The potential contribution of increased vegetable and fruit consumption to health gain in the European Union

Evaluating self-reported retrospective average daily fruit, vegetable, and egg intake: Trustworthy-Sometimes!

Retrospective self-reports are commonly used to assess dietary intake. Yet, their use is criticized as it is unclear whether the underlying assumptions for valid self-reports are met: Individuals have to consider the behavior of all days in the retention interval and weigh the behavior of all days equally. This study examines whether these assumptions for retrospective self-reports are met and whether interindividual differences in self-report performance are relevant regarding these assumptions. Ninety-two participants aged 18-61 years participated in seven sequential 24-h recalls and one retrospective 7-day recall concerning their intake of fruit, vegetables, and eggs. A multiple linear regression approach was used to examine the relation between the daily reported dietary intake and the 7-day recall. In the overall sample, the requirements for retrospective self-reports were not tenable. Distinguishing good and poor self-reporters based on a rational criterion showed that the requirements can be taken as given for good self-reporters, whereas poor self-reporters base their retrospective self-reports mostly on recency effects. The underlying requirements for retrospective self-reports appear to be met in two thirds of the sample, supporting the use of retrospective self-reports to capture dietary behavior. Future research should investigate characteristics separating good from poor self-reporters.

Associations of fruit & vegetable intake and physical activity with poor self-rated health among Chinese older adults

BACKGROUND

Despite the existing literature highlights the central roles of sociodemographic factors, fruit & vegetable (F&V) intake, and physical activities for maintaining good health, less is known about the associations in the Chinese context. This study attempted to explore the associations of servings of F&V intake and levels of physical activities with poor self-rated health (SRH) among Chinese older adults.

METHODS

Data were drawn from the Study on Global Ageing and Adult Health-China (SAGE-China) issued by the World Health Organization and included 7560 respondents aged ≥60 years in China. After screening out the potential confounding factors, multiple logistic regression models were adopted to explore the associations of sociodemographic factors, servings of F&V intake, and levels of physical activities with poor SRH.

RESULTS

Among the sample, nearly a quarter reported poor health status. There were significant gender differences in the case of servings of F&V intake and levels of physical activities. Logistic regressions indicated that higher fruit intake was associated with lower likelihood of vigorous level of physical activity as compared to zero intake. Likewise, higher vegetable intake (≥10 servings) was associated with a higher likelihood of vigorous & moderate level of physical activity when compared to lower intake (≤ 4 servings). Higher fruit intake was associated with a lower likelihood of poor SRH. Similarly, vegetable intake (5 servings: AOR = 0.69, 95%CI: 0.58-0.83; 6-9 servings: AOR = 0.72, 95%CI: 0.59-0.87) was significantly associated with poor SRH. Additionally, vigorous level of physical activity (AOR = 0.79, 95%CI: 0.65-0.97) and vigorous fitness/leisure (AOR = 0.57, 95%CI: 0.39-0.84) were significantly associated with poor SRH.

CONCLUSION

This study suggested that older adults with high fruit intake had lower probability of performing vigorous & moderate level of physical activity, while those with high vegetable intake had higher probability of performing vigorous & moderate level of physical activity. Likewise, the older adults with high F&V intake and higher probability of performing vigorous level of physical activity, walk/bike activity, and vigorous/moderate fitness/leisure had less likelihood to face the risk for poor SRH outcomes. The appropriate servings of F&V intake and levels of physical activity should be highlighted.

How supportive is the global food supply of food-based dietary guidelines? A descriptive time series analysis of food supply alignment from 1961 to 2013

BACKGROUND

FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved over time. The aim of this study was to determine to what extent the global food supply aligns with FBDGs, and to examine historical trends.

METHODS

Descriptive time series analysis of food supply alignment (FSA), 1961-2013. FSA was characterised as a ratio dividing country-level food supply data by FBDG across four food groups: fruit and vegetables (FV); sugar (SU); fish and seafood (FS); and red and processed meat (RP). FBDG data was collected from guidance produced by international bodies, and from countries with published FBDGs. The food supply was estimated using yearly FAOSTAT data. A population-weighted average of this ratio was created for all countries included in the analysis, and stratified by region and country income.

FINDINGS

FBDGs from 89 countries were included. Of those, 80% had country guidelines for FV, 34% for SU, 44% for FS, and 21% for RP. FSA (1.0 = perfect alignment) based on global guidelines showed a higher supply than recommended for FV (1.2), SU (1.2) and RP (1.1). FSA based on country guidelines showed a lower supply than recommended for FV (0.9) and a higher supply than recommended for SU (2.3), RP (2.3) and FS (1.4). FSA also showed substantial differences in levels and trends across region and country income.

INTERPRETATION

As of 2013, food supplies were not aligned with national and international FBDGs and misalignment persisted across five decades with subtantial variation in trends based on geography and country income. The long running nature of these trends suggest that the transition toward sustainable and healthful food systems represent a signifiant global challange. Additionally, acknowledging the degree of misalignment between macro-level structural factors, such as the composition of the food supply, in relation to national or global food policy aims may further aid efforts for population level adherence.

A review of the uses and reliability of food balance sheets in health research

CONTEXT

Food Balance Sheets (FBSs) are constructed by the Food and Agricultural Organization (FAO) and portray the food supply and utilization pattern of a country over time.

OBJECTIVE

To examine and analyse the uses of FAO-FBS data in international studies of health and nutrition, and to identify the reported strengths, limitations and reliability of FBS.

DATA SOURCES

PubMed, SCOPUS, EMBASE, Food Science and Technology Abstracts (FSTA) and Google Scholar.

DATA EXTRACTION

Data extracted were author, year of publication, country/countries of the study, aim, study design, analysis, data collected, data sources and outcomes. Additional relevant information (e.g. strengths and limitations of the FBS), were also included. The bibliographies of all included studies were further searched, and any potentially relevant studies retrieved and assessed.

DATA ANALYSIS

119 eligible studies (all study designs) published from the earliest available to the end of April, 2016 were collated into five categories of use: within-country analysis of food availability, nutrient availability and/or dietary trends (n = 17); inter-country, regional or global comparison of food groups, nutrient availability and/or dietary trends (n = 45); comparison of FBS with other national sources of dietary data (n = 7); association between FBS dietary factors and mortality or health outcomes (n = 45); and modelling studies (n = 5).

CONCLUSION

Studies indicate that FBS are useful for international comparison and analysis of trends over time, as they are standardized and updated regularly. FBS data are more reliable when averaged over several years; when results are reported as nutrient densities, trends, and percentage of energy or ratios, rather than absolute values. Also, users should be aware that the quality of FBS data depends on the reliability of national input data. The FBS is a vital source of global food composition data and is valuable for epidemiological studies when reported and analysed appropriately.

Assessing the Influence of Compost and Biochar Amendments on the Mobility and Uptake of Heavy Metals by Green Leafy Vegetables

Municipal green-waste compost and wheat straw biochar amendments were assessed for their assistance in regulating the mobility of Cu, Pb, Zn, Cd, Cr and Ni and the uptake of these metals by five commonly grown green leafy vegetables (radish, lettuce, dill, spinach and parsley). The amendments were applied alone or combination of both in 5% and 10% (v/w) doses to soil contaminated with heavy metals. Vegetables were grown for eight weeks under greenhouse conditions, and in collected samples plant uptake and metal speciation in soil after sequential extraction procedure (BCR) were analyzed by Microwave Plasma Atomic Emission Spectrometer (MP-AES). The results of our study show that organic amendments noticeably reduced the uptake of heavy metals by various leafy vegetables, with the best result of reduced leaf accumulation for single biochar and biochar–compost mix application at higher dose. Single application of green-waste municipal compost may have adverse effects on heavy metal uptake, increasing the risk of vegetable contamination with Zn, Pb and Cr. This study recommends careful selection of vegetables for cultivation when organic fertilizers are applied to soil with elevated contents of trace elements or co-application of compost in mix with biochar to mitigate possible negative effects and human health risk.

Culturally Optimised Nutritionally Adequate Food Baskets for Dietary Guidelines for Minimum Wage Estonian Families

Although low socioeconomic groups have the highest risk of noncommunicable diseases in Estonia, national dietary guidelines and nutrition recommendations do not consider affordability. This study aims to help develop nutritionally adequate, health-promoting, and culturally acceptable dietary guidelines at an affordable price. Three food baskets (FBs) were optimised using linear programming to meet recommended nutrient intakes (RNIs), or Estonian dietary guidelines, or both. In total, 6255 prices of 422 foods were collected. The Estonian National Dietary Survey (ENDS) provided a proxy for cultural acceptability. Food baskets for a family of four, earning minimum wage, contain between 73 and 96 foods and cost between 10.66 and 10.92 EUR per day. The nutritionally adequate FB that does not follow Estonian dietary guidelines deviates the least (26% on average) from ENDS but contains twice the sugar, sweets, and savoury snacks recommended. The health-promoting FB (40% deviation) contains a limited amount of sugar, sweets, and savoury snacks. However, values for vitamin D, iodine, iron, and folate are low compared with RNIs, as is calcium for women of reproductive age. When both the RNIs and dietary guidelines are enforced, the average deviation (73%) and cost (10.92 EUR) are highest. The composition of these FBs can help guide the development of dietary guidelines for low income families in Estonia.

The beneficial effects of nutraceuticals and natural products on small dense LDL levels, LDL particle number and LDL particle size: a clinical review

Cardiovascular diseases (CVDs) are globally the major causes of morbidity and mortality. Evidence shows that smaller and denser low-dense lipoprotein (sdLDL) particles are independent atherogenic risk factors for CVD due to their greater susceptibility to oxidation, and permeability in the endothelium of arterial walls. sdLDL levels are an independent risk factor and of more predictive value than total LDL-C for the assessment of coronary artery disease and metabolic syndrome. Functional food ingredients have attracted significant attention for the management of dyslipidemia and subsequently increase cardio-metabolic health. However, to date there is no study that has investigated the effect of these bioactive natural compounds on sdLDL levels. Therefore, the aim of the present review is to summarize the evidence accrued on the effect of special dietary ingredients such as omega-3 polyunsaturated fatty acids, nutraceuticals and herbal medicines on the levels of sdLDL, LDL particle number, and LDL particle size. Based on the results of the existing clinical trials this review suggests that natural products such as medicinal plants, nutraceuticals and omega-3 fatty acids can be used as adjunct or complementary therapeutic agents to reduce sdLDL levels, LDL particle numbers or increase LDL particle size and subsequently may prevent and treat CVD, with the advantage that theses natural agents are generally safe, accessible, and inexpensive.

Breads Fortified with Freeze-Dried Vegetables: Quality and Nutritional Attributes. Part 1: Breads Containing Oil as an Ingredient

There is increasing emphasis on reformulating processed foods to make them healthier. This study for the first time comprehensively investigated the effects of fortifying bread (containing oil as an ingredient) with freeze-dried vegetables on its nutritional and physico-chemical attributes. Breads fortified with carrot, tomato, beetroot or broccoli were assessed for nutrition, antioxidant potential, storage life, shelf stability, textural changes and macronutrient oxidation. Furthermore, using an in vitro model the study for the first time examined the impact of vegetable addition on the oxidative stability of macronutrients during human gastro-intestinal digestion. As expected, adding vegetables improved the nutritional and antioxidant properties of bread. Beetroot and broccoli significantly improved bread storage life. None of the vegetables significantly affected bread textural changes during storage compared to the control. Lipid oxidation in fresh bread was significantly reduced by all four types of vegetables whilst protein oxidation was lowered by beetroot, carrot and broccoli. The vegetables demonstrated varying effects on macronutrient oxidation during gastro-intestinal digestion. Beetroot consistently showed positive effects suggesting its addition to bread could be particularly beneficial.

Perceived purchase of healthy foods is associated with regular consumption of fruits and vegetables

OBJECTIVE

To identify healthy food (HF) purchase habits and intake of fruits and vegetables (FV) in parents responsible for grocery shopping for their families.

METHODS

Survey with mothers and fathers (n = 216) of children aged 7-10 years in Brazil.

RESULTS

Grocery purchases occurred mostly at supermarkets. Purchase of HF was considered to be frequent by 80% of parents, who cited FV as main examples of HF. The more frequent the reported purchase was of HF, the higher was the prevalence of regular consumption of FV (P = .002). Only 34% of respondents reported weekly intakes that could be classified as regular.

CONCLUSIONS AND IMPLICATIONS

Perceived frequent shopping for healthy foods was positively associated with regular consumption of FV but a gap between perception and behavior was identified. Nutrition education strategies need to go beyond a merely informative role and take consumers' opinions and points of view into consideration to become truly effective.

Effect of naringin on hemodynamic changes and left ventricular function in renal artery occluded renovascular hypertension in rats

Background:

Renal artery occlusion (RAO) induced hypertension is a major health problem associated with structural and functional variations of the renal and cardiac vasculature. Naringin a flavanone glycoside derived possesses metal-chelating, antioxidant and free radical scavenging properties.

Objective:

The objective of this study was to investigate the antihypertensive activity of naringin in RAO induced hypertension in rats.

Material and Methods:

Male Wistar rats (180-200 g) were divided into five groups Sham, RAO, naringin (20, 40 and 80 mg/kg). Animals were pretreated with naringin (20, 40 and 80 mg/kg p.o) for 4 weeks. On the last day of the experiment, left renal artery was occluded with renal bulldog clamp for 4 h. After assessment of hemodynamic and left ventricular function various biochemical (superoxide dismutase [SOD], glutathione [GSH] and malondialdehyde [MDA]) and histological parameters were determined in the kidney.

Results:

RAO group significantly (P < 0.001) increased hemodynamic parameters at 15, 30 and 45 min of clamp removal. Naringin (40 and 80 mg/kg) treated groups showed a significant decrease in hemodynamic parameters at 15 min. after clamp removal that remained sustained for 60 min. Naringin (40 and 80 mg/kg) treated groups showed significant improvement in left ventricular function at 15, 30 and 45 min after clamp removal. Alteration in level of SOD, GSH and MDA was significantly restored by naringin (40 and 80 mg/kg) treatment. It also reduced histological aberration induced in kidney by RAO.

Conclusion:

It is concluded that the antihypertensive activity of naringin may result through inhibition of oxidative stress.

Do we produce enough fruits and vegetables to meet global health need?

BACKGROUND

Low fruit and vegetable (FV) intake is a leading risk factor for chronic disease globally, but much of the world's population does not consume the recommended servings of FV daily. It remains unknown whether global supply of FV is sufficient to meet current and growing population needs. We sought to determine whether supply of FV is sufficient to meet current and growing population needs, globally and in individual countries.

METHODS AND FINDINGS

We used global data on agricultural production and population size to compare supply of FV in 2009 with population need, globally and in individual countries. We found that the global supply of FV falls, on average, 22% short of population need according to nutrition recommendations (supply:need ratio: 0.78 [Range: 0.05-2.01]). This ratio varies widely by country income level, with a median supply:need ratio of 0.42 and 1.02 in low-income and high-income countries, respectively. A sensitivity analysis accounting for need-side food wastage showed similar insufficiency, to a slightly greater extent (global supply:need ratio: 0.66, varying from 0.37 [low-income countries] to 0.77 [high-income countries]). Using agricultural production and population projections, we also estimated supply and need for FV for 2025 and 2050. Assuming medium fertility and projected growth in agricultural production, the global supply:need ratio for FV increases slightly to 0.81 by 2025 and to 0.88 by 2050, with similar patterns seen across country income levels. In a sensitivity analysis assuming no change from current levels of FV production, the global supply:need ratio for FV decreases to 0.66 by 2025 and to 0.57 by 2050.

CONCLUSION

The global nutrition and agricultural communities need to find innovative ways to increase FV production and consumption to meet population health needs, particularly in low-income countries.

The relationship of dietary sodium, potassium, fruits, and vegetables intake with blood pressure among Korean adults aged 40 and older

BACKGROUND/OBJECTIVES

The inverse relationships of combined fruits and vegetables intake with blood pressure have been reported. However, whether there are such relationships with salty vegetables has rarely been investigated in epidemiologic studies. We evaluated the relation of combined and separate intake of fruits, vegetable intakes, and salty vegetables, as well as sodium and potassium, with blood pressure among the middle-aged and elderly populations.

SUBJECTS/METHODS

The present cross-sectional analysis of a prospective cohort baseline survey was performed with 6,283 subjects (2,443 men and 3,840 women) and free of hypertension, diabetes, cardiovascular diseases, and cancer. Dietary data were collected by trained interviewers using food frequency questionnaire.

RESULTS

The significantly inverse linear trend of diastolic blood pressure (DBP) was found in fruits and non-pickled vegetables (81.2 mmHg in the lowest quintile vs 79.0 mmHg in the highest quintile, P for trend = 0.0040) and fruits only (80.9 mmHg in the lowest quintile vs 79.4 mmHg in the highest quintile, P for trend = 0.0430) among men. In contrast, sodium and sodium to potassium ratio were positively related with blood pressure among men (DBP, 78.8 mmHg in the lowest quintile vs 80.6 mmHg in the highest quintile, P for trend = 0.0079 for sodium; DBP, 79.0 mmHg in the lowest quintile vs 80.7 mmHg in the highest quintile, P for trend = 0.0199 and SBP, 123.8 mmHg in the lowest quintile vs 125.9 mmHg in the highest quintile for sodium/potassium). Kimchies consumption was positively related to DBP for men (78.2 mmHg in the lowest quintile vs 80.9 mmHg in the highest quintile for DBP, P for trend = 0.0003). Among women, these relations were not found.

CONCLUSION

Fruits and/or non-pickled vegetables may be inversely, but sodium, sodium to potassium, and Kimchies may be positively related to blood pressure among men.

The effect of raw vegetable and fruit intake on thyroid cancer risk among women: a case–control study in South Korea

Thyroid cancer is the most common cancer among Korean women. However, there are few data on dietary factors related to thyroid cancer risk. The objective of the present study was to evaluate the association between raw vegetables and fruits intake and thyroid cancer in a case–control study. We included 111 histologically confirmed malignant thyroid cancer cases and 115 benign cases. Controls who did not have nodules in thyroid ultrasonography were matched to cases by age ( ± 2 years). Food and nutrient intakes were estimated using a quantitative FFQ with 121 items. Conditional logistic regression analysis was used to obtain OR and corresponding 95 % CI. The intake of total vegetables was not associated with malignant thyroid cancer, but inversely associated with benign cases. High raw vegetable intake was inversely associated with thyroid cancer risk both in malignant and benign cases (P for trend = 0·01 in both malignant and benign cases). Among fruits, persimmon intake had an inverse association with thyroid cancer risk in both malignant and benign cases (P for trend = 0·06 in malignant cases; P for trend = 0·01 in benign cases) and tangerine intake had an inverse association in malignant cases (P for trend = 0·03). The frequency of consumption of raw vegetables and persimmon also had a consistent inverse association in both malignant and benign cases. These results suggest that high consumption of raw vegetables, persimmons and tangerines may decrease thyroid cancer risk and help prevent early-stage thyroid cancer.

Screening of fruit products for norovirus and the difficulty of interpreting positive PCR results

Despite recent norovirus (NoV) outbreaks related to consumption of fruit products, little is known regarding the NoV load on these foods. Therefore, 75 fruit products were screened for NoV presence by using an evaluated in-house NoV detection methodology consisting of a NoV extraction method and a reverse transcription quantitative PCR assay. Additionally, the fruit samples were screened for bacterial pathogens and bacterial hygiene indicators. Results of the NoV screening showed that 18 of 75 samples tested positive for GI and/or GII NoV despite a good bacteriological quality. The recovery of murine norovirus 1 virus particles acting as process control was successful in 31 of 75 samples with a mean recovery efficiency of 11.32% ± 6.08%. The level of detected NoV genomic copies ranged between 2.5 and 5.0 log per 10 g. NoV GI and/or GII were found in 4 of 10, 7 of 30, 6 of 20, and 1 of 15 of the tested raspberries, cherry tomatoes, strawberries, and fruit salad samples, respectively. However, confirmation of the positive quantitative PCR results by sequencing genotyping regions in the NoV genome was not possible. Due to the nature of the method used (reverse transcription quantitative PCR) for detection of genomic material, no differentiation was possible between infectious and noninfectious viral particles. No NoV outbreaks related to the tested fruit product types were reported during the screening period, which hampers a conclusion as to whether these unexpected high numbers of NoV-positive results should be perceived as a public health threat. These results, however, may indicate a prior NoV contamination of the tested food samples throughout the fresh produce chain.

Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study

BACKGROUND

Many observational studies support the recommendation to eat sufficient amounts of fruit and vegetables as part of a healthy diet.

OBJECTIVE

The present study aimed to investigate the association between consumption of fruit, vegetables, and olive oil and the incidence of coronary heart disease (CHD) in 29,689 women enrolled between 1993 and 1998 in 5 European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts in northern (Turin and Varese), central (Florence), and southern (Naples and Ragusa) Italy.

DESIGN

Baseline dietary, anthropometric, and lifestyle characteristics were collected. Major events of CHD (fatal and nonfatal myocardial infarction and coronary revascularization) were identified through a review of clinical records. Analyses were stratified by center and adjusted for hypertension, smoking, education, menopause, physical activity, anthropometric measures, nonalcohol energy, alcohol, total meat, vegetables in analyses for fruit, and fruit in analyses for vegetables.

RESULTS

During a mean follow-up of 7.85 y, 144 major CHD events were identified. A strong reduction in CHD risk among women in the highest quartile of consumption of leafy vegetables (hazard ratio: 0.54; 95% CI: 0.33, 0.90; P for trend = 0.03) and olive oil (hazard ratio: 0.56; 95% CI: 0.31, 0.99; P for trend = 0.04) was found. In contrast, no association emerged between fruit consumption and CHD risk.

CONCLUSION

An inverse association between increasing consumption of leafy vegetables and olive oil and CHD risk emerged in this large cohort of Italian women.

Fruit and vegetable intake by adults in Ribeirão Preto, Southeastern Brazil

OBJECTIVE

To assess fruit and vegetable intake by adults and identify sociodemographic and life style variables associated with this intake.

METHODS

A population-based cross-sectional study was performed in the urban area of the city of Ribeirão Preto, Southeastern Brazil, in 2006. Sample was selected using three-stage cluster sampling, with census tracts as primary units. Sample was comprised of 930 participants aged 30 years and more and the design effect was considered in data analysis. Fruit and vegetable intake was based on a semi-quantitative food frequency questionnaire, using mean scores of frequency of fruit and vegetable intake, daily intake and minimum intake of such foods as indicators. The independent variables analyzed were as follows: age group, marital status, level of education, per capita household income, nutritional status, smoking and physical activity. Mean scores of frequency of intake were estimated by point and 95% confidence intervals. Prevalence ratios were also estimated by point and 95% confidence intervals to analyze association, using Poisson regression. Linear trend tests were applied, adopting a 5% confidence level.

RESULTS

Only 24% of men and 38% of women met the minimum recommendation for fruit and vegetable intake; there was a positive association with age and per capita income. Women with a higher level of education and men who lived with a female partner consumed more fruits and vegetables than others. Physical activity, smoking and nutritional status were not associated with the minimum recommended fruit and vegetable intake.

CONCLUSIONS

Socioeconomic factors have an important influence on fruit and vegetable intake and, as these are subject to intervention, they can contribute to the adoption of healthy eating habits.

Association between folate intake from different food sources in Norway and homocysteine status in a dietary intervention among young male adults

The aim of the present investigation was to study the effect of a dietary intervention which combined nutrition information with increased availability of vegetables, fruits and wholegrain bread. The effect of the intervention was determined by changes in the intake of vegetables, fruits, wholegrain bread and estimated nutrients. Furthermore, the study investigated whether changes in relative contribution from different food sources of folate were related to changes in the concentration of plasma total homocysteine (p-tHcy). The 5-month intervention study included 376 male recruits from the Norwegian National Guard, Vaernes (intervention group) and 105 male recruits from the Norwegian National Guard, Heggelia (control group). The study resulted in an increase in the total consumption of vegetables, fruits, berries and juice (P < 0·001) and of wholegrain bread (P < 0·001). The participants in the intervention group showed a higher increase in the intake of dietary fibre (P < 0·001) and folate (P < 0·001) compared with the control group. The relative contribution of folate intake from fruits, vegetables and wholegrain bread was higher in the intervention group compared with the control group (P < 0·001 for all). The increased intake of folate from wholegrain bread was inversely associated with a reduced concentration of p-tHcy (P = 0·017). In summary, the dietary intervention resulted in an increased intake of vegetables, fruits and wholegrain bread and a subsequent increase in folate intake from these food components. Reduction in the concentration of p-tHcy was significantly related to an increased folate intake due to an increased consumption of wholegrain bread.

Estimating the cardiovascular mortality burden attributable to the European Common Agricultural Policy on dietary saturated fats

OBJECTIVE

To estimate the burden of cardiovascular disease within 15 European Union countries (before the 2004 enlargement) as a result of excess dietary saturated fats attributable to the Common Agricultural Policy (CAP).

METHODS

A spreadsheet model was developed to synthesize data on population, diet, cholesterol levels and mortality rates. A conservative estimate of a reduction in saturated fat consumption of just 2.2 g was chosen, representing 1% of daily energy intake. The fall in serum cholesterol concentration was then calculated, assuming that this 1% reduction in saturated fat consumption was replaced with 0.5% monounsaturated and 0.5% polyunsaturated fats. The resulting reduction in cardiovascular and stroke deaths was then estimated, and a sensitivity analysis conducted.

FINDINGS

Reducing saturated fat consumption by 1% and increasing monounsaturated and polyunsaturated fat by 0.5% each would lower blood cholesterol levels by approximately 0.06 mmol/l, resulting in approximately 9800 fewer coronary heart disease deaths and 3000 fewer stroke deaths each year.

CONCLUSION

The cardiovascular disease burden attributable to CAP appears substantial. Furthermore, these calculations were conservative estimates, and the true mortality burden may be higher. The analysis contributes to the current wider debate concerning the relationship between CAP, health and chronic disease across Europe, together with recent international developments and commitments to reduce chronic diseases. The reported mortality estimates should be considered in relation to the current CAP and any future reforms.

Hypolipidemic effect of Telfairia occidentalis (fluted pumpkin) in rats fed a cholesterol-rich diet

Telfairia occidentalis (fluted pumpkin) is one of the commonly consumed leafy vegetables in Nigeria. In order to justify its inclusion in herbal preparations in African traditional medicine, the possible hypolipidemic effect of this vegetable was investigated in rats fed a cholesterol-rich diet. The ability of Questran, a hypolipidemic drug, to attenuate hypercholesterolemia was also examined. Rats were fed with either a basal diet containing cholic acid (0.2%) or a supplemented diet with T. occidentalis at the 3% and 6% levels. Oral administration of cholesterol for 9 consecutive weeks resulted in a significant increase (P < .001) in the relative weight of the heart of cholesterol-fed rats. However, supplemented diets significantly (P < .001) ameliorated the cholesterol-induced enlargement of the heart. Rats fed on supplemented diets had a dose-dependent reduction in plasma and postmitochondrial supernatant fraction (PMF) cholesterol levels. In particular, supplemented diets containing 3% and 6% T. occidentalis decreased plasma and PMF cholesterol levels by 20% and 30% and by 30% and 45%, respectively. A similar decrease in plasma and PMF cholesterol levels was obtained in Questran-treated hypercholesterolemic rats. Furthermore, 3% and 6% T. occidentalis-supplemented diets significantly (P < .05) decreased the cholesterol-induced increase in plasma and PMF low-density lipoprotein (LDL) cholesterol levels by 24% and 48% and by 28% and 52%, respectively. In contrast, there was no significant difference (P > .05) in plasma and PMF triglyceride levels of rats fed on supplemented diets when compared with cholesterol-fed rats. There were significant decreases (P < .05) in lipid peroxidation levels in rats fed on the supplemented diets. Specifically, 3% and 6% T. occidentalis-supplemented diets decreased plasma and PMF lipid peroxidation by 24% and 20% and by 42% and 21%, respectively. This study demonstrates that T. occidentalis may be a useful therapy for hypercholesterolemia through reducing oxidative stress and cholesterol levels.

A Study of Dietary Patterns in the Mexican-American Population and Their Association with Obesity

OBJECTIVE

Data from the National Health and Nutrition Examination Survey 2001-2002 indicate that prevalence of overweight and obesity continues to rise among Mexican Americans. Little is know about the dietary factors associated with this trend. Ethnic groups have different dietary patterns based on their geographical locations and cultural influences. We examined the dietary patterns of Mexican Americans and their association with total and central obesity. We hypothesized that Mexican-American adults following a traditional diet would have a lower prevalence of obesity than those following a more typical American diet.

SUBJECTS

Data from the National Health and Nutrition Examination Survey 2001-2002 included 659 Mexican-American adults, ages 18 years and older.

EXPERIMENTAL DESIGN

Dietary patterns were defined by cluster analysis of food group variables, expressed as percentage contribution to total energy intake. Obesity was assessed by body mass index (calculated as kg/m2) and central obesity by waist circumference.

RESULTS

We defined four dietary patterns, each named for the food groups that were most predominant relative to the other clusters: poultry and alcohol, milk and baked products, traditional Mexican, and meat. Surprisingly, we did not identify a clear "healthy pattern" group in this population, as has been generally observed in other ethnic groups. Although the traditional Mexican diet contains relatively high intakes of legumes and dietary fiber, it also was high in cholesterol. Contrary to our hypothesis, those consuming the traditional Mexican diet pattern had high BMI and waist circumference values, which did not differ significantly from other groups.

CONCLUSION

In this representative population of Mexican-American adults, we identified distinct dietary patterns, but these were not significantly associated with obesity. Rather, obesity was prevalent in all diet groups. More details on possible changes within the traditional pattern, including use of fast food vs home-prepared Mexican foods, are needed to better understand how diet can be associated with obesity in this population.

Vegetable and fruit intake and mortality from chronic disease in New Zealand

OBJECTIVE

To estimate mortality attributable to inadequate vegetable and fruit intake in New Zealand in 1997, and the burden of disease that could be avoided in 2011 if modest increases in vegetable and fruit intake were to occur.

METHODS

Comparative risk assessment methodology was used to estimate both attributable and avoidable mortality due to inadequate vegetable and fruit consumption (< 600 g/day). Vegetables and fruit were defined as all fresh, frozen, canned, dried or juiced vegetables and fruit, except potatoes, nuts, seeds and pulses. Disease outcomes assessed were mortality from ischaemic heart disease, ischaemic stroke, and lung, oesophageal, stomach and colorectal cancers.

RESULTS

In 1997, mean vegetable and fruit intake was 420 g/day in males and 404 g/day in females. Inadequate vegetable and fruit intake is estimated to have contributed to 1,559 deaths (6% of all deaths) in that year, including 1,171 from ischaemic heart disease, 179 from ischaemic stroke and 209 from cancer. Modest increases in vegetable and fruit intake (40 g/day above the historic trend) could prevent 334 deaths each year from 2011, mostly from ischaemic heart disease.

CONCLUSIONS

Inadequate vegetable and fruit intake is an important cause of mortality in New Zealand. Small increases in vegetable and fruit intake could have a major impact on population health within a decade.

Preventive effect of naringin on isoproterenol-induced cardiotoxicity in Wistar rats: an in vivo and in vitro study

This study was aimed to evaluate the preventive role of naringin on heart weight, blood glucose, total proteins, albumin/globulin (A/G) ratio, serum uric acid, serum iron, plasma iron binding capacity and membrane bound enzymes such as sodium potassium-dependent adenosine triphosphatase (Na(+)/K(+) ATPase), calcium-dependent adenosine triphosphatase (Ca(2+) ATPase) and magnesium-dependent adenosine triphosphatase (Mg(2+) ATPase) and glycoproteins such as hexose, hexosamine, fucose and sialic acid in isoproterenol (ISO)-induced myocardial infarction (MI) in rats and in vitro free radical scavenging assay. Male albino Wistar rats were pretreated with naringin (10, 20 and 40 mg/kg, respectively) for a period of 56 days. After the treatment period, ISO (85 mg/kg) was subcutaneously injected to rats at an interval of 24 h for 2 days. ISO-induced rats showed a significant (P<0.05) increase in the heart weight, blood glucose, serum uric acid, serum iron and a significant (P<0.05) decrease in the levels of total proteins, A/G ratio and iron binding capacity. A significant (P<0.05) decrease in the activity of Na(+)/K(+) ATPase and increase in the activities of Ca(2+) and Mg(2+) ATPase in the heart and a significant (P<0.05) increase in the levels of glycoproteins in serum and the heart were also observed in ISO-induced rats. Pretreatment with naringin for a period of 56 days exhibited a significant (P<0.05) effect and altered these biochemical parameters positively in ISO-induced rats. Naringin also scavenges 1,1-diphenyl-2-picrylhydrazyl (DPPH), 2,2'-azinobis-(3-ethyl-benzothiazoline-6-sulfonic acid) (ABTS) and nitric oxide (NO) radicals in vitro. Thus, our study shows that naringin has cardioprotective role in ISO-induced MI in rats.

Successful strategies to increase the consumption of fruits and vegetables: results from the Danish ‘6 a day’ Work-site Canteen Model Study

Objective:

To investigate changes in the consumption of fruits and vegetables in work-site canteens using the tools of continuous quality improvement, and to gain knowledge of practical strategies being effective in increasing the consumption.

Design:

Study design included baseline data collection, an 8 h training session for all canteen staff, goal setting, strategy development and implementation for each canteen, end-point data collection and a follow-up data collection 4 months from the end-point (1 year from baseline). The main outcome measurement was average grams of fruits and vegetables per lunch meal served per customer (net weight; potatoes not included).

Setting:

Five workplaces in Denmark: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility.

Subjects:

Work-site canteen managers, staff and customers.

Results:

There were significant increases in the total consumption of fruits and vegetables for all five work-site canteens from baseline to end-point, 70 g per customer on average (67, 54, 39, 88 and 103 g, respectively). The follow-up data collection showed that the canteens either maintained or significantly increased consumption, the average increase being 95 g per customer compared with baseline (77, 60, 86, 70 and 183 g, respectively).

Conclusions:

This study demonstrates a large potential for work-site canteens to increase customers' intake of fruits and vegetables at lunch and suggests a broad spectrum of strategies to compose meals that are both rich in fruits and vegetables and attractive to customers.

The burden of cardiovascular disease and cancer attributable to low fruit and vegetable intake in the European Union: differences between old and new Member States

Objective

To estimate the burden of disease attributable to low fruit and vegetable intake in the 15 countries that were members of the European Union (EU) before May 2004 (EU-15) and the 10 countries that then joined it (EU-10).

Design

Data on fruit and vegetable intake, target levels of intake and estimates of relative risks, deaths and disability were combined to obtain the burden of ischaemic heart disease, ischaemic stroke and four types of cancer (lung/bronchus/trachea, stomach, oesophagus, and colon/rectum) attributable to low fruit and vegetable consumption.

Setting

EU-15 and EU-10 Member States.

Results

The number of lives potentially saved annually from the selected outcomes if fruit and vegetable intake increased to 600 g person−1 day−1 reached 892 000 and 423 000 in the EU-15 and EU-10, respectively; total disease burden could decrease by 1.9% and 3.6%, respectively. The burden of ischaemic heart disease and stroke could be reduced by up to 17% and 10%, respectively, in the EU-15 and by 24% and 15%, respectively, in the EU-10; potential reductions for the selected cancers varied from 1% to 12% in the EU-15 and from 2% to 17% in the EU-10.

Conclusions

The potential health gain of increased fruit and vegetable intake is particularly large in the new Member States, and particularly high for cardiovascular diseases, a main cause of health divide in Europe. This stresses the need for better nutrition programmes and policies that take account of economic, social and cultural specificities.

Orange juice ingestion and supplemental vitamin C are equally effective at reducing plasma lipid peroxidation in healthy adult women

OBJECTIVE

To directly examine the contribution of vitamin C to the antioxidant potential of fruits and vegetables, the antioxidant effect of orange juice consumption (8 and 16 fl. oz.) was compared to the antioxidant effect of supplemental vitamin C (dosage equivalent to that supplied by 8 fl. oz. of orange juice).

METHODS

Subjects (n = 11; 28.6 +/- 2.1 years) received each treatment in a 3 x 3 randomized crossover design, and each two-week treatment was preceded by a two-week washout. During the entire trial, subjects restricted fruit and vegetable consumption to < or =3 servings per day except the vitamin C-rich foods (items containing >20 mg/serving), which were restricted to < or =3 servings per week. A fasting blood sample was collected at the end of each washout and each treatment period.

RESULTS

Following washouts, plasma vitamin C and lipid peroxidation (plasma TBARS) were similar by treatment group and averaged 25.4 +/- 3.6 micromol/L and 3.82 +/- 0.10 nmol/mL respectively. Plasma vitamin C concentrations were similar following each treatment period, 37.9 +/- 8.1, 45.8 +/- 9.4, and 38.3 +/- 12.4 micromol/L for the 8 and 16 fl. oz. orange juice treatments and the supplement treatment, respectively. All intervention treatments reduced plasma TBARS as compared to pretreatment values: -47% (p = 0.013), -40% (p = 0.083), and -46% (p = 0.015) for the 8 and 16 fl. oz. orange juice treatments and supplement treatment respectively.

CONCLUSIONS

These data indicate that the regular consumption of 8 fl. oz. orange juice or supplemental vitamin C ( approximately 70 mg/day) effectively reduced a marker of lipid peroxidation in plasma.

The European Common Agricultural Policy on fruits and vegetables: exploring potential health gain from reform

BACKGROUND

Consumption of fruits and vegetables is associated with a reduced risk of cardiovascular disease and cancer. The European Union Common Agricultural Policy keeps prices high by limiting the availability of fruits and vegetables. This policy is at odds with public health interests. We assess the potential health gain for the Dutch population of discontinuing EU withdrawal support for fruits and vegetables.

METHODS

The maximum effect of the reform was estimated by assuming that a quantity equivalent to the amount of produce withdrawn in recent years would be brought onto the market. For the calculation of the effect of consumption change on health we constructed a multi-state life table model in which consumption of fruits and vegetables is linked to ischaemic heart disease, stroke, and cancer of the oesophagus, stomach, colorectum, lung and breast. Uncertainty is quantified using Monte Carlo simulation.

RESULTS

The reform would maximally increase the average consumption of fruits and vegetables by 1.80% (95% uncertainty interval 1.12-2.73), with an ensuing increase in life expectancy of 3.8 (2.2-5.9) days for men and 2.6 (1.5-4.2) days for women. The reform is also likely to decrease socio-economic inequalities in health.

CONCLUSION

Ending EU withdrawal support for fruits and vegetables could result in a modest health gain for the Dutch population, though uncertainty in the estimates is high. A more comprehensive examination of the health effects of the EU agricultural policy could help to ensure health is duly considered in decision-making.

Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view

Public health policy differs from programme insofar as the former is the expression of goals at a higher decision-making level (international, regional, national or provincial) and the latter involves the execution of intervention measures at the community or individual level. It has recently become fashionable to speak of "evidence-based" policy. There is now ample evidence to suggest that early nutritional influences on chronic disease risk in later life are contributing to the acceleration of the overall worldwide epidemic of obesity and non-transmissible diseases. In developing countries, in which 80% of the world's population resides, the opportunities for preventive policy must be balanced against needs, cost and effectiveness considerations and the intrinsic limitations of policy execution. Not everyone in the population is at risk of suffering from any given negative condition of interest, nor will everyone at risk benefit from any given intervention. Hence, decisions must be made between universal or targeted policies, seeking maximal cost-efficiency, but without sowing the seeds of either discrimination or stigmatization with a non-universal application of benefits. Moreover, although large segments of the covered population may benefit from a public health measure, it may produce adverse and harmful effects on another segment. It is ethically incumbent on policy makers to minimize unintended consequences of public health measures. With respect to the particular case of mothers, fetuses and infants and long-term health, only a limited number of processes are amenable to intervention measures that could be codified in policy and executed as programmes.

Fruit cross-reactive allergens: a theme of uprising interest for consumers' health

Regular consumption of fruits has a positive influence on human health by disease prevention. However parallel to dietetic benefits, IgE-mediated fruit allergies have been shown to be an increasing health risk for children and adults in the Northern hemisphere. The spectrum of food allergies ranges from chronic symptoms to more acute problems and even anaphylaxis. Fruit proteins with high primary sequence similarity display also homologous tertiary structures, resulting in similar epitopes to IgEs and consequently in cross-reactivity. In this review we present the major allergens of stone and pome fruits and discuss the presence of homologous proteins in small fruits. Interestingly these proteins, which might pose an allergenic potential for pre-sensitised individuals are expressed also in strawberry, raspberry and blueberry, otherwise rich in beneficial biofactors.

Linear furanocoumarin protects rat myocardium against lipidperoxidation and membrane damage during experimental myocardial injury

The antioxidant activity and the membrane effects of linear furanocoumarin marmesinin isolated from Aegle marmelose was evaluated during experimental myocardial injury. Isoproterenol (150 mg kg(-1) intraperitonially twice at an interval of 24 h) caused increase in the levels of serum marker enzymes via creatinekinase (CK), creatinekinase-MB (CK-MB) isoenzyme, lactatedehydrogenase (LDH) and lactatedehydrogenase isoenzyme (LDH1). It also produced electrocardiographic changes such as increased heart rate, reduced R amplitude and ST elevation. Marmesinin at a dose of 200 mg kg(-1), when administered orally, demonstrated a decrease in serum enzyme levels and restored the electrocardiographic changes towards normalcy. Myocardial injury was accompanied by the disintegration of lipidperoxides and the impairment of natural scavengers. Marmesinin oral treatment for 2 days before and during isoproterenol administration decreased the effect of lipidperoxidation. It was also shown to have a membrane stabilizing action by inhibiting the release of beta-glucuronidase from the subcellular fractions. Thus, linear furanocoumarin marmesinin could have the protective effect against the damage caused by experimental myocardial injury.

The challenge of measuring global fruit and vegetable intake

The WHO recently conducted, within its Global Burden of Disease 2000 Study, a Comparative Risk Assessment (CRA) to estimate the global health effect of low fruit and vegetable intake. This paper summarizes the methods used to obtain exposure data for the CRA and provides estimates of worldwide fruit and vegetable intakes. Intakes were derived from 26 national population-based surveys, complemented with food supply statistics. Estimates were stratified by 14 subregions, 8 age groups, and gender. Subregions were categorized on the bases of child mortality under age 5 y and 15- to 59-y-old male mortality (A: very low child and adult mortality; B: low child and adult mortality; C: low child, high adult mortality; D: high child and adult mortality; E: high child, very high adult mortality). Mean intakes were highest in Europe A [median = 449 g/(person.d)] and the Western Pacific Region A. They were lowest in America B [median = 192 g/(person.d)], and low in Europe C, the South East Asian Regions B and D, and Africa E. Children and elderly individuals generally had lower intakes than middle-aged adults. SDs varied considerably by region, gender, and age [overall median = 223 g/(person.d)]. Assessing exposure levels for the CRA had major methodological limitations, particularly due to the lack of nationally representative intake data. The results showed mean intakes generally lower than current recommendations, with large variations among subregions. If the burden of disease attributable to dietary factors is to be assessed more accurately, more countries will have to assess the dietary intake of their populations using comparable methods.

Evaluating the potential health gain of the World Health Organization's recommendation concerning vegetable and fruit consumption

OBJECTIVE

The World Health Organization (WHO) recommends a daily intake of at least 400 g of vegetables and fruit. The aim of this paper was to evaluate the public health benefit of meeting this WHO recommendation by applying a statistical method that combines estimated intake distributions and simulated intake changes.

DESIGN AND SETTING

The benefit of an increased consumption of vegetables and fruit was quantified by the preventable proportion of diseases. This proportion was estimated by a general formula derived in the paper that incorporates individual relative risks. Three different strategies of increasing usual intake were simulated and compared. The first strategy assumes that all individuals increase their intake by the same amount, the second assumes a constant increase among low consumers, and the third simulates individual increments necessary to meet the WHO recommendation. Calculations were made for three different scenarios with varying relative risks.

RESULTS

The third simulation strategy turned out to be the most appropriate one to quantify the potential health gain of the current dietary recommendation. Applying this strategy to prevent cancer, the proportion of preventable cases was country-specific. Estimates for France and Sweden were 21.9% and 19.3%, respectively, which are somewhat lower than the non-specific figure published by the World Cancer Research Fund.

CONCLUSIONS

To improve estimates of the preventable proportion of diseases, the estimation formula presented here can be applied. Its application requires intake data to estimate the initial intake distribution in the population and to simulate adequate dietary changes.

The burden of disease attributable to nutrition in Europe

OBJECTIVE

This review examines the extent to which differences in nutrition could explain the diversity of health in Europe and how dietary patterns might contribute to the overall burden of disease in the region.

SETTING

Europe.

DESIGN

Between-country variations and time trends in dietary and health patterns in Europe are described, taking into account recent evidence on east-west mortality differentials. Existing information on the contribution of dietary factors to the overall burden of disease in Europe and to the burden of cardiovascular diseases and cancer is then reviewed, including a discussion of the methodological challenges that face those seeking to quantify this burden accurately.

RESULTS

While evidence from ecological data have long suggested that variations in health patterns in Europe may be at least partly attributed to differences in dietary intake, recent research into the major risks to disease, disability and death is confirming the importance of poor nutrition to major health problems and overall disease burden in Europe. Findings from the Global Burden of Disease 2000 study suggest that 4.4% of the overall burden of disease in the region could be attributed to low fruit and vegetable intake, and 7.8% to overweight and obesity.

CONCLUSIONS

The burden of disease attributed to poor nutrition in Europe appears to be substantial and probably underestimated. However, better quantification of the contribution of nutrition to the region's burden of disease awaits further research to assess the dietary intake of Europeans and to explore the relationship between nutritional factors and health outcomes in diverse parts of Europe.

Vegetable intake and long-term survival among middle-aged men in Italy

PURPOSE

To examine prospectively the relationship between vegetable consumption and long-term survival.

METHODS

In 1965, a total of 1536 Italian males from two Italian rural cohorts of the Seven Countries Study, aged 45-65 years, were examined. Information on lifestyle and food consumption collected at this visit, and total and cause-specific mortality data collected in 30 years of follow-up were analyzed for the present study.

RESULTS

During a period of 30 years, 1096 deaths occurred (308 from coronary heart disease, 325 from cancer, 158 from cerebrovascular disease and 305 from all other causes). The age-adjusted life expectancy for men consuming more than 60 g/day of vegetables was nearly 2 years longer than for men consuming less than 20 g/day. This increase in survival was more striking in smokers than nonsmokers (2.1 vs. a 1 year gain). The association also held for both geographic cohorts, although the pattern of vegetable consumption was very different in the two villages.

CONCLUSIONS

The results suggest a positive association between vegetable intake and life expectancy. Vegetable intake may be especially protective for smokers although the biological explanation for such an effect is unclear.

Discrepancies between ecological and individual data on fruit and vegetable consumption in fifteen countries

Although food supply statistics are commonly used in ecological studies of diet and disease, little information is available on how they compare with reported intakes of foods. The objective of the present study was to compare fruit and vegetable availability with estimates of national mean intakes derived from national food consumption surveys. Food availability statistics from the FAO were used. For each country, mean national supply, based on at least 3 years of FAO data, was calculated. National estimates of mean fruit and vegetable intakes were derived from population-based surveys from fifteen countries, gathered for the World Health Organization Global Burden of Disease Study revision for 2000. Extrapolations were made when survey data did not cover all age groups. For each country, the FAO:survey estimate ratio was calculated. This ratio ranged from 0.93 to 2.70 (median value=1.39). Although there was a tendency for FAO data to overestimate intakes (fourteen out of fifteen countries), the degree of overestimation varied greatly among the countries included in this study (5-270 %). As food supply statistics are the only source of information on dietary patterns in most countries of the world, further information on how they reflect food intakes is needed. Obtaining detailed and valid estimates of dietary intakes in more countries around the world will be essential for such comparisons.

Flavan-3-ols and procyanidins protect liposomes against lipid oxidation and disruption of the bilayer structure

The antioxidant activity and the membrane effects of the flavanols (-)-epicatechin, (+)-catechin, and their related oligomers, the procyanidins, were evaluated in liposomes composed by phosphatidylcholine:phosphatidylserine (60:40, molar ratio). When liposomes were oxidized with a steady source of free radicals, the flavanols and procyanidins (25 microM monomer equivalents) inhibited oxidation in a manner that was related to procyanidin chain length. Flavanols and procyanidins did not influence membrane fluidity or lipid lateral phase separation. However, flavanols and procyanidins induced a decrease in the membrane surface potential and protected membranes from detergent-induced disruption. These effects were dependent on flavonoid concentration, procyanidin chain length, and membrane composition. Flavanol- and procyanidin-induced inhibition of lipid oxidation was correlated with their effect on membrane surface potential and integrity. These results indicate that the interaction of flavanols and procyanidins with phospholipid head groups, particularly with those containing hydroxyl groups, is associated with a reduced rate of membrane lipid oxidation. Thus, flavanols and procyanidins can potentially reduce oxidative modifications of membranes by restraining the access of oxidants to the bilayer and the propagation of lipid oxidation in the hydrophobic membrane matrix.

Fruit and vegetables - attitudes and knowledge of primary school children

OBJECTIVES

To evaluate whether children, aged 8-11 years could correctly identify commonly available fruit and vegetables; to assess the acceptability of these; and to gain a broad understanding of children's perceptions of 'healthy eating'.

METHODS

Fruit and vegetables used were those readily available in retail outlets in the UK. Data were collected from three year-groups (n = 221) using a questionnaire supported by semistructured interviews and discussions.

RESULTS

Overall, fruit was more popular than vegetables and recognition of fruit better; melons being the least well identified. Recognition of vegetables increased with age; the least well identified being cabbage which was confused with lettuce by 32, 16 and 17% of pupils in their respective age groups. Most children (75%) were familiar with the term healthy eating, citing school (46%) as the most common source of information. Pupils showed an awareness and understanding of current recommendations for a balanced diet, although the message has become confused.

CONCLUSIONS

If fresh fruit and vegetables are to form part of a balanced diet, the 'health message' needs to be clear. Fruit is well liked; vegetables are less acceptable with many being poorly recognized, factors which need to be addressed.

Lyophilized apple counteracts the development of hypercholesterolemia, oxidative stress, and renal dysfunction in obese Zucker rats

Apples may have selective effects on abnormalities associated with the plurimetabolic syndrome. Therefore, the effects of 20% lyophilized apple supplementation on plasma and tissue lipids and on protection against susceptibility to oxidative stress and renal dysfunction were investigated in Zucker lean (Fa/-) or obese (fa/fa) rats. The experimental diets were equilibrated for sugar supply, contained 0.25 g/100 g cholesterol and provided only one third of the vitamin E requirement. Obese Zucker rats were hypercholesterolemic with cholesterol accumulation in LDL and HDL fractions. The apple diet lowered plasma and LDL cholesterol (-22 and -70%, respectively, P < 0.01) in obese Zucker rats and, in parallel, reduced triglyceride accumulation in heart and liver. Zucker rats fed the apple diet also had a larger intestinal pool and greater fecal excretion of bile acids. The heart concentration and urinary excretion of malondialdehyde were reduced by apple consumption in obese Zucker rats, suggesting better protection against peroxidation. Glucosuria and proteinuria in obese Zucker rats were also suppressed by the apple diet. In conclusion, despite their moderate fiber content, apples improve substantially the lipid status and peroxidative parameters in obese Zucker rats, suggesting that other plant constituents such as polyphenols are involved in these effects.

A framework for the evidence base to support Health Impact Assessment

OBJECTIVE

To introduce a conceptual structure that can be used to organise the evidence base for Health Impact Assessment (HIA).

BACKGROUND

HIA can be used to judge the potential health effects of a policy, programme or project on a population, and the distribution of those effects. Progress has been made in incorporating HIA into routine practice, especially (in the UK) at local level. However, these advances have mainly been restricted to process issues, including policy engagement and community involvement, while the evidence base has been relatively neglected. RELATING POLICIES TO THEIR IMPACT ON HEALTH: The key distinctive feature of HIA is that determinants of health are not taken as given, but rather as factors that themselves have determinants. Nine ways are distinguished in which evidence on health and its determinants can be related to policy, and examples are given from the literature. The most complete of these is an analysis of health effects in the context of a comparison of options. A simple model, the policy/risk assessment model (PRAM), is introduced as a framework that relates changes in levels of exposures or other risk factors to changes in health status. This approach allows a distinction to be made between the technical process of HIA and the political process of decision making, which involves lines of accountability. Extension of the PRAM model to complex policy areas and its adaptation to non-quantitative examples are discussed. ISSUES FOR THE FUTURE: A sound evidence base is essential to the long term reputation of HIA. Research gaps are discussed, especially the need for evidence connecting policy options with changes in determinants of health. It is proposed that policy options could be considered as "exposure" variables in research. The methodology needs to be developed in the course of work on specific issues, concentrated in policy areas that are relatively tractable.

CONCLUSIONS

A system of coordination needs to be established, at national or supranational level, building on existing initiatives. The framework suggested in this paper can be used to collate and evaluate what is already known, both to identify gaps where research is required and to enable an informed judgement to be made about the potential health impacts of policy options. These judgements should be made widely available for policy makers and for those undertaking health impact assessment.