American Journal of Preventive Medicine
Volume 32, Issue 4 , Pages 354-355, April 2007

Still Not Enough:

Can We Achieve Our Goals for Americans to Eat More Fruits and Vegetables in the Future?

  • Linda Nebeling, PhD, MPH, RD, FADA

      Affiliations

    • Health Promotion Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
    • Corresponding Author InformationAddress correspondence and reprint requests to: Linda Nebeling, PhD, MPH, RD, FADA, Health Promotion Research Branch, National Cancer Institute, 6130 Executive Boulevard, EPN 4060, Bethesda MD 20892-7326.
    • ,
  • Amy L. Yaroch, PhD

      Affiliations

    • Health Promotion Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
    • ,
  • Jennifer D. Seymour, PhD

      Affiliations

    • Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia
    • ,
  • Joel Kimmons, PhD

      Affiliations

    • Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia

Article Outline

 

Since 1990, Dietary Guidelines for Americans1 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.2, 3 Their findings are similar to previous findings4, 5 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.6, 7

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.8 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 colleagues9 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).10 Specifically with regard to particular settings, faith-based programs have had some success, as demonstrated by the original Black Churches United for Better Health11 and Eat for Life12 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.13 This successful program continues to be disseminated by the National Cancer Institute, African-American churches, and their partners across the United States.14 More recent policy approaches such as the United States Department of Agriculture (USDA) Fruit and Vegetable Pilot Program15 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 consumption16, 17 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.18 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.19

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.

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No financial conflict of interest was reported by the authors of this paper.

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References 

  1. U.S. Department of Health and Human ServicesU.S. Department of Agriculture. Dietary guidelines for Americans, 2005. 6th ed.. Washington DC: U.S. Government Printing Office; 2005;January
  2. Kant A, Graubard BI, Kumanyika SK. Trends in black–white differentials in dietary intakes of U.S. adults, 1971–2002. Am J Prev Med. 2007;32:265–274
  3. Casagrande SS, Wang Y, Anderson C, Gary TL. Have Americans increased their fruit and vegetable intake? (The trends between 1988 and 2002). Am J Prev Med. 2007;32:257–264
  4. Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM. Most Americans eat much less than recommended amounts of fruits and vegetables. J Am Diet Assoc. 2006;106:1371–1379
  5. Patterson BH, Block G, Rosenberger WF, Pee D, Kahle LL. Fruit and vegetables in the American diet: data from the NHANES II survey. Am J Public Health. 1990;80:1443–1449
  6. IARC Handbooks of Cancer Prevention. In: Fruits and vegetables. vol. 8:Lyon, France: IARC Press; 2003;
  7. Hung HC, Joshipura KJ, Jiang R, et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst. 2004;96:1577–1584
  8. Centers 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.
  9. Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med. 2002;35:25–41
  10. French SA, Stables GJ. Environmental interventions to promote vegetable and fruit consumption among youth in school settings. Prev Med. 2004;36(6 part 1):593–610
  11. Campbell MK, 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;89:1390–1396
  12. Resnicow 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;91:1686–1693
  13. Resnicow K, Campbell MK, Carr C, et al. Body and soul: a dietary intervention conducted through African-American churches. Am J Prev Med. 2004;27:97–105
  14. National Cancer Institute, National Institutes of Health. Body and soul: a celebration of healthy eating and living. Available at: http://www.bodyandsoul.nih.gov/.
  15. Buzby 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.
  16. Potter JD, Finnegan JR, Guinard J-X, et al. 5-A-Day for Better Health Program evaluation report (NIH Publication No. 01-4904). Bethesda MD: National Institutes of Health, National Cancer Institute; 2000;November
  17. Stables G, Subar AF, Patterson BH, 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;102:809–817
  18. National Fruit and Vegetable Program. “Fruits & Veggies—More Matters.” Available at: http://www.fruitsandveggiesmatter.gov and http://www.fruitsandveggiesmorematters.org.
  19. National Cancer Institute, National Institutes of Health. 5-A-Day for Better Health Program monograph (NIH Publication 01-5019). 2001;Bethesda MD: Author; September

 The full text of this aricle is available via AJPM Online at www.ajpm-online.net.

PII: S0749-3797(06)00568-X

doi:10.1016/j.amepre.2006.12.018

American Journal of Preventive Medicine
Volume 32, Issue 4 , Pages 354-355, April 2007

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