Children's fruit and vegetable intake : Associations with the neighbourhood food environment

Objective : To examine associations between availability of different types of food outlets and children's fruit and vegetable intake.
Method : Parents of 340 5–6 and 461 10–12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit ≥ 2 times/day and vegetables ≥ 3 times/day, according to access to food outlets.
Results : Overall, 62.5% of children ate fruit ≥ 2 times/day and 46.4% ate vegetables ≥ 3 times/day. The more fast food outlets (OR = 0.82, 95%CI = 0.67–0.99) and convenience stores (OR = 0.84, 95%CI = 0.73–0.98) close to home, the lower the likelihood of consuming fruit ≥ 2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables ≥ 3 times/day (OR = 0.84, 95%CI = 0.74–0.95). The likelihood of consuming vegetables ≥ 3 times/day was greater the farther children lived from a supermarket (OR = 1.27, 95%CI = 1.07–1.51) or a fast food outlet (OR = 1.19, 95%CI = 1.06–1.35).
Conclusion : Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.

Associations between fruit and vegetable intake, leisure-time physical activity, sitting time and self-rated health among older adults : cross-sectional data from the WELL study

Background
Lifestyle behaviours, such as healthy diet, physical activity and sedentary behaviour, are key elements of healthy ageing and important modifiable risk factors in the prevention of chronic diseases. Little is known about the relationship between these behaviours in older adults. The purpose of this study was to explore the relationship between fruit and vegetable (F&V) intake, leisure-time physical activity (LTPA) and sitting time (ST), and their association with self-rated health in older adults.

Methods
This cross-sectional study comprised 3,644 older adults (48% men) aged 55-65 years, who participated in the Wellbeing, Eating and Exercise for a Long Life ("WELL") study. Respondents completed a postal survey about their health and their eating and physical activity behaviours in 2010 (38% response rate). Spearman's coefficient (rho) was used to evaluate the relationship between F&V intake, LTPA and ST. Their individual and shared associations with self-rated health were examined using ordinal logistic regression models, stratified by sex and adjusted for confounders (BMI, smoking, long-term illness and socio-demographic characteristics).

Results
The correlations between F&V intake, LTPA and ST were low. F&V intake and LTPA were positively associated with self-rated health. Each additional serving of F&V or MET-hour of LTPA were associated with approximately 10% higher likelihood of reporting health as good or better among women and men. The association between ST and self-rated health was not significant in the multivariate analysis. A significant interaction was found (ST*F&V intake). The effect of F&V intake on self-rated health increased with increasing ST in women, whereas the effect decreased with increasing ST in men.

Conclusion
This study contributes to the scarce literature related to lifestyle behaviours and their association with health indicators among older adults. The findings suggest that a modest increase in F&V intake, or LTPA could have a marked effect on the health of older adults. Further research is needed to fully understand the correlates and determinants of lifestyle behaviours, particularly sitting time, in this age group.

Randomized controlled trial of a telephone-based intervention for child fruit and vegetable intake: long-term follow-up

Telephone-based interventions can be effective in increasing child fruit and vegetable intake in the short term (<6 mo). The long-term efficacy of such interventions, however, is unknown.

Fruit and vegetable consumption and stroke : meta-analysis of cohort studies

Background
Increased consumption of fruit and vegetables has been shown to be associated with a reduced risk of stroke in most epidemiological studies, although the extent of the association is uncertain. We quantitatively assessed the relation between fruit and vegetable intake and incidence of stroke in a meta-analysis of cohort studies.

Methods
We searched MEDLINE, EMBASE, the Cochrane Library, and bibliographies of retrieved articles. Studies were included if they reported relative risks and corresponding 95% CIs of stroke with respect to frequency of fruit and vegetable intake.

Findings
Eight studies, consisting of nine independent cohorts, met the inclusion criteria. These groups included 257 551 individuals (4917 stroke events) with an average follow-up of 13 years. Compared with individuals who had less than three servings of fruit and vegetables per day, the pooled relative risk of stroke was 0·89 (95% CI 0·83–0·97) for those with three to five servings per day, and 0·74 (0·69–0·79) for those with more than five servings per day. Subgroup analyses showed that fruit and vegetables had a significant protective effect on both ischaemic and haemorrhagic stroke.

Interpretation
Increased fruit and vegetable intake in the range commonly consumed is associated with a reduced risk of stroke. Our results provide strong support for the recommendations to consume more than five servings of fruit and vegetables per day, which is likely to cause a major reduction in strokes.

Health professionals' and dietetics practitioners' perceived effectiveness of fruit and vegetable parenting practices across six countries

Fruit and vegetable intake may reduce the risk of some chronic diseases. However, many children consume less-than-recommended amounts of fruit and vegetables. Because health professionals and dietetics practitioners often work with parents to increase children's fruit and vegetable intake, assessing their opinions about the effectiveness of parenting practices is an important step in understanding how to promote fruit and vegetable intake among preschool-aged children. Using a cross-sectional design, collaborators from six countries distributed an Internet survey to health and nutrition organization members. A self-selected sample reported their perceptions of the effectiveness of 39 parenting practices intended to promote fruit and vegetable consumption in preschool-aged children from May 18, 2008, to September 16, 2008. A total of 889 participants (55% United States, 22.6% Mexico, 10.9% Australia, 4.4% Spain, 3.3% Chile, 2.2% United Kingdom, and 1.6% other countries) completed the survey. The fruit and vegetable intake–related parenting practices items were categorized into three dimensions (structure, responsiveness, and control) based on a parenting theory conceptual framework and dichotomized as effective/ineffective based on professional perceptions. The theoretically derived factor structures for effective and ineffective parenting practices were evaluated using separate confirmatory factor analyses and demonstrated acceptable fit. Fruit and vegetable intake–related parenting practices that provide external control were perceived as ineffective or counterproductive, whereas fruit and vegetable intake–related parenting practices that provided structure, nondirective control, and were responsive were perceived as effective in getting preschool-aged children to consume fruit and vegetables. Future research needs to develop and validate a parent-reported measure of these fruit and vegetable intake–related parenting practices and to empirically evaluate the effect of parental use of the parenting practices on child fruit and vegetable consumption.

Does the choice of neighbourhood supermarket access measure influence associations with individual-level fruit and vegetable consumption? A case study from Glasgow

Background
Previous studies have provided mixed evidence with regards to associations between food store access and dietary outcomes. This study examines the most commonly applied measures of locational access to assess whether associations between supermarket access and fruit and vegetable consumption are affected by the choice of access measure and scale.

Method
Supermarket location data from Glasgow, UK (n = 119), and fruit and vegetable intake data from the 'Health and Well-Being' Survey (n = 1041) were used to compare various measures of locational access. These exposure variables included proximity estimates (with different points-of-origin used to vary levels of aggregation) and density measures using three approaches (Euclidean and road network buffers and Kernel density estimation) at distances ranging from 0.4 km to 5 km. Further analysis was conducted to assess the impact of using smaller buffer sizes for individuals who did not own a car. Associations between these multiple access measures and fruit and vegetable consumption were estimated using linear regression models.

Results
Levels of spatial aggregation did not impact on the proximity estimates. Counts of supermarkets within Euclidean buffers were associated with fruit and vegetable consumption at 1 km, 2 km and 3 km, and for our road network buffers at 2 km, 3 km, and 4 km. Kernel density estimates provided the strongest associations and were significant at a distance of 2 km, 3 km, 4 km and 5 km. Presence of a supermarket within 0.4 km of road network distance from where people lived was positively associated with fruit consumption amongst those without a car (coef. 0.657; s.e. 0.247; p0.008).

Conclusions
The associations between locational access to supermarkets and individual-level dietary behaviour are sensitive to the method by which the food environment variable is captured. Care needs to be taken to ensure robust and conceptually appropriate measures of access are used and these should be grounded in a clear a priori reasoning.

Perceptions of fruit and vegetable dietary guidelines among Australian young adults

Aim:  Regular consumption of fruit and vegetables has been associated with a decreased risk of a number of chronic diseases. An appropriate level of knowledge is important to successfully adhere to the dietary guidelines for eating fruit and vegetables. However, there is little research about the level of knowledge that young adults have about fruit and vegetable consumption. The current study aimed to investigate the recall and understanding of Australian dietary guidelines, food product and serving size knowledge in a population of young adults. Methods:  One hundred and six undergraduate students completed online questionnaires regarding (1) knowledge of dietary recommendations; (2) knowledge of serving size information; and (3) foods that could be included as part of fruit and vegetable intake. Results:  The results showed that the sample had significant knowledge gaps in all three areas. Approximately half (54%) of participants correctly reported the recommended daily intake of fruit and vegetables, the majority were not able to correctly report serving sizes (correct responses were 30–61%) and were not able to identify all ingredients from a recipe that counted towards fruit and vegetable intake. Conclusions:  Past interventions have not tended to focus on the fruit and vegetable knowledge, or behaviours, of Australian young adults. On the basis of findings from this study, it appears that more work is needed to develop messages to effectively target this important group.

Associations between fruit and vegetable consumption and depressive symptoms: evidence from a national Canadian longitudinal survey

BACKGROUND: Several cross-sectional studies have demonstrated associations between diet quality, including fruit and vegetable consumption, and mental health. However, research examining these associations longitudinally, while accounting for related lifestyle factors (eg, smoking, physical activity) is scarce. METHODS: This study used data from the National Population Health Survey (NPHS), a large, national longitudinal survey of Canadians. The sample included 8353 participants aged 18 and older. Every 2 years from 2002/2003 to 2010/2011, participants completed self-reports of daily fruit and vegetable consumption, physical activity, smoking and symptoms of depression and psychological distress. Using generalised estimating equations, we modelled the associations between fruit and vegetable consumption at each timepoint and depression at the next timepoint, adjusting for relevant covariates. RESULTS: Fruit and vegetable consumption at each cycle was inversely associated with next-cycle depression (β=-0.03, 95% CI -0.05 to -0.01, p<0.01) and psychological distress (β=-0.03, 95% CI -0.05 to -0.02, p<0.0001). However, once models were adjusted for other health-related factors, these associations were attenuated (β=-0.01, 95% CI -0.04 to 0.02, p=0.55; β=-0.00, 95% CI -0.03 to 0.02, p=0.78 for models predicting depression and distress, respectively). CONCLUSIONS: These findings suggest that relations between fruit and vegetable intake, other health-related behaviours and depression are complex. Behaviours such as smoking and physical activity may have a more important impact on depression than fruit and vegetable intake. Randomised control trials of diet are necessary to disentangle the effects of multiple health behaviours on mental health.

Family correlates of fruit and vegetable consumption in children and adolescents : a systematic review

Objectives To review associations between the family environment and young people’s fruit and vegetable consumption.

Design A systematic review. Published English-language (n 60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6–11 years) and/or adolescents (aged 12–18 years) and at least one potential family correlate of dietary intake was included.

Results Parental modelling and parental intake were consistently and positively associated with children’s fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children’s fruit and vegetable consumption. Parental intake was positively associated with adolescents’ fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents’ FJV consumption.

Conclusions Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating.

Fruit and vegetable consumption and the risk of proximal colon, distal colon and rectal cancers in a case-control study in Western Australia

Background Fruits and vegetables (F/V) have been examined extensively in nutrition research in relation to colorectal cancer (CRC). However, their protective effect is subject to debate, possibly because of different effects on different subsites of the large bowel.

Objective To determine whether any association between F/V consumption and risk of CRC differed by subsite of the bowel (proximal colon, distal colon, and rectum).

Design The Western Australian Bowel Health Study is a population-based, case-control study conducted between June 2005 and August 2007. Complete food frequency questionnaire data were analysed from 834 CRC cases and 939 controls. Logistic regression analysis was used to estimate the effects of quartiles of F/V intake on risk of CRC at different subsites. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for CRC overall and for the three separate subsites.

Results Risk of proximal colon cancer and rectal cancer was not associated with intakes of total F/V, total vegetable, or total fruit. Brassica vegetable intake was inversely related with proximal colon cancer (Q4 vs Q1 OR 0.62; 95% CI 0.41 to 0.93). For distal colon cancer, significant negative trends were seen for total F/V, and total vegetable intake. Distal colon cancer risk was significantly decreased for intake of dark yellow vegetables (Q4 vs Q1 OR 0.61; 95% CI 0.41 to 0.92) and apples (Q4 vs Q1 OR 0.51; 95% CI 0.34 to 0.77). An increased risk for CRC was found to be associated with intake of fruit juice (Q4 vs Q1 OR 1.74; 95% CI 1.24 to 2.45).

Conclusions Our results suggest that different F/V may confer different risks for cancer of the proximal colon, distal colon, or rectum. Future studies might consider taking into account the location of the tumor when examining the relation between F/V consumption and risk of CRC.

Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison

BACKGROUND: Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US). METHODS: Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies. RESULTS: Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES. CONCLUSIONS: Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.

Improving availability, promotion and purchase of fruit and vegetable and non sugar-sweetened drink products at community sporting clubs: a randomised trial

BACKGROUND: Amateur sporting clubs represent an attractive setting for health promotion. This study assesses the impact of a multi-component intervention on the availability, promotion and purchase of fruit and vegetable and non sugar -sweetened drink products from community sporting club canteens. We also assessed the impact the intervention on sporting club revenue from the sale of food and beverages. METHOD: A repeat cross-sectional, parallel group, cluster randomized controlled trial was undertaken with amateur community football clubs in New South Wales, Australia. The intervention was conducted over 2.5 winter sporting seasons and sought to improve the availability and promotion of fruit and vegetables and non sugar-sweetened drinks in sporting club canteens. Trial outcomes were assessed via telephone surveys of sporting club representatives and members. RESULTS: Eighty five sporting clubs and 1143 club members participated in the study. Relative to the control group, at follow-up, clubs allocated to the intervention were significantly more likely to have fruit and vegetable products available at the club canteen (OR = 5.13; 95% CI 1.70-15.38), were more likely to promote fruit and vegetable selection using reduced pricing and meal deals (OR = 34.48; 95% CI 4.18-250.00) and members of intervention clubs were more likely to report purchase of fruit and vegetable (OR = 2.58 95% CI; 1.08-6.18) and non sugar -sweetened drink (OR = 1.56; 95% CI 1.09-2.25) products. There was no significant difference between groups in the annual club revenue from food and non-alcoholic beverage sales. CONCLUSION: The findings demonstrate that the intervention can improve the nutrition environment of sporting clubs and the purchasing behaviour of members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12609000224224 .