Excerpts from: Fruit and vegetable consumption and all-cause, cancer and CVC mortality (2014)

I’ve discussed Oyebode O, Gordon-Dseagu V, Walker A, et al. J Epidemiol Community Health 2014;68:856–862 at previous posts.

The previous discussions about vegetables can be accessed here.

After I began to read the research evidence, for a long time I had the intention of reaching the goal of 7-plus portions of vegetables and fruits (with a predominant proportion of vegetables) per day. I’ve subsequently achieved success in reaching the goal, and sticking to it. The key thing was the evidence, and the intention. What makes it easy is having a sense of what the numbers are, and how to get the numbers into place. It’s not complicated, nor is it difficult.

We can add that surveys indicate that few people reach this goal.

Each of the following items constitutes a separate excerpt from the above-noted journal article

Below are excerpts from the above-noted Open Source journal article that I am pleased to share with you, in the event that such research interests you:

• The HSE [Health Survey for England] is an annual survey which uses a multistage stratified design to sample a new, nationally representative random cross section of the free-living population of England each year.

• Since 2001, HSE participants have been asked about fruit and vegetable consumption on the previous day (the 24 h from midnight to midnight).

• A maximum of one portion of pulses, one of fruit juice or a smoothie, and one of dried fruit can contribute to the total daily portions of fruit and vegetables.

• These were categorised with less than one portion as the reference category, then categories increasing by two portions daily with the highest category defined pragmatically, limited by the low number of participants eating larger quantities.

• Mean daily portions of fruit and vegetables consumed by participants in the study were 3.8 (SD 2.6): 2.3 portions of fruit (SD 2.0) and 1.5 portions of vegetables (SD 1.2).

• Those who consumed more fruit and vegetables were generally older, less likely to smoke and more likely to be women, in a non-manual household, with degree level education. The proportion of study participants who were vigorously active in the last 4 weeks increased as more portions of fruit and vegetables were consumed.

• The effect of vegetable consumption was greater, HR for three+ portions daily 0.68 (0.58 to 0.79)). Consuming portions of vegetables conferred significantly greater benefit than portions of fruit at two to less than three and three+ portions daily (table 4).

• Fruit consumption was not significantly associated with deaths from cancer or from CVD. Vegetable consumption was significantly associated with reduced CVD and cancer death.

• Consumption of vegetables appeared to be significantly better than similar quantities of fruit. When different types of fruit and vegetable were examined separately, increased consumption of portions of vegetables, salad, fresh and dried fruit showed significant associations with lower mortality. However, frozen/canned fruit consumption was apparently associated with a higher risk of mortality.

• This study has found a strong association, but not necessarily a causal relationship.

• Our analyses did adjust for BMI, which acts as a proxy for energy balance between intake and expenditure.

• Unlike some other published studies, we found a protective effect for all-cancer.

• It is also the case that salad, fresh fruit and some vegetables are likely to be consumed raw. Raw vegetables have been shown by others to have a stronger inverse association with mortality than cooked vegetables.

• In these analyses, consuming frozen/canned fruit was associated with an increased risk of mortality. As far as we know, no other studies have shown this result. This may be due to confounding for example by (poor) access to fresh groceries in deprived areas or among people with pre-existing ill-health or a more hectic lifestyle. These confounding aspects are not covered by the adjustments made in our analyses; further adjustment with other socioeconomic or dietary measurements may demonstrate that this apparent effect is due to confounding. Community level barriers may have an effect on diet independent of social class or education. Nutritionally, frozen fruit is generally held to be equivalent to fresh fruit. However, most canned fruit contains high sugar levels; fruit packed not in syrup but in fruit juice (which still contains fructose but less sugar overall) is less available and more expensive. Because of the questions asked, consumption of canned fruit cannot be distinguished from frozen fruit. Analysis of National Diet and Nutrition Survey data would enable examination of dietary patterns to elucidate, albeit on smaller samples, the relative contributions of frozen and of canned fruit to ‘frozen and canned’ consumption, and of the overall dietary patterns and other characteristics of those who eat frozen and canned fruit, to examine possible explanations for this unexpected finding.

• Fruit and vegetable consumption is inversely related to household income. This is not surprising, given the perception in England that fruit and vegetables are more expensive than unhealthy foods and that health education without changing the environment in which individual choices are taken, tends to increase inequalities. With increasing evidence of their health benefits, policy-makers may need to consider broader initiatives to promote fruit and vegetable consumption, particularly vegetables and salad, as with the Australian guidance. In order to have an impact on those who are most socioeconomically disadvantaged, this should move beyond health education, for example, through fiscal policies.

• Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

[End of excerpts from Oyebode O, Gordon-Dseagu V, Walker A, et al. J Epidemiol Community Health 2014;68:856–862 ]

Defining powerhouse fruits and vegetables

Also of relevance is Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Prev Chronic Dis 2014;11:130390. DOI: http://dx.doi.org/10.5888/pcd11.130390.

The list in the above-noted study is of a provisional nature, as I understand from the text.

A July 27, 2015 CBC article is entitled: “Superfood rankings overvalued, dietitian says.”

Updates

A Jan. 7, 2015 CBC article is entitled: “Food purchases, calories go up after holidays:
Despite resolutions, consumers spent more on both healthy and less-healthy foods.”

A Jan. 12, 2015 CBC article is entitled: “What’s the secret to Japan’s slender population? Serious ‘eating education’: ‘We don’t just teach them about cooking; we teach them about the importance of eating local,’ teacher says.”

A Feb. 7, 2015 CBC article is entitled: “Why toddler foods have so much sugar and salt: ‘The child’s biology really makes them vulnerable’ to food industry.”

An August 1, 2015 New York Times article is entitled: “My Dinner With Longevity Expert Dan Buettner (No Kale Required).” The article notes: Not a lot of dairy products.

A Nov. 16, 2016 CBC article is entitled: “Do we have it backward on giving kids low fat milk instead of whole? Whole milk consumption linked to leanness in early childhood, Canadian study finds.”

An April 25, 2017 Science Daily article is entitled: “Parents’ use of emotional feeding increases emotional eating in school-age children.”

A summary of the research report from the Society for Research in Child Development, on which the article is based, reads:

“Emotional eating is not uncommon in children and adolescents, but why youth eat emotionally has been unclear. Now a new longitudinal study from Norway has found that school-age children whose parents fed them more to soothe their negative feelings were more likely to eat emotionally later on. The reverse was also found to be the case, with parents of children who were more easily soothed by food being more likely to feed them for emotional reasons.”

An April 25, 2017 Guardian article is entitled: “Backlash after report claims saturated fats do not increase heart risk: Relying on low fat foods to avoid heart disease is misguided, say cardiologists, but critics say comments ignore evidence.”

An April 26, 2017 CBC article is entitled: “Pass the butter: Cutting saturated fat does not reduce heart disease risk, cardiologists say: Focus should instead be on eating ‘real food,’ walking and reducing stress.”