Dietary surveillance for states and communities

Using Behavioral Risk Factor Surveillance System Data to Estimate the Percentage of the Population Meeting US Department of Agriculture Food Patterns Fruit and Vegetable Intake Recommendations

Most Americans do not eat enough fruits and vegetables with significant variation by state. State-level self-reported frequency of fruit and vegetable consumption is available from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS). However, BRFSS cannot be used to directly compare states' progress toward national goals because of incongruence in units used to measure intake and because distributions from frequency data are not reflective of usual intake. To help states track progress, we developed scoring algorithms from external data and applied them to BRFSS 2011 data to estimate the percentage of each state's adult population meeting US Department of Agriculture Food Patterns fruit and vegetable intake recommendations. We used 24-hour dietary recall data from the National Health and Nutrition Examination Survey, 2007-2010, to fit sex- and age-specific models that estimate probabilities of meeting recommendations as functions of reported consumption frequency, race/ethnicity, and poverty-income ratio adjusting for intraindividual variation. Regression parameters derived from these models were applied to BRFSS to estimate the percentage meeting recommendations. We estimate that 7%-18% of state populations met fruit recommendations and 5%-12% met vegetable recommendations. Our method provides a new tool for states to track progress toward meeting dietary recommendations.

Evaluating brief measures of fruit and vegetable consumption frequency and variety: cognition, interpretation, and other measurement issues

To evaluate whether items from 3 brief measures of fruit and vegetable consumption were understood and interpreted as intended, cognitive testing was conducted in a purposive sample of 31 white, African-American and Hispanic persons. The measurement instruments tested were the fruit and vegetable module from the Behavioral Risk Factor Surveillance System (to measure frequency), and 1 fruit and 1 vegetable variety measurement instrument developed by the investigators. The cognitive testing interviews were analyzed qualitatively to identify interpretation difficulties and other measurement issues. The testing identified a number of measurement issues, including issues related to time frame, wording, interpretation, grouping of items, and serving size. Recommendations based on the findings were incorporated into revised versions of each instrument, which were further tested in a small sample. As revised and presented in this article, these instruments for assessing fruit and vegetable frequency and variety appear to be understood and interpreted as intended across different racial and ethnic groups, and may be useful in situations requiring brief dietary assessment, although further testing is needed.

Choose a variety of fruits and vegetables daily: understanding the complexities

The 2000 edition of Nutrition and Your Health: Dietary Guidelines for Americans is the first to include a recommendation aimed specifically at fruits and vegetables, apart from grains. This paper discusses these changes in the Dietary Guidelines, summarizes the methods of assessment pertaining to fruit and vegetable intakes and their related factors, and reviews the data available on current levels and trends over time. Recent methodological advances in the measurement of both the aggregate U.S. food supply and foods consumed by individuals have allowed for better estimates with which recommendations can be compared. The data on individual intakes suggest the following: Americans are consuming fruits and vegetables at a level near the minimum recommendations; to be in concordance with energy-based recommendations, they would have to consume approximately 2 more servings per day; and dark green and deep yellow vegetables are accounting for a disproportionately small share of the total. Fruit and vegetable consumption appears to be rising, but only slightly, and this increase might be only an artifact of shifts in the population demographics. A number of studies suggest that low income households in poor central cities and sparsely populated rural areas often have less access to food stores and face higher prices for food, including fruits and vegetables, compared with other households. At the aggregate level, supplying enough fruits and vegetables to meet dietary recommendations for all U.S. consumers would require adjustments in U.S. agricultural production, trade, marketing practices and prices of these commodities.