lecture 4-Fruit and vegetable intake

Question 1

what are the health benefits of High intakes of fruits and vegetables (WHO, 1990)

Answer 1

1. Cardiovascular disease
2. Certain cancers, e.g. bowel cancers
3. Type II diabetes
4. Osteoporosis
5. Obesity
6. Dementia and Alzheimer’s disease

Question 2

what are the current recommendations for fruit and veg intake? (WHO, 1990)

Answer 2

400g (5 portions) fruit & veg per day

Question 3

explain the Bazzano LA, et al. (2002) study

Answer 3

FV intake negatively associated with stroke incidence, stroke mortality, cardiovascular disease mortality, all cause mortality

Question 4

explain the Riboli E, Norat T. Am (2003) study

Answer 4

FV intake negatively associated with cancers of mouth, pharynx, oesophagus, lung, stomach, colon and rectum

Question 5

explain the Harding AH, et al. (2008) study

Answer 5

FV intake negatively associated with diabetes

Question 6

explain the Tohill BC. World Health Organization 2005 study

Answer 6

FV intake negatively associated with obesity

Question 7

what is the outcome of the Keys A et al. Am J Epidemiol 1986 study?

Answer 7

Mediterranean diet negatively associated with CVD risk.

Question 8

Dilis et al. B J Nutr, 2012 study

med diet

Answer 8

Mediterranean diet negatively associated with CHD incidence and mortality

Question 9

Kontou et al. (2012)

med diet

Answer 9

Mediterranean diet negatively associated with colorectal cancer

Question 10

Escrich et al. (2011)

med diet

Answer 10

Mediterranean diet negatively associated with breast cancer

Question 11

McCall DO, et al. Circulation 2009

F&V intake

Answer 11

Increased FV intake improved microvascular function

Question 12

Macready AL, et al.

F&V intake

Answer 12

Increased FV intake improved mf. and inflammatory status

Question 13

Yeon JY, et al

F&V intake

Answer 13

Increased FV intake improved profiles in is. and oxidative stress

Question 14

Gibson A, et al.

F&V intake

Answer 14

Increased FV intake improved immune function

Question 15

Tanumihardjo SA, et al

F&V intake

Answer 15

Increased FV intake improved weight maintenance

Question 16

Appleton KM, McGill R, Woodside JV. (2009) Fruit and vegetable consumption in older people in Northern Ireland: Levels and patterns.

Answer 16

Telephone survey on FV consumption in 1000 individuals over the age of 65 years, living in Northern Ireland.
FV consumption based on self-report questionnaires
Demographic and lifestyle variables

Results based on 426 respondents, representative of the target population
Average intakes = 4.0 FV portions/day
Weekdays: Fruit and vegetables intakes significantly predicted (R2=0.08, ajd. R2=0.06, F(10,418)=3.63, p<0.01
FV intakes depend on gender, age and deprivation score

Question 17

The best predictors of high FV intakes are cognitions:

Answer 17

1. Awareness of FV recommendations
2. Nutritional Knowledge
3. Health Knowledge
4. Positive attitudes towards FV
5. Positive attitudes towards health
6. Beliefs in the benefits of FV for health
7. Perceptions of others
8. Beliefs in abilities

Question 18

Appleton KM, McGill R, Neville C, Woodside JV. (2010) Barriers to increasing fruit and vegetable intakes in the older population of NI: Low levels of liking and low awareness of current recommendations.

Answer 18

Telephone survey on FV consumption and barriers / facilitators to FV consumption of 1000 individuals over the age of 65 years, living in Northern Ireland.

Results based on 426 respondents, representative of the target population

Low fruit and vegetable intakes were associated with:

1. low levels of liking
2. low awareness of current recommendations
3. low willingness to change
4. demographic variables

Question 19

Ashfield-Watt P (2006). Fruits and vegetables, 5+ a day: are we getting the message across?

Answer 19

Two surveys to investigate the value of the 5+ a day campaign for fruits and vegetables in New Zealand

Household surveys 1999 – 200 ppts, 2000 – 520 ppts.

High awareness of campaign, high recognition of the logo,
High awareness of a need to consume more fruits and vegetables
Increased intentions to consume more fruit and vegetables

Intakes were not effected, but more effected by demographics

Question 20

Rooney C, et al. (2017) How much is ‘5-a-day’?: A qualitative investigation into consumer understanding of fruit and vegetable intake guidelines.

Answer 20

Aim: to understand the knowledge or lack of knowledge of the 5-a-day FV message.

Mixed methods: Six semi-structured focus groups (28 adults) in low FV consumers. Questionnaires assessing knowledge of the 5-a-day FV message.

High awareness of the 5-a-day message. Low knowledge of the foods included and of portion sizes, and misunderstanding of the concept of variety.

Question 21

Appleton KM, et al. (2018) Low fruit and vegetable knowledge is associated with low knowledge of the details of the 5-a-day fruit and vegetable message in the UK: Findings from two cross-sectional questionnaire studies.

Answer 21

Aim: to understand the knowledge or lack of knowledge of the 5-a-day FV message most associated with poor FV intakes.

Study 1:
A short questionnaire (7 questions) administered to a general population on the streets of Bournemouth.
A total of 507 individuals (males, females, aged 18-80+ years, from all SES categories) completed the questionnaire.
Results:
High awareness of the 5-a-day message. Awareness of the message was associated with FV intakes. Confusion over the details of the message were high, and higher confusion was associated with low FV intakes. Greatest confusion related to portion sizes.
Aim: to understand the knowledge or lack of knowledge of the 5-a-day FV message most associated with poor FV intakes.

Study 2:
A comprehensive questionnaire administered by post to a general UK population.

A total of 247 individuals (males, females, aged 18-80+ years, from all areas) completed the questionnaire.
Results:
High awareness of the 5-a-day message. Knowledge of the details of the message were low, and low knowledge was associated with low FV intakes.

Lowest knowledge related to portion sizes and variety, but intakes were not related to this specific knowledge.

Question 22

Rooney C, et al. (2017)

Answer 22

Increased understanding is needed on portion sizes and variety
Smart 5-a-day mobile phone application to increase FV portion size knowledge

Question 23

Appleton KM, Passmore D, Burn I, Pidgeon H, Nation P, Boobyer C, Jiang N. An interactive mobile phone application, Smart 5-a-day, for increasing knowledge of and adherence to fruit and vegetable recommendations

Answer 23

Randomized controlled test

94 individuals – 50 tested the app, 44 acted as controls
Testing for 2 weeks or 4 weeks

Outcomes – FV awareness, FV knowledge, FFQ intake, FV behaviour
Assessed at baseline, 2 weeks and 4 weeks

	App usage and feedback
	Data collected during and after use

Question 24

Rennie L, Uskul AK, Adams C, Appleton KM. (2014)

Answer 24

Online survey

532 participants either read vs. did not read a short informational health message about the benefits of increasing fruit consumption,

and then visualized from first-person perspective vs. from third-person perspective vs. did not visualise themselves increasing their fruit consumption.

Outcomes: intentions to increase fruit consumption, attitudes, social norms, perceived behavioural control, self-efficacy, action planning and coping planning.
Effects of visualization orientation were only found when combined with the health message,
and stronger effects were found for first-person perspective visualization vs. third-person perspective visualization.

Question 25

Adams C, Rennie L, Uskul AK, Appleton KM. (2015) Visualising future behavior: Effects for snacking on biscuit bars, but no effects for snacking on fruit.

Answer 25

Aim: To investigate the impact of visualising a fruit eating experience on subsequent fruit consumption ``` Participants were randomized to: visualising eating fruit (N=72), visualising eating biscuit bars (N=75), or no visualisation (N=72). ``` Outcomes: subsequent intentions, snack choice, and self-reported fruit consumption two days later. Other measures: liking, usual behaviour, previous behaviour, perceived social pressures, perceived control and self-efficacy. Intentions: No effects of fruit visualisation, without and with background variables Effects of biscuit bar visualisation, without and with background variables. Subsequent consumption: No effects of fruit visualisation, without and with background variables No effects of biscuit bar visualisation, without and with background variables

Question 26

Appleton KM. Visualising healthy eating: A role for enjoyment in the use of visualisation for increasing fruit consumption.

Answer 26

Aim: To investigate the impact of visualising an enjoyable fruit eating experience on subsequent fruit consumption Participants were randomized to visualising: an enjoyable fruit eating experience (E+) (N=44), a non-enjoyable fruit eating experience (E-) (N=48), or neither an enjoyable or non-enjoyable experience (NE) (N=41). Outcomes: subsequent intentions, snack choice, and self-reported fruit consumption two days later. Other measures: liking, usual behaviour, previous behaviour, perceived social pressures, perceived control and self-efficacy. Manipulation check – differences in enjoyment, no difference in detail or clarity Intentions differ by condition (enjoyment) Intentions were determined by conditions (enjoyment) and attitudes (positive) Behaviour was not predicted

Question 27

Other predictors of high FV intakes?

Answer 27

1. Taste / liking 2. Availability and other environmental factors 3. Higher consumption of meals and culinary skills 4. Higher time and willingness to prepare meals 5. Reduced cost

Question 28

Appleton, KM. A role for enjoyment in promoting healthy eating: Greater fruit selection and consumption following the use of more enjoyable fruit on a health promotion poster.

Answer 28

Aim: To investigate the use of enjoyable fruit compared to traditional fruit on a health promotion poster ``` Participants were randomized to view health promotion posters that featured: traditional fruit (apples and bananas) (N=70), or enjoyable fruit (grapes and strawberries) (N=68). ``` Outcomes: subsequent intentions, snack choice, and self-reported fruit consumption two days later. Other measures: liking, usual behaviour, previous behaviour, perceived social norms, perceived control and self-efficacy Intention to consume fruit was positively associated with viewing the traditional poster, liking fruit and previous fruit consumption Likelihood of consuming fruit was positively associated with likely enjoyment of the fruit, liking fruit and previous fruit consumption Immediate fruit selection was positively associated with likely enjoyment of the fruit on the poster Fruit consumption the following day was positively associated with viewing the enjoyable fruit poster and usual fruit consumption

Question 29

Savage JS, et al. (2013). The addition of a plain or herb-flavoured reduced fat dip is associated with improved pre-schoolers intake of vegetables.

Answer 29

Aim: To increase veg tasting, liking and consumption in 3-5 year olds ``` Study 1. Participants were exposed to 3 target veg with: plain reduced fat dip favoured flavoured reduced fat dip no dip ``` Increased willingness to taste for dips compared to no dip. No differences between dips. Study 2. Participants were exposed to 2 target unfamiliar or disliked veg with: favoured flavoured reduced fat dip no dip Increased willingness to taste for dip compared to no dip.

Question 30

Wardle J, et al. (2003). Increasing children’s acceptance of vegetables: a randomised controlled trial of parent-led exposure

Answer 30

Aim: To increase liking and intake of a previously disliked veg in 2-6 year olds ``` Participants were randomised to receive: 14 daily exposures to a disliked veg no exposures (wait-list) ``` Increased liking, ranking and consumption of the veg from pre to post exposure period following exposure than following no exposure.

Question 31

Appleton KM. Increases in fruit intakes in low consumers of fruit following two community-based repeated exposure interventions.

Answer 31

Aim: To increase liking and intake of fruit in older individuals ``` 95 Participants were randomized to: Single exposure (E1): fruit sampling on one occasion only Repeated Exposure (E5): fruit sampling on one occasion per week for five weeks Repeated Exposure Plus (E5+): fruit sampling on one occasion per week for five weeks and fruit provision of one portion of fruit per day to consume at home for the five weeks. ``` Intakes of fruit and vegetables were assessed every week using 24 hour food recalls of the day before fruit sampling. Liking was also assessed at every fruit sampling occasion Familiar were liked significantly more than novel fruits. No differences were found between groups Low consumers (1 portion of fruit / day or less) Fruit intake increased in repeated exposure groups over time but did not change in the single exposure group Low consumers (<1 portion of fruit / day) Familiar fruits were liked significantly more than novel fruits. No differences were found between groups

Question 32

what are changing F&V intake interventions based on?

Answer 32

1. Taste / liking 2. Availability and other 3. environmental factors 4. Higher consumption of meals and culinary skills 5. Higher time and willingness to prepare meals 6. Reduced cost

Question 33

Spill MK, et al. (2011). Serving large portions of vegetable soup at the start of a meal affected children’s energy and vegetable

Answer 33

Aim: To increase vegetable intakes in 3-5 year olds ``` Participants received a starter at lunch of: 150g tomato soup 225g tomato soup 300g tomato soup No soup ``` Greater vegetable intakes in all soup conditions compared to no soup. Increasing the portion size increased vegetable intake.

Question 34

Just DR, Wansink B. (2009). Smarter lunchrooms: using behavioural economics to improve meal selection.

Answer 34

Aim: To increase vegetable selection in a school canteen Salad bar No salad bar More children choosing salad with salad bar compared to no salad bar. Salad bar positioned in the centre of the canteen Salad bar positioned at the side of the room More children choosing salad selection with central salad bar compared to the side salad bar.

Question 35

Schreinemachers P, et al. (2015). The effect of women’s home gardens on vegetable production and consumption in Bangladesh. Food Security, 7, 97-107

Answer 35

Aim: To increase vegetable production and consumption in families ``` Education, garden training, garden equipment, seeds, cooking skills No intervention (wait-list) ``` Increased vegetable production and consumption in the intervention group compared to the control.

Question 36

Carney PA, et al. (2012). Impact of a community gardening project on vegetable intake, food security and family relationships: a community-based participatory research study

Answer 36

Aim: To increase vegetable intakes in families Community gardening programme, including education, garden experiences, cooking and tasting, and social activities No control Increased vegetable intakes and reduced food insecurity from pre - post intervention.

Question 37

Weinrich TR et al. (2012). Impact of community-based intervention on serving and intake of vegetables among low-income, rural Appalachian families.

Answer 37

Aim: To increase serving and consumption of vegetables in families 8 weekly interactive sessions for food preparers, including recipes and handouts 8 weekly mailings of the same recipes and handouts More recipes use in the intervention group compared to the control. No differences in servings or intakes.