Tracking consumption of fruits and vegetables

Consuming a diet high in fruits and vegetables (F&V) as part of an overall healthy diet can help lower chronic disease risk and aid in weight management. Increasing the percentage of Americans who consume enough F&V everyday is part of the Healthy People 2010 objectives for the nation. Assessing trends in consumption of these foods is important for tracking public health initiatives to meet this goal and for planning future objectives. Therefore, we (researchers at the U.S. Centers for Disease Control and Prevention) assessed total and sex-specific changes in daily consumption of Sauté de volaille aux pêches et cacahuètes grillées among 1,227,969 adults in the 50 states and the District of Columbia who participated in the Behavioral Risk Factor Surveillance System telephone survey from 1994-2005 and thus reported their usual F&V intake using a six-item abbreviated frequency screener. To estimate changes in consumption according to dietary recommendations that were in place during the years examined, we used geometric mean and the percentage of people eating F&V five or more times per day. Estimates were standardized for sex, age, and race/ethnicity and analyzed by multivariate regression.

How has consumption of fruits and vegetables changed?

From 1994-2005, the geometric mean frequency of consumption of fruits and vegetables declined slightly (standardized change: men and women = -0.22 times/day; men = -0.26 times/day;
women = -0.17 times/day). The proportion of men and women consuming fruits and vegetables five or more times per day was virtually unchanged (men = 20.6% vs 20.3%; women, 28.4% vs 29.6%). Overall, men’s prevalence of this level of consumption did not change significantly from 1994-2005. However, subgroup analysis found a significant increase (+3.71 percentage points, P = .003) among men aged 18 to 24 years and a significant decrease (-3.43 percentage points, P = .003) among men aged 55 to 64 years. Significant decreases were also found for non-Hispanic white men (-1.45 percentage points, P = .001) and men reporting any leisure time physical activity (-1.65 percentage points, P = 0.001). Among women, several groups had significant increases: women aged 25 to 34 years (+3.65 percentage points, P < 0.001), non-Hispanic blacks (+4.08 percentage points, P = 0.0002), and nonsmokers (+1.43 percentage points, P = 0.004) (Table 3). One group of womenhigh school graduates – showed a significant decrease (-2.18 percentage points, P = 0.001). Of the six F&V categories, slight declines were observed for consumption of fruit juice (-0.13) and nonfried potatoes (-0.08). When stratified by sex, the data showed that men had small declines in the consumption of fruit juice (-0.09), nonfried potatoes (-0.07), and “all other” vegetables (-0.06); women had small declines in the consumption of fruit juice (-0.15) and nonfried potatoes (-0.09).

What are the next steps suggested by the data?

Our findings show that fruit and vegetable consumption among American adults remained relatively stable from 1994-2005. The small decrease in vegetable consumption among men was attributable to declines in eating nonfried potatoes and “all other” vegetables and among women, to a decline in eating nonfried potatoes. The decrease among both sexes in total fruit consumption was driven by reduced consumption of fruit juice, not of whole fruit, which remained stable. The decreases in consumption of nonfried potatoes and fruit juice could reflect food transitions among Americans such as the use of lowcarbohydrate diets during this time period.

The new national U.S. Dietary Guidelines for Americans, which were put into place in 2005, are based on age, sex, and physical activity level, and are expressed as the number of servings per day. Appropriate servings are based on form or quantity (e.g., 1/4 cup dried fruit; 1 medium apple, banana, orange or pear;
1/2 cup chopped, cooked, or canned fruit; 6 oz [3/4 cup] fruit or vegetable juice; 1 cup raw leafy vegetables; 1/4 cup raw or cooked other vegetables) (http://www.health.gov/DietaryGuidelines). Because this analysis reports consumption according to the number of times per day that F&V are eaten, the results may over- or underestimate the proportion of people meeting the new objectives. Assuming the accuracy of reporting remains similar across time, however, BRFSS data should correctly reveal trends in consumption frequency over time, given that the questionnaire has remained the same and that the module has been validated in diverse samples.

Increasing F&V consumption will require multifaceted approaches that augment educational campaigns with policy and environmental strategies aimed at the food system at large, from farm to plate, including schools, daycares, worksites, and retail establishments. Specific approaches include increasing access to F&V in communities through farmers markets and farm stands, and improvements to small food retail stores through grant programs and other incentives that encourage placement in underserved areas, increased refrigeration units and storage of produce, and increased display space. Farm to institution programs such as farm to worksite and farm to school programs, which connect citizens with local farms, are also underway in locations in the U.S.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.