Sarah M Frank1, Jacqui Webster2, Briar McKenzie2, Pascal Geldsetzer3, Jennifer Manne-Goehler4, Glennis Andall-Brereton5, Corine Houehanou6, Dismand Houinato6, Mongal Singh Gurung7, Brice Wilfried Bicaba8, Roy Wong McClure9, Adil Supiyev10, Zhaxybay Zhumadilov10, Andrew Stokes11, Demetre Labadarios12, Abla Mehio Sibai13, Bolormaa Norov14, Krishna K Aryal15, Khem Bahadur Karki16, Gibson B Kagaruki17, Mary T Mayige17, Joao S Martins18, Rifat Atun3, Till Bärnighausen19, Sebastian Vollmer20, Lindsay M Jaacks3. 1. Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA. 2. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. 3. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA. 4. Massachusetts General Hospital, Boston, MA. 5. Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago. 6. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Atlantique, Benin. 7. Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan. 8. Direction de la Protection de la Santé de la Population, Ouagadougou, Kadiogo, Burkina Faso. 9. Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica. 10. National Laboratory Astana and University Medical Center, Nazarbayev University, Astana, Kazakhstan. 11. Center for Global Health and Development, Boston University School of Public Health, Boston, MA. 12. Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa. 13. American University of Beirut, Beirut, Lebanon. 14. National Center for Public Health, Ulaanbaatar, Mongolia. 15. DFID/NHSP3/MEOR, Abt Associates, Kathmandu, Nepal. 16. Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. 17. National Institute for Medical Research, Dar es Salaam, Tanzania. 18. Faculty of Medicine and Health Sciences, National University of East Timor, Rua Jacinto Candido, Dili, Timor-Leste. 19. Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany. 20. Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany.
Abstract
BACKGROUND: The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required. OBJECTIVES: The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation. METHODS: Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics. RESULTS: The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24-2.09). CONCLUSIONS: Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs.
BACKGROUND: The WHO recommends 400 g/d of fruits and vegetables (the equivalent of ∼5 servings/d) for the prevention of noncommunicable diseases (NCDs). However, there is limited evidence regarding individual-level correlates of meeting these recommendations in low- and middle-income countries (LMICs). In order to target policies and interventions aimed at improving intake, global monitoring of fruit and vegetable consumption by socio-demographic subpopulations is required. OBJECTIVES: The aims of this study were to 1) assess the proportion of individuals meeting the WHO recommendation and 2) evaluate socio-demographic predictors (age, sex, and educational attainment) of meeting the WHO recommendation. METHODS: Data were collected from 193,606 individuals aged ≥15 y in 28 LMICs between 2005 and 2016. The prevalence of meeting the WHO recommendation took into account the complex survey designs, and countries were weighted according to their World Bank population estimates in 2015. Poisson regression was used to estimate associations with socio-demographic characteristics. RESULTS: The proportion (95% CI) of individuals aged ≥15 y who met the WHO recommendation was 18.0% (16.6-19.4%). Mean intake of fruits was 1.15 (1.10-1.20) servings per day and for vegetables, 2.46 (2.40-2.51) servings/d. The proportion of individuals meeting the recommendation increased with increasing country gross domestic product (GDP) class (P < 0.0001) and with decreasing country FAO food price index (FPI; indicating greater stability of food prices; P < 0.0001). At the individual level, those with secondary education or greater were more likely to achieve the recommendation compared with individuals with no formal education: risk ratio (95% CI), 1.61 (1.24-2.09). CONCLUSIONS: Over 80% of individuals aged ≥15 y living in these 28 LMICs consumed lower amounts of fruits and vegetables than recommended by the WHO. Policies to promote fruit and vegetable consumption in LMICs are urgently needed to address the observed inequities in intake and prevent NCDs.
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