Fruit and vegetable consumption of U.S. adults by level of variety, What We Eat in America, NHANES 2013-2016

Authors: Hoy, M Katherine; Clemens, John; Martin, Carrie; Moshfegh, Alanna

Submitted to: Current Developments in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/25/2020
Publication Date: 2/4/2020
Citation: Hoy, M.K., Clemens, J.C., Martin, C.L., Moshfegh, A.J. 2020. Fruit and vegetable consumption of U.S. adults by level of variety, What We Eat in America, NHANES 2013-2016. Current Developments in Nutrition. 4(3). https://doi.org/10.1093/cdn/nzaa014.
DOI: https://doi.org/10.1093/cdn/nzaa014

Interpretive Summary: Dietary guidance encourages consuming a variety of fruit and vegetables (FV) to enhance intake of the array of nutrients and bioactive compounds they contain. The dietary intake of U.S. adults has not been evaluated in the context of variety. Therefore, this study describes FV intake of U.S. adults and compares intake by level of FV variety. One-day dietary intake data of adults 20+ years (N=10,064) in WWEIA, NHANES 2013-2016 were used. FV variety was the count of foods consumed that contributed to total FV intake. To be counted, at least 0.1 cup equivalent (CE) FV of each single FV item and 0.2 CE FV from a mixed dish had to have been consumed. Each was counted only once and a mixed dish counted as one item. The Food Patterns Equivalents Databases 2013-2014 and 2015-2016 were used to determine the CE of FV intake. Individuals were classified for variety of intake as High (5+ items, N=2316); Moderate (3-4, N=3423); Low (1-2 items, N=3746). Average FV intakes were High 4.4; Moderate: 2.6; Low: 1.4 CE (P<0.001). Those in the High variety level consumed more FV not in mixed dishes; they contributed 67% to FV intake of the High vs Moderate (58%) and Low (53%) (P<0.001), whereas those in mixed dishes contributed 12% to intake of H vs M (17%) and L (27%) groups, (P<0.001). As variety level went from Low to High, FV intake increased. Intake of the High, Moderate and Low levels respectively were 1.4, 0.6 and 0.03 CE of vegetables excluding potatoes; 1.2, 0.6, and 0.3 CE of fruit; and 0.5, 0.4, and 0.4 CE from mixed dishes. Those with more variety of FV intake include FV in their diet as side dishes, salads and snacks more frequently resulting in higher total FV intakes. These results illustrate the beneficial impact on FV intake of including a variety of FV items each day, and support suggestions for boosting intake by choosing FV at snacks, adding FV to mixed dishes and including vegetable side dishes at meals.

Technical Abstract: Dietary guidance encourages consuming a variety of fruit and vegetables (FV) to enhance intake of the array of nutrients and bioactive compounds they contain. The dietary intake of U.S. adults has not been evaluated in the context of variety. Therefore, the purpose of this study was to describe FV intake of U.S. adults using the What We Eat in America Food Categories and compare intake by variety level. One-day dietary intake data of adults 20+ years (N=10,064) in WWEIA, NHANES 2013-2016 were used. FV variety was the count of foods consumed that contributed to total FV intake. To be counted, at least 0.1 cup equivalent (CE) FV of each single FV item and 0.2 CE FV from a mixed dish had to have been consumed. A FV reported >1 time during the day was counted only once; a mixed dish counted as one. The Food Patterns Equivalents Databases 2013-2014 and 2015-2016 were used to determine the CE of FV intake. Individuals were classified for variety of intake as High (5+ items, N=2316); Moderate (3-4, N=3423); Low (1-2 items, N=3746). Differences in percent contribution of WWEIA Food Categories to FV intake between each level of variety were compared by t-test. Those with a count of ‘0’ (N=579) were excluded. Mean FV intakes for each group were High 4.4; Moderate 2.6; Low 1.4 CE (P<0.001). FV not in mixed dishes contributed 67% to FV intake of the High vs Moderate (58%) and Low (53%) (P<0.001), whereas mixed dishes contributed 12% to intake of High vs Moderate (17%) and Low (27%) groups, (P<0.001). The contribution of vegetables excluding potatoes to intakes of High, Moderate and Low groups, respectively, was 32%, 24% and 19%, (P<0.001); contribution of white potatoes for High vs Moderate and Low was 7% vs 12% and 15%, (P<0.001). Fruit not in mixed dishes accounted for 28% of intake of High vs Moderate (22%) and Low (19%), (P<0.001). FV intake of the High, Moderate and Low levels respectively were 1.4, 0.6 and 0.03 CE from vegetables excluding potatoes; 1.2, 0.6, and 0.3 CE from fruit; and 0.5, 0.4, and 0.4 CE from mixed dishes. The percentages reporting vegetables excluding potatoes from High, Moderate and Low groups were 89, 64 and 34, respectively; 75, 49, and 22 for Fruit; and 72, 71, and 72 for mixed dishes. Those with more variety of FV intake include FV in their diet as side dishes, salads and snacks more frequently resulting in higher total FV intakes. These results illustrate the beneficial impact on FV intake of including a variety of FV items each day, and support suggestions for boosting intake by choosing FV at snacks, adding FV to mixed dishes and including vegetable side dishes at meals.