Adults Meeting Fruit and Vegetable Intake Recommendations …

Discussion

In 2019, fruit and vegetable intake among U.S. adults remained low, with only approximately one in 10 adults meeting either recommendation; differences were found by state, age, sex, race/ethnicity, and household income. Consistent with previous analyses of BRFSS data (4,5), a higher percentage of women than men met recommendations for fruit and vegetable intake, and larger disparities were observed in vegetable intake than fruit intake by age groups and household income. Results were also consistent with earlier findings (5) that higher percentages of Hispanic than non-Hispanic White adults met fruit intake recommendations while lower percentages of non-Hispanic Black than non-Hispanic White adults met vegetable intake recommendations. In 2015, intake was also low: 12.2% of respondents met fruit intake recommendations and 9.3% met vegetable intake recommendations (5); however, direct comparisons between current findings to those of 2015 cannot be made because of changes in methodology.***

Perceived barriers to fruit and vegetable consumption include cost, as well as limited availability and access (6–8). For some persons, such barriers might have worsened during the COVID-19 pandemic, related to economic and supply chain disruptions that could further limit ability to access healthier foods (9). Tailored intervention efforts to increase fruit and vegetable intake are needed to reduce age, sex, racial/ethnic, and income disparities in meeting fruit and vegetable intake recommendations among U.S. adults. States and communities can take actions by supporting food policy councils (community-based coalitions often supporting a specific community such as households with incomes below the federal poverty level or persons from racial and ethnic minority groups) to build a more sustainable food system,^††† supporting community retail programs to attract grocery stores and supermarkets to underserved communities to improve community food quality^§§§ and increase healthy food access, promoting participation in federal nutrition assistance programs,^¶¶¶ and implementing nutrition incentive and produce prescription programs**** that provide resources for persons to purchase fruits and vegetables. Additional efforts might include the use of nutrition standards, organizational food service guidelines,^†††† and farm-to-institution approaches to ensure that culturally preferred fruit and vegetable offerings are available in work sites, hospitals, park and recreation centers, food banks and pantries, restaurants, and other locations (10). Education and social marketing can also help to ensure awareness of the recommended amounts of fruits and vegetables to consume and how to incorporate fruits and vegetables into meals and snacks.^§§§§ Finally, conditions in which persons are born, live, learn, work, play, worship, and age, known as social determinants of health, affect health and influence the opportunities available to practice healthy behaviors. Ensuring that all persons, at all times, have physical, social, and economic access to enough foods, including fruits and vegetables that are safe, high quality, and meet their dietary needs and food preferences, requires multisectoral and multilevel collaboration.^¶¶¶¶

The findings of this report are subject to at least five limitations. First, self-reported dietary behaviors are subject to recall and social desirability biases whereby different demographic groups might overestimate and others underestimate dietary intake.***** Second, BRFSS includes only noninstitutionalized adults; therefore, findings cannot be generalized to the entire U.S. adult population. In addition, U.S. territories were excluded because of the NHANES scoring algorithm. Third, using the algorithms to estimate intake might have resulted in measurement error. However, previous analyses showed that applying prediction equations to BRFSS frequency data yielded estimates comparable with national estimates that used more accurate 24-hour recalls (4). Fourth, 14% (59,589) of participants had missing fruit and vegetable data, and these respondents tended to be older and have a lower income. However, the percentage of missing data on fruit and vegetable and respondent characteristics are similar to that in previous studies (4,5). Finally, 16% (54,306) of participants had missing income data, but the estimated percentage of persons meeting recommendations was similar when missing income was imputed based on age, sex, and race/ethnicity.

Too few U.S. residents consume the recommended amounts of fruits and vegetables. Following a dietary pattern that includes sufficient fruits and vegetables can help protect against some chronic conditions that are among the leading causes of mortality in the United States (2); some of these conditions are also associated with more severe illness from COVID-19 (3). For most states, the BRFSS module is the only source of uniform, state-level dietary data for adults, and this information often provides critical metrics for state chronic disease plans. States can use the findings to guide their programs, communications and social marketing, and policies to support improving fruit and vegetable access and intake. Continued efforts to increase fruit and vegetable consumption by improving access and affordability in diverse community and institutional settings will help mitigate health disparities among U.S. residents.