Portal de Periódicos da CAPES

Still Not EnoughCan We Achieve Our Goals for Americans to Eat More Fruits and Vegetables in the Future?

2007; Elsevier BV; Volume: 32; Issue: 4 Linguagem: Inglês

10.1016/j.amepre.2006.12.018

1873-2607

Linda Nebeling, Amy L. Yaroch, Jennifer Seymour, Joel Kimmons,

Consumer Attitudes and Food Labeling

Since 1990, Dietary Guidelines for Americans1U.S. Department of Health and Human ServicesU.S. Department of AgricultureDietary guidelines for Americans, 2005. 6th ed. U.S. Government Printing Office, Washington DC2005Google Scholar has recommended consuming at least two servings of fruits and three servings of vegetables daily. The 2005 release of the guidelines expanded the specificity of recommended intakes for individuals of different ages, genders, and levels of physical activity, increasing recommended fruit and vegetable intake for most of the population, and changed the recommendations to cups from servings. In this journal issue, two manuscripts provide estimates and describe trends in fruit and vegetable consumption in U.S. adults across a variety of race and demographic groups using National Health and Nutrition Examination Surveys (NHANES) data.2Kant A. Graubard B.I. Kumanyika S.K. Trends in black–white differentials in dietary intakes of U.S. adults, 1971–2002.Am J Prev Med. 2007; 32: 265-274Abstract Full Text Full Text PDF Scopus (114) Google Scholar, 3Casagrande S.S. Wang Y. Anderson C. Gary T.L. Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002.Am J Prev Med. 2007; 32: 257-264Abstract Full Text Full Text PDF PubMed Scopus (303) Google Scholar Their findings are similar to previous findings4Guenther P.M. Dodd K.W. Reedy J. Krebs-Smith S.M. Most Americans eat much less than recommended amounts of fruits and vegetables.J Am Diet Assoc. 2006; 106: 1371-1379Abstract Full Text Full Text PDF PubMed Scopus (484) Google Scholar, 5Patterson B.H. Block G. Rosenberger W.F. Pee D. Kahle L.L. Fruit and vegetables in the American diet: data from the NHANES II survey.Am J Public Health. 1990; 80: 1443-1449Crossref PubMed Scopus (234) Google Scholar and report that over time, the majority of U.S. adults continue to consume fewer than five servings of fruits and vegetables daily. This is a public health concern because consuming a diet high in fruits and vegetables is associated with a decreased risk of certain chronic diseases, such as cardiovascular disease, diabetes, and some cancers.6IARC Handbooks of Cancer Prevention.in: Fruits and vegetables. vol. 8. IARC Press, Lyon, France2003Google Scholar, 7Hung H.C. Joshipura K.J. Jiang R. et al.Fruit and vegetable intake and risk of major chronic disease.J Natl Cancer Inst. 2004; 96: 1577-1584Crossref PubMed Scopus (983) Google Scholar The NHANES I (1971–1975), II (1976–1980), III (1988–1994), and 1999–2002 are cross-sectional nationally representative surveys of the U.S. civilian, noninstitutionalized population that employ a complex, stratified, multistage probability cluster sampling design.8Centers for Disease Control and Prevention, National Center for Health Statistics. National health and nutrition examination survey. Hyattsville MD. Available at: www.cdc.gov/nchs/nhanes.htm.Google Scholar Dietary intake information is collected by a trained interviewer using a single 24-hour dietary recall. NHANES incorporates the most comprehensive approach for national dietary surveillance within the United States. These data are critical in their ability to track national dietary consumption patterns, as well as to provide key evidence to help form research directions aimed at improving dietary intake behaviors. Although other surveys exist for collecting national estimates of fruit and vegetable intake, NHANES is considered the most valid, because it uses a 24-hour dietary recall, considered the gold standard self-report, rather than a short fruit and vegetable screener. Previous behavioral intervention research has focused on increasing fruit and vegetable intake mostly through increasing knowledge and skills at the individual level with some environmental or policy components. Ammerman and colleagues9Ammerman A.S. Lindquist C.H. Lohr K.N. Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence.Prev Med. 2002; 35: 25-41Crossref PubMed Scopus (358) Google Scholar found an average increase in fruit and vegetable consumption of 0.6 serving per day in an evidence-based review of the literature. Multicomponent school food environment interventions directed toward youth have been more successful increasing fruit consumption (0.2–0.6 servings daily) than vegetable consumption (0–0.3 servings daily).10French S.A. Stables G.J. Environmental interventions to promote vegetable and fruit consumption among youth in school settings.Prev Med. 2004; 36: 593-610Google Scholar Specifically with regard to particular settings, faith-based programs have had some success, as demonstrated by the original Black Churches United for Better Health11Campbell M.K. Demark-Wahnefried W. Symons M. et al.Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health Project.Am J Public Health. 1999; 89: 1390-1396Crossref PubMed Scopus (300) Google Scholar and Eat for Life12Resnicow K. Jackson A. Wang T. et al.A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial.Am J Public Health. 2001; 91: 1686-1693Crossref PubMed Scopus (394) Google Scholar interventions. These programs were merged into the Body and Soul Program that in an effectiveness trial showed up to a 1.4 serving difference in the change in fruit and vegetable consumption between treatment and control groups.13Resnicow K. Campbell M.K. Carr C. et al.Body and soul: a dietary intervention conducted through African-American churches.Am J Prev Med. 2004; 27: 97-105Abstract Full Text Full Text PDF PubMed Scopus (276) Google Scholar This successful program continues to be disseminated by the National Cancer Institute, African-American churches, and their partners across the United States.14National Cancer Institute, National Institutes of Health. Body and soul: a celebration of healthy eating and living. Available at: http://www.bodyandsoul.nih.gov/.Google Scholar More recent policy approaches such as the United States Department of Agriculture (USDA) Fruit and Vegetable Pilot Program15Buzby JC, Guthrie JF, Kantor LS. Evaluation of the USDA Fruit and Vegetable Pilot Program: report to Congress. Food Assistance and Nutrition Research Program, Food and Rural Economics Division, Economic Research Center, United States Department of Agriculture. Available at: http://www.fns.usda.gov/cnd/research/fv030063.pdf.Google Scholar hold promise for increasing fruit and vegetable consumption. The original project, to provide free fruits and vegetables to schoolchildren, was implemented in schools in four states and one Indian Tribal Organization (ITO). This project was made permanent in 2004 and in 2006 was expanded to 13 states and three ITOs. Increases in public awareness of the importance of and recommendations for fruit and vegetable consumption16Potter J.D. Finnegan J.R. Guinard J.-X. et al.5-A-Day for Better Health Program evaluation report (NIH Publication No. 01-4904). National Institutes of Health, National Cancer Institute, Bethesda MD2000Google Scholar, 17Stables G. Subar A.F. Patterson B.H. et al.Changes in fruit and vegetable consumption and awareness among U.S. adults: results of the 1991 and 1997 5-A-Day for better health program surveys.J Am Diet Assoc. 2002; 102: 809-817Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar are yet to be accompanied by increased intake, demonstrating the need for a reinvigorated effort to promote fruit and vegetable consumption. On March 19, 2007, "Fruits & Veggies—More Matters" will be launched.18National Fruit and Vegetable Program. "Fruits & Veggies—More Matters." Available at: http://www.fruitsandveggiesmatter.gov and http://www.fruitsandveggiesmorematters.org.Google Scholar This effort will build on the strong public–private partnership begun in 1991 by the 5-A-Day for Better Health Program. This program previously incorporated nutrition education and social marketing strategies to raise awareness of recommendations for fruit and vegetable consumption and sought to increase intake as well.19National Cancer Institute, National Institutes of Health5-A-Day for Better Health Program monograph (NIH Publication 01-5019). 2001Google Scholar Future research should evaluate which strategies are most effective for increasing fruit and vegetable consumption, with attention focused on environmental and policy activities that complement existing traditional education and communication strategies. Innovative programs to increase fruit and vegetable consumption such as community gardens, farmers markets, school gardens, farm-to-school, salad bars, policies for food provided at meetings, and access to supermarkets in low-income communities need to be evaluated to find best practices. A new call-to-action—such as "Fruits & Veggies—More Matters," in combination with continued research at multiple levels as described above—is needed to first affect behavior and then help enable sustainable change. No financial conflict of interest was reported by the authors of this paper.