1、外文文献 ： Fruit and Vegetables in the American Diet: Data from the NHANES 11 Survey BLOSSOM H. PArrERSON, MA, GLADYS BLOCK, PHD, WILLIAM F. ROSENBERGER, MPHIL,DAVID PEE, MPHIL, AND LISA L. KAHLE, BAAbstract Twenty-four hour dietary recall data from the Second National Health and Nutrition Examination S
2、urvey (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 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 n
3、umber of servings. An estimated 45 percent of the population had no 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 recommended by the US
4、 Departments of Agriculture 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 fruit contained about 17 grams of dietary fiber. Althou
5、gh caloric and fat intake increased with increasing servings of fruit and vegetables, the percent of calories from fat remained relatively constant. Although these data are 10 years old, more recent surveys have shown similar results. The discrepancy between dietary guidelines and the actual diet su
6、ggests a need for extensive public education. (Am J Public Health 1990; 80:1443-1449)IntroductionIn a recent article, it was found that a large proportion of the adult United States population eats no vegetables (0.17)or fruit (0.41) on any given day. The Surgeon Generals Report on Nutrition and Hea
7、lth2 recommends increasing consumption of vegetables and fruit. Based on a comprehensive literature review, the National Academy of Sciences(NAS) concluded that diet influences the risk of several major chronic diseases and recommended eating five or more daily servings of a combination of vegetable
8、s and fruit, especially green and yellow vegetables and citrus fruit.3 The US Department of Agriculture (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
9、of vegetables.45 These 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 maintaining desirable weight. It is important therefore to deter
10、mine 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 fat intake and maintenance of appropriate body weight. In the NHANES II data, collected between 1976 and 1980, it is possible to examine the
11、se relationships in self-selected diets that were actually consumed during a 24-hour 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 dete
12、rmine the number of servings consumed. In the present inquiry we estimate the number of servings consumed, taking 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.
13、 While it is obvious that intake 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. Similarly, the dietary fiber intake contained in diets
14、 including multiple servings of fruit and vegetables may be inadequately appreciated by the general public.Methods The NHANES II survey was conducted by the National Center for Health Statistics between 1976 and 1980.6A highly stratified multi-stage probability design was used to obtain a representa
15、tive sample of the civilian no institutionalized population, ages six months to 74 years; 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, permittin
16、g inference about the total Black and White noninstitutionalized US population.7 Group means and standard errors were calculated using software appropriate for complex sample survey data.8 Standard errors are frequently large for Blacks, due to their small number in the survey. Therefore, results fo
17、r Blacks should be viewed with caution. Conversely, standard errors for Whites are small due to the very large sample size, so that small differences in intake, while not biologically meaningful, could be statistically significant. Dietary interviews were conducted by interviewers with a knowledge o
18、f food preparation and nutrient composition. A measure of portion size 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 recall days
19、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 reported portion sizes, the number of grams consumed was calculated and included on the 24-hour recall tape for
20、 each food reported by each respondent. We converted the number of grams reported for each fruit and vegetable into a number of servings as follows. We used as a guide suggested serving sizes given by a food guidance system developed to help implement the USDA/DHHS dietary guidelines.5 For fruits, a
21、 serving is defined as an average piece of whole fruit or six ounces of fruit juice, and for vegetables, one-half cup, cooked or raw. An examination of a sample of actual food records showed that some reported amounts of fruit or vegetables, such as a slice of onion on a hamburger, or lemon juice ad
22、ded to tea, were too small to be considered a serving, while others were so large that theyshould be considered as more than a single serving. We chose a lower limit of one ounce (30 grams) for any serving of a fruit or vegetable, and two ounces (62 grams) for fruit juice. Small lower limits on a si
23、ngle serving were chosen so as not to eliminate portions consumed by persons with small appetites. This choice may result in some overestimation of the pro- portions eating one or more servings on the recall day. We chose an upper limit for a single serving so that a large portion (eaten on a single
24、 occasion) would be treated as more than a single serving. A single portion of a fruit or vegetable was considered to be at most two servings so as not to overestimate the number of servings of big eaters. Juice consumed on a single eating occasion was considered (at most) three servings. In order t
25、o convert a large portion of whole fruit or vegetables into two servings, we determined a representative or typical number of grams in a half cup serving of vegetables, and the weight of an average piece of fruit, using weights given for the most popular vegetables and fruits in Agriculture Handbook
26、 No. 456. 12 A half cup serving Of many vegetables weights about 75 grams, and many whole fruits weigh roughly 120 grams. We defined as two servings any portion of vegetables (except salad) weighing 150 grams or more, and any portion of fruit (excluding fruit juice) weighing 240 grams or more. For f
27、ruit juice, individualsconsuming between 12 and 18 ounces (372 to 557 grams) were given credit for two servings of fruit, and those consuming 18 or more ounces (558 or more grams) were given credit for three servings. An individual eating a green salad on a single occasion was given credit for a sin
28、gle serving rather than for multiple servings corresponding to each ingredient. Thus individuals could be credited with a maximum of one salad per eating occasion, or a maximum of the four different occasions per day coded in the survey. Individual foods included in each food category are givenelsew
29、here.1 Vegetables include potatoes, dried peas and beans (e.g., black-eyed peas, kidney beans), green salad(primarily lettuce and raw tomatoes), as well as all other vegetables not falling into one of these categories. This last group is designated garden vegetables and includes, for example, green
30、beans, corn, and broccoli. Fruit refers to whole fruit and fruit juice. In this article, fruit juices include citrus and other natural fruit juices, but exclude both fortified and non-fortified fruit drinks. A list is available from the authors on request. We report mean nutrient intake by number of
31、 servings(0, 1, 2, 3 or more) of fruit cross-classified by number ofservings of vegetables. Nutrient intake was calculated by the National Center for Health Statistics, using USDA nutrient data, updated 1980. Because consumption of fruit and vegetables is associated with age, sex, and race,1 we cont
32、rolled for these factors in each cell of the crossclassification tables using a method equivalent to direct standardization. This method for finding means and the corresponding variance estimates, adjusted for age, race, and sex, is given in the Appendix. The method uses regression coefficients to o
33、btain estimates of means.Results Because the NHANES II data were collected before the recommendations above were issued, they do not reflect their impact; rather the guidelines are used as a standard against which to describe the diet. In the spirit of both the USDA/DHHS and NAS guidelines, we defin
34、e three or more servings Of vegetables and two or more servings of fruit as meeting the vegetable and fruit guidelines, respectively. The proportions meeting these guidelines are shockingly small (Table 1). On the recall day, 27 percent met the vegetable guidelines and 29 percent met the fruit guide
35、lines, while only 9 percent met both. In general, proportions were highest among older Whites but, even in this group, fewer than one-third ate the recommended servings of vegetables, and fewer than half ate the recommended servings of fruit. More men had adequate numbers of servings of vegetables t
36、han did women; the opposite was true for fruit. About two-thirds as many Blacks as Whites met these guidelines. Only about 5 percent of Black women and 7 percent of Black men consumed the recommended numbers of both fruit and vegetable servings. Eleven percent ate neither fruit nor vegetables on the
37、 recall day, 45 percent had no servings of fruit, and 22 percenthad no servings of a vegetable (Table 2). In contrast to the five or more servings of fruit and vegetables recommended, zero or one serving might be considered clearly inadequate. Thirty-five percent of Black adults and 27 percent of Wh
38、ite adults had at most one serving of a food in the fruit/vegetable food group (data available from author on request). Mean numbers of servings of fruit (1.08, SE = .03) and vegetables (1.77, SE = .02) were far below recommended levels and were lower for Blacks than for Whites (data available from
39、author on request). Mean vegetable intake wassomewhat higher for males than females; the opposite was true 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 s
40、erving of garden vegetables was eaten by 43 percent ofthe 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 declined with age, while those consuming non-fried potatoes inc
41、reased (data available on request to author). Dried peas and beans, good sources of fiber, wereeaten by only about 10 percent of the population. About half the population consumed no servings or only one serving of a vegetable (Figure 1). Among those who reported only one serving of a vegetable, sal
42、ad was the most popular, reported by 39 percent. Twenty-nine percent consumed a 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
43、, 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, 27 percent had juice only, and 45 percent had whole fruit only (data available o
44、n request to author). Table 4 shows average intake of dietary fiber, vitamin A, and vitamin C among persons consuming various numbers ofservings of fruit and vegetables. These nutrient levels represent dietary intake from all food sources, but exclude vitamin supplements. Persons who consumed neithe
45、r fruit nor vegetables had, on average, only 5.6 grams of 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 of fruit and vegetables
46、 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 fiber. The recommended level of fiber intake was achieved only by those who had three or more servings
47、of both fruit and vegetables, a group representing only 4 percent of the US adult population. In the United States, it is estimated that the usual foods available to consumers provide about half of the total vitamin A activity in the diet as provitamin A carotenoids, found in plant products, and the
48、 other half as retinol. 14 Among those eating 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 were associated with mean vitamin A intake
49、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 or 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 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
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