Research articleHave Americans Increased Their Fruit and Vegetable Intake?: The Trends Between 1988 and 2002
Introduction
Consuming a diet high in fruits and vegetables is associated with a decreased risk of certain chronic diseases including cardiovascular disease,1, 2, 3, 4 cancer,1, 5 and diabetes.6, 7, 8, 9 Beginning in 1985, the United States Department of Agriculture (USDA) Dietary Guidelines for Healthy Americans recommended consuming at least two servings of fruit and three servings of vegetables daily.10, 11 In 1991, the 5-A-Day Program for Better Health was initiated by the National Cancer Institute and the Produce for Better Health Foundation to increase public awareness of the importance of eating at least five fruits and vegetables daily.12 This was done through education, advertising campaigns, and school and workplace interventions.
Previous research indicates that only a small proportion of Americans meet USDA guidelines for daily servings of fruits and vegetables.13, 14, 15 Twenty-four-hour dietary recall data from the Second National Health and Nutrition Examination Survey (NHANES II, 1976–1980) estimated that only 27% of adults consumed three or more servings of vegetables and 29% consumed two or more servings of fruit as recommended by the USDA; only 9% met both guidelines.14 Previous trend studies including the Behavioral Risk Factor Surveillance System (BRFSS) (1990–2000)13, 15 and the National Health Interview Survey (NHIS) (1987–1992)16 found little or no improvement in fruit and vegetable consumption. However, a limitation of the dietary data reported in these studies is the inability to account for portion size. Respondents may over-report their fruit and vegetable consumption if they view this as socially desirable, resulting in reporting errors and bias.17, 18
This analysis was conducted to assess current trends in Americans’ fruit and vegetable consumption. The current study attempts to overcome the major limitations of previous studies by using 24-hour dietary recall data collected in NHANES III (1988–1994) and NHANES 1999–2002. Unlike prior trend studies, serving size estimations were determined to evaluate if national efforts to increase fruit and vegetable consumption were successful.
Section snippets
Materials and Methods
The National Health and Nutrition Examination Survey (NHANES) is a stratified multistage probability survey conducted in the noninstitutionalized population, aged ≥6 months administered by the National Center for Health Statistics (NCHS). The NHANES survey has two parts: (1) an in-home interview for demographic and basic health information, and (2) a health examination in a mobile examination center (MEC). Household interviews are conducted by trained staff, and the MEC is staffed by
Population Characteristics
Sixty-eight percent and 65%, respectively, of the study population was aged less than 50 years in 1988–1994 and 1999–2002, with a greater number of individuals aged more than 70 years represented in 1999–2002 (11.2% vs 9.4%) (p<0.001). There were slight differences, although not significant (p=0.055), in ethnicity between 1988–1994 and 1999–2002, with 76.8% and 72.4%, respectively, of those sampled reporting ethnicity as non-Hispanic white, 10.8% and 10.3% reporting non-Hispanic black, and 5.0%
Discussion
Approximately 89% of Americans failed to meet USDA dietary guidelines for fruits and vegetables in NHANES III 1988–1994 and NHANES 1999–2002. Furthermore, there was no improvement in Americans’ fruit consumption during this period, and there was a small decrease in vegetable intake. In addition, about half of participants did not consume any fruit and a quarter consumed no vegetables. Although 35% in 1988–1994 and 32% in 1999–2002 consumed equal to or more than three servings of vegetables per
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