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

Umbrella Review of Systematic Reviews and Meta-analyses on Consumption of Different Food Groups and Risk of All-cause Mortality

Consumption of different food groups is linked to a range of health outcomes. It is essential to integrate the most reliable evidence regarding intake of different food groups and risk of mortality to optimize dietary guidance. Our aim is to systematically and comprehensively assess the associations between the consumption of various food groups and all-cause mortality. The food groups under consideration include edible grains (refined and whole grains), fruits, vegetables, nuts, legumes, fish and fish products, eggs, dairy products/milk, meat and meat products (including processed meat, unprocessed red and white meat), sugar-sweetened beverages, and added sugars. We present these associations with high compared with low consumption and per serving comparisons. We comprehensively and systematically reviewed a search in Medline, Embase, Web of Science, and Epistemonikos (PROSPERO: CRD42024498035), identifying 41 meta-analyses involving over a million participants, many of which showed significant heterogeneity. Of the 41 studies, 18 were rated high quality, 8 moderate quality, 5 low quality, and 10 critically low quality according to AMSTAR-2 assessments. Our findings revealed that higher consumption of nuts, whole grains, fruits, vegetables, and fish was associated with lower mortality rates, both in high compared with low comparisons and per serving analyses. Similarly, we observed favorable outcomes for legumes and white meat in high compared with low comparisons. Conversely, high intakes of red and processed meats, as well as sugar-sweetened beverages, were linked to higher all-cause mortality. Dairy products and refined grains did not show clear associations with mortality, whereas there was a tendency in all-cause mortality for high intakes of added sugars and eggs.

Production risk and technical efficiency of dry-season vegetable farmers in the Upper East Region of Ghana

The Ghanaian population is aware of the increasing health challenges in our health facilities and the need to consume more vegetables to improve their health status. This, coupled with population growth and changing consumer patterns has led to an increasing demand for vegetable products in Ghana. Smallholder farmers in the country have thus intensified the production of vegetables during the dry season to meet consumers' demand and to generate income. However, their outputs have been lower than the country's potential, so the research was conducted to identify the causes and determinants of the low yields. A total of 322 dry-season vegetable farmers in seven (7) districts in twenty-four (24) communities were selected from the Upper East Region of Ghana using a purposive random sampling technique. The Kumbhakar model was employed to compute the production risk, technical inefficiency and determinants of vegetable production in the region. The study reveals that the input variables: labour, seed, fertilizer, agrochemical and irrigation costs positively are related to the output value of vegetables with an increasing return to scale. In addition, labour, seed and agrochemical costs show a significant production risk-decreasing effect while the risk of vegetable production is reduced with fertilizer and irrigation costs. The study further depicts that extension visits, experience, water pumps and gravity-fed irrigation systems positively affect the technical efficiency of dry-season vegetable production. Again, given the current state of technology and resources available to the farmers, enhancing the vegetable outputs could be achieved by reducing the technical inefficiencies by 27% while considering the effects of production risk. The study concludes that the farmers can improve the output of the vegetable farms for higher income by adopting the best vegetable production practices such as efficient water-saving irrigation technologies and fertilizer usage while adopting the knowledge from the extension training to improve their technical efficiency.

The associations of obesity with demographic and lifestyle factors among Hong Kong adults

Background: Obesity is a risk factor for leading causes of death. Aim: This study investigated the associations of obesity with demographic and lifestyle factors among adults aged 18-64 in Hong Kong. Methods: The study uses data (n = 24,855) from the government online database. It uses T-tests to compare mean values for body mass index (BMI), waist circumference, and weight-to-height ratio obese; analysis of variance for not-obese, BMI-obese-only, central-obese, and BMI + central-obese; Pearson chi-square tests for categorical variables; and multinomial logistic regression to obtain the odd ratios. It uses IBM SPSS version 26 to conduct all analyses, and at a 95% confidence level. Results: The analyses show that the risks of central-obese, and BMI + central-obese increase by 4%, and 4%/year of age, respectively. Females have 60%, 38%, and 60% lower risks of BMI-obese-only, central-obese, and BMI + central-obese, respectively, and people with tertiary education have 28%, 20%, and 20% lower risks, respectively. Employed people have a 40% higher risk of BMI-obese-only when compared with the unemployed; students have a 46% lower risk of BMI + central-obese and home-makers have a 38% higher risk. The risk of central-obese decreases by 14%/10 min/day of moderate physical activity, but could be different among females, and vigorous physical activity yielded mixed results. The risk of BMI + central-obese decreases by 9%/day/week of vegetable intake. Conclusions: Obesity is associated with multiple demographic and lifestyle factors. Keep doing vigorous and moderate physical activity but state alert to obesity risk factors, and frequent vegetable intake are recommended. Lifelong learning and continuing education could be an effective strategy to combat obesity.

Social Markers of Differences in Fruit and/or Vegetable Consumption Among Brazilians: An Intersectional Analysis

OBJECTIVE

The objective of this study was to examine the differences in fruit and/or vegetable consumption (FVC) among Brazilian adults by examining various social markers, such as gender, race, income, and education level.

METHOD

A cross-sectional study of 88,531 Brazilian adults aged 18 years or older who participated in the 2019 National Health Survey was conducted. The dependent variable was irregular FVC (<5 d/wk). Individuals at the highest risk for irregular FVC include those who are men and Black and who have lower education levels and lower income. Individuals at lower risk include those who are women and White and who have higher education levels and higher income. The prevalence of irregular FVC was calculated considering the levels of the social risk index for FVC and the intersections among two, three, and four risk categories. Odds ratio (OR) and 95% confidence interval (CI) analyses were performed to compare groups at higher risk with those at lower risk.

RESULTS

The prevalence of irregular FVC was 57.2% in the general population, 38.1% for individuals in the lowest risk group, 47.5% for individuals in one risk category, 57.9% for individuals in two risk categories, 67.6% for individuals in three risk categories, and 74.4% for individuals in the highest-risk group, and there were significant differences at each level. The highest risk group had a 4.36 (95% CI, 3.86-4.92) times greater chance of irregular FVC.

CONCLUSIONS

The complex path to promote FVC among the Brazilian population underscores the need for intersectoral policies aimed at reducing inequalities.

Does stress compromise fruit and vegetable intake? A randomized controlled trial testing a model with planning as a mediator and stress as a moderator

OBJECTIVE

Individuals experiencing higher stress levels tend to consume fewer fruits and vegetables compared to their less stressed counterparts. Thus, to promote fruit and vegetable (FV) consumption, action planning has been proven effective in translating behavioral intentions into actual dietary behaviors. This study aims to evaluate a 7-day intervention designed to improve FV planning and intake, while also examining the role of stress.

METHODS

The trial employed a 3 (time: pretest, post-test, and follow-up) * 2 (group: intervention vs. control) between-participant factorial design. A total of 99 young Chinese adults (age = 23.84 years ± 4.63, 26 men) who had formed an explicit intention to consume more fruit and vegetables, participated in a 7-day online randomized controlled trial.

RESULTS

The intervention successfully enhanced FV planning as well as FV intake. Furthermore, a moderated mediation model revealed that FV planning mediated the relationship between experimental conditions and FV intake, with stress moderating this mediation. Specifically, planning facilitated FV intake for individuals with low stress levels, while this effect was not observed for those with high stress levels.

CONCLUSION

These findings confirm the positive impact of the planning intervention on improving FV intake, particularly for individuals with low stress levels, and highlight stress as a barrier to health behavior change that warrants further attention in future studies.

Intake of vegetables and fruits at midlife and the risk of physical frailty in later life

OBJECTIVES

Our study evaluated the independent and overall associations of vegetable and fruit consumption at midlife with the likelihood of physical frailty in later life. We also investigated whether specific nutrients in these foods could have accounted for these associations, if present.

DESIGN

Prospective cohort study.

SETTING

A population-based cohort of Chinese adults followed over a period of 20 years in Singapore.

PARTICIPANTS

We used data from 11,959 subjects who participated in the baseline (1993-1998) and follow-up 3 (2014-2017) interviews of the Singapore Chinese Health Study.

MEASUREMENTS

At baseline, dietary intake was evaluated using a validated food frequency questionnaire. During the follow-up 3 visits, physical frailty was assessed using a modified Cardiovascular Health Study phenotype that included weakness, slowness, exhaustion and weight loss. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations with physical frailty.

RESULTS

Participants had mean ages of 52 years at baseline, and 72 years at follow-up 3. Baseline intake of vegetables, but not of fruits, showed a dose-dependent inverse relationship with physical frailty at follow-up 3 (Ptrend = 0.001). Compared to participants in the lowest quintile of vegetable intake, those in the highest quintile had reduced odds of frailty [OR (95% CI): 0.73 (0.60-0.89)]. Among the components of physical frailty, vegetable intake had the strongest inverse association with weakness defined by handgrip strength [OR (95% CI) between extreme quintiles: 0.62 (0.52-0.73); Ptrend < 0.001]. In models that were individually adjusted for nutrients, the vegetable-frailty association was attenuated and no longer statistically significant after adjusting for the intake of β-carotene, lutein, folate, α-carotene, and isothiocyanates.

CONCLUSION

Increased midlife intake of vegetables was associated with reduced odds of physical frailty in later life, and the intake of β-carotene, lutein, folate, α-carotene, and isothiocyanates could have accounted for this association.

Boosting Health Benefits in Vegetables: A Novel Ultraviolet B (UVB) Device for Rapid At-Home Enhancement of Phytochemicals and Bioactivity

The consumption of vegetables is essential for reducing the risk of noncommunicable diseases, yet global intake falls short of recommended levels. Enhancing the nutraceutical content of vegetables through postharvest abiotic stress, such as ultraviolet B (UVB) radiation, offers a promising solution to increase health benefits. This study developed a user-friendly, at-home UVB device designed to increase the phytochemical content in common vegetables like carrots, lettuce, and broccoli. The device applies UVB radiation (305-315 nm) to fresh-cut vegetables, optimizing exposure time and intensity to maximize nutraceutical enrichment. The results demonstrated that UVB exposure increased the phenolic content by 44% in carrots, 58% in broccoli, and 10% in lettuce, with chlorogenic acid levels rising by 367% in lettuce, 547% in broccoli, and 43% in carrots after 48 h of storage. UVB treatment also enhanced antioxidant activity by up to 41% in broccoli and anti-inflammatory potential by 22% in carrots. In terms of gene expression, UVB treatment upregulated UCP-1 expression by 555% in carrots, enhanced thermogenesis, and increased SIRT-1 and ATGL expression by over 200%, promoting lipid metabolism. This process provides a convenient and efficient method for consumers to boost the health benefits of their vegetables. The study concludes that UVB-induced abiotic stress is an effective strategy to improve vegetable nutritional quality, offering a novel approach to increasing bioactive compound intake and aiding in the prevention of diet-related diseases.

Effect of Fruit and Vegetable Consumption on Human Health: An Update of the Literature

Several meta-analyses have consistently demonstrated that the consumption of an adequate level of fruit and vegetables (F&V), along with other food groups, is associated with a low risk of all-cause mortality, and, as such, represents one of the major modifiable risk factors related to the growing burden of Non-Communicable Diseases (NCDs). The aim of the present narrative review was to provide an up-to-date analysis of systematic reviews and meta-analyses published in the past five years, dealing with the effects of F&V consumption on human health, focusing on specific pathologies, such as total mortality, cancer, cardiovascular diseases (CVDs), type 2 diabetes, intestinal inflammation, and bone and respiratory illnesses. The results of our evaluation confirmed and consolidated the protective role of F&V consumption against the development of NCDs, especially CVDs. However, the need to corroborate existing evidence and clarify the role of confounding factors by performing additional randomized control trials and adopting more standardized approaches and study designs also emerged. Moreover, evaluating the protective role of fruit and vegetables as separate food categories appeared to be one of the most interesting areas to investigate in the near future. Overall, these outcomes could help in addressing future research to better establish a causal relationship between F&V consumption and human health.

Did COVID-19 influence fruit and vegetable consumption? Explaining and comparing pandemic peak and post-peak periods

The COVID-19 pandemic, one of the worst global health crises in the last century, impacted nearly every aspect of people's lives, including their dietary choices and food consumption patterns. It arrived during a long shift in American diets featuring increasingly large portions of processed foods as well as fruit and vegetable consumption that is well below recommended levels. Improving the latter has been a key part of policymakers' efforts to improve consumers' diets. This study surveyed individuals in the US South to determine the factors influencing their consumption of fruit and vegetables during the pandemic peak and how these have changed post-peak. During the peak, food venue, demographics, and concerns about diet and the seriousness of the virus heavily affected consumption. Greater amounts of fresh fruit and vegetables were consumed post-peak pandemic. Changes post-peak were predicted by food venue. Cooking meals at home was the main positive predictor for consumption. US policymakers should try and leverage the changes since the peak to promote greater consumption of fruit and vegetables.

Characteristics associated with fruit and vegetable consumption in mid aged and older Chinese men and women: a cross-sectional analysis of the first wave of WHO SAGE China

Adequate fruit and vegetable consumption is essential for healthy ageing and prevention and management of chronic disease. This study aimed to examine characteristics associated with fruit and vegetable consumption in Chinese men and women aged 50 years and over. Data from the first wave of the Chinese cohort (2008-2010) of the WHO's Study on global AGEing and adult health (SAGE) survey was used. Fruit and vegetable consumption was assessed by self-reported typical consumption in serves/day. Characteristics examined were age, education, financial security, home ownership, marital status, social cohesion and rural location. Associations with fruit and vegetable consumption were assessed using multiple linear regression adjusted for confounders and stratified by sex. Overall, women consumed more serves of fruit per day than men (mean (standard deviation): 2·6 (2·2) and 2·2 (2·1) serves/day, respectively) whereas men consumed more serves of vegetables than women (7·2 (4·0) and 6·7 (3·7)). Lower fruit consumption was associated with lower education, lower social participation, income insecurity, renting, being un-partnered and rural residency in men and women, as well as older age in women. Lower vegetable consumption was associated with older age, lower education and urban residency in men and women and lower social participation in men and being unpartnered in women. This study has identified characteristics associated with fruit and vegetable intake in a sample of mid aged and older Chinese men and women. Further research on the interrelationships between these characteristics and fruit and vegetable intake as well as longitudinal relationships is warranted.

Nitrate: "the source makes the poison"

Interest in the role of dietary nitrate in human health and disease has grown exponentially in recent years. However, consensus is yet to be reached as to whether consuming nitrate from various food sources is beneficial or harmful to health. Global authorities continue to recommend an acceptable daily intake (ADI) of nitrate of 3.7 mg/kg-bw/day due to concerns over its carcinogenicity. This is despite evidence showing that nitrate consumption from vegetable sources, exceeding the ADI, is associated with decreased cancer prevalence and improvements in cardiovascular, oral, metabolic and neurocognitive health. This review examines the paradox between dietary nitrate and health and disease and highlights the key role of the dietary source and food matrix in moderating this interaction. We present mechanistic and epidemiological evidence to support the notion that consuming vegetable-derived nitrate promotes a beneficial increase in nitric oxide generation and limits toxic N-nitroso compound formation seen with high intakes of nitrate added during food processing or present in contaminated water. We demonstrate the need for a more pragmatic approach to nitrate-related nutritional research and guidelines. Ultimately, we provide an overview of our knowledge in this field to facilitate the various therapeutic applications of dietary nitrate, whilst maintaining population safety.

Disease burden of esophageal cancer attributable to low fruit intake in China and globally from 1990 to 2019

OBJECTIVE

To understand the disease burden of esophageal cancer (EC) attributable to inadequate fruit intake in China and global from 1990 to 2019 stratified by age and sex.

METHODS

Global Burden of Disease Study (GBD 2019) were pooled to calculate the number of deaths, standardized mortality rate, disability-adjusted life years (DALY) and DALY rate of EC attributed to low fruit intake in China and globally by age and sex from 1990 to 2019. The population attributable fractions (PAF) were applied to estimate the proportion of EC caused by low fruit intake. Joinpoint was used to estimate average annual percentage of change (AAPC) to reflect the time change trend of the EC burden attributable to inadequate fruit intake in China and globally.

RESULTS

In the Chinese population in 2019, the attributable DALY of EC in males was 356,000 person-years, while it was 80,600 person-years in females. The attributable standardized mortality and DALY rates for different age groups in China increased with age, peaking in the group aged 70 years and above. From 1990 to 2019 in China, the number of deaths, standardized mortality rates, DALY and standardized DALY rates of EC attributable to inadequate fruit intake showed a decreasing trend (AAPCs: -1.62%, -4.54%, -2.10% and -4.88%, respectively), with statistical significance (P<0.001).

CONCLUSION

The overall burden of EC attributed to inadequate fruit intake in China has demonstrated a downward trend. However, due to the aging population, the disease burden in China remains higher than the global average. Hence, prevention and health education efforts should focus on the population with low fruit intake.

Relationship of increased fruit/vegetable intake with reduced consumption of sweets: Psychological mechanisms and associated weight loss in women within behavioral obesity treatments

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants' change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants' changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

Spatial variation of zero fruits/vegetables consumption and associated factors among children aged 6-23 months in Ethiopia: geographical weighted regression analysis

Background

After 6 months, nutrient-dense, varied diets containing fruits and vegetables are crucial to supplement breastfeeding. Like many other low-income countries, Ethiopia has very low FV consumption. Zero vegetable or fruit (ZVF) consumption has been shown to significantly raise the risk of non-communicable diseases and has been ranked among the top 10 risk factors for mortality. And it is associated with poor health, an increased risk of obesity, and a higher risk of non-communicable diseases. Thus, this study's goal was to investigate the spatial distribution of ZVF consumption and its spatial determinants among children aged 6-23 months in Ethiopia.

Methods

A cross-sectional study design was employed. A total of 1,489 weighted samples were included from kids' datasets from the 2019 Ethiopian mini-demographic and health survey. STATA version 16, ArcGIS version 10.8, Kuldorff's SaTScan version 9.6, and MGWR version 2.0 software were used for analysis. Spatial regression analyses (geographical weighted regression and ordinary least squares analysis) were conducted. Models were compared using AICc and adjusted R2. A p-value of less than 0.05 was used to declare statistically significant spatial predictors, and the corresponding local coefficients were mapped.

Results

The spatial distribution of ZVF consumption among children aged 6-23 months was non-random in Ethiopia. Spatial scan analysis revealed a total of 120 significant clusters. Maternal education, wealth status, age of the child, place of delivery, number of under-five children in the house, and current pregnancy status were significant predictors of the spatial variation of ZVF consumption.

Conclusion

Significant geographic variation in ZVF consumption was found in this study throughout Ethiopia's regions. Significant predictors of the spatial variation in ZVF consumption were maternal education, wealth status, child age, place of delivery, number of under-five children in the home, and status as a pregnant woman at the time of birth. Therefore, in order to improve children's adequate consumption of fruit and vegetables, area-based interventions that can consider these significant factors into account are needed.

Clusters in Infant Environmental Factors Influence School-Age Children's Vegetable Preferences in Japan

It remains unclear how the various environmental factors are combined in practice to influence vegetable preferences in school-aged children. This study aimed to clarify the environmental factors during infancy and their association with vegetable preference in school-aged children. To find clusters of early childhood environmental factors, we conducted a factor analysis on 58 items related to early childhood environmental factors and a k-means cluster analysis using the factors obtained. The association of the extracted factors and clusters with vegetable preferences was assessed by multiple regression analysis. Twelve factors relating to vegetable eating, cooking and harvesting experience, and parental attitudes were extracted by factor analysis. Three clusters, "low awareness of experiences", "high awareness" and "low positive encouragement", were then extracted. In the multiple regression analysis, all 12 factors were found to be associated with vegetable preferences. Furthermore, it was found that the "high awareness" group had a significantly higher score for vegetable preference than the "low awareness of experiences" group (β = 0.56, 95% CI: 0.37-0.74). Thus, the study found that environmental factors during infancy, in isolation and combination, influenced vegetable preferences in school-aged children. Assessing the combination of various environmental factors during infancy may contribute to a better understanding of future vegetable preferences.

Potential for positive biodiversity outcomes under diet-driven land use change in Great Britain

Background

A shift toward human diets that include more fruit and vegetables, and less meat is a potential pathway to improve public health and reduce food system-related greenhouse gas emissions. Associated changes in land use could include conversion of grazing land into horticulture, which makes more efficient use of land per unit of dietary energy and frees-up land for other uses.

Methods

Here we use Great Britain as a case study to estimate potential impacts on biodiversity from converting grazing land to a mixture of horticulture and natural land covers by fitting species distribution models for over 800 species, including pollinating insects and species of conservation priority.

Results

Across several land use scenarios that consider the current ratio of domestic fruit and vegetable production to imports, our statistical models suggest a potential for gains to biodiversity, including a tendency for more species to gain habitable area than to lose habitable area. Moreover, the models suggest that climate change impacts on biodiversity could be mitigated to a degree by land use changes associated with dietary shifts.

Conclusions

Our analysis demonstrates that options exist for changing agricultural land uses in a way that can generate win-win-win outcomes for biodiversity, adaptation to climate change and public health.

Time Trends in Income-related Differences in Food Group Intakes: The National Health and Nutrition Survey, Japan in 2010, 2014, and 2018

BACKGROUND

We aimed to clarify whether differences in food group intake according to household income have changed over the last decade in Japanese people aged 20 years or older.

METHODS

This cross-sectional study was based on the 2010, 2014, and 2018 National Health and Nutrition Surveys in Japan. Food intake was assessed using a 1-day semi-weighed household dietary record. The participants were categorized into three groups based on their income. The mean of each food intake according to the income group was estimated by adjusting for age, occupation, and number of participants from the same household. The significance of the interaction terms between income and survey year was evaluated to assess the change in income-related differences in food intake over time.

RESULTS

Cereal intake was lower in the middle- and the highest-income groups than in the lowest-income group, regardless of sex, and the interaction between income and year was nonsignificant for cereal intake. In the former two surveys, vegetable intake was higher among the highest-income women, while in the 2018 survey, the vegetable intake decreased in the women in the middle- and the highest-income groups. The interaction between income and year was significant for vegetable intake among the women. For other foods, the differences in intake among the income groups did not significantly change over time.

CONCLUSION

The tendency for lower cereal intake in the higher-income groups was consistent over time in both the sexes, and the tendency for higher vegetable intake in the highest income women disappeared over time.

Diet Quality and Mortality among Chinese Adults: Findings from the China Health and Nutrition Survey

The association between diet quality and all-cause mortality in Chinese population is unclear. We aimed to study the associations of three a priori diet quality indices-including the Diet Quality Index-International (DQI-I), Chinese Healthy Eating Index (CHEI), and energy-adjusted Dietary Inflammatory Index (E-DII)-and their included components with all-cause mortality. We used baseline data from the 2004, 2006, 2009, and 2011 waves of the China Health and Nutrition Survey (CHNS). We used a multivariable-adjusted Cox model to examine the associations between DQI-I, CHEI, and E-DII with all-cause mortality. During a mean of 7 years of follow-up, a total of 461 deaths occurred among 12,914 participants. For DQI-I, there were significant inverse associations with mortality for the variety score (HRQ4 vs. Q1 = 0.69, 95%CI = 0.52-0.92) and overall balance score (HR>0 vs. 0 = 0.81, 95%CI = 0.66-0.91). The adequacy score of CHEI was associated with 40% less risk of all-cause mortality (HRQ4 vs. Q1 = 0.60, 95%CI = 0.43-0.84). E-DII was not associated with mortality. An estimated 20.1%, 13.9%, and 31.3% of total mortality would be averted if the DQI-I variety score, DQI-I overall balance score, and CHEI adequacy score improved from the bottom to the top quartile, respectively. Improving diet quality, especially improving diet variety and adequacy, and having a more balanced diet may reduce all-cause mortality in Chinese adults.

Evolution of fruit and vegetable intake among health promotion service participants in a Brazilian metropolis: 48-month follow-up of a randomized controlled community trial

OBJECTIVE

To assess longitudinal effects of a nutrition intervention on fruit and vegetable (F&V) intake among Primary Health Care (PHC) service participants in Belo Horizonte, Brazil.

METHODS

Demographics and health data on 3414 PHC service participants were collected at baseline in 2013-2014. F&V intake was assessed at baseline, 12, 36, and 48 months until 2017-2018. Services were randomized to control (CG, usual care) or intervention (IG, usual care and a Transtheoretical Model-based intervention to increase F&V intake). We performed difference-in-differences (DiD) analysis to identify intervention effects on F&V intake, and sensitivity analyses of participants observed at all timepoints.

RESULTS

Participants were mostly middle-aged, low-income women. Mean baseline intakes were 168.7 g of fruit, 202.0 g of vegetables, and 370.7 g of F&V, with lower fruit in the IG (164.1 g) than the CG (172.3 g). At 12 months, the intervention increased fruit intake in the IG and fruit and F&V intake among individuals with low baseline F&V intake. Fruit intake remained higher at 36 months in the IG. No effect on vegetable intake was identified. According to sensitivity analyses, effects on fruit intake among the complete sample did not remain significant at 36 months, and an effect on fruit intake at 36 months was identified among those with adequate baseline F&V intake. Reductions in F&V intake did not remain significant.

CONCLUSIONS

At 12 months, a TTM-based intervention increased fruit intake in the overall sample, and fruit and F&V intake among individuals with low baseline intakes. Repeated interventions may be needed over time.

TRIAL REGISTRATION NUMBER

RBR-9h7ckx.

Improvements in cardiovascular disease risk factors associated with modest weight loss following treatment in patients with binge-eating disorder and obesity

BACKGROUND

Modest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%).

METHOD

Of 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss.

RESULTS

At posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure).

CONCLUSIONS

Modest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes.

PUBLIC SIGNIFICANCE STATEMENT

Individuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors.

Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study

BACKGROUND

Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia.

METHODS

An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities.

RESULT

In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity.

CONCLUSION

The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs.

Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study

BACKGROUND

Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake.

OBJECTIVE

This pilot study aimed first to translate the digital game "Veggies4myHeart" into French and to assess its influence on young children's preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms.

METHODS

During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview.

RESULTS

A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children's declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools.

CONCLUSIONS

In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake.

Dietary Recommendations for Ethiopians on the Basis of Priority Diet-Related Diseases and Causes of Death in Ethiopia: An Umbrella Review

Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30-90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50-150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15-35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200-300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200-300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).

Dietary trends among Polish women in 2011-2022-cross-sectional study of food consumption frequency among women aged 20-50 in Silesia region, Poland

Background

Women's nutrition should be different from that of men. Women have lower energy requirements than men. And the need for certain vitamins and minerals is higher in women, this applies to iron, calcium, magnesium, vitamin D and vitamin B9 (folic acid). This is related to hormonal changes including menstruation, pregnancy, breastfeeding and the onset of menopause. Through hormonal changes and the changing physiological state, women are at greater risk of anaemia, bone weakness and osteoporosis.The aim of the study was to assess changes in the dietary pattern among women from the Silesian Agglomeration in Poland between 2011 and 2022.

Material and method

The survey was conducted in 2011 (March-May 2011) and in 2022 (October-November 2022) among women living in the Silesian Agglomeration (Silesia region) in Poland aged 20-50. After consideration of the inclusion and exclusion criteria, 745 women were included in the final analysis, including 437 women screened in 2011 and 308 women screened in 2022.The research tool used in this publication was a survey questionnaire consisting of 2 parts. The first part of the questionnaire consisted of demographic data. The second part of the study focused on the dietary habits of the women surveyed and the frequency of consumption of individual foods (FFQ).

Results

More women in 2022 ate breakfast than in 2011 (77.6% vs. 63.8% p < 0.001), were more likely to eat breakfast I at home (73.1% vs. 62.5%; p < 0.001), were more likely to eat breakfast II (39.0% vs. 35.2%; p = 0.001), were more likely to eat breakfast II at home (28.6% vs. 19.2%; p = 0.002), and were more likely to eat lunch at work (16.6% vs. 3.4%; p < 0.001). Women in 2022 were more likely to consume fast-food (p = 0.001), salty snacks (chips, crisps) (p < 0.001) and sweets (p < 0.001). Women in 2022 were more likely to consume whole-grain bread (p < 0.001), wholemeal pasta (p < 0.001), brown rice (p < 0.001), oatmeal (p < 0.001), buckwheat groats (p = 0.06), and bran (p < 0.001) than women in 2011. They were less likely to consume white bread (p < 0.0001), light pasta (p = 0.004), white rice (p = 0.008) and cornflakes (p < 0.001) in 2022.Women in 2022 were significantly more likely to consume vegetables (p < 0.001) than women in 2011.

Conclusion

Eating habits in Silesia region women changed between 2011 and 2022. In 2022, women were more likely to choose cereal products considered health-promoting and rich in dietary fiber (including whole-grain bread, whole-grain pasta, oatmeal, bran) were more likely to consume vegetables, dry pulses and vegetarian dinners, and consumed less meat, cured meats, fish and dairy products. Consumption of fast-food, salty snacks (such as chips) and sweets increased.

The Association between Fruit and Vegetable Intake and Socioeconomic Factors in the Households of Pakistan Using Quantile Regression Model

The purpose of this study was to examine the impact of socioeconomic factors on fruit and vegetable consumption in the households of Pakistan. Secondary data were used from a national-level survey, i.e. "Household Integrated Income and Consumption Survey" (HIICS) 2015-2016 published by the Pakistan Bureau of Statistics. A total of 11,187 households were included in the final analysis. Quantile regression models were applied to investigate the association between socioeconomic factors and the consumption of fruit and vegetable. More than half of the households in the sample did not meet the World Health Organization's (WHO) recommended criteria for fruit and vegetable consumption, which is 400 g/day/capita. According to the quantile regression model, household income is an important factor in increasing fruit and vegetable intake because an increase in income leads to a greater likelihood of spending on healthy and nutritious foods. The increased consumption of fruit and vegetable was caused by the household head's high education, which created multiple resources to increase income. Households in two provinces, i.e. Khyber Pakhtunkhwa and Baluchistan, have a greater impact on fruit and vegetable consumption than other provinces due to natural resource availability. Household size and dependency ratio hurt the consumption of fruit and vegetable because women and children are not able to do work. These results are very useful because a better understanding of the socioeconomic characteristics associated with fruit and vegetable intake could improve the effectiveness of policies aimed at increasing fruit and vegetable consumption and reducing the risk of chronic diseases.

Eating Patterns of Young Women (18–25 y) with Overweight and Obesity: A Preliminary Investigation

Overweight and obesity impact up to 40% of young women in Australia; however, young women are challenging to recruit to research and are rarely the focus of weight loss interventions. This study aimed to examine dietary patterns in young women (18–25 years; BMI > 25 kg/m2). An analysis of participants’ (mean age: 22.6 year; BMI: 32.2 kg/m2) 3-day food records found young women with overweight/obesity consumed a diet characterised by total energy intake of 9174 (2526) kJ/day, with the first meal at 9:12 am (range: 4:30 am–12:40 pm), the last at 10:43 pm (range: 2:40 pm–2:00 am), and an average eating window of 11.5 h. Young women had poor quality diets, which did not meet dietary recommendations for most core food groups, and high intake of refined carbohydrates. They also reported consuming at least one takeaway meal per day and >30% of total energy intake was from discretionary items. The findings showed that young women with overweight or obesity consume most of their energy intake in the afternoons and late into the evenings and have poor-quality diets with high-discretionary intake, each of which have been shown in previous work to be associated with increased weight and risk of metabolic comorbidities. While these findings require further examination in larger groups with both qualitative and longitudinal data collection to verify the impact of these eating patterns on weight maintenance, the eating behaviours identified here may present a suitable target for novel weight loss interventions in young women, who are an understudied population group in need of tailored weight management solutions.

Fruit and vegetable consumption as a preventative strategy for non-communicable diseases

A high intake of fruit and vegetables (FV) has consistently been associated with a reduced risk of a number of non-communicable diseases. This evidence base is largely from prospective cohort studies, with meta-analyses demonstrating an association between increased FV intake and reduced risk of both CHD and stroke, although the evidence is less certain for cancer and diabetes. Controlled intervention trials examining either clinical or intermediate risk factor endpoints are more scarce. Therefore, evidence that FV consumption reduces the risk of disease is so far largely confined to observational epidemiology, which is hampered by some methodological uncertainties. Although increased FV intake is promoted across all dietary guidelines, national surveys confirm that dietary intakes are suboptimal and are not increasing over time. A range of barriers to increasing FV intake exist, including economic, physical and behavioural barriers that must be considered when exploring potential opportunities to change this, considering the feasibility of different approaches to encourage increased FV consumption. Such interventions must include consideration of context, for example, challenges and uncertainties which exist with the whole food system.

Japanese carotenoid database with α- and β-carotene, β-cryptoxanthin, lutein, zeaxanthin, lycopene, and fucoxanthin and intake in adult women

Carotenoid intake is associated with low mortality and cancer risks; data on non-provitamin carotenoid intake is limited especially in Asians. We aimed to estimate carotenoid intake in Japanese adult women. Carotenoid content database comprises 196 food items, including 39 fruits, 87 vegetables and mushrooms, and 11 seaweeds, and was established using data from the literature and analyses of foods available in Japan. We surveyed the intake of these foods in Japanese women aged 21-56 years (n=109). Total intake of 7 carotenoids (mean±SD [range]) was 7,450±3,840 (1,160-21,300) μg/day; α-carotene, β-carotene, β-cryptoxanthin, lutein, zeaxanthin, lycopene, and fucoxanthin represented 4.3%, 23%, 3.4%, 15%, 2.0%, 39%, and 13% of total intake, respectively. Lutein intake was 1,132±686 (294-3,490) μg/day; its best sources were spinach, cucumber, chicken egg, green onion, and Chinese chives, representing 51% of total intake. Lutein can be obtained from a variety of sources. Thus, lutein intake levels did not vary widely among individuals and very few individuals consumed insufficient levels of lutein. Intake of zeaxanthin, lycopene, and fucoxanthin was 149±93 (2-479), 2,890±2,970 (0-17,100), and 980±1,230 (0-5,660) μg/day, respectively. Their intake required rich sources including chicken egg for zeaxanthin (52%); tomato products for lycopene (98%), and wakame seaweed for fucoxanthin (76%). The carotenoid content database including all food items consumed in Japan will be helpful for further investigations on carotenoid intake and its health benefits.

The associations of soya intakes with non-communicable diseases: a scoping review of meta-analyses

This scoping review aimed to identify published meta-analyses of the associations of dietary soya intakes with cardiovascular, cancer and diabetes II diseases and the best relative risk estimates. A published novel assessment process combining the well-validated Cochrane Review measures, the AMSTAR 2 checklist and a published algorithm specifically designed for conducting a scoping review of similar meta-analyses was employed. This scoping review identified and evaluated twenty-eight meta-analysis reports, published between 2000 and 2021, on the associations of soya intakes with cardiovascular, cancer and diabetes II diseases. It identified eighteen significantly negatively associated risk–disease pairs for total soya intakes, four significantly negatively associated risk–disease pairs for unfermented soya intakes and four significantly negatively associated risk–disease pairs for fermented soya intakes when compared high against low intakes. The largest significant risk decrease found was gastric cancer mortalities with relative risk (RR) 0·49 (95 % CI: 0·35, 0·68); followed by colorectal cancer mortalities RR 0·59 (95 % CI: 0·41, 0·84); ovarian cancer RR 0·52 (95 % CI: 0·42, 0·66) and endocrine-related gynaecological cancer RR 0·61 (95 % CI: 0·53, 0·72). The fermented soya intake and gastric cancer risk–disease pair were identified to be significantly positively associated, RR 1·22 (95 % CI: 1·02, 1·44) when compared high against low intakes. Four significantly negatively associated risk–disease dose–responses were also identified. Being the products with lower greenhouse gas emission intensities, soya products could be the better dietary alternatives to animal products for reducing cardiovascular, cancer and diabetes II diseases and helping combat climate change.

Consumption of Key Food Groups by Individuals Consuming Popular Diet Patterns: Mixed Effects of Replacing Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains

Adults in the United States are increasingly following 'popular' diet patterns that restrict food groups, macronutrients, or eating time. However, the intake of food groups associated with these diet patterns has not been well characterized. The objectives of this study were to (1) characterize the mean intake of food groups among consumers of popular diet patterns in the US, and (2) model the effect of targeted food substitutions on the intake of food groups. Data were acquired from the National Health and Nutrition Examination Survey, 2005-2018 (n = 34,411). A diet model was developed to assess the effects of replacing one serving each of foods highest in added sugar, sodium, saturated fat, and refined grains with healthy alternatives on the intake of key food groups for each diet pattern. Modeled replacement resulted in increased intake of fruit and whole grains and decreased intake of dairy for most diet patterns, while the effects on the intake of vegetables, protein foods, and oils were variable across diet patterns. The complexity of the natural eating environment, in which many people consume mixed dishes that include both healthy and less healthy ingredients, produces a challenge for health professionals when providing dietary counseling. Nevertheless, this substitution approach may help improve adherence to dietary guidelines, especially if used as a steppingstone for further dietary improvement.

The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student's Food Behaviours, Health and Dining Experience: A Systematic Review and Meta-Analysis

The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).

The effect of a school-based fruit and vegetable promotion program on adolescents' fruit and vegetable consumption behavior in Turkey

PURPOSE

The aim of this study was to analyze the effect of a school-based F&V promotion program developed in line with the transtheoretical model (TTM) on the consumption behavior of middle school students.

DESIGN AND METHODS

The study was designed as semi-experimental research with pre-/post- and follow-up tests and a control group. It was conducted at a total of six middle schools in the district of Fethiye/Muğla, Turkey. Three of the schools were selected with the random clustering method as an intervention group and the others as the control group. The F&V promotion program was executed in the intervention group for a period of 24 weeks.

RESULTS

It was found in the 6th and 12th months after the intervention that the daily number of portions of fruits (p<.01) and vegetables (p<.01) consumed by the students in the intervention group was significantly more compared to the control group. The perception of the pros of F&V consumption and self-efficacy in the intervention group were higher than in the controls (p<.01).

CONCLUSIONS

The school-based F&V consumption promotion program was effective in increasing the number of portions of fruits and vegetables students consumed and in improving their behaviors in this regard.

APPLICATION TO PRACTICE

The study indicates that the interventions described may be recommended to school nurses for use in their efforts to increase levels of F&V consumption.

Phytochemical Characterization of Citrus-Based Products Supporting Their Antioxidant Effect and Sensory Quality

The increasing attention on the impact of food on human and environmental health has led to a greater awareness about nutrition, food processing, and food waste. In this perspective, the present work deals with the investigation of the chemical non-volatile and volatile profiles of two Citrus-based products, produced through a conscious process, using Citrus peels as natural gelling agents. Moreover, the total polyphenol content (TPC) and the antioxidant properties were evaluated, as well as their sensorial properties. Chemical and antioxidant results were compared with those of Citrus fresh fruits (C. reticulata, C. sinensis, and C. limon). Concerning the non-volatile fingerprint, the two samples showed a very similar composition, characterized by flavanones (naringenin, hesperetin, and eriodyctiol O-glycosides), flavones (diosmetin and apigenin C-glucosides), and limonoids (limonin, nomilinic acid, and its glucoside). The amount of both flavonoids and limonoids was higher in the Lemon product than in the Mixed Citrus one, as well as the TPC and the antioxidant activity. The aroma composition of the two samples was characterized by monoterpene hydrocarbons as the main chemical class, mainly represented by limonene. The sensorial analysis, finally, evidenced a good quality of both the products. These results showed that the most representative components of Citrus fruits persist even after the transformation process, and the aroma and sensorial properties endow an added value to Citrus preparations.

Potential for positive biodiversity outcomes under diet-driven land use change in Great Britain

Background: A shift toward human diets that include more fruit and vegetables, and less meat is a potential pathway to improve public health and reduce food system-related greenhouse gas emissions. Associated changes in land use could include conversion of grazing land into horticulture, which makes more efficient use of land per unit of dietary energy and frees-up land for other uses. Methods: Here we use Great Britain as a case study to estimate potential impacts on biodiversity from converting grazing land to a mixture of horticulture and natural land covers by fitting species distribution models for over 800 species, including pollinating insects and species of conservation priority. Results: Across several land use scenarios that consider the current ratio of domestic fruit and vegetable production to imports, our statistical models suggest a potential for gains to biodiversity, including a tendency for more species to gain habitable area than to lose habitable area. Moreover, the models suggest that climate change impacts on biodiversity could be mitigated to a degree by land use changes associated with dietary shifts. Conclusions: Our analysis demonstrates that options exist for changing agricultural land uses in a way that can generate win-win-win outcomes for biodiversity, adaptation to climate change and public health.

Intervention for promoting intake of fruits and vegetables in Brazilians: a randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of a nutritional intervention to promote fruit and vegetable (FV) intake.

DESIGN

A randomised controlled community trial was conducted to evaluate the effectiveness of a 7-month nutritional intervention and to promote FV intake, separately and together. All participants attended physical exercise sessions. The intervention was based on the transtheoretical model and Paulo Freire's pedagogy. The interventions included group educational sessions, motivational cards and informational materials. The primary outcome was a change in FV intake (g/d), and secondary outcomes included stages of change, self-efficacy, decisional balance and knowledge on FV. All data were collected face-to-face; and FV intake was assessed using a validated brief questionnaire.

SETTING

Health promotion services of Brazilian Primary Health Care.

PARTICIPANTS

3414 users of Brazilian Primary Health Care (1931 in the control group and 1483 in the intervention group (IG)).

RESULTS

At baseline, the average daily FV intake was 370·4 g/d (95 % CI 364·2, 376·6). The increase in FV intake (23·4 g/d; 95 % CI 6·7, 40·0) and fruit intake (+17·3 g/d; 95 % CI 5·1, 29·4; P = 0·01) was greater in the IG among participants in the lowest baseline intake. Participants in the IG also showed progression in the stages of change (P < 0·001), increased self-efficacy (P < 0·001) and improved knowledge of FV crops (P < 0·001).

CONCLUSIONS

The nutritional intervention was effective in increasing FV intake and fruits intake among individuals with a lower intake at baseline and in maintaining FV intake among those who reported consuming FV as recommended (400 g/d).

Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial

BACKGROUND

Previous studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up.

METHODS

The study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data.

RESULTS

At baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33).

CONCLUSION

No evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting.

TRIAL REGISTRATION

ISRCTN, ISRCTN43284296 . Registered 28 April 2017 - retrospectively registered.

The role of diet in renal cell carcinoma incidence: an umbrella review of meta-analyses of observational studies

BACKGROUND

Evidence associating diet with the incidence of renal cell carcinoma (RCC) is inconclusive. We aimed to summarize evidence associating dietary factors with RCC incidence and assess the strength and validity of this evidence.

METHODS

We conducted an umbrella review of systematic reviews or meta-analyses (SRoMAs) that assessed the association between diet and RCC incidence. Through April 2021, PubMed, Web of Science, Embase, The Cochrane Library, Scopus, and WCRF were searched. Two independent reviewers selected studies, extracted data, and appraised the quality of SRoMAs. According to credibility assessment criteria, evidence can be divided into five categories: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV), and nonsignificant (class V).

RESULTS

Twenty-nine meta-analyses were obtained after screening. After excluding 7 overlapping meta-analyses, 22 meta-analyses including 502 individual studies and 64 summary hazard ratios for RCC incidence were included: dietary patterns or dietary quality indices (n = 6), foods (n = 13), beverages (n = 4), alcohol (n = 7), macronutrients (n =15), and micronutrients (n =19). No meta-analyses had high methodological quality. Five meta-analyses exhibited small study effects; one meta-analysis showed evidence of excess significance bias. No dietary factors showed convincing or highly suggestive evidence of association with RCC in the overall analysis. Two protective factors had suggestive evidence (vegetables (0.74, 95% confidence interval 0.63 to 0.86) and vitamin C (0.77, 0.66 to 0.90)) in overall analysis. One protective factor had convincing evidence (moderate drinking (0.77, 0.70 to 0.84)) in Europe and North America and one protective factor had highly suggestive evidence (cruciferous vegetables (0.78, 0.70 to 0.86)) in North America.

CONCLUSIONS

Although many meta-analyses have assessed associations between dietary factors and RCC, no high-quality evidence exists (classes I and II) in the overall analysis. Increased intake of vegetables and vitamin C is negatively associated with RCC risk. Moderate drinking might be beneficial for Europeans and North Americans, and cruciferous vegetables might be beneficial to North Americans, but the results should be interpreted with caution. More researches are needed in the future.

TRIAL REGISTRATION

PROSPERO CRD42021246619.

Estimating impact of food choices on life expectancy: A modeling study

BACKGROUND

Interpreting and utilizing the findings of nutritional research can be challenging to clinicians, policy makers, and even researchers. To make better decisions about diet, innovative methods that integrate best evidence are needed. We have developed a decision support model that predicts how dietary choices affect life expectancy (LE).

METHODS AND FINDINGS

Based on meta-analyses and data from the Global Burden of Disease study (2019), we used life table methodology to estimate how LE changes with sustained changes in the intake of fruits, vegetables, whole grains, refined grains, nuts, legumes, fish, eggs, milk/dairy, red meat, processed meat, and sugar-sweetened beverages. We present estimates (with 95% uncertainty intervals [95% UIs]) for an optimized diet and a feasibility approach diet. An optimal diet had substantially higher intake than a typical diet of whole grains, legumes, fish, fruits, vegetables, and included a handful of nuts, while reducing red and processed meats, sugar-sweetened beverages, and refined grains. A feasibility approach diet was a midpoint between an optimal and a typical Western diet. A sustained change from a typical Western diet to the optimal diet from age 20 years would increase LE by more than a decade for women from the United States (10.7 [95% UI 8.4 to 12.3] years) and men (13.0 [95% UI 9.4 to 14.3] years). The largest gains would be made by eating more legumes (females: 2.2 [95% UI 1.1 to 3.4]; males: 2.5 [95% UI 1.1 to 3.9]), whole grains (females: 2.0 [95% UI 1.3 to 2.7]; males: 2.3 [95% UI 1.6 to 3.0]), and nuts (females: 1.7 [95% UI 1.5 to 2.0]; males: 2.0 [95% UI 1.7 to 2.3]), and less red meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]) and processed meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]). Changing from a typical diet to the optimized diet at age 60 years would increase LE by 8.0 (95% UI 6.2 to 9.3) years for women and 8.8 (95% UI 6.8 to 10.0) years for men, and 80-year-olds would gain 3.4 years (95% UI females: 2.6 to 3.8/males: 2.7 to 3.9). Change from typical to feasibility approach diet would increase LE by 6.2 (95% UI 3.5 to 8.1) years for 20-year-old women from the United States and 7.3 (95% UI 4.7 to 9.5) years for men. Using NutriGrade, the overall quality of evidence was assessed as moderate. The methodology provides population estimates under given assumptions and is not meant as individualized forecasting, with study limitations that include uncertainty for time to achieve full effects, the effect of eggs, white meat, and oils, individual variation in protective and risk factors, uncertainties for future development of medical treatments; and changes in lifestyle.

CONCLUSIONS

A sustained dietary change may give substantial health gains for people of all ages both for optimized and feasible changes. Gains are predicted to be larger the earlier the dietary changes are initiated in life. The Food4HealthyLife calculator that we provide online could be useful for clinicians, policy makers, and laypeople to understand the health impact of dietary choices.

KCNQ Potassium Channels as Targets of Botanical Folk Medicines

Since prehistory, human species have depended on plants for both food and medicine. Even in countries with ready access to modern medicines, alternative treatments are still highly regarded and commonly used. Unlike modern pharmaceuticals, many botanical medicines are in widespread use despite a lack of safety and efficacy data derived from controlled clinical trials and often unclear mechanisms of action. Contributing to this are the complex and undefined composition and likely multifactorial mechanisms of action and multiple targets of many botanical medicines. Here, we review the newfound importance of the ubiquitous KCNQ subfamily of voltage-gated potassium channels as targets for botanical medicines, including basil, capers, cilantro, lavender, fennel, chamomile, ginger, and Camellia, Sophora, and Mallotus species. We discuss the implications for the traditional use of these plants for disorders such as seizures, hypertension, and diabetes and the molecular mechanisms of plant secondary metabolite effects on KCNQ channels.

The relationship between maternal prenatal and postnatal vegetable intake and repeated measures of infant vegetable intake frequency in a national U.S. sample

Experimental research suggests that passive flavor transfer from maternal diet to the infant via amniotic fluid and breastmilk may improve infant vegetable intake. This secondary analysis examined associations between maternal (prenatal and postnatal) and infant vegetable intake in 696 mothers with eligible dietary data from the U.S. longitudinal Infant Feeding Practices Study II. Adjusted mixed models examined associations between 4 levels of maternal vegetable intake (mean splits of high/low on prenatal and postnatal food frequency questionnaires) and repeated measures of infant vegetable intake frequency (times/day, from monthly surveys). Mothers were on average 29.5 years old, mostly non-Hispanic White (86.2%) and educated (84.0% ≥some college). In base models, mothers with consistently high vegetable intake (vs. consistently low) reported more frequent infant vegetable intake. In multivariable models, infant vegetable intake was significantly more frequent amongst mothers with consistently high prenatal/high postnatal intake (0.9 times/day) versus consistently low intake (0.8 times/day). In this sample, maternal vegetable consumption was associated with frequency of infant vegetable consumption; consistently high vegetable intake across prenatal and postnatal periods was most strongly associated with infant intake. While infant vegetable intake is multifactorial, maternal prenatal and postnatal vegetable intake appeared to have a small but significant influence.

Vegetable Preference and Prediction of Proteinuria: A Retrospective Cohort Study

INTRODUCTION

Little information is available about the association between vegetable preference and chronic kidney disease.

METHODS

This retrospective cohort study included 10,819 university workers in Japan who underwent their annual health checkups between January 2005 and March 2013. According to a question "Do you like vegetables"? with 3 possible answers of "I like vegetables," "I like vegetables somewhat," or "I dislike vegetables," 2,831, 2,249, and 104 male workers and 3,902, 1,648, and 85 female workers were classified into the "like," "somewhat," and "dislike" groups, respectively. An association between vegetable preference and incidence of proteinuria (dipstick urinary protein ≥1+) was assessed using Cox proportional-hazards models adjusted for clinically relevant factors.

RESULTS

During the median observational period of 5.0 years, the incidence of proteinuria was observed in 650 (12.7%) male and 789 (14.1%) female workers. Among male workers, the "dislike" group had a significantly higher risk of proteinuria (multivariable-adjusted hazard ratio of "like," "somewhat," and "dislike" groups: 1.00 [reference], 1.05 [0.90-1.23], and 1.59 [1.01-2.50], respectively). Among female workers, vegetable preference was associated with the incidence of proteinuria in a dose-dependent manner (1.00 [reference], 1.20 [1.04-1.40], 1.95 [1.26-3.02], respectively).

CONCLUSION

"Do you like vegetables"? was a clinically useful tool to identify subjects vulnerable to proteinuria.

Evaluation of a social marketing approach to healthy, home-cooked family meals for low-income mothers of young children

Cooking is a complex behavior associated with more frequent and nutrient-dense family meals. The Cook Together, Eat Together (CTET) social marketing program used formative, process, and outcome evaluations over a 3-year period to design a program to increase fruit and vegetable intake and frequency of family meals. We used a quasi-experimental, mixed-methods design with a nonequivalent comparison group to evaluate fruit and vegetable intake and family meals. Eight focus groups of mothers in low-income families with young children revealed two predominant behavioral mediators: (i) importance of family time and (ii) desire for children to learn to cook and become self-sufficient adults. Program design was grounded in formative evaluation and organized by the four Ps of social marketing: (i) product-learning to prepare healthy meals while teaching children to cook; (ii) price-lowered by reducing barriers of food cost, kitchen clean-up, meal planning, grocery shopping; (iii) placement-in neighborhood gathering places with a "cooking social"; and (iv) promotion-flyers, newsletters, and social media. Outcome indicators were assessed pre/post intervention with questions from instruments validated for the audience. Significant changes (n = 68, p ≥ .002, Bonferroni adjustment for p = .05, Cohen's d = .50 medium effect size) were found in consumption of fruits and vegetables with an average increase of half cup each per day. CTET participation significantly increased fruits and vegetables served and eaten at family meals. A social marketing approach can help families with young children increase fruit and vegetable consumption.

Pathways to "5-a-day": modeling the health impacts and environmental footprints of meeting the target for fruit and vegetable intake in the United Kingdom

BACKGROUND

Fruit and vegetable consumption in the United Kingdom is currently well below recommended levels, with a significant associated public health burden. The United Kingdom has committed to reducing its carbon emissions to net zero by 2050, and this transition will require shifts towards plant-based diets.

OBJECTIVE

The aim was to quantify the health effects, environmental footprints, and cost associated with 4 different pathways to meeting the United Kingdom's "5-a-day" recommendation for fruit and vegetable consumption.

METHODS

Dietary data based on 18,006 food diaries from 4528 individuals participating in the UK National Diet and Nutrition Survey (2012/13-2016/17) constituted the baseline diet. Linear programming was used to model the hypothetical adoption of the 5-a-day (400 g) recommendation, which was assessed according to 4 pathways differing in their prioritization of fruits versus vegetables and UK-produced versus imported varieties. Increases in fruit and vegetable consumption were substituted for consumption of sweet snacks and meat, respectively. Changes in life expectancy were assessed using the IOMLIFET life table model. Greenhouse gas emissions (GHGEs), blue water footprint (WF), and total diet cost were quantified for each 5-a-day diet.

RESULTS

Achieving the 5-a-day target in the United Kingdom could increase average life expectancy at birth by 7-8 mo and reduce diet-related GHGEs by 6.1 to 12.2 Mt carbon dioxide equivalents/y; blue WFs would change by -0.14 to +0.07 km3/y. Greater reductions in GHGEs were achieved by prioritizing increased vegetable consumption over fruit, whereas the greatest reduction in WF was obtained by prioritizing vegetable varieties produced in the United Kingdom. All consumption pathways increased diet cost (£0.34-£0.46/d).

CONCLUSIONS

Benefits to both population and environmental health could be expected from consumption pathways that meet the United Kingdom's 5-a-day target for fruit and vegetables. Our analysis identifies cross-sectoral trade-offs and opportunities for national policy to promote fruit and vegetable consumption in the United Kingdom.

The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review

BACKGROUND

Dietary intake is an important modifiable risk factor for cardiovascular disease. However, to our knowledge, there are no systematic reviews of nutrition interventions in the context of cardiovascular disease prevention and management within rural communities. This is important to investigate, given the unique geographic, social, and contextual factors associated with rurality.

OBJECTIVE

Our primary objective was to systematically assess evidence on the effectiveness of randomized controlled trials to improve dietary intake in the context of cardiovascular disease prevention and management in rural communities.

METHODS

Nine electronic databases were searched from inception to June 2020, including MEDLINE, The Cochrane Library, Embase, Emcare, PsycINFO, Scopus, Rural and Remote Health, CINAHL, and AMED. Randomized controlled trials that reported results of interventions with adult, rural populations and measured change in dietary intake compared to usual care, alternative intervention, or no intervention controls were included. Included randomized controlled trials were also assessed according to the TIDieR (Template for Intervention Description and Reporting) checklist and RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.

RESULTS

Thirteen articles reporting results of randomized controlled trials were identified. Included articles reported a range of nutrition interventions and measured 18 dietary intake outcomes. Most studies (n = 10) demonstrated effectiveness in altering at least 1 dietary intake outcome, including fruit and/or vegetable (n = 9), fiber (n = 2), Dietary Risk Assessment score (n = 2), energy, dairy, carotene, vitamin C and sodium (all n = 1). However, there was wide variation in the reporting of intervention components (according to the TIDieR checklist) and impact (according to RE-AIM framework), resulting in difficulty interpreting the "real-world" implications of these results.

CONCLUSIONS

Through this systematic review, we found limited evidence of improvement in dietary intakes due to nutrition interventions in the context of cardiovascular disease prevention and management in rural communities. Fruit and/or vegetable intakes were the most frequently reported dietary intake outcomes, and most likely to be improved across the included studies. Included studies were generally not well reported, which may hinder replication by clinicians and consolidation of the evidence base by other researchers. Given the substantial burden of cardiovascular disease experienced by those living in rural areas of developed countries, additional high-quality nutrition research that acknowledges the complexities of rural health is required.

Association of Nursery School-Level Promotion of Vegetable Eating with Caregiver-Reported Vegetable Consumption Behaviours among Preschool Children: A Multilevel Analysis of Japanese Children

Nursery schools can play an important role in children developing healthy eating behaviours, including vegetable consumption. However, the effect of school-level vegetable promotion on vegetable consumption and body mass index (BMI) remains unclear. This study examined the associations of nursery school-level promotion of eating vegetables first at meals with Japanese children’s vegetable consumption behaviours and BMI. We used cross-sectional data collected in 2015, 2016, and 2017 on 7402 children in classes of 3–5-year-olds in all 133 licensed nursery schools in Adachi, Tokyo, Japan. Caregivers were surveyed on their children’s eating behaviours (frequency of eating vegetables, willingness to eat vegetables and number of kinds of vegetables eaten), height and weight. Nursery school-level promotion of eating vegetables first at meals was assessed using individual responses, with the percentage of caregivers reporting that their children ate vegetables first at meals as a proxy for the school-level penetration of the promotion of vegetable eating. Multilevel analyses were conducted to investigate the associations of school-level vegetable-eating promotion with vegetable consumption behaviours and BMI. Children in schools that were 1 interquartile range higher on vegetable promotion ate vegetable dishes more often (β = 0.04; 95% CI: 0.004–0.07), and were more often willing to eat vegetables (adjusted odds ratio = 1.17; 95% CI: 1.07–1.28), as well as to eat more kinds of vegetables (adjusted odds ratio = 1.19 times; 95% CI: 1.06–1.34). School-level vegetable-eating promotion was not associated with BMI. The school-level health strategy of eating vegetables first may be effective in increasing children’s vegetable intake but not in preventing being overweight.

Nutrition and health or nutrients and health?

Diet is an important contributor to human health and public health bodies are issuing guidelines aimed at favouring healthy food choices. The aim of our paper is to discuss the aspects underlying the concept of nutrient profiles, that is, defining levels of energy, some macronutrients, or salt which should not be exceeded in individual foods, according to the available evidence, to help in understanding to what extent such approach may actually be useful for improving nutrition and quality of life of European consumers. We list several pitfalls and oversimplifications of the current approaches to nutrient profiling and of the dichotomic classification of foods into "healthy" and "unhealthy" products. In view of the current "Facilitating healthier food choices - establishing nutrient profiles" EU initiative, we believe that further debate among all stakeholders is warranted and must consider all the limitations outlined in this paper.