Introduction

The benefits of a high fruit and vegetable consumption for health are well known, resulting in current recommendations that all individuals should consume at least 5 portions of fruit and vegetables per day (1). Low intakes of fruit and vegetables have previously been reported in the older population of Great Britain, particularly among certain socio-demographic groups (2). Levels and patterns of consumption in the older population of Northern Ireland however, remain unknown. Reasons for low consumption and potential means of increasing consumption have also previously been suggested (3, 4). Few of these studies, however, have been conducted on older people and barriers towards increasing consumption may differ between younger and older adults. Furthermore, none of these studies, as far as we are aware, have been conducted in Northern Ireland, yet farming directives, rural activities, transport infrastructures, health education schemes vary with location.

Knowledge of the level of fruit and vegetable consumption by older people in Northern Ireland could highlight a need for interventions to improve fruit and vegetable consumption in this population. Patterns of consumption will allow potential interventions to target those most at risk from low intakes, and identification of barriers and suggested solutions, particularly for those currently consuming few fruit and vegetables and those identified as most at risk from low intakes, will increase the chances of intervention success.

Objectives and methodology

This project aimed to:

• assess current levels of fruit and vegetable consumption in a large sample of older people in Northern Ireland.
• assess current patterns of fruit and vegetable consumption in a large sample of older people in Northern Ireland.
• identify barriers and suggested solutions for increasing fruit and vegetable intakes in a large sample of older people in Northern Ireland.

Current levels of fruit and vegetable consumption, various demographic and lifestyle variables, barriers and suggested solutions to increasing fruit and vegetable consumption were assessed in a representative sample of older people from Northern Ireland, using a telephone survey.

Current levels of fruit and vegetable consumption were measured using direct questions asking for type and amount of fruit and / or vegetables consumed for all meals and between-meal periods on weekdays and at weekends, and amounts were subsequently converted into portions (5). Demographic and lifestyle variables included gender, age, marital status, living status, region of residence, deprivation score of residence based on postcode (6), distance travelled for food shopping, frequency with which individuals received help with food shopping, frequency with which individuals received help with food cooking, frequency with which individuals had food delivered, and frequency with which individuals consumed food out of the house; all variables that have previously been suggested to impact on diet quality and could impact on fruit and vegetable consumption (2,3,4,7) . Barriers to fruit and vegetable consumption were investigated using 22 closed-response items focussing on various aspects of food consumption previously found to affect fruit and vegetable consumption, and one open-ended question “Are there any reasons why you do not eat more fruit and vegetables than you currently do?”. Perceived solutions for increased fruit and vegetable consumption were investigated using one open-ended question “What can be done to help people eat more fruit and vegetables?”.

To conduct the survey, names, addresses and telephone numbers were obtained for one thousand people, representative of the population of Northern Ireland over the age of 65 years with respect to gender, age, marital status, and area of residence in line with the 2001 census data for Northern Ireland. All individuals were telephoned up to twice during working hours, from January – April, 2008, in order to take part in the study.

Findings

Levels of fruit and vegetable consumption

Data were gained from 426 individuals: 159 men and 267 women ranging in age from 65 – 90+ years, both married and unmarried, and from across Northern Ireland, representative of the whole population.

These individuals reported a mean consumption of 4.0 portions of fruit and vegetables per weekday, ranging from 0-8 portions, where 148 (35%) individuals were consuming 5 portions per day or more, and a mean consumption of 4.1 portions of fruit and vegetables per weekend day, ranging from 0-8 portions, where 161 (38%) individuals were consuming 5 portions per day or more.

Figure 1: Distribution of individuals consuming 0-8 portions of fruit and vegetables per weekday (diamonds) and per weekend day (squares)

These data suggest that older people in Northern Ireland are consuming less fruit and vegetables per day, than is currently recommended for optimal health. These levels of consumption however are higher than those in similar populations in the rest of the UK, as reported in 1998, possibly as a result of a greater proximity to rural activities in Northern Ireland resulting in a greater availability and accessibility of fruit and vegetables for the Northern Irish population (8).

Patterns of fruit and vegetable consumption

Patterns of fruit and vegetable consumption were investigated using regression. On weekdays, greater fruit and vegetables consumption was significantly associated with females, younger individuals and those living in less deprived areas. On weekend days, greater consumption was significantly associated with females and younger individuals.

This pattern of findings suggests that males, older people and those living in more deprived areas should be targeted by and may particularly benefit from interventions aiming to increase fruit and vegetable consumption among the older population of Northern Ireland.

The particular pattern is unsurprising given previous research, where gender differences have been attributed to differences in traditional gender roles (7), differences with age have been considered part of general changes in food consumption as a result of age-related changes in appetite and digestion (7), and differences dependent on socio-economic status have largely been attributed to the cost and poor value (in terms of energy provided per pence) of fruit and vegetables and of obtaining, storing and preparing these items for consumption (3,4). The absence of effects of living status, region and lifestyle may be explained by the close family ties and social networks found in Northern Ireland (9).

Barriers to and suggested solutions for increasing fruit and vegetable consumption

Principle component analysis of the 22 closed-response items revealed five barriers associated with fruit and vegetables consumption: ‘willingness to change’, ‘liking’, ‘ease’, ‘difficulties’ and ‘awareness’. The importance of each of these factors for fruit and vegetable consumption was investigated using regression.

In the whole sample, different associations were found for female and male participants. For females, greater fruit and vegetable consumption was associated with greater liking of fruit and vegetables, greater awareness of recommended levels of fruit and vegetable consumption, and greater willingness to change their diet. For males, greater fruit and vegetable consumption was associated with greater liking and greater awareness. Neither ease of consumption nor difficulties in achieving consumption were associated with fruit and vegetable intakes. Similar findings were also found in those currently consuming few fruit and vegetables, and those identified as most at risk from low intakes – males (as above), older people and those living in most deprived areas.

Responses to the open-response questions were analysed using content analysis. These responses also suggested that individuals may benefit from increased awareness of current recommendations, the details and reasons for those recommendations, and strategies to increase willingness to change/motivation. Approx. 10% of individuals also provided environmental reasons for not consuming more fruit and vegetables than currently. Responses did not differ between the whole sample, those currently consuming few fruit and vegetables, and those identified as most at risk from low intakes.

The most common responses provided to the question on suggested solutions included increasing awareness, knowledge and motivation / willingness to change, plus some environmental solutions. Responses, again, did not differ between the whole sample, those currently consuming few fruit and vegetables, and those identified as most at risk from low intakes.

These findings suggest that interventions aiming to increase fruit and vegetable consumption should focus on increasing liking for fruits and vegetables, increasing awareness of current recommendations, increasing knowledge of the benefits of fruits and vegetables for health and use strategies to increase willingness to change. The similar patterns found in all groups also suggest that these interventions may benefit all individuals equally. Strategies to increase liking typically focus on increasing exposure to and positive experience with different fruits and vegetables and different fruit and vegetables products and dishes, and have achieved some success elsewhere (10).

Interventions to improve awareness and knowledge have focussed on improving nutrition education, and specifically the benefits of fruits and vegetables for health, and have again achieved considerable success (11). Strategies suggested to increase willingness to change include increasing confidence, encouraging commitment, and forming positive associations with others and the environment in relation to fruit and vegetable intakes, again with success (12). Approx. 10-20% of respondents may also benefit from environmental strategies, such as reductions in price and improvements in access and availability.

Conclusions

The findings of this study suggest that fruit and vegetables intake in the older population of Northern Ireland lie below those currently recommended for health, and that intakes are particularly low in males, in older people and in those living in more deprived areas. Responses to questions on barriers to increasing fruit and vegetable consumption suggest that interventions should focus predominantly on improving awareness and experience of different fruits and vegetables and fruit and vegetable products and dishes, improving knowledge and awareness of current recommendations and of the benefits of consuming fruits and vegetables, and a number of strategies aimed at improving motivation/willingness to change.

Acknowledgements

Grateful thanks are extended to the Changing Ageing Partnership, Institute of Governance, QUB, for funding this work. The full report on the work can be found at http://www.changingageing.org/Research/ResearchSeedFund/CompletedResearch/

Part of this work is also currently in press: Appleton KM, McGill R, Woodside JV. Fruit and vegetable consumption in older people in Northern Ireland: Levels and patterns. British Journal of Nutrition.

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