Interventions on Fruit and Vegetable Intake in Low-, Middle-, and High-Income Countries: A Scoping Review of Evidence and Knowledge Gaps.

内容摘要

BackgroundAdequate fruit and vegetable (F&V) intake is important for health, yet populations globally are failing to meet recommendations.ObjectiveA scoping review to summarize available evidence of evaluations of interventions to increase F&V intake globally, focusing on target populations, intervention strategies, research methods, and summarizing their evaluated impacts.MethodsWe searched PubMed and Web of Science in February 2023 for intervention studies in which dietary intake of fruit and/or vegetables were documented. Eligible studies included all age groups, excluding those targeting populations with specific disease-related conditions, such as cancer patients/survivors. Only articles published in English since 2012 were included in the review.ResultsWe identified 6338 articles, with 226 meeting inclusion criteria, comprising 223 unique studies and 284 intervention comparisons. Most comparisons occurred in high-income countries (n = 192) compared to low- and middle-income countries (n = 92). Randomized controlled trials (RCTs; 37.3%) and cluster RCTs (52.5%) were predominant. Interventions primarily targeted adults (31.7%), school-aged children (18.0%), children under-five (14.4%), and adolescents (13.7%), lasting an average of 24 weeks (range: 2 weeks to 20 years). Food-frequency questionnaires (59.2%) and 24-h recalls (26.8%) were the most used dietary assessment method. Health and nutrition communication (75.9%) was the most common intervention, utilizing interpersonal communication, mass media, and information-communication technology, often in combinations. Positive impacts on fruit (43.9%), vegetable (40.2%), and combined F&V intake (53.0%) were observed in nearly half the intervention comparisons.ConclusionsThese findings highlight the predominance of health and nutrition communication interventions, predominantly in high-income countries, showing mixed success in improving F&V intake, emphasizing the need for context-specific strategies and standardized methodologies to design sustainable, cost-effective interventions for better diet quality and health outcomes.Plain language titleA literature review assessing what we know and do not know about efforts to improve fruit and vegetable intake across the world. Eating enough fruit and vegetables is important to stay healthy, but most people do not eat enough diverse fruits and vegetables. Various strategies have been tried to increase fruit and vegetable intake; however, what worked, for whom, and in which context is not well understood. In this paper, we summarize the intervention strategies that have been implemented and their impact across different countries and age groups. Of the 226 published articles comprising 284 intervention comparisons included in this review, most intervention comparisons were from high-income countries (67.6%). Most intervention comparisons in which dietary intake of fruit and/or vegetables was documented focused on adults (31.7%), followed by school-aged children (5-9.9 years of age; 18.0%) and children under 5 years of age (14.4%). The interventions lasted an average of 24 weeks. Health and nutrition communication was the most commonly used component to encourage study participants to eat more fruit and vegetables. Different approaches were used, like talking to people in group settings and using mass media or technology. About one-half of studies found a positive impact on fruit intake, vegetable intake, and/or the intake of total fruit and vegetables. Few interventions have been implemented in low- and middle-income countries. The findings highlight the dominance of health and nutrition communication interventions, mainly in high-income countries, with mixed success in improving fruit and vegetable intake. Tailored, context-specific strategies are needed to enhance the intake of fruit and vegetables worldwide. Additionally, harmonizing study designs and methods is crucial for accurately evaluating intervention impact and strategies used. More research is needed to better understand how to improve fruit and vegetable intake in low- and middle-income countries and across different age groups.