vegetable research journal

Fruits, vegetables, and health: A comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake

Affiliations.

• 1 Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA.
• 2 Think Healthy Group, Inc., Washington, DC, USA.
• 3 Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA.
• 4 Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
• 5 Center for Nutrition Research, Institute for Food Safety and Health, Illinois Institute of Technology, Bedford Park, Illinois, USA.
• 6 Biofortis Research, Merieux NutriSciences, Addison, Illinois, USA.
• 7 Department of Human Nutrition, University of Alabama, Tuscaloosa, Alabama, USA.
• 8 Department of Epidemiology, University of Washington, Seattle, Washington, USA.
• 9 School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA.
• 10 Bone and Body Composition Laboratory, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia, USA.
• 11 College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA.
• 12 Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey, USA.
• 13 D&V Systematic Evidence Review, Bronx, New York, USA.
• PMID: 31267783
• DOI: 10.1080/10408398.2019.1632258

Fruit and vegetables (F&V) have been a cornerstone of healthy dietary recommendations; the 2015-2020 U.S. Dietary Guidelines for Americans recommend that F&V constitute one-half of the plate at each meal. F&V include a diverse collection of plant foods that vary in their energy, nutrient, and dietary bioactive contents. F&V have potential health-promoting effects beyond providing basic nutrition needs in humans, including their role in reducing inflammation and their potential preventive effects on various chronic disease states leading to decreases in years lost due to premature mortality and years lived with disability/morbidity. Current global intakes of F&V are well below recommendations. Given the importance of F&V for health, public policies that promote dietary interventions to help increase F&V intake are warranted. This externally commissioned expert comprehensive narrative, umbrella review summarizes up-to-date clinical and observational evidence on current intakes of F&V, discusses the available evidence on the potential health benefits of F&V, and offers implementation strategies to help ensure that public health messaging is reflective of current science. This review demonstrates that F&V provide benefits beyond helping to achieve basic nutrient requirements in humans. The scientific evidence for providing public health recommendations to increase F&V consumption for prevention of disease is strong. Current evidence suggests that F&V have the strongest effects in relation to prevention of CVDs, noting a nonlinear threshold effect of 800 g per day (i.e., about 5 servings a day). A growing body of clinical evidence (mostly small RCTs) demonstrates effects of specific F&V on certain chronic disease states; however, more research on the role of individual F&V for specific disease prevention strategies is still needed in many areas. Data from the systematic reviews and mostly observational studies cited in this report also support intake of certain types of F&V, particularly cruciferous vegetables, dark-green leafy vegetables, citrus fruits, and dark-colored berries, which have superior effects on biomarkers, surrogate endpoints, and outcomes of chronic disease.

Keywords: Fruit; health; nutrition; produce; vegetable.

Publication types

• Diet, Healthy*
• Nutrition Policy*
• Observational Studies as Topic
• Systematic Reviews as Topic
• United States
• Vegetables*

International Journal of Vegetable Science

Subject Area and Category

• Agronomy and Crop Science
• Plant Science

Taylor and Francis Ltd.

Publication type

19315260, 19315279

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The Role of Research for Vegetable Production Under a Changing Climate Future Trends and Goals

• First Online: 10 April 2021

Cite this chapter

• Shashank Shekhar Solankey 5 ,
• Meenakshi Kumari 6 ,
• Manoj Kumar 7 &
• Silvana Nicola 8  

Part of the book series: Advances in Olericulture ((ADOL))

310 Accesses

3 Citations

Vegetables are known as protective foods as they are rich in micronutrients, vitamins and health benefiting compounds. Now a days, our climate is changing which effects both quality and production of most of the vegetable crops worldwide. Vegetables are very perishable and highly sensitive to climate variability and high temperature during growing is the major cause of low yields and will be further magnified by climate change. Other climatic factors like low temperature, flooding, water stress, drought, rainfall and salinity would be major limiting factors in increasing vegetable productivity. But various management practices have developed which raise the yield and quality grown under different climatic situations. Improvement of vegetable crops through biotechnology, genetic engineering, protected cultivation, grafting are an appropriate adaptation strategies to cope with climate change. Various agronomic practices like organic farming, conservation tillage, mulching and cropping system are able to reduce the challenges of climate change. The population of various insect and pest are also increasing due to change in climate.

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Department of Horticulture (Vegetable and Floriculture), Bihar Agricultural University, Sabour, Bhagalpur, Bihar, India

Shashank Shekhar Solankey

Department of Vegetable Science, Chandra Shekhar Azad University of Agriculture & Technology, Kanpur, Uttar Pradesh, India

Meenakshi Kumari

Division of Vegetable Crops, ICAR-Indian Institute of Horticultural Research, Bengaluru, Karnataka, India

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Department of Agricultural, Forest and Food Sciences, DISAFA, Vegetable Crops and Medicinal & Aromatic Plants, VEGMAP, University of Turin, Grugliasco, TO, Italy

Silvana Nicola

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Solankey, S.S., Kumari, M., Kumar, M., Nicola, S. (2021). The Role of Research for Vegetable Production Under a Changing Climate Future Trends and Goals. In: Solankey, S.S., Kumari, M., Kumar, M. (eds) Advances in Research on Vegetable Production Under a Changing Climate Vol. 1. Advances in Olericulture. Springer, Cham. https://doi.org/10.1007/978-3-030-63497-1_1

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Peer-reviewed

Research Article

Perennial vegetables: A neglected resource for biodiversity, carbon sequestration, and nutrition

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Perennial Agriculture Institute, Holyoke, Massachusetts, United States of America

Roles Conceptualization, Methodology, Visualization, Writing – review & editing

Affiliation Union of Concerned Scientists, Washington, D.C., United States of America

Roles Visualization, Writing – review & editing

• Eric Toensmeier, 
• Rafter Ferguson, 
• Mamta Mehra

• Published: July 10, 2020
• https://doi.org/10.1371/journal.pone.0234611
• Reader Comments

Perennial vegetables are a neglected and underutilized class of crops with potential to address 21 st century challenges. They represent 33–56% of cultivated vegetable species, and occupy 6% of world vegetable cropland. Despite their distinct relevance to climate change mitigation and nutritional security, perennial vegetables receive little attention in the scientific literature. Compared to widely grown and marketed vegetable crops, many perennial vegetables show higher levels of key nutrients needed to address deficiencies. Trees with edible leaves are the group of vegetables with the highest levels of these key nutrients. Individual “multi-nutrient” species are identified with very high levels of multiple nutrients for addressing deficiencies. This paper reports on the synthesis and meta-analysis of a heretofore fragmented global literature on 613 cultivated perennial vegetables, representing 107 botanical families from every inhabited continent, in order to characterize the extent and potential of this class of crops. Carbon sequestration potential from new adoption of perennial vegetables is estimated at 22.7–280.6 MMT CO2-eq/yr on 4.6–26.4 Mha by 2050.

Citation: Toensmeier E, Ferguson R, Mehra M (2020) Perennial vegetables: A neglected resource for biodiversity, carbon sequestration, and nutrition. PLoS ONE 15(7): e0234611. https://doi.org/10.1371/journal.pone.0234611

Editor: Birinchi Sarma, Banaras Hindu University, INDIA

Received: September 16, 2019; Accepted: May 29, 2020; Published: July 10, 2020

Copyright: © 2020 Toensmeier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The perennialization of crop production has been proposed as a multifunctional approach to address environmental and other challenges in agriculture, due to the many benefits of perennial crops [ 1 ], but the perennialization of vegetable production has largely been ignored. Perennial vegetables (PVs) are a neglected and underutilized class of crops with potential to address crises of crop biodiversity, climate change, and nutrient deficiencies. While some individual species have been studied closely, as a class PVs have received little attention in peer-reviewed literature (for exceptions see [ 1 – 3 ]), though a body of grey literature has developed on the subject in recent decades [ 4 , 5 ].

PVs are perennial plants cultivated for their edible vegetative growth (e.g., leaves) and/or reproductive structures (e.g., flowerbuds). They include some savory tree fruits that are used in cooked dishes, but not sweet or tart dessert fruits. Further definition is offered in the Methods below.

Many PVs are suited to conditions where production of annual vegetables is difficult. For example, PV crops include numerous halophytes, desert species, aquatic species, and shade crops. The many shade tolerant PVs are particularly suited to multistrata agroforestry systems [ 4 ].

While many PVs are regional crops, of which little is known outside of the areas in which they are cultivated, a few are widely known and globally traded commodity crops. PVs are currently cultivated on at least 3.3 Mha, 6% of the 52 Mha of world vegetable land. FAO [ 6 ] reports 1.1 Mha in table olives ( Olea europaea , 10.6 Mha in global production, of which 10% is used for table olives, here defined as a vegetable use, [ 7 ]), 1.5 Mha in asparagus ( Asparagus officinalis ), 0.6 Mha in avocado ( Persea americana ), and 0.1 Mha in globe artichoke ( Cynara scolymus ). Additionally, India has 38,000 ha in the tree vegetable moringa ( Moringa oleifera , [ 8 ]). Note that these are only five of the over 600 cultivated species inventoried in this paper, though the area in cultivation of most PVs is surely very small.

Greater adoption of a wider array of perennial vegetables could help to address some of the central, interlocking issues of the 21 st century: climate change, biodiversity, and nutrition. The great diversity of PVs is a powerful tool to address the loss of crop biodiversity. As perennials, PVs sequester carbon, particularly the woody species. Many PVs are high in the key nutrients needed to remedy nutrient deficiencies that impact billions of people.

Crop biodiversity

Crop biodiversity is essential to agroecological food production and multifunctional agriculture. However, globally, crop biodiversity is declining, in part driven by intensive, industrialized agriculture [ 9 ] Eighty percent of global crop production comes from 17 botanical families, just 4% of the total number of plant families [ 10 ].

Many benefits can come from increasing crop biodiversity. Increased cultivation of neglected and underutilized perennial crops can increase resilience to climate change impacts. This kind of crop diversification is an important risk-management strategy, especially in the context of the narrowing of crop diversity on which food security depends. Many perennial crops produce in seasons when other crops are not available [ 11 ]. Crop diversification at the family level can also reduce pest pressure, as many pests and diseases are family-specific [ 12 ].

Climate change mitigation

Agricultural production is the source of 12.5% of anthropogenic emissions, yet the agriculture sector also has mitigation potential, including via carbon sequestration [ 13 ]. The perennialization of agriculture is one way to sequester excess atmospheric carbon in soils and living biomass. This includes transition to reduced tillage perennial crops and use of agroforestry systems which incorporate perennial plants [ 14 ]. PVs are well-suited to no-till and agroforestry production systems as they do not require tillage after establishment, and many are shade-tolerant, making them ideal for the understory of agroforestry systems. For example, in western China, the PV species daylily ( Hemerocallis fulva ) is cultivated for its edible flowers in the understory of rows of jujube ( Zizyphus jujuba ), alternating with rows of annual crops [ 15 ].

Recent research has shown that for all of the world’s people to consume a healthy portion of vegetables in their diet, global vegetable production would need to be tripled [ 16 ]. While underconsumption of vegetables is a global problem, economic and development context produce distinct syndromes of nutrient deficiency: what is sometimes called “traditional” malnutrition (largely in the Global South), and industrial diet deficiencies (largely in the Global North) [ 17 ].

An estimated two billion people are affected by traditional malnutrition, a set of deficiencies of particular vitamins and minerals. The most significant of these deficiencies are iron, zinc, vitamin A, iodine, and folate. Collectively deficiencies in these nutrients account for 7% of global disease burden [ 18 ]. While iodine is not found at useful levels in terrestrial plants, iron, vitamin A, zinc and folate are found at high levels in some vegetables including PVs.

Meanwhile, the low vegetable intake characteristic of the Western industrial diet produces its own separate set of nutritional deficiencies, impacting hundreds of millions of people and increasing the prevalence of heart disease, osteoporosis, high blood pressure, diabetes, and obesity. The key nutrients in this case include fiber, calcium, magnesium, and antioxidants including vitamins A, C, and E [ 17 ]. Magnesium deficiency affects 60% of people in the United States, and is implicated in diabetes, high blood pressure, and heart disease [ 19 ]. Calcium is critical to reducing risks from osteoporosis [ 20 ]. Dietary fiber is correlated with reduction in coronary heart disease and obesity. In the United States average fiber intake is less than 50% of the recommended levels [ 21 ]. Antioxidants help to reduce the risk of cardiovascular disease, a widespread health issue in wealthy countries [ 22 ]. Many PVs are quite high in fiber, calcium, magnesium, and antioxidants and thus have potential to address these industrial diet deficiencies.

A role for perennial vegetables

Given the relevance of PVs to the interlocking crises of crop biodiversity loss, climate change, and nutrient deficiencies, it is imperative to explore the potential of this underutilized and neglected class of vegetables. In order to address the scope of this resource and its potential contribution to addressing the agricultural biodiversity crisis, we must ask how many PV species are cultivated, and what agroecological niches they occupy in regards to form, parts used, and climate suitability. To investigate their climate mitigation potential, this study investigates the per-hectare carbon sequestration potential of PVs, as well as asking how widely they might be adopted in the future. To determine the nutritional impact of PVs, this study asks how PVs compare to globally-traded vegetables, and seeks standout species both “suberabundant” in individual key nutrients as well as “multi-nutrient” crops with high levels of two or more nutrients essential to addressing deficiencies. The study also investigates the relative nutrition of different forms (e.g. woody plants) and parts used (e.g. flowerbuds).

Materials and methods

Perennial vegetables defined.

As PVs are a class of crops that has received little notice, we begin by offering a functional definition. The criteria for this definition include botanical form, harvest considerations, what parts used, and how those parts are used in the world’s cuisines.

For purposes of this study, “perennial” indicates crops which live for 3 or more years. We divide the PVs discussed in this study into three categories by form: woody plants, vines, and herbs. Woody plants include trees, shrubs, bamboos, palms, cacti, mangroves, and woody succulents. Perennial vines include both lianas and herbaceous vines. Perennial herbs include forbs, ferns, grasses and grasslike plants, and both floating and emergent aquatics. For the purposes of this discussion we include perennial crops that are sometimes cultivated as annuals. For example, the African eggplant ( Solanum aethiopicum ) is most commonly grown as an annual but can also be managed as a perennial. We include some species which include both perennial and annual (or biennial) crop varieties, such as kale ( Brassica oleracea ).

In order to be considered perennial, vegetables must provide more than one year of harvest. We exclude crops that live for several years but are killed by harvest, such as with some heart-of-palm vegetables like coconut [ 23 ].

Some PVs have edible vegetative parts. This includes leaves, shoots, and other vegetative structures like petioles and cactus cladodes. Culinary herbs are excluded based on the assumption that they are consumed in smaller quantities than vegetables due to strong flavors. Some species are used as culinary herbs in one region, and vegetables in another. In such cases, the crop is included in this study’s analysis.

Other PVs have edible reproductive structures, including flowerbuds, flowers, unripe fruit, ripe fruit, and unripe seeds. Classification of fruits as vegetables is challenging. Many annual fruits are commonly used as vegetables, such as tomato ( Solanum lycopersicum ), string beans ( Phaseolus vulgaris ), and winter squash ( Cucurbita spp.). The distinction is not botanical but rather based on how the fruit is used and how it tastes. Use also varies to some degree between cultures. This study follows [ 24 ] in distinguishing between dessert fruits which are sweet or tart, and vegetable fruits which are eaten in salads, cooked dishes, and appetizers. Dessert fruits are excluded from the study. PV fruits are used in salads, cooked in soups and stews, or otherwise a central part of a meal. For example, the fruit of chayote ( Sechium edule ) is widely consumed as a vegetable in Mesoamerican cuisines and throughout the tropics. In some cases a fruit is a vegetable when unripe, and a dessert fruit when ripe, as in the papaya ( Carica papaya ).

Roots crops like sweet potato ( Ipomoea batatas ) and starchy fruits like breadfruit ( Artocarpus altilis ) are excluded on the grounds that nutritionally they are more properly seen as staple crops primarily producing carbohydrates, with lower vitamin and mineral content than other vegetables. Root crops are also incompatible with no-till perennial production systems as they require excavation for harvest [ 13 ].

Biodiversity

This study aims to quantify for the first time how many PV species are in cultivation, and identify their agroecological niches as to climate, shade tolerance, form and parts used. In the absence of a well-integrated literature, several approaches were used to identify and characterize the global extent of cultivated perennial vegetable crop species.

The first approach analyzed species from [ 25 ], which provides a global list of cultivated vegetables. Though incomplete, it is international and can be used as a proxy for the world’s vegetable crop biodiversity. After the elimination of root crops (as above), the remaining species were categorized into perennial, perennial grown as annual, and annual crops.

Second, we reviewed 6,000 species profiled in [ 26 ], a six-volume compendium of cultivated crops (excluding ornamentals), identifying those cultivated as vegetables. All species that are cultivated for the purpose of vegetable production, whether or not it is their primary use, were considered for this study. Note that cultivation does not necessarily indicate domestication.

The third approach was a search for cultivated PVs in global listings of crops and vegetables, as well as regional and specialty resources. The resources used in developing this listing were [ 4 , 5 , 13 , 26 – 53 ]. These crops were classified by part used, form, cultivation status, and adaptability to climate, moisture, and shade. This information is important in assessing the PV species available to fit various agroecological niches.

All cultivated PVs identified by the study were characterized by climate suitability and shade tolerance. Thermal climate analysis divided the crops into tropical lowlands (USDA hardiness zones 10–11, elevation under 1500m), tropical highlands (USDA hardiness zones 10–11, elevation over 1500m), subtropical (USDA zone 9), warm temperate (USDA zones 7–8), cold temperate (USDA zones 4–6), boreal (USDA zones 2–3), and arctic (USDA zone 1). Rainfall categories are humid (1000+mm rainfall/yr), semi-arid (250-1000mm rainfall/yr), arid (0-250mm rainfaal/yr), and aquatic. Shade tolerance was also assessed.

Carbon sequestration

In order to assess the potential carbon sequestration potential of PVs, we must first estimate per-hectare sequestration rates, adoption rates, and total potential adoption. Existing data are sparse for all aspects of this question. Despite this, an approach based on available data and a range of plausible scenarios is useful for exploring the and defining the boundaries of the solution space for these critical questions. In order to model potential impact, we therefore developed twelve scenarios built around estimates for carbon sequestration rate, and a range of plausible values for rate of adoption, potential (maximum) scale of adoption, and the ratio of adoption between woody and herbaceous PVs.

We consulted the research literature for the available data on per-hectare carbon sequestration impacts of individual PVs, as well as sequestration rates for relevant farming systems ( Table 1 ), categorized by a three-level classification scheme: a broad top-level dichotomy of (1) woody perennials and (2) perennial vines and herbs, and then production system and sample species or system. The average rate for woody PVs is 3.7 tC/ha/yr, while that of perennial vines and herbs is 0.43 tC/ha/yr/.

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https://doi.org/10.1371/journal.pone.0234611.t001

Carbon sequestration rates of PVs, where known, are shown here. Rates for farming systems that match PV production systems are shown as well.

The ratio of Mha in woody to non-woody PVs is important to scenario development, as woody PVs have much higher sequestration rates. Currently there at 1.7 Mha of woody Pvs and 1.6 Mha of herbaceous perennial PVs [ 16 ]. The scenarios assume that 25%, 50%, and 75% of new adoption is woody.

The potential scale of adoption of PVs is also necessary to calculate climate impact. One set of scenarios assumes that total global vegetable production area remains constant at 58.2 Mha. A second set of scenarios assume that world vegetable production area triples to 174.5 Mha, in line with estimates of the growth needed to provide all of humanity with sufficient nutrients [ 16 ].

Adoption rates are set based on historical data from [ 6 ] for the global production area of artichoke, asparagus, avocado, and olive from 1967–2017. In the absence of similar data for the other PVs, only the sum of these four PVs is considered in projecting the future adoption between 2020–2050. Both linear and exponential trends are modeled.

Twelve scenarios were developed, using the variables adoption rate (linear and exponential), percent of woody PVs out of total PVs adopted (25%, 50%, and 75%), and total global vegetable production area (58.2 Mha and 174.5 Mha). In scenarios 1 and 2, the current world vegetable production area is used, while in scenarios 3 and 4, world vegetable production area is tripled to meet nutritional needs. In scenarios 1 and 3, a linear adoption rate is used, while in scenarios 2 and 4 an exponential rate is used. For each scenario, woody PVs are assumed to occupy 25%, 50%, and 75% of new adoption.

Determining the potential of PVs to address nutrient deficiencies is a core goal of this study. To this end, it aims to compare PVs to globally-traded vegetables in several ways. Individual species with “superabundant” levels of single key nutrients are identified, as are “multi-nutrient” species with high levels of multiple key nutrients. Subclasses of PVs, based on form and part used, are also compared to globally-traded vegetables.

Nutrients assessed were those identified as priorities for addressing deficiencies in the literature (fiber, Ca, Fe, Zn, folate, and antioxidants). In the case of antioxidants, vitamins A, C, and E were selected as data are more available for these than other antioxidants. Note that terrestrial plants do not contain significant iodine, so this nutrient was not assessed despite the importance of addressing iodine deficiency.

Following an extensive literature review, we conducted a meta-analysis on nutrient content using data from [ 17 , 28 , 32 , 36 , 40 , 41 , 49 – 50 , 53 , 65 – 109 ]. Our analysis produced mean nutrient values for 240 species of perennial vegetables, including 31 species that are frequently grown as annuals despite having a perennial lifecycle.

As the international standard for vegetable nutrient testing is a fresh weight sample of 100 grams, this was used as the basis of data collection and comparison for this study. In several cases values were converted from dry weight to fresh weight. As vegetables are usually consumed fresh (rather than dried), and this study compares vegetables to vegetables, values were not converted to dry weight, though dry weight comparison would offer some advantages.

For several reasons, the direct ability of these crops to meet daily requirements was not calculated. The first reason is that for all vegetables, limited bioavailability means that less than 100% of nutrients are actually digested. Bioavailability is variable, for example increasing if small amounts of animal protein are consumed, and this makes calculating the precise dietary impact of vegetable consumption difficult. Nevertheless there is consensus that vegetables are an essential source of nutrients [ 110 ]. The second reason is that the daily requirement for each nutrient varies widely between ages, genders, and pregnancy and lactation status [ 111 ]. It was therefore determined that the data should be compared to vegetables which are widely grown and marketed.

To this end, we selected 22 vegetable species tracked by the FAO Statistical Service [ 16 ] as a reference set and nutritional benchmark. These reference crops, both annual and perennial, include okra ( Abelmoschus esculentus ), leek ( Allium ampeloprasum ), scallion ( Allium fistulosum ), asparagus ( Asparagus officinalis ), broccoli ( Brassica oleracea Italica group), cabbage ( Brassica oleracea Capitata group), cauliflower ( Brassica oleracea Botrytis group), kale and collard greens ( Brassica oleracea Acephala group), pak choi and Chinese cabbage ( Brassica rapa ), pepper ( Capsicum annuum ), cucumber ( Cucumis sativus ), summer squash and zucchini ( Cucurbita spp.), winter squash ( Cucurbita spp.), globe artichoke ( Cynara scolymus ), lettuce ( Lactuca sativa ), avocado ( Persea americana ), green bean ( Phaseolus vulgaris ), pea ( Pisum sativum ), tomato ( Solanum lycopersicum ), eggplant ( Solanum melongena ), spinach ( Spinacea oleracea ), and sweet corn ( Zea mays ). While cassava leaf ( Manihot esculenta ) is also tracked by FAO, we opted to exclude it as an outlier due to its exceptionally high values. The values for summer squash/zucchini and winter squash represent the mean values for Cucurbita moschata , C . pepo , C . maxima , and unspecified Cucurbita spp, at the unripe stage for summer squash/zucchini and ripe stage for winter squash.

We constructed categorical levels for each nutrient based on nutrient levels across the set of the reference crops ( Table 2 ). For each nutrient, we divided the range found within the reference set into “low” (the lowest third), “medium” (the middle third) and “high” (the highest third). We classified nutrient concentrations below the lowest value found in the reference vegetables as “very low,” while those above the highest value as “very high.” We classified nutrient values more than twice the highest reference crop levels “extremely high.” For Vitamin A, the lowest point in the range for the reference vegetables was 0. For this reason the “very low” category is not applied to Vitamin A.

https://doi.org/10.1371/journal.pone.0234611.t002

For those nutrients for which data was acquired, we compared nutrient content across categories of crop form and part used, in terms of the percentage of crops in each category with one or more superabundant nutrients. Data was not available for every nutrient for all reference crops. Similarly, data was not available for every nutrient for each PV (see S1 Fig in the supplementary materials for information on the number of data points for each nutrient, plant form, and part used). It is possible that complete data for reference crops and/or PVs would shift our results slightly.

In order to assess the potential of PV crops to ameliorate nutritional deficiencies associated with traditional malnutrition (iron, zinc, vitamin A, iodine, and folate) and industrial malnutrition (including fiber, calcium, magnesium, and antioxidants), we scored each crop separately based on the abundance of nutrients relevant to each syndrome. In both cases, “extremely high” levels were given 3 points, “very high” two points, and “high” one point. A combined score of 6 was set to qualify species as “multi-nutrient” crops.

In order to relate nutrient content with agroecological niche, we also show superabundant and multi-nutrient PVs according to the plant form and part used.

It is also a goal of this study to identify standout species with superabundant levels of individual key nutrients. To this end, the vegetables were ranked in order of concentration from highest to lowest for each nutrient. This enabled the development of “top ten” lists for each nutrient, showing the ten crops with the highest levels of the nutrient in descending order.

PVs are a large and diverse group. They represent a third to half of vegetable crop species and over 7% of all cultivated crops. Most are herbaceous perennials, but over a third are woody plants. Leaves are the most widely used part. There are species suited to virtually all climates where crops are grown.

A literature search was conducted for this study with the aim of compiling a comprehensive list of cultivated PVs. This search found 613 cultivated species of PVs. Further analysis broke down these species by cultivation status, form and part used, and climate suitability. The full list is included as supplemental document “Cultivated Perennial Vegetable Species” as an Excel spreadsheet.

We approached the goal of assessing the extent of PV cultivation in several ways. Our analysis of [ 25 ], a reference which is limited exclusively to cultivated vegetables, found 63 fully perennial crops out of a total of 180 vegetable crops, including 37 perennials sometimes grown as annuals. PVs represent 35–56% of the cultivated vegetable species profiled in this source.

This study also sought to determine the percentage of all crops which are PVs. Of the 6,000 crop species and subspecies profiled in [ 26 ], 470 are perennials cultivated as vegetables, including 45 perennials sometimes grown as annuals, suggesting that 7.7% of all cultivated crop species are PVs.

Cultivated PV species were broken down by form and part used. Woody plants comprised 36.5%, vines 11.7%, and perennial herbs 50.9%. Of these, 114 (18.5%) are perennials often grown as annuals. Fig 1 shows the part used for woody, vine, and herbaceous perennial PVs. Note that some species have more than one part used. While 80% of global crop production comes from only 14 botanical families [ 10 ], this study found that cultivated PVs represent 107 botanical families.

This figure shows the form (woody perennial, perennial vine, or perennial herb) and part consumed as vegetable (leaf, shoot, other vegetative part, flowerbud, flower, fruit, and unripe seed). Note that some species have more than one part consumed as a vegetable and thus are shown more than once.

https://doi.org/10.1371/journal.pone.0234611.g001

The level of domestication of these 613 cultivated PV species was also assessed (see Fig 2 ). Eighteen (2.9%) are global crops, with over $1 billion USD in sales [ 6 ]. Minor global crops, which are cultivated outside of their continent of origin but with sales under $1 billion, account for 30.7% of cultivated PVs. Regional crops, which though cultivated have never been taken up outside of their region of origin, make up 61.0% of cultivated PVs. Historic crops, which are formerly cultivated but now abandoned, are 1.5%. New and experimental crops account for the remaining 2.6% of cultivated PVs.

This figure shows the number and relative portion of cultivated PV species by domestication status. “Global” indicates produced in more than one region, with global sales over $1 billion USD. “Minor global” crops are produced in multiple regions, with value under $1 billion. “Regional” crops are cultivated only in their region of origin. “Historic” crops were cultivated historically but have been abandoned as crops. “New and experimental” crops are new to cultivation or under active breeding development.

https://doi.org/10.1371/journal.pone.0234611.g002

In order to assess the geographic variability of PV crops, we analyzed the full list of cultivated species to determine climate suitability. While PV species are suited to virtually every climate where crops are grown, diversity follows a familiar latitudinal gradient: increasing with humidity and temperature, from the poles toward the equator. Fig 3 shows the distribution of PV species for climate types.

“Arctic-boreal” includes arctic and boreal species (USDA hardiness zones 1–3), “temperate” includes warm and cold temperate species (USDA hardiness zones 4–8), “tropical” includes tropical lowlands (USDA zones 10–11, below 1500m elevation), tropical highlands (USDA zones 10–11, above 1500m elevation), and subtropics (USDA zone 9).

https://doi.org/10.1371/journal.pone.0234611.g003

Many PVs can be, in some cases must be, cultivated in shade. Nine percent of the 613 cultivated species identified in the study are suited to full shade, and 46% to partial shade.

The carbon sequestration impact of PV adoption under the 12 adoption scenarios as described in the methodology section is shown in Table 3 . Total new adoption area of PVs ranges from 4.9–26.4 Mha. Carbon sequestration ranges from 22.7–280.6 MMT CO2-eq/yr in 2050.

https://doi.org/10.1371/journal.pone.0234611.t003

This figure shows the carbon sequestration impact for each of 12 scenarios based on Mha new adoption of PVs by 2050, the percentage of woody PVs, and sequestration rates.

In the comparison of PVs widely-grown reference vegetables, our results indicate that many PVs are high in the nutrients required to address widespread nutritional deficiencies, and certain species and subclasses of PVs are especially likely to be high in the key nutrients needed. The full set of data including those used in meta-analysis is included as S1 Data “Perennial Vegetable Nutrient Data” as an Excel spreadsheet.

Of 240 PV species, 154 (64%) showed superabundant levels of nutrients (rated “very high” or “extremely high” as defined in Table 2 ). A full 23 PVs (10%) showed superabundant levels of four or more nutrients. The proportion of crops with superabundant nutrients across plant form and part used in displayed in Fig 4 . Proportional levels of superabundant nutrients, especially of multiple nutrients, are most prominent in woody plants with edible leaves.

Nutrient levels are classified as superabundant when they are higher than the highest level of that nutrient among the reference vegetables. Here the percentage of crops with one or more superabundant nutrients is displayed for 240 perennial vegetables broken down by plant form and part used. The numbers of crops within each category are displayed along the top of the plot.

https://doi.org/10.1371/journal.pone.0234611.g004

Table 4 shows the species with high levels of nutrients (annual and perennial) with the greatest potential to address traditional malnutrition. These nutrient levels are the results of meta-analysis, often from many sources, so references cannot be shown here. However, the “meta-analysis” sheet of the Perennial Vegetable Nutrition Data in the supplemental materials shows sources for all nutrition data. Note that several species only make the chart due to the combination of different plant parts. Woody perennials were the largest group in this category, with 62% of species being woody. They are followed by herbaceous perennials (25%), and vines (13%). Leaves are the part eaten for 81%, with leaves and flowers and/or fruit for 13% and fruit for 13%.

https://doi.org/10.1371/journal.pone.0234611.t004

Table 5 shows the multi-nutrient species with the greatest potential to address industrial diet deficiencies. Note that several species only make the chart due to the combination of different plant parts and may or may not be ranked for an individual part. Note that several species only make the chart due to the combination of different plant parts. Woody perennials were again the largest group in this category, with 58% of species being woody. They are followed by herbaceous perennials (29%), and vines (13%). A majority (75%) feature leaves as the sole edible part, with 17% leaves with additional parts, and 8% shoots.

https://doi.org/10.1371/journal.pone.0234611.t005

For each nutrient, the ten crops with highest concentrations were ranked. See S2 Table “Top Ten Species by Nutrient Concentration” for results. Of these species with at least one elite-level nutrient concentration, 52% are woody, 33% are herbaceous perennials, and 15% are vines. For the part used, 64% are leaves, 13% are fruits and unripe seeds, 7% are flowers or flowerbuds, and 5% are shoots.

PVs are highly a highly diverse and underutilized class of crop plants. They offer impressive potential to address nutrient deficiencies impacting billions of people around the world. PVs sequester carbon, and increased adoption to provide nutrition would offer this important cobenefit. Their suitability to a wide range of climates, as well as for growing conditions adverse to annual vegetables, indicates a potential for scaling up production across a broad geographic range.

Carbon sequestration impacts are variable depending on the assumptions used. The mitigation potential of PVs will be greater if a) global vegetable area is increased to be sufficient to meet nutrient needs and b) an emphasis is placed on woody PVs rather than vines and herbaceous perennials.

PVs offer a modest but important contribution to agricultural climate change mitigation on vegetable cropland. Potential global impact of improved management of all global cropland is estimated at 1,400–2,300 MMT CO2-eq by 2050 [ 14 ]. As 3.5% of world cropland is in vegetable production currently [ 6 ], the mitigation potential for this land is 49–80 MMT CO2-eq/yr in 2050 under improved management. Increased PV adoption would sequester 22.7–280.6 MMT CO2-eq in 2050, demonstrating a notable improvement in carbon dioxide removal and storage in soils and perennial biomass via the partial perennialization of vegetable production.

Perennial crops, as a class, are not more nutritious than annual crops as a class. Indeed some annual crops (notably the Amaranthus species) greatly exceed the nutrition of the reference crops, clearly standing out for their ability to address nutrient deficiencies. However, the nutrition of perennials as a class, and of many individual perennial crops, certainly outperforms the reference vegetables tracked by FAO (the reference vegetables include both annuals and perennials, but only those that are widely grown and traded). The high frequency of superabundance in woody PVs is clearly shown in Fig 4 .

Regarding the top ten species for each key nutrient, the superior performance of perennial species is notable, particularly woody perennials. It is also noteworthy that, of the crops tracked by FAO, only cassava leaf makes it onto these lists. It would appear that the vegetables which are most widely grown and marketed are not those best suited to addressing nutrient deficiencies. An exception is folate, for which few vegetables, annual or perennial, exceeded the set of reference vegetables. Folate, however, is also the least-reported nutrient of the nine nutrients we examined (81 data points, compared with 221 for calcium).

Some species are found on the multi-nutrient tables for both traditional malnutrition and industrial diet deficiencies. These species represent extremely powerful tools to address nutrient deficiencies. They include the woody plants Cnidoscolus aconitifolius , Manihot esculenta , Moringa oleifera , Morus alba , Senna obtusifolia , S . sophera , and Toona sinensis , the perennial vines Momordica cochinchinensis and Vitis vinifera , and the perennial herb Solanum aethiopicum .

The meta-analysis approach taken in this study does not account for differences between variety, climate, farming system and practice, and soils, all of which can impact nutritional composition. [ 67 ]. Further research should account for and determine the reasons for variation within species.

Data on sequestration rates of PV species, in various production systems, are needed. This would allow improved climate impact projections.

Conclusions

Perennial vegetables represent a very large and neglected group of crops. They have potential to increase carbon sequestration in vegetable production and address nutrient deficiencies affecting over 2 billion people. They offer an important set of tools to tackle some of the key challenges of the 21st century.

This study found that the vegetables which are most widely grown and marketed are not those best able to address nutrient deficiencies, with a few exceptions. As world vegetable production needs to be tripled to provide healthy diets for all, efforts should be made to incorporate PVs in the new production areas.

It is especially good news that tree vegetables are among the most nutritious, feature high sequestration rates, and represent over a quarter of PV species. Note that tree vegetables are not confined to the tropics, with multiple species for colder climates, even including cold drylands.

The identification of species with high levels of multiple key nutrients offers to potential to highlight these crops in development and nutrition campaigns. Regional programs could identify species suited to the climate and targeted to the specific nutrient needs of the population. Given the wide distribution of PVs, species native to a given region can be prioritized.

Perennial vegetables can play a role in the perennialization of agriculture to increase carbon sequestration in soil and perennial biomass. Their potential for use in agroforestry systems, especially given the abundance of shade-tolerant PV species, is notable given the high sequestration rates of agroforestry systems. It should be noted that some PVs sequester far more carbon than others, notably the full-sized woody plants like trees, palms, and bamboos.

Time and time, again around the world, over the course of thousands of years, farmers and gardeners have taken these species into cultivation. Their highly desirable biodiversity, carbon sequestration, and nutrition impacts should be a major motivation to research, cultivate, and promote PV crops. This study is intended as a launching point for initiatives to increase the adoption and utilization of these remarkable crops.

Supporting information

S1 table. cultivated perennial vegetable species of the world..

An inventory of 613 cultivated perennial vegetable species with form, part used, and climate suitability.

https://doi.org/10.1371/journal.pone.0234611.s001

S2 Table. Perennial vegetable nutrition.

Mata-analysis of data on nutrition of 240 annual and perennial vegetable species.

https://doi.org/10.1371/journal.pone.0234611.s002

S1 Data. Top ten species by nutrient concentration.

Tables of the ten vegetable species highest in each of the key nutrients for addressing traditional malnutrition and industrial diet deficiencies.

https://doi.org/10.1371/journal.pone.0234611.s003

S1 Fig. Nutritional data acquired by plant form and part used.

This figure displays the number of data points acquired for each nutrient, their distribution across crops by plant form and part used. Numbers in parenthesis on the vertical axis represent the number of crops in that category. Numbers in parenthesis on the horizontal axis represent the total number of data points for that nutrient. Numbers in cells show the number of data points of a given nutrient for a given category of crops. Fill color in each cell represents the proportion of crops in the given category for which data on the given nutrient is present.

https://doi.org/10.1371/journal.pone.0234611.s004

Acknowledgments

This research was inspired by the work of David Kennedy and Leaf for Life. Thank you to Educational Concerns for Hunger Organization and the World Vegetable Centre for assistance in obtaining data.

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Fruit and Vegetable Intake: Benefits and Progress of Nutrition Education Interventions- Narrative Review Article

Background:.

Sufficient intake of fruits and vegetables has been associated with a reduced risk of chronic diseases and body weight management but the exact mechanism is unknown. The World Health Organisation and Food and Agriculture of the United Nation reports recommend adults to consume at least five servings of fruits and vegetables per day excluding starchy vegetables. This review focuses on the importance of fruits and vegetables as well as the benefits and progress of nutrition education in improving intake.

For this narrative review, more than 100 relevant scientific articles were considered from various databases (e.g Science Direct, Pub Med and Google Scholar) using the keywords Fruit and vegetable, Nutrition education, Body weight, Obesity, Benefits and challenges.

Existing data suggests that despite the protective effects of fruits and vegetables, their intakes are still inadequate in many countries, especially developing ones. Consequently enhancing strategies to promote fruit and vegetable intake are essential for health promotion among population. A number of reviews confirm that a well planned and behaviour focused nutrition education intervention can significantly improve behaviour and health indicators.

Conclusion:

Despite challenges in nutrition education intervention programs, they are considered as a good investment in terms of cost benefit ratio. Rapid improvement in trends of nutrition education can be seen in many countries and majority of interventions has been successful in increasing fruits and vegetables intake. It is recommended that health professionals use multiple interventions to deliver information in several smaller doses over time to ensure improved outcomes.

Introduction

“Fruits and vegetables (F&V) are considered in dietary guidance because of their high concentrations of dietary fiber, vitamins, minerals, especially electrolytes; and more recently phytochemicals, especially antioxidants” ( 1 ). Various reviews have associated low intake of fruits and vegetables with chronic diseases such as cardiovascular diseases, blood pressure, hypercholesterolemia, osteoporosis, many cancers, chronic obstructive pulmonary diseases, respiratory problems as well as mental health ( 2 – 6 ). Despite an increasing focus on the health benefits of fruits and vegetables, their consumption is below the recommended intake among adults ( 7 , 8 ). Therefore, considering how nutritional related health problems have risen drastically globally, it seems critical that formal nutrition education aiming to increase knowledge and fruits and vegetables intake be given priority in health education programs and health promotion. This review provides an insight into the importance of fruits and vegetables as well as the benefits and progress of nutrition education in improving intake.

Importance of F&V in the diet

Sufficient intake of fruit and vegetables (F&V) has been related epidemiologically with reduced risk of many non-communicable diseases. Currently, much interest are focused on the vital role of antioxidants which impart bright colour to F&V and act as scavengers cleaning up free radicals before they cause detrimental health effects ( 9 ). Moreover, fibers found in F&V have been shown to reduce intestinal passage rates by forming a bulk, leading to a more gradual nutrient absorption ( 10 ) hence preventing constipation. They can be fermented in the colon, increasing the concentration of short chain fatty acids having anticarcinogenic properties ( 11 ) and maintaining gut health. Several studies have highlighted the CVD risk-reducing potential of F&V whereby their intake were strongly associated with lower cardiovascular risk factors such as lower blood pressure (BP), cholesterol and triacylglycerol thus preventing premature cardiovascular disorders ( 2 ). Recently Habauzit et al. ( 12 ) reported that fruits containing a high amount of anthocyanins, flavonols and procyanidins, such as berries, grapes and pomegranate are effective at decreasing cardiovascular risk while citrus fruits and apples had a moderate effect on BP and blood lipid level. An increased consumption of carotenoid-rich F&V maintains the cholesterol level in blood since they reduce oxidative damage and cause an increase in LDL oxidation resistance ( 13 ). An increased consumption of cruciferous vegetables was also reported to cause a decrease in the risk of intestinal, bowel, thyroid, pancreatic and lung cancer ( 4 ).

F&V have also been suggested to prevent osteoporosis in adults mainly for their rich sources of calcium and other vitamins which are vital in bone health ( 3 ). The high fiber content of F&V may play a role in calcium absorption and reduce the ‘acid load’ of the diet ( 14 ) enhancing bone formation and suppressing bone resorption which consequently result in greater bone strength ( 15 ). Moreover, phytoingredients in F&V such as gooseberry, curcumin, and soya isoflavones have shown to be protective against lens damage which occurs due to hyperglycemia ( 16 ) and certain flavonoids such as quercetin can prevent oxidative stress in the pathogenesis of glaucoma ( 17 ). Also, a high intake of F&V was inversely associated with the risk of COPD and respiratory symptoms ( 5 ). Higher total fruit and vegetable intake is also associated with lower risk of cognitive decline hence proved beneficial for mental health ( 6 , 18 ). Based on available evidence, a clear relationship between F&V and diseases has been well established however no protective effect of overall fruit and vegetable intake (FVI) against lung diseases were found. Green leafy vegetables, rather than fruit, were suggested to have a genuine protective effect against lung cancer ( 19 ). Risk of proximal colon cancer, rectal cancer ( 20 ) and aggressive and non-aggressive urothelial cell carcinomas ( 21 ) are not associated with FVI and no protective role were seen on the risk of endometrial cancer in post menopausal women ( 22 ). The accepted recommendation is to consume a variety of F&V because studies demonstrate that a combination of F&V have more potential benefits rather than a single fruit or vegetable ( 23 ). However further studies are warranted.

Fruits and Vegetable Intake (FVI), Body Weight and Obesity

Interestingly, phytochemicals in F&V have been found to act as anti-obesity agents because they may play a role in suppressing growth of adipose tissue ( 1 , 24 ). Adiposity is closely related to biomarkers of oxidative stress and inflammation and a diet rich in F&V can modify these adiposity related metabolic biomarkers in overweight women ( 25 ). A recent study by Vilaplana et al. ( 26 ) demonstrated that Carica papaya and Morinda citrifolia exhibited high lipase inhibition which can be considered as potential options for the management of obesity and maintaining body weight. To date, the red varieties of Allium cepa , Lactuca sativa , Capsicum annum , Brassica oleracea var sabellica and orange-fleshed type of Ipomoea batatas appear to be the richest vegetables sources of potential anti-obesity phytochemicals that can control the initiation and development of obesity ( 27 ).

It is also understood that fruits and non-starchy vegetables are very low in energy since they contain high amount of water and fiber and can be consumed in a relatively larger amount contributing to increased satiety to maintain normal weight ( 28 ). Fibers also form a gel-like environment in the small intestine, resulting in reduced activity of the enzymes involved in the digestion of fat, protein and carbohydrates ( 29 ). Hence an increased FVI can help to ease weight loss and this can be achieved when F&V displace high-energy-dense foods such as saturated fats, sugar ( 30 ) so that the overall energy density of the diet is reduced ( 31 ). Additionally, fruits have been suggested to prevent obesity since they add up to dietary variety both between and within food groups and palatability to the diet which has been revealed to be an important predictor of body fat ( 32 ). However discrepancies exist with respect to F&V with high glycemic index carbohydrates that are related to a more immediate decrease in appetite and increase in food intake in the short term ( 33 ). High consumption of fructose in F&V is related to obesity in rodents but no effect has yet been demonstrated in humans ( 34 ). FVI in over-weight and obese people is much lower than the recommendation since they tend to restrict intake of these F&V when trying to lose weight.

A significant relationship was observed between BMI and vegetable intake whereby overweight participants had lower intake of vegetables ( 35 – 37 ). This finding is consistent to that of Epuru et al. ( 38 ) who also found a clear trend between prevalence of obesity and low FVI. Furthermore given that fruits are often eaten raw but vegetables are frequently prepared by adding fatty substances (e.g. oil while frying) which reduce the low energy dense uniqueness of vegetables, nutritionists should be careful when promoting FVI among population because the idea may not work with all target population. For instance, the intake of vegetables is associated with a higher risk of obesity in Chinese adults due to use of oil for stir frying vegetables and this highlights the importance of choosing the right cooking methods ( 39 ). Interestingly, many studies report a decrease in body weight with increased FVI ( 40 – 42 ). For instance, in a 10 year follow up study, high FVI reduced long-term risk of weight gain and obesity among Spanish adults ( 43 , 44 ) demonstrated greater weight loss from high vegetable intake when a high vegetable diet was compared with a control diet comprised of ‘usual intake’.

Global Intake of Fruits and Vegetables

According to World Health Organisation STEP-wise approach to surveillance surveys on chronic disease risk factors conducted in several African countries including Mauritius and in line with existing Food and Agriculture Organisation data, fruit and vegetable intake (FVI) levels were found to be below the recommended daily intake of 400g/person ( 45 ). With the current ‘5 A day’ message, a large gap still exists between the recommended and actual intake and many worldwide are not receiving the quantity or variety of F&V that they should have ( 46 , 47 ). Table 1 shows the mean fruits and vegetables intake (FVI) in selected countries.

Fruits and vegetable consumption in adults in selected countries

Available data reveals that the average FVI is not positively linked to the status of the country since greater consumption can be seen in developing countries such as Uganda and PR China compared to developed countries such as Denmark, Germany, UK and France. Data from GEMS/Food cluster diet shows that in US, mean F&V intake is 189.30 g/day and 255 g/day respectively, and recently, adults were found to have F&V about 1.1 times and 1.6 times/day respectively ( 48 ). F&V are consumed in the amount of 146.81 g/day and 176.96 g/day respectively in Hong Kong accounting for a total of 324 g/day ( 49 ). 209 g/day and 228.6 g/day F&V were reported among adults respectively in Germany and recent German Health Interview and Examination Survey data report that women and men consume 3.1 and 2.4 servings of F&V per day respectively ( 50 ). Mean F&V were 179g/day and 133g/day respectively in Malaysia ( 51 ). Current data based from the Canadian Community Health Survey which measured the number of times participants consumed F&V, rather than the actual quantity consumed, reported that only 40.8% Canadians aged ≥12 years consume F&V 5 or more times per day ( 52 ).

Likewise, The Healthy People 2010 report ( 8 ) stated that the trends in FVI over the previous decade were relatively flat and has not been able to meet the Healthy People 2010 goals. The latter targets increasing to 75% the proportion of persons aged ≥ 2 years who consume two or more servings of fruit daily and to 50% those who consume three or more servings of vegetables daily. Recently published Global Phytonutrient Report ( 55 ) reveals that to achieve the WHO recommendation, most adults should at least double their current intake of F&V worldwide. Many countries like France, Spain ( 56 ), US, ( 57 ) and Mauritius ( 58 ) follow the ‘5 A Day’ recommended guidelines. However presently, it has been reported that 5 servings a day are not enough since those consuming 7 or more servings of fruits and vegetables a day, are having more health benefits and prolonged lives [e.g. those who ate 5 to 7 servings of fruits and vegetables per day had a 36% lower risk of dying from any cause; 3 to 5 servings was associated with 29% lower risk while 1 to 3 servings was linked with a 14% lower risk] ( 59 ). Countries like Canada, Australia, and Denmark have a recommendation in the range of 6 to10 servings of F&V daily ( 60 – 62 ). Since different countries are using different guidelines, the ideal recommendation of F&V is still being debated and there is need of a unified message to promote intake around the world.

Requirement and strategies for nutrition education to boost FVI

Nutrition education is defined as “any combination of educational strategies, accompanied by environmental supports, designed to facilitate voluntary adoption of food choices and other food and nutrition-related behaviors conducive to health and wellbeing”( 63 ). Educational interventions to encourage Americans to improve their diets may prevent rising incidence of heart diseases and save health care expenditures ( 64 ). The high prevalence of nutrition-related chronic illnesses with obesity and overweight among the most challenging and steadily rising public health problems suggests that nutrition education needs to be a priority for adults and nutrition educators must be knowledgeable about diet and disease relationships specific to the population ( 65 ). The scope of nutrition education is broader than just educating about nutrition in relation to personal health. It can cover a wide range of issues and topics such as an increase in quantity and quality of foods, ways of improving nutritive value of a diet, importance of sanitary food handling practices at home, in market, factories and institutions serving food to large numbers of people such as schools, hospitals and restaurants ( 66 ) hence ensuring food safety and reducing morbidity.

To meet current F&V recommendation, many countries have developed targeted campaigns and interventions to increase FVI to adequate level. Pollard et al. ( 67 ) monitored changes in behaviors regarding FVI in Western Australia before and after the “Go for 2&5” and found that most changes mainly in knowledge, attitudes, and behaviors concerning FVI took place after the campaign. In particular, respondents who correctly identified the recommended intake of F&V doubled indicating that health campaign with nutrition education as an integral component is fruitful. Resnicow et al. ( 68 ) also reported that an “Eat for Life program”, a multicomponent intervention to increase FVI conducted resulted in a significant increase in FVI. These studies are consistent to that of Ammerman et al. ( 69 ) who reviewed the efficacy of behavioral interventions to modify FVI emphasizing on studies in North America, Europe and Australia and noted a significant effect in increasing FVI. Moreover, in an intervention using a general nutrition course, participants increased consumption of not only total F&V but also fresh F&V along with a significant decrease in intake of high energy density French fries ( 70 ). Bensley et al. ( 71 ) compared traditional nutrition education to that of an internet one and found that both required follow-up counseling to achieve FVI levels and in both interventions, those who were provided counseling consumed more vegetables, fruits and fruit juice. In order to achieve and sustain FVI at the recommended levels, intervention alone is not enough as it requires a combination of other approaches such as social marketing, behavioral economics approaches, and technology based behavior change models to ensure that required goals are met ( 72 ). The findings from previous reviews are interesting showing that most of the interventions lead to an increased consumption of F&V at least in the short term. However no such review has conducted a Meta analysis quantifying the effectiveness of the interventions. Few intervention reviews have been done to see whether nutrition education is effective. One of such review is that of Taylor et al. ( 73 ) who conducted a Meta analysis of various intervention studies whereby five of them reported significant positive changes in weight and BMI. Four studies had effective interventions targeting determinants of dietary intake and dietary behaviors and nutritional intake. However uncertainty do remains due to insufficient details provided for nutrition intervention protocols, inconsistency in approach of delivery and comparisons between delivery modes and content of information provided to participants between studies. Eyles et al. ( 74 ) found that tailored nutrition education was a promising strategy for improving the diets of adults over the long term but stated that future studies should ensure adequate reporting of research design and reduce the chances of false-positive findings via more objective measures of diet. Likewise tailored interventions were more effective than non-tailored interventions in improving the short-term dietary behaviors of participants whereby delivery of information in several smaller doses over time was more likely to improve effectiveness ( 75 ). Lara et al. ( 76 ) noted that nutrition education was a significant factor in increasing fruit and vegetable in-takes and are therefore effective, sustainable in the long term and considered it to be of public health significance. Table 2 below summarises findings of some successful nutrition education intervention.

Summary and findings of some successful nutrition education interventions

Abbreviations: FV: Fruit & vegetable; FVI: Fruit & Vegetable Intake; FFQ: Food Frequency Questionnaire; +: positive intervention effect; –: negative intervention effect

Overall nutrition education contributes significantly to a change in food and nutrition related behaviors but where many components are involved, it achieves positive results in some and negative in others. Guillaumie et al. ( 77 ) concluded that most psychosocial variables significantly increased in an intervention group exposed to a nutrition education plan with the exception of vegetable intake. Assema et al. ( 78 ) found an intervention effect in saturated fat intake during the main meal and fruit juice consumption but not for daily intake of fruit and vegetables. Contento et al. ( 79 ) stated that “the reported effectiveness, or lack thereof, of nutrition education interventions in various studies depends on many factors, including the nature, duration, and power of the interventions and the degree to which the interventions were implemented as designed”. The author remarked that in order to assure the success of a nutrition education strategy, major implications need to be considered such as developing and testing instruments with each new target audience before any intervention study, it will then be feasible to make judgments about the effectiveness of nutrition education and impact of interventions on mediating variables would be understood.

Moreover, to be successful, nutrition education needs to be much more comprehensive than giving basic nutrition information. It should address food preferences and sensory affective factors; person-related factors such as perceptions, beliefs, and attitudes; meanings and social norms; and environmental factors ( 80 ). Effective nutrition interventions should have a behavioral focus that will reduce the targeted risk factors and comprise strategies that are developmentally and culturally appropriate ( 81 ). Barriers pertaining to health preventive behaviors along with the determinants of intake should be taken into account and solutions should be designed ( 67 ). For example, low income groups can be targeted to opt for cheap sources of F&V to meet the 5 a day demand ( 78 ). Where possible, consumption of tropical fruits should be encouraged and at the same time this will increase the profits of fruit vendors and that of the country at large. Men can be targeted through educational campaigns at work and through eye catching advertisement ( 73 ). The government can review tax on F&V and promote more display areas such as farmers markets and shops in most regions to increase availability ( 56 ). Involvement of stakeholders, ministries, and legislation at higher level can be thought-out concerning produce and distribution channel related factors as well as for food labeling which are sometimes misleading and difficult to interpret ( 82 ). Furthermore, accounting for the high prevalence of diabetes with 387 million cases reported globally which is expected to rise to 592 million by 2035 ( 83 ) and with more than 1.9 billion adults having obesity problems ( 84 ), diabetes concept of not consuming certain fruits may lead to further health detriment. Research shows that diabetic people would benefit greatly from consuming a variety of F&V, which help to lower degrees of inflammation, to have better glycemic control, and reduce odds of diabetic retinopathy ( 85 ). Additionally, there is no evidence to support that fructose present in fruits under normal conditions has a negative impact on the glycemic control in Type 2 diabetes ( 86 ). However, the role of fructose and fruit sugars in the development of the current obesity and diabetic epidemic remains controversial and the general population including overweight and obese person should be given correct information. Nutrition intervention programs should aim healthy food habits including the consumption of F&V together with physical exercise aiming to reduce body weight and improve health status. Messages and interventions should be creative, engaging, supportive and inexpensive ( 87 ) with realistic goals ensuring that the Mauritian population, also type 2 diabetic and obese people understand the message of having fruits just as the general population, without fearing worsening of their glycemic control.

Challenges on nutrition education intervention programs

Despite clear evidence on the benefits of nutrition education intervention, there are major challenges that are faced by nutrition educators. These are: a) realistic educational goals, b) thorough research designs, c) explicit theoretical bases, and d) valid and reliable measurements ( 88 ). Assuring effective communication skills of nutrition educators and the quality of nutrition education or behavior change interventions implemented is questionable ( 89 ). Quality assurance tools and validated guidelines targeting specific target population are uncertain ( 90 ). Monitoring and evaluation within integrated programs does not always capture the impact on nutritional status sufficiently or in a timely manner to allow for improving implementation ( 91 ). Methodological challenge such as small sample size and mostly female respondents may prevent experimentally conclusive and sustainable evidence ( 78 ). Nutrition education is also influenced by several barriers ( 92 – 95 ) and predisposing factors such as attitudes, beliefs, values, capacity, self-efficacy, individual differences ( 96 ) that need to be overcome. Thus, several drawbacks of nutrition education deserve attention.

The relationship between FVI and reductions in risk for many major health problems is strongly supported in many research studies but the effects of F&V on plasma lipid levels, diabetes, and body weight have yet to be explored. Still, F&V are believed to be protective against adiposity and are considered as a potential treatment in the management of obesity. Despite their numerous health benefits, few countries fulfilled 400g daily requirement for FVI. Many nutrition education strategies have positively impacted on people’s nutrition and health behavior yet there are many factors which need to be considered and challenges that need to be overcome when designing nutrition education strategies. To be successful, nutrition education needs to be much more comprehensive than giving basic nutrition information. Current focus is on the effectiveness of methods of information dissemination and validation of educational tools. It is important for nutrition educators to deal with dietary behaviors that are associated with specific diseases adapted to explicit target population. Nutrient-based information alone is inadequate. Most successful strategies have been the delivery of information in several smaller doses over time. Although promoting healthy lifestyles is a challenge, it can be realized by focusing on positive “to-do” behaviors, rather than on “not-to-do” behaviors aiming at increasing the percentage of people adopting healthier eating habits.

Ethical considerations

Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.

Acknowledgements

The Department of Health Sciences, Faculty of Science, University of Mauritius is acknowledged for research support. The authors declare that there is no conflict of interests

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• Published: 17 April 2024

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Confronting the challenge of promoting fruit and vegetable intake for obesity management: An alternative approach

• Marleigh Hefner 1 ,
• Gaurav Kudchadkar 1   na1 ,
• Raksa Andalib Hia 1   na1 ,
• Most Arifa Sultan 1   na1 ,
• Holli Booe 1 &
• Nikhil V. Dhurandhar   ORCID: orcid.org/0000-0002-1356-1064 1  

International Journal of Obesity ( 2024 ) Cite this article

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Fruits and vegetables (F&V) are an abundant source of health-promoting nutrients, such as fiber, water, and micronutrients. F&V intake is linked with enhanced human health across many domains, including lower adiposity in adults [ 1 ]. As such, F&V are an integral component of a balanced, nutritious eating pattern [ 2 ]. For weight management, F&V are advantageous due to their higher nutrient density and lower energy density. Indeed, incorporation of F&V within a calorie-restricted diet may enhance weight loss [ 3 ].

Yet, despite the well communicated benefits of F&V consumption for general health, global trends reveal suboptimal intakes of F&V across adult and adolescent populations [ 4 , 5 ]. Some of our best efforts of promoting F&V consumption have yielded underwhelming improvements in F&V consumption and been unable to enhance long-term F&V intake adherence [ 6 , 7 , 8 , 9 ].

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These authors contributed equally: Gaurav Kudchadkar, Raksa Andalib Hia, Most Arifa Sultan.

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Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA

Marleigh Hefner, Gaurav Kudchadkar, Raksa Andalib Hia, Most Arifa Sultan, Holli Booe & Nikhil V. Dhurandhar

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NVD and HB contributed to conceptualization. NVD, HB, MH, GK, RAH, and MAS performed the review of the literature and contributed to writing. MH wrote the first draft of the manuscript. All authors contributed to the manuscript revision, read, and approved the submitted version.

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Correspondence to Holli Booe or Nikhil V. Dhurandhar .

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Hefner, M., Kudchadkar, G., Hia, R.A. et al. Confronting the challenge of promoting fruit and vegetable intake for obesity management: An alternative approach. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01520-8

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Received : 01 December 2023

Revised : 02 April 2024

Accepted : 04 April 2024

Published : 17 April 2024

DOI : https://doi.org/10.1038/s41366-024-01520-8

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April 24, 2024

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Research finds social media can be used to increase fruit and vegetable intake in young people

by Aston University

Researchers from Aston University have found that people following healthy eating accounts on social media for as little as two weeks ate more fruit and vegetables and less junk food. The work is published in the journal DIGITAL HEALTH .

Previous research has shown that positive social norms about fruit and vegetables increases individuals' consumption. The research team sought to investigate whether positive representation of healthier food on social media would have the same effect. The research was led by Dr. Lily Hawkins, whose Ph.D. study it was, supervised by Dr. Jason Thomas and Professor Claire Farrow in the School of Psychology.

The researchers recruited 52 volunteers, all social media users , with a mean age of 22, and split them into two groups. Volunteers in the first group, known as the intervention group , were asked to follow healthy eating Instagram accounts in addition to their usual accounts. Volunteers in the second group, known as the control group, were asked to follow interior design accounts. The experiment lasted two weeks, and the volunteers recorded what they ate and drank during the time period.

Overall, participants following the healthy eating accounts ate an extra 1.4 portions of fruit and vegetables per day and 0.8 fewer energy dense items, such as high-calorie snacks and sugar-sweetened drinks, per day. This is a substantial improvement compared to previous educational and social media-based interventions attempting to improve diets.

Dr. Thomas and the team believe affiliation is a key component of the change in eating behavior. For example, the effect was more pronounced among participants who felt affiliated with other Instagram users.

The 2018 NHS Health Survey for England study showed that only 28% of the UK population consumed the recommended five portions of fruit and vegetables per day. Low consumption of such food is linked to heart disease , cancer and stroke, so identifying ways to encourage higher consumption is vital.

Exposing people to positive social norms, using posters in canteens encouraging vegetable consumption, or in bars to discourage dangerous levels of drinking, have been shown to work. Social media is so prevalent now that the researchers believe it could be an ideal way to spread positive social norms around high fruit and vegetable consumption , particularly among younger people.

Dr. Thomas said, "This is only a pilot intervention study at the moment, but it's quite an exciting suite of findings, as it suggests that even some minor tweaks to our social media accounts might lead to substantial improvements in diet, at zero cost! Our future work will examine whether such interventions actually do change our perceptions of what others are consuming, and also, whether these interventions produce effects that are sustained over time."

Dr. Hawkins, who is now at the University of Exeter, said, "Our previous research has demonstrated that social norms on social media may nudge food consumption, but this pilot demonstrates that this translates to the real world. Of course, we would like to now understand whether this can be replicated in a larger, community sample."

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