Teach Your Patients About Adequate Fruit and Vegetable Consumption

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Teach Your Patients About Adequate Fruit and Vegetable Consumption

Increased consumption of fruits and vegetables is thought to increase health and reduce risk for cancer and cardiovascular disease. This trial was designed to quantify the impact of nutritional counseling vs. behavioral dietary counseling on fruit and vegetable consumption in 271 patients at an inner-city health center.

Patients randomized to the first intervention group received education about the importance of increasing fruit and vegetable consumption, with emphasis on how the biological elements of nutrients work to optimize health. Key to this intervention was the "five a day" recommendation - five servings of fruits and vegetables daily. Behavioral counseling was based on social learning theory and the "stage of change" model, which links positive behavior change with emotional readiness. To this end, each patient received personalized, specific advice tailored toward setting short- and long-term goals with regard to fruit and vegetable consumption.

Both interventions were performed by research nurses; all counseling sessions were audiotaped to ensure the two types of counseling remained distinct. Main outcome measures, assessed at baseline, eight weeks and one year, included self-reported daily fruit and vegetable intake (number of portions); plasma concentrations of alphatocopherol, beta-carotene and ascorbic acid; and 24-hour urinary potassium excretion, which are also markers associated with fruit and vegetable consumption.

Behavioral and nutritional counseling resulted in increases in fruit and vegetable consumption after 12 months, but more significantly in the behavioral group: 1.49 additional portions daily vs. 0.87 additional portions daily. The percentage of participants adhering to the "five a day" maxim also increased dramatically (42% vs. 27%, respectively). Moreover, plasma concentrations of beta-carotene and alphatocopherol increased in both groups. (Plasma beta-carotene more than doubled in both groups, while plasma alphatocopherol increased by 33% in the behavioral group vs. 28% in the nutrition group.)

The authors conclude that both interventions are feasible in primary care settings and could be adapted for group administration. They also note that because their findings involved individuals drawn from a low-income population (where fruit and vegetable intake is relatively low compared to higher-income populations), such interventions "may help address socioeconomic inequalities in health."

Steptoe A, Perkins-Porras L, McKay C, et al. Behavioral counseling to increase consumption of fruit and vegetables in low income adults: randomised trial. British Medical Journal, April 19, 2003:326.
www.bmj.com