CPHNPresenting Nutrition Series

‘Report on the consumption of vegetables and fruit

in NSW : 2003’

Authors: Debra HectorLiz StoryVicki Flood

Presenting Nutrition SeriesIntroduction for Users

o The presentations are designed to assist professionals throughout NSW disseminate information on public health nutrition

o Each presentation is based on an existing CPHN report

o Users are requested to provide full acknowledgement of the authors, CPHN and the Department of Health

o Notes version of the ppt gives table/figure and page numbers, for easy reference to the report

o Further information and explanation of each slide should be sought from the report. Visit http://www.cphn.biochem.usyd.edu.au

o Users should use Excel to prepare slides with data for other areas, modelled on the sample provided

o Any questions can be referred to Lesley King on 02 9351 8015.

The Report

• Rationale for the promotion of fruit and vegetable consumption

• Risks and burden of disease associated with low consumption

• Recommended levels of consumption• Current levels of consumption of V & F in NSW • Recommendations for monitoring V & F

consumption in NSW

Conceptual framework for monitoring vegetables & fruit consumption

Food / nutrition policy and action

Food supply / community access

F&N–related ‘literacy’ (knowledge, attitudes, beliefs)

Food purchasing / acquisition

Food and supplement consumption habits

Nutrient intakes

Biomedical risk factors

Diet-related

diseases/conditions

Adapted from: Webb K in Marks et al Monitoring food habits in the Australian population using short questions 2001

Association between V & F Intake and Chronic Disease – Evaluation of the Evidence

Source: Adapted from Van Duyn and Pivonka 2000, 5+A Day New Zealand, Accessed Feb 22 2002

DiseaseStrength of Evidence Assessment of

Evidence

Neural Tube Birth Defects Substantial, proven Proven

Cancer – number of sites Substantial, growing Extremely convincing

Cardiovascular diseases Substantial, growing Very convincing

Diverticulosis Strong Convincing

Cataracts/Macular Disease Growing Convincing

Type 2 Diabetes Mixed, Indirect Convincing

Stroke Limited, Building Becoming convincing

Hypertension Limited Suggestive

COPD New Suggestive

Overweight and Obesity Sparse, Indirect Convincing as part of treatment/preventionSource: 5+A Day New Zealand

Protective effects of eating vegetables and fruit …

consume WHOLE vegetables and fruit

the MORE the better

the more VARIETY the better

the EARLIER the better

Recommended Intakes for Protective Effects

Quantity and Variety

Dose-Response

intake risk

‘Extra 50g vegs and fruit each day could cut risk of premature death by 20%’ (EPIC)

Exposure period

High consumption of V & Fshould begin in childhood

‘Women consuming at least 2.5 serves daily of V & F as adolescents were 46% less likely to develop ovarian cancer’ (Fairfield et al, 2001)

Burden of Disease

Burden of disease is the amount of ill health and disability attributable to a given factor

‘Inadequate intake of vegetables and fruit accounts for around 3% of the total burden of disease in Australia*’ (Mathers et al 2000)

*compared to 2% from alcohol and 10% from tobacco – note, 3% is very likely to be an underestimate of the true burden of disease related to inadequate vegetable and fruit consumption

Burden of disease attributable to inadequate V & F consumption,

Australia, 1995

Persons

Deaths

YLL

YLD

DALYs

Number Per Cent

4 057 3.2

55 963 4.2

12 114 1.0

98 077 2.7Source: AIHW 1999(Mathers et al 2000)

Most of the burden of disease is attributable to cancers and cardiovascular disease

Burden of cancer related to inadequate V & F consumption

(in Australia, 1995)

Inadequate V & F consumption accounts for 11% of the total cancer burden

Low V intake (<4 serves/day) accounts for 17% of risk of colorectal cancer, 9% lung and prostate cancer, 2% breast cancer (Marks et al 2001)

Total health care costs associated with low consumption of vegetables for these 4 cancers is $59 million per year

Increasing average V intake by one serve/day would potentially save the health care system $24 million/year for cancer treatment costs alone

Consumption Recommendations

Australian Dietary Guidelines 2003(children, adolescents, adults and older people)

‘Eat plenty of …. vegetables (including legumes) and fruit’

Minimum daily serves:

5 vegetables and 2 fruit

Consumption Recommendations

Australian Guide to Healthy Eating

– how many serves?

Vegetables FruitAdults 4 - 8 2 - 4

Children (4-7 yrs) 2 - 4 1 - 2

Children (8-11yrs) 3 - 5 1 - 2

Adolescents (12-18yrs) 4 - 9 3 - 4

Note - AGHE includes fruit juice and potatoes as part of the recommended serves, some other guides exclude these items

How much do we eat?

Two main surveys in the last decade:

• National Nutrition Survey,1995 (n=2881for NSW)– 24 hr recall, FFQ and short questions

• NSW Health Surveys (1997/1998 in this report)

– Short questions (n=35,025 adults in 97/98)

Usual consumption of VEGETABLES by FEMALES - results of 2 surveys

NNS 1995 and NSW HS 1997/98

22.1

56.6

22.2

31.2

47.6

21.2

0

10

20

30

40

50

60

70

1 or less 2-3 serves 4 or more

Number of serves

%

NNS NSW HS

Usual consumption of VEGETABLES by MALES - results of 2 surveys

NNS 1995 and NSW HS 1997/98

28.5

57.3

13.3

42.4 40.7

16.9

0

10

20

30

40

50

60

70

1 or less 2-3 serves 4 or more

Number of serves

%

NNS NSW HS

Usual consumption of FRUIT by FEMALES - results of 2 surveys

NNS 1995 (NSW) and NSW HS 1997/98

7.5

44.743.049.3

7.0

48.4

0

10

20

30

40

50

60

70

1 or less 2-3 serves 4 or more

Number of serves

%

NNS NSW HS

Usual consumption of FRUIT by MALES - results of 2 surveys

NNS 1995 (NSW) and NSW HS 1997/98

57.6

35.4

6.3

60.5

32.2

7.3

0

10

20

30

40

50

60

70

1 or less 2-3 serves 4 or more

Number of serves

%

NNS NSW HS

Proportion of adult MALES consuming serves of VEGETABLES (per day) in NSW,

by AGE (NSW HS 1997/98)

0

5

10

15

20

25

30

35

40

< 1 1<2 2<3 3<4 4<5 5+

number of serves

% c

on

sum

ing

All

18-24

25-34

35-44

45-54

55-64

65-74

75+

Proportion of adult FEMALES consuming serves of VEGETABLES (per day) in NSW, by

age (NSW HS 1997/98)

0

5

10

15

20

25

30

35

40

< 1 1<2 2<3 3<4 4<5 5+

number of serves

% c

on

sum

ing

All

18-24

25-34

35-44

45-54

55-64

65-74

75+

Proportion of adult MALES consuming serves of FRUIT (per day) in NSW, by age

(NSW HS 1997/98)

0

5

10

15

20

25

30

35

40

< 1 1<2 2<3 3<4 4<5

number of serves

% c

on

sum

ing

All

18-24

25-34

35-44

45-54

55-64

65-74

75+

Proportion of adult FEMALES consuming serves (per day) of FRUIT in NSW, by age

(NSW HS 1997/98)

0

5

10

15

20

25

30

35

40

45

< 1 1<2 2<3 3<4 4<5

number of serves

% c

on

sum

ing

All

18-24

25-34

35-44

45-54

55-64

65-74

75+

Mean serves of VEGETABLES consumed by male and female adults in NSW, by age

(NSW HS 1997/98)

2.22.1

2.4 2.42.5

2.42.5

2.1

2.3

2.5

2.7

2.9

2.7

2.4

2.02.0

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

All 18-24 25-34 35-44 45-54 55-64 65-74 75+

Age (years)

Me

an

nu

mb

er

of

se

rve

s

Males

Females

Mean serves of FRUIT consumed by male and female adults in NSW, by age

(NSW HS 1997/98)

1.6

1.41.5

1.6 1.61.7 1.7

1.6 1.61.7

1.9 1.9 1.9 1.9

1.6

1.8

0.0

0.5

1.0

1.5

2.0

2.5

All 18-24 25-34 35-44 45-54 55-64 65-74 75+

Age (years)

Me

an

nu

mb

er

of

se

rve

s

Males

Females

VEGETABLE consumption in Central Coast AHS compared to NSW overall (NSW HS 1997/98)

0

5

10

15

20

25

30

35

40

<1 1<2 2<3 3<4 4<5 5+

Number of serves

% c

on

su

min

g

CC MalesNSW MalesCC femalesNSW females

FRUIT consumption in Central Coast AHS compared to NSW overall (NSW HS 1997/98)

0

5

10

15

20

25

30

35

40

<1 1<2 2<3 3<4 4+

Number of serves

% c

on

sum

ing

CC Males

NSW Males

CC females

NSW females

Serves of vegetables usually eaten each day by adolescents in NSW - results of 2 surveys

0

10

20

30

40

50

60

do noteat vegs

1 or less 2-3 4-5 6 ormore

notstated

Number of serves

% c

on

sum

ing

NNS 1995 NSWsub-sample (12-19 years) Boys

NNS 1995 NSWsub-sample (12-19 years) Girls

NSW ASSADsurvey 1996 (12-17 years) Boys

NSW ASSADsurvey 1996 (12-17 years) Girls

Serves of fruit usually eaten each day by adolescents in NSW - results of 2 surveys

0

10

20

30

40

50

60

do noteat fruit

1 orless

2-3 4-5 6 ormore

notstated

Number of serves

% c

on

sum

ing

NNS 1995 NSWsub-sample (12-19 years) Boys

NNS 1995 NSWsub-sample (12-19 years) Girls

NSW ASSADsurvey 1996 (12-17 years) Boys

NSW ASSADsurvey 1996 (12-17 years) Girls

N.b. 4 is the largest ‘number of serves’ category in the NNS

Is there a trade-off in consumption of vegetables for fruit (or vice versa) in adolescents? NO - those that have low vegetable consumption generally consume

small amounts of fruit, those that have high vegetable consumption consume large amounts of fruit

Vegetables, serves per day

33262418>6

122449154-5

51349332-3

4733561 or lessFruit, serves per day

>64-52-31 or less

Cross-tabulation of V & F serves usually eaten each day* (vegetables as a % of fruit category)

*ASSAD – Australian School Students’ Alcohol and Drugs Survey 1996

DIFFERENT TYPES of FRUIT consumed by ADULTS in NSW (mean serves/capita/day)

(1995 NNS NSW sub-sample)

0.00

0.10

0.20

0.30

pomme berry citrus stone tropical driedfruit

other

Mea

n se

rves

/cap

ita/d

ay

Males

Females

DIFFERENT TYPES of VEGETABLES consumed by ADULTS in NSW (mean serves/per capita/day)

(1995 NNS NSW sub-sample)

0.00

0.25

0.50

0.75

1.00

1.25

1.50

pota

toes

bras

sicae

carro

t

leaf &

sta

lk

peas

&bean

s

tomat

o

othe

r fru

iting

veg

legum

esot

her

Mea

n se

rves

/cap

ita/d

ay

Males

Females

DIFFERENT TYPES of FRUIT consumed by BOYS aged 2-18 years in NSW (mean serves/capita/day)

(1995 NNS NSW sub-sample)

0.0

0.1

0.2

0.3

0.4

0.5

pomme citrus stone tropical driedfruit

other

mea

n se

rves

/cap

ita/d

ay

2-7 years

8-11 years

12-18 years

DIFFERENT TYPES of FRUIT consumed by GIRLS aged 2-18 years in NSW (mean serves/capita/day)

(1995 NNS NSW sub-sample)

0.0

0.1

0.2

0.3

0.4

0.5

pomme citrus stone tropical driedfruit

other

mea

n se

rves

/cap

ita/d

ay

2-7 years

8-11 years

12-18 years

DIFFERENT TYPES of VEGETABLES consumed by BOYS aged 2-18 years in NSW

(mean serves/capita/day) (1995 NNS NSW sub-sample)

0.00.2

0.40.60.8

1.01.2

1.41.6

me

an

se

rve

s/ca

pita

/da

y

2-7 years

8-11 years

12-18 years

DIFFERENT TYPES of VEGETABLES consumed by GIRLS aged 2-18 years in NSW

(mean serves/capita/day) (1995 NNS NSW sub-sample)

0.00.2

0.40.6

0.81.0

1.21.4

1.6

me

an

se

rve

s/ca

pita

/da

y

2-7 years

8-11 years

12-18 years

Fruit consumption – Vulnerable Sub-groups

Sub-groups likely to consume low or very low amounts of fruit:

Men (most age groups compared to women) Women in the most disadvantaged

socioeconomic areas Indigenous women Men, particularly, and women living in very

remote areas

Vegetable consumption

– Vulnerable Sub-groups

• For each age group, women consume more vegetables than men

• Vegetable consumption is lowest in men 18-44 years and women 18-24 years

• Vegetable consumption does not appear to be affected by socioeconomic status, degree of remoteness, or indigenous status (although variety of vegetables consumed might - no data available)

Factors Contributing to Inadequate Consumption

Knowledge and Attitudes

• People know V & F are good for them but do not know of specific health problems (except cancers) from not eating enough

• Most people think they are eating enough V & F, although about 33% males and females under 45 years would like to increase their V & F consumption (NNS)

• It’s easier to increase fruit consumption – snacks

• Consumers are not interested in longer-term health benefits of V & F consumption, more interested in immediate benefits, eg energy, boosted immune system

Factors Contributing to Inadequate Consumption

Access and Supply

• 23% of people in a WA survey reported lack of variety and poor quality as the main barrier to increasing fruit intake (14% for vegetables)

• 7% of people said high cost is the main barrier to increasing vegetable consumption, 16% said fruit is too expensive

• Lack of availability of fruit and vegetables in the workplace, retail, and institutional settings was a barrier

Conclusions

Current consumption levels are well below those recommended, across all ages, for both sexes and especially for

some population sub-groups

Conclusions

Data from two surveys* show that 80% of men and women eat less than the recommended serves of (five) vegetables per day, and 50%

eat less than the recommended serves of (two) fruit per day in NSW

* 1995 National Nutrition Survey, 1997/98 NSW Health Survey

Conclusions

The variety of vegetables and fruits consumed is limited

Conclusions

The report highlights the importance of increasing consumption levels of a

variety of vegetables and fruit in NSW (across all ages and consumption

levels), and provides a sound basis for further investment in order to achieve

health benefits

Recommendations

• Continue to monitor V & F consumption through NSW health surveys – include a special module on V & F consumption

• Questions should cover types of vegetables and fruit

• Develop methods to assess key aspects of access and supply of V & F in NSW

Recommendations

• At local/regional level consider use of a scanning tool to gather information on the sales of V & F

• Conduct economic analyses of health care costs associated with inadequate intake of V & F for NSW

• Extend efforts to promote consumption of V & F