Identify and categorise different models of community-based fruit and vegetable prescription programs, to determine variation in terms of methodology, target population characteristics, and outcomes measured. Applying the scoping review methodology, ten electronic databases were utilised to identify community-based fruit and vegetable incentive programs. Results were evaluated by two independent reviewers, using Covidence software. All full-text reviews were completed and documented using the PRISMA-ScR guidelines. Search results were stored and reviewed within the Covidence software. Thirty full-text articles were utilised from the 40 206 identified in the search. Target populations were predominantly female, non-white, and low-income. Considerable heterogeneity was found in both study design and quality. Fruit and vegetable vouchers were utilised in 63 % (n 19) of the studies. Prescriptions were primarily provided by community health centres (47 %; n 14) or NGOs (307 %; n 9) and could be redeemed at farmers’ markets (40 %; n 12) or grocery stores (27 %; n 8). When measured, diet quality significantly improved in 94 % (n 16), health outcomes significantly improved in 83 % (n 10), and food security status improved in 82 % (n 10) of studies. Providing financial incentives to offset the cost of fresh fruits and vegetables can increase consumption, improve health outcomes, and improve food security status. The majority of studies showed significant improvements in at least one outcome, demonstrating the effectiveness of community-based fruit and vegetable prescription programs. However, the diversity of measurement techniques and heterogeneity of design, dosage, and duration impeded meaningful comparisons. Further well-designed studies are warranted to compare the magnitude of effects among different program methodologies.

Blood carotenoid concentration measurement is considered the gold standard for fruit and vegetable (F&V) intake estimation; however, this method is invasive and expensive. Recently, skin carotenoid status (SCS) measured by optical sensors has been evaluated as a promising parameter for F&V intake estimation. In this cross-sectional study, we aimed to validate the utility of resonance Raman spectroscopy (RRS)-assessed SCS as a biomarker of F&V intake in Korean adults. We used data from 108 participants aged 20–69 years who completed SCS measurements, blood collection and 3-d dietary recordings. Serum carotenoid concentrations were quantified using HPLC, and dietary carotenoid and F&V intakes were estimated via 3-d dietary records using a carotenoid database for common Korean foods. The correlations of the SCS with serum carotenoid concentrations, dietary carotenoid intake and F&V intake were examined to assess SCS validity. SCS was positively correlated with total serum carotenoid concentration (r = 0·52, 95 % CI = 0·36, 0·64, P < 0·001), serum β-carotene concentration (r = 0·60, 95 % CI = 0·47, 0·71, P < 0·001), total carotenoid intake (r = 0·20, 95 % CI = 0·01, 0·37, P = 0·04), β-carotene intake (r = 0·30, 95 % CI = 0·11, 0·46, P = 0·002) and F&V intake (r = 0·40, 95 % CI = 0·23, 0·55, P < 0·001). These results suggest that SCS can be a valid biomarker of F&V intake in Korean adults.

Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.

Average diet quality is low in the UK and is socioeconomically patterned, contributing to the risk of non-communicable disease and poor health. Achieving meaningful dietary change in the long term is challenging, with intervention required on a number of different levels which reflect the multiple determinants of dietary choice. Dietary patterns have been identified which contribute positively to health outcomes; one of these is the Mediterranean diet (MD) which has been demonstrated to be associated with reduced non-communicable disease risk. Most research exploring the health benefits of the MD has been conducted in Mediterranean regions but, increasingly, research is also being conducted in non-Mediterranean regions. The MD is a dietary pattern that could have positive impacts on both health and environmental outcomes, while being palatable, appetising and acceptable. In this review, we consider the studies that have explored transferability of the MD. To achieve long-term dietary change towards a MD, it is likely that the dietary pattern will have to be culturally adapted, yet preserving the core health-promoting elements and nutritional composition, while considering the food system transition required to support changes at population level. Population-specific barriers need to be identified and ways sought to overcome these barriers, for example, key food availability and cost. This should follow a formal cultural adaptation framework. Such an approach is likely to enhance the extent of adherence in the longer term, thus having an impact on population health.

Increasing fruit and vegetable (F&V) intake has a protective role against chronic conditions such as cardiovascular disease, cancer and diabetes. The present study aimed to validate an instrument for measuring the perception of effective factors on consumption behaviour of F&V based on Pender's health promotion model (HPM).This cross-sectional validation survey has consisted of five steps: literature review in order to plan and develop an instrument, face validity assessment, content validity assessment, reliability assessment and construct validity assessment with the cooperation of experts in health education, nutritionists and the target group (government employees). In the present study, reliability and validity of constructs were determined through Cronbach's alpha and exploratory factor analysis, respectively, in SPSS 22. The mean impact score was acceptable for 96·42 % of items in face validity. The mean scores of content validity ratio (CVR), content validity index (CVI) and reliability were 0·92, 0·97 and 0·96, respectively. According to the principal component analysis with varimax rotation, 104 items were identified in 15 factors contributing to 61·17 % of the model cumulative variance. Given the favourable scores of the research instrument in face validity, content validity and reliability as well as its ability to predict the extracted factors from the model, it can be used as a suitable instrument in future studies.

Fruit and vegetable (FV) intake is associated with reduced risk of a number of non-communicable diseases. Research tends to focus on antioxidants, flavonoids and polyphenols contained in FV as the main beneficial components to health; however, increasing FV may also alter overall diet profile. Extra FV may be substituted for foods thought to be less healthy, therefore altering the overall macronutrient and/or micronutrient content in the diet. This analysis merged dietary data from four intervention studies in participants with varying health conditions and examined the effect of increased FV consumption on diet profile. Dietary intake was assessed by either diet diaries or diet histories used in four FV randomised intervention studies. All food and drink intake recorded was analysed using WISP version 3.0, and FV portions were manually counted using household measures. Regression analysis revealed significant increases in intakes of energy (172 kJ (+41 kcal)), carbohydrate (+3·9 g/4184 kJ (1000 kcal)), total sugars (+6·0 g/4184 kJ (1000 kcal)) and fibre (+0·8 g/4184 kJ (1000 kcal)) and significant decreases in intakes of total fat (−1·4 g/4184 kJ (1000 kcal)), SFA (−0·6 g/4184 kJ (1000 kcal)), MUFA (−0·6 g/4184 kJ (1000 kcal)), PUFA (−0·1 g/4184 kJ (1000 kcal)) and starch (−2·1 g/4184 kJ (1000 kcal)) per one portion increase in FV. Significant percentage increases were also observed in vitamin C (+24 %) and -carotene (+20 %) intake, per one portion increase in FV. In conclusion, pooled analysis of four FV intervention studies, that used similar approaches to achieving dietary change, in participants with varying health conditions, demonstrated an increase in energy, total carbohydrate, sugars and fibre intake, and a decrease in fat intake alongside an expected increase in micronutrient intake.

Eating fruit and vegetables (FV) offers important health benefits for children and adolescents, but their average intake is low. To explore if negative trends with age exist as children grow, this study modelled differences in FV consumption from childhood to young adulthood. A pseudo-panel was constructed using years 1–4 (combined) of the Rolling Programme of the UK National Diet and Nutrition Survey (NDNS) (2008/2009–2011/2012). Intake of FV in the NDNS was recorded using 4-d unweighted food diaries. The data consisted of 2131 observations of individuals aged 2–23 years. Age-year-cohort decomposition regression analyses were used to separate age effects from year and cohort effects in the data. Total energy intake was included to account for age differences in overall energy consumption. Fruit intake started to decrease from the age of 7 years for boys and girls, and reached its lowest level during adolescence. By 17 years, boys were consuming 0·93 (P=0·037) less fruit portions compared with the age of 2 years. By 15 years, girls were consuming 0·8 fruit portions less (P=0·053). Vegetable intake changed little during childhood and adolescence (P=0·0834 and P=0·843 for change between 7 and 12 years, boys and girls, respectively). There was unclear evidence of recovery of FV intakes in early adulthood. Efforts to improve FV intake should consider these trends, and focus attention on the factors influencing intake across childhood and adolescence in order to improve the nutritional quality of diets during these periods.

The growth hormone (GH) insulin-like growth factor (IGF) axis has been linked to insulin metabolism and cancer risk. Experimental evidence indicates that the GH–IGF axis itself can be influenced by dietary flavonoids. As fruit and vegetable (FV) intake is a major source of flavonoid consumption, FV’s beneficial health effects may be explained via flavonoids’ influence on the GH–IGF axis, but observational evidence is currently rare. We used data from Dortmund Nutritional and Anthropometric Longitudinally Designed Study participants to analyse prospective associations between FV, fruit intake and flavonoid intake from FV (FlavFV) with IGF-1 and its binding proteins IGFBP-2 and IGFBP-3. Subjects needed to provide a fasting blood sample in adulthood (18–39 years) and at least two 3-d weighed dietary records in early life (0·5−2 years, n 191), mid-childhood (3−7 years, n 265) or adolescence (girls: 9−15 years, boys: 10−16 years, n 261). Additional analyses were conducted among those providing at least three 24-h urine samples in adolescence (n 236) to address the predictor urinary hippuric acid (HA), a biomarker of polyphenol intake. Higher fruit intake in mid-childhood and adolescence was related to higher IGFBP-2 in adulthood (P=0·03 and P=0·045). Comparable trends (P=0·045−0·09) were discernable for FV intake (but not FlavFV) in all three time windows. Similarly, higher adolescent HA excretion tended to be related (P=0·06) to higher adult IGFBP-2 levels. Regarding IGFBP-3, a marginal (P=0·08) positive association was observed with FlavFV in mid-childhood only. None of the investigated dietary factors was related to IGF-1. In conclusion, higher fruit and FV intakes during growth may be relevant for adult IGFBP-2, but probably not for IGFBP-3 or IGF-1.

We examined whether there are sex differences in children’s fruit and vegetable (FV) intake and in descriptive norms (i.e. perceived FV intake) related to parents and friends. We also studied whether friends’ impact is as important as that of parents on children’s FV intake. Data from the PRO GREENS project in Finland were obtained from 424 children at the age 11 years at baseline. At baseline, 2009 children filled in a questionnaire about descriptive norms conceptualised as perceived FV intake of their parents and friends. They also filled in a validated FFQ that assessed their FV intake both at baseline and in the follow-up in 2010. The associations were examined with multi-level regression analyses with multi-group comparisons. Girls reported higher perceived FV intake of friends and higher own fruit intake at baseline, compared with boys, and higher vegetable intake both at baseline and in the follow-up. Perceived FV intake of parents and friends was positively associated with both girls’ and boys’ FV intake in both study years. The impact of perceived fruit intake of the mother was stronger among boys. The change in children’s FV intake was affected only by perceived FV intake of father and friends. No large sex differences in descriptive norms were found, but the impact of friends on children’s FV intake can generally be considered as important as that of parents. Future interventions could benefit from taking into account friends’ impact as role models on children’s FV intake.

Problematic eating behaviours during early childhood could be mediators of poor dietary habits. This study aims to prospectively relate early eating behaviours with fruit and vegetable (F&V) intake and a healthy diet variety score of children aged between 4 and 5 years. Eating behaviours were assessed in three European birth cohorts (Generation XXI from Portugal, ALSPAC from the UK and EDEN from France) at 4–6, 12–15, 24 and 48–54 months of age, based on the child’s feeding difficulties, mother’s perception of child’s poor eating (eating small quantities at each meal, not eating enough or needing to be stimulated to eat), food refusal and difficulties in the establishment of daily food routines. Daily servings of F&V (>1 v. ≤1 serving/d, except in Generation XXI: >3 v. ≤3) and the Healthy Plate Variety Score (categorised by the median score of each sample) were calculated using FFQ. Associations were tested by logistic regressions adjusted for maternal age, education, smoking during pregnancy, any breast-feeding and the child’s z-score BMI at 4–5 years of age. Children with more feeding difficulties, poor eating, food refusal/neophobia and difficulties in establishing a daily routine at 12–15, 24 and 48–54 months of age had in general lower F&V intake at 4–5 years of age. The association with vegetables was slightly stronger than with fruits. These early feeding problems were also inversely associated with the variety score at 4–5 years of age, particularly when eating behaviours were reported after 12–15 months of age. A better understanding of these early feeding difficulties may help define strategies to increase the dietary quality in children.

Low salt intake and high fruit and vegetable intake (FVI) have been shown to reduce blood pressure (BP) in adults. Longitudinal data on the independent effect of both FVI and salt intake on BP in healthy normotensive children are not available yet. In the present study, we aimed to characterise the concomitant influence of salt intake and FVI on BP development throughout childhood and adolescence. We examined 435 healthy subjects, for whom at least three repeated measurements of BP had been taken and who had provided 24 h urine samples and 3 d weighed dietary records between 4 and 18 years of age. BP was measured using a mercury sphygmomanometer (Mercuro 300, WelchAllyn) and salt intake was determined based on 24 h Na excretion. The intra-individual change in salt intake was almost significantly associated with the change in systolic BP (SBP, P= 0·06) and marginally (P= 0·09) with that in diastolic BP (DBP) in puberty, but not in pre-puberty. A 1 g/d increase in salt intake was associated with a 0·2 mmHg increase in SBP. In pre-puberty, but not in puberty, differences in FVI between children predicted between-person variations in SBP and DBP (P= 0·03). Corresponding findings were obtained for 24 h K excretion (a urinary indicator for FVI). A 100 g/d lower FVI was related to a 0·4 mmHg higher BP value. In conclusion, in healthy children and adolescents with BP in the low-normal range, both salt intake and FVI may already start to influence BP, although at a small magnitude. The potential importance of establishing healthy eating habits in childhood for later BP development emphasises the role of higher FVI and lower salt intake in the prevention of hypertension in the long run.