CPHN Presenting Nutrition Series ‘Report on the consumption of vegetables and fruit in NSW : 2003’

1. CPHNPresenting Nutrition Series‘Report on the consumption of vegetables and fruitin NSW : 2003’ Authors: Debra Hector Liz Story Vicki Flood

2. Presenting Nutrition SeriesIntroduction for Users The presentations are designed to assist professionals throughout NSW disseminate information on public health nutrition Each presentation is based on an existing CPHN report Users are requested to provide full acknowledgement of the authors, CPHN and the Department of Health Notes version of the ppt gives table/figure and page numbers, for easy reference to the report Further information and explanation of each slide should be sought from the report. Visit http://www.cphn.biochem.usyd.edu.au Users should use Excel to prepare slides with data for other areas, modelled on the sample provided Any questions can be referred to Lesley King on 02 9351 8015.

3. 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

4. Conceptual framework for monitoring vegetables & fruit consumption Diet- related diseases/ conditions Biomedical risk factors Nutrient intakes Food and supplement consumption habits Food purchasing / acquisition F&N–related ‘literacy’ (knowledge, attitudes, beliefs) Food supply / community access Food / nutrition policy and action Adapted from: Webb K in Marks et al Monitoring food habits in the Australian population using short questions 2001

5. Association between V & F Intake and Chronic Disease – Evaluation of the Evidence Source: 5+A Day New Zealand Source: Adapted from Van Duyn and Pivonka 2000, 5+A Day New Zealand, Accessed Feb 22 2002

6. consume WHOLE vegetables and fruit Protective effects of eating vegetables and fruit … the MORE the better the more VARIETY the better the EARLIER the better

7. 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 & F should 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) Recommended Intakes for Protective Effects

8. 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

9. Burden of disease attributable to inadequate V & F consumption, Australia, 1995 Source: AIHW 1999(Mathers et al 2000) Most of the burden of disease is attributable to cancers and cardiovascular disease

10. 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 byone serve/daywould potentially save the health care system $24 million/year for cancer treatment costs alone

11. 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

12. Australian Guide to Healthy Eating – how many serves? Vegetables Fruit Adults 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 Consumption Recommendations

13. 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)

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

28. Cross-tabulation of V & F serves usually eaten each day* (vegetables as a % of fruit category) Vegetables, serves per day 1 or less 2-3 4-5 >6 Fruit, serves per day 1 or less 56 33 7 4 2-3 33 49 13 5 4-5 15 49 24 12 >6 18 24 26 33 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 *ASSAD – Australian School Students’ Alcohol and Drugs Survey 1996

35. 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

36. 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)

37. Factors Contributing to Inadequate ConsumptionKnowledge 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

38. Factors Contributing to Inadequate ConsumptionAccess andSupply • 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

39. ConclusionsCurrent consumption levels are well below those recommended, across all ages, for both sexes and especially for some population sub-groups

40. ConclusionsData 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

41. ConclusionsThe variety of vegetables and fruits consumed is limited

42. ConclusionsThe 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

43. 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

44. 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