Americans Still Not Eating Enough Fruits and Vegetables


 According to two recent studies in the American Journal of Preventive Medicine


San Diego, March 19, 2007 – "Eat your vegetables" has been heard at the dinner tables of America for a long time. Has the message gotten through? Since 1990 the Dietary Guidelines for Americans has recommended consuming at least two servings of fruits and three servings of vegetables daily. However, two studies published in the April issue of the American Journal of Preventive Medicine clearly show that Americans are not meeting the mark. This is a serious public health concern because consuming a diet high in fruits and vegetables is associated with decreased risk of obesity and certain chronic diseases, such as cardiovascular disease, diabetes and some cancers.

Researchers from the Johns Hopkins School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research in Baltimore analyzed NHANES data (National Health and Nutrition Examination Surveys) to determine trends over time for fruit and vegetable consumption among American adults. The answers are not encouraging. Despite campaigns and slogans, Americans have not increased their consumption, with 28% and 32% meeting USDA guidelines for fruits and vegetables, respectively, and less than 11% meeting the current USDA guidelines for both fruits and vegetables.

The study included 14,997 adults (≥18 years) from 1988 to 1994 and 8,910 adults from 1999 to 2002 with complete demographic and dietary data. Approximately 62% did not consume any whole fruit servings and 25% of participants reported eating no daily vegetable servings. There was no improvement in Americans' fruit consumption during this period and there was a small decrease in vegetable intake.

In the article, Tiffany Gary, PhD, states, "Low fruit and vegetable consumption with no indication of improvement between 1988 and 2002 as well as consumption disparities across ethnic, income, and educational groups should alarm public health officials and professionals. With two thirds of the U.S. adult population overweight or obese, the implications of a diet low in fruits and vegetables are extensive…New strategies, in addition to the 5-A-Day Campaign, are necessary to help Americans make desirable behavioral changes to consume a healthy diet that includes a variety of fruits and vegetables."

Previous studies have shown a disparity in the diets of blacks and whites, as well as a more serious disparity in the incidence of heart disease, cancer and stroke. A second article published in the April issue of the American Journal of Preventive Medicine examined whether the diets of non-Hispanic blacks have improved relative to the diets of whites.

Also working with the data from the National Health and Nutrition Examination Surveys (NHANES) I (1971–75); II (1976–1980); III (1988–1994); 1999–2000; and 2001–2002, researchers found that little progress has been made in closing the gap between blacks and whites. In fact, the authors point out that the results are remarkable for similarity of trajectories in all race-gender groups. The quantity of food, total energy intake, energy from carbohydrate, and energy density increased, and energy from total and saturated fat and cholesterol intake decreased across the board. These results suggest a population-wide shift in intake of energy and macronutrients over the 3-decade span of the four surveys and may reflect changes in diet that were adopted by all race–gender groups.

Dr. Ashima Kant, PhD, Queens College of the City University of New York, concludes, "Dietary intake trends in blacks and whites over the past several decades appear to be similar—suggesting that previously identified dietary risk factors that differentially affect black Americans have not improved in a relative sense. The differences observed need to be confirmed with biomarkers, but would seem sufficiently strong to warrant intensified study and action to better understand the sociocultural or environmental factors that anchor these persistent differentials and identify approaches to effect change while building on strengths of current dietary patterns where possible."

Emphasizing the need to encourage proper diet, Linda C Nebeling, PhD, MD, RD, FADA, of the National Cancer Institute, NIH, states in a commentary in the same issue, "The majority of U.S. adults continue to consume fewer than five servings of fruits and vegetables daily. Increases in public awareness of the importance of and recommendations for fruit and vegetable consumption 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. This effort will build on the strong public-private partnership begun in 1991 by the 5-A-Day for Better Health Program."

The first article is "Have Americans Increased Their Fruit and Vegetable Intake? The Trends Between 1988 and 2002" by Sarah Stark Casagrande, MHS; Youfa Wang, MD, PhD; Cheryl Anderson, PhD, MPH; and Tiffany L Gary, PhD. The second contribution is "Trends in Black-White Differentials in Dietary Intakes of U.S. Adults, 1971-2002" by Ashima Kant, PhD; Barry I Graubard, PhD; and Shiriki K Kumanyika, PhD, MPH. The commentary is "Still Not Enough: Can We Achieve Our Goals for Americans to Eat More Fruits and Vegetables in the Future?" by Linda C Nebeling, PhD, MD, RD; FADA, Amy L Yaroch, PhD; Jennifer D Seymour, PhD; and Joel Kimmons, PhD. All three articles appear in the American Journal of Preventive Medicine, Volume 32, Issue 4 (April 2007) published by Elsevier.

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Full texts of the articles are available upon request; contact eAJPM@ucsd.edu to obtain copies. To request an interview with the lead authors, please contact Tiffany L. Gary at tgary@jhsph.edu, Linda C Nebeling at nebelinl@mail.nih.gov and Ashima Kant at ashima.kant@qc.cuny.edu.

About The American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine is ranked 14th out of 99 Public, Environmental & Occupational Health titles and 16th out of 105 General and Internal Medicine titles according to the Thomson Scientific Institute for Scientific Information's 2005 Journal Citation Reports.

Fruits & Veggies — More Matters™
Closing the consumption gap requires a new national call-to-action, Fruits & Veggies—More Matters™, which will launch on March 19, 2007. This new call for a healthier America is attainable and easy for people to understand. It is simply to eat more fruits and veggies at every eating occasion.

This new national call-to-action was carefully researched and developed. The underlying research supporting it includes extensive qualitative and quantitative research among more than 1,000 consumers, including Caucasian, African American and Hispanic women, men, tweens and children. Formative research also included in-depth analyses of existing programs focused on encouraging healthy eating, as well as detailed interviews with public health and industry leaders, audience specialists and nutrition and health experts.

The research findings also demonstrated that moms, the primary gatekeepers to the family, are best reached in a way that is straight-talking, positive and supportive. Moms understand their responsibility to their family’s well-being and believe that “more” is better and will act on it.
This new public health initiative to increase fruit and vegetable consumption replaces the 5 A Day program, which will be phased out by the end of 2008.
For additional information contact Katie Conover, 202 729 4175, Katie.conover@ogilvypr.com


About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

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