Fruit and vegetable intake among adults in 16 states: results of a brief telephone survey

Personal characteristics, cooking at home and shopping frequency influence consumption

This study examines how the consumption of fruits and vegetables is affected by home cooking habits and shopping patterns, including distance to patronized stores and frequency of shopping, in two low-income predominantly African American urban neighborhoods in New Orleans, Louisiana.

In-person interviews were conducted in 2013 with 901 adult residents who identified themselves as the primary household shopper. Respondents were asked where and how often they shopped and answered a food frequency questionnaire. Addresses were geocoded and distances to the stores where respondents shopped were calculated. Multivariable logistic regression was used to examine the relationship between food consumption and personal factors, neighborhood factors and shopping habits.

Consumption of daily servings of fresh produce increased by 3% for each additional trip to a grocery store, by 76% for shopping at a farmer's market, and by 38% for preparing food at home. Each additional trip to a convenience store increased the frequency of consumption of chips, candy and pastries by 3%. The distance from residence to the type of store patronized was not associated with consumption of produce or chips, candy or pastries.

Shopping at full-service grocery stores, farmer's markets and cooking at home were positively associated with the consumption of fresh produce while shopping at convenience stores was associated with increased consumption of chips, candy and pastries. These findings are useful for designing programmatic interventions to increase fresh fruit and vegetable consumption among residents in low-income urban communities.

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Shopping frequency and store type influence consumption of food.

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Distance to patronized store was not associated with consumption.

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Food prepared at home is associated with increased consumption of produce.

Is a Nutrition Education Intervention Associated with a Higher Intake of Fruit and Vegetables and Improved Nutritional Knowledge among Housewives in Mauritius?

The purpose of the study was to assess the determinants of nutrition behaviors and body mass index and determine the impact of a nutrition education intervention (NEI) among Mauritian housewives. A pretest-posttest design was used assessing Nutrition Knowledge (NK), Nutrition Attitudes, Fruit and Vegetable Intake (FVI), body mass index (BMI). Two hundred Mauritian housewives were recruited. The NEI was in the form of a lecture and lasted for twenty minutes. Statistical tests performed revealed that the mean NK score at baseline was 65.8 ± 6.92 and a significant increase of +17.1 at post-test and +16.1 at follow-up was observed. Determinants of NK were age, presence of elderly people, and BMI. Mean nutrition attitude score at baseline was 2.37 ± 0.22 with significant increase of +0.2 (post-test) and +0.17 at follow-up. Age, level of education, presence of elders, and NK were linked to a positive attitude. FVI was predicted by age, income, presence of elders, NK, and nutrition attitudes. Baseline FVI was 4.77 ± 1.11 which increased significantly (p < 0.001) to 4.98 ± 1.13 at post-test and 5.03 ± 1.20 at follow up. NEI had a positive impact suggesting the benefits of such intervention in the promotion of healthy nutrition behaviors.

Control Constructs: Do They Mediate the Relation between Educational Attainment and Health Behaviour?

Health promoting behaviours seem to be more prevalent among people with higher socio-economic status (SES). The main purpose of this article was to study (a) the relationship between education (as a dimension of SES) and intention and health behaviour (fruit/vegetable consumption), (b) the relationship between education and control conceptualizations (health locus of control (HLC), responseefficacy and self-efficacy) and (c) to what extent the relationship between education and intention/health behaviour (fruit/vegetable consumption) was mediated through different control beliefs. The results showed that women with higher education had higher intentions to consume fruit/vegetables and consumed fruit/vegetables more frequently. Higher education was associated with higher selfefficacy and response-efficacy beliefs and less belief in HLCchance. These control beliefs partly mediated the education–intention/behaviour relationship.

Folic Acid Intake and Neural Tube Defects: Two Egyptian Centers Experience

Neural tube defects (NTDs) are a group of congenital malformations with worldwide distribution and complex etiopathogenesis. Folic acid plays a pivotal role in their prevention. We aimed to identify the protective effect of folic acid intake against NTDs and its dependence on different socioeconomic and environmental factors in a cohort of mothers in Egypt. A cross-sectional study was carried over a period of 12 months on mothers who gave birth to babies with NTDs (group 1) and a control group with healthy offsprings (group 2). Both groups completed 2 questionnaires: food frequency questionnaire targeting the daily folate intake, and socioeconomic status and medical history questionnaire. Both groups of mothers received folate <800 μg/day, recommended for pregnant women. A strong association was detected between NTDs and urban residency with medium educated mothers, with negative consanguinity, who had folate intake < 400 μg daily, and who had their food long cooked. Each of these factors separately had a limited impact to cause NTDs, but when present together they did augment each other. Interestingly enough is the role of fava bean, cauliflower, spinach, and mango in predisposing of NTDs in the presence of the above-mentioned factors. The protective effect of folic acid intake against NTDs may depend on the synergism of different socioeconomic and environmental factors (which differ from country to another). In Egypt, females especially the medium-educated who live in urban areas should be well-informed with the value of folate intake in the periconceptional period.

Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Foods

A 36-item Short Diet Questionnaire (SDQ) was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, “NuAge” (n = 1793, 52.4% women), recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years). Following revision, the SDQ was administered to 527 NuAge participants (55% female), distributed among the three age groups, both sexes and languages (French, English) prior to the second of three non-consecutive 24 h diet recalls (24HR) and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05) except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01), ranging from 0.19 (cholesterol) to 0.45 (fruits and vegetables). Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

Fruit and vegetable intake among older adults: a scoping review

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Influence of lifestyle factors on inflammation in men and women with type 2 diabetes: results from the National Health and Nutrition Examination Survey, 1999-2004

BACKGROUND

Type 2 diabetes is associated with low-grade systemic inflammation, increasing the risk for various adverse health outcomes.

PURPOSE

Our objective was to investigate the association between C-reactive protein (CRP), a marker for systemic inflammation, and lifestyle factors in a national sample of people with type 2 diabetes.

METHODS

This study analyzed data from 1,086 men and women with diabetes, who completed the 1999-2004 NHANES. Lifestyle factors included diet quality, body mass index (BMI), smoking, and physical activity.

RESULTS

Stratified logistic regression showed that for both men and women, BMI was a strong predictor of elevated CRP after adjusting for age, energy intake, race/ethnicity, medications, diabetes duration, and glycosylated hemoglobin. However, among men, but not among women, the likelihood of elevated CRP increased with lower diet quality and physical inactivity.

CONCLUSIONS

Among people with type 2 diabetes, higher levels of CRP were associated with lower diet quality and physical inactivity among men, and with obesity among both men and women.

Differences in food intake among obese and nonobese women and men with type 2 diabetes

OBJECTIVE

Weight reduction is a key goal for the prevention of vascular complications in obese individuals with type 2 diabetes, but a nutritionally balanced intake is also important in this regard. We compared dietary intakes and vitamin supplement use between obese and nonobese women and men with type 2 diabetes to identify gaps in adherence to nutritional management guidelines.

METHODS

We analyzed data from a longitudinal study of adults with type 2 diabetes, wherein participants were assessed once per season over 1 year. Dietary data were collected using a validated semiquantitative, self-administered food-frequency questionnaire. Given the absence of seasonal variations in anthropometric variables and dietary intake, data from multiple visits were averaged for each individual. Associations of both intake of fruit and vegetables and nutrients related to cardiovascular disease risk were compared between obese (body mass index ≥ 30 kg/m²) and nonobese individuals through multivariable linear regression with adjustments for age, education, and energy intake.

RESULTS

Among the 200 participants (93 women and 107 men), 53% of women and 43% of men were obese. Compared with nonobese women, obese women consumed more saturated fat (mean difference, 1.2% of total energy intake; 95% confidence interval [CI], 3% to 2.2%) and sodium (mean difference, 0.3 g; 95% CI, 0.04 to 0.5 g), and they had a lower intake of fiber (mean difference, -2.7 g; 95% CI, -4.4 to -0.9 g) and magnesium (mean difference, -33.6 mg; 95% CI, -55.2 to -12.0 g). No differences in dietary intake were observed between obese and nonobese men, but the intakes of men overall were similar to those of obese women. Compared with nonobese participants, fewer obese individuals used vitamin/mineral supplements (women: 37% vs 48%, men: 26% vs 38%).

CONCLUSIONS

Obese women and both obese and nonobese men appeared to have poorer dietary quality compared with nonobese women. Our findings support the need to emphasize dietary composition in addition to weight control in diabetes.

Rural and urban differences in the associations between characteristics of the community food environment and fruit and vegetable intake

OBJECTIVE

To examine the relationship between measures of the household and retail food environments and fruit and vegetable (FV) intake in both urban and rural environmental contexts.

DESIGN

A cross-sectional design was used. Data for FV intake and other characteristics were collected via survey instrument and geocoded to the objective food environment based on a ground-truthed (windshield audit) survey of the retail food environment.

SETTING

One urban and 6 contiguous rural counties.

PARTICIPANTS

This study involved 2,556 residents of the Brazos Valley, Texas, who were selected through random-digit dialing.

MAIN OUTCOME MEASURE

Two-item scale of FV intake.

ANALYSIS

Data were analyzed using chi-square analysis, 2-sample t tests, and linear regression.

RESULTS

Distance to supermarket or supercenter was insignificant in the urban model, but significant in the rural model (β = -.014, P < .010, confidence interval = -.024, -.003).

CONCLUSIONS AND IMPLICATIONS

Retail food environments have different impacts on FV intake in urban and rural settings. Interventions to improve FV intake in these settings should account for the importance of distance to the retail food environment in rural settings.

Identifying patterns of eating and physical activity in children: a latent class analysis of obesity risk

We used latent class analysis (LCA) to identify heterogeneous subgroups with respect to behavioral obesity risk factors in a sample of 4th grade children (n = 997) residing in Southern California. Multiple dimensions assessing physical activity, eating and sedentary behavior, and weight perceptions were explored. A set of 11 latent class indicators were used in the analysis. The final model yielded a five-class solution: "High-sedentary, high-fat/high-sugar (HF/HS) snacks, not weight conscious," "dieting without exercise, weight conscious," "high-sedentary, HF/HS snacks, weight conscious," "active, healthy eating," and "low healthy, snack food, inactive, not weight conscious." The results suggested distinct subtypes of children with respect to obesity-related risk behaviors. Ethnicity, gender, and a socioeconomic status proxy variable significantly predicted the above latent classes. Overweight or obese weight status was determined based on the Centers for Disease Control and Prevention BMI (kg/m²)-for-age-and-sex percentile (overweight, 85th percentile ≤ BMI < 95th percentile; obese, 95th percentile ≤ BMI). The identified latent subgroup membership, in turn, was associated with the children's weight categories. The results suggest that intervention programs could be refined or targeted based on children's characteristics to promote effective pediatric obesity interventions.

Randomized controlled trial of a brief research-based intervention promoting fruit and vegetable consumption

OBJECTIVE

The present study sought to test the efficacy of a brief research-based, leaflet-like intervention to promote eating the recommended daily intake of fruit and vegetables (RDIFV).

DESIGN

A controlled, pre- post-test experimental study with random allocation and a 1 week self-report behavioural follow-up was conducted.

METHOD

The intervention employed persuasive communication targeting self-efficacy and intention, and invited participants to form implementation intentions in relation to acquiring and preparing fruit and vegetables for consumption.

RESULTS

Intervention participants had stronger post-intervention intentions to consume the RDIFV, and higher anticipated regret in relation to failing to do so, compared with controls, controlling for pre-intervention scores. At follow-up, the intervention group was found to have eaten more fruit and vegetables and to have consumed the RDIFV more frequently.

DISCUSSION

It is concluded that this study supports the previously reported power of implementation intentions to prompt enactment of intentions, and that a brief research-based leaflet-like intervention could result in immediate enhancement of intentions and anticipated regret, and promote greater fruit and vegetable consumption.

Focus groups inform a web-based program to increase fruit and vegetable intake

OBJECTIVE

To use focus groups to inform a web-based educational intervention for increased fruit and vegetable (FV) consumption.

METHODS

Twelve groups (participants=137, aged 21-65) were recruited from four geographically diverse health systems. Four groups were stratified by gender and eight by race (white and African American) and gender. Questions included perceptions of healthy eating, factors that encourage or serve as barriers to FV consumption and features preferred for a web-based educational intervention.

RESULTS

Though knowledgeable about healthy eating, participants did not know how to achieve or always care about healthy nutritional choices. Motivators for FV consumption included being role models and health concerns. Barriers included: lack of time, expense and FV availability. Website preferences included: visuals, links, tailored materials, menu suggestions, goal setting assistance, printable summaries and built in motivation. The developers incorporated nearly all suggestions.

CONCLUSION

Focus groups provided needs-based tactical strategies for an online, education intervention targeting factors to improve FV consumption.

PRACTICE IMPLICATIONS

Focus groups can provide valuable input to inform interventions. Further, web-based programs' abilities to offer information without time or geographic constraints, with capacity for tailoring and tracking progress makes them a valuable addition in the arsenal of efforts to promote healthy behaviors.

Are school employees role models of healthful eating? Dietary intake results from the ACTION worksite wellness trial

BACKGROUND

Little is known about the dietary intake of school employees, a key target group for improving school nutrition.

OBJECTIVE

To investigate selected dietary variables and weight status among elementary school personnel.

DESIGN

Cross-sectional, descriptive study.

SUBJECTS/SETTING

Elementary school employees (n=373) from 22 schools in a suburban parish (county) of southeastern Louisiana were randomly selected for evaluation at baseline of ACTION, a school-based worksite wellness trial.

METHODS

Two 24-hour dietary recalls were administered on nonconsecutive days by registered dietitians using the Nutrition Data System for Research. Height and weight were measured by trained examiners and body mass index calculated as kg/m(2).

STATISTICAL ANALYSES PERFORMED

Descriptive analyses characterized energy, macronutrient, fiber, and MyPyramid food group consumption. Inferential statistics (t tests, analysis of variance, chi(2)) were used to examine differences in intake and compliance with recommendations by demographic and weight status categories.

RESULTS

Approximately 31% and 40% of the sample were overweight and obese, respectively, with higher obesity rates than state and national estimates. Mean daily energy intake among women was 1,862+/-492 kcal and among men was 2,668+/-796 kcal. Obese employees consumed more energy (+288 kcal, P<0.001) and more energy from fat (P<0.001) than those who were normal weight. Approximately 45% of the sample exceeded dietary fat recommendations. On average, only 9% had fiber intakes at or above their Adequate Intake, which is consistent with the finding that more than 25% of employees did not eat fruit, 58% did not eat dark-green vegetables, and 45% did not eat whole grains on the recalled days. Only 7% of employees met the MyPyramid recommendations for fruits or vegetables, and 14% of the sample met those for milk and dairy foods.

CONCLUSIONS

These results suggest that greater attention be directed to understanding and improving the diets of school employees given their high rates of overweight and obesity, poor diets, and important role in student health.

Action schools! BC--Healthy Eating: effects of a whole-school model to modifying eating behaviours of elementary school children

OBJECTIVES

The rate of obesity and associated risk factors in Canadian youth is increasing at an alarming rate. Nutrition plays an important role in weight maintenance. This study reports the effectiveness of Action Schools! BC---Healthy Eating, a school-based fruit and vegetable (FV) intervention, in effecting change in: 1) students' intake of FV, 2) students' knowledge, attitudes and perceptions regarding FV, and 3) students' willingness to try new FV.

METHODS

Five schools that represented geographic, socio-economic and size variation were recruited as Action Schools! BC--Healthy Eating intervention schools. A second set of five schools were selected as matched healthy eating usual practice schools. Student outcomes were measured at baseline and at 12-week follow-up using self-report questionnaires. Classroom logs and progress reports were used to assess implementation dose and fidelity. The intervention included school-wide activities based on individualized Action Plans addressing goals across six Action Zones.

RESULTS

Significant differences were found between conditions over time while controlling for baseline levels. Fruit servings, FV servings, FV variety, and percent of FV tried from a fixed list increased in intervention schools. Teachers implemented a mean of 64% of requested classroom dose, and school Action Teams implemented activities across 80% of the whole-school model.

DISCUSSION

A whole-school framework can impact FV intake, but results were modest due to implementation issues. Further implementation and evaluation are necessary to fully understand the effectiveness of this initiative.

Action schools! BC--Healthy Eating: effects of a whole-school model to modifying eating behaviours of elementary school children

OBJECTIVES

The rate of obesity and associated risk factors in Canadian youth is increasing at an alarming rate. Nutrition plays an important role in weight maintenance. This study reports the effectiveness of Action Schools! BC---Healthy Eating, a school-based fruit and vegetable (FV) intervention, in effecting change in: 1) students' intake of FV, 2) students' knowledge, attitudes and perceptions regarding FV, and 3) students' willingness to try new FV.

METHODS

Five schools that represented geographic, socio-economic and size variation were recruited as Action Schools! BC--Healthy Eating intervention schools. A second set of five schools were selected as matched healthy eating usual practice schools. Student outcomes were measured at baseline and at 12-week follow-up using self-report questionnaires. Classroom logs and progress reports were used to assess implementation dose and fidelity. The intervention included school-wide activities based on individualized Action Plans addressing goals across six Action Zones.

RESULTS

Significant differences were found between conditions over time while controlling for baseline levels. Fruit servings, FV servings, FV variety, and percent of FV tried from a fixed list increased in intervention schools. Teachers implemented a mean of 64% of requested classroom dose, and school Action Teams implemented activities across 80% of the whole-school model.

DISCUSSION

A whole-school framework can impact FV intake, but results were modest due to implementation issues. Further implementation and evaluation are necessary to fully understand the effectiveness of this initiative.

Socioeconomic patterns of obesity in Canada: modeling the role of health behaviour

Among Canadians, previous research has associated obesity with indicators of socioeconomic position. Several health behaviours have demonstrated similar variation, suggesting that social patterning of obesity may be partially explained by behavioural differences. The objective of this study was to examine obesity in relation to income and education among Canadians, and to characterize the indirect associations potentially occurring through fruit and vegetable intake, leisure-time physical activity (LTPA), and smoking. The present secondary analysis of the 2004 Canadian Community Health Survey was restricted to adults (25-64 y) with measured height and weight data (men, n = 3767; women, n = 3823). Interrelationships among socioeconomic indicators, behaviours, and BMI groups were examined by age-adjusted path analysis. For men, obesity was positively associated with income directly and through current smoking. Obesity was also negatively associated with education, directly and through fruit and vegetable intake, and was negatively associated with income through LTPA (r2 = 0.17). For women, obesity was negatively associated with education both directly and indirectly through LTPA and with fruit and vegetable intake. No direct association was observed between income and obesity for women, but an indirect negative association existed via LTPA and fruit and vegetable intake (r2 = 0.15). The direct and indirect associations between obesity and socioeconomic indicators were consistently inverse among women, but this relationship was not the case in men, suggesting that clearer social patterns of adiposity exist for Canadian women. The limited amount of variance explained by these models likely reflects the complexity of obesity development.

Plenary Lecture

Taste preferences, food choices and eating habits all change with age. The transition from childhood to adolescence and adult life is associated with reduced sweet taste preferences, lower sugars consumption and reduced energy density of the diet. Ageing is associated with elevated acceptance of bitter tastes, elevated preferences for vegetables and salad greens, and increased consumption of whole grains, vegetables and fruit. The age-associated drop in energy intakes is achieved through a reduction in the weight and volume of food consumed, as well as a reduction in the overall energy density of the diet. Energy density drops from a peak of 5 kJ (1.2 kcal)/g in adolescence and early adult life to a low of 3.1 kJ (0.75 kcal)/g for adult women aged 45–54 years. Older adults, particularly women, consume less fat and saturated fat and more fibre and vitamin C, suggesting a shift in consumption from snacks, sweets and desserts towards grains, vegetables and fruit. These changes in food preferences and eating habits are associated, on a population level, with a decline in preferences for sweet taste and with increased acceptance of bitter tastes. At present there are no data to show a causal relationship between age-related changes in sensory function and the selection of a more bulky energy-dilute diet. However, it is a plausible hypothesis that sensory factors mediate adjustments in energy density of foods at different life stages.

Relationship of fruit and vegetable consumption in middle-aged men to medicare expenditures in older age: the Chicago Western Electric Study

BACKGROUND

High fruit and vegetable intake is associated with lower risk of hypertension, cardiovascular disease, and cancer. Little is known about the relationship of fruit and vegetable intake to health care expenditures.

OBJECTIVE

Examine whether fruit and vegetable intake among middle-aged adults is related to Medicare charges-total, cardiovascular disease, cancer-related-in older age.

DESIGN

Participants were grouped into one of three strata according to fruit and vegetable intake, determined from detailed dietary history (1958-1959): less than 14 cups per month, 14 to 42 cups per month, or more than 42 cups per month. Combined intake was classified as low, medium, or high. Medicare claims data (1984-2000) were used to estimate mean annual spending for eligible surviving participants (65 years and older) from the Chicago Western Electric Study: 1,063 men age 40 to 55 and without coronary heart disease, diabetes, and cancer at baseline (1957-1958). Cumulative charges before death (n = 401) were also calculated.

RESULTS

Higher fruit and fruit plus vegetable intakes were associated with lower mean annual and cumulative Medicare charges (P values for trend .019 to .862). For example, with adjustment for baseline age, education, total energy intake, and multiple baseline risk factors, annual cardiovascular disease-related charges were 3,128 dollars vs 4,223 dollars for men with high vs low intake of fruit plus vegetables. Corresponding figures were 1,352 dollars vs 1,640 dollars for cancer-related charges and 10,024 dollars vs 12,211 dollars for total charges. Results were generally similar for vegetable intake.

CONCLUSION

These findings, albeit mostly not statistically significant, suggest that for men high intake of fruits and fruits plus vegetables earlier in life has potential not only for better health status but also for lower health care costs in older age.

Methods and baseline characteristics of two group-randomized trials with multiracial and multiethnic working-class samples

INTRODUCTION

Few papers address the methodological challenges in recruiting participants for studies of cancer prevention interventions designed for multiracial and multiethnic working-class populations. This paper reports the results of the sample selection and survey methods for two group-randomized intervention studies.

METHODS

The two group-randomized intervention studies, Healthy Directions-Small Business (HD-SB) and Healthy Directions-Health Centers (HD-HC), included a worksite-based study in 26 small manufacturing businesses and a study in 10 outpatient health centers. We used selection and recruitment methods to obtain a multiracial and multiethnic working-class study sample. In 2000 and 2001, we assessed baseline measures of sociodemographic characteristics and behavioral outcomes by self-report. We then computed intraclass correlation coefficients (ICCs).

RESULTS

Of the 1740 participants in the HD-SB study, 68% were non-Hispanic whites, and 76% had working-class occupations. In the HD-HC study, 59% of 2219 participants were non-Hispanic whites. Among those who worked, 51% had working-class occupations. Large percentages of both samples reported not meeting recommended guidelines for the target behaviors. For example, 86% of members of both samples consumed fewer than the recommended five servings of fruits and vegetables per day. The ICCs for the four target behaviors in HD-SB were between 0.006 and 0.02. In the HD-HC study, the ICCs ranged from 0.0004 to 0.003.

CONCLUSION

The two studies were successful in recruiting multiracial and multiethnic working-class participants. Researchers will find the estimates of the primary outcomes and their ICCs useful for planning future studies.

Factors associated with BMI, weight perceptions and trying to lose weight in African-American smokers

This study examined sociodemographic, behavioral and psychosocial factors associated with BMI, weight perceptions and trying to lose weight among African-American smokers (N=600, M=44.2 years, 70% female). Sixty-eight percent of the sample were overweight or obese (sample BMI M=28.0, SD=6.7). Three separate, simultaneous multivariable regression models were used to determine which factors were associated with BMI, weight perceptions and trying to lose weight. Poorer health, female gender and high-school education or higher were significantly associated with higher BMIs (p<0.05). Being female (OR=5.8, 95% CI=3.6-9.3) and having a higher BMI (OR=0.6, 95% CI=0.5-0.6) was associated with perception of overweight and smoking more cigarettes per day (OR=1.0, 95% CI=1.0-1.1), and perceiving oneself as overweight (OR=14.1, 95% CI=8.2-24.2) was associated with trying to lose weight. Participants somewhat underestimated their BMI in their weight perceptions. Those who perceived themselves as overweight were more likely to be trying to lose weight; therefore, increasing participant awareness of actual BMI status may lead to improved weight-control efforts in African-American smokers. Several expected associations with outcomes were not found, suggesting that BMI and weight constructs are not well-understood in this population.

Diet and physical activity behavior among users of prescription weight loss medications

BACKGROUND: There is limited population-based data on diet and physical activity behaviors and weight loss among users of prescription weight loss medications. Most findings are from clinical settings or from research that includes organized behavioral programs. METHODS: We analyzed data from the 1998 Behavioral Risk Factor Surveillance System, an annual telephone survey conducted in all fifty states, the District of Columbia and Puerto Rico. The sample consisted of 135,435 noninstitutionalized adults aged 18 years old and older. We determined the prevalence and odds of prescription weight loss medication use, odds of 10% weight loss, and among current weight loss medication users, the prevalence and odds for diet and physical activity behaviors. RESULTS: 10.2% of obese women and 3.1% of obese men reported using prescription weight loss medications in the past 2 years. Of users, 28.2% had lost at least 10% of their pretreatment body weight. The odds of losing at least this much weight were higher among women, those who usually consumed >/= 5 fruits and vegetables daily and those who met physical activity recommendations. Among current prescription weight loss medication users, 26.7% reported both eating fewer calories and meeting recommended leisure-time physical activity levels (<40% of any group met both). Of those meeting both recommendations, almost half (47.2%) had lost 10% of their pretreatment body weight. Of current users, 9% reported using the medications for weight maintenance. CONCLUSIONS: Only 26.7% of prescription weight loss medication users reported following recommended diet and physical activity behaviors. Further research is needed to assess whether behavioral changes are associated with greater weight loss and maintenance among prescription weight loss medication users.

Estimates of fruit and vegetable intake in childhood and adult dietary behaviors of African American women

OBJECTIVE

This exploratory study examined how estimates of one's fruit and vegetable intake in childhood are related to 3 current dietary behaviors among African American women: intake of fruits and vegetables, exposure to and preference for fruits and vegetables, and preference for trying new foods.

DESIGN

Baseline data from a randomized dietary intervention trial.

SETTING

Ten urban public health centers in St. Louis, Missouri.

PARTICIPANTS

1227 African American women.

VARIABLES MEASURED

A 33-item fruit and vegetable food frequency questionnaire, items measuring estimates of childhood fruit and vegetable intake, adult fruit and vegetable intake, exposure to and preference for fruit and vegetable, and preference for trying new foods.

ANALYSIS

Linear regression evaluated the association between predictors and continuous measures; logistic regression determined the association between predictors and categorical measures.

RESULTS

Estimates of one's vegetable intake as a child were significantly related to exposure and preference for both fruits and vegetables, trying of new foods, and intake of both fruits and vegetables in adulthood. Estimates of eating fruit as a child were not significantly associated with these adult dietary behaviors.

CONCLUSIONS AND IMPLICATIONS

Developmental influences on adult dietary patterns may be stronger for vegetables than fruits among African American women. Additional emphasis is needed regarding exposure to and preference for vegetable intake in childhood.

Final results of the Maryland WIC Food for Life Program

BACKGROUND

The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland.

METHODS

We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm.

RESULTS

Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes.

CONCLUSIONS

Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.

Review of evaluation tools used to assess the impact of nutrition education on dietary intake and quality, weight management practices, and physical activity of low-income audiences

Nutrition education programs and social marketing campaigns frequently focus on low-income audiences with the goal of improving dietary intake and quality, weight management practices, and physical activity. The impact of nutrition education can be assessed by measuring change in relation to any or all of these broad variables. Unfortunately, little information is available concerning the reliability, validity, and sensitivity to change of measures used to assess these constructs with low-income audiences of adults and adolescents. This article reviews the literature and discusses the types of available measures that have been used and evaluated for the above audiences. It describes specific measures used to assess total diet, consumption of food groups from the Food Guide Pyramid, and behaviors related to weight management and physical activity. Overall, this review suggests that there is a critical need for additional development and evaluation of dietary quality measurement tools for low-income and minority audiences.

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS)

BACKGROUND

This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents.

METHODS

BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each student's area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances.

RESULTS

Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship.

CONCLUSIONS

This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.

Sex differences in fruit and vegetable intake in older adults

Fruits and vegetables are important components of a healthy diet, but intakes in most Western countries are well below the recommended five servings a day. Men in particular are eating too little. The aim of this study is to understand the processes underlying this gender difference. Fruit and vegetable intake, nutrition knowledge, taste preferences, attitudes to fruit and vegetable intake, and dieting status, were assessed in a simple questionnaire in 1,024 older adults attending population-based cancer screening across the UK. The results confirmed the pattern of men consuming fewer servings of fruit and vegetables daily than women (2.52 vs 3.47; p<0.01). Fewer men than women knew the current recommendations for fruit and vegetable intake, and fewer were aware of the links between fruit and vegetable consumption and disease prevention. Women rated their liking for vegetables but not fruit higher, and there were no differences in attitudes. Men were less likely to be dieting to lose weight. Multivariate analysis showed that the gender difference in intake was substantially attenuated by controlling for nutrition knowledge. There were no significant attenuating effects of preferences, attitudes or dieting status. These results indicate that men's poorer nutrition knowledge explains a significant part of their lower intake of fruit and vegetables.

The role of energy density

Dietary energy density (ED) appears to have a major influence on the regulation of food intake and body weight. If people consume a fixed weight of food each day, then high-ED diets should be associated with high energy intakes and with overweight. In contrast, low-ED diets should result in lower daily energy intakes and therefore weight loss. For this approach to work, low-ED foods must be as palatable as high-ED foods and, calorie for calorie, have a greater satiating power. Each of those assumptions is debatable. Dietary ED depends chiefly on the water content of foods. As a rule, high-ED foods are more palatable but less satiating, whereas low-ED foods are more satiating but less palatable. Consumer preferences for high-ED foods can be explained in terms of good taste, low cost, and convenience. Low-ED foods, such as fresh produce, provide less energy per unit cost than do high-ED foods, which often contain added sugars and fats. Poverty and obesity may well be linked through the habitual consumption of a low-cost, high-ED diet.

Fruit and vegetable assessment: performance of 2 new short instruments and a food frequency questionnaire

OBJECTIVE

To evaluate the ability of 2 new short assessment instruments and a food frequency questionnaire (FFQ) to measure intake of fruit and vegetables. The "All-Day" screener asks frequency and portion size questions about 9 food items. The "By-Meal" screener is similar, except that it asks about 2 of those 9 food items in terms of mealtime.

DESIGN

Survey participants completed 4 telephone-administered 24-hour dietary recalls over 1 year, a self-administered FFQ 1 to 2 months later, and 1 of 2 self-administered screeners after an additional 7 months.

SUBJECTS/SETTING

Participating were 202 men and 260 women aged 20 to 70 years living throughout the United States.

STATISTICAL ANALYSES

Fruit and vegetable intakes measured by each screener and the FFQ were compared with true usual intake based on a measurement error model with 24-hour dietary recalls as the reference instrument.

RESULTS

Estimates of median daily servings of fruit and vegetables were as follows: For men: True intake (5.8) vs All-Day screener (5.0), By-Meal screener (5.5), and FFQ (6.6); for women: true intake (4.2) vs All-Day screener (5.0), By-Meal screener (5.4), and FFQ (6.2). Estimated correlations between the test instruments and true intake were as follows: For men: All-Day screener (0.66), By-Meal screener (0.67), FFQ (0.68); for women: All-Day screener (0.51), By-Meal screener (0.53), and FFQ (0.54).

APPLICATIONS/CONCLUSIONS

Both screeners might be useful to estimate median intakes of fruit and vegetable servings in US populations, but they might be less useful in accurately ranking individuals. More research is needed before using the screeners in ethnic or low-literacy populations.

Self-efficacy, perceived benefits, and weight satisfaction discriminate among stages of change for fruit and vegetable intakes for young men and women

This study determined whether psychosocial, weight satisfaction, and dietary pattern variables discriminate between the Stages of Change for fruit and vegetable intakes among young men and women. A random sample of 18 to 24 year-olds, from 10 states returned 1438 surveys. Discriminant analyses for fruit intake conveyed that between precontemplation and contemplation/preparation, pro-scores and self-efficacy predicted the men's but not women's stages. Between contemplation/preparation and action/maintenance, self-efficacy and breakfast consumption best predicted stage for women, whereas men were discriminated only by self-efficacy. Discriminant analyses for vegetable intake were similar by gender. Precontemplation and contemplation/preparation were discriminated by pro-score and staging into contemplation/preparation versus action/maintenance was best predicted by self-efficacy and weight satisfaction. Young men and women are at different places in the Stages of Change process and few are meeting the vegetable guidelines. Dietary interventions can be most effective if specifically tailored to food group, stage, and gender.

Quality of diets consumed by older rural adults

Older adults residing in rural communities are at risk for low dietary quality because of a variety of social, physical and environmental circumstances. Minority elders are at additional risk because of poorer health status and lower socioeconomic status. This study evaluated the food group intake of 130 older (>70 years) African American (34%), European American (36%), and Native American (30%) residents of two rural communities in central North Carolina. An interviewer-administered food frequency questionnaire was used to measure dietary intake. Food items were classified into food groups similar to the United States Department of Agriculture (USDA) Food Guide Pyramid and the National Cancer Institutes 5 A Day for Better Health program. None of the survey participants met minimum intake recommendations and most over-consumed fats, oils, sweets and snacks. African Americans and Native Americans consumed fewer servings of meats,fruits and vegetables, and fats, oils, sweets and snacks than European Americans. African American men consumed the fewest servings of fruits and vegetables of all gender/ethnic groups. Consumption of fats, oils and sweets was greatest among those 85 years and older and was more common among denture users. National strategies to educate the public about the importance of consuming a varied diet based on the recommendations presented in national nutrition education campaigns may not be reaching older adults in rural communities, particularly minority group members.

Personal and professional nutrition-related practices of US female physicians

BACKGROUND

The extent to which female physicians personally and clinically adhere to dietary recommendations is unknown and has implications for patients.

OBJECTIVES

We aimed to identify US female physicians' personal and professional nutrition- and weight-related habits and to identify which, if any, of their personal habits predicted their clinical practices.

DESIGN

Our sample included the 4501 respondents to the Women Physicians' Health Study, a large, cross-sectional, questionnaire-based study of the health behaviors and counseling practices of US female physicians.

RESULTS

Forty-three percent of physicians performed nutrition counseling, and 50% performed weight counseling with patients at least yearly. Forty-six percent thought that discussing nutrition was highly relevant to their practices, 47% thought the same about discussing weight, and 21% stated that they had received extensive related training. Primary care physicians, obstetricians-gynecologists, pediatricians, vegetarians, and those with a personal history of obesity were more likely to provide nutrition and weight counseling to patients. Female physicians report regularly performing more nutrition and weight counseling than they do most other types of prevention-related counseling. Female physicians report relatively healthy diet-related habits, and these personal habits are related to their likelihood to counsel their patients about nutrition and weight.

CONCLUSIONS

Nutrition and weight-related issues are important to female physicians in both their personal and professional lives, and these 2 spheres influence each other.

The importance of decisional balance and self-efficacy in relation to stages of change for fruit and vegetable intakes by young adults

PURPOSE

To examine the stages of change, decisional balance, and self-efficacy constructs in relation to fruit and vegetable intakes by young adults 18-24 years old.

DESIGN

A cross-sectional project was conducted by 10 states in January-July 2000 to examine decisional balance and self-efficacy in relation to stage of change for increasing fruit and vegetable intake among young adults.

SUBJECTS

In all, 1545 usable surveys were returned (response rate = 55%). More non-respondents were men and precontemplators than respondents. Sixty-one percent of respondents were women, 90.3% were white, and 49.7% were current students.

SETTING

Alabama, Kansas, Maine, Michigan, Nebraska, New York, Rhode Island, Oregon, South Dakota, and Wisconsin.

MEASURES

A telephone screening interview and a self-administered mail survey.

ANALYSIS

Analysis of variance, principal components analysis, cluster analysis, and chi 2 test.

RESULTS

From precontemplation to maintenance, a significant linear trend was found toward higher food intake and self-efficacy for fruits and vegetables. The patterns of shifts in the pros and cons across the stages resembled those of other health behaviors. The decisional balance items were further classified into five component factors that varied significantly in importance across the stages. Four subject clusters were derived (unconcerned, reluctant, exploring, and action-oriented); distribution of the clusters agreed with that of the five stages.

CONCLUSIONS

This study supports applicability of the Transtheoretical Model for assessing fruit and vegetable consumption by young adults. Derivation of the four clusters implies the importance of including decisional balance and self-efficacy as outcome measures besides dietary behavior for evaluating the effectiveness of nutrition interventions.

Consumption of fruits, vegetables, soft drinks, and high-fat-containing snacks among Mexican children on the Mexico-U.S. border

BACKGROUND

The recommended diet for children would promote health, support growth, and prevent risk of disease. Diets high in fruits and vegetables demonstrate a strong and consistent pattern for decreasing the risk for many cancers and providing benefits against cardiovascular disease, diabetes, obesity, and stroke. The purpose of this study was to assess fruit, vegetable, soft drink, and high-fat-containing snack consumption among fifth- and ninth-grade children attending public schools in the northeastern Mexican state of Baja California.

METHODS

A randomized design was used to select 20 schools with fifth-grade students and 20 schools with ninth-grade students in each of the five Baja California counties. A randomized sample of 20 classes of fifth- and ninth-grade students was then selected. The food frequency questionnaire used contained 36 items. Foods were grouped in the five main food categories, plus soft drinks, sweets, and high-fat-containing snacks. Means, standard deviations (SDs), and frequencies were calculated using SPSS, while chi square was employed to test the association between food consumption and selected variables.

RESULTS

Mean daily intake of fruits was 1.5 by children from both grades, while daily mean intake of vegetables was 2.5 for fifth-grade students. The percentage of children with intakes lower than the standard (Apple of Health) was 77 and 80% for fifth and ninth graders for fruits and 62 and 53% for vegetables, respectively. At least 92% of fifth graders reported consuming one soft drink, and 85% consumed one portion of high-fat-containing snacks daily.

CONCLUSIONS

Our results demonstrated overall low intake of fruits and vegetables and excessive consumption of soft drinks and high-fat-containing snacks, leading to the possibility of costly health complications later in life.

Measuring stage of change for assessing readiness to increase fruit and vegetable intake among 18- to 24-year-olds

PURPOSE

To examine the appropriateness of the five-stage schema developed for addictive behaviors when applied to nonaddictive behaviors such as fruit and vegetable consumption.

DESIGN

A cross-sectional mail survey was conducted.

SETTING

Self-administered questionnaires were mailed to the home addresses of respondents recruited in 10 states and returned upon completion.

SUBJECTS

In all, 116 male and 185 female young adults (response rate = 70%) completed the questionnaires. Most respondents were Caucasian (74.4%) and college students (62.2%).

MEASURES

Statistical analyses included analysis of variance with Scheffe's test, Pearson correlation and Cronbach's alpha coefficients, factor analysis, and cluster analysis.

RESULTS

Staging algorithms for fruits and vegetables were developed according to the five-stage schema, and their construct validity was verified by the incremental trend of food intakes. The algorithms identified more than 80% of the subjects as precontemplators, preparers, or maintainers for both food groups. This distribution pattern agreed well with the three-factor solution generated from the stages of change questionnaire, for which internal reliability and validity were confirmed. Seven cluster profiles of the respondents were derived based on the three generated factors and appeared to represent stage subgroupings of those factors. The two food groups shared marked similarities regarding the profiling of the clusters, which was validated by comparing food intake. The results, however, cannot be generalized because of limitations involved in the current sample.

CONCLUSIONS

The original five stages of change and traditional staging measures may need to be adapted and/or extended for dietary change.

A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial

OBJECTIVES

This study reports on Eat for Life, a multicomponent intervention to increase fruit and vegetable consumption among African Americans that was delivered through Black churches.

METHODS

Fourteen churches were randomly assigned to 3 treatment conditions: (1) comparison, (2) self-help intervention with 1 telephone cue call, and (3) self-help with 1 cue call and 3 counseling calls. The telephone counseling in group 3 was based on motivational interviewing. The primary outcome, assessed at baseline and 1-year follow-up, was fruit and vegetable intake as assessed by 3 food frequency questionnaires.

RESULTS

Change in fruit and vegetable intake was significantly greater in the motivational interviewing group than in the comparison and self-help groups. The net difference between the motivational interviewing and comparison groups was 1.38, 1.03, and 1.21 servings of fruits and vegetables per day for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. The net difference between the motivational interviewing and self-help groups was 1.14, 1.10, and 0.97 servings for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively.

CONCLUSIONS

Motivational interviewing appears to be a promising strategy for modifying dietary behavior, and Black churches are an excellent setting to implement and evaluate health promotion programs.

Seattle 5 a Day worksite program to increase fruit and vegetable consumption

BACKGROUND

5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables. The Seattle 5 a Day worksite investigators designed and evaluated an intervention, organized on stages of behavioral change, to increase worksitewide fruit and vegetable consumption.

METHODS

We recruited 28 worksites with cafeterias and randomized 14 to intervention and 14 to control. The intervention addressed both changes in the work environment and individual level behavior change. In each worksite, an employee advisory board, with study interventionist assistance, implemented the program. By surveying cross-sectional samples of 125 employees per worksite, we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline. Unobtrusive site-level indicators including plate observation and cafeteria checklist were also used.

RESULTS

The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites, with an intervention effect of 0.3 daily serving (P < 0.05). Other measures of fruit and vegetable consumption, including unobtrusive indicators, supported the effectiveness of the intervention.

CONCLUSIONS

This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias. There was a significant differential increase in fruit and vegetable consumption in the intervention worksites. This kind of worksite intervention can achieve important health benefits on a population basis, because of its potential to reach large numbers of people.

Risk factor distribution among sociodemographically diverse African American adults

Because African Americans tend to have lower socioeconomic status (SES) than whites and numerous health indicators are related to SES variables, it is important when examining between-group differences in health indices to account for SES differences. This study examined the effects of income and education on several biologic and behavioral risk factors in a sample of sociodemographically diverse African American adults. Approximately 1,000 African American adults (aged 18-87) were recruited from 14 churches with predominantly black membership to participate in a nutrition education intervention. Demographics, height, weight, blood pressure, self-reported cigarette and alcohol use, self-reported diet by food frequency questionnaire, serum carotenoids, serum total cholesterol, and nutrition knowledge were assessed. The association of these risk factors were examined by four levels of education and income. For men, body mass index, blood pressure, total cholesterol, daily intake of fruits and vegetables, serum carotenoids, heavy alcohol use, or exercise were not associated significantly with income or education using analysis of variance (ANOVA). Past month alcohol use and nutrition knowledge were associated positively with education, but not income. For women, body mass index and smoking were associated inversely with income, but not with education. Blood pressure, total cholesterol, intake of fruits and vegetables, heavy alcohol use, and exercise were not associated with either income or education using ANOVA. Serum carotenoids, any 30-day alcohol use, and nutrition knowledge were associated positively with both income and education. Results using linear regression generally were similar for men and women, although a few more variables were associated significantly with SES compared to ANOVA analyses. Several health indicators that have been associated with socioeconomic variables in whites were not associated or only weakly associated in this diverse sample of African Americans. One interpretation of these findings is that SES factors may function differently among blacks and whites.

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.

Intake of vegetables rich in carotenoids and risk of coronary heart disease in men: The Physicians' Health Study

BACKGROUND

Previous studies of diet and coronary heart disease (CHD) have focused on intake of nutrients rather than whole foods. Because of the findings that dietary fibre, folate and antioxidants may be protective for CHD, increased intake of vegetables has been recommended. However, due to the chemical and physical complexity of vegetables, the effects of individual nutrients may differ if eaten as whole foods. Moreover, little is known about the direct association between vegetable intake and risk of CHD.

METHODS

We prospectively evaluated the relation between vegetable intake and CHD risk in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among 22 071 US male physicians aged 40-84 years in 1982. In this analysis, we included 15 220 men without heart disease, stroke or cancer at baseline who provided information on their vegetable intake at baseline, and in the 2nd, 4th and 6th years of follow-up using a simple semiquantitative food frequency questionnaire including eight vegetables. We confirmed 1148 incident cases of CHD (387 incident cases of myocardial infarction and 761 incident cases of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty) during 12 years of follow-up.

RESULTS

After adjusting for age, randomized treatment, body mass index (BMI), smoking, alcohol intake, physical activity, history of diabetes, history of hypertension, history of high cholesterol, and use of multivitamins, men who consumed at least 2.5 servings/day of vegetables had a relative risk (RR) of 0.77 (95% CI : 0.60-0.98) for CHD, compared with men in the lowest category (<1 serving/day). Adjusting for the same covariates in an analysis of the overall trend that considered intake of vegetables as a continuous variable, we found a RR of 0.83 (95% CI : 0.71-0.98) for risk of CHD for each additional serving/day of vegetables. The inverse relation between vegetable intake and CHD risk was more evident among men with a BMI > or =25 (RR = 0.71, 95% CI : 0.51-0.99) or current smokers (RR = 0.40, 95% CI : 0.18-0.86) comparing highest to the lowest categories of intake.

CONCLUSIONS

Our results suggest an inverse association between vegetable intake and risk of CHD. These prospective data support current dietary guidelines to increase vegetable intake for the prevention of CHD.