Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA.
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
J Nutr. 2019 Jul 1;149(7):1252-1259. doi: 10.1093/jn/nxz040.
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.
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.
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.
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).
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.
世界卫生组织（WHO）建议，为预防非传染性疾病（NCDs），人们每天应食用 400 克水果和蔬菜（相当于每天食用 5 份）。然而，在中低收入国家（LMICs），有关个人层面达到这一建议的相关因素的证据有限。为了制定旨在改善摄入量的政策和干预措施，需要对不同社会人口亚群的水果和蔬菜消费情况进行全球监测。
本研究旨在 1）评估符合 WHO 建议的个体比例，2）评估符合 WHO 建议的社会人口学预测因素（年龄、性别和教育程度）。
数据来自 2005 年至 2016 年间在 28 个 LMIC 中 193606 名年龄≥15 岁的个体。符合 WHO 建议的比例考虑到了复杂的调查设计，并根据各国 2015 年的世界银行人口估计数对各国进行了加权。使用泊松回归来估计与社会人口学特征的关联。
年龄≥15 岁的个体中，符合 WHO 建议的比例为 18.0%（16.6-19.4%）。每天摄入的水果平均为 1.15（1.10-1.20）份，蔬菜为 2.46（2.40-2.51）份。符合建议的个体比例随着国家人均国内生产总值（GDP）类别（P<0.0001）的增加和国家粮农组织食品价格指数（FPI；表示食品价格更加稳定；P<0.0001）的降低而增加。在个体层面，与没有正规教育的个体相比，接受过中等教育或更高等教育的个体更有可能达到建议标准：风险比（95%CI）为 1.61（1.24-2.09）。
在这 28 个 LMIC 中，80%以上的年龄≥15 岁的个体摄入的水果和蔬菜量低于 WHO 建议的量。迫切需要在 LMIC 中制定促进水果和蔬菜消费的政策，以解决观察到的摄入量不平等问题，并预防 NCDs。
