Title: Promoting fruit and veg consumption to improve health

Key words: cardiovascular disease, cancer, public health, interventions, dyslipidaemia, obesity, diet, lifestyle, polyunsaturates, fruit, vegetables, Mediterranean diet, antioxidant, cardioprotection, colorectal cancer, fibre,

Date: Sept 2006

Category: Special diets, Macronutrients

Nutrimed Module:

Type: Article

Author: Morgan, G

 

 

Promoting fruit and vegetable consumption to improve health

 

Cardiovascular disease and cancer remain the two largest causes of mortality in developed countries. Public health measures to combat this epidemic have recognised the multi-factorial nature of the problem and have sought through a combination of health intervention programmes, education and improved health delivery to improve the situation. The following facts relate to the dietary aspects of the problem.

 

Cardiovascular disease

Increasing obesity in developed countries has helped to focus research on the role of dyslipidaemia in the aetiology of heart disease. The beneficial role of increased polyunsaturated fatty acid intake confirmed in many studies (e.g. the Dart and Reinfarction Trial 1989). Combined approaches addressing obesity, diet and lifestyle factors have been shown to reduce cardiovascular morbidity significantly (see Truswell 1994 for a meta-analysis review of such trials).

 

Nevertheless, policies to increase the amount of polyunsaturates in the diet have not led to a reduction in cardiovascular morbidity over the last 30 years. Improvements in survival due to increased polyunsaturated intake and acute medical care have been largely swallowed up by obesity related factors (Stephen & Wald 1990, Rosenman 1993). In the UK marked regional and socio-economic variation attest to the fact of a weak association with fat intake and a much stronger association with fruit and vegetable consumption (MAFF 1991b). These associations are most apparent in comparisons between Scotland and the rest of Europe (Riemersma 1986). The benefits of the Mediterranean diet serve as an example of the antioxidant cardioprotective effects of fruit and vegetables (Renaud & de Lorgeril 1992).

 

Cancer

Marked regional and temporal variations and the difficulties of conducting large prospective studies have handicapped research in this area. Many surveys have shown associations between cancer rates and diet, following the initial report of Armstrong & Doll (1978). Colorectal cancers have shown the strongest association, studies suggesting that 25-35% of such cancers could be prevented by high intakes of vegetables and fibre ( see Bingham 2001 for a review of this and other research findings).

 

Present recommendations are to increase the consumption of fruit and vegetables to 400 grams/day in order to curtail the epidemic of these two diseases. Average intakes presently stand at around 250 grams/day (National Heart Forum 1997) and one survey (Block 1991) showed that, amongst 12000 adults on one day, only 40% consumed any fruit or vegetable at all. Amongst children, the lower socio-economic classes, the elderly and infirm, the figures are even worse. Much therefore remains to be done. A concerted effort from government agencies down is called for to help redress the balance and needs and requires action from:

  • The European Union through the Common Agricultural Policy to institute policies resulting in the efficient production and distribution of high quality food and a sensitivity to the demands of the consumer.
  • The UK government through the DOH, MAFF and other umbrella organisations to realise these objectives on a national level.
  • National and local authorities to facilitate transport and distribution. Around 67% of fruit and vegetables are now supplied by supermarkets and local planning needs to ensure that these are located in areas which serve the whole community.
  • Educational bodies such as schools and health promoting agencies to Promote such schemes as ‘At Least Five a Day’ and ‘Healthy Eating in Schools’. Health providers such as nurses, doctors and nutritionists and caterers also should be encouraged to make a greater input into such programmes.

 

Effective national and local policies to raise awareness and provide solutions to the problem must also take account of the conservative nature of the groups most at risk and the fact that fruit and vegetables are an expensive food item and one that is frequently inconvenient to procure and prepare. Innovative ways of making these foods affordable and attractive to these target groups should be looked at. A coordinated effort by all the groups concerned is called for if the encouraging results of the US and Australia in modifying peoples’ dietary habits and lifestyles and reducing the rate of cardiovascular disease in particular are to be achieved in this country.

 

 

References

1. Diet and Reinfarction Trial. Burr ML, Gilbert JF, Holliday RM et al. (1989) Effects of changes in fat, fish and fibre intakes on death and myocardial reinfarction. Lancet ii : 757-761

2. Truswell AS. (1994) Review of dietary intervention studies: effect on coronary events and on total mortality. Australian New Zealand

Journal of Medicine 24: 98-106

3. Stephen AM, Wald NJ. (1990) Trends in individual consumption of dietary fat in the United States, 1920-1984. Am J Clin Nutr 52: 457-469

4. Rosenman RH. (1993) the independent roles of diet and serum lipids in the 20th-century rise and decline of coronary heart disease mortality. Integr Physiol Behav Sci 28(1): 84-98

5. MAFF, Ministry of Agriculture, Fisheries and Food. (1991b) Household Food Consumption and Expenditure 1990. Annual Report of the National Food Survey Committee. London, HMSO

6. Riemersma RA et al. (1986) Linoleic acid content in adipose tissue and coronary heart disease. BMJ 292: 1423-7

7. Renaud S, de Lorgeril M. (1992) Wine, alcohol, platelets and the French paradox for coronary heart disease. Lancet 339: 1523-6

8. Armstrong B, Doll R. (1978) Environmental factors and cancer  incidence in different countries. Int J Cancer 15: 617-631

9. Bingham S. (2000) Diet and cancer prevention. In: Human Nutrition and Dietetics, 10th ed. Churchill Livingastone, London

10. National Heart Forum, ed. Sharp I. (1997) At Least Five a Day.  Strategies to increase vegetable and fruit consumption. London,  HMSO

11. Block G. (1991) Dietary guidelines and the results of food consumption surveys. Am J Clin Nutr 53: 356S-357S