Q: How important are nutrition and dietary factors in health and chronic disease prevention?
A: The Surgeon General's Report on Nutrition and Health in 1988 noted that 2/3 of all deaths are due to diseases associated with diet. The report also says that the three most important personal habits that influence health are smoking, alcohol consumption, and diet. For the two out of three adults who do not drink alcohol excessively or smoke, the single most important personal choice influencing long-term health is what they eat.
In 1997, the World Cancer Research Fund and the American Institute for Cancer Research report, "Food, Nutrition and the Prevention of Cancer: A Global Perspective" stated that recommended diets in conjunction with physical activity and normal BMI could reduce cancer incidence by 30β40%.
For heart disease, the 1989 National Academy of Sciences report, Diet and Health: Implications for Reducing Chronic Disease Risk, projected that 20% of deaths could be avoided by reducing fats and increasing fruits, vegetables, breads, cereals, and legumes (dry beans and peas).
Q: Why do fruits and vegetables help prevent certain cancers?
A: Of all the dietary factors thought to be related to cancer, the research evidence is most consistent for the association between increased consumption of fruits and vegetables and reduced risk of a variety of cancers. The evidence is strongest for digestive (oral, larynx, esophagus, stomach, colon, rectum) and respiratory cancers. The vitamins, fiber, carotenoids, or other components in fruits and vegetables such as phytochemicals may be responsible for this protective effect. Phytochemicals are non-nutritive components of plants that have properties, which help reduce the risk of developing certain cancers.
Fruits and vegetables are rich sources of Vitamin A, Vitamin C, and fiber and contain many other compounds: micronutrients like selenium; antioxidants like carotenoids; and phytochemicals like indoles, isothiocyanates, flavonoids, phenols, allium compounds, and limonene.
Hyson D. The health benefits of fruit and vegetables for better health. Wilmington, DE: Produce for Better Health Foundation, 2002. Available at:
http://www.5aday.org/news/graphics/r..._doc2002.pdf.*
Steinmetz KA, Potter JD. Vegetables, fruit, and cancer Prevention: a Review. J Am Diet Assoc 1996;96:1027β1039.
Q: Will eating more fruits and vegetables as part of a healthy diet help prevent other diseases?
A: As well as decreasing the risk of cancer, a diet rich with fruits and vegetables and low in fats, particularly saturated fats, may also help to reduce the risk of cardiovascular disease, high blood pressure and diabetes.
Appel LJ, Moore TJ, Obarzonek E, Vollmer WM, Svetkey LP, Sacks FM Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. A Clinical trial of the effects of dietary patters on blood pressure. New England Journal of Medicine. 1997;336(16):1117β1124.
Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, Whelton PK. Fruit and vegetable intake and risk of cardiovascular disease in US adults: The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutrition. 2002;76:93β99.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002;346(6):393β403.
Law MR, Morris JK. By how much does fruit and vegetable consumption reduce the risk of ischemic heart disease? European Journal of Clinical Nutrition. 1998;52(8):549β556.
Ness AR, Powles JW. Fruit and Vegetables, and Cardiovascular Disease: A Review. Inter J Epi 1997;26:1β13.
United States Department of Agriculture. America's eating habits: changes and consequences. (AIB-750). Washington, DC: U.S. Government Printing Office, 1999
Q. How do key nutrients found in fruits and vegetables help prevent certain cancers?
A: Carotenoids (lycopene, lutein, beta-carotene, alpha-carotene) may inhibit the initiation and promotion of carcinogenesis in the body. Carotenoids are powerful antioxidants and can prevent the formation of free radicals. Free radicals are the by product of cellular metabolism or environmental stressors, such as smoking, and may cause cellular damage if present in high concentrations. Carotenoid-rich fruits and vegetables are considered to be protective against certain cancers. Beta-carotene is a precursor to Vitamin A also.
Rich food sources include dark-green vegetables and brightly colored (red, yellow, orange) fruits and vegetables.
Vitamin C blocks the formation of carcinogenic nitrosamines in the digestive tract. Vitamin C also acts as an antioxidant by preventing the oxidation of certain chemicals to active carcinogens.
Rich food sources of Vitamin C include citrus fruits, strawberries, and dark-green vegetables like broccoli and spinach.
Dietary Fiber is the non-digestible or partially digestible material found in plant cells. It acts as an internal scrub brush in the body. Fiber may help prevent certain cancers by:
Reducing fecal transit time in the bowel and thereby decreasing the time the bowel is exposed to potential carcinogens.
Increasing fecal water content in the intestinal tract, thereby increasing stool bulk which may dilute carcinogen concentrations in the colon.
Binding with bile acids in the intestinal tract, some of which could convert to carcinogens if left in an unbound form.
Good sources of dietary fiber are found in 3 specific food groups: fruits, vegetables including beans and legumes, and whole grain breads and cereals. NCI recommends eating 20β30 grams of fiber daily, with an upper limit of 35 gm as part of a healthy diet.
Frei B (ed), Grei B. Natural antioxidants in human health and disease. New York, NY: Academic Press, 1994.
Butrum RR, Clifford CR, Lanza E. NCI Dietary Guidelines: Rationale. Am J Clin Nutr. 1988;48:888β995.
World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research, 1997.
Q. What are antioxidants and how do they work?
A. Antioxidants act as cell protectors.
Oxygen, an essential element for life, can create damaging by-products during normal cellular metabolism. Antioxidants counteract these cellular by-products, called free radicals, and bind with them before they can cause damage. If left unchecked, free radicals may cause heart damage, cancer, cataracts, and a weak immune system.
Antioxidants work by: binding to the free radicals; transforming them into non-damaging compounds; or repairing cellular damage. Antioxidants come in a variety of forms and include Vitamin C, Vitamin E, the Carotenoids, and Selenium.
Good sources of antioxidants include fruits and vegetables. The highest concentrations are found in the most deeply or brightly colored fruits and vegetables (spinach, carrots, red bell peppers, tomatoes).
Q. What about using antioxidant supplements?
A. Depending upon supplements for antioxidants may short change you on their benefits in the long run. Supplements do not contain the variety of nutrients and phytochemicals found in whole fruits and vegetables some of which are believed to work in partnership with other nutrients to maintain your cells in a healthy state.
Also, high doses of single nutrients may be harmful. Large amounts of beta-carotene supplements have been shown to increase the risk for lung cancer in male smokers). High doses of one nutrient could possibly offset the health benefits of another nutrient. Moreover, supplements do not contain fiber.
Albanes D, et al. N Eng J Med. 1994;330:1029β35.
Good Sources of Vitamin C:
Tomato, Collard, Apricot, Tangerine, Broccoli, Potato (w/skin), Honeydew Watermelon, Brussels Sprout, Spinach, Kiwi Grapefruit, Bell Pepper,Cabbage,Mango, Pineapple, Mustard, Green Cauliflower, Orange, Plum, Chili Pepper, Strawberries
Good Sources of Vitamin A:
Pumpkin, Collard, Apricot, Cantaloupe, Spinach, Leaf Lettuce, Mango, Kale, Romaine Lettuce, Sweet Potato, Carrot, Mustard, Green Winter Quash
Good Sources of Fiber:
Sweet Potato, Brussels Sprout, Apple, Cherries, Peas, Carrots, Oranges, Banana, Spinach, Cooked Beans, Pear, Blackberries, Dates, Prunes, Grapefruit, Strawberries, Blueberries, Figs, Kiwi
Q: Why is it important to eat a variety of colorful fruits and vegetables?
A: Specific phytochemicals are found in different colors of fruit and vegetables. To get the full benefits of these phytochemicals, one needs to eat a variety of colors. For example, indoles are found in cruciferous vegetables; such as broccoli and phenols are found in blue or purple fruits and vegetables; such as plums.
For more information on phytochemicals, visit:
www.5aday.gov www.5aday.org* www.cdc.gov/nccdphp/dnpa/5aday/index.htm
A fact sheet may also be found at:
http://ohioline.osu.edu/hyg-fact/5000/5050.html.*
Q: What are the objectives of the 5 A Day Program?
A: The 5 A Day Program was launched at the national level in 1991 as an education effort to encourage Americans to eat 5 or more servings of fruits and vegetables everyday for better health. The 5 A Day Program is a unique public-private partnership between the:
American Cancer Society (ACS)
Centers for Disease Control and Prevention (CDC)
National Cancer Institute (NCI)
Produce for Better Health Foundation (PBH)
United States Department of Agriculture (USDA)
Also, each state and U.S. Territory has developed 5 A Day Programs to conduct research and outreach through an extensive network of community partners.
Q: What are the components of the 5 A Day Program?
A: The 5 A Day Program focuses on several key areas to further the goal of increasing consumption of fruits and vegetables for all Americans:
Building state and community capacity and infrastructure
Policy and environmental change
Nutrition education and behavior change
Research
Evaluation
Communications
Working with industry and other national partners
Q: Who are the members of the 5 A Day Program Partnership and what are their roles?
A: The national 5 A Day Program began in 1991 as a unique public private partnership between the National Cancer Institute (NCI) and Produce for Better Health (PBH) a non-profit organization that promotes the consumption of fruits and vegetables. Recently, the 5 A Day Program has expanded to become the largest public/private partnership for nutrition. 5 A Day partners include federal agencies, private industry, states, and nonprofit community and advocacy organizations. NCI has licensed 55 state and territorial health agencies (including the U.S. Air Force, Army, Navy, Marine Corps, and Coast Guard, as well as Indian Health Services) to coordinate and deliver 5 A Day activities through multiple community channels. PBH has licensed over 1000 industry members, representing 35,000 supermarkets nationwide. In 2002 a Memorandum of Agreement was signed between the CDC, NCI and USDA to define working relationships that would increase the consumption of fruits and vegetables by the American Public.
The Centers for Disease Control and Prevention (CDC) works with and assists States with their 5 A Day programs and is incorporating 5 A Day programming into their comprehensive nutrition and physical activity grants. These grants are awarded to states for nutrition education, intervention activities, and pilot research projects. CDC also supports environmental and policy strategies to promote increased fruit and vegetable consumption. Through the Behavioral Risk Factor Surveillance System (BRFSS),
http://apps.nccd.cdc.gov/5ADaySurveillance/ CDC monitors the fruit and vegetable consumption.
NCI provides leadership in the areas of research, research dissemination, and communication of the 5 A Day message. The USDA's Food and Nutrition Service promotes 5 A Day in classrooms, cafeterias, and food assistance programs across the nation. Using social marketing and a theory-driven educational approach, the community programs seek to raise public awareness of the health benefits of eating "5 a day" and provide interactive and skill building activities to show Americans how to accomplish this goal.
Coalition participants include:
State and county health agencies
Industry (supermarkets, commodities)
State Departments of Education
State Departments of Agriculture, including cooperative extension and Women, Infant and Children (WIC) clinics
American Cancer Society
Businesses
Q: What is the 5 A Day Program's Behavioral Research and Evaluation component?
A: Since 1992, NCI's 5 A Day Program funded research grant projects and overall program evaluation, including process and outcome evaluation. Current data show a favorable trend in awareness of the need to eat "5 a day." Awareness has increased from 8% in 1991 to 19% in 1997 (NCI 5 A Day for Better Health Program Survey). In 1993, NCI funded 9 four-year Research Project Grants with randomized controlled designs to determine the effectiveness of 5 A Day behavior change interventions in settings including: schools, worksites, churches, and food assistance programs. In addition, the 5 A Day Program collaborated with the Centers for Disease Control and Prevention (CDC) to award 20 one-year 5 A Day Evaluation Studies to state health agencies. Most of these grants targeted underserved populations: children, low-income, minority, and low-income elderly.
Q: What is the 5 A Day Program's Communications Research component?
A: The national media campaign, a collaborative effort including ACS, CDC, NCI, PBH, and USDA, spreads the 5 A Day message to the public through media events and campaigns held throughout the year. These initiatives involve broadcast media, national spokespersons, print and special events. Annual 5 A Day Month (September) activities allow a myriad of 5 A Day participants to join forces for a month of highly visible promotions. State 5 A Day coordinators play an integral role in disseminating the message to the communities they serve.
NCI's Office of Cancer Communications has adapted a social marketing model for 5 A Day communications strategies. The Consumer-based Health Communications (CHC) model guides the research that is consistently used in the program to learn about its target audience, to track its progress, and to evaluate and study the audience's attitudes and behaviors about nutrition, fruits and vegetables, and general lifestyle and health issues.
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