To identify determinants of fruit and vegetable (F&V) consumption among school-aged children.

A survey study was conducted in October 2010. The questionnaire contained questions concerning social and demographic data, lifestyle and dietary habits, particularly the frequency of F&V consumption, availability of F&V and knowledge about recommended amounts of F&V intake.

Polish primary schools.

Children (n 1255) aged 9 years from randomly selected primary schools and their parents.

The children’s consumption of fruit and of vegetables was influenced by the fruit consumption and vegetable consumption of their parents (r=0·333 and r=0·273, respectively; P=0·001), parents encouraging their children to eat F&V (r=0·259 and r=0·271, respectively; P=0·001), giving children F&V to take to school (r=0·338 and r=0·321, respectively; P=0·001) and the availability of F&V at home (r=0·200 and r=0·296, respectively; P=0·001). Parental education influenced only the frequency of fruit consumption (r=0·074; P=0·01). A correlation between parents’ knowledge of the recommended intakes and the frequency of vegetable and fruit consumption by children was noticed (r=0·258 and r=0·192, respectively, P=0·001).

Factors within the family environment such as parents’ dietary habits and F&V availability had the greatest influence on the F&V consumption by children. Educational activities aimed at parents are crucial to increase the consumption of F&V among children.

The present study examines the impact of Health Bucks, a farmers’ market incentive programme, on awareness of and access to farmers’ markets, and fruit and vegetable purchase and consumption in low-income New York City neighbourhoods.

The evaluation used two primary data collection methods: (i) an on-site point-of-purchase survey of farmers’ market shoppers; and (ii) a random-digit-dial telephone survey of residents in neighbourhoods where the programme operates. Additionally, we conducted a quasi-experimental analysis examining differential time trends in consumption before and after programme introduction using secondary Community Health Survey (CHS) data.

New York City farmers’ markets and communities.

Farmers’ market shoppers (n 2287) completing point-of-purchase surveys in a representative sample of New York City farmers’ markets in 2010; residents (n 1025) completing random-digit-dial telephone survey interviews in 2010; and respondents (n 35 606) completing CHS interviews in 2002, 2004, 2008 and 2009.

Greater Health Bucks exposure was associated with: (i) greater awareness of farmers’ markets; (ii) increased frequency and amount of farmers’ market purchases; and (iii) greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption. However, our CHS analysis did not detect impacts on consumption.

While our study provides promising evidence that use of farmers’ market incentives is associated with increased awareness and use of farmers’ markets, additional research is needed to better understand impacts on fruit and vegetable consumption.

To determine whether food label information and advertisements for foods containing no fruit cause children to have a false impression of the foods’ fruit content.

In the food label condition, a trained researcher showed each child sixteen different food label photographs depicting front-of-food label packages that varied with regard to fruit content (i.e. real fruit v. sham fruit) and label elements. In the food advertisement condition, children viewed sixteen, 30 s television food advertisements with similar fruit content and label elements as in the food label condition. After viewing each food label and advertisement, children responded to the question ‘Did they use fruit to make this?’ with responses of yes, no or don’t know.

Schools, day-care centres, after-school programmes and other community groups.

Children aged 4–7 years.

In the food label condition, χ2 analysis of within fruit content variation differences indicated children (n 58; mean age 4·2 years) were significantly more accurate in identifying real fruit foods as the label’s informational load increased and were least accurate when neither a fruit name nor an image was on the label. Children (n 49; mean age 5·4 years) in the food advertisement condition were more likely to identify real fruit foods when advertisements had fruit images compared with when no image was included, while fruit images in advertisements for sham fruit foods significantly reduced accuracy of responses.

Findings suggest that labels and advertisements for sham fruit foods mislead children with regard to the food’s real fruit content.

Fruit and vegetable claims on food packages are not regulated under Australian food standards. The present study aimed to: (i) investigate the number and healthiness of products carrying fruit and vegetable claims in Australia; and (ii) compare the nutrition composition of these products with fresh fruit and/or vegetables.

Content analysis of fruit and vegetable claims on food packages. The Australian food standards nutrient profiling model was used to determine the proportion of products not meeting nutrient profiling criteria. The nutrient composition of products carrying claims referencing the servings of fruit and vegetables in the product were compared with that of the dominant fruit and/or vegetables in each product.

The five largest supermarket chains in Australia.

All available products in the fruit snacks, soups and fruit and vegetable juices/fruit drinks categories (n 762) were surveyed. Nutrition composition, ingredients and claims were recorded for each product.

Of the products surveyed, 48 % (n 366) carried at least one claim, of which 34 % (n 124) did not meet nutrient profiling. Products carrying claims referencing the number of servings of fruit and vegetables had more energy, sodium, saturated fat and sugar, and less fibre, than fresh fruit and/or vegetables (all P<0·001).

Many products carried fruit and vegetable claims and were significantly higher in energy, saturated fat, sugars and sodium than fresh fruit and vegetables. Marketing these products as a way of meeting fruit and vegetable intake is inaccurate and potentially misleading. Fruit and vegetable claims should be regulated using nutrient profiling.

People eat more unhealthy foods when served more (portion size effect) and when the food is served in larger units (unit size effect). The present study aimed to examine whether these effects can be used for the good: to increase vegetable consumption among children.

A 2×2 between-subjects experiment was conducted at two schools. Pupils were presented in class with cucumber that varied both in unit size (one piece v. pre-sliced) and portion size (one-third v. two-thirds of a cucumber). Children ate ad libitum during the morning break and filled in a survey.

Primary schools in the centre of the Netherlands.

Primary-school pupils (n 255) aged 8–13 years.

Children ate 54 % more cucumber when served a large compared with a smaller portion (difference of 49 g; P<0·001). Large units did not impact consumption (P=0·58), but were considered as less convenient to eat than small units (P=0·001).

Findings suggest that children’s vegetable intake can be improved by serving larger portions in smaller-sized pieces.

To determine the effect of increasing fruit visibility, adding information and lowering price on fruit purchasing at a university cafeteria in Lima, Peru.

Quasi-experimental pilot study of a three-phase stepped intervention. In Phase 1, fruit was displayed >3 m from the point of purchase with no additional information. Phase 2 consisted in displaying the fruit near the point of purchase with added health and price information. Phase 3 added a 33 % price reduction. The duration of each phase was 3 weeks and phases were separated by 2-week breaks. Primary outcomes were total pieces of fruit and number of meals sold daily.

A university cafeteria in Lima, Peru.

Approximately 150 people, students and non-student adults, who purchased food daily. Twelve students participated in post-intervention interviews.

Fruit purchasing doubled from Phase 1 to Phase 3 (P<0·01) and remained significant after adjusting for the number of meals sold daily (P<0·05). There was no evidence of a difference in fruit sold between the other phases. Females purchased 100 % of the fruit in Phase 1, 82 % in Phase 2 and 67 % in Phase 3 (P<0·01). Males increased their purchasing significantly between Phase 1 and 3 (P<0·01). Non-student adults purchased more fruit with each phase (P<0·05) whereas students did not. Qualitatively, the most common reason for not purchasing fruit was a marked preference to buy unhealthy snack foods.

Promoting fruit consumption by product placement close to the point of purchase, adding health information and price reduction had a positive effect on fruit purchasing in a university cafeteria, especially in males and non-student adults.

While vegetables are often studied as one food group, global measures may mask variation in the types and forms of vegetables preferred by different individuals. To explore preferences for and perceptions of vegetables, we assessed main food preparers based on their preparation of eight specific vegetables and mushrooms.

An online self-report survey.

Ontario, Canada. Measures included perceived benefits and obstacles of vegetables, convenience orientation and variety seeking in meal preparation.

Of the 4517 randomly selected consumers who received the invitation, 1013 responded to the survey (22·4 % response). Data from the main food preparers were analysed (n 756).

Latent profile analysis indicated three segments of food preparers. More open to new recipes, the ‘crucifer lover’ segment (13 %) prepared and consumed substantially more Brussels sprouts, broccoli and asparagus than the other segments. Although similar to the ‘average consumer’ segment (54 %) in many ways, the ‘frozen vegetable user’ segment (33 %) used significantly more frozen vegetables than the other segments due to higher prioritization of time and convenience in meal preparation and stronger ‘healthy=not tasty’ perception. Perception of specific vegetables on taste, healthiness, ease of preparation and cost varied significantly across the three consumer segments. Crucifer lovers also differed with respect to shopping and cooking habits compared with the frozen vegetable users.

The substantial heterogeneity in the types of vegetables consumed and perceptions across the three consumer segments has implications for the development of new approaches to promoting these foods.

Few published community garden studies have focused on low socio-economic youth living in public housing or used a community-based participatory research approach in conjunction with youth-focused community garden programmes. The objective of the present study was to evaluate the feasibility (i.e. demand, acceptability, implementation and limited-effectiveness testing) of a 10-week experiential theory-based gardening and nutrition education programme targeting youth living in public housing.

In this mixed-methods feasibility study, demand and acceptability were measured using a combination of pre- and post-programme surveys and interviews. Implementation was measured via field notes and attendance. Limited-effectiveness was measured quantitatively using a pre–post design and repeated-measures ANOVA tests.

Two public housing sites in the Dan River Region of south central Virginia, USA.

Forty-three youth (primarily African American), twenty-five parents and two site leaders.

The positive demand and acceptability findings indicate the high potential of the programme to be used and be suitable for the youth, parents and site leaders. Field notes revealed numerous implementation facilitators and barriers. Youth weekly attendance averaged 4·6 of 10 sessions. Significant improvements (P<0·05) were found for some (e.g. fruit and vegetable asking self-efficacy, overall gardening knowledge, knowledge of MyPlate recommendations), but not all limited-effectiveness measures (e.g. willingness to try fruits and vegetables, fruit and vegetable eating self-efficacy).

This community-based participatory research study demonstrates numerous factors that supported and threatened the feasibility of a gardening and nutrition programme targeting youth in public housing. Lessons learned are being used to adapt and strengthen the programme for future efforts targeting fruit and vegetable behaviours.

Our objective was to pilot collaborations between two urban farms with two corner stores to increase access to fresh produce in low-income neighbourhoods.

We conducted a pre–post evaluation of two farm–store collaborations using quantitative distribution and sales data. Using semi-structured interviews, we qualitatively assessed feasibility of implementation and collaboration acceptability to farmers and storeowners.

Low-income urban neighbourhoods in Baltimore, MD, USA in 2012.

Pair #1 included a 0·25 acre (0·1 ha) urban farm with a store serving local residents and was promoted by the neighbourhood association. Pair #2 included a 2 acre (0·8 ha) urban farm with a store serving bus commuters.

Produce was delivered all nine intervention weeks in both pairs. Pair #1 produced a significant increase in the mean number of produce varieties carried in the store by 11·3 (P<0·01) and sold 86 % of all items delivered. Pair #2 resulted in a non-significant increase in the number of produce varieties carried by 2·2 (P=0·44) and sold 63 % of all items delivered.

Our case study suggests that pairing urban farms with corner stores for produce distribution may be feasible and could be a new model to increase access to fruits and vegetables among low-income urban neighbourhoods. For future programmes to be successful, strong community backing may be vital to support produce sales.

To examine the cross-sectional and inter-temporal validity of the Household Food Insecurity Access Scale (HFIAS) for rural households in Burundi.

Longitudinal survey about food security and agricultural production, individually administered by trained interviewers in June 2007 and 2012.

Ngozi, north of Burundi.

Three hundred and fourteen household heads were interviewed.

Tobit models showed that the HFIAS was significantly correlated with objective measures of food security, in this case total annual food production (P<0·01), livestock keeping (P<0·01) and coffee production (P<0·01) in both 2007 and 2012. This confirms that the HFIAS is cross-sectionally valid and corroborates the findings of previous studies. However, while total food production decreased by more than 25 % in terms of energy between 2007 and 2012, households reported an improvement in their perceived food security over the same period, with the HFIAS decreasing from 13·9 to 10·8 (P<0·001). This finding questions the inter-temporal validity of the HFIAS. It may be partly explained through response shifts, in which households assess their own food security status in comparison to that of their peers.

The evidence from our study suggests that the HFIAS is cross-sectionally valid, but may not be inter-temporally valid, and should not be used as a single indicator to study temporal trends in food security.

To investigate the display of food at non-food store checkouts; and to classify foods by type and nutrient content, presence of price promotions and whether food was at child height.

Cross-sectional survey of checkout displays at non-food stores. Foods were classified as ‘less healthy’ or healthier using the UK Food Standards Agency’s Nutrient Profile Model. Written price promotions were recorded. Child height was defined as the sight line of an 11-year-old approximated from UK growth charts.

A large indoor shopping mall, Gateshead, UK, February–March 2014.

Two hundred and five out of 219 non-food stores in the shopping mall directory which were open for trading.

Thirty-two (15·6 %) of 205 non-food stores displayed food at the checkout. All displayed less healthy foods, and fourteen (43·8 %) had healthier foods. Overall, 5911 checkout foods were identified. Of these, 4763 (80·6 %) were ‘less healthy’. No fruits, vegetables, nuts or seeds were found. Of 4763 less healthy foods displayed, 195 (4·1 %) were subject to price promotions, compared with twelve of 1148 (1·0 %) healthier foods (χ2(df=1)=25·4, P<0·0001). There was no difference in the proportion of less healthy (95·1 %) and healthier (96·2 %) foods displayed at child height.

Almost one-sixth of non-food stores displayed checkout food, the majority of which was ‘less healthy’ and displayed at child height. Less healthy food was more likely to be subject to a written price promotion than healthier food. Further research into the drivers and consequences of checkout food in non-food stores is needed. Public health regulation may be warranted.

National data for the USA show increases in sports and energy drink consumption over the past decade with the largest increases among young adults aged 20–34 years. The present study aimed to identify sociodemographic factors and health-risk behaviours associated with sports and energy drink consumption among young adults.

Cross-sectional analysis of survey data from the third wave of a cohort study (Project EAT-III: Eating and Activity in Teens and Young Adults). Regression models stratified on gender and adjusted for sociodemographic characteristics were used to examine associations of sports and energy drink consumption with eating behaviours, physical activity, media use, weight-control behaviours, sleep patterns and substance use.

Participants completed baseline surveys in 1998–1999 as students at public secondary schools in Minneapolis/St. Paul, Minnesota, USA and the EAT-III surveys online or by mail in 2008–2009.

The sample consisted of 2287 participants (55 % female, mean age 25·3 years).

Results showed 31·0 % of young adults consumed sports drinks and 18·8 % consumed energy drinks at least weekly. Among men and women, sports drink consumption was associated with higher sugar-sweetened soda and fruit juice intake, video game use and use of muscle-enhancing substances like creatine (P≤0·01). Energy drink consumption was associated with lower breakfast frequency and higher sugar-sweetened soda intake, video game use, use of unhealthy weight-control behaviours, trouble sleeping and substance use among men and women (P<0·05).

Health professionals should consider the clustering of sports and energy drink consumption with other unhealthy behaviours in the design of programmes and services for young adults.

We conducted a meta-analysis to evaluate the relationship between vitamin E and age-related cataract (ARC).

The fixed- or random-effect model was selected based on heterogeneity. Meta-regression was used to explore potential sources of between-study heterogeneity. Publication bias was evaluated using Begg’s test. The dose–response relationship was assessed by a restricted cubic spline model.

Relevant studies were identified by a search of PubMed and the Cochrane Library to May 2014, without language restrictions.

Studies involved samples of people of all ages.

Dietary vitamin E intake, dietary and supplemental vitamin E intake, and high serum tocopherol levels were significantly associated with decreased risk of ARC, the pooled relative risk was 0·73 (95 % CI 0·58, 0·92), 0·86 (95 % CI 0·75, 0·99) and 0·77 (95 % CI 0·66, 0·91), respectively. Supplemental vitamin E intake was non-significantly associated with ARC risk (relative risk=0·92; 95 % CI 0·78, 1·07). The findings from dose–response analysis showed evidence of a non-linear association between dietary vitamin E intake and ARC. The risk of ARC decreased with dietary vitamin E intake from 7 mg/d (relative risk=0·94; 95 % CI 0·90, 0·97).

The findings of the meta-analysis indicated that dietary vitamin E intake, dietary and supplemental vitamin E intake, and high level of serum tocopherol might be significantly associated with reduced ARC risk.

The objective of the present study was to investigate associations between sugar intake and overweight using dietary biomarkers in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).

Prospective cohort study.

EPIC-Norfolk in the UK, recruitment between 1993 and 1997.

Men and women (n 1734) aged 39–77 years. Sucrose intake was assessed using 7 d diet diaries. Baseline spot urine samples were analysed for sucrose by GC-MS. Sucrose concentration adjusted by specific gravity was used as a biomarker for intake. Regression analyses were used to investigate associations between sucrose intake and risk of BMI>25·0 kg/m2 after three years of follow-up.

After three years of follow-up, mean BMI was 26·8 kg/m2. Self-reported sucrose intake was significantly positively associated with the biomarker. Associations between the biomarker and BMI were positive (β=0·25; 95 % CI 0·08, 0·43), while they were inverse when using self-reported dietary data (β=−1·40; 95 % CI −1·81, −0·99). The age- and sex-adjusted OR for BMI>25·0 kg/m2 in participants in the fifth v. first quintile was 1·54 (95 % CI 1·12, 2·12; Ptrend=0·003) when using biomarker and 0·56 (95 % CI 0·40, 0·77; Ptrend<0·001) with self-reported dietary data.

Our results suggest that sucrose measured by objective biomarker but not self-reported sucrose intake is positively associated with BMI. Future studies should consider the use of objective biomarkers of sucrose intake.

To explain patterns of fruit and vegetable consumption in nine former Soviet Union countries by exploring the influence of a range of individual- and community-level determinants.

Cross-sectional nationally representative surveys and area profiles were undertaken in 2010 in nine countries of the former Soviet Union as part of the Health in Times of Transition (HITT) study. Individual- and area-level determinants were analysed, taking into account potential confounding at the individual and area level.

Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine.

Adult survey respondents (n 17 998) aged 18–95 years.

Being male, increasing age, lack of education and lack of financial resources were associated with lower probability of consuming adequate amounts of fruit or vegetables. Daily fruit or vegetable consumption was positively correlated with the number of shops selling fruit and vegetables (for women) and with the number of convenience stores (for men). Billboard advertising of snacks and sweet drinks was negatively related to daily fruit or vegetable consumption, although the reverse was true for billboards advertising soft drinks. Men living near a fast-food outlet had a lower probability of fruit or vegetable consumption, while the opposite was true for the number of local food restaurants.

Overall fruit and vegetable consumption in the former Soviet Union is inadequate, particularly among lower socio-economic groups. Both individual- and community-level factors play a role in explaining inadequate nutrition and thus provide potential entry points for policy interventions, while the nuanced influence of community factors informs the agenda for future research.

To investigate dietary and non-dietary characteristics of wholegrain bread eaters in the Norwegian Women and Cancer study.

Cross-sectional study using an FFQ.

Women were divided into two groups according to wholegrain bread consumption.

Adult women (n 69 471).

Median daily consumption of standardized slices of wholegrain bread was 2·5 in the low intake group and 4·5 in the high intake group. The OR for high wholegrain bread consumption was 0·28, 2·19 and 4·63 for the first, third and fourth quartile of energy intake, respectively, compared with the second quartile. Living outside Oslo or in East Norway and having a high level of physical activity were associated with high wholegrain bread consumption. BMI and smoking were inversely associated with wholegrain bread consumption. Intake of many food items was positively associated with wholegrain bread consumption (P trend <0·01). After adjustment for energy intake, consumption of most food items was inversely associated with wholegrain bread consumption (P trend <0·001). The mean intakes of thiamin and Fe were higher in those with high wholegrain bread consumption, even after taking energy intake into account.

Energy intake was strongly positively associated with wholegrain bread consumption. Geographical differences in wholegrain bread consumption were observed. Our study suggests that women with high wholegrain bread consumption do not generally have a healthier diet than those who eat less wholegrain bread, but that they tend to be healthier in regard to other lifestyle factors.

To explore the effect of seasonality on fruit and vegetable availability and prices across three outlet types (farmers’ markets, roadside stands and conventional supermarkets).

Cross-sectional survey of geographically clustered supermarkets, farmers’ markets and roadside stands. Enumerators recorded the availability and lowest price for eleven fruits and eighteen vegetables in each season of 2011.

Price data were collected at retail outlets located in central and eastern North Carolina.

The sample consisted of thirty-three supermarkets, thirty-four farmers’ markets and twenty-three roadside stands.

Outside the local harvest season, the availability of many fruits and vegetables was substantially lower at farmers’ markets and roadside stands compared with supermarkets. Given sufficient availability, some items were significantly cheaper (P<0·05) at direct retail outlets in the peak season (e.g. cantaloupe cost 36·0 % less at roadside stands than supermarkets), while others were significantly more expensive (e.g. carrots cost 137·9 % more at farmers’ markets than supermarkets). Although small samples limited statistical power in many non-peak comparisons, these results also showed some differences by item: two-thirds of fruits were cheaper at one or both direct outlets in the spring and autumn, whereas five of eighteen vegetables cost more at direct retail year-round.

Commonly consumed fruits and vegetables were more widely available at supermarkets in central and eastern North Carolina than at direct retail outlets, in each season. Contingent on item availability, price competitiveness of the direct retail outlets varied by fruit and vegetable. For many items, the outlets compete on price in more than one season.

To examine characteristics potentially associated with school lunch fruit and vegetable waste, both overall and pre/post implementation of the Healthy, Hunger-Free Kids Act.

Multi-year (2010–2013) cross-sectional study using pre- and post-meal digital photographs of students’ school lunch trays to estimate fruit and vegetable availability and consumption. Fruit and vegetable items were categorized for factors suspected to impact waste: prior farm to school years, placement (main menu, salad bar), procurement (local, conventional), preparation (cooked, raw) and meal component (entrée, side, topping). Analyses to assess within-category differences in waste volume were performed using a Tobit model.

Wisconsin elementary schools participating in farm to school programmes, USA.

Children in third to fifth grade.

Many within-factor differences were detected overall and/or across time. Cooked fruits were wasted less than raw, while cooked vegetables were wasted more than raw. Where identified, locally sourced items were wasted more than conventionally sourced (+0·1 cups, P<0·0001) and salad bar items more than main menu items (+0·01 cups, P<0·0001). Increasing prior farm to school years decreased waste (−0·02 cups, P<0·0001). Items previously tried were wasted at the same volume whether reported as liked or not. New school lunch meal pattern requirement implementation did not uniformly impact fruit and vegetable waste across all categories and there was no change in waste for seven of fifteen assessed categories.

Many factors impact elementary students’ school lunch waste. These factors may be helpful for school food-service authorities to consider when planning school menus.

To describe adherence with infant feeding and complementary feeding guidelines.

Prospective study of infant feeding and complementary feeding practices were collected as part of the Cork BASELINE Birth Cohort Study.

Cork, Ireland.

Data are described for the 823 infants for whom a diary was completed.

Breast-feeding was initiated in 81 % of infants, and 34 %, 14 % and 1 % of infants were exclusively breast-fed at hospital discharge, 2 and 6 months, respectively. Stage one infant formula decreased from 71 % at 2 months to 13 % at 12 months. The majority of infants (79 %) were introduced to solids between 17 and 26 weeks and 18 % were given solid foods before 17 weeks. Mothers of infants who commenced complementary feeding prior to 17 weeks were younger (29·8 v. 31·5 years; P<0·001) and more likely to smoke (18 v. 8 %; P=0·004). The first food was usually baby rice (69 %), infant breakfast cereals (14 %) or fruit/vegetables (14 %). Meals were generally home-made (49 %), cereal-based (35 %), manufactured (10 %), dairy (3 %) and dessert-based (3 %). The median gap between the first–second, second–third, third–fourth and fourth–fifth new foods was 4, 2, 2 and 2 d, respectively.

We present the largest prospective cohort study to date on early infant feeding in Ireland. The rate of breast-feeding is low by international norms. Most mothers introduce complementary foods between 4 and 6 months with lengthy gaps between each new food/food product. There is a high prevalence of exposure to infant breakfast cereals, which are composite foods, among the first foods introduced.