National Nutrition Month --- March 2007

March is National Nutrition Month. A healthy diet is high in fruits and vegetables, and evidence indicates that eating more fruits and vegetables can lower a person's risk for chronic diseases such as certain cancers and cardiovascular disease (1). Healthy People 2010 objectives include increasing the proportion of persons who eat adequate amounts of fruit and vegetables every day (objectives 19-5 and 19-6) (2).

In March, the Produce for Better Health Foundation, a nonprofit consumer education organization, introduced the Fruit & Veggies --- More Matters health initiative, which provides nutritional information, cooking advice, and shopping tips to help members of the public increase consumption of fruits and vegetables. CDC, the foundation, and other partners are collaborating through research, education, and environmental and policy strategies to encourage persons in the United States to eat more fruits and vegetables. Additional information on National Nutrition Month is available at http://www.eatright.org/ and on the Produce for Better Health Foundation's health initiative at http://www.fruitsandveggiesmorematters.org/. Information regarding 5 A Day for Better Health, a CDC-led program (including several public and private partners) to increase fruit and vegetable consumption, is available at http://www.5aday.gov/.

Fruit and Vegetable Consumption Among Adults --- United States, 2005

A diet high in fruits and vegetables is associated with decreased risk for chronic diseases (1). In addition, because fruits and vegetables have low energy density (i.e., few calories relative to volume), eating them as part of a reduced-calorie diet can be beneficial for weight management (2). Healthy People 2010 health objectives include increasing to 75% the percentage of persons aged >2 years who eat at least two daily servings* of fruit (objective 19-5) and increasing to 50% the proportion of persons aged >2 years who eat at least three daily servings of vegetables, with at least one third being dark green or orange vegetables (objective 19-6) (3). To assess the level of fruit and vegetable consumption among adults by state and demographic characteristics, data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. This report describes the results of that analysis, which indicated that 32.6% of adults consumed fruit two or more times per day and 27.2% ate vegetables three or more times per day. The results underscore the need for continued interventions that encourage greater fruit and vegetable consumption among U.S. adults.

BRFSS is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized, U.S. civilian population aged >18 years. BRFSS data are used to provide information regarding health behaviors that relate to the leading causes of death among U.S. adults and to monitor state progress toward health objectives. BRFSS data are weighted to the respondents' probabilities of being selected and to the age-, race/ethnicity-, and sex-specific populations from annually adjusted census reports in the state. In 2005, response rates^† among the states ranged from 34.6% to 67.4% (median: 51.1%) when calculated by the guidelines of the Council of American Survey and Research Organizations. Cooperation rates^§ ranged from 58.7% to 85.3% (median: 75.1%). City- and county-level 2005 data on health behaviors, including consumption of fruits and vegetables, for more than 153 cities are available as part of the BRFSS Selected Metropolitan/Micropolitan Area Risk Trends project.

The BRFSS module on fruits and vegetables included six questions that were preceded by the following statement: "These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth." The six questions were as follows: 1) "How often do you drink fruit juices such as orange, grapefruit, or tomato?" 2) "Not counting juice, how often do you eat fruit?" 3) "How often do you eat green salad?" 4) "How often do you eat potatoes, not including French fries, fried potatoes, or potato chips?" 5) "How often do you eat carrots?" 6) "Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat? (Example: a serving of vegetables at both lunch and dinner would be two servings.)" Participants were not given a definition of serving size. Total daily fruit consumption was calculated based on responses to questions 1 and 2, and total daily vegetable consumption was based on responses to questions 3--6. The percentage of adults who consumed fruit two or more times per day and vegetables three or more times per day was calculated for the overall population and by selected characteristics. To calculate consumption in times per day, weekly frequencies were divided by seven, monthly frequencies were divided by 30, and yearly frequencies were divided by 365. To be consistent with past analyses, the answer to question 6 was treated as times per day.

Data from all 50 states and the District of Columbia (DC) were included. A total of 347,278 persons completed the interview. After excluding persons who did not report selected demographic or behavioral risk-factor information (n = 38,317), persons who did not answer all six questions in the fruit and vegetable module (n = 14,179), and persons who reported consumption of fruits and vegetables >25 times per day (an unlikely frequency of consumption) (n = 61), 305,504 persons were included in the final sample.

In 2005, approximately 32.6% of the U.S. adult population surveyed consumed fruit two or more times per day, and 27.2% ate vegetables three or more times per day. The prevalence of consuming fruit two or more times per day was 28.7% among women and 36.4% among men. By age, prevalence of consuming fruit two or more times per day ranged from 27.9% among persons aged 35--44 years to 45.9% among persons aged >65 years. Among racial/ethnic populations, Hispanics had the highest prevalence (37.2%) of consuming fruit two or more times per day, and non-Hispanic whites had the lowest prevalence (31.2%). College graduates had the highest level of fruit consumption (37.4%) compared with lower levels of education, as did persons who earned >$50,000 per year (32.4%) compared with those who earned less. Persons who were not overweight or obese (i.e., body mass index [BMI] <25) had the highest prevalence of consuming fruit two or more times per day (36.0%), and obese persons (BMI >30) had the lowest prevalence (28.1%).

The prevalence of eating vegetables three or more times per day was 22.1% among men and 32.2% among women and ranged from 20.9% among persons aged 18--24 years to 33.7% among persons aged >65 years. Among racial/ethnic populations, whites had the highest prevalence (28.6%) of eating vegetables three or more times per day, and Hispanics had the lowest prevalence (20.4%). College graduates had the highest level of vegetable consumption (33.3%) compared with lower education levels, as did persons earning >$50,000 per year (30.3%) compared with those earning less. Persons who were not overweight or obese had the highest prevalence of eating vegetables three or more times per day (28.9%), and overweight persons had the lowest prevalence (26.0%).

Twenty-six states reported that >30% of the adults consumed fruit two or more times per day, and 10 states reported that >30% of adults ate vegetables three or more times per day . By state, the prevalence of eating fruit two or more times per day ranged from 19.2% to 37.8%, and the prevalence of eating vegetables three or more times per day ranged from 20.9% to 39.0%. No state reached the Healthy People 2010 national objectives for fruit and vegetable consumption.

Reported by: HM Blanck, PhD, DA Galuska, PhD, C Gillespie, MS, L Kettel Khan, PhD, MK Serdula, MD, MK Solera, MS, Div of Nutrition and Physical Activity; AH Mokdad, PhD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion; LP Cohen, MD, EIS Officer, CDC.

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