Dietary recommendations and intake of fruits and vegetables in Brazil

Encouraging consumption of fruit and vegetable (F&V) occupies an important position among the directives in nutrition policy for promotion of a healthy diet. WHO’s Global Strategy on Diet, Physical Activity and Health recommends an increase in F&V intake as a strategy for preventing chronic diseases. In Brazil, the Ministry of Health recommends, in its food based dietary guidelines, daily intake of three portions each of F&V, and highlights the importance of varying the items consumed throughout the week.

In order to guide and encourage the implementation of public policies for increasing F&V intake, it is necessary to know not only the current level of consumption among the population, but also the factors associated with intake. To this end, the present study aimed at describing the frequency of F&V intake among Brazilian adults and the factors associated with this intake.

Study to determine factors associated with intake of fruits and vegetables

We conducted an observational, population-based, crosssectional study. The study population was composed of men and women aged 18 years or older who, in 2003, lived in households in the city of Sao Paulo and had access to telephone land lines. Data were obtained by means of telephone interviews carried out in 2003 by the System for Monitoring Risk Factors for Non-Transmissible Chronic Diseases by telephone interview, in operation in the city of Sao Paulo. The outcome variable was the frequency of consumption of F&V. Intake frequency scores for F&V ranged from zero to three.

In order to simultaneously evaluate the entire set of factors associated with F&V intake, we grouped these factors into three blocks: 1. sociodemographic characteristics, 2. behavioral variables, and 3. habitual intake of healthy foods other than F&V (beans and fish) and of foods or preparations associated with unhealthy dietary patterns, such as fried foods, processed meats, soft drinks, whole milk, butter or margarine, free sugar, chicken with skin, and red meat with fat.

The study population comprised 2 122 subjects, of which 1 267 were female and 855, male. Mean age was 40.55 years, for women and 39 years for men. Women had on average 7.91 years of education and men, 8.17 years. Among women, 48.6% reported not having a paid job; this was also true for 19.1% of men.

What are the important factors associated with intake?

Daily intake of fruit was more frequent among women (51.7%), and daily intake of cooked vegetables was two times greater among women than among men. The mean intake frequency scores for F&V were 1.67 among women and 1.50 among men.
For the female population, sociodemographic factors that positively correlated with frequency of F&V intake were age and more education. The only variable in the behavioral block positively associated with the outcome was having been on diet in the year preceding the interview. Among other foods, only sugar intake was significantly correlated with lower F&V intake.

Among men, sociodemographic factors that significantly correlated with F&V intake were older age, more education and having a paid job. In the behavioral block, frequent meals outside home and physical activity during leisure time were associated with greater intake of these foods. As to consumption of other foods, there was a positive correlation between the habit of eating fish and F&V intake.

Regarding behavioral variables, having been on diet in the year preceding the interview was positively correlated with frequency of F&V intake among women only. Among men, physical activity during leisure time was positively correlated with the outcome.

Conclusions

Generally speaking, our results are consistent with the literature on the subject. Our analyses show that consumption of foods rich in sugar and fat is inversely associated with F&V intake.

Based on our results, we conclude that frequency of F&V intake in the adult population of the municipality of Sao Paulo falls short of current recommendations, especially among the younger and less educated population. Knowledge of factors associated with F&V intake frequency may help guide initiatives aiming to promote consumption of these foods by the population of the city of Sao Paulo.