fruit and vegetables in the american diet data from the nhanes ii survey

1、Fruit and Vegetables in the American Diet: Data from the NHANES 11 SurveyBLOSSOM H. PArrERSON, MA, GLADYS BLOCK, PHD, WILLIAM F. ROSENBERGER, MPHIL, DAVID PEE, MPHIL, AND LISA L. KAHLE, BAAbstract: Twenty-four hour dieta

2、ry recall data from the Second National Health and Nutrition Examination Survey (1976-80) were used to estimate the numbers of servings of fruit and vegetables consumed by Black and White adults, to examine the types of

3、servings (e.g., potatoes, garden vegetables, fruit, and juice), and to estimate the mean intake of calories, fat, dietary fiber, and vitamins A and C by number of servings. An estimated 45 percent of the population had n

4、o servings of fruit or juice and 22 percent had no servings of a vegetable on the recall day. Only 27 percent consumed the three or more servings of vegetables and 29 percent had the two or more servings of fruit recomme

5、nded by the US Departments ofIntroductionIn a recent article,' it was found that a large proportion ofthe adult United States population eats no vegetables (0.17) or fruit (0.41) on any given day. The Surgeon General

6、's Report on Nutrition and Health2 recommends increasing consumption of vegetables and fruit. Based on a comprehen- sive literature review, the National Academy of Sciences (NAS) concluded that diet influences the ri

7、sk of several major chronic diseases and recommended eating five or more daily servings of a combination of vegetables and fruit, especially green and yellow vegetables and citrus fruit.3 The US Department of Agriculture

8、 (USDA) and the Department of Health and Human Services (DHHS) recommend as part of their food guidance system that the daily diet include two to three servings of fruit and three to five servings of vegeta- bles.45 Thes

9、e specific recommendations are in the context of general recommendations for a diet that meets nutrient requirements, does not include excessive amounts of fat (in particular saturated fats), and is consistent with maint

10、aining desirable weight. It is important therefore to determine what relation increased fruit and vegetable consumption might have, not only to intake of obviously related nutrients such as vitamins A and C but also to f

11、at intake and maintenance of appropriate body weight. In the NHANES II data, collected between 1976 and 1980, it is possible to examine these relationships in self-selected diets that were actually consumed during a 24-h

12、our period by a representative sample of US adults. The article mentioned above' described the proportions of the US population that consumed any amount of a given food, however large or small; no attempt was made to

13、 determine the number of servings consumed. In the present inquiry we estimate the number of servings consumed, takingAddress reprint requests to Blossom H. Patterson, MA, Clinical and Diagnostic Trials Section, Biometry

14、 Branch, Division of Cancer Prevention and Control, National Cancer Institute, Executive Plaza North, Rm 344, Bethesda, MD 20892. Dr. Block is also with that Section at NCI; the other co-authors are with Information Mana

15、gement Services, Inc., Silver Spring, MD. This paper, submitted to the Journal August 3, 1989, was revised and accepted for publication May 10, 1990.© 1990 American Journal of Public Health 0090-0036/90$1.50Agricult

16、ure and of Health and Human Services; 9 percent had both. Consumption was lower among Blacks than Whites. The choice of vegetables lacked variety. Diets including at least three servings of vegetables and two servings of

17、 fruit contained about 17 grams ofdietary fiber. Although caloric and fat intake increased with increas- ing servings of fruit and vegetables, the percent of calories from fat remained relatively constant. Although these

18、 data are 10 years old, more recent surveys have shown similar results. The discrepancy between dietary guidelines and the actual diet suggests a need for extensive public education. (Am J Public Health 1990; 80:1443-144

19、9)portion size into account. We also examine the intake of calories, fat, fiber, and vitamins A and C in the diets of persons consuming various numbers of servings of fruit and vegetables. While it is obvious that intake

20、 of vitamins A and C would increase with increasing numbers of servings, the relative contribution of fruit versus vegetables is not well known, nor is the nutrient intake actually achieved in self-selected diets. Simila

21、rly, the dietary fiber intake con- tained in diets including multiple servings of fruit and vege- tables may be inadequately appreciated by the general public.MethodsThe NHANES II survey was conducted by the National Cen

22、ter for Health Statistics between 1976 and 1980.6 A highly stratified multi-stage probability design was used to obtain a representative sample of the civilian noninstitutionalized population, ages six months to 74 years

23、; we report on 10,313 White and 1,335 Black adults ages 19 to 74. We excluded other races because of small numbers, as well as imputed, unreliable, or surrogate data. Results are based on weighted data, permitting infere

24、nce about the total Black and White noninstitutionalized US population.7 Group means and stan- dard errors were calculated using software appropriate for complex sample survey data.8 Standard errors are frequently large

25、for Blacks, due to their small number in the survey. Therefore, results for Blacks should be viewed with caution. Conversely, standard errors for Whites are small due to the very large sample size, so that small differen

26、ces in intake, while not biologically meaningful, could be statistically significant. Dietary interviews were conducted by interviewers with a knowledge offood preparation and nutrient composition. A measure ofportion si

27、ze was obtained using three-dimensional food models, as well as dishes and glassware of various sizes. Subjects were asked to report all food and drink consumed in the 24-hour period before the interview day. Almost all

28、recall days were weekdays. Food codes, food weight, and nutrient values were based on data from the USDA, industry, and other sources.9 The coding of these foods has been described elsewhere. '° Based on reporte

29、d portion sizes, the number of grams consumed was calculated and included on the 24-hour recall tape“ for each food reported by each respondent.AJPH December 1990, Vol. 80, No. 12 1443FRUIT AND VEGETABLES IN AMERICAN DIE

30、TTABLE 2-Proportions (standard error) of Persons Ages 19-74 and Numbers in Sample, by Numbers of Servings of Fruit and/or Vegetables Consumed: Estimates Based on Data from NHANES II, 1976-80Servings of Vegetablest Servin

31、gs of Fruit* 0 1 2 3+ All0 .11 (<.01) .11 (<.01) .11 (<.01) .11 (<.01) .45 (.01) 1,306 1,244 1,233 1,247 5,0301 .05 (<.01) .07 (<.01) .07 (<.01) .07 (<.01) .26 (<.01) 633 814 804 847 3,098 2 .0

32、3 (<.01) .04 (<.01) .04 (<.01) .05 (<.01) .15 (<.01) 325 450 486 562 1,823 3+ .02 (<.01) .03 (<.01) .04 (<.01) .04 (<.01) .14 (.01) 261 403 481 552 1,697 All .22 (.01) .26 (.01) .26 (.01) .27 (

33、.01) 1.000 2,525 2,911 3,004 3,208 11,648*Whole fruit and fruit juice t Potatoes, salad, dned peas and beans, all other vegetables (denoted “garden“: see text)somewhat higher for males than females; the opposite was true

34、 for fruit and juice. The mean number of servings of garden vegetables, a group including the green and yellow vegetables emphasized by the NAS guidelines, was only 0.65 (SE = .01). At least one serving of garden vegetab

35、les was eaten by 43 percent of the adult population, and there were no notable differences by race or sex (Table 3). Potatoes and salad were more popular among Whites than Blacks. Proportions eating fried potatoes declin

36、ed with age, while those consuming non-fried potatoes increased (data available on request to author). Dried peas and beans, good sources of fiber, were eaten by only about 10 percent of the population. About half the po

37、pulation consumed no servings or only one serving of a vegetable (Figure 1). Among those who reported only one serving of a vegetable, salad was the most popular, reported by 39 percent. Twenty-nine percent con- sumed a

38、serving of potatoes as their only vegetable, and over half of these servings of potatoes were fried. Among those reporting two servings of a vegetable, some did not achieve variety: 9 percent had two servings of potatoes

39、, 7 percent reported two servings of salad, and 5 percent ate two servings of dried peas and beans. Only slightly more than half of the population (55 percent) had at least one serving of fruit or fruit juice. Of these,

40、27 percent had juice only, and 45 percent had whole fruit only (data available on request to author). Table 4 shows average intake ofdietary fiber, vitamin A, and vitamin C among persons consuming various numbers ofservi

41、ngs of fruit and vegetables. These nutrient levels repre- sent dietary intake from all food sources, but exclude vitamin supplements. Persons who consumed neither fruit nor veg- etables had, on average, only 5.6 grams of

42、 fiber in their diet on the recall day, or about one-fourth of the 20-30 grams recommended by the National Cancer Institute.13 The amount of fiber in these self-selected diets increased with the total number of servings

43、of fruit and vegetables consumed, and this increase was similar for both fruit and vegetables. A total of five servings of a combination of fruit and vegetables was associated with an intake of approximately 17 grams of

44、fiber. The recommended level of fiber intake was achieved only by those who had three or more servings ofboth fruit and vegetables, a group representing only 4 percent of the US adult population. In the United States, it

45、 is estimated that the usual foods available to consumers provide about halfofthe total vitamin A activity in the diet as provitamin A carotenoids, found in plant products, and the other half as retinol. 14 Among those e

46、ating both fruit and vegetables, the US Recommended Daily Allowance (RDA) of 5000 lUs of vitamin A was attained only by those having at least two servings, while five servings of a combination of fruit and vegetables wer

47、e associated with mean vitamin A intake of about 8000 IUs. If either vegetables or fruit were eaten to the exclusion of the other (true of over half the population), the US RDA was reached only among those having three o

48、r more servings. For vitamin C, fruit and vegetables represent the primary source in the US diet,10 and Table 4 shows that fruit in particular is associated with higher intake. Among those consuming no fruit, the US RDA

49、of 60mg was attained only by those who had three or more servings of vegetables. This is notable in view of the fact that 45 percent of the US population consumed no servings of fruit on the day of the survey. Table 5 sh

50、ows caloric and fat intake by servings of fruit and vegetables. Caloric intake increased as numbers of servings of either food increased. However, the additional calories were not due to the fruit or vegetables alone, as

51、 fat intake also increased substantially. This is presumably due in part to fats such as butter and margarine added to potatoes and other vegetables and to oils in salad dressings; people who eat more servings of fruit a

52、nd vegetables may also eat more food in general. The increase in dietary fat intake associated with increased servings of vegetables was greater than that associated with increased servings of fruit (data available on re

53、quest to author). Those who ate no fruit and three or more servings of vegetables had an average of 95 grams of fat in their diets, while those who ate three servings of fruit and no vegetables had 78 grams.TABLE 3-Propo

54、rtions (standard error) of Persons Consuming One or More Servings of a Vegetable, by Race, Sex, and Type of Vegetable: Estimates Based on Data from NHANES II, 1976-80Whites BlacksType of Vegetable Males Females Males Fem

55、ales AllGarden Vegetables* .42 (.01) .44 (.01) .41 (.03) .44 (.02) .43 (.01) Potatoes Fried .22 (.01) .13 (.01) .15 (.02) .10 (.01) .17 (<.01) Not Fried .28 (.01) .26 (.01) .20 (.02) .20 (.02) .26 (.01) All .46 (.01)

56、.37 (.01) .33 (.03) .30 (.03) .40 (.01) Salad .39 (.01) .40 (.01) .19 (.02) .24 (.02) .37 (.01) Dried Peas and Beans .11 (.01) .08 (.01) .13 (.02) .10 (.02) .10 (.01)*All vegetables except potatoes, salad, and dried peas