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Interventions and public health nutrition

Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population

European Journal of Clinical Nutrition volume 66, pages 369–375 (2012)Cite this article

Abstract

Background/Objectives:

Lower-income subgroups consume fewer servings of fruit and vegetables (FVs) compared with their more advantaged counterparts. To overcome financial barriers, FV voucher delivery has been proposed.

Subjects/Methods:

In a 12-month trial, 302 low-income adults 18–60 years old (defined by evaluation of deprivation and inequalities in health examination centers, a specific deprivation score) were randomized into two groups: dietary advice alone (‘advice’), or dietary advice plus FV vouchers (‘FV vouchers’) (10–40 euros/month) exchangeable for fresh fruits and vegetables. Self-reported data were collected on FV consumption and socioeconomic status at baseline, 3, 9 and 12 months. Anthropometric and blood pressure measurements were conducted at these periods, as well as blood samples obtained for determination of vitamins. Descriptive analyses, multiple linear regression and logistic regression were performed to evaluate the impact of FV.

Results:

Between baseline and 3-month follow-up, mean FV consumption increased significantly in both the ‘advice’ (0.62±1.29 times/day, P=0.0004) and ‘FV vouchers’ groups (0.74±1.90, P=0.002), with no difference between groups. Subjects in the FV vouchers group had significantly decreased risk of low FV consumption (<1 time/day) compared with those in the advice group (P=0.008). No change was noted in vitamin levels (vitamin C and β-carotene). The high number of lost-to-follow-up cases did not permit analysis at 9 or 12 months.

Conclusion:

In the low-income population, FV voucher delivery decreased the proportion of low FV consumers at 3 months. Longer-term studies are needed to assess their impact on nutritional status.

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References

  • AFSSA (2006–2007). INCA2 [Etude Individuelle Nationale des Consommations Alimentaires 2]. http://www.anses.fr/Documents/PASER-Sy-INCA2.pdf.

  • Ammerman AS, Lindquist CH, Lohr KN, Hersey J (2002). The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med 35, 25–41.

    Article  Google Scholar 

  • Anderson JV, Bybee DI, Brown RM, McLean DF, Garcia EM, Breer ML et al. (2001). 5 a day fruit and vegetable intervention improves consumption in a low income population. J Am Diet Assoc 101, 195–202.

    Article  CAS  Google Scholar 

  • Bihan H, Castetbon K, Mejean C, Peneau S, Pelabon L, Jellouli F et al. (2010). Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population. J Nutr 140, 823–830.

    Article  CAS  Google Scholar 

  • Bowen DI, Beresford SAA (2002). Dietary interventions to prevent disease. Annu Rev Public Health 23, 255–286.

    Article  Google Scholar 

  • Burr ML, Trembeth J, Jones KB, Geen J, Lynch LA, Roberts ZES (2007). The effects of dietary advice and vouchers on the intake of fruit and fruit juice by pregnant women in a deprived area: a controlled trial. Public Health Nutr 10, 559–565.

    Article  CAS  Google Scholar 

  • Casagrande SS, Wang Y, Anderson C, Gary TL (2007). Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002. Am J Prev Med 32, 257–263.

    Article  Google Scholar 

  • Castetbon K, Vernay M, Malon A, Salanave B, Deschamps V, Roudier C et al. (2009). Dietary intake, physical activity and nutritional status in adults: the French nutrition and health survey (ENNS, 2006–2007). Br J Nutr 102, 733–743.

    Article  CAS  Google Scholar 

  • Darmon N, Drewnowski A (2008). Does social class predict diet quality? Am J Clin Nutr 87, 1107–1117.

    Article  CAS  Google Scholar 

  • Dauchet L, Amouyel P, Hercberg S, Dallongeville J (2006). Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 136, 2588–2593.

    Article  CAS  Google Scholar 

  • Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ (2003). Low-income consumers’ attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables. Public Health Nutr 6, 159–168.

    Article  CAS  Google Scholar 

  • Escalon H, Bossard C, Beck F (2008). BNS 2008 [Baromètre Nutrition Santé 2008]. INPES 2008. http://www.inpes.sante.fr/CFESBases/catalogue/pdf/1270.pdf.

  • Glanz K, Yaroch AL (2004). Strategies for increasing fruit and vegetable intake in grocery stores and communities: policy, pricing, and environmental change. Prev Med 39, S75–S80.

    Article  Google Scholar 

  • He FJ, Nowson CA, MacGregor GA (2006). Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 367, 320–326.

    Article  Google Scholar 

  • Hercberg S, Chat-Yung S, Chauliac M (2008). The French national nutrition and health program: 2001–2006–2010. Int J Public Health 53, 68–77.

    Article  Google Scholar 

  • Hercberg S, Preziosi P, Galan P, Devanlay M, Keller H, Bourgeois C et al. (1994). Vitamin status of a healthy French population: dietary intakes and biochemical markers. Int J Vitam Nutr Res 64, 220–232.

    CAS  PubMed  Google Scholar 

  • Herman DR, Harrison GG, Afifi AA, Jenks E (2008). Effect of a targeted subsidy on intake of fruits and vegetables among low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children. Am J Public Health 98, 98–105.

    Article  Google Scholar 

  • Herman DR, Harrison GG, Jenks E (2006). Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase. J Am Diet Assoc 106, 740–744.

    Article  Google Scholar 

  • Hung HC, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA et al. (2004). Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 96, 1577–1584.

    Article  Google Scholar 

  • Irala-Estévez JD, Groth M, Johansson L, Oltersdorf U, Prättälä R, Martínez-González MA (2000). A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables. Eur J Clin Nutr 54, 706–714.

    Article  Google Scholar 

  • John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW (2002). Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet 359, 1969–1974.

    Article  CAS  Google Scholar 

  • Johnson DB, Beaudoin S, Smith LT, Beresford SAA, LoGerfo JP (2004). Increasing fruit and vegetable intake in homebound elders: the Seattle Senior Farmers’ Market Nutrition Pilot Program. Prev Chronic Dis 1, A03.

    PubMed  Google Scholar 

  • Kamphuis CBM, Giskes K, de Bruijn GJ, Wendel-Vos W, Brug J, van Lenthe FJ (2006). Environmental determinants of fruit and vegetable consumption among adults: a systematic review. Br J Nutr 96, 620–635.

    CAS  PubMed  Google Scholar 

  • Kaplan GA, Keil JE (1993). Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 88, 1973–1998.

    Article  CAS  Google Scholar 

  • Kunkel ME, Luccia B, Moore AC (2003). Evaluation of the South Carolina seniors farmers’ market nutrition education program. J Am Diet Assoc 103, 880–883.

    Article  Google Scholar 

  • Méjean C, Deschamps V, Bellin-Lestienne C, Oleko A, Darmon N, Hercberg S et al. (2010). Associations of socioeconomic factors with inadequate dietary intake in food aid users in France (The ABENA study 2004–2005). Eur J Clin Nutr 64, 374–382.

    Article  Google Scholar 

  • Mosdøl A, Erens B, Brunner EJ (2008). Estimated prevalence and predictors of vitamin C deficiency within UK's low-income population. J Public Health (Oxford, England) 30, 456–460.

    Article  Google Scholar 

  • Owen AL, Owen GM (1997). Twenty years of WIC: a review of some effects of the program. J Am Diet Assoc 97, 777–782.

    Article  CAS  Google Scholar 

  • Pomerleau J, Lock K, Knai C, McKee M (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: a systematic review of the literature. J Nutr 135, 2486–2495.

    Article  CAS  Google Scholar 

  • Roos G, Johansson L, Kasmel A, Klumbiené J, Prättälä R (2001). Disparities in vegetable and fruit consumption: European cases from the north to the south. Public Health Nutr 4, 35–43.

    Article  CAS  Google Scholar 

  • Sass C, Guéguen R, Moulin JJ, Abric L, Dauphinot V, Dupré C et al. (2006). Comparison of the individual deprivation index of the French Health Examination Centres and the administrative definition of deprivation. Santé Publ 18, 513–522.

    Article  CAS  Google Scholar 

  • Speek AJ, Schrijver J, Schreurs WH (1984). Fluorometric determination of total vitamin C in whole blood by high-performance liquid chromatography with pre-column derivatization. J Chromatogr 305, 53–60.

    Article  CAS  Google Scholar 

  • Steptoe A, Perkins-Porras L, McKay C, Rink E, Hilton S, Cappucci FP (2003). Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. BMJ (Clin Res Ed) 326, 855.

    Article  Google Scholar 

  • Symon AG, Wrieden WL (2003). A qualitative study of pregnant teenagers’ perceptions of the acceptability of a nutritional education intervention. Midwifery 19, 140–147.

    Article  Google Scholar 

  • Winkleby MA, Howard-Pitney B, Albright CA, Bruce B, Kraemer HC, Fortmann SP (1997). Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills. Prev Med 26, 874–882.

    Article  CAS  Google Scholar 

  • Wrieden WL, Hannah MK, Bolton-Smith C, Tavendale R, Morrison C, Tunstall-Pedoe H (2000). Plasma vitamin C and food choice in the third Glasgow MONICA population survey. J Epidemiol Community Health 54, 355–360.

    Article  CAS  Google Scholar 

  • WCRF and AICR (2007). Food, Nutrition Physical Activity and the Prevention of Cancer: A Global Perspective. WCRF and AICR: Washington, DC. p 517. http://www.dietandcancerreport.org/downloads/summary/english.pdf.

  • World Health Organization (2004). WHO global strategy on diet, physical activity and health. http://www.who.int/dietphysicalactivity/strategy/eb11344/en/index.html.

  • Willett W (1998). Nutritional Epidemiology, 2nd edn, vol. 30. Oxford University Press: Oxford, UK.

    Book  Google Scholar 

  • Zino S, Skeaff M, Williams S, Mann J (1997). Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants. BMJ 314, 1787–1791.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by INTERFEL (Interprofession of Fruits and Vegetables) and the League Against Cancer. We especially acknowledge Saida Barnat (INTERFEL) for her involvement in this project.

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Authors and Affiliations

  1. UMR U557 INSERM,

    H Bihan, C Méjean, A Sedeaud, P Galan, S Péneau & S Hercberg

  2. U1125 INRA,

    H Bihan, C Méjean, A Sedeaud, P Galan, S Péneau & S Hercberg

  3. Université Paris 13,

    H Bihan, C Méjean, A Sedeaud, P Galan, S Péneau & S Hercberg

  4. Centre de Recherche en Nutrition Humaine IdF, Bobigny, France

    H Bihan, C Méjean, A Sedeaud, P Galan, S Péneau & S Hercberg

  5. Unité de Surveillance et d’Epidémiologie Nutritionnelle, Institut de Veille Sanitaire InVS,

    K Castetbon & S Hercberg

  6. Université Paris 13, Centre de Recherche en Nutrition Humaine IdF, Bobigny, France

    K Castetbon & S Hercberg

  7. Département de Biologie Intégrée, Pavillon B, Grenoble, France

    H Faure & V Ducros

  8. Centre d’Examens de Santé de la Caisse Primaire d’Assurance Maladie de Seine-Saint-Denis, Bobigny, France

    H Le Clésiau

  9. Département de Santé Publique, Hôpital Avicenne, Bobigny, France

    S Hercberg

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  1. H Bihan
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Correspondence to H Bihan.

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Contributors: HB, SP, HLC, PG and SH designed the research, AS and HB conducted the research, HB and CM analyzed the data, HB wrote the paper, SP, CM and KC revised the draft and HF, and VD performed specific biological analysis. HB had primary responsibility for final content. All authors read and approved the final manuscript.

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Bihan, H., Méjean, C., Castetbon, K. et al. Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population. Eur J Clin Nutr 66, 369–375 (2012). https://doi.org/10.1038/ejcn.2011.173

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