables combined (P<0.05). Women ate significantly less vegetables if they ate out of home more often or skipped at least one main meal (breakfast, lunch or dinner) or ate more processed foods (P<0.05, P<0.01 and P<0.001, respectively). Fruit and vegetable diversity was not associated with any of the factors investigated.

CONCLUSIONS

In this population, fruit and vegetable intakes are driven by different determinants. Indeed, while vegetable consumption was related only to behavioural determinants, fruit consumption was influenced only by economic status. Therefore, programmes promoting fruit and vegetable intake would be more effective if they account for these specific determinants in their design.

Do smoking and fruit and vegetable intake mediate the association between socio-economic status and plasma carotenoids?

BACKGROUND

The aim was to study whether the association between educational attainment and antioxidant status is mediated by smoking and fruit and vegetable intake.

METHODS

Cross-sectional analyses of the Oslo Youth Study 2006 wave were carried out. Information about education, smoking habits and diet was collected by questionnaire for 261 subjects (142 women and 119 men aged 38-42 years). Blood samples, height and weight measurements were taken by the participants' General Practitioner. Blood were analysed for plasma carotenoids. Linear regression analyses were used to examine whether smoking and fruit and vegetable intake mediate the association between education and plasma carotenoids.

RESULTS

Educational level was positively associated with β-cryptoxanthin, α-carotene and lutein/zeaxanthin, but not with total carotenoids, β-carotene or lycopene. Education was negatively associated with smoking and positively associated with fruit and vegetable intake. Smoking was negatively associated with β-cryptoxanthin, and fruit and vegetable intake was positively associated with β-cryptoxanthin (adjusted for educational level). Moreover, cigarette consumption mediated the association between education and β-cryptoxanthin by 37%, while fruit and vegetable intake mediated this association by 18%. The total mediation effect was 55%.

CONCLUSION

Smoking seemed to be more important as a mediator between education and plasma levels of β-cryptoxanthin than the intake of fruit and vegetables, but more studies are needed to establish the relative importance of smoking and diet as mediators of the association between education and antioxidant status.

Factors affecting food choice in relation to fruit and vegetable intake: a review

The present review provides an investigation into the food choice decisions made by individuals in relation to fruit and vegetable consumption. A comprehensive body of evidence now exists concerning the protective effect of fruit and vegetables against a number of diseases, particularly cardiovascular disease and certain forms of cancer. Current UK recommendations are to increase intakes of fruit and vegetables to 400 g/person per d. In the main body of the review the factors that affect food choice decisions of adults in relation to fruit and vegetable consumption are studied, following a suggested framework of food choice. Factors covered include sensory appeal, familiarity and habit, social interactions, cost, availability, time constraints, personal ideology, media and advertising and health. The content of the review shows just how complex the food choice process can be. Health promotion techniques can be better targeted towards certain groups of individuals, all holding similar sets of values, when making food choice decisions. Food choice, in relation to fruit and vegetable intake, needs to be studied in more depth, in order to provide effective nutrition education programmes, in particular the sets of priorities that different sub-groups of the population consider when making food choice decisions.

Barriers to healthy nutrition: perceptions and experiences of Iranian women

Background

A sound understanding of community perceptions and experiences regarding barriers to a healthy diet is a prerequisite for the design of effective interventions aimed at prevention of diet-related non-communicable diseases (NCDs). This study focused on exploring barriers to healthy nutrition as experienced by women participating in the Tehran Lipid Glucose Study (TLGS).

Methods

A grounded theory approach was used for analyzing the participants’ experiences and their perceptions regarding these barriers. Data collection was conducted through sixteen semi-structured focus group discussions, between 2008 and 2009. Participants were 102 women, aged 25-65 years, selected and recruited from the TGLS cohort. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method.

Results

The study revealed that the most important barriers to healthy nutrition were: 1) Interpersonal/cultural effects, 2) Lack of access to healthy foods, and 3) Food preferences.

Conclusions

Understanding these barriers might contribute to existing literature by providing evidence from a different culture, and help design effective preventive strategies, and implement appropriate interventions among Tehranian families.

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective is to determine the effectiveness of i) advice to increase fruit and vegetable consumption ii) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.

Factors associated with fruit and vegetable consumption among adults

BACKGROUND

The higher consumption of fruit and vegetables is considered to be an indicator of healthy eating and the protective effects of fruit and vegetable (FV) consumption for noncommunicable diseases have been investigated extensively. The present study aimed to investigate the association between fruit and vegetable intake (FVI), health behaviours and socio-demographic factors among adult Canadians.

METHODS

This analysis was based on the information from the Canadian Community Health Survey, Cycle 3.1. Daily intake of fruit and vegetables from a total number of 15,512 apparently healthy individuals, aged 18-64 years, were assessed using a structured questionnaire, which included 20 questions on the frequency of consumption of different types of fruit and vegetables. Multiple logistic regression models were used to determine the association between FVI and some socio-economic factors and lifestyle behaviour among adult Canadians.

RESULTS

In total 77% of Canadian adults consumed fruit and vegetables less than five times per day. Females were more likely to consume more fruit [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.75-2.4], vegetables (OR 1.95; 95% CI 1.65-2.29) and FV (OR 2.52; 95% CI 2.20-2.90) than males. Single/never married individuals, individuals with higher levels of education, never smokers, former drinkers and older people reported more consumption of fruit and vegetables than others.

CONCLUSIONS

The results obtained in the present study indicate an association between FVI and some socio-economic and healthy lifestyle behaviours, and that a substantial gap exists between the recommended level and the actual intake of the FV among the Canadian population. Because a higher intake of FV improves public health, it is imperative to tailor nutrition education at the individual and community levels in Canadian populations.

Consumer segmentation based on the level and structure of fruit and vegetable intake: an empirical evidence for US adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2006

OBJECTIVE

To identify consumption patterns of fruit and vegetables within a representative sample of US adults with a focus on degree of produce processing and to explore sociodemographic, lifestyle and nutritional profiles associated with these patterns.

DESIGN

Cross-sectional analysis. Fruit and vegetable (F&V) consumption data were collected using two non-consecutive 24 h recalls. For the purpose of the study, F&V intakes were aggregated into seven subgroups indicating degree of processing, which afterwards were used as inputs into cluster analysis.

SETTING

The 2005-2006 National Health and Nutrition Examination Survey.

SUBJECTS

The sample consisted of 2444 adults aged 20-59 years.

RESULTS

Total average F&V intake of the adults was below the recommended level. Thereby, 20 % of the respondents consumed fruit only in the form of juice. Three F&V consumption patterns were identified: 'low-intake F&V consumers' (74 % of respondents), 'consumers of healthier F&V options' (13 %) and 'intensive fruit juice consumers' (13 %). These groups differed markedly in terms of their sociodemographic, lifestyle and health characteristics, such as gender, age, race/ethnicity, education, smoking, weight status, etc. Differences in nutrient profiles were also found, with the 'consumers of healthier F&V options' showing better nutritional quality compared with other clusters.

CONCLUSIONS

Only a small share of US adults combines high F&V intakes with healthier F&V options that lead to a better nutritional profile. This raises discussion about a need to deliver more specific F&V promotion messages, including advice on healthier preparation methods, especially for the specific population groups.

A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults

This Review examined socioeconomic inequalities in intakes of dietary factors associated with weight gain, overweight/obesity among adults in Europe. Literature searches of studies published between 1990 and 2007 examining socioeconomic position (SEP) and the consumption of energy, fat, fibre, fruit, vegetables, energy-rich drinks and meal patterns were conducted. Forty-seven articles met the inclusion criteria. The direction of associations between SEP and energy intakes were inconsistent. Approximately half the associations examined between SEP and fat intakes showed higher total fat intakes among socioeconomically disadvantaged groups. There was some evidence that these groups consume a diet lower in fibre. The most consistent evidence of dietary inequalities was for fruit and vegetable consumption; lower socioeconomic groups were less likely to consume fruit and vegetables. Differences in energy, fat and fibre intakes (when found) were small-to-moderate in magnitude; however, differences were moderate-to-large for fruit and vegetable intakes. Socioeconomic inequalities in the consumption of energy-rich drinks and meal patterns were relatively under-studied compared with other dietary factors. There were no regional or gender differences in the direction and magnitude of the inequalities in the dietary factors examined. The findings suggest that dietary behaviours may contribute to socioeconomic inequalities in overweight/obesity in Europe. However, there is only consistent evidence that fruit and vegetables may make an important contribution to inequalities in weight status across European regions.

Fruit and vegetable availability among ten European countries:how does it compare with the ‘five-a-day’ recommendation?

Recasting the role of fruit and vegetables (F&V) in the diet, and planning national and international campaigns to enhance their consumption are major public health service objectives. The present study seeks to describe F&V availability patterns in ten European countries and examine compliance with current recommendations. The mean and median F&V availability (g/person per d) was estimated based on household budget survey data retrieved from the Data Food Networking (DAFNE) databank. Low F&V consumers were identified based on WHO international recommendations (minimum combined F&V intake of about 400 g/person per d) and current conservative guidelines of a minimum daily intake of three portions of vegetables and two portions of fruit. Considerable disparities in F&V availability were found among the surveyed European populations. Only in Mediterranean countries did the mean daily population intake clearly exceed combined F&V recommendations. Dietary patterns were positively skewed in all populations studied, on account of the presence of exceptionally high values among segments of the populations. Moreover, the correlation was unexpectedly weak between the proportion of low fruit and low vegetable consumers (Spearman's correlation coefficient +0·18). More than 50 % of the households in the surveyed populations are likely to consume less than the recommended daily vegetable intake of three portions, and this applies even to the two Mediterranean populations. The efficiency of F&V promoting strategies may be enhanced if F&V are addressed separately; furthermore, interventions that would specifically focus on vegetables are probably needed.

Reliability of parental and self–reported determinants of fruit and vegetable intake among 6th graders

Objective:

To assess the reliability of newly developed questionnaires measuring theoretical constructs believed to predict fruit and vegetable consumption among 6th–grade pupils.

Design:

Participating pupils and parents completed questionnaires twice, 14 days apart.

Setting:

One hundred and twenty–nine pupils from 6th–grade classes (average age: 11.9 years) at two schools in Norway and their parents were invited to participate.

Results:

The test–retest reliability was found to be good or very good for scales reported both by the pupils and their parents. All scales showed acceptable to strong correlations between time 1 and time 2, and only one scale had significant different mean values at the two times. The internal consistency reliability of the scales was acceptable to good.

Conclusions:

Sixth graders and their parents are able to provide reliable reports on theoretical determinants of the pupilapos;s fruit and vegetable consumption.

Who eats four or more servings of fruit and vegetables per day? Multivariate classification tree analysis of data from the 1998 Survey of Lifestyle, Attitudes and Nutrition in the Republic of Ireland

Objective

To identify, using the novel application of multivariate classification trees, the socio-economic, sociodemographic and health-related lifestyle behaviour profile of adults who comply with the recommended 4 or more servings per day of fruit and vegetables.

Design

Cross-sectional 1998 Survey of Lifestyle, Attitudes and Nutrition.

Setting

Community-dwelling adults aged 18 years and over on the Republic of Ireland electoral register.

Subjects

Six thousand five hundred and thirty-nine (response rate 62%) adults responded to a self-administered postal questionnaire, including a semi-quantitative food-frequency questionnaire.

Results

The most important determining factor of compliance with the fruit and vegetable dietary recommendations was gender. A complex constellation of sociodemographic and socio-economic factors emerged for males whereas the important predictors of 4 or more servings of fruit and vegetable consumption among females were strongly socio-economic in nature. A separate algorithm was run to investigate the importance of health-related lifestyle and other dietary factors on compliance with the fruit and vegetable recommendations. Following an initial split on compliance with dairy recommendations, a combination of non-dietary behaviours showed a consistent pattern of healthier options more likely to lead to compliance with fruit and vegetable recommendations. There did, however, appear to be a compensatory element between the variables, particularly around smoking, suggesting the non-existence of an exclusive lifestyle for health risk.

Conclusions

Material and structural influences matter very much for females in respect to compliance with fruit and vegetable recommendations. For males, while these factors are important they appear to be mediated through other more socially contextual-type factors. Recognition of the role that each of these factors plays in influencing dietary habits of men and women has implications for the manner in which dietary strategies and policies are developed and implemented.

Lifestyle characteristics among participants in a Norwegian colorectal cancer screening trial

The aim of the present study was to evaluate to what extent lifestyle-related variables predict participation for flexible sigmoidoscopy (FS) screening when the compliance is relatively high. During 2001, a randomized sample of 6961 men and women, born between 1946 and 1950, were invited to have a flexible sigmoidoscopy screening examination. Attendees (n = 4111) were asked to fill in a questionnaire focusing on physical activity, body weight, smoking habits and diet. The questionnaire was sent by mail to non-attendees (n = 2628) and a randomized corresponding control group not invited to screening (n = 7000). Sixty-one percent attended for screening. The questionnaire response rate among attendees, non-attendees and controls was 97, 11 and 61%, respectively. Attendees were more physically active (P < 0.001), and showed more adherence to general dietary recommendations, compared with controls. Opposing their healthy exercise and dietary habits, however, attendees were more likely to be moderate smokers compared with controls. The present offer of FS screening, achieving a relatively high compliance rate, may have reached attendees using screening as a supplement to an already healthy lifestyle, but also those who seek amelioration through health checks for risks behaviour that they are perfectly well aware of, such as smoking.

Psychosocial predictors of eating habits among adults in their mid-30s: the Oslo Youth Study follow-up 1991-1999

Background

The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.

Methods

Two hundred and forty men and 279 women that participated in the Oslo Youth Study were followed from 1991 to 1999 (mean age 25 and 33 years, respectively). Questionnaires at baseline (1991) included the constructs of the TPB and dietary habits, and at follow-up (1999) questionnaires included demographic factors and diet. For the assessment of diet, a food frequency questionnaire (FFQ) with a few food items was used at baseline while an extensive semi-quantitative FFQ was used at follow-up.

Results

Among men, attitudes, subjective norms and previous eating behaviour were significant predictors of fruit and vegetable intake, while education and past eating behaviour were predictive of whole grain intake in multivariate analyses predicting dietary intake at follow-up. For women, perceived behavioural control, perceived social norms and past behaviour were predictive of fruit and vegetable intake, while subjective norms, education and past eating behaviour were predictive of whole grain intake. For total fat intake, intention was predictive for men and perceived behavioural control for women. Household income and past consumption of sugar-rich foods were significant predictors of added sugar intake among men, while past intake of sugar-rich foods was a significant predictor of added sugar intake among women.

Conclusion

After adjusting for potential confounding factors, all psychosocial factors assessed among young adults appeared predictive of one or more eating behaviours reported eight years later. Results point to the influence of psychosocial factors on future eating behaviours and the potential for interventions targeting such factors.

The Norwegian School Fruit Programme: evaluating paid vs. no-cost subscriptions

BACKGROUND

This study reports the effect of providing Norwegian school children with free fruit or vegetables every school day and the effect of an existing fee-based School Fruit Programme.

METHODS

Seventh grade pupils and their parents completed questionnaires at baseline (autumn 2001) and at follow-up (spring 2002). Nine schools participated in the School Fruit Programme for free (Free fruit), nine schools took part at standard conditions (Paid fruit), and 20 schools did not take part in the subscription programme (No fruit). A total of 795 7th graders (11 or 12 years old at baseline) participated both at baseline and at follow-up.

RESULTS

At follow-up, pupils attending the Free fruit schools had significantly higher intake of fruit and vegetables at school than the pupils at the Paid fruit and No fruit schools (P < 0.001, mean intakes were 1.1, 0.4 and 0.2 portions, respectively). Subscribers at the Paid fruit schools had significantly higher intake than the non-subscribers at the same schools.

CONCLUSIONS

Providing a free piece of fruit or a vegetable is an effective strategy to increase school children's fruit and vegetable intake. The existing School Fruit Programme appears to increase the intake among the subscribers, but thereby also tends to increase an existing difference in consumption patterns among subscribers and non-subscribers.

Comparative analysis of body mass index, consumption of fruits and vegetables, smoking, and physical activity among Florida residents

The purpose of this study was to compare body mass index (BMI), consumption of fruits and vegetables, smoking, and physical activity in residents of the 7 Florida counties with the highest reported BMI to residents of the 7 Florida counties with the lowest reported BMI utilizing 2002 data from the Florida Department of Health Behavioral Risk Factor Surveillance System. Results showed that survey respondents in counties with the lowest mean BMI consumed significantly more fruits and vegetables, compared to respondents in counties with the highest BMI. A positive relation between mean BMI and consumption of fruits and vegetables remained when controlled for physical activity, but not for smoking. Education about the importance of increased fruit and vegetable consumption, as well as physical activity, are important factors in the campaign against obesity.

Correlates of fruit and vegetable intake among Norwegian schoolchildren: parental and self-reports

OBJECTIVES

To identify correlates of 6th and 7th graders' (age 10-12 years) fruit and vegetable intake, to investigate parent-child correlations of fruit and vegetable intake, and to compare parents' and children's reports of children's accessibility, skills and preferences with respect to fruit and vegetables.

DESIGN

The results presented are based on the baseline survey of the 'Fruits and Vegetables Make the Marks Project', where 38 schools participated.

SETTING

Fruit and vegetable intake was measured by food frequency questions. Theoretical factors, based on Social Cognitive Theory, potentially correlated to intake were measured, including behavioural skills, accessibility, modelling, intention, preferences, self-efficacy and awareness of 5-a-day recommendations.

SUBJECTS

In total, 1950 (participation rate 85%) 6th and 7th graders and 1647 of their parents participated.

RESULTS

Overall, 34% of the variance in the pupils' reported fruit and vegetable intake was explained by the measured factors. The strongest correlates to fruit and vegetable intake were preferences and accessibility. The correlation between the children's and their parents' fruit and vegetable intake was 0.23. The parents perceived their children's accessibility to be better than what was reported by the children (P<0.01), while the children reported their skills to be better than what was perceived by their parents (P<0.01).

CONCLUSION

The results from this study clearly point to a need for nutrition interventions aimed at parents. An important next step will be to investigate whether the identified correlates predict future fruit and vegetable intake, and whether they mediate any changes in intake in an intervention study.

Societal aspects of genetically modified foods

This paper aims to examine some of the reasons behind public controversy associated with the introduction of genetically modified foods in Europe the 1990s. The historical background to the controversy is provided to give context. The issue of public acceptance of genetically modified foods, and indeed the emerging biosciences more generally, is considered in the context of risk perceptions and attitudes, public trust in regulatory institutions, scientists, and industry, and the need to develop communication strategies that explicitly include public concerns rather than exclude them. Increased public participation has been promoted as a way of increasing trust in institutional practices associated with the biosciences, although questions still arise as to how to best utilise the outputs of such exercises in policy development. This issue will become more of a priority as decision-making systems become more transparent and open to public scrutiny. The results are discussed in the context of risk assessment and risk management, and recommendations for future research are made. In particular, it is recommended that new methods are developed in order to integrate public values more efficaciously into risk analysis processes, specifically with respect to the biosciences and to technology implementation in general.

Urinary Excretion of Flavonoids Reflects Even Small Changes in the Dietary Intake of Fruits and Vegetables

Background: Due to the random and systematic measurement errors associated with current dietary assessment instruments, there is a need to develop more objective methods of measuring the intake of foods of importance to human health. Objective: The purpose of this study was to test whether urinary excretion of flavonoids could be used to identify subjects who are meeting Norwegian recommendations for fruit and vegetable intake (5 servings per day) from individuals who are consuming the national average amount of fruits and vegetables (2 servings per day). Design: Twenty-four-hour urine samples were collected in a strict crossover controlled feeding study. Forty healthy subjects (19–34 years) were included in the study. After a 1-week run-in period, one group was given a controlled diet that included 2 servings (300 g) of fruits and vegetables daily for 14 days, while the other group was given a diet containing 5 servings (750 g) per day. Following a 2-week washout and a 1 week run-in period, the regimens were switched between the groups. Results: An increased intake of mixed fruits and vegetables from 2 to 5 servings per day significantly enhanced urinary excretion of eriodictyol, naringenin, hesperetin, quercetin, kaempferol, isorhamnetin, and tamarixetin. The citrus flavonoids naringenin and hesperetin showed a steep dose-response relationship to dietary intake of fruits and vegetables, whereas the association to eriodictyol, quercetin, kaempferol, isorhamnetin, and tamarixetin was more moderate. Conclusion: The present study indicates that urinary excretion of dietary flavonoids may be used to assess changes of mixed fruit and vegetable intake corresponding to an increase from the present national intake in Norway to the recommended amount of 5 servings of fruits and vegetables daily.

Validity and reproducibility of self-reported intake of fruit and vegetable among 6th graders

OBJECTIVE

Reproducible and valid methods for measuring fruit and vegetable consumption among young school children are urgently needed. The aim of this study was to test the reproducibility and the validity of a newly developed questionnaire on the intake of fruit and vegetable among Norwegian 6th graders. The questionnaire consisted of a 24-h recall part and a food frequency part.

DESIGN

A total of 114 pupils completed the questionnaire two times 14 days apart, and another 85 pupils completed the questionnaire and 7-day food diaries.

SUBJECTS

Pupils of 6th grade with a mean age of 11.9 y.

RESULTS

Spearman correlation coefficients between the frequency part of the questionnaire administered two times varied from 0.62 for fruit to 0.83 for potato, and no difference was seen between the average intakes from the two 24-h recalls. The 24-h recall part of the questionnaire gave higher estimates for the average intake of fruit and juice compared to the 7-day record, while no difference was observed for vegetable intake. Spearman correlation coefficients between the frequency part and the records varied from 0.21 for fruit and potato to 0.32 for the total intake of fruit and vegetable.

CONCLUSION

Both the 24-h recall and the frequency part gave a consistent response on separate occasions over the test-retest study period. The 6th graders were capable of recording yesterday's intake of vegetable, but overestimated the intake of fruit and juice. The ability to rank subjects based on the frequency part was rather low.

Six carotenoids in plasma used to assess recommended intake of fruits and vegetables in a controlled feeding study

BACKGROUND

There is a need for objective and universally applicable biomarkers for the intake of foods believed to affect human health.

OBJECTIVE

The purpose of this feeding study was to test whether plasma concentrations of carotenoids could be used to distinguish recommended consumption of mixed fruits and vegetables (five a day) from the current national intake of fruits and vegetables (two a day).

DESIGN

A strict crossover design was chosen to correct for observed interindividual variations in carotenoid response. A total of 40 healthy subjects were included in the study. After 1 week run-in period with no fruits and vegetables in the diet, one group was given two portions (300 g) of fruits and vegetables daily, while another group was given five portions (750 g) for 14 days. Following a 2 week wash-out period and 1 week run-in, the regimens were switched between the groups. Fruits and vegetables were combined to match a typical Norwegian diet.

RESULTS

Enhanced intake from two to five portions of mixed fruits and vegetables increased plasma concentrations of alpha-carotene (P=0.033) and lutein (P=0.051) in a crossover analysis. Analysis of data in the parallel part of the study revealed differences between the high and low intake for plasma concentrations of alpha-carotene (P=0.013) and beta-carotene (P=0.016). A trend was also evident for plasma concentrations of lycopene (P=0.057) and lutein (P=0.076) in the parallel analysis. No effect of high vs low intake of fruits and vegetables was observed for plasma concentrations of beta-cryptoxanthin, zeaxanthin, cholesterol and triacylglycerols.

CONCLUSION

The study indicates that plasma concentration of alpha-carotene, beta-carotene and lutein may be used to assess changes of fruit and vegetable intake corresponding to an increase from the present national intake in Norway to the recommended amount of five portions of fruits and vegetables daily.

SPONSORSHIP

Norwegian Research Council, National Nutrition Council, Throne Holst Foundation for Nutrition Research and Freia Chokoladefabriks Medisinske Fond.

Sociodemographic differences in dietary habits described by food frequency questions — results from Denmark

OBJECTIVES

To investigate whether a modest number of food frequency questions are sufficient to describe sociodemographic differences in dietary habits, and to identify sociodemographic characteristics of subjects adhering to food-based dietary guidelines operationalised in a "healthy-diet index".

DESIGN

Cross-sectional population survey.

SUBJECTS

A total of 480 men, 515 women, aged 15-90 y. Random sample of private telephone numbers drawn from regional telephone records, geographically stratified. Participation rate 62%.

METHODS

Computer-assisted telephone interviews, including six food frequency questions, a question on type of fat spreads used on bread, questions on seven sociodemographic variables.

RESULTS

The summary of the healthy-diet index showed that the subjects who adhered to food-based dietary guidelines (top quintile) compared to those who did not (bottom quintile) were most often women (odds ratio (OR)=6.07; confidence interval (CI): 3.91-9.43, women vs men), of older age (OR=9.72; CI: 3.02-31.31, old age vs young), highly educated (OR=3.69; CI: 1.53-8.92, high education vs low) and living in multiperson households including children (OR=4.66; CI: 2.47-8.80, multiperson household vs single household). The results also showed that gender difference in dietary habits is associated with other sociodemographic variables.

CONCLUSIONS

The selected food frequency questions proved sufficient to describe sociodemographic differences in dietary habits, and this method may be a valuable supplement to traditional quantitative dietary surveys in monitoring sociodemographic changes in eating patterns. The results also underline the influence of sociodemographic status on dietary habits.

SPONSORSHIP

The Danish Nutrition Council funded the study.

Food sources of carbohydrates in a European cohort of adults

OBJECTIVE

To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospective Investigation into Cancer and Nutrition (EPIC).

METHODS

Of the 27 redefined EPIC study centres, 19 contributed subjects of both genders and eight centres female participants only (men, women, after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total). Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software. The major sources of dietary carbohydrate were identified, and 16 food groups were examined.

RESULTS

The 10 food groups contributing most carbohydrate were bread; fruit; milk and milk products; sweet buns, cakes and pies; potato; sugar and jam; pasta and rice; vegetables and legumes; crispbread; and fruit and vegetable juices. Consumption of fruits as well as vegetables and legumes was higher in southern compared with northern centres, while soft drinks consumption was higher in the north. Italian centres had high pasta and rice consumption, but breakfast cereal, potato, and sweet buns, cakes and pies were higher in northern centres. In Sweden, lower bread consumption was balanced with a higher consumption of crispbread, and with sweet buns, cakes and pies. Overall, men consumed higher amounts of vegetables and legumes, bread, soft drinks, potatoes, pasta and rice, breakfast cereal and sugar and jam than women, but fruit consumption appeared more frequent in women.

CONCLUSION

The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region. When comparing and interpreting diet-disease relationships across populations, researchers need to consider all types of foods.

Applying theory of planned behavior to fruit and vegetable consumption of young adolescents

PURPOSE

The purpose of this research was to investigate how well Theory of Planned Behavior (TPB) predicted frequency of consumption of fruits and vegetables among seventh graders and to investigate whether gender or socioeconomic status (SES) had moderating effects on the relationships between the constructs in the model.

DESIGN

Two identical self-administered paper and pencil surveys were distributed 6 months apart. Path analyses of the TPB models by gender and SES were performed with AMOS software.

SETTING

The study occurred in eight middle schools from school districts in the Minneapolis--St. Paul metropolitan area, where a minimum of 20% of the students qualified for free or reduced-price meals.

SUBJECTS

Of the invited seventh graders, 1406 (74%) completed data for the model constructs at baseline and for behavior at interim data collection.

MEASURES

We assessed frequency of consumption of fruits and vegetables and attitudes, subjective norms, barriers, and intentions related to this behavior. Three levels of SES were created based on questions about free lunch, parents' education, and work.

RESULTS

No significant direct effects of attitudes and subjective norms on behavior were found, but for barriers, both indirect effects through intentions and direct effects on behavior were significant. Seven percent of the variation in the frequency of fruit and vegetable consumption and 31% of the variation in intention to eat more fruits and vegetables were explained by the model. Gender appeared to have moderating effects on the relationships between attitudes and intention and between intentions and behavior in the model. There were no moderator effects of SES, but the larger dropout rates from the low-SES group could have caused the groups to become more homogeneous.

CONCLUSION

The data fit the model well; still, large proportions of the variance in the frequency of consumption of fruits and vegetables were unexplained. This may be related to the operationalization of the model constructs or to missing important factors in the model. Furthermore, there appeared to be strong relationships between subjective norms or barriers and intentions as well as gender differences in the strengths of the relationships in the model that may have implications for intervention methods or messages.

Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21

BACKGROUND

Eating behavior is an etiologic factor in the development of lifestyle-related diseases. Knowledge about the stability of eating behavior during the transition from adolescence to early adulthood has implication for dietary interventions for children and young adolescents.

METHOD

Dietary data were collected by means of a short food frequency questionnaire as part of a Norwegian longitudinal cohort study on health behavior, lifestyle, and self-reported health of adolescents. Of 885 14-year-old baseline participants, 521 21-year-olds participated and 40% completed all surveys at each time point.

RESULTS

Mean weekly frequency of consumption of fruit and vegetables decreased by 1-2.5 times per week between ages 14 and 21, whereas that of sugar-containing soft drinks increased by almost 1 time per week between ages 15 and 16. Tracking of consumption patterns into young adulthood was seen for all four foods (P < 0.05 for differences in means between the tracking groups). The proportions of individuals remaining in the same tracking categories at the major transition stages were 50-70%. Yet, some changed in the opposite direction of the observed trends.

CONCLUSIONS

Despite the overall changes in mean weekly frequency of consumption and prevalence of daily consumers, relative ranking by frequency at age 14 indicated some stability of eating behavior into young adulthood.

A comparison of knowledge and attitudes about diet and health among 35- to 75-year-old adults in the United States and Geneva, Switzerland

OBJECTIVES

This study compared responses of US and Geneva residents to items on analogous questionnaires concerning knowledge and attitudes about diet and health.

METHODS

Comparable data were available from 2 population-based sample surveys: the Cancer Control Supplement of the 1987 National Health Interview Survey and the 1994 Bus Santé 2000 in Geneva, Switzerland. Samples included 10,366 US respondents and 698 Geneva respondents, aged 35 to 74 years. The analysis involved descriptive statistics, contingency tables, and linear regression models.

RESULTS

In both the United States and Geneva, health consciousness was greater among women and more highly educated persons than among other groups. Compared with Americans, Genevans assigned more importance to avoiding salt, sugar, and overweight (odds ratio = 1.6, 2.9, and 5.9, respectively) and less importance to lowering cholesterol (odds ratio = 0.6). Genevans were more likely to recognize the relatively high fiber content of lettuce, carrots, and apples. Recognition of low-fat foods was slightly better in the United States.

CONCLUSIONS

Knowledge and attitudes differed despite high general diet and health awareness in both populations. Identifying why generally similar dietary guidance messages are embraced to different extents across cultures may facilitate global implementation.

Disparities in vegetable and fruit consumption: European cases from the north to the south

OBJECTIVE

To present disparities in consumption of vegetables and fruits in Europe and to discuss how educational level, region and level of consumption influence the variation.

DESIGN

A review of selected studies from 1985 to 1997.

SETTING/SUBJECTS

33 studies (13 dietary surveys, nine household budget surveys and 11 health behaviour surveys) representing 15 European countries were selected based on criteria developed as part of the study. Association between educational level and consumption of vegetables and fruits was registered for each study and common conclusions were identified.

RESULTS

In the majority of the studies, with the exception of a few in southern and eastern Europe, consumption of vegetables and fruits was more common among those with higher education. The results suggest that in regions where consumption of vegetables and fruits is more common, the lower social classes tend to consume more of these than the higher social classes.

CONCLUSIONS

The differences in the patterns of disparities in vegetable and fruit consumption between regions, as well as within populations, need to be considered when efforts to improve nutrition and health are planned.

Fruit and vegetable consumption in relation to risk factors for cancer: a report from the Malmö Diet and Cancer Study

OBJECTIVE

To examine the associations between the consumption of fruit and vegetables and other markers of cancer risk.

DESIGN

A cross-sectional survey within the population-based prospective Malmö Diet and Cancer (MDC) Study. Information on food habits was collected through the modified diet history method designed and validated for the MDC Study. Data on smoking and alcohol habits, leisure time physical activity, birth country, education, socioeconomic status and cohabitation status were collected through a questionnaire.

SETTING

Malmö, the third largest city in Sweden.

SUBJECTS

All subjects who entered the MDC Study during winter 1991 to summer 1994 (men and women living in Malmö, aged between 46 and 68 years), with a total of 15 173.

RESULTS

Women consumed more fruit and vegetables than men. Low consumption of both fruits and vegetables was associated with unfavourable nutrient profiles: higher percentage of energy from fat and lower intakes of antioxidant nutrients and dietary fibre. Low consumption was also associated with smoking, low leisure time physical activity, low education and being born in Sweden. High age was associated with low vegetable consumption in both genders.

CONCLUSION

This study indicates that several established risk markers and risk factors of cancer may be independently associated with low fruit and vegetable consumption. The findings suggest that the adverse effects of factors such as smoking, low physical activity and a high-fat diet could partly be explained by low consumption of fruit or vegetables. The implied health benefits of a low or moderate alcohol consumption may be similarly confounded by high consumption of fruit or vegetables.

A comparison of household food availability in 11 countries

OBJECTIVE: To identify intercountry food intake patterns, we compared the household food availability data collected by the Nationwide Food Consumption Survey (NFCS) in the United States and the Household Budget Surveys (HBS) from 10 European countries that participated in the DAta Food NEtworking (DAFNE) project, namely Belgium, Germany, Greece, Hungary, Ireland, Luxembourg, Norway, Poland, Spain and the United Kingdom. METHODOLOGY: The DAFNE project harmonized European household food availability data by clarifying which food items were included in each country's HBS, and then defining comparable food categories among countries. NFCS household data were harmonized with the HBS data by applying the same procedures used in the DAFNE project. RESULTS: The results presented in this paper reveal a number of similarities and differences in household food availability among 11 nations. In nearly all countries studied, red meat was available in greater quantities than poultry and seafood combined. Most countries favoured bread and rolls over other types of grain products, had a low to moderate availability of seafood and legumes, had a moderate amount of sugar available, and consumed approximately two-thirds or more of fruits and vegetables in a fresh form. Milk availability tended to be inversely correlated with cheese availability. Only in Mediterranean households was vegetable oil, namely olive oil, the primary type of added lipid available. While the data presented in this paper can do much to improve our understanding of food availability in US and European households, it is important to remember that these data do not include foods purchased and consumed away from home. APPLICATIONS: Despite the limitations of household food availability data, the results presented in this paper can help health professionals develop a more international perspective.