Fruit and vegetable consumption in later life

Age and Ageing, Nov, 1998 by Angela E. Johnson, Angela J. M. Donkin, Kevin Morgan, Roger J. Neale, Robert M. Page, Richard L. Silburn

Abstract

Objective: to assess levels of fruit and vegetable consumption in elderly people, and to examine the socioeconomic, physical and psychological factors which influence this consumption.

Methods: a three-phase survey: face to face interviews; self-completed dietary diaries with a food frequency questionnaire; and follow-up face-to-face interviews.

Participants: 445 elderly people (aged 65 ) randomly selected from general practitioner lists in urban Nottingham and rural Nottinghamshire, Lincolnshire and Leicestershire.

Results: the recommended target of five portions of fruit and vegetables a day was achieved by less than half the respondents: 37% of those living in the urban area and 51% of those living in the rural area. Low fruit and vegetable consumption was particularly associated with being male, smoking and having low levels of social engagement.

Conclusions: most elderly people consume less than the recommended levels of fruit and vegetables. Health programmes promoting fruit and vegetable consumption may not be successfully reaching elderly people and need to target those particularly at risk of low consumption.

Keywords: dietary recommendations, fruit and vegetables

Introduction

Fruit and vegetable consumption may reduce the risk of several chronic diseases, including cancers, cardiovascular disease, coronary heart disease, hypertension and stroke [1-7]. The World Health Organisation therefore recommends the consumption of at least 400 g, or five portions, of fruit and vegetables a day [5,8-10]. Most adults' consumption falls short of this recommendation, with only 32% of American respondents [11] and 4% of Scottish respondents [12] meeting the `five a day' targets. Fruit and vegetable intake has been found to be higher in older, as opposed to younger, adults [12-16], but little is known about the typical fruit and vegetable intake of elderly people in the UK. The benefits of fruit and vegetable consumption continue into old age: the consumption of vegetables in old age has been found to be associated with a reduction in cancer mortality [7]. With advancing age, the requirements for some antioxidants may be increased [17, 18].

The factors which may affect fruit and vegetable consumption are: socio-economic circumstances, physical factors and psychological wellbeing. Being male [12, 15, 19], having a lower income, lower educational attainment and lower occupational status have been associated with eating less fruit and vegetables [12, 13, 15, 19-21]. Physical health may play a role in fruit and vegetable consumption, reducing appetite and the ability to shop and cook; and smokers eat less fruit and vegetables than non-smokers [12, 15, 22, 23]. Psychological well being also plays a role in diet, with participation in a greater variety of social and physical activities [21], a higher life satisfaction [24] and fewer problematic life events [21] being associated with more adequate diets, and lower mortality [25] in elderly subjects.

Previous research has looked at the possible influences on fruit and vegetable consumption in isolation, or in combination with only a few other influences. We have estimated the proportion of elderly people who are meeting the `five-a-day' target; and assessed the levels of fruit and vegetable consumption in relation to socio-economic, physical and psycho-social factors.

Subjects and methods

Sample

The study was conducted in two areas: an urban area (the city of Nottingham) and a rural area comprising parts of Nottinghamshire, Lincolnshire and Leicestershire. Of 159 general practitioners (GPs) with patients living in Nottingham, 127 (78%) agreed to support the study. With the consent of these GPs, Nottinghamshire Family Health Services Authority age/sex lists were used to identify all non-institutionalized individuals aged 65 years and over living within the Nottingham area. From the resulting sample of 26055, 1584 individuals were randomly selected. The target was to complete 800 interviews. The sample was stratified at age 75 with equal probability representation in the age groups 65-74 and 75 .

Of 76 GPs with patients living in the rural area, 47 (62%) agreed to support the study. With the consent of these GPs, Family Health Services Authority age/sex lists were used to identify all non-institutionalized individuals aged 55 and over. From the resulting sample of 4408, 669 individuals were randomly selected. The target was to complete 400 interviews. The sample was stratified at ages 65 and 75 with equal probability of representation in the age groups 55-64, 65-74 and 75 . Respondents aged 65 were included in this analysis.

Data collection

The study comprised three phases of data collection.

In phase I, face-to-face interviews were conducted with the whole sample using a structured questionnaire on diet, shopping behaviour, household and socio-economic circumstances, physical health and psychological well-being. All interviews were conducted on a laptop computer in the respondents' own homes. Data collection took place over 17 months (January 1994-May 1995).