Miller, Victoria and Yusuf, Salim and Chow, Clara K and Dehghan, Mahshid and Corsi, Daniel J and Lock, Karen and Popkin, Barry and Rangarajan, Sumathy and Khatib, Rasha and Lear, Scott A and Mony, Prem and Kaur, Manmeet and Mohan, V and Vijayakumar, Krishnapillai and Gupta, Rajeev and Kruger, Annamarie and Tsolekile, Lungiswa and Mohammadifard, Noushin and Rahman, Omar and Rosengren, Annika and Avezum, Alvaro and Orlandini, Andrés and Ismail, Noorhassim and Lopez-Jaramillo, Patricio and Yusufali, Afzalhussein and Karsidag, Kubilay and Iqbal, Romaina and Chifamba, Jephat and Oakley, Solange Martinez and Ariffin, Farnaza and Zatonska, Katarzyna and Poirier, Paul and Wei, Li and Jian, Bo and Hui, Chen and Xu, Liu and Xiulin, Bai and Teo, Koon and Mente, Andrew (2016) Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet Global Health, 4 (10). e695. ISSN 2214109X
Background Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and affordability. Methods We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity and non-sale prices of fruits and vegetables from grocery stores and market places between Jan 1, 2009, and Dec 31, 2013. We determined the cost of fruits and vegetables relative to income per household member. Linear random effects models, adjusting for the clustering of households within communities, were used to assess mean fruit and vegetable intake by their relative cost. Findings Of 143 305 participants who reported plausible energy intake in the food frequency questionnaire, mean fruit and vegetable intake was 3·76 servings (95% CI 3·66–3·86) per day. Mean daily consumption was 2·14 servings (1·93–2·36) in low-income countries (LICs), 3·17 servings (2·99–3·35) in lower-middle-income countries (LMICs), 4·31 servings (4·09–4·53) in upper-middle-income countries (UMICs), and 5·42 servings (5·13–5·71) in high-income countries (HICs). In 130 402 participants who had household income data available, the cost of two servings of fruits and three servings of vegetables per day per individual accounted for 51·97% (95% CI 46·06–57·88) of household income in LICs, 18·10% (14·53–21·68) in LMICs, 15·87% (11·51–20·23) in UMICs, and 1·85% (−3·90 to 7·59) in HICs (ptrend=0·0001). In all regions, a higher percentage of income to meet the guidelines was required in rural areas than in urban areas (p<0·0001 for each pairwise comparison). Fruit and vegetable consumption among individuals decreased as the relative cost increased (ptrend=0·00040). Interpretation The consumption of fruit and vegetables is low worldwide, particularly in LICs, and this is associated with low affordability. Policies worldwide should enhance the availability and affordability of fruits and vegetables. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
|Divisions:||Department of Diabetology|
|Deposited By:||surendar radha|
|Deposited On:||13 Sep 2016 14:47|
|Last Modified:||13 Sep 2016 14:47|
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