There is plenty of news coverage early this week on this CDC report, much centered of course on the theme of "Americans still not eating enough fruits and veggies." Not above the fold news, but some interesting observations in the report...

From the CDC

State-Specific Trends in Fruit and Vegetable Consumption Among Adults --- United States, 2000--2009
September 10, 2010 / 59(35);1125-1130

A diet high in fruits and vegetables can reduce the risk for many leading causes of death (1--3) and can play an important role in weight management (4). Healthy People 2010 objectives for fruits and vegetables include targets of increasing to 75% the proportion of persons aged =2 years who consume two or more servings of fruit daily and to 50% those who consume three or more servings of vegetables daily.* To assess states' progress over the past decade in meeting these targets among adults and to provide an update of the 2005 subgroup estimates (5), CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that, in 2009, an estimated 32.5% of adults consumed fruit two or more times per day and 26.3% consumed vegetables three or more times per day, far short of the national targets. Overall, the proportion of adults who met the fruit target declined slightly, but significantly, from 34.4% in 2000 to 32.5% in 2009; no significant change was observed in meeting the vegetable target. No state met either target, and substantial variability occurred among states. Only one state had statistically significant increases in the percentages of adults meeting each target. These findings underscore the need for interventions at national, state, and community levels, across multiple settings (e.g., worksites, community venues, and restaurants) to improve fruit and vegetable access, availability, and affordability, as a means of increasing individual consumption.

BRFSS is an ongoing, state-based, telephone survey of the noninstitutionalized U.S. civilian population aged =18 years. Data are used to monitor the prevalence of health behaviors and progress toward national and state-specific health objectives. BRFSS uses a multistage design based on random-digit dialing methods to gather a representative sample from each state. Data were included from all 50 states and the District of Columbia (DC) for years in which the fruit and vegetable module was included in the core survey: 2000 (N = 179,139), 2002 (N = 238,852), 2003 (N = 255,657), 2005 (N = 347,278), 2007 (N = 420,217), and 2009 (N = 420,968). Median survey response rates by state, calculated using Council of American Survey Research Organizations (CASRO) guidelines,† were 48.9% (range: 28.8%--71.8%) for 2000 and 52.5% (range: 37.9--66.9%) for 2009. Median cooperation rates were 53.2% (range: 35.5%--77.7%) for 2000 and 75.0% (range: 55.5%-- 88.0%) for 2009.

For each survey year, prevalence estimates were weighted to the respondent's probability of being selected for the age-, race-, and sex-specific distributions for the state based on U.S. Census data. Logistic regression analysis was used to assess temporal changes in consumption during 2000--2009, including year as a continuous variable and controlling for changes in state distributions of age through standardization to the 2000 U.S. standard population; a p-value of <0.05 was used to assess statistical significance.

Six BRFSS questions assess fruit and vegetable intake and are the only diet intake questions on the core survey: "These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth. How often do you..." 1) "...drink fruit juices such as orange, grapefruit, or tomato?" 2) "Not counting juice, how often do you eat fruit?" 3) " green salad?" 4) " potatoes, not including French fries, fried potatoes, or potato chips?" 5) " carrots?" 6) "Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?" Consumption was divided by 7 for weekly frequencies, 30 for monthly frequencies, and 365 for yearly frequencies to calculate daily consumption. Total daily consumption of fruit was the sum of responses to questions 1--2 and vegetables the sum of responses to questions 3--6. Participants were not given a definition of serving size. To be consistent with previous reports, respondents who did not answer all six questions and those who reported consuming fruits and vegetables 25 or more times per day were excluded (n = 24,652 for 2009) from the final sample.

In 2009, an estimated 32.5% of U.S. adults consumed fruit two or more times per day (Table 1), with the highest percentage in DC (40.2%) and the lowest in Oklahoma (18.1%). The percentage of adults who consumed vegetables three or more times per day was 26.3%, with the highest percentage in Tennessee (33.0%) and the lowest in South Dakota (19.6%). Thus, no state met either of the Healthy People 2010 targets related to fruit and vegetable consumption among adults. Twelve states and DC had 35%--45% of adults who consumed fruit two or more times per day, compared with no states that had 35%--45% of adults who consumed vegetables three or more times per day (Figure).

From 2000 to 2009, the overall prevalence of consuming fruit two or more times per day decreased slightly, but significantly, from 34.4% to 32.5% (Table 1). Slight but significant increasing linear trends for fruit consumption were observed in four states, decreasing trends in 22 states and DC, and no significant change in 24 states. The prevalence of consuming vegetables three or more times per day did not change significantly during this period (26.7% in 2000 and 26.3% in 2009). Slight but significant increasing trends were observed in 11 states and DC, decreasing trends in 14 states, and no significant change in 25 states. Idaho was the only state that had significant, although slight, increases in both fruit and vegetable consumption, whereas 10 states had slight but significant decreases in both proportions.

Overall in 2009, the prevalence of consuming fruit two or more times per day or vegetables three or more times per day varied substantially by selected characteristics (Table 2), with the greatest prevalences observed among women (36.1% for fruit two or more times per day and 30.9% for vegetables three or more times per day), persons aged =65 years (41.3% and 29.0%), college graduates (36.9% and 32.2%), persons with annual household income =$50,000 (32.9% and 29.4%), and persons with a body mass index (weight [kg] / height [m2]) <25.0 (36.6% and 28.3%). Consumption by race/ethnicity varied by the type of produce; for example, Hispanics had the highest prevalence of fruit consumption (37.2%) but the lowest prevalence of vegetable consumption (19.7%).

Reported by

KA Grimm, MPH, HM Blanck, PhD, KS Scanlon, PhD, LV Moore, PhD, LM Grummer-Strawn, PhD, Div of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion; JL Foltz, MD, EIS Officer, CDC.