Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels

findings from the Prospective Urban Rural Epidemiology (PURE) study

Victoria Miller, Salim Yusuf, Clara K. Chow, Mahshid Dehghan, Daniel J. Corsi, Karen Lock, Barry Popkin, Sumathy Rangarajan, Rasha Khatib, Scott A. Lear, Prem Mony, Manmeet Kaur, Viswanathan Mohan, Krishnapillai Vijayakumar, Rajeev Gupta, Annamarie Kruger, Lungiswa Tsolekile, Noushin Mohammadifard, Omar Rahman, Annika Rosengren & 19 others Alvaro Avezum, Andrés Orlandini, Noor Hassim Ismail, Patricio Lopez-Jaramillo, Afzalhussein Yusufali, Kubilay Karsidag, Romaina Iqbal, Jephat Chifamba, Solange Martinez Oakley, Farnaza Ariffin, Katarzyna Zatonska, Paul Poirier, Li Wei, Bo Jian, Chen Hui, Liu Xu, Bai Xiulin, Koon Teo, Andrew Mente

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)e695-e703
JournalThe Lancet Global Health
Volume4
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

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Vegetables
Fruit
Epidemiology
Canada
Costs and Cost Analysis
Guidelines
Food
Health
Ontario
Energy Intake
France
Germany
Cluster Analysis
Stroke
Organizations

ASJC Scopus subject areas

  • Medicine(all)

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Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels : findings from the Prospective Urban Rural Epidemiology (PURE) study. / Miller, Victoria; Yusuf, Salim; Chow, Clara K.; Dehghan, Mahshid; Corsi, Daniel J.; Lock, Karen; Popkin, Barry; Rangarajan, Sumathy; Khatib, Rasha; Lear, Scott A.; Mony, Prem; Kaur, Manmeet; Mohan, Viswanathan; Vijayakumar, Krishnapillai; Gupta, Rajeev; Kruger, Annamarie; Tsolekile, Lungiswa; Mohammadifard, Noushin; Rahman, Omar; Rosengren, Annika; Avezum, Alvaro; Orlandini, Andrés; Ismail, Noor Hassim; Lopez-Jaramillo, Patricio; Yusufali, Afzalhussein; Karsidag, Kubilay; Iqbal, Romaina; Chifamba, Jephat; Oakley, Solange Martinez; Ariffin, Farnaza; Zatonska, Katarzyna; Poirier, Paul; Wei, Li; Jian, Bo; Hui, Chen; Xu, Liu; Xiulin, Bai; Teo, Koon; Mente, Andrew.

In: The Lancet Global Health, Vol. 4, No. 10, 01.10.2016, p. e695-e703.

Research output: Contribution to journalArticle

Miller, V, Yusuf, S, Chow, CK, Dehghan, M, Corsi, DJ, Lock, K, Popkin, B, Rangarajan, S, Khatib, R, Lear, SA, Mony, P, Kaur, M, Mohan, V, Vijayakumar, K, Gupta, R, Kruger, A, Tsolekile, L, Mohammadifard, N, Rahman, O, Rosengren, A, Avezum, A, Orlandini, A, Ismail, NH, Lopez-Jaramillo, P, Yusufali, A, Karsidag, K, Iqbal, R, Chifamba, J, Oakley, SM, Ariffin, F, Zatonska, K, Poirier, P, Wei, L, Jian, B, Hui, C, Xu, L, Xiulin, B, Teo, K & Mente, A 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, vol. 4, no. 10, pp. e695-e703. https://doi.org/10.1016/S2214-109X(16)30186-3
Miller, Victoria ; Yusuf, Salim ; Chow, Clara K. ; Dehghan, Mahshid ; Corsi, Daniel J. ; Lock, Karen ; Popkin, Barry ; Rangarajan, Sumathy ; Khatib, Rasha ; Lear, Scott A. ; Mony, Prem ; Kaur, Manmeet ; Mohan, Viswanathan ; Vijayakumar, Krishnapillai ; Gupta, Rajeev ; Kruger, Annamarie ; Tsolekile, Lungiswa ; Mohammadifard, Noushin ; Rahman, Omar ; Rosengren, Annika ; Avezum, Alvaro ; Orlandini, Andrés ; Ismail, Noor Hassim ; Lopez-Jaramillo, Patricio ; Yusufali, Afzalhussein ; Karsidag, Kubilay ; Iqbal, Romaina ; Chifamba, Jephat ; Oakley, Solange Martinez ; Ariffin, Farnaza ; Zatonska, Katarzyna ; Poirier, Paul ; Wei, Li ; Jian, Bo ; Hui, Chen ; Xu, Liu ; Xiulin, Bai ; Teo, Koon ; Mente, Andrew. / Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels : findings from the Prospective Urban Rural Epidemiology (PURE) study. In: The Lancet Global Health. 2016 ; Vol. 4, No. 10. pp. e695-e703.
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abstract = "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.",
author = "Victoria Miller and Salim Yusuf and Chow, {Clara K.} and Mahshid Dehghan and Corsi, {Daniel J.} and Karen Lock and Barry Popkin and Sumathy Rangarajan and Rasha Khatib and Lear, {Scott A.} and Prem Mony and Manmeet Kaur and Viswanathan Mohan and Krishnapillai Vijayakumar and Rajeev Gupta and Annamarie Kruger and Lungiswa Tsolekile and Noushin Mohammadifard and Omar Rahman and Annika Rosengren and Alvaro Avezum and Andr{\'e}s Orlandini and Ismail, {Noor Hassim} and Patricio Lopez-Jaramillo and Afzalhussein Yusufali and Kubilay Karsidag and Romaina Iqbal and Jephat Chifamba and Oakley, {Solange Martinez} and Farnaza Ariffin and Katarzyna Zatonska and Paul Poirier and Li Wei and Bo Jian and Chen Hui and Liu Xu and Bai Xiulin and Koon Teo and Andrew Mente",
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TY - JOUR

T1 - Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels

T2 - findings from the Prospective Urban Rural Epidemiology (PURE) study

AU - Miller, Victoria

AU - Yusuf, Salim

AU - Chow, Clara K.

AU - Dehghan, Mahshid

AU - Corsi, Daniel J.

AU - Lock, Karen

AU - Popkin, Barry

AU - Rangarajan, Sumathy

AU - Khatib, Rasha

AU - Lear, Scott A.

AU - Mony, Prem

AU - Kaur, Manmeet

AU - Mohan, Viswanathan

AU - Vijayakumar, Krishnapillai

AU - Gupta, Rajeev

AU - Kruger, Annamarie

AU - Tsolekile, Lungiswa

AU - Mohammadifard, Noushin

AU - Rahman, Omar

AU - Rosengren, Annika

AU - Avezum, Alvaro

AU - Orlandini, Andrés

AU - Ismail, Noor Hassim

AU - Lopez-Jaramillo, Patricio

AU - Yusufali, Afzalhussein

AU - Karsidag, Kubilay

AU - Iqbal, Romaina

AU - Chifamba, Jephat

AU - Oakley, Solange Martinez

AU - Ariffin, Farnaza

AU - Zatonska, Katarzyna

AU - Poirier, Paul

AU - Wei, Li

AU - Jian, Bo

AU - Hui, Chen

AU - Xu, Liu

AU - Xiulin, Bai

AU - Teo, Koon

AU - Mente, Andrew

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

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