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To review the evidence on the association between fruit and vegetable (F&V) consumption and risk of chronic disease, and to assess trends in the prevalence of low F&V consumption.
Systematic review and cross-sectional analyses of a Mediterranean cohort.
The Seguimiento University of Navarra (SUN) project (Spanish dynamic cohort of graduates).
A systematic review of prospective studies aimed to assess the relationship between fruit and/or vegetables consumption and chronic disease incidence was conducted. We also assessed 18 457 university graduates (59·4 % women; mean age = 39 (sd 12) years) enrolled in a dynamic cohort with permanently open recruitment. Baseline data were collected between 1999 and 2010 using a validated 136-item FFQ. Four definitions for low F&V consumption were used (<400 g/d, <200 g/4184 kJ (1000 kcal) per d, ≤2 servings/d and ≤1 serving/d). Multivariate-adjusted cross-sectional associations between the prevalence of low F&V consumption and the year of recruitment were estimated.
The systematic review found that a high F&V consumption is inversely associated with CVD incidence and mortality. This association is not so clear for cancer. Inconsistent findings have been reported for diabetes. In all, 13 % of participants in the SUN cohort did not meet the goal of consuming at least 400 g/d of F&V and 2·1 % of them did not reach >1 serving/d. Between 1999 and 2010 the consumption of F&V significantly increased.
Even among health-conscious university graduates, low F&V consumption is fairly prevalent. Although the temporal trends suggest an improvement, preventive strategies addressed to increase F&V consumption are needed.
To evaluate the reproducibility of a semi-quantitative FFQ used in the Seguimiento Universidad de Navarra (SUN) project.
The data that were analysed were collected from an FFQ answered twice by a 326-participant subsample of the SUN project (115 men, 35·3 %; 211 women, 64·7 %), with either less than 1 year or more than 1 year between responses. The questionnaire included 136 items. Pearson correlation coefficients (r) were calculated to evaluate the magnitude of the association between both measures after energy adjustment and correcting for within-person variability. We also evaluated misclassification by quintiles distribution.
The highest corrected correlations among participants who answered before 1 year were found for PUFA (r = 0·99). Among participants who answered after 1 year between both questionnaires, olive oil had the highest corrected correlation (r = 0·99). The highest percentage of gross misclassification, lowest quintile in FFQ1 and highest quintile in FFQ2 or highest quintile in FFQ1 and lowest quintile in FFQ2 was for cereals, fish or seafood, and n-3 fatty acids (7·6 %). Alcoholic drinks had the highest percentage of reasonable classification, same or adjacent quintile, in FFQ1 and FFQ2 (86·4 %).
Our study suggests that FFQ reproducibility is acceptable for participants who answered the same questionnaire twice less than 1 year apart. Participants who answered FFQ more than 1 year apart showed worse values on reproducibility. We consider this Spanish FFQ as an important, valid and reproducible tool in nutritional epidemiology.
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