Consumption of fruit and vegetables among elderly people: a cross sectional study from Iran

Salehi Leili, Eftekhar Hassan, Mohammad Kazem, Tavafian Sedigheh, Jazayery Abolghasem, Montazeri, Montazeri Ali

Description

There is substantial evidence that low consumption of fruit and vegetables (FV) is a major risk factor for many chronic diseases. The aim of this study was to assess FV consumption and the variables that influence it among elderly individuals in Iran aged 60 and over. Methods This was a cross-sectional study to investigate FV intake by a randomly-selected sample of members of elderly centers in Tehran, Iran. A multidimensional questionnaire was used to collect data on demographic characteristics, daily consumption of FV, knowledge, self-efficacy, social support, perceived benefits, and barriers against FV. Data were analyzed using t-tests, one way analysis of variance, Pearson correlation, and logistic regression. Results In total, 400 elderly individuals took part in the study. The mean age of the participants was 64.07 (SD = 4.49) years, and most were female (74.5%). The mean number of FV servings per day was 1.76 (SD = 1.15). Ninety-seven percent of participants (n = 388) did not know the recommended intake was at least five servings of FV per day. Similarly, 88.3% (n = 353) did not know the size of a single serving. The most frequent perceived benefits of and barriers against FV consumption were availability and expense, respectively. Knowledge (OR = 0.59, 95% CI = 0.39-0.88), perceived benefits (OR = 0.92, 95% CI = 0.88-0.96) and barriers (OR = 1.08, 95% CI = 1.04-1.14), self-efficacy (OR = 0.89, 95% CI = 0.83-0.95) and family support (OR = 0.91, 95% CI = 0.83-0.99) were significantly associated with fruit and vegetable consumption. Conclusion The findings of this study indicate that FV intake among elderly individuals in Iran was lower than the recommended minimum of five daily servings and varied greatly with age, marital status, educational attainment, and income level. The results also indicated that low perceived benefits, low self-efficacy, and perceived barriers could lead to lower consumption of FV. It seems that in order to improve FV consumption among elderly individuals in Iran, raising awareness, improving perception of benefits and enhancing self-efficacy regarding FV consumption should receive more attention. Indeed, it is essential to plan health education programs and nutritional interventions for this group of the population.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2010
• Nombre de lectures: 11
• Langue: English

Extrait

Salehi et al. Nutrition Journal 2010, 9:2
http://www.nutritionj.com/content/9/1/2
RESEARCH Open Access
Consumption of fruit and vegetables among
elderly people: a cross sectional study from Iran
1 1 2* 3 4Leili Salehi , Hassan Eftekhar , Kazem Mohammad , Sedigheh Sadat Tavafian , Abolghasem Jazayery ,
5*Ali Montazeri
Abstract
Background: There is substantial evidence that low consumption of fruit and vegetables (FV) is a major risk factor
for many chronic diseases. The aim of this study was to assess FV consumption and the variables that influence it
among elderly individuals in Iran aged 60 and over.
Methods: This was a cross-sectional study to investigate FV intake by a randomly-selected sample of members of
elderly centers in Tehran, Iran. A multidimensional questionnaire was used to collect data on demographic
characteristics, daily consumption of FV, knowledge, self-efficacy, social support, perceived benefits, and barriers
against FV. Data were analyzed using t-tests, one way analysis of variance, Pearson correlation, and logistic
regression.
Results: In total, 400 elderly individuals took part in the study. The mean age of the participants was 64.07 (SD =
4.49) years, and most were female (74.5%). The mean number of FV servings per day was 1.76 (SD = 1.15).
Ninetyseven percent of participants (n = 388) did not know the recommended intake was at least five servings of FV per
day. Similarly, 88.3% (n = 353) did not know the size of a single serving. The most frequent perceived benefits of
and barriers against FV consumption were availability and expense, respectively. Knowledge (OR = 0.59, 95% CI =
0.39-0.88), perceived benefits (OR = 0.92, 95% CI = 0.88-0.96) and barriers (OR = 1.08, 95% CI = 1.04-1.14),
selfefficacy (OR = 0.89, 95% CI = 0.83-0.95) and family support (OR = 0.91, 95% CI = 0.83-0.99) were significantly
associated with fruit and vegetable consumption.
Conclusion: The findings of this study indicate that FV intake among elderly individuals in Iran was lower than the
recommended minimum of five daily servings and varied greatly with age, marital status, educational attainment,
and income level. The results also indicated that low perceived benefits, low self-efficacy, and perceived barriers
could lead to lower consumption of FV. It seems that in order to improve FV consumption among elderly
individuals in Iran, raising awareness, improving perception of benefits and enhancing self-efficacy regarding FV
consumption should receive more attention. Indeed, it is essential to plan health education programs and
nutritional interventions for this group of the population.
Background vegetables is associated with a reduced risk of cancer [4]
Coronary heart disease (CHD), cancer and stroke are and CHD [5]. Furthermore, previous studies have shown
leading causes of death [1] that are more prevalent strong negative relationships between FV intake and
among elderly individuals [2] and there is substantial obesity [6], diabetes [7] and hypertension [8]. Despite all
evidence that low intake of fruit and vegetables (FV) is a these benefits, people do not properly follow the
minimajorriskfactorforsuchdiseases [3]. Several studies mum recommended consumption of five servings of FV
have shown that adequate consumption of fruit and per day [9]. Data on FV intake derived from food
balance sheets in 21 countries (mainly developing
countries) showed that only in three of those countries did* Correspondence: [e-mail]; [e-mail]
2Department of Epidemiology and Statistics, School of Public Health, Tehran FV intake meet the minimum World Health
OrganizaUniversity of Medical Sciences, Tehran, Iran tion (WHO) recommended consumption [10], although5 of Mental Health, Iranian Institute for Health Sciences Research,
ACECR, Tehran, Iran
© 2010 Salehi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.Salehi et al. Nutrition Journal 2010, 9:2 Page 2 of 9
http://www.nutritionj.com/content/9/1/2
theuseoffoodbalancesheetsasasinglesourceof Methods
information may have weaknesses [11]. Design and data collection
In general, many factors contribute to FV intake. For This was a cross-sectional study among a randomly
instance, one study showed that knowledge, attitudes, selected sample of members of elderly centers in
Tehskills and self-efficacy were among the factors that ran, Iran. The study was conducted between September
might influence an individual’s likelihood of taking five 2007 and April 2008. Tehran has 23 elderly centers in
servings of FV per day [12]. It has also been shown that which free educational and social services are offered to
promoting healthy eating behaviors would be successful members. Membership is free of charge and all
indiviif influencing factors were considered through appropri- duals aged 60 and above are eligible to join. A random
ate models of health behavior change [13]. One of the sample was selected from all listed members. The
sammost popular models for studying behavioral change in ple size was estimated on the basis of a single
proporhealth education/promotion is the Transtheoretical tion design. We assumed that at best 50% of the elderly
Model (TTM). This assumes that health behavior would have adequate FV intake. Thus, a study with a
change involves progress through six stages: pre-con- sample of 385 elderly would have 80% power to detect a
templation, contemplation, preparation, action, mainte- difference of 5% (45-55%) at the 0.05 significance level.
nance, and termination [14,15]. Studies have Thesamplesizeactuallyobtainedforthisstudywas
demonstrated that the TTM is effective in predicting 454. Those who did not agree to take part in the study
and promoting fruit and vegetable consumption in dif- and those who were suffering from serious illness or
ferent population groups [16,17]. had undergone a surgical operation up to 3 months
Many studies have revealed variables that influence FV before the date of data collection were excluded (n =
consumption among elderly populations worldwide 422).
[18,19], but little is known about the frequency, distribu- The Ethics Committee of Tehran University of
Medition, and determinants of FV consumption among cal Sciences approved the study. Before the study was
elderly individuals in Iran [20]. The only study that has conducted, the aim, method and confidentiality were
reported the exact amount of FV consumption among explained fully to the potential participants and if they
the elderly in Iran was an investigation among a Middle were satisfied and willing to take part they were asked
Eastern elderly population including Iranians. It to read and sign a consent form. The headmasters of all
reported that the average FV intake was 358 g/day in 23 elderly centers were also approached about their
willmales and 349 g/day in females [21]. In Iran the total ingnesstoparticipate.Tocollect data, trained
intermean energy intake exceeded requirements and was viewers conducted face-to-face interviews. The
mainly obtained from carbohydrates such as simple interviewers had high school diplomas. Each interview
sugar. The Iranian diet is mainly composed of bread lasted for approximately 45 minutes.
and rice as major energy sources, while chronic diseases Instruments
are the main causes of mortality and morbidity in Iran We used several instruments to collect data. Their
relia[22] and their trend in the country is rising [23,24]. In bility was assessed among a sub-sample of 20
particiIran, cardiovascular disease (CVD) accounts for 38% of pants using Cronbach’s alpha coefficient. The
deaths [25]; the second most common cause of death is instruments and findings are explained as follows:
road traffic-related injuries [26], and the third is cancer 1. Demographic and anthropometrics questionnaire
[27]. Diabetes accounts for 7.7% [28], and 82% of This comprised three sections covering demographic
women and 63% of men aged 50 years and above are and anthropometrics data including information on age,
overweight [29]. It seems possible that this profile of the sex, education, income, marital status, health status
country’s health status could be improved in part if Ira- (having a chronic disease or not) and BMI. Chronic
disnians, especially those in higher risk groups such as ease was indicated by asking each individual to respond
elderly individuals, took adequate amounts of fruit and to the question: ‘Do you have any long-standing
disvegetables. eases’? Anyone who responded positively was asked to
The present study was conducted to investigate factors indicate the name of the disease. Weight was measured
that contribute to FV consumption by elderly indivi- using the same digital scales (SECA, calibrated in Iran)
duals in Iran. We were particularly interested in study- while the subjects were minimally clothed and not
wearing the effects of the following determinants: age, ing shoes. Height was measured by a tape measure while
gender, education, marital status, employment and eco- the subjects were standing and not wearing shoes and
nomic status, chronic disease, body mass index (BMI), the shoulders were in a normal position. BMI was
calcu2stages of change, self effic