Foreword to a Scoping Review of Interventions on Fruit and Vegetable Intake in Low-,Middle-,and High-Income Countries: A Global Perspective

Abstract

A healthy diet low in fat, sugars, and sodium and high in fruit and vegetables (F&V) is recommended to ensure overall health and reduce risk of noncommunicable diseases. However, despite the evidence of strong health benefits, dietary intake of both fruit and vegetables is inadequate in most populations worldwide. To better understand the state of the evidence of what has worked to improve F&V intake, we conducted a scoping review to summarize available evidence of interventions focusing on the impact on F&V intake, including those aiming to improve F&V intake specifically and those targeting diet, health, lifestyle or environment more broadly. We chose to take a global view as lessons learnt from studies in high-income countries may provide important insights for other contexts. The evidence summarized in this Food and Nutrition Bulletin supplement can be used to inform program and policy design as well as future research areas.

Foreword

A healthy diet low in fat, sugars and sodium and high in fruit and vegetables (F&V) is recommended to ensure overall health and reduce risk of noncommunicable diseases (NCDs).^1,2 This is particularly important considering the increasing rates of overweight and obesity worldwide. ³ However, despite the strong health benefits, dietary intake of both fruit and vegetables is inadequate in most populations and across all age groups worldwide.^4–6 A recent analysis of dietary micronutrient intake estimated that 4 billion people do not consume adequate amounts of folate and vitamin C and 3.6 billion have inadequate intakes of vitamin A. ⁷ F&V are the primary food source of these vitamins. The importance of adequate intake of F&V begins early in life and remains critical throughout the lifecycle. A recent analysis of food pattern modeling concluded that ample intake of diverse vegetables among infants and young children is a key part of complementary feeding to ensure adequate micronutrient intakes required for normal growth and development in early childhood. ⁸

Dietary patterns once established, are difficult to change. Dietary choices are driven by an interplay of people's sociodemographic, socioenvironmental, and personal factors and the food systems to which they are exposed. ⁹ Given the complexity of dietary drivers, multipronged solutions are likely needed to create a healthier, more sustainable, equitable, and resilient food system to ensure human health and protect the planet. ¹⁰ However, evidence is limited as to how to improve people's diets, including how to increase the intake of F&V.

In an effort to increase the intake of F&V, CGIAR is leading the Fruit and Vegetables for Sustainable Healthy Diets (FRESH) Initiative, which is being implemented in Benin, the Philippines, Sri Lanka, and Tanzania. FRESH builds on multidisciplinary, international collaborations and uses end-to-end approaches from consumption to production to address barriers related to desirability or preferences, affordability, accessibility, and availability of F&V with the overarching goal of increasing F&V intake and in turn improving diet quality, nutrition, and health outcomes while also improving livelihoods, empowering women and youth and mitigating negative environmental impacts. ¹¹

To better understand the state of the evidence of what has worked to improve F&V intake, we conducted a scoping review to summarize available evidence of interventions focusing on the impact on F&V intake, including those aiming to improve F&V intake specifically and those targeting diet, health, lifestyle or environment more broadly. Although the FRESH Initiative focuses on low- and middle-income countries, we chose to take a global view as lessons learnt from studies in high-income countries may provide important insights for low- and middle-income countries. The evidence summarized in this supplement can be used to inform program and policy design as well as future research areas, including those carried out under FRESH.

Considering the expected heterogeneity in implemented interventions, study design, and study contexts, a scoping review was determined to be the most useful type of review to determine the scope of the evidence, identify knowledge gaps, and inform future interventions and programs. ¹² To be included in the scoping review, assessment of dietary intake was considered one of the eligibility criteria. ¹³ Findings of the scoping review are summarized in the present Food and Nutrition Bulletin supplement. The objective of the first review paper is to examine how available research was conducted, to summarize study design, population groups, methods, and interventions used and to provide a general overview of findings. ¹⁴ The subsequent review paper dives into the results by intervention components and strategic approach. ¹⁵ In the last paper, we put the reviewed evidence and identified research gaps into perspective, considered the relevance of these findings as well as research needs at the global, regional, and national level of the 4 FRESH target countries: Benin, Philippines, Sri Lanka, and Tanzania. ¹⁶