ArticlePDF Available

How much is ‘5-a-day’?: consumer knowledge of fruit and vegetable portion sizes

Authors:
Ciara Rooney at Queen's University Belfast
Ciara Rooney
Michelle C Mckinley at Queen's University Belfast
Michelle C Mckinley
Katherine Appleton at Bournemouth University
Katherine Appleton
Ian Young at Queen's University Belfast
Ian Young
Show all 11 authorsHide
Download full-text PDF
Read full-text
Download citation
Content uploaded by Michelle C Mckinley
Author content
All content in this area was uploaded by Michelle C Mckinley on Jul 17, 2014
Content may be subject to copyright.
Irish Section Meeting, 19–21 June 2013, Childhood nutrition and obesity: current status and future challenges
How much is ‘5-a-day’?: consumer knowledge of fruit and
vegetable portion sizes
C. Rooney
1
, M. C. McKinley
1
, K. M. Appleton
2
, I. S. Young
1
, A. J. McGrath
1
, C. R. Draffin
1
,
S. Bhattacharya
1
, L. L. Hamill
1
, S. E. C. M. Gilchrist
1
, C. E. Neville
1
and J. V. Woodside
1
1
Nutrition and Metabolism Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, UK,
BT12 6BJ and
2
School of Psychology, David Keir Building, Queen’s University Belfast, UK, BT7 1NN
Research has shown that a diet rich in fruit and vegetables (FV) may provide protection against certain chronic illnesses including
cardiovascular diseases
(1)
. Based on such evidence, the World Health Organisation set a minimum daily target of 400 g FV (the equivalent
of five 80 g portions), which has been termed the ‘5-a-day’ public health message in the UK. Despite this, evidence shows that people in
Northern Ireland still have an insufficient intake of FV
(2)
. A number of studies have proposed that knowledge is an important factor
affecting FV intake and adherence to nutritional guidelines
(3)
. However, to date there is minimal research on the level of knowledge
consumers have on FV portion sizes, which could be an important determinant in adherence to the ‘5-a-day’ message. Hence, the
objective of the current study was to assess the knowledge of FV portion sizes in a sample of low FV consumers (O2 portions/day).
The study sample was comprised of 30 low FV consumers who were recruited to take part in a FV dietary intervention. Participants
completed a questionnaire at baseline which assessed knowledge of four key areas: awareness of FV guidelines; identification of foods
which are classified as a fruit or vegetable according to the ‘5-a-day’ message; portion sizes of commonly consumed FV; and total
portions provided by a combination of FV (to reflect normal dietary patterns). Descriptive statistics were used to analyse questionnaire
responses. Spearman’s Rank Correlation Coefficients and Mann-Whitney U Tests were used to examine associations between knowledge
scores and demographic variables, as well as to establish if BMI correlated with under or over-estimation of portion size.
Results from the questionnaire identified knowledge gaps in two of the four areas assessed (see table below). All participants (n=30)
claimed to be aware of FV guidelines and scored well when asked to identify foods that are classified as FV. Respondents did not score as
well when asked to estimate how many portions examples of FV counted as according to the ‘5-a-day’ message, individually or for FV
combinations. Neither total, nor subscale, knowledge scores were significantly associated with habitual FV intake (all p>0.05). Further-
more, knowledge scores were not associated with other demographic variables including age, years of education, gender or BMI
(all p>0.05). In 73% of cases, individuals’ perception of how many portions different amounts of FV equated to was greater than in the
‘5-a-day’ guidelines. There was no significant relationship between over/under estimating portions and BMI (p=0.40), but females were
more likely to overestimate portions (p=0.02). As correlations were weak, it was unnecessary to perform a multivariate test of effects.
Number of questionnaire
items per domain
Median Score Score as a %
Median IQR
1
Median IQR
1
Overall knowledge score 73
2
47.7 45.7, 49.0 65.1 62.7, 67.1
Subscales
Awareness of FV guidelines 1 1.0 1.0, 1.0 100 100, 100
Identifying FV 39 35.0 33.0, 38.0 91.0 84.6, 97.4
Portion sizes of individual FV 27 10.0 9.0, 12.0 37.0 33.3, 44.4
Portion sizes of combinations of FV 7 1.5 1.0, 3.0 21.4 14.3, 42.9
1
IQR; Interquartile Range.
2
Awareness of FV guidelines was not included in FV portion size knowledge score.
In conclusion, this study suggests that whilst consumers are aware of FV guidelines, they lack knowledge on FV portion size. The
results indicate that consumers might underestimate the amount of FV required to achieve the ‘5-a-day’ guidelines.
1. Dauchet L, Amouyel P, Herchberg S et al. (2006) J Nutr 136, 2588–2593.
2. Scarborough P, Morgan RD, Webster P et al. (2011) BMJ Open 1, 1–7.
3. Shaikh A, Yaroch R, Nebeling L (2008) Am J Prev Med 34, 535–543.
Proceedings of the Nutrition Society (2013), 72 (OCE3), E132 doi:10.1017/S0029665113001559
... When the public health benefits of fruit and vegetable consumption are so clear, it may seem strange that uptake falls short of the recommended amounts. This may partly be explained by a lack of clarity and understanding as to what a portion comprises (16,17). This is not helped in the UK by the confusing labelling used by different supermarkets for the same product in different formats and packaging sizes (18). ...
Horticulture in the UK
Technical Report
Full-text available
  • Mar 2016
Public health analysis suggests that many lives can be saved if the UK population actually followed dietary guidelines on fruit and vegetable daily intake. The Government’s Eatwell Plate suggests that more than a third of UK daily diets should comprise fruit and vegetables and yet currently less than a quarter of diets are taken from this source. A UK debate on the status of the horticultural industry and its potential to meet a recommended increase in consumption is long overdue. This paper, largely based on secondary sources of data, presents current national levels of fruit and vegetable production and consumption. It outlines the origins of what horticultural produce is consumed here and the potential for meeting demand should diets adapt to those suggested by government guidelines. The Briefing provides a summary of key facts on UK horticulture based on information that is publicly available. An FRC seminar is planned to take account of non-documented industry views in order to complete or correct the picture presented here but our current objective is to outline the situation as it appears from published data: • There has been a big decline in area given to horticultural production. From 1985 to 2014, there has been a decline of 27% for fruit and vegetables combined. The area growing vegetables has declined by 26% and the area growing fruit by 35%. • Fruit and vegetables are by far the greatest source of imports in the UK food system. The trade gap in horticulture has risen to £7.8 billion a year, about 37% of the UK’s total food trade gap of £21 billion in 2014. Although some growers have extensive growing operations in Southern Europe and further afield, this makes sense for them as commercial enterprises but still does not resolve the serious lack of UK horticultural output. This is important to meet the 21st century challenge of increasing production for health everywhere and to ensure that rich consumer societies do not excessively distort international trade for their purposes. • Some imports (e.g. pineapples, avocados) could not be grown in the UK (or not yet) but others which could be UK grown (e.g. brassicas, mushrooms, lettuce) have seen massive drops in production. • The proportion of the adult population (over 16 years) in the UK consuming five or more portions of fruit and vegetables per day stood at only 26% in 2013. • Only 16% of children achieved an intake of 5-a-day or more in 2013. • The Consumer Price Index for food items as a whole has shown a significant increase of 35% in 2007-2013. Within this, the price of vegetables has increased by 27% and fresh fruit by 26%, less than the average for the food sector as a whole. • Horticulture is unevenly distributed across the country, partly for climatic reasons, but areas that used to have sizeable sectors (e.g. the South West) have seen a heavy decline. A ‘re-boot’ of regional strategies is overdue to incorporate a review of planning and financial regulations and to rebuild bioregional resilience where appropriate. • Land used for horticulture is highly productive. Only 3.5% of UK croppable land is down to horticulture, yet producing £3.7 billion worth of produce. For every one hectare of land under fruit and vegetables, 4.5 hectares are used for wheat for animal feed- with the inevitably slower and less efficient energy conversion rates. • Horticultural wages for seasonal workers are low, not helped by the abolition of the Agricultural Wages Board. Horticulture occupies only 2% of the farmed area in England yet employs 12% of the agricultural labour force and at least 35% of the UK’s casual farm labour force. The Briefing makes a series of recommendations: • The Government (DEFRA) forthcoming 25 year Food Strategy should apply a ‘health lens’ to its proposed focus on ‘Brand Britain’ • Government, growers, land use specialists, industry and regional bodies should begin to plan the infrastructure needed for a massive reinvestment in, and policy support for, horticulture. • Both academics and civil society should examine the scope for encouraging demand for more home produced, sustainable horticulture and higher consumption of fruit and vegetables in the UK • Public health and environmental analysts should work more clearly on how to narrow the gap between supply of, and demand for, fruit and vegetables. Modelling studies as well as practical investigations should be funded. • A new research strand should be set up by the Government Research Councils into how to build demand for more sustainable home production. • A new more unified voice between all parties is needed to champion the British horticultural sector; this lack should be the subject of a joint inquiry by the Parliamentary Health, Environmental Audit and Environment, Food & Rural Affairs Committees.
View
Chapter Four. UK Horticulture Production and National Dietary Guidelines
Article
Full-text available
  • Dec 2016
Public health analysis suggests that many lives can be saved if the UK population followed dietary guidelines on fruit and vegetable daily intake. The Government's Eatwell Plate recommends that more than a third of UK daily diets should comprise fruit and vegetables and yet currently less than a quarter of diets are taken from this source. A UK debate on the status of the horticultural industry and its potential to meet a recommended increase in consumption is long overdue.
View
View
Differences in coronary heart disease, stroke and cancer mortality rates between England, Wales, Scotland and Northern Ireland: The role of diet and nutrition
Article
Full-text available
  • Nov 2011
Introduction It is unclear how much of the geographical variation in coronary heart disease (CHD), stroke and cancer mortality rates within the UK is associated with diet. The aim of this study is to estimate how many deaths from CHD, stroke and cancer would be delayed or averted if Wales, Scotland and Northern Ireland adopted a diet equivalent in nutritional quality to the English diet. Methods Mortality data for CHD, stroke and 10 diet-related cancers for 2007–2009 were used to calculate the mortality gap (the difference between actual mortality and English mortality rates) for Wales, Scotland and Northern Ireland. Estimates of mean national consumption of 10 dietary factors were used as baseline and counterfactual inputs in a macrosimulation model (DIETRON). An uncertainty analysis was conducted using a Monte Carlo simulation with 5000 iterations. Results The mortality gap in the modelled scenario (achieving the English diet) was reduced by 81% (95% credible intervals: 62% to 108%) for Wales, 40% (33% to 51%) for Scotland and 81% (67% to 99%) for Northern Ireland, equating to approximately 3700 deaths delayed or averted annually. For CHD only, the mortality gap was reduced by 88% (69% to 118%) for Wales, 58% (47% to 72%) for Scotland, and 88% (70% to 111%) for Northern Ireland. Conclusion Improving the average diet in Wales, Scotland and Northern Ireland to a level already achieved in England could have a substantial impact on reducing geographical variations in chronic disease mortality rates in the UK. Much of the mortality gap between Scotland and England is explained by non-dietary risk factors.
View
Fruit and Vegetable Consumption and Risk of Coronary Heart Disease: A Meta-Analysis of Cohort Studies
Article
Full-text available
  • Oct 2006
The consumption of fruit and vegetables is associated with a reduced rate of coronary heart disease (CHD) in observational cohorts. The purpose of this study was to assess the strength of this association in a meta-analysis. Cohort studies were selected if they reported relative risks (RRs) and 95% CI for coronary heart disease or mortality and if they presented a quantitative assessment of fruit and vegetable intake. The pooled RRs were calculated for each additional portion of fruit and/or vegetables consumed per day, and the linearity of the associations were examined. Nine studies were eligible for inclusion in the meta-analysis that consisted of 91,379 men, 129,701 women, and 5,007 CHD events. The risk of CHD was decreased by 4% [RR (95% CI): 0.96 (0.93-0.99), P = 0.0027] for each additional portion per day of fruit and vegetable intake and by 7% [0.93 (0.89-0.96), P < 0.0001] for fruit intake. The association between vegetable intake and CHD risk was heterogeneous (P = 0.0043), more marked for cardiovascular mortality [0.74 (0.75-0.84), P < 0.0001] than for fatal and nonfatal myocardial infarction [0.95 (0.92-0.99), P = 0.0058]. Visual inspection of the funnel plot suggested a publication bias, although not statistically significant. Therefore, the reported RRs are probably overestimated. This meta-analysis of cohort studies shows that fruit and vegetable consumption is inversely associated with the risk of CHD. The causal mechanism of this association, however, remains to be demonstrated.
View
Psychosocial Predictors of Fruit and Vegetable Consumption in Adults:: A Review of the Literature
Article
  • Jul 2008
  • AM J PREV MED
Adequate fruit and vegetable intake has been found to promote health and reduce the risk of several cancers and chronic diseases. Understanding the psychological determinants of fruit and vegetable intake is needed to design effective intervention programs. Papers published in English from 1994 to 2006 that described the relationship between psychosocial predictors and fruit and vegetable intake in adults were reviewed. Studies and their constructs were independently rated based on the direction of significant effects, quality of execution, design suitability, and frequency. Methodology from the Guide to Community Preventive Services was used to systematically review and synthesize findings. Twenty-five psychosocial constructs spanning 35 studies were reviewed (14 prospective and 21 cross-sectional/descriptive studies). Strong evidence was found for self-efficacy, social support, and knowledge as predictors of adult fruit and vegetable intake. Weaker evidence was found for variables including barriers, intentions, attitudes/beliefs, stages of change, and autonomous motivation. The findings underscore the need to design future behavioral interventions that use strong experimental designs with efficacious constructs and to conduct formal mediation analyses to determine the strength of these potential predictors of fruit and vegetable intake.
View
  • Jan 2006
  • J NUTR
  • 2588-2593
  • L Dauchet
  • P Amouyel
  • S Herchberg
Dauchet L, Amouyel P, Herchberg S et al. (2006) J Nutr 136, 2588-2593.
  • Jan 2011
  • 1-7
  • P Scarborough
  • R D Morgan
  • P Webster
Scarborough P, Morgan RD, Webster P et al. (2011) BMJ Open 1, 1-7.
  • Jan 2008
  • 535-543
  • A Shaikh
  • R Yaroch
  • L Nebeling
Shaikh A, Yaroch R, Nebeling L (2008) Am J Prev Med 34, 535–543.