"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 (¡Ý18 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¨C75); II (1976¨C1980); III (1988¨C1994); 1999¨C2000; and 2001¨C2002, 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¨Cgender 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¨Cgender 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¡ªsuggesting 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¡ªMore 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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