25 Jan

Fruit, Vegetable and Fat Intake: DISCUSSION

population-based data

Results from the study suggest that in this population of African-American adults, older participants, women, those with higher socioeconomic status and those who were physically active tended to report better dietary patterns. These findings were not explained by age and sex differences.

National recommendations put forth by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) advise that for a 2,200-calorie diet, daily fat intake should not exceed 73 g of total fat and that not more than 24 of those grams should be obtained from saturated fat. Recommendations also specify two-to-three servings of fruits and three-to-four servings of vegetables per day. Only 8% of 2,172 Project DIRECT participants reported eating at least two servings of fruit per day, and only 3% reporting eating three or more. Likewise, only 16% reported eating at least three servings of vegetables per day, and 6% reported eating four or more. Overall, the dietary patterns of participants fell far below recommendations. silagra 100

The data in this study were similar to the 1994-1996 USDA Continuing Survey of Food Intakes by Individuals (CSFII) data for non-Hispanic blacks with respect to total fat intake; USDA reported that 25% of the non-Hispanic blacks met the recommendation of <30% of calories from total daily fat intake. Comparison of data for our participants with USDA data for non-Hispanic blacks on mean food pyramid servings of fruit and vegetables showed somewhat poorer dietary patterns for our participants. USDA reported a mean of 4.5 servings of fruit (1.4) and vegetables (3.1) compared with our standardized mean of 3.9 servings of fruit and vegetables.

Our study has several strengths. First, the study evaluated a population-based sample (with high response rates) from Raleigh and Greensboro, NC derived from a probability sample of US. Census files. In addition, our assessment of fruit, vegetable and fat intake in African-American adults adds to the limited data in this area. Furthermore, we had comprehensive data to assess various sociodemographic, health and behavior correlates of fruit, vegetable and fat intake.

Nonetheless, several limitations should be noted. First, all of our data were self-reported except for measured weight. However, many of the questions included on the Project DIRECT questionnaire were derived from national health surveys, such as the BRFSS, where various validation studies of self-reported data have been ongoing. Second, because the study was cross-sectional, no inferences could be made about causal associations. For example, our findings related to differences in dietary patterns by obesity and diabetes status cannot be interpreted as changes that participants made as a result of having these health conditions. Third, because three dietary questions needed for calculations for the short-screener version of the Block questionnaire were missing, our estimates for fruit, vegetable and fat intake are probably underestimated. For example, our assessment did not account for intake of pizza and ice cream, both high-fat food items. Similarly, our assessment did not allow us to estimate total calorie intake. Previous evaluation of this short fat screener has estimated that the screener accounted for only half of the fat intakes of the study populations. Therefore, our conclusion that fat intakes were higher than national recommendations is extremely conservative. Fourth, all participants in the study resided in one of two cities in the southeastern United States. A recent study conducted among areas in the southern region also found that fat intake was higher, and fruit and vegetable intake was lower, when compared to national recommendations. Another study found significant differences in dietary risk factors according to region of birth, with southern-born respondents having the highest-risk diets. Therefore, our data may have limited generalizability to populations in other regions of the United States. Finally, this was an exploratory study with multiple comparisons, so the risk of type-1 error is high.
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As a nation, the American public has a long way to go to achieve a healthful diet. The study of trend data from Nationwide Food Consumption Surveys reported that fewer than one-fourth of participants overall met even four of the eight recommendations outlined in the study. Data from the present study support these patterns in African Americans. Given the high rates of obesity in this population, focusing on these dietary shortcomings is particularly important when attempting to design weight-loss interventions. Future research should examine specific nutritional, weight loss and cultural components that may contribute to dietary patterns in African Americans; for example, perceptions, attitudes, and behaviors regarding food preferences, food preparation, food availability, body image, weight and nutrition during pregnancy, weight-loss attempts and participation in programs. Improvements in these diet-related factors along with an increase in physical activity and other lifestyle changes are crucial components in preventing and other chronic diseases in this population.

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