The Associations of Fruit and Vegetable Intakes with Burden of Diseases: A Systematic Review of Meta-Analyses

Trends and age-period-cohort analysis of upper aerodigestive tract and stomach cancer mortality in Lithuania, 1987-2016

OBJECTIVES

Lithuania has among the highest mortality rates for upper aerodigestive tract (UADT) and stomach cancer in Europe. The aim of this study was to analyze trends during the period 1987-2016 in Lithuania, evaluating the effect of birth-cohort, period, and age.

STUDY DESIGN

Observational time trends study.

METHODS

Data on numbers of deaths and population size by each calendar year in 5-year age groups in 1987-2016 were obtained from the WHO mortality database. Joinpoint regression analysis was used to evaluate changes in time trends. Age-period-cohort analysis was performed to assess age, calendar period of death, and birth-cohort effects.

RESULTS

UADT cancer mortality in men increased between 1987 and 1993, annual percentage change (APC) = 6.6% (95% confidence interval [CI]: 3.8, 9.4), and was stable thereafter, APC = 0.3% (95% CI: 0.0, 0.6). The age-standardized mortality rate (ASMR) was 23.6/100,000 in 2016. In women, rates increased steadily by 1.6% (95% CI: 0.9%, 2.3%) per year from 1987 to 2016, ASMR = 2.3/100,000 in 2016. Age-period-cohort analysis showed statistically significant cohort effects in both sexes. In men, rates peaked in birth-cohorts born around 1952, declined in 1957-1962 birth-cohorts, and fluctuated in later birth-cohorts. In women, rates started rising in 1947 birth cohort and peaked in the 1967 birth cohort. Stomach cancer mortality declined throughout the study period in men by -2.4%, (95% CI: -2.6%, -2.1%) annually, and women by -2.8% (95% CI: -3.1%, -2.4%), ASMR = 16.1/100,000 and 6.0/100,000 in 2016, respectively. Birth-cohort effects were significant in both sexes. Rates decreased in cohorts born around 1920 onwards, but declines in the youngest generations have slowed in men and reversed in women.

CONCLUSIONS

The birth-cohort effects in UADT and stomach cancer mortality trends imply that the elevated burden in Lithuania could be reduced by effective strategies targeting known risk factors. Further research in causes of unfavorable trends in younger cohorts is warranted.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Optimising Repeated Exposure: Determining Optimal Stimulus Shape for Introducing a Novel Vegetable among Children

Although it is well evident that a healthy diet rich in fruit and vegetables could prevent a number of major chronic diseases, national and international guidelines concerning their intake are not being reached by a large percentage of the population, including children. Thus, it is of interest to investigate how the consumption of this food group by children could be increased. The aim of this study was to examine the impact of serving style on the consumption of a raw snack vegetable (daikon) and the influence of its exposure on liking and intake of the vegetable. A group of 185 children 3–5 years old participated in the study. Two kindergartens served as intervention groups, while the third was assigned to be the control group of the study (n = 50). The intervention groups were repeatedly exposed to one of three different serving styles of daikon: sticks (n = 42), triangles (n = 46) or grated (n = 47), and they were all visited 7 times during the exposure period, on the same frequency (twice per week). Familiarity and liking of the target vegetable, daikon, and six other vegetables (cucumber, celery, celeriac, broccoli, cauliflower and beetroot) were measured at baseline, post-intervention and two follow up sessions (3- and 6-month) to investigate the likelihood of generalisation effects. Intake of daikon was measured at all control sessions and exposures. Moreover, children were asked to rank their favourite serving style of daikon and beetroot, among triangle, stick and grated, towards understanding the influence of shape on the efficacy of the exposure. The results revealed significant changes between liking and intake of daikon for the groups of triangles and sticks and the control group (p < 0.05). The group that received grated daikon did not show significant differences in liking and at intake levels during the exposures but performed well in the long-term. Throughout the exposure period, intake levels followed an overall increasing pattern, with all the groups to demonstrate a decrease of their intake at the last session, which was not found significant for the triangle group. Mere exposure was efficient towards increasing liking and intake of the novel vegetable with all the shapes to deliver positive results, but based on this study no particular serving style can be recommended.

Projections of disability-adjusted life years for major diseases due to a change in vegetable intake in 2017-2040 in Japan

Background

Low vegetable intake is one of the key dietary risk factors known to be associated with a range of health problems, including cardiovascular diseases (CVDs), cancer, and diabetes and kidney diseases (DKDs). Using data from Japan’s National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017, this study aimed to forecast the impact of change in vegetable intake on disability-adjusted life years (DALYs) between 2017 and 2040 for three diseases.

Methods

We generated a three-component model of cause-specific DALYs, including changes in major behavioural and metabolic risk predictors, the socio-demographic index and an autoregressive integrated moving average model to project future DALY rates for 2017–2040 using the data between 1990 and 2016. Data on Vegetable consumption and risk predictors, and DALY rate were obtained from Japan’s National Health and Nutrition Surveys and the Global Burden of Diseases Study in 2017. We also modelled three scenarios of better, moderate and worse cases to evaluate the impact of change in vegetable consumption on the DALY rates for three diseases (CVDs, cancer, and DKDs).

Results

Projected mean vegetable intake in the total population showed a decreasing trend through 2040 to 237.7 g/day. A significant difference between the reference scenario and the better case scenario was observed with un-overlapped 95% prediction intervals of DALY rates in females aged 20–49 years (− 8.0%) for CVDs, the total population for cancer (− 5.6%), and in males (− 8.2%) and females (− 13.7%) for DKDs.

Conclusions

Our analysis indicates that increased vegetable consumption would have a significant reduction in the burdens of CVDs, cancer and DKDs in Japan. By estimating the disease burden attributable to low vegetable intake under different scenarios of future vegetable consumption, our study can inform the design of targeted interventions for public health challenges.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10772-2.

Associations of carbohydrates and carbohydrate-rich foods with incidence of type 2 diabetes

Dietary carbohydrates have long been expected to be associated with risk of type 2 diabetes; however, the associations for many carbohydrates and carbohydrate-rich foods remain inconclusive. This study analysed associations between intakes of six types of carbohydrates and thirteen carbohydrate-rich foods with incident type 2 diabetes in 26 622 participants (61 % women) in the Malmö Diet and Cancer Study in southern Sweden. Dietary intake was assessed at baseline (1991-1996) by using a modified diet history method. During mean follow-up of 18 years, 4046 cases were identified. Adjusting for potential confounders (including lifestyle, BMI and dietary factors), comparing highest v. lowest quintile of intake, monosaccharides (hazard ratio (HR) 0·88; 95 % CI 0·79, 0·98; Ptrend = 0·02) and fruits (HR 0·91; 95 % CI 0·82, 1·01; Ptrend = 0·03) were inversely associated with incident type 2 diabetes, while disaccharides (HR 1·17; 95 % CI 1·04, 1·30; Ptrend = 0·002) and sweets (HR 1·09; 95 % CI 1·00, 1·19; Ptrend = 0·02) were positively associated. After stratification by sex, marmalade/honey/jam (HR 0·82; 95 % CI 0·72, 0·94; Ptrend < 0·001) and vegetables (HR 0·85; 95 % CI 0·73, 0·98; Ptrend = 0·06) were inversely associated with incident type 2 diabetes in men and chocolate (HR 1·26; 95 % CI 1·09, 1·46; Ptrend < 0·001) was positively associated in women. In conclusion, we identified inverse associations for intake of monosaccharides and fruits with type 2 diabetes risk, and positive associations for disaccharides and sweets. Additional sex-specific associations were also identified. Future studies are needed to explore these associations further.

Dietary Intake in Association with All-Cause Mortality and Colorectal Cancer Mortality among Colorectal Cancer Survivors: A Systematic Review and Meta-Analysis of Prospective Studies

Simple Summary

Given that an extensive range of dietary factors has not been investigated among colorectal cancer (CRC) survivors to date, we carried out a systematic review and meta-analysis to determine the effects of both prediagnostic and postdiagnostic dietary intake on all-cause mortality and CRC-specific mortality among CRC survivors. In total, 45 studies were included in the final analysis of 35 food items, 8 macronutrients, 27 micronutrients, 2 dietary patterns, and 13 dietary indexes in association with all-cause mortality and CRC-specific mortality. We found that an unhealthy dietary pattern increased the risks of both all-cause mortality and CRC-specific mortality. The role of prediagnostic and postdiagnostic intake such as macronutrients and fatty acids could be different in the risk of all-cause mortality. Overall, comprehensive evidence for the effect of substantial numbers of prediagnostic and postdiagnostic dietary items on mortality outcomes is reported in this study.

Abstract

We carried out a systematic review and meta-analysis to determine the effects of both prediagnostic and postdiagnostic dietary intake on all-cause mortality and CRC-specific mortality among CRC survivors. An extensive search of PubMed and Embase was conducted to identify eligible studies. We applied a random-effects model to estimate the pooled relative risks (RRs)/hazard ratios (HRs) and their 95% confidence intervals (CIs). As a result, a total of 45 studies were included in the final analysis. Pooled effect sizes from at least three study populations showed that whole grains and calcium were inversely associated with all-cause mortality, with RRs/HRs (95% CIs) of 0.83 (0.69–0.99) and 0.84 (0.73–0.97), respectively. In contrast, a positive association between an unhealthy dietary pattern and both all-cause mortality (RR/HR = 1.47, 95% CI = 1.05–2.05) and CRC-specific mortality (RR/HR = 1.52, 95% CI = 1.13–2.06) was observed among CRC survivors. In the subgroup analysis by CRC diagnosis, prediagnostic and postdiagnostic dietary intake such as carbohydrates, proteins, lipids, and fiber were observed to have different effects on all-cause mortality. Overall, an unhealthy dietary pattern increased the risks of both all-cause mortality and CRC-specific mortality. The role of prediagnostic and postdiagnostic intake of dietary elements such as macronutrients and fatty acids could be different in the risk of all-cause mortality.

Dietary Patterns and Their Association with Body Composition and Cardiometabolic Markers in Children and Adolescents: Genobox Cohort

Diet is a key factor for obesity development; however, limited data are available on dietary cluster analysis in children with obesity. We aimed to assess the associations between dietary patterns and obesity and several cardiometabolic markers. Anthropometry, bioelectrical impedance, blood pressure and plasma biomarkers of oxidative stress, inflammation and endothelial damage were determined in 674 Caucasian children, aged 5-16, with normal or excess weight. Using a food frequency questionnaire and cluster analysis, two consistent dietary patterns were shown, labeled as health conscious (HC) and sweet and processed (SP). The HC pattern included a greater proportion of participants with overweight/obesity than the SP cluster (80.1% vs. 63.8%). However, children with obesity within the HC cluster, showed less abdominal fat, through waist to hip (0.93 vs. 0.94) and waist to height (0.61 vs. 0.63) indexes (p < 0.01). Univariate general models showed several additional differences in cardiometabolic risk biomarkers in the global and stratified analyses, with a healthier profile being observed mainly in the HC cluster. However, multivariate models questioned these findings and pointed out the need for further studies in this field. Anyhow, our findings support the benefits of a healthy diet and highlight the importance of dietary patterns in the cardiometabolic risk assessment of children with overweight/obesity, beyond weight control.

Fruit and vegetable consumption among South Asians: A systematic review and meta-analysis

BACKGROUND AND AIMS

Low consumption of fruit and vegetables is associated with high prevalence of non-communicable diseases, especially among South Asians. The aim of our study was to systematically review data published on fruit and vegetable intake among South Asian countries.

METHODS

This review included 43 studies conducted from December 1999 to 2019 among South Asians. Literature searching was undertaken in PubMed® database and World Health Organization website. The main outcomes were pooled using random effect meta-analysis.

RESULTS

The highest fruit consumption by both men and women (2.4 servings/day) was found in Bhutan (2004) while the lowest reports (0.43 servings/day) were from Sri Lanka (2011) and Bangladesh (2002). With regard to vegetable consumption, Indians (2007) had the lowest reported intake (0.9 servings/day), while the highest value, 3.8 servings/day, was reported in Bhutanese adults (2014). When both intakes were considered, the highest (4.28; 95% CI, 4.02 to 4.55; p=0.15; I²=51%, p<0.001) and the lowest (1.83; 95% CI, 1.41 to 2.25; p<0.001; I²=100%, p<0.001) pooled mean values, were attained for Bhutan and Bangladesh, respectively. The highest percentage of respondents (86.2%) achieved the World Health Organization recommendation of five fruit and vegetables (400 g) per day in Afghanistan (2013) whereas the lowest (0%) reported in Bangladesh (2005).

CONCLUSIONS

Residents of almost all South Asian countries appear to consume extremely low quantities of fruit and vegetables, lower than the World Health Organization recommendation. Hence, immediate initiatives should be implemented to enhance the intake of fruit and vegetables across the region.

Nutrients and Caloric Intake Associated with Fruits, Vegetables, and Legumes in the Elderly European Population

Nutrition is emerging as a key factor in promoting healthy lifestyles in the growing elderly population across Europe. In this study, we examined the non-animal-derived food source consumption among the elderly European population to evaluate the actual contributions of these foods to the diet of the elders. We gathered 21 studies conducted in 17 European countries to evaluate the fruit, vegetable, and legume (along with their derived products) consumption among the elderly (>65 years) population. Foods' nutritional values were calculated and compared to the recommended intakes. A Bayesian multilevel hierarchical analysis was conducted to estimate the caloric intake of food categories and to compare the elderly and general adult populations. Although the lowest consumption was generally associated with the lowest nutrient and fiber intake, the reverse was not always the case. Concerning the general adult population, no differences in the related caloric intake of elders were noticed. Differences were instead evident when foods were divided into subclasses. Elderly populations consume fruit and fruit products, but they drink less fruit and vegetable juices and nectars. In conclusion, elderlies' fruit and vegetable consumption showed a peculiar pattern with respect to the general adult population, whose recognition could be helpful to address tailored policies. Constantly updated studies, including all the lifespan ages, are warranted to design tailored effective public health interventions.

StudentKost: a cross-sectional study assessing college students' diets: reason for concern?

College students constitute a significant proportion of the young adult population in Norway. They are in their reproductive years, which is of interest regarding diet and preconception health. Our objective was to assess young college students' diet and nutrient intake in relation to national dietary recommendations and assess the probability of inadequate micronutrient intake for both genders using the Nordic Nutrition Recommendations, and also to evaluate its consequences on preconception health and create a groundwork for future interventions on this group. At the University of Agder (UiA), we enrolled 622 students aged 18-40 years for a cross-sectional study of student's diet, StudentKost. The students completed a food frequency questionnaire, including questions of supplement use, over the past 4 weeks. Intake of fruits, vegetables, oily fish, and whole grain was lower than recommended, as were mean intake of folate, iron, and iodine. Our main findings are that students have a somewhat suboptimal diet compared to the Norwegian dietary guidelines. Male students had generally lower diet quality than females. Compared to the Nordic Nutrition Recommendations (NNR), we also saw a relatively high probability of inadequate intake of several micronutrients and a very high probability for some micronutrients in a significant portion of the sample. Public health effort should be directed towards improving students and young adults' diet in general, and interventions towards improving preconception health should be explored. The low participation rate limits the generalizability of our findings. Our findings encourage further investigation into young adults' diet.

Reactions to an Online Demonstration of the Effect of Increased Fruit and Vegetable Consumption on Appearance: Survey Study

Background

Inadequate fruit and vegetable consumption causes a considerable disease burden and premature mortality. Despite public health promotion of a healthy diet, the average consumption is still below recommended levels. Fruit and vegetable consumption influences human skin color, increasing red/yellow/orange pigment in the skin. Given that this color is deemed attractive and healthy-looking, the appearance benefit may motivate to eat more fruit and vegetables. Such appearance motivation could be particularly useful in young individuals who currently eat the least fruit and vegetables.

Objective

Our objectives were to assess how widely the impact of diet on skin color is known within the UK and to compare the strength of motivation to eat fruit and vegetables based on health and appearance benefits among different demographic groups.

Methods

Four groups of UK residents (N=200 per group) were recruited through the Prolific online platform. Groups comprised younger (aged 18-24) and older adults (aged 40-60) of low and high self-reported socioeconomic status (1-5 and 6-10 on a 10-point rating scale). Facial images simulating the skin color associated with low and high fruit and vegetable diets were shown to participants. Questionnaires were used to assess (1) background knowledge of the health and skin color effects of dietary fruit and vegetables, (2) the specific motivational impact of the skin color illustration, and (3) the relative importance of motivation to consume fruit and vegetables arising from health and skin color appearance benefits.

Results

We found that 61% (n=487) of all participants were unaware of the dietary–skin color association. We also found that 57% (n=457) of participants found the simple demonstration of the dietary impact on skin color positively motivating to eat more fruit and vegetables. The visual demonstration was equally motivating for participants of high and low self-reported socioeconomic status (P=.63) and different ethnic backgrounds (White N=453, Black N=182, Asian N=87, P=.22). Health benefits from a diet high in fruit and vegetables were regarded as more motivating than skin color appearance benefits. The appearance-changing benefits of a high fruit and vegetable diet (compared to the health benefits) were relatively more important for the younger participants (Mann-Whitney U=96,263, P<.001) and for women (N=489) than for men (N=310, U=83,763, P=.01).

Conclusions

These findings indicate that the promotion of the skin color effects of diets high in fruit and vegetables could provide additional motivation for a healthier diet. Our study indicates the broad appeal of appearance benefits from dietary fruit and vegetable (across ethnicity and socioeconomic status) and particularly amongst young adults where an inadequate diet is most prevalent.

Eating Vegetables First at Start of Meal and Food Intake among Preschool Children in Japan

Eating behavior is an important aspect for dietary quality and long-term health. This study examined associations between eating vegetables first at a meal and food intakes among preschool children in Tokyo, Japan. We used cross-sectional data of 135 preschool children from seven nursery schools in Adachi City, Tokyo, Japan. Caregivers completed a survey on child’s eating behaviors and a diet questionnaire. Linear regression was used to examine frequency of eating vegetables first at a meal and food intakes; percent difference and the corresponding 95% confidence interval (95% CI) were presented. Overall, 25.2% of children reported eating vegetables first at a meal every time, 52.6% sometimes, and 22.2% not often or never. In the multivariate analysis, higher vegetable intake remained significant after adjusting for other covariates (compared with the group of eating vegetables first not often or never, the group reported sometimes: 27%, 95% CI: 0–63%; the group reported every time: 93%, 95% CI: 43–159%). No significant difference in intake by frequency categories of eating vegetables first was observed for other food groups, including fruits, meat, fish, cereals, and sweets. Children eating vegetables first at a meal more was associated with higher total intake of vegetables compared with children who did not eat vegetables first, among Japanese preschool children.

Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation

INTRODUCTION

Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

METHODS AND ANALYSIS

In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT03952338.

Wild Lactobacillus casei Group Strains: Potentiality to Ferment Plant Derived Juices

Plant derived beverages have recently gained consumers’ interest, particularly due to their intrinsic functional properties. They can also act as non-dairy carriers for probiotics and prebiotics, meeting the needs of lactose allergic/intolerant people and vegans. Direct fermentation of fruit and vegetables juices by probiotic lactic acid bacteria could be a tool to increase safety, shelf-life, nutrients bioavailability and to improve sensorial features of plant derived juices. This study aims to screen wild Lactobacillus casei-group strains isolated from dairy matrices for probiotic features, such as acid and bile salts resistance, and test them for the potentiality to ferment celery and orange juices. Strains’ ability to produce exopolysaccharides (EPS) in situ is also checked. These evaluations were performed for the first time in fruit and vegetables matrices by means of an impedometric analysis, recently shown to be a suitable and rapid method to measure microorganisms’ growth, acidification performances and EPS production. This study allowed the selection of three potentially probiotic L. casei-group wild strains able to ferment fruit and vegetable juices and also producing EPS. These strains with three-in-one abilities could be used to produce new functional fermented plant derived juices.

Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR)

Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.

Arterial Stiffness, Sugar-Sweetened Beverages and Fruits Intake in a Rural Population Sample: Data from the Brisighella Heart Study

Introduction: There is conflicting information linking fruit and fructose intake with cardiometabolic disorders. The main objective of our study was to evaluate the association between intake of fruits and sugar-sweetened beverages, and carotid-femoral pulse wave velocity (cfPWV), a non-invasive marker of arterial aging, in a large population sample. Methods: For this study, we selected four age and sex-matched subgroups from the last Brisighella Heart Study population survey, after exclusion of those in secondary prevention for cardiovascular diseases, affected by gout and moderate-to-severe chronic kidney disease (defined as eGFR < 60 mL/min), and/or actively treated with direct vasodilating drugs (calcium-antagonists, alpha-blockers, nitrates). The remaining subjects were classified into four groups: (1) low fruit and low sugar-sweetened beverage intake (LFLB), (2) high fruit and low sugar-sweetened beverage intake (HFLB), (3) low fruit and high sugar-sweetened beverage intake (LFHB), (4) high fruit and high sugar-sweetened beverage intake (HFHB). Results: CfPWV was significantly elevated in subjects consuming a higher fructose load, particularly when it was derived from industrially sweetened beverages (pooled LFHB & HFHB: 9.6 ± 2.3 m/s; pooled LFLB & HFLB: 8.6 ± 2.3 m/s, p < 0.001). Moreover, the main predictors of cfPWV values were serum uric acid (B = 0.391, 95%CI 0.321–0.486, p = 0.001), fructose load from both fruits and sugar-sweetened beverages (B = 0.310, 95%CI 0.099–0.522, p = 0.004), triglycerides (B = 0.228, 95%CI 0.117–0.389, p = 0.018), fasting plasma glucose (B = 0.015, 95%CI 0.008–0.022, p < 0.001) and estimated Glomerular Filtration Rate (B = −0.043, 95%CI −0.052–−0.035, p < 0.001). Conclusion: our data suggest that increased intake of fructose derived from industrial sweetened beverages, though not from fruits, is associated with higher pulse wave velocity.

Helsinki by nature: The Nature Step to Respiratory Health

Background

The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs.

Results

The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, affects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking “nature” to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, traffic arrangements, energy production, and importantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously.

Conclusions

In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.

Intake of 100% Fruit Juice Is Associated with Improved Diet Quality of Adults: NHANES 2013-2016 Analysis

Fruit intake is generally associated with better diet quality and overall health. This report examined the effect of 100% fruit juice (considered a part of total fruit servings) and its replacement with whole fruits equivalents on nutrient intake and diet quality. National Health and Nutrition Examination Survey 2013-2016 data (24-h dietary recall) from adults 19+ years (n = 10,112) were used to assess the diet quality and nutrient intakes and to isocalorically replace with 100% fruit juice intakes whole fruit equivalents in a modeling analysis. About 15.6% adults were 100% fruit juice consumers. Consumers had higher diet quality (10% higher Healthy Eating Index, HEI 2015 score), and higher intakes of energy, calcium, magnesium, potassium, vitamin C and vitamin D than non-consumers. Consumption of 100% fruit juice was also associated with lower risk of being overweight/obese (-22%) and having metabolic syndrome (-27%). Replacing 100% fruit juice with whole fruits equivalents did not affect nutrient intake except for a modest increase (+6.4%) in dietary fiber. Results show that 100% fruit juice intake was associated with better diet quality and higher nutrient intake. Replacement of 100% fruit juice intake with whole fruits equivalents had no significant effect on nutrients except for dietary fiber.

Time-trend analysis of fruit and vegetable intake in Hong Kong, 2004-2016

OBJECTIVES

In 2005, the Hong Kong government launched a series of large-scale dietary promotion campaigns aiming to increase fruit and vegetable intake. This study aimed to investigate changes in mean fruit and vegetable intake in the population between 2004 and 2016.

STUDY DESIGN

Time-trend analysis.

METHODS

Fruit and vegetable intake data from adults aged 18-64 years between 2004 and 2016 were extracted from government online databases. Descriptive analyses were conducted. One-way analysis of variance was employed to compare population-weighted age-specific and sex-specific mean fruit and vegetable intake at 95% confidence levels in SPSS.

RESULTS

Between 2004 and 2016, mean fruit intake (males: 0.70-1.22 servings/day; females: 0.95-1.59 servings/day) and mean vegetable intake (males: 1.80-2.51 servings/day; females: 2.10-2.83 servings/day) among Hong Kong adults across all age groups were lower than recommended. Adults aged 45-54 years and over ate more fruit than younger adults. However, decreasing fruit intake trends were observed among both females and males across all ages. The decreased mean fruit intake among males aged 35-54 years and females aged 35-44 years and below has become statistically significant in more recent years, which may indicate a slow transitioning toward significantly lower mean fruit intake across these age groups. Although statistically non-significant, increasing vegetable intake trends were observed among adults aged 35-44 years and below, which may indicate a slow transitioning process toward significantly higher mean vegetable intake among these age groups. However, there is concern about the downward vegetable intake trends among adults aged 45-64 years.

CONCLUSIONS

More research is needed to investigate the effectiveness of dietary promotion campaigns, especially in terms of promotion coverage and population age ranges. More effective strategies are needed to increase fruit and vegetable intake in the population.