Fruit and Vegetables:

Are we eating enough?

A Summary of Findings by Ingrid Hart

Introduction
Fruit and vegetables have been identified by the World Health Organization as having an important role in the reduction of noncommunicable diseases such as heart disease, stroke and some cancers(1). The 2003 report on the burden of disease in New Zealand estimated that in 1997, low fruit and vegetable intake contributed to 1559 deaths in New Zealand(2). The ability of public health programmes to improve the fruit and vegetable intake of New Zealanders needs to be adequately evaluated. However, up until recently there have been no published, brief measures of fruit or vegetable intake validated for the New Zealand adult population. Thus it appears previous estimates of population fruit or vegetable intakes in New Zealand, made using intake screening questions (ISQs), are subject to error that is unquantifiable(3-5).

Aims
The aim of this research was to: Determine the proportion of New Zealand adults, aged 25-60 years, eating at least two servings of fruit or three servings of vegetables per day using validated instruments Investigate the association between different demographic variables on fruit and vegetable intake goal achievement Investigate the demographic affects on the over and under-reporting of intake when one-item ISQs were used

Method
In 2005, 3800 New Zealanders, aged 25-60 years, were randomly selected from the New Zealand electoral rolls to participate in a postal survey. Fruit and vegetable intake was measured using two, food frequency questionnaires validated for use in the New Zealand adult population, two un-validated intake-screening questions and a demographic questionnaire. Pearsons chi- square tests were used to analyse the differences in proportions of males and females meeting the goals for each demographic variable.

Key Findings
The survey had a 67% response rate and the study sample was nationally representative A greater proportion of participants met the vegetable goal, 74% (95% CI: 72%, 76%), than the fruit goal, 53% (CI 51%, 55%). Females were statistically significantly more likely than males to be meeting the vegetable goal (p=0.005) and the fruit goal (p<0.0001) (refer Figure 1).

Figure 1. Percentage of participants meeting goals by age and gender

90

80

70

Age (Years)

Vegetable Female 60 Vegetable Male Fruit Female Fruit Male 50

40

30 25-29 30-39 40-49 50-60 Percent meeting goal (%)

Age was positively associated with fruit and vegetable goal attainment for females (p<0.0001, p=0.002 respectively) but not males (p=0.155, p=0.051 respectively). Living situation was positively associated with vegetable goal attainment for both males (p=0.014) and females (p=0.002) but had no affect on fruit goal attainment (males p=0.756, females p=0.147).

Table 1. Percentage of participants over and under-reporting with the fruit and vegetable ISQs
Fruit ISQ Under-report Over-report % % Total Sex Male Female Educational Qualification No Qualification Secondary school Polytech/trade University 8.9 10.8 Vegetable ISQ Under-report Over-report % % 32.4 6

10.7 7.5

9.5 11.8

36.8 28.9

5.3 6.5

12.0 8.6 8.7 6.7

9.4 12.1 11.1 10.7

39.2 30.1 35.3 27.4

4.7 6.7 6.8 5.0

When the one-item intake screening questions were used, 32% of participants under-reported and only 6% over-reported their vegetable intake (refer Table 1). Males were also more likely to under-report vegetable intake than females (refer Table 1). Subjects without a secondary school qualification were more likely to under-report intake with both the fruit and vegetable screening questions than university educated subjects (refer Table 1).

education levels. These findings have implications for public health nutrition policy makers, researchers and programme evaluators.

Recommendations
Fruit intake and vegetable intake should be measured separately using instruments validated for use within the New Zealand population. Given the degree of underreporting highlighted in the present study, particularly for the vegetable ISQ, the ability of ISQs to inform and monitor evidence-based public health programmes needs to be called into question. Further analyses examining the affect of socio-economic status on the likelihood of fruit goal and vegetable goal attainment should be carried out using this data set.

Conclusion
This research indicates that males, not living in a family situation, are the most at risk group within the New Zealand population, aged 25-60 years, of having low fruit and vegetable intake. It also indicates that those in younger age groups are less likely to meet the fruit and vegetable guidelines than older New Zealanders. The intake screening questions (ISQs), which were similar to those that have been used in national surveys, were poor predictors of fruit and vegetable goal attainment, particularly in those with low
1.

2. 3. 4. 5.

World Health Organisation, Food and Agriculture Organisation. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO expert consultation. WHO Technical Report Series: 916 2002 [cited 2007 18 May]; Available from: http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf Ministry of Health. Nutrition and the Burden of Disease: New Zealand 1997-2011. Wellington: Ministry of Health; 2003. Ministry of Health. A Portrait of Health: Key Results of the 2002/03 New Zealand Health Survey. Wellington: Ministry of Health; 2004. Russell DG, Parnell WR, Wilson NC. NZ Food: NZ People. Key results of the 1997 National Nutrition Survey. Wellington: Ministry of Health; 1999. Sullivan C, Oakden J, Young J, Lau M, Lawson R. Pulp Fiction- The Facts Harvested. A study of New Zealanders' physical activity and nutrition. Wellington: Cancer Society of New Zealand; 2004.