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Kaur S. Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review. Nutr Res Rev 2023; 36:420-447. [PMID: 36004512 DOI: 10.1017/s0954422422000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.
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Affiliation(s)
- Sukhdeep Kaur
- Department of Food and Nutrition, Punjab Agricultural University, Ludhiana, Punjab141004, India
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Tang Y, Dong J, Gruda N, Jiang H. China Requires a Sustainable Transition of Vegetable Supply from Area-Dependent to Yield-Dependent and Decreased Vegetable Loss and Waste. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1223. [PMID: 36673990 PMCID: PMC9859069 DOI: 10.3390/ijerph20021223] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
China, the largest country in vegetable supply, faces a transition to sustainable vegetable production to counteract resource waste and environmental pollution. However, there are knowledge gaps on the main constraints and how to achieve sustainable vegetable supply. Herein, we integrated the vegetable production and supply data in China, compared its current status with five horticulture-developed countries US, the Netherlands, Greece, Japan and South Korea, using data from the Food and Agriculture Organization (FAO) and National Bureau of Statistics of China, and predicted the vegetable supply in 2030 and 2050 by a model prediction. The vegetable supply in China increased from 592 g capita-1 d-1 in 1995 to 1262 g capita-1 d-1 in 2018 and will keep constant in 2030 and 2050. Compared to the five countries, the greater vegetable supply is primarily achieved by higher harvested areas rather than higher yield. However, it is predicted that the harvested areas will decrease by 13.6% and 24.7% in 2030 and 2050. Instead, steady increases in vegetable yield by 11.8% and 28.3% are predicted for this period. The high vegetable supply and greater vegetable preference indicated by the high vegetable-to-meat production ratio cannot guarantee recommended vegetable intake, potentially due to the high rate of vegetable loss and waste. Under the scenarios of decreased vegetable loss and waste, the harvested area will decrease by 37.3-67.2% in 2030 and 2050. This study points out that the sustainable transition of Chinese vegetable supply can be realized by enhancing yield and limiting vegetable loss and waste instead of expanding the harvested area.
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Affiliation(s)
- Ying Tang
- Department of Agronomy and Horticulture, Jiangsu Vocational College of Agriculture and Forestry, Jurong 212400, China
| | - Jinlong Dong
- State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China
| | - Nazim Gruda
- Institute of Crop Science and Resource Conservation, Division of Horticultural Sciences, University of Bonn, 53121 Bonn, Germany
| | - Haibo Jiang
- Jiangsu Station for Protection of Arable Land Quality and Agricultural Environment, Nanjing 210029, China
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Bam NE, Chitha W, Ntsaba J, Nomatshila SC, Apalata T, Mabunda SA. Lifestyle determinants of diabetes mellitus amongst people living with HIV in the Eastern Cape province, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e7. [PMID: 35695437 PMCID: PMC9210181 DOI: 10.4102/phcfm.v14i1.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Type 2 diabetes mellitus (DM) has serious consequences for those affected. Little is documented on the lifestyle determinants of type 2 DM in people living with human immunodeficiency virus (PLWHIV). Aim This study aimed to assess the lifestyle determinants of type 2 DM amongst PLWHIV who were on antiretroviral treatment (ARV). Setting This study was undertaken in 10 community health clinics and 140 clinics in South Africa’s Eastern Cape province. Methods This case control study was undertaken amongst PLWHIV who were on ARV in OR Tambo district. Results Cases and controls showed statistically significant differences on the duration of time on ARV (p < 0.0001), vigorous work (p = 0.019), participation in moderate sport (p = 0.007) and consuming daily fruit and vegetable servings (p = 0.021). Those reporting to be on ARVs for 6 to 10 years were three times more likely to be diabetic than those who had only been on ARV for a year or less (odds ratio [OR] = 3.0; p = 0.017) and in comparison, to participants who reported having one serving, participants who had four fruit and vegetable servings daily were 3.2 times more likely to be diabetic (OR = 3.2; p = 0.002). Conclusion This study revealed significant nutritional imbalances on fruit and vegetable servings and on participation in moderate sport resulting in poor diabetic control. Routine screening and measurements need to focus on dietary and physical lifestyle determinants of type 2 DM in order to counsel patients on ARV on balanced nutrition and optimise outcomes in the quality care of PLWHIV.
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Affiliation(s)
- Nokwanda E Bam
- Department of Nursing, Faculty of Health Sciences, North-West University, Mahikeng.
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Gebremedhin MH, Gebrekirstos LG. Dietary and Behavioral Risk Factors of Ischemic Heart Disease Among Patients of Medical Outpatient Departments in Southern Ethiopia: Unmatched Case-Control Study. Integr Blood Press Control 2021; 14:123-132. [PMID: 34588813 PMCID: PMC8473848 DOI: 10.2147/ibpc.s322663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Worldwide mortality due to cardiovascular disease is the dominant cause of death, and ischemic heart disease is the leading one. Though risk factors for Ischemic heart diseases are modifiable and preventable, it is not well investigated in the local context. Thus, this study aimed to assess the dietary and behavioral risk factors for ischemic heart disease among patients in medical outpatient departments in Southern, Ethiopia. METHODS A facility-based unmatched case-control study was conducted from November 16 to March 20, 2020, among patients with ischemic heart disease and those patients who visited the three hospitals of the Wolaita Zone. A convenient sampling method was used and the data were entered using Epi data version 3.1 and exported to SPSS version 21 for analysis, a p-value <0.05, were considered statistically significant. RESULTS A total of 557 study participants (140 cases and 417 controls) were included in a ratio of 1:3. The adjusted odds ratio for having no formal education (AOR = 3.18; 95% CI: 1.59, 6.34), previous history of hypertension (AOR= 2.84; 95% CI: 1.73, 4.66), physical inactivity (AOR= 2.23; 95% CI: 1.32, 3.76), inadequate intake of fruit and vegetable consumption (AOR= 2.43; 95% CI; 1.40, 4,22), palm oil use for food preparation (AOR= 2.12; 95% CI: 1.23, 3.63) and obesity (AOR= 5.68; 95% CI: 2.63, 12.23) increased the occurrence of the disease. CONCLUSION Although ischemic heart disease is preventable, using relatively simple and inexpensive lifestyle changes, it is projected to cause preventable loss of life. So, expanding health education and healthy life styles including exercise is recommended.
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Affiliation(s)
- Meron Hadis Gebremedhin
- School of medicine, College of health science and medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Lielt Gebreselassie Gebrekirstos
- Department of maternity and reproductive health, College of health science and medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Siegel KR, Albright AL. Population-Level Approaches to Preventing Type 2 Diabetes Globally. Endocrinol Metab Clin North Am 2021; 50:401-414. [PMID: 34399953 DOI: 10.1016/j.ecl.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes (T2DM) is increasingly considered an epidemic rooted in modern society as much as in individual behavior. Addressing the T2DM burden thus involves a dual approach, simultaneously addressing high-risk individuals and whole populations. Within this context, this article summarizes the evidence base, in terms of effectiveness and cost-effectiveness, for population-level approaches to prevent T2DM: (1) modifications to the food environment; (2) modifications to the built environment and physical activity; and (3) programs and policies to address social and economic factors. Existing knowledge gaps are also discussed.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA
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Social inequality in food consumption between 2008 and 2019 in Brazil. Public Health Nutr 2021; 25:214-224. [PMID: 34407905 PMCID: PMC8883783 DOI: 10.1017/s1368980021002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: To analyse the trend of social inequality in food consumption among Brazilians from 2008 to 2019. Design: Time series analyses using cross-sectional annual data from the Telephone Surveillance System (VIGITEL 2008–2019). Food consumption was evaluated through: (1) consumption of five or more portions of fruits and vegetables in ≥5 d/week; (2) consumption of beans in ≥5 d/week and (3) consumption of soft drinks or artificial juices in ≥5 d/week. Absolute inequality was assessed by the slope index of inequality (SII) and relative inequality by the concentration index (CIX). SII and CIX positive values indicate higher prevalence among more educated citizens and negative among less educated ones. Time trend was assessed by linear regression using weighted least squares. Setting: 26 Brazilian state capitals and the Federal District. Participants: 621 689 individuals ≥18 years. Results: Fruits and vegetable consumption was more prevalent among the more educated citizens, while beans were mostly consumed by the less educated, and soft drinks or artificial juices was more prevalent among individuals with intermediate education. The highest absolute inequality was found for beans (SII2019 -25·9). In 12 years, the absolute inequality increased for fruit and vegetable consumption (from SII2008 12·8 to SII2019 16·2), remained for beans (SII2008 -23·1 to SII2019 -25·9) and reduced for soft drinks or artificial juices (SII2008 8·7 to SII2019 0·4). Relative inequality was low and constant. Conclusion: Despite the advances reducing inequalities in soft drinks or artificial juice consumption, the increase in the social gap for adequate consumption of fruits and vegetables is troublesome.
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Baldwin JN, Ashton LM, Forder PM, Haslam RL, Hure AJ, Loxton DJ, Patterson AJ, Collins CE. Increasing Fruit and Vegetable Variety over Time Is Associated with Lower 15-Year Healthcare Costs: Results from the Australian Longitudinal Study on Women's Health. Nutrients 2021; 13:2829. [PMID: 34444989 PMCID: PMC8398554 DOI: 10.3390/nu13082829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 01/04/2023] Open
Abstract
Healthcare costs are lower for adults who consume more vegetables; however, the association between healthcare costs and fruit and vegetable varieties is unclear. Our aim was to investigate the association between (i) baseline fruit and vegetable (F&V) varieties, and (ii) changes in F&V varieties over time with 15-year healthcare costs in an Australian Longitudinal Study on Women's Health. The data for Survey 3 (n = 8833 women, aged 50-55 years) and Survey 7 (n = 6955, aged 62-67 years) of the 1946-1951 cohort were used. The F&V variety was assessed using the Fruit and Vegetable Variety (FAVVA) index calculated from the Cancer Council of Victoria's Dietary Questionnaire for Epidemiological Studies food frequency questionnaire. The baseline FAVVA and change in FAVVA were analysed as continuous predictors of Medicare claims/costs by using multiple regression analyses. Healthy weight women made, on average, 4.3 (95% confidence interval (CI) 1.7-6.8) fewer claims for every 10-point-higher FAVVA. Healthy weight women with higher fruit varieties incurred fewer charges; however, this was reversed for women overweight/obese. Across the sample, for every 10-point increase in FAVVA over time, women made 4.3 (95% CI 1.9-6.8) fewer claims and incurred $309.1 (95% CI $129.3-488.8) less in charges over 15 years. A higher F&V variety is associated with a small reduction in healthcare claims for healthy weight women only. An increasing F&V variety over time is associated with lower healthcare costs.
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Affiliation(s)
- Jennifer N. Baldwin
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Lee M. Ashton
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Peta M. Forder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia; (P.M.F.); (A.J.H.); (D.J.L.)
| | - Rebecca L. Haslam
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alexis J. Hure
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia; (P.M.F.); (A.J.H.); (D.J.L.)
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Deborah J. Loxton
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia; (P.M.F.); (A.J.H.); (D.J.L.)
| | - Amanda J. Patterson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
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Nutritional and Environmental Assessment of Increasing the Content of Fruit and Vegetables in the UK Diet. SUSTAINABILITY 2021. [DOI: 10.3390/su13031076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the interest in increasing the consumption of fruit and vegetables in the UK, the total average consumption is still below the recommended intakes. Evidence indicates that the UK government’s “five-a-day” policy has not been effective in reaching its goal. The results of fiscal policies (e.g., subsidies) to increase fruit and vegetable consumption are uncertain due to complex substitutions done by consumers amongst overall food choice. The goal of the present study was to estimate the prices (i.e., shadow prices) at which consumers can increase their intake of fruits and vegetables by 10% (higher than that achieved by the “five-a-day” policy) without changing the overall taste of the diet (utility). We estimated the ex-ante effect of increasing the UK’s fruit and vegetable consumption by 10% on household nutrient purchases and greenhouse gas emissions. The required changes in prices were estimated by extending the model of consumer behaviour under rationing. The model combines consumption data, demand elasticities estimated from home scan data, and nutrient coefficients for 20 foods consumed in the UK. Our results suggest that to increase vegetable and fruit consumption by 10% (under the current preferences), their prices should decline by 21% and 13%, respectively. However, there is a trade-off between nutrition and environmental goals; total average household caloric purchase declined by 11 kcal, but greenhouse gas emissions increased by 0.7 CO2-eq kg/kg of food.
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Sinyolo S, Ndinda C, Murendo C, Sinyolo SA, Neluheni M. Access to Information Technologies and Consumption of Fruits and Vegetables in South Africa: Evidence from Nationally Representative Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134880. [PMID: 32645827 PMCID: PMC7370009 DOI: 10.3390/ijerph17134880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Abstract
Extensive evidence indicates that fruit and vegetable (F+V) consumption leads to reduced chances of diet related non-communicable diseases (NCDs). However, the F+V consumption levels remain low. This paper investigates the extent to which access to information technologies improves F+V consumption in South Africa. A nationally representative sample of 20,908 households was analysed using the Poisson and logit regression models. The study results indicated that most households do not consume sufficient F+V per day. Only 26% of the household heads consumed F+V at least five times a day. Access to mobile phones, radio, television, and internet was associated with increasing frequency of F+V consumption, and higher chances that a household would consume the minimum recommended levels. The association between the communication technologies and F+V consumption varied. Television access had the highest association with both foods, while internet was only significantly associated with vegetable consumption. Several demographic and socio-economic factors played a key role in shaping F+V consumption patterns. The results show that there is scope to disseminate nutrition awareness and education programs, through mobile phones, internet, radio and television in South Africa. The interventions to promote F+V consumption should be tailored according to the different socio-economic profiles of the population.
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Affiliation(s)
- Sikhulumile Sinyolo
- Human Sciences Research Council, 134 Pretorius Street, Pretoria 0001, South Africa; (C.N.); (M.N.)
- Correspondence:
| | - Catherine Ndinda
- Human Sciences Research Council, 134 Pretorius Street, Pretoria 0001, South Africa; (C.N.); (M.N.)
| | - Conrad Murendo
- International Crops Research Institute for the Semi-Arid Tropics, Box 776, Bulawayo 263, Zimbabwe;
- Link Development Analytics, 70079 Zengeza 4, Chitungwiza 263, Zimbabwe
| | - Sithembile A. Sinyolo
- Agriculture Sector Education and Training Authority, 529 Belvedere Street, Arcadia, Pretoria 0002, South Africa;
| | - Mudzunga Neluheni
- Human Sciences Research Council, 134 Pretorius Street, Pretoria 0001, South Africa; (C.N.); (M.N.)
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