Science Newsletters

The IFAVA newsletter provides members with access to credible, sound scientific evidence specific to vegetables and fruit. An undertaking of this kind cannot be accomplished without the generous support of many who have contributed to the development and review of the content. As the first Chair of IFAVA, I would like to personally thank all those who have been active in the development of this new tool, to spread the valuable message of eating vegetables and fruit. I would specifically like to thank the scientific committee and editorial board for their vision and commitment on this program.

Ron Lemaire
Executive Vice President & Director of Marketing
Canadian Produce Marketing Association

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English Newsletters
	The US Special Supplemental Nutrition Program for Women, Infants, Children - WIC
	The USA’s Special Supplemental Nutrition Program for Women, Infants, and Children – WIC – administered by 2,200 state and local WIC agencies under the auspices of the United States Department of Agriculture serves over nine million qualifying mothers and young children who are income eligible and at nutrition risk, including over half of all America’s infants and one-quarter of its children between one and five years of age. Quality nutrition services are the centerpiece of WIC: nutrition and breastfeeding education, nutritious foods, and improved healthcare access for low and moderate income women and children with, or at risk of developing, nutrition-related health problems, including overweight, obesity, and type-2 diabetes. The foods included in the WIC food packages are specifically selected for their nutritional value to supplement the nutrients found lacking in the diets of low-income populations and include fresh, frozen, canned, and dried fruits and vegetables, prepared baby fruits, vegetables, and meats, low-fat dairy, whole grain cereals and bread, light tuna, salmon, sardines, and mackerel, canned and dried beans, peanut butter, eggs, juice, and iron-fortified infant formula. WIC consumers use cash value vouchers to purchase healthy fruit and vegetable choices in retail settings or farmers’ markets. Since implementation of the new food packages, researchers have sought to determine the success of fruit and vegetable voucher implementation. We are pleased to share three examples of their research.
	Better Information for Better Behaviour
	The challenge of modifying food environment… For tackling the so-called obesity epidemic, it is now well recognized that only focusing on consumer education has a limited efficiency if the food environment does not allow consumers to comply easily with the recommendations. However, modifying the food environment is a complex task, due to the multiplicity of factors, of sociocultural, economical and regulatory constraints. There is no single and simple solutions which could be applied everywhere. The papers of this issue illustrate this complexity and suggest some possibilities. The first challenge is to adapt recommendations to a specific dietary context: optimizing individual actual diets by linear programming appears to be a promising tool for establishing realistic food based dietary guidelines for a specific population. But their implementation through, for example, regulation of food advertising or the posting of pertinent information for consumers in restaurants is controversial. The design of such actions requires the protracted involvement of many stakeholders originating from various disciplines and fields of expertise. The novelty and complexity of problems we are now facing require new imaginative solutions. It would be interesting in the future to compare, for example, the efficiency (and difficulties) of regulatory actions, like in New York city, and the French experience of the voluntary charters of nutritional improvement contracted between the government and food producers and retailers….
	Fruit & Vegetables and Mental Health
	Depression is a major cause of disability worldwide and the impact of diet on mental health is raising increasing interest. Two studies presented in this issue have examined the relationship between dietary patterns and the presence of depressive symptoms in large samples of adults. Both studies evidenced that dietary patterns rich in processed food, sugar and refined grains were associated with higher levels of depressive symptoms. By contrast, the British study showed that a healthy diet characterized by high intake of vegetables, fruits, and fish was associated with lower depressive symptoms, whereas no protective dietary pattern could be evidenced in the Australian study. A common limitation of these studies is their cross-sectional design which cannot rule out reverse causality. Nevertheless, as explained in the accompanying review, these findings have biological plausibility. Depression is more prevalent among people with high plasma homocysteine. Folate and other B vitamins found in green leafy vegetables and whole grain can lower plasma homocysteine. Long-chain omega 3 polyunsaturated fatty acids found in fish play a major role in brain function and structure. Conversely, a high glycemic load diet is associated with worsening of mood. The clear suggestion is that dietary intake of vegetables, fruits and fish, provide a set of nutrients that could contribute to improve well-being. As often noted in nutrition, the sum of the parts is greater than the whole.
	Obesity Costs
	The health consequences of obesity among children and adults are well recognized, ranging from early cardiovascular disease, gallbladder disease, diabetes and even adverse mental health consequences. As the developed world becomes increasingly obese (for example, data from the 2007-2008 National Health and Nutrition Examination Survey in the United States suggest that 18.1% of children 2-19 years old are obese while another 16.1% are overweight), the economic consequences of this epidemic are already being appreciated. The accompanying articles in this issue illustrates the gravity of the problem, especially in the context of growing concern about accelerating health care costs as a percentage of gross domestic products. While effective interventions remain wanting, these studies suggest that successful efforts to improve dietary balance and eliminate other risk factors for obesity and overweight will save much more in health care costs than the cost of the intervention. Indeed, a recent article published in Health Affairs suggested that a $2 billion annual investment in childhood obesity prevention would be cost-effective if it could produce even a modest reduction in the number of children who were obese. These articles should redouble our efforts to identify opportunities for prevention of obesity in childhood, in pregnancy (especially because of multigenerational effects) and in adulthood.
	Impact of the Environmental on Fruit & Vegetable Intake
	Many Fruit and Vegetable (F&V) promotion efforts are still based on the notion that people’s health beliefs and related motivations are the most important drivers of F&V consumption. Such campaigns therefore communicate about the health promoting properties of F&V, implying that when we teach ‘the public’ that F&V are healthful, they will be sensible enough to eat enough from these food groups. Results from a wealth of health behaviour research show, however, that health beliefs are only one of many drivers of consumption, and most often not the most important one. Research shows that there are three important categories of determinants of health-related behaviours, such as F&V consumption: motivation, ability and opportunity. When people are motivated to eat enough F&V, when they have the abilities to buy, prepare and consume enough F&V, and when their environment offers plenty of opportunities to obtain and eat F&V, chances improve that people will eat more adequate amounts. Until recently most research aiming to gain insight in the determinants of F&V intakes was focussed on motivational factors. In recent years more attention is being paid to the environmental opportunities that enable or promote F&V intakes, i.e. opportunities that may make the healthy choice the easy or default choice. Four ‘sorts’ of ‘the environment’ have been distinguished in the scientific literature: 1.The physical environment, i.e. environmental factors that influence or determine availability and accessibility. 2.The social-cultural environment, i.e. factors that define what is socially acceptable and appropriate; what one sees others do and what one is encouraged to do by others. 3.The political environment, i.e. the rules and regulations that may influence behaviours such as F&V consumption. 4.The economic environment, i.e. factors that relate to what is affordable. In this IFAVA newsletter three contributions focus on such potential environmental influences on F&V intakes. Dr. Lukar Thornton presents an overview of some of the research he conducted with his colleagues at Deakin University, Australia, on physical environmental factors and F&V intakes. His study explored if access to supermarkets and other stores with F&V was associated with F&V intakes in different populations. Only few significant associations were found, but this line of research is still in its early stages, and more research is necessary on a range of availability and accessibility related issues to learn more about the relevance of physical environmental factors. Dr. Ange Aikenhead of the International Association for the Study of Obesity presents research results regarding the political environment, and more specifically regarding rules and regulations for marketing to children. It has been established in recent reviews of the evidence that marketing of unhealthy foods to children is associated with less healthful diets and more overweight and obesity. Dr. Aikenhead presents results further indicating that the political environment is of great importance to restrict exposure to such marketing in order to promote healthier diets among children. Finally, Prof. Ritva Prättälä from the National Institute for Health and Welfare in Helsinki, Finland, presents research results regarding the importance of the economic environment. Her research clearly confirms that in many countries, especially in Northern Europe, evident disparities in F&V intakes exist according to socioeconomic position. In other words: the less well-off have lower intakes of F&V. Her studies further show that in the countries where these disparities are apparent, availability of F&V is lower and prices are higher. These three contributions are important examples of research focussing on disentangling the broad range of potential influences on F&V intake, going beyond mere personal and motivational factors. Such research is necessary to inform more effective F&V promotion.
	Fruit & Vegetable Consumption - Socioeconomic Determinants and Health
	The 6th Edition of the EGEA Conference was held in Brussels in May 5-7 2010 Once again this was a highly successful event bringing together distinguished scholars, experts and officials. The theme of the event was Social and Health Benefits of a Balanced Diet: the role of Fruit and Vegetables. Obesity is an increasing curse in our modern societies. The consequence is an increase in obesity related diseases such as diabetes, cardiovascular diseases and other non-communicable diseases. Obesity is the result of our live style with too little physical activity and an unhealthy diet, where we eat too much food and far too little of Fruit and Vegetables (F&V). Inevitably this lifestyle has an increasing cost for our societies in the treatment of obesity related diseases. Unless we succeed in stopping the trend this cost is only going to further accelerate like a snowball bringing down an avalanche. To this mounting financial cost should be additionally added the emotional cost and stress for individuals suffering from obesity. The WHO recommends a minimum daily consumption of 400gr of F&V. One of the themes of the Conference was to discuss the link between low consumption of F&V and the prevalence of obesity. Although it is widely assumed that F&V consumption has a beneficial effect on preventing overweight and obesity, it is not easy to demonstrate the causality. Another aspect considered by the Conference was the fact that low consumption of F&V and higher incidence of obesity is associated with lower socio-economic groups. This creates a vicious circle exacerbating the disadvantages that such groups are already fighting against. The issue is therefore how can we establish policies and introduce instruments to break this circle of disadvantage. One of these instruments is the newly introduced EU School Fruit Scheme. The School Fruit Scheme was adopted by the EU in 2008 and now 25 out of 27 Member States participate in the programme. This is a fantastic success considering that prior to the introduction of the scheme only 6-7 programs were running on a national basis and only to a limited extent. The idea is to combine the consumption of F&V in schools with a nutrition policy and balanced diet, connecting children with agriculture. The consumption of F&V in itself is not the primary objective, but rather to use the School Fruit Scheme as an opportunity to force health, education and agriculture authorities and stakeholders to work together as "The key to the door". Nutrition, healthy lifestyle, agriculture and environment should be brought into the curriculum as a natural element. We need to invest in our children so that their consumption of F&V during their life is permanently increased. There is a lot to do if we are to win the fight against obesity and future EGEA conferences will make an important contribution to this battle.
	Dietary Patterns in Adolescents
	Adolescence is one of the most dynamic and complex transitions in the lifespan, characterised by rapid biological, psychological and social change. Adolescence is the age of exploratory, sometimes risky, behaviour and is a time when the physiological need for lifestyles including diets with high nutritional quality is particularly important. The eating behaviours of adolescents are likely to play an important role in the development of a range of chronic conditions, including overweight and obesity. Furthermore, eating patterns, preferences and habits adopted during this life phase may track into adulthood. Many adolescents have unhealthy diets. For example, data from the Health Behaviour in School Children (HBSC) study shows that less than two-fifths of young people eat fruit daily, and only about a third eat vegetables each day. Furthermore, dietary trend data from the United States suggests that daily caloric intake appears to be increasing in young people – primarily from energy-dense nutrientpoor foods, an increase in snacks, eating away from home and an increase in portion sizes. New research described in this Newsletter throws further light on adolescent eating behaviours. Female adolescents in particular were likely to report persistent use of unhealthy weight control behaviours, which are often associated with poorer dietary intake and less frequent meals. Females were more likely to eat out-of home foods, compared to males. Out-of-home eating added a number of desirable foods and nutrients to adolescents’ diets, but was also associated with higher consumption of energy from fat and sugars. Obesogenic diets and physical activity behaviours were associated – weakly, and associations differed for males and females. The findings highlight the complexity of adolescent dietary behaviours. Gender differences in dietary behaviours warrant further investigation. Multi-level influences on adolescent dietary behaviours need to be better understood for the design and implementation of effective interventions promoting healthy dietary behaviours among adolescents.
	Ideas to Increase Fruit and Vegetable Consumption
	The health benefits of a high Fruit and Vegetable (F&V) intake are beyond doubt. However, actual consumption of this food group is insufficient in large parts of the population, resulting in calls for interventions to increase it. In this edition of the IFAVA Newsletter, three attempts to do so are presented, focusing on different factors influencing the choice of F&V for a meal. The way foods are prepared is an important determinant of consumers’ attitudes towards them. Lack of knowledge and experience as to how to cook vegetables can therefore present a barrier to their consumption as reflected in a recent study from Brisbane, Australia. Winkler and Turrell suggest that the knowhow of vegetable preparation appears to be particularly low in groups that have repeatedly shown a low consumption. As preparation also strongly influences taste and consistency, it is an important factor for consumer acceptance. In their study, Rennie and Wise show a preference for steamed vegetables over cooked ones, suggesting that cooking techniques should be considered in interventions to promote vegetable intake. However, in everyday life, many people have to rely on community nutrition and catering for their food at least on working days, placing canteens in the focus of intervention approaches. Children are a particular target group for such attempts as their F&V consumption is generally too low. A recent investigation reported by Swanson and Branscum showed that intake in young children can be increased by offering sliced fruit, particularly the varieties difficult to handle. These three findings show the need to consider all factors influencing food choice when promoting F&V consumption.
	Increasing Fruit & Vegetable Consumption to Reduce Energy Intake
	Increased consumption of Fruits and Vegetables (F&V) can help to facilitate weight loss; however, several clinical trials testing this effect have reported a decline in intake over time. A sustained increase may be more likely if people are taught specific strategies for incorporating more F&V into their diets to manage their hunger and eat fewer calories. This can be achieved when F&V displace high-energy-dense foods so that the overall energy density of the diet is reduced. A simple and effective strategy is to increase the proportion of vegetables or fruits at a meal, for example by substituting them for more energy-dense ingredients in mixed dishes or by serving larger portions as side dishes. Another approach is to fill up at the start of a meal with a low-energy-dense salad or whole fruit so that intake of more energy-dense foods during the rest of the meal is reduced. People also need to be aware of strategies that are ineffective in reducing energy intake, such as consuming fruit as juice rather than eating it whole. In addition, simply advising people to add F&V to their meals may have little effect on energy intake and could even increase it if the additions are not very low in energy density. There are many reasons why people may not sustain an increased intake of F&V in order to manage their weight, and one of these could be that this approach is not perceived to be effective. Future interventions should explore whether teaching people specific strategies to enhance satiety by incorporating F&V in their diets will not only prevent a decline in intake, but will also promote greater weight loss.
	Eating for Pregnancy
	Over the last several decades, evidence indicates that many strategies to prevent the two leading causes of infant mortality in the developed world - birth defects and prematurity/low birthweight - have their greatest influence when commenced before a pregnancy is conceived. The traditional prenatal care pathway to preventing poor pregnancy outcomes is often inadequate because it starts too late. A good example is that adequate folate levels at the time of organogenesis (days 17-56 after conception) is associated with a 50%-70% reduction in neural tube defects. By waiting to start vitamins with folic acid at the first prenatal visit it will be too late to prevent most neural tube defects. Unfortunately, as illustrated by the articles featured in this issue, most women, even those hoping to become pregnant, are not adopting proven protective behaviors before conception. Many explanations exist: health promoting messages are not reaching women; they are being framed in a way that lacks personal relevance; they are not reiterated regularly; they involve personal or financial costs that are judged negatively; or they lack credibility. The bottom line is that impacting health choice, such as eating more green leafy vegetables, taking a multivitamin with folic acid daily or achieving a healthy BMI, is far more complex than we know how to address. Until translational research receives the funding and respect it deserves, we will continue to have a disconnect between the science we know and its ability to shape the futures of today’s women and tomorrow’s children.
	Fruit and Vegetables and Cognitive Function
	Cognitive impairment is a broad term to describe a wide variety of impaired brain function relating to the ability of a person to think, concentrate, reason and remember. The most severe degree of cognitive impairment is dementia. Currently, no pharmaceutical treatment is available to cure dementia. Prevention is however a way to reduce the burden of dementia in western countries, and diet might be a successful candidate. Several epidemiological studies have shown that high intake of Fruits and Vegetables (F&V) was associated with a decreased risk of developing dementia in cohorts of elderly people. But few studies have addressed the impact of food intake during infancy or at midlife on cognitive function. The results presented in this Newsletter show that people engaged in a healthy diet have a lower risk of cognitive and functional decline. They also highlight that F&V intake is closely linked to other favorable behaviours (such as no smoking, low alcohol consumption and high physical activity). Children fed a diet characterized by high consumption of fruit, vegetables and home prepared foods had higher IQ, verbal IQ and better memory performance at age 4 years. Adjustment for maternal education, intelligence and social class attenuated the association but it remained significant. These findings show that F&V intake might be associated with better cognitive performances but one must keep in mind that unmeasured confounding factors (especially social and cultural ones) may partly explain these results.
	Fruit and Vegetable Consumption - Determinants among Adolescents
	Adolescents have to engage with a social environment of increasing complexity and diversity. The agents in this engagement include family and peer relationships, the internet, television, mobile phones, the media and electronic gadgetry. All of these provide a flow of information that influences adolescents’ perception of their size and shape, self-esteem, fashions and ways of behaving (including dietary choices, skipping meals, eating fruits and vegetables and fast foods). In order to implement public health policies that are effective against adolescent overweight and obesity (and which contribute to health in other ways), it seems essential to obtain a picture of the relationship between the social environment, frequency of obesity and key dietary variables. Recent surveys have been based on large numbers of adolescents ranging in age from 11 to 17 years. In the largest study – of more than 162 thousand adolescents in 35 countries - there were some surprises. For example, the relationship between the percentage of overweight/obese adolescents and economic inequality – or the social gradient (differences in wealth between top and bottom) – was different for the high income countries compared with those of middle income. Why should this be? Clearly social dynamics operate differently in distinct cultures and in countries which vary in wealth. The sheer complexity of the relationship between country based economics and adolescent obesity is mirrored by the complexity of the relationships between family circumstances and adolescent dietary behaviours. These outcomes raise the question of whether it is possible to draw a single all embracing conclusion from such complicated arenas. Although large surveys have value, they may not provide the elements for policy development. We can ask, is there an average adolescent? Answer – No! Consequently we are unlikely to find solutions in the ‘average’ values of variables that influence adolescent behaviour and body weight. In dealing with complicated environments where predictability is low, it may be better to do our research locally, and to uncover relationships in the areas where we live and work. John Blundell Institute of Psychological Sciences, University of Leeds, UK
	Living Healthy and Feeling Better
	How far do we have to go back? As the articles in this newsletter highlight, we are now confronting challenges affecting all our different sectors in the food chain, in nutrition and health. In the more affluent parts of Europe, life expectancy is going up by three months every year - reflecting not only how we live now and our better management of disease, but also our biological responses to this generation's early feeding practices. In growing up we were much thinner than today's children and had a very different diet and level of physical activity. Now healthy living is becoming one of the top issues not only for politicians but also doctors. The whole issue of climate change is being negotiated with huge implications for the food chain and as we foresee the re-negotiation of the Common Agricultural Policy in the European Union. As illustrated in the articles below we have to confront not only the challenge of ageing but also of the diseases which affect us a long time before we finally die. Life expectancy can differ even within a single European country by 10 years, with the poor dying earlier yet living within a kilometre or two of their wealthy neighbours. They also have up to 20 years less of a disability and disease free life; and diet is increasingly seen to play an exceptionally important part. Clearly we need to rethink the importance of the Mediterranean diet and some are even considering the Palaeolithic diet which probably had even more fruit and vegetables. W Philip T James London School of Hygiene and Tropical Medicine, UK
	The Gap Between Recommendations and Real Consumption (In Europe)
	An adequate consumption of Fruits and Vegetables (F&V) is an important component of a healthy diet to prevent major non-communicable diseases such as cardiovascular diseases, diabetes, gastrointestinal cancer and obesity. The recently published European nutrition and health report 2009 indicates that a minimum daily intake of 400g of F&V (excluding potatoes and other starchy tubers), which is the minimum amount recommended by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), has not been achieved in many European Union countries. Data from dietary surveys carried out in the adult population suggest that Austria, Germany, Italy and Poland only have been able to meet this recommendation. The FAO food balance sheets present a comprehensive picture of the pattern of a country’s food supply during a specified reference period and show the quantities and types of food available in a country. Although an increase has been observed in the mean supply of F&V over the past years, in almost two thirds of the 53 Member States in the WHO European Region their mean supply is far below the recommended supply of 600g per capita per day. The second action area of the WHO European Action Plan for Food and Nutrition Policy 2007-2012 is entitled ensuring a safe, healthy and sustainable food supply. Member States are encouraged to take integrated action in this area in order to improve the availability and affordability of F&V by revising, for instance, their agricultural policies; providing technical advice and market incentives for local horticulture (including urban horticulture) and reducing trade barriers to imports. A preliminary analysis of currently available national policy documents, carried out by the WHO Regional Office for Europe, suggest that nine documents only include an objective to increase the production and growing of F&V. In contrast, campaigns targeting the availability of F&V in local settings such as schools or work places have been widely implemented as well as initiatives aiming to improve the individual consumption. These campaigns and initiatives are promising in reducing the gap between recommendations and real consumption of F&V in Europe, but many countries still need to take action in this regard. Trudy Wijnhoven Technical Officer, Nutrition Surveillance WHO Regional Office for Europe
	The Perception of Fruit and Vegetables
	For several years, most governments have been announcing policies exhorting people to eat a healthy diet (around the iconic images of fruits and vegetables (F&V)) and to undertake more physical activity in order to help prevent a range of diseases. Eat less unhealthy foods and move more. Almost everyone agrees that it makes sense; no one is actually advocating eating fewer F&V or to move less. However, the percentage of people in most societies who ‘claim’ to meet prescribed targets is depressingly low (the true figure may be even lower than ‘claimed’). Why is this? A number of studies are now being conducted to reveal why people – both adults and children – are unable to meet the quite reasonable and not especially demanding targets being set. Barriers exist both in the individual and in the environment. For young children their parents apparently present significant barriers (the corollary is that the parents could therefore be a positive influence). But parents have perceptions of the barriers they themselves confront, one of which is the perceived pressure of time. In a modern world people blame a lack of time for being unable to eat a healthy, balanced diet. Can anything be done about these barriers? One problem is there are abundant alternatives to a healthy diet and living a physically active life. These alternatives are not marketed as ‘unhealthy practices’ but they are incorporated into cultural forces that promote the consumption of easy to find, cheap to buy, energy dense products and enjoyable sedentary activities (often sitting down watching someone else do something). All of these are legitimised in the commercial market of a consumer society. It may be perceived as being unfair but it is not against the law. In this environment, does the identification of barriers exhaust all possibilities for the failure of people to meet targets? Could there be an underlying ‘unwillingness’? Is it possible that people actually enjoy the taste and easy mouthfeel of ‘unhealthy’ foods or that they dislike the effort of physical activity? Self denial is not a popular lifestyle choice. The preservation of ‘freedom of choice’ is a goal of most democratic societies. However, to change unhealthy lifestyles may require a greater degree of coercion (limitation of choice) than currently exists. Pr John Blundell Director of the Institute of Psychological Sciences University of Leeds, UK
	Health Benefits of Allium Vegetable Intakes
	There is little doubt that nutrition and health are intimately intertwined. For generations, people have believed that foods can do more than merely provide energy and nutrients for growth and development and thus contribute to overall health and disease prevention. Beliefs about the medicinal properties of foods have been highlighted in a number of the early writings. Hippocrates is frequently quoted to proclaim “Let food be thy medicine and medicine be thy food.” Today, statements about the ability of foods and food components to reduce disease risks or enhance the quality of life are relatively commonplace and continue to captivate our lives. Garlic and other allium foods (onions, leeks, chives, etc.) are commonly consumed foods which are often revered for their potential medicinal properties. This reverence has been promoted in recent years, especially for garlic, because of the emergence of data revealing that in addition to antimicrobial properties these foods may reduce human illnesses including that related to heart disease and cancer. The ability of garlic and its constituents to assist in maintaining normal immune-competence and possibly improve mental function suggests it, and possibly other allium foods, may have widespread health implications1, 2. Unfortunately, while the interrelationship between garlic intake and health are intriguing, there remain a dearth of well-controlled clinical investigations with allium foods and the data that exist is often inconsistent. The current series of articles point to the potential benefits of garlic, and onions, in several health related conditions. The articles also provide evidence that it would be unwise, and inappropriate, to assume that all individuals will respond identically, if at all. J. A. Milner, Nutritional Science Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
	Children Nutritional Needs: School Meals or Packed Lunches?
	Low consumption of fruit and vegetables (F&V) is a worrying phenomenon among children. According to the Pro-Children study financed by the European Commission, in average only 17.6% of the 11-year-old children reach the WHO minimum recommended level of 400g/day. One of the reasons of low F&V consumption by children is their apparent lack of availability. According to the same study, only 22% of children reported good availability at school and during leisure-time activities. Improving the eating habits of children and adolescents is an important strategy for improving public health. Increased F&V consumption can have an immediate effect on maintaining a healthy body weight and reducing the risk of certain diseases over the longer term. Interventions targeting healthy nutrition need to occur early in childhood or during adolescence, in order to prevent or reverse the adverse health effects of overweight and poor eating habits. This highlights the importance of ensuring an appropriate availability of F&V at school. Schools can reach almost all children and adolescents during their first decades of life and are a critical part of the social environment that shape young people's behavior. The European school fruit scheme with an annual budget of €90 million should generate positive effects and bring benefits to schoolchildren, their parents and teachers as regards increased availability of F&V. Lars Hoelgaard Deputy Director General, European Commission, Belgium
	Fruit and Vegetables in the World
	The World Health Report 2003 published by WHO highlighted that low fruit and vegetable intake is among the top 10 risk factors for disease prevention. If this is not enough to focus attention then the fact that an estimated 2.7 million lives could be saved annually with sufficient levels of fruit and vegetable consumption certainly should. But does it? The fact is that wherever you live in the world a range of factors are impacting on your health. Modern lifestyles and eating habits, more sedentary jobs, changed working environments and a range of other factors have all combined to place each of us more at risk of chronic disease. Consuming the recommended levels of fruit and vegetables is a relatively simple and effective way of helping to reduce the impact of a wide range of serious – and largely preventable – health problems throughout the world. Through activities such as this newsletter, the International Fruit & Vegetable Alliance is actively involved in encouraging efforts to increase the consumption of fruit and vegetables globally for better health. While the science linking increased consumption to better health outcomes provides a strong foundation for action, there is no doubt that we need to better understand current consumption patterns and examine ways to effect behavioral change in order to make a long term difference. The articles presented in this edition of the newsletter reflect this need to appreciate why consumption of fruit and vegetables is not more in line with the potential health benefits. If parents, doctors, public and private health practitioners, grower organizations, governments and other bodies are all convinced of the substantial health credentials, the question remains as to why consumption is not higher. Understanding the motivating factors for consumers is a critical part of this important health puzzle. Chris Rowley - IFAVA Co-Chair & Horticulture Australia Limited Health Initiative Coordinator
	Close Environment Impact on F&V Consumption
	Why do so few people eat healthy diets? Most people do not meet national dietary guidelines. A UK national survey in 2001 showed how many people met each nutrition target but left out a crucial piece of information: how many met all the targets at once - i.e. ate a healthy diet? The answer was barely one percent. Despite repeated surveys, researchers and policy-makers struggle to find the answers. Does income really matter? Is education more important? Or local food supplies - 'food deserts'? Would extra cash make a difference? The traditional approach sees individual behaviour as the problem and seeks to change it. But behaviour change depends on a sequence of changes: changes in information, of attitudes, in motivation, changes in skills and resources, access and availability, changes in social norms and cultural expectations. Purchases are strongly influenced by what is available, by price, by past experience and by marketing messages. New research described in this Newsletter throws further light on what infuences behaviour. Parents, even on low incomes, know the basics of healthy eating but not always the detail. A TV in the bedroom undermines healthy eating patterns. Family meals help, but not a lot. These findings show the complexity of dietary behaviour. Interventions which tackle only part of the problem will probably fail. Real change - at the level of agricultural policy, prices and marketing - is needed if we really want to help all people meet the healthy targets. Tim Lobstein Director of Policy and Programmes IASO - IOTF - UK
	How to improve F&V consumption at School?
	Growing evidence has shown that low consumption of fruits and vegetables (F&V) is associated with the risk of some chronic diseases, particularly obesity. Prevention efforts need to include early interventions to increase F&V consumption of children. Several international studies have shown that school intervention early in childhood is of major importance and that both school and home play a complementary role. So, the question becomes “how to make the consumption of F&V increase in schools ?” International initiatives have been developed and have concerned 3 types of experiences: 1. Increasing F&V availability in canteens, like the "Farm to school" program in Michigan, or with vending machines; 2. Organizing gardening activities at school; 3. Offering a fruit or a vegetable for snack, experiences followed in Denmark and Norway. In 2008, this was one of the priority areas of the public health policies of the French Ministry of Agriculture, with the program "un fruit pour la recré" (“a fruit for recreation time”). This type of program will spread all over the European countries by the end of 2009 with the School Fruit and Vegetable Scheme. The purpose is not only to improve children's knowledge, but also to change habits and behaviors. Martine Padilla Scientific administrator, CIHEAM-IAMM, UMR Moisa.
	How F&V could be beneficial for health?
	A high intake of fruits and vegetables (F&V) is a strong determinant of health and results in a low risk for cardiovascular diseases and some forms of cancer. Scientific evidence supporting the health benefits of F&V is primarily derived from epidemiological studies. What is missing is a profound understanding of the bioactive constituents in F&V, the underlying mechanisms, and the dose-response relationship. The articles introduced in this Ifava Newsletter further enhance our understanding of why F&V are so healthy. Liu et al. investigate the contribution of fruits to the overall intake of antioxidants. Their data suggest that some fruits are really “superfruits” due to their high antioxidative potential. Whether these effects measured in test tubes are still relevant after the intestinal digestion of fruits, has yet to be studied in humans. Esmaillzadeh et al. report that a high intake of F&V protects against non-specific chronic low-grade inflammation. This type of inflammation occurs in obese subjects and is associated with an increased risk of cardiovascular diseases. A high F&V intake is also associated with lower blood pressure. He et al. suggest in their article that F&V as a major dietary source of potassium contribute to blood pressure reduction. Together these articles exemplify the different types of bioactive constituents in F&V. For the consumer, the maximum health benefit clearly results from a daily intake of at least 400 grams of various F&V. Dr. Bernhard Watzl Max Rubner-Institute, Karlsruhe, Germany
	From the 2008 WCRF Policy Report
	In 2007 the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published the Second Expert Report, Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. This report is the most current and comprehensive analysis of the literature on diet, physical activity and cancer. It includes 10 recommendations that comprise a blueprint people can follow to help reduce their risk of developing cancer. But making these recommendations is just the first step. Equally important is understanding how to achieve them. To this end, a companion publication to the Second Expert Report, Policy and Action for Cancer Prevention, addresses why people practice particular eating and physical activity habits over a lifetime. It looks at the success of studies that have been designed to change those behaviours and it makes recommendations for policy-makers and decision-takers at international, national and local levels. These recommendations, if implemented, will help influence and change the lifestyle choices that people make, reducing their risk of cancer and other chronic diseases. The overarching message of the Policy Report is that public health is everyone’s business and that everyone in society has a role to play. In this issue, we take a look at the methodology behind the Policy Report, the evidence on the effectiveness of interventions to increase vegetable and fruit consumption, and at some of the recommendations and actor groups involved. Kate Allen WCRF International Director (Science & Communications)
	Community Based Interventions
	Improving healthy nutrition at the workplace: Why are we so behind in France? The implementation of Worksite Health Programs in France is the responsibility of individual employers, as per the national labour law and as a result of a long social history. This translates as priority to OSH (Occupational Safety and Health) approach and poorly developed Workplace Health Promotion. Nutrition is addressed by occupational practitioners in terms of irregular work hours, for example people working at night, but is otherwise often absent from workplace topics. Moreover it is difficult to strike a good balance between the proposition of nutrition policies in the workplace and individual freedom regarding dietary behaviours. It is assumed that people generally wish to eat what they want and do not appreciate an imposed nutritional message. Nevertheless, there is clear evidence of the links between lifestyles, including nutrition habits, working conditions, and ill-health. The current French figures on F&V point to low consumption. It is well known that price, taste, and eating habits in the home are determining factors; in the work place, there is also the issue of where to find fruit and vegetables and how to keep them. The ideas of CSR (Corporate Social Responsibility) or Sustainable Development and work-life balance are increasingly becoming topics of debate and policy. This is partly in response to the fact that individuals also are becoming more concerned with their own health. Some first examples of positive actions to improve access of F&V in the workplace include direct services offered to companies, vending machines which also deliver fruit compotes and fresh fruit, and nutrition information and education programs led by companies themselves or by workplace collective catering companies. Times are changing in response to demand of French consumers for healthier options, and specifically fresh fruit and vegetables, in the workplace. Benjamin Sahler Aract Limousin Limoges - France
	University Food Choices
	The three papers in this issue of the Ifava newsletter provide an interesting perspective on the dietary behaviour of university students and point to possible explanations and ways of improving health behaviours. The results in the first paper regarding a cohort of German students provide further evidence of the poor lifestyle habits already observed in European student surveys and national reports published in the last decade. Some points may be highlighted from this and the two following papers. Studies based on the university environment draw upon a short period of life; thus the number of studies is relatively limited. However, the results consistently demonstrate that university students are particularly vulnerable to poor health behaviours and should be taken seriously by public health authorities. It will be important to conduct studies on the impact of university-based interventions in terms of academic performance as well as health and dietary behaviours in later life. Furthermore, it will be essential to assess whether those traits identified amongst university students are transitory or persist beyond university life. Medical students appear to have comparatively (though slightly) better health behaviours, but whether these are linked to a stronger health consciousness or rather reflect other explanatory models deserves scrutiny. Clearly, food offered in university canteens is a part of the explanation of poor diets amongst students; improvement in the nutritional quality and price of the offered meals is a modest, but efficient way to lead to improvement. Finally, addressing the economic constraints of the student (and indeed the general) population, and making safe, healthy foods available and affordable to all must continue to be a priority, in part because disease prevention through good nutrition initiatives makes clear economic sense. Pr Ambroise Martin University of Lyon - France
	Carotenoids: Elderly Healthy Diet Marker
	Incidence of cardiovascular disease and cancer increases with aging. Preventive strategies are of utmost importance for healthy aging and quality of life. Among them, the reduction in oxidative damage appears to be an important strategy to reduce cancer and cardiovascular disease mortality. Carotenoids are known to be powerful anti-oxidants and may be good candidates to protect against damage caused by oxidative stress, since epidemiologic studies suggest that a diet with high fruit and vegetable intake is protective against cancer and cardiovascular disease. Carotenoids (alpha-carotene, beta-carotene, lycopene...) are present in a wide variety of fruits and vegetables. It is generally considered that plasma carotenoids are a valid biological marker for vegetable and fruit intake. Studying the relationship between plasma carotenoids and mortality may be of great interest, especially in older adults who are more prone to oxidative stress and in order to propose dietary guidelines for this population. Sarcopenia is characterized by a loss of muscle mass, and loss of strength is a major hallmark for aging. It is also a main component of frailty and is predictive for disability. Developing strategies to fight against sarcopenia in the elderly is of utmost importance. Among various potential mechanisms, oxidative stress that can damage mitochondrial DNA may be a causal factor for sarcopenia. Therefore, results of studies developed to determine whether carotenoid intake may be protective against the decline in muscle mass and function may provide new perspectives. Pr Bonnefoy Department of Geriatric Medicine Hospital Lyon-Sud (Pierre-Bénite) - France
	Pregnant Women-A new nutritional risk group without fruit and vegetable consumption?
	PREGNANT WOMEN A new nutritional risk group without fruit and vegetable consumption? Fetal nutrition may influence the subsequent risk of chronic childhood and adulthood diseases. Unbalanced food intake together with metabolic changes occurring during pregnancy may influence the mother’s health by increasing the risk of obesity, which may be risk factor for metabolic conditions including gestational diabetes mellitus and hypertension. Although recommendations for dietary intake and weight during pregnancy might be vary, several recommend an adequate (400-500 grams) daily intake of fresh fruit and vegetables for whole population. What a woman eats during pregnancy should cover her nutritional requirements, facilitate optimum growth of the fetus, prepare the body for a birth without complications, and contribute to a satisfactory lactation period. Given that energy intake need only be raised a little while nutrient intake must be increased much more, it would be advisable to lower fat and simple carbohydrate intakes and increase those of fruit, vegetables, greens and legumes. Along with vegetables, fruits provide antioxidants, especially vitamin C and beta-carotenes, which are essential during pregnancy. Undoubtedly, unless at least 4 - 5 portions of these foods are taken daily, it is impossible to reach the folic acid recommendation for pregnant women. However, not only are proposed dietary guidelines generally not followed by the population, most women of childbearing age don't even know they exist. They therefore frequently go through pregnancy with suboptimall nutritional status. Dietary counselling combined with the provision of food products during pregnancy is of importance in modifying food and nutrient intake, with potential health benefits. Hanna Lagström Turku Institute for Child and Youth Research University of Turku - Finlande
	F&V and Energy Density
	In recent years, policy statements related to obesity have acknowledged the utility of dietary energy density as a guide to food choices. The World Health Organization recommends reducing the energy density of the diet as a strategy to stem the global obesity epidemic. Reductions in energy density can be achieved by increasing intake of vegetables and fruits. Their high water content allows people to eat satisfying amounts of food with few calories per bite. Filling up at the start of a meal with vegetables or fruit and increasing the proportion of vegetables in a main course have been found to control hunger and moderate energy intake. Thus, a number of studies show that eating vegetables and fruits can lower the energy density of a meal and this in turn can reduce energy intake. Can we extrapolate from these short-term studies and promote increased consumption of vegetables and fruits for weight loss? While several recent studies support this suggestion, the current body of evidence is small and the results have been inconsistent. Most studies of the relationship between vegetable and fruit consumption and weight status have not assessed the impact on dietary energy density, and have not controlled for critical variables that could affect intake such as preparation method, type of fruit or vegetable, timing of consumption, or whether they are added to the diet or substituted for other ingredients. Eating more vegetables and fruits could provide consumers with a powerful tool to control their weight while improving the quality of their diets. However, additional strategic investigations of how to use vegetables and fruits to lower dietary energy density, to enhance satiety, and to influence energy balance are needed for the development of effective, evidence-based consumer messages. Barbara J. Rolls Center for Childhood Obesity Research, The Pennsylvania State University, USA
	Parental Role in Children's Diets
	Currently, preventing childhood obesity is geared to putting a stop to the intense, unethical drive to commercialise many aspects of children's lives. Child labour used to be common in Europe and sadly still is in the developing world, but essentially society has always focused on the need to protect children. Those who still believe in the discredited economic system of an unfettered free market model emphasise the role of parental responsibility, but what can parents do to cope with the current "obesogenic" or "toxic" environment? Parents can play a key role in ensuring their child's wellbeing. Prepregnancy nutrition is now considered to influence fetal growth: adequate intakes of fruit, vegetables and essential fats, with modest intakes of animal protein, not only limit congenital defects but affect the child's long term health. Mothers on a good diet and who breast feed influence the baby's food preferences; weaning onto fruit and vegetables establishes long term taste preferences. The pre-school period is crucial and parents can ensure they establish a Mediterranean food system at home. Avoid "food choices" because children are better on a fixed high quality diet until their mid teen-age years. Nurseries should be regulated to provide high quality foods and active play. Parents can also influence the school arrangements for food and nutrition education, promoting the development of parental contracts which prohibit in-school confectionary, soft drinks or "junk" food. They can also promote local community schemes which use the Finnish model of including vegetables and a salad bar within the cost of main meals at local restaurants/ canteens. So parents still have an influential role! W.P T James LSHTM & IOTF/IASO, London, UK
	Fruit and Vegetable Consumption among adolescents
	A healthful diet helps to reduce risk for common health problems among adolescents and young adults such as hypertension and obesity. Further, consuming a nutrient-dense diet is critical to support the rapid physical growth that characterizes adolescence. Eating behaviors established during these early years often influence diet later in adulthood, and thus may have an impact on long-term health. Despite the importance of good nutrition, surveillance data indicate most youth do not achieve dietary recommendations. There is a great need for nutrition interventions to address the gaps between current behaviors and recommendations. This issue describes three examples of research conducted to inform such interventions: • Adams and Bahr examined fruit and vegetable intake in college students and describe the demographic characteristics and other health behaviors of students with poor intake. • Dart and Couch evaluated an intervention designed to improve intakes of fruit, vegetables, and low-fat dairy foods in adolescents with hypertension. • Kasparek followed nearly 200 students for six months and examined the influence of diet and other lifestyle behaviors on weight change during the transition to college. The importance of intervening early to promote healthy lifestyle behaviors in youth is evident. These three studies illustrate the various types of research that must be completed to better understand what groups are in greatest need of interventions and what strategies may be most successful. Nicole Larson University of Minnesota, Mineapolis, USA
	F&V Consumption in low income population
	Forty years ago, Paris witnessed ‘Les Événements’. The startling and exciting outburst of radicalism involved students, in alliance with trade unionists, taking to the streets to demand an end to the old conservative system of inequality and corruption. The elderly President De Gaulle was so impressed by the intensity of the street violence that he went briefly into exile. The protesters wanted not only cultural liberation but also direct participation in government and business. The revolutionary demands were idealistic, but they failed to win the day. Shortly after May 1968 the Gaullists were re-elected. Today, the Paris Conference* and this Newsletter address the theme of promoting fruit and vegetable consumption. This may be seen, forty years on, as yet another retreat from the ideals of social solidarity. Such a view would be too simplistic: indeed, simply wrong. Social inequalities in health are among the most important consequences of stratified societies. Large health inequalities persist in rich countries and, as noted by the ‘Marxists, tendance Groucho’ of 1968, they have both material and cultural roots. The focus on strategies to increase fruit and vegetable consumption among people on low incomes is a sign that industrial interests, reflected by IFAVA, can change in a progressive way. Distinctly less romantic than university occupations, but if put into place with creativity and determination, it is likely to do more for the health of the socially disadvantaged. Eric Brunner Reader in Epidemiology and Public Health University College London, UK
	F&V Accessibility
	How to support fruit and vegetables accessibility for young people The nutritional messages such as “eat 5 fruit and vegetables per day” are well known, but despite this, the consumption of fruit and vegetables has not increased. In France, younger generations spend four times less in buying fruit than their grand-parents. It is important to have a better understanding of the factors influencing the behaviour of children and teenagers, since this knowledge would suggest new and more effective actions. To improve the accessibility to fruit and vegetables, it is necessary to emphasize their attractiveness, quality, and the diversity and availability of their sale-points, as well as improving their image and innovation. It is also necessary to show the ease and pleasure of eating fruit and vegetables and to awaken the taste-buds of young people. This newsletter reports scientific results on the correlation between the fruit and vegetable consumption of children or teenagers and their environment, including availability of the fruit and vegetable at home, distances between the home and food-stores, and the presence of a person cooking at home. The European Commission would like to launch a programme for distribution of fruit at school, starting in school year 2009. France will support this “school fruit scheme” during its Presidency of the Council of the Union, but will require high quality fruit and a presentation that is fun and interactive for children. Indeed, giving young people a taste and appetite for fruits is very important, but it is also necessary to accompany them in discovering the product they have in their hands and with consideration of their fear and rejection of the unknown. Laure Souliac, Head of the Office “Nutrition and Valorization of Food Quality” Minister of Agriculture and Fisheries, France
	Children's Health
	Once upon a time, in such an old period that I can hardly remember, children were taught to eat a sufficient amount of good foods in order to become tall and strong. How this was working, nobody really knew. Therefore, I was surprised when, because of my old knowledge in nutrition, I was asked to provide some comments about worrying medical news. I thought that this modern world was at least improving health. Food choices have actually expanded in such huge proportion that within a country, or even a community, including the smallest one, the family eating patterns may differ strikingly. This widening of food choices leads to confusion between choosing for immediate pleasure and choosing for real health benefits. Three recent examples, around the world, remind us that modern foods may be safer but still need to be part of a balanced diet, beginning in childhood. In Turkey, children, and not only women or grand mothers, those eating less fruits and vegetables (and less fibres) were more likely to suffer constipation. In Canada, the risk of suffering from severe inflammatory bowel disease (Crohn’s disease) is reduced by 30 % in children eating higher amounts of vegetable and by 60 % in those eating higher amounts of fruit. The effect is proportional to the amount eaten. Dietary fibres seem to contribute to the overall benefit in combination with vitamins. Higher consumption of nuts and fish also prove to be beneficial. Although Crohn’s disease is rare in children, a reason for its increased occurrence may be due to a decreased protection against inflammation provided by a high fat, low fibre but modern diet. Unbalanced intakes of the different fatty acids may also trigger inflammatory processes that are exacerbated in Crohn’s disease. In Europe, about 16 million children are now overweight or obese, an unknown situation 30 years ago. The occurrence of various cardiovascular risk factors (the so called “metabolic syndrome”) was analysed in 5 different countries: Greece, Italy, Poland, Hungary and France. It was found that about one out of two of these young obese already has an enhanced cardiovascular risk, i.e. they become old before time. This suggests that negative changes in the environment such as less fruit and vegetable in the diet, are now overtaking health protective factors. These three examples illustrate how several risks can be increased early in life. Does reducing them just mean doing the opposite? Yes. How far is it achievable? As much as we really want it…and I want it for sure for my grand children. Yours faithfully, Granny Smith Marie Laure Frelut, APHP, Saint Vincent de Paul Hospital, Paris - France
	Acid-base Balance and Alkaliniaing Foods
	The impact of diet on the body’s acid-base equilibrium has long been ignored because of its extremely effective blood buffering systems. However, more and more studies suggest that Western-style diets, rich in meats and processed foods, are globally acidic. This is unfavourable to the entire organism and especially in maintaining skeletal mineral balance. Among regularly consumed foods, only fruits and vegetables, despite their sometimes acidic flavour, have alkaline properties due to their organic potassium salts. Many other foods (meat, cold cuts, salted cheese) are acidifying, whereas milk or cereal products are relatively neutral in terms of acid-base balance. These fundamental bases must no longer be ignored. Nutritional recommendations, especially for osteoporosis, must now be based on the role of nutritional associations - milk products of course, but associated with fruits and vegetables. In the case of copious meals with meat and salty foods, fruits and vegetables would be the best antidote to excess proteins and salt. Christian Rémésy, Research Director Inra, France
	Fruit and Vegetables: Children's Preferences
	The first article in this edition of the newsletter explores the widely replicated, but poorly understood finding of sex differences in children’s consumption of fruit and vegetables (FV). Using data from the Fruit and Vegetables Make the Marks study, Elling Bere and colleagues identified greater preference for, and perceived availability of FV as the principal determinants of girls’ higher intake. There are also age differences in children’s responses to food and our second article describes qualitative research into the relationship between children’s cognitive development and their food preferences and perceptions (Zeinstra et al). The authors found that younger children were more concerned with the texture and appearance of food whereas older children were more influenced by taste. They further report that children of all ages were largely impervious to appeals to eat “healthily”. Finally Privitera reports on research into the efficacy of ‘flavourreinforcement’ learning in increasing liking. Not only were children’s preferences increased when foods were sweetened but effects persisted long after sweetening ceased. Together, the articles in the current issue highlight some factors to consider when devising interventions – that boys are predisposed to like FV less than girls (Bere) that influences on food likes and dislikes differ with age (Zeinstra et al) and that an effective practical strategy for increasing liking for FV may be to add sweeteners (Zeinstra). Since children’s FV intake still falls well below recommended levels in most countries, these research findings are important and timely. Lucy Cooke, CR-UK Health Behaviour Unit, University College, London
	Interventions at school to increase fruit and vegetable intake
	Low fruit and vegetable intake is known to be associated with poor health, particularly cardiovascular disease and cancer. With the worldwide increase in childhood obesity, and increased risk of non-communicable diseases, there is recognition that children’s diets need to be improved. Schools appear to be an ideal environment to focus interventions designed to increase fruit and vegetable intake. The studies in this newsletter show that school fruit and vegetable interventions are effective. This is supported by our new literature review of school-based fruit and vegetable interventions and programmes worldwide which includes 37 studies (http://www.lshtm.ac.uk/ecohost/projects/schoolfv.htm). A majority of these studies (70%) produced a significant positive effect on children’s fruit and vegetable intake in both older and younger age groups. These studies included a range of interventions including increasing fruit and vegetable availability as part of snack or meal programmes, nutrition promotion or integrating education together with increased accessibility to fruit and vegetables. A range of approaches increase intake. The relevant approach will depend on the local context including differences in local education systems and cultural preferences. As new proposals for an EU School Fruit and Vegetable Scheme are assessed, we hope that the success shown by school schemes are recognised as an important mechanism to improve public health. Joia de Sa, Research Fellow Karen Lock, Lecturer in Public Health London School of Hygiene and Tropical Medicine, UK
	Editorial from the 2007 WCRF Report
	In 1997, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published the groundbreaking Expert Report, Food, Nutrition and the Prevention of Cancer: a Global Perspective. The Report was a catalyst for change, creating great opportunities for advancing knowledge in the area of diet and cancer prevention, and stimulating a surge of research in the field. Since then, technology has revolutionised the way that information is collected and analysed. As a result, in 2001 WCRF/AICR set out to systematically review and assess the body of evidence on food, nutrition, physical activity, and cancer, and to produce a second Expert Report. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, published in November 2007, is the largest project of its kind, and the conclusions and recommendations for preventing cancer are as definitive as the available evidence allows. (http://www.dietandcancerreport.org) The good news is that although cancer is one of the world’s biggest killers, the disease isn’t simply due to fate or bad luck: up to a third of cancers may be preventable by making lifestyle changes. By following WCRF/AICR’s 10 recommendations and by avoiding exposure to tobacco smoke, people can now take action, knowing that the changes they make really can help protect against cancer. In this issue we take a closer look at the recommendations on plant foods and obesity, as well as the methodology behind the Second Expert Report. Martin Wiseman Second Expert Report Project Director WCRF International
	Fruit and Vegetable Intake and Respiratory Health
	Lung diseases have increased significantly in the last 10 years and account for substantial morbidity and mortality. The influence of dietary factors has generated growing interest because of their potential impact on the genesis and evolution of lung diseases, particularly in how they may modulate the effects of environmental exposures. These factors include antioxidants, omega-3 fatty acids, and other micronutrients that might affect the immune response. Several epidemiological studies have suggested that greater intake of fresh fruits and antioxidant vitamins, particularly vitamin C, are related to lesser prevelance of cough, wheeze and asthma, and to a lower decline in lung function, and COPD symptons (Romieu, 2001,2005) but there is little information on healthy dietary patterns in relation to obstructive lung disease. Three recent studies provide additional evidence for the impact of diet on lung diseases, in particular that high consumption of fruits and vegetables, fish and whole grain products as part of a "prudent dietary pattern" is related to higher pulmonary function and less repiratory symptoms in children (Burns, 2007) and lower incidence of COPD in adults (Varraso, 2007). Similarly, children with a better adherence to the traditional Mediterranean diet, high in fruits, vegetables, fish, nuts, and whole grain products had fewer asthma and allergic rhinitis sypmtoms (Chatzi, 2007). It is time for health professionals to promote a "healthy dietary pattern" starting in childhood as part of public health messages in order to improve respiratory health. Isabelle Romieu Professor of Environmental Epidemiology, Instituto Nacional de salud Public, Mexico
	Scientific Newsletter-Neurodegenerative Diseases
	The prevalence of neurodegenerative diseases (ND) increases with age and clearly represent a major public health problem in aging populations. Strategies for the prevention of dementia are therefore needed. Furthermore the onset of ND is insidious and the neurodegenerative process may exist for many years before dementia. ND can be influenced by many factors; among them several nutrients may play an important role. Higher intake of several nutrients (vitamins C, E, B12, folates, flavonoïds, unsaturated fatty acids) have been associated with a lower risk for Alzheimer disease or slower cognitive decline. However results of different available studies are contradictory and may suggest the importance of combination of several anti-oxidants. There is now converging evidence that composite dietary patterns as Mediterranean Diet or consumption of fruits or vegetables are related not only to lower risk for cardiovascular diseases but also to slower cognitive decline or reduction in risk for Alzheimer’s disease, and attractive hypotheses are suggested. Converging results of future prospective studies of long duration including patients at early stage and controlling for known confounding factors should lead to specific recommendations in the future. Professor Marc BONNEFOY CHU, Lyon - France
	Culinary Strategy: Healthy World Produce Traditions
	In the face of mounting diet-linked chronic diseases, public health experts are urging us to dramatically increase our consumption of produce. As culinary educators, we approach such a challenge by first considering strategy. When rethinking the American diet, where produce has traditionally played a secondary role, it is useful to look to other cultures for inspiration, especially at a time when Americans are increasingly demonstrating an unprecedented interest in new culinary tastes.
	Promoting Consumption of F&V: Programs
	Working together for fruit and vegetable promotion: Each year, 2.7 million lives could potentially be saved if fruit and vegetable (F&V) consumption was sufficiently increased. WHO and FAO are working together to actively promote F&V consumption over the world. A Joint FAO/WHO Expert Consultation recommended a minimum intake of 400g of F&V per day for the prevention of chronic diseases and for the prevention of several micronutrient deficiencies. Current data shows that for most countries, this goal is far from being met.
	Overcoming the socioeconomic and gender gap in fruit and vegetable intake
	Why is it so difficult for most people to reach the daily recommendation for fruit and vegetables? In Sweden, less than 20 percent of the adult population reaches the intake goal of 500 grams per day, and less than 10 percent of children reach their goal of 400 grams. A universal pattern can be observed across northern Europe: Intake is lower in men compared to women, in people on low incomes and in those with lower education compared to higher socioeconomic groups. Is it a matter of low availability? Is the perceived high cost of fruits and vegetables preventing desired change? Are other,
	June Newsletter 2007
	Where does the new EU Regulation on claims leave fruit & vegetables promotion? Given the current debate on obesity and the role that fruit and vegetables can have in any serious solution to address this epidemic, it seems more than reasonable that the new Regulation on Nutrition and Health Claims should allow the fruit and vegetable sector, along with public authorities, to continue promoting without restriction the unique nutritional health benefits of consuming more fresh fruits and vegetables.
	Nutritional Life-Style and Diabetes
	Nutritional life-style and Diabetes Diabetes mellitus (type II) has become a significant threat to public health worldwide: it has been estimated that at least 171 million people are affected and it is assumed that by 2030 this figure will have more than doubled to 366 million people. While the developing countries will experience the highest burden, the impact in the developed countries is also considerable. Reasons for the continuing rise in the diabetes prevalence include the rising life expectancy and aging of populations, the increasing prevalence of obesity and associated life-style factors of low physical activity and inappropriate diet. The latter refers to both the quantitative and qualitative aspects of eating behaviour.
	March 2007 - Obesity, Fruit and Vegetables
	We are all involved in obesity policies A key element in the Amsterdam Treaty was the statement that “… high levels of human health protection shall be ensured in the definition and implementation of all Community policies and activities…” All policies and activities? Yes – because it is not enough to tell school children to eat better snacks or to tell parents they should read food labels carefully. Focussing on the individual will not solve the problem. We have to ask why that individual is at risk of obesity. We have to look at causes. We have to ask: Why?
	February 2007 - Diets, Fruit and Vegetables
	The Healthiest Diet in the World As I write this, I have on my desk the latest diet books. Each one claims to reveal the secret to lasting weight loss and maintenance. Most of them claim that a healthy weight can be obtained without much effort, and some even allege that weight loss can be achieved without dieting or exercise. If only they were right. We are all waiting for that miracle. With obesity now a worldwide epidemic, we need all the help we can get. In the United States, for example,
	January 2007 - F&V Accessibility
	Availability and accessibility of fresh fruit and vegetables (F&V) has become the most important issue in understanding why people do not eat enough F&V everyday: no F&V in vending machines, non existent new distribution systems for F&V, lack of availability at schools, lack of preparation knowledge…
	December 2006 - Newsletter
	Osteoporosis, a global health problem, is increasingly significant as people live longer and the world's population grows. Prevention and treatment of osteoporosis and its complications are essential socioeconomic priorities, calling for the development and implementation of strategies, in particular nutritional approaches and policies.
	November 2006 – Nutrition intervention in schools:
	Schools represent a unique setting for the promotion of fruit and vegetable intake in children: they reach large captive audiences and provide many opportunities to improve nutrition, including formal learning, feeding, as well as other activities such as cooking and gardening. In addition, school-based fruit and vegetable promotion programmes can in many cases be practical and implemented at low costs but they have to compete with other priorities in increasingly crowded curricula.
	October 2006 – Fruit and Vegetables and Cardiovascular Health.
	Recent results from the Women’s Health Initiative indicate that a diet low in fat but high in fruit, vegetables and grains does not significantly reduce the risk of cardiovascular disease in postmenopausal women...
	September 2006 – Childhood Obesity
	If you had asked a group of medical doctors 40 years ago whether child health would steadily improve throughout the twenty-first century, the answer would most likely have been “yes”. ...
	July/August 2006 – A European Perspective on Dietary Patterns:
	Looking at regional dietary patterns, cardiovascular health, and a study of fruit and vegetable consumption of 11-year old children in nine European countries.
	June 2006 – From pre-natal to childhood: The importance of fruit and vegetables.
	An analysis of prenatal, postnatal, and early childhood influences on fruit and vegetable acceptance throughout childhood and into adulthood. This volume also examines the impact of exposure and consumption patterns and their link to children’s food preferences.
	May 2006 – Nutrition: Global Dynamics, Disease Prevention and Consumption Patterns.
	Our first edition looks at the global energy imbalance and related obesity levels, gives a European outlook on the protective effective of fruit and vegetable consumption against certain cancers, and looks at social and cultural barriers to eating healthy.
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French Newsletters
	Dec/07 Consommation de fruits & légumes et cancer - Le rapport 2007 du WCRF
	Nov/07 Consommation de fruits & légumes et voies
	Oct/07 Fruits & légumes : prévention des maladies neurodégénératives
	Sept/07 Fruits & légumes : pratiques culinaires à travers le monde
	juillet-aout/07 “Nouveaux programmes pour la promotion des fruits et légumes”
	juin/07 “Allégations nutritionnelles”
	avril/07 “Diabète de type 2”
	mars/07 “Obésité”
	fev/07 Les Stratègies D’Amaigrissement
	jan/07 Deux facteurs clés : accessibilité et disponibilité
	dec/06 Fruits et légumes et os :défis et opportunités pour l’avenir
	nov/06 Des clés pour mieux comprendre
	oct/06 Fruits et Légumes et Santé Cardiovasculaire
	sept/06 Quelles sont les causes de la montée galopante de l’obésite?
	juillet/06 Alimentation méditerranéenne, végétaux et santé
	juin/06 L’enfance: une période critique du développement des habitudes alimentaires
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Spanish Newsletters
	Espanol - La gacetilla Científica. Nro 13 Junio 2007. Reclamos en cuanto a la salud.
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