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Behavioural counselling to increase consumption of fruit and vegetables in low income adults : randomised trial

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Steptoe, Andrew, Perkins-Porras, Linda, McKay, Catherine, Rink, Elisabeth, Hilton, Sean and Cappuccio, Francesco P.. (2003) Behavioural counselling to increase consumption of fruit and vegetables in low income adults : randomised trial. BMJ, Vol.326 (No.7394). ISSN Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial

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Official URL: http://dx.doi.org/10.1136/bmj.326.7394.855

Abstract

Objective To measure the effect of brief behavioural counselling in general practice on patients’ consumption of fruit and vegetables in adults from a low income population. Design Parallel group randomised controlled trial. Setting Primary health centre in a deprived, ethnically mixed inner city area. Participants 271 patients aged 18-70 years without serious illness. Intervention Brief individual behavioural counselling based on the stage of change model; time matched nutrition education counselling. Main outcome measures Self reported number of portions of fruit and vegetables eaten per day, plasma β carotene, α tocopherol, and ascorbic acid concentrations, and 24 hour urinary potassium excretion. Assessment at baseline, eight weeks, and 12 months. Results Consumption of fruit and vegetables increased from baseline to 12 months by 1.5 and 0.9 portions per day in the behavioural and nutrition groups (mean difference 0.6 portions, 95% confidence interval 0.1 to 1.1). The proportion of participants eating five or more portions a day increased by 42% and 27% in the two groups (mean difference 15%, 3% to 28%). Plasma β carotene and α tocopherol concentrations increased in both groups, but the rise in β carotene was greater in the behavioural group (mean difference 0.16 μmol/l, 0.001 μmol/l to 1.34 μmol/l). There were no changes in plasma ascorbic acid concentrations or urinary potassium excretion. Differences were maintained when analysis was restricted to the 177 participants with incomes ≤ £400 (€596, $640) a week. Conclusions Brief individual counselling in primary care can elicit sustained increases in consumption of fruit and vegetables in low income adults in the general population.

Item Type: Journal Article
Subjects: R Medicine > RM Therapeutics. Pharmacology
Divisions: Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Nutrition counseling -- Great Britain, Diet -- Great Britain, Poor -- Health and hygiene -- Great Britain
Journal or Publication Title: BMJ
Publisher: BMJ Group
ISSN: Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial
Date: 2003
Volume: Vol.326
Number: No.7394
Identification Number: 10.1136/bmj.326.7394.855
Status: Peer Reviewed
Access rights to Published version: Open Access
Funder: Great Britain. Dept. of Health (DoH), Medical Research Council (Great Britain) (MRC)
Grant number: 121695 (DoH/MRC)
References: 1 Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 1997;26:1-13. 2 Working Group on Diet and Cancer, Committee on Medical Aspects of Food and Nutrition Policy. Nutritional aspects of the development of cancer (48). Department of Health report on health and social subjects. London: Stationery Office, 1998. 3 Department of Health. Saving lives: our healthier nation. London: Stationery Office, 1999. 4 Department of Health. Five-a-day programme. www.doh.gov.uk/fiveaday (accessed 3 February 2003). 5 Bowen DJ, Beresford SA. Dietary interventions to prevent disease. Ann Rev Public Health 2002;23:255-86. 6 Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med 2002;35:25-41. 7 John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet 2002;359:1969-74. 8 Treasure T, MacRae KD. Minimisation: the platinum standard for trials? Randomisation doesn’t guarantee similarity of groups; minimisation does. BMJ 1998;317:362-3. 9 Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997;12:38-48. 10 Wardle J, Parmenter K, Waller J. Nutrition knowledge and food intake. Appetite 2000;34:269-75. 11 Cappuccio FP, Rink E, Perkins-Porras L, Mc Kay C, Hilton S, Steptoe A. Estimation of fruit and vegetable intake using a two-item dietary questionnaire: a potential tool for primary health care workers. Nutr Metab Cardiovasc Dis (in press). 12 Roe L, Strong C, Whiteside C, Neil A, Mant D. Dietary interventions in primary care: validity of the DINE method for diet assessment. Fam Pract 1994;11:375-81. 13 Vuilleumier J, Keck E. Fluorometric assay of vitamin C in biological materials using a centrifugal analyser with fluorescence attachment. J Micronutrient Anal 1989;5:25-34. 14 Down D. Family spending: a report on the 1999-2000 family expenditure survey. London: Stationery Office, 2000. 15 Ministry of Agriculture, Food and Fisheries. National food survey 1999. London: Stationery Office, 2000. 16 COI Communications and Food Standards Agency. Consumer attitudes to food standards. London: Taylor Nelson Sofres, 2001. 17 Khaw KT, Bingham S, Welch A, Luben R, Wareham N, Oaken S, et al. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European prospective investigation into cancer and nutrition. Lancet 2001;357:657-63. 18 Ness AR, Cappuccio FP, Atkinson RW, Khaw KT, Cook DG. Plasma vitamin C levels in men and women from different ethnic backgrounds living in England. Int J Epidemiol 1999;28:450-5. 19 Armstrong NC, Paganga G, Brunner E, Miller NJ, Nanchahal K, Shipley M, et al. Reference values for alpha tocopherol and beta carotene in the Whitehall II study. Free Radic Res 1997;27:207-19. 20 US Department of Agriculture, Agriculture Research Service. USDA nutrient database for standard reference, release 14. www.nal.usda.gov/fnic/ foodcomp (accessed February 2003).
URI: http://wrap.warwick.ac.uk/id/eprint/4350

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