Objectives: This study aimed to identify the main vegetable sources of overweight participants during a 12-month randomised controlled trial for weight loss.
Methods: Secondary analysis using data from diet history interviews to determine changes to daily vegetable intake amounts and types throughout the trial at 0, 3 and 12 months.
Results: Pre-trial 77% participants consumed frozen vegetables. At baseline (n = 113, 85 F), participants reported 345 ± 170 (56-920) g/day vegetables increasing to 498 ± 180 (146-930) g/day at 3 months and remaining stable at 475 ± 169(170-1053) g/day by 12 months (p = 0.001). At baseline, 32 of 34 different vegetable categories were reported, mainly tomato (69.9 g/day) and, potato (58.2 g/day). After 3 months (n = 109), seven vegetables remained in the top 10 reported (contributing 72%). Tomato remained top ranked to 12 months.
Conclusion: Following advice to consume more vegetables, consumption increased above the Australian Dietary recommendation of ~375 g/day. Tomatoes remained a mainstay regardless of the time of year, but choices changed with time. Frozen vegetables may be a feasible option

O\u27Shea, Jane E

Probst, Yasmine

Tapsell, Linda C

Thorne, Rebecca L

English

Research Online

University of Wollongong Research Online Illawarra Health and Medical Research Institute Faculty of Science, Medicine and Health 1-1-2018 Translating advice to eat more vegetables into practice: observations from a 12-month weight loss trial Jane E. O'Shea University of Wollongong, janeo@uow.edu.au Linda C. Tapsell University of Wollongong, ltapsell@uow.edu.au Rebecca L. Thorne University of Wollongong, beck@uow.edu.au Yasmine Probst University of Wollongong, yasmine@uow.edu.au Follow this and additional works at: https://ro.uow.edu.au/ihmri  Part of the Medicine and Health Sciences Commons Recommended Citation O'Shea, Jane E.; Tapsell, Linda C.; Thorne, Rebecca L.; and Probst, Yasmine, "Translating advice to eat more vegetables into practice: observations from a 12-month weight loss trial" (2018). Illawarra Health and Medical Research Institute. 1275. https://ro.uow.edu.au/ihmri/1275 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au Translating advice to eat more vegetables into practice: observations from a 12-month weight loss trial Abstract Objectives: This study aimed to identify the main vegetable sources of overweight participants during a 12-month randomised controlled trial for weight loss. Methods: Secondary analysis using data from diet history interviews to determine changes to daily vegetable intake amounts and types throughout the trial at 0, 3 and 12 months. Results: Pre-trial 77% participants consumed frozen vegetables. At baseline (n = 113, 85 F), participants reported 345 ± 170 (56-920) g/day vegetables increasing to 498 ± 180 (146-930) g/day at 3 months and remaining stable at 475 ± 169(170-1053) g/day by 12 months (p = 0.001). At baseline, 32 of 34 different vegetable categories were reported, mainly tomato (69.9 g/day) and, potato (58.2 g/day). After 3 months (n = 109), seven vegetables remained in the top 10 reported (contributing 72%). Tomato remained top ranked to 12 months. Conclusion: Following advice to consume more vegetables, consumption increased above the Australian Dietary recommendation of ~375 g/day. Tomatoes remained a mainstay regardless of the time of year, but choices changed with time. Frozen vegetables may be a feasible option. Disciplines Medicine and Health Sciences Publication Details O'Shea, J., Tapsell, L., Thorne, R. & Probst, Y. (2019). Translating advice to eat more vegetables into practice: observations from a 12-month weight loss trial.European Journal of Clinical Nutrition, 73 801-804. This journal article is available at Research Online: https://ro.uow.edu.au/ihmri/1275 1  Translating advice to eat more vegetables into practice: Observations from a 12 month weight 1 loss trial 2  3 Running title: Translating vegetable advice into practice 4  5  6 Jane O’Shea1 7 1School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, NSW 8 Australia  9  10 Linda Tapsell1,2 11 1School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, NSW 12 Australia  13 2Illawarra Health and Medical Research Institute, Wollongong NSW 14  15 Rebecca Thorne1 16 1School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, NSW 17 Australia  18  19 Yasmine Probst1, 2* 20 1School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, NSW 21 Australia  22 2Illawarra Health and Medical Research Institute, Wollongong NSW 23  24 * Corresponding author: yasmine@uow.edu.au 25  26 2  ABSTRACT 27 Objectives: This study aimed to identify the main vegetable sources of overweight participants 28 during a 12-month randomised controlled trial for weight loss.  29 Methods: Secondary analysis using data from diet history interviews to determine changes to daily 30 vegetable intake amounts and types throughout the trial at 0, 3 and 12mo. 31 Results: Pre-trial 77% participants consumed frozen vegetables. At baseline (n=113, 85 F) 32 participants reported 345±170(56-920)g/d vegetables increasing to 498±180(146-930)g/d at 3mo and 33 remaining stable at 475±169(170-1053)g/d by 12mo (p=0.001). At baseline 32 of 34 different 34 vegetable categories were reported, mainly tomato (69.9g/day), potato (58.2g/day). After 3mo 35 (n=109), seven vegetables remained in the top ten reported (contributing 72%). Tomato remained top 36 ranked to 12mo.  37 Conclusion: Following advice to consume more vegetables, consumption increased above the 38 Australian Dietary recommendation of ~375g/d. Tomatoes remained a mainstay regardless of the 39 time of year, but choices changed with time. Frozen vegetables may be a feasible option.  40 3  VEGETABLE INTAKES IN CLINICAL TRIALS 41 Advice for weight management suggests a wide variety of low-fat and nutrient-dense foods. Such 42 messages translate to increased vegetable intakes with a positive association for weight change with 43 higher fibre vegetable types.(1, 2)  Despite dietary guidelines there is a perceived difficulty to increase 44 the amount eaten.(3) The aim of this study was to describe the pattern of vegetable consumption of 45 participants in a weight loss trial.  46 A secondary observational analysis of a 12 month parallel, randomised controlled trial testing the 47 effects of a higher vegetable consumption on weight loss was undertaken.(4) The trial was approved 48 by the University of Wollongong Human Research Ethics Committee and registered with ANZCTR 49 [#1260000784011]. Participants provided written informed consent.  50 Baseline participants included n=113 healthy, overweight adults from the Illawarra region, NSW, 51 Australia (Supplementary material). Participants were screened for vegetable consumption type 52 (fresh, dried, canned or frozen). Those not eating vegetables or extreme vegetarians were excluded.  53 This secondary analysis focussed on vegetable intakes only. Both arms were given structured advice 54 indicating intervention serving sizes double that of the control arm. Vegetable categories remained 55 the same and advice encouraged increased variety based on vegetable colour. Total kilojoule intake 56 was restricted to 80% of estimated energy requirements modelled for comparable macronutrient 57 intakes in both arms. Dietary intake was assessed using a diet history interview following a validated 58 proforma at baseline 3, 6, 9 and 12 months. Dietary data was analysed using Foodworks (v6.0.2562, 59 Xyris Pty Ltd, QLD, Australia) software using the AUSNUT 2007(5) food composition database. 60 Mixed meals were considered by individual ingredients. Vegetable data was extracted and separated 61 into 34 botanically and conceptually similar categories. Statistical analyses used SPSS (v19.0.0, IBM 62 Corporation, USA). Screening questionnaire responses were collated and total and categorical 63 vegetable intakes determined and rank ordered by category and timing. Serves equated to 0.5C 64 4  cooked vegetables. Analyses for vegetable type and variety employed a general linear model 65 RMANOVA for parametric data with α=0.05. 66 The cohort was predominantly female (75.22%) and middle aged (M:49.57±9.13, F:48.73±9.53 y) 67 and overweight (M:30.6±2.8, F:29.8±2.7kg/m2). The majority were Australian-born (75.22%), 68 employed (85.84%) with tertiary qualifications (60.18%).  69 Pre intervention all participants ate at least two vegetable types with one participant not eating fresh 70 vegetables. There was a significant increase in total vegetables consumed between baseline 71 (345±170(56-920)g/d) and three months (498±180(146-930)g/d) continuing to 12 months, 72 (475±169(170-1053)g/d) (p=0.001) mirrored in energy contributions from vegetables (p=0.000) 73 (Figure 1). At baseline the total number of vegetable categories was 32. Median categories increased 74 between baseline (12, 5-19 categories) and each time point thereafter (p=0.004) (Table 1). Despite 75 only 62 (54%) participants reporting legume intakes pre intervention, legumes at three months 76 increased to 77 (70%) and to 39.55±51.77g per participant (p< 0.001) sustained to 12months.  77 The top 30% (10 of 34) of vegetables eaten (Table 1) contributed 70 to 78% of the total weight of all 78 vegetables. The least eaten categories included broad beans, fennel, artichoke, parsnip, turnip/swede. 79 Vegetables which increased in popularity as the seasonal temperatures decreased (three to six 80 months), included mixed vegetables and pumpkin (p<0.001). Legume consumption increased from 81 baseline, ranked #11 moving to #5 at 12months (p<0.001, Table 1).   82 As tomatoes and potatoes were increasingly popular, further analyses were conducted. Many forms 83 of tomatoes were used, including canned, dried, paste, puree, soups and salsa, with 72-88% fresh 84 tomatoes. Tomato intakes were greater at three and 12months compared to baseline (p=0.004 and 85 0.002, respectively), declining during the cooler months  (p=0.00), and increasing again at nine 86 months (p=0.047) as seasonal temperatures increased. Potatoes were baked, boiled, mashed, fried, 87 battered or as potato salad. There was a decrease in intake of potatoes (p=0.04) particularly ‘fried’ 88 potatoes (p=0.009) over 12months. 89 5   90 DISCUSSION 91 With targeted dietary counselling, nearly 80% of the cohort increased and maintained their 92 consumption for 12months. Intakes at baseline may relate to knowledge of recommendations to eat 93 more vegetables. A high number of tertiary qualified, employed females may also contribute to the 94 high reported intakes as employment and education are barriers to consumption. It may be argued 95 that participants were highly motivated (77.5% retention rate) sustained by repeated counselling  and 96 positive feedback encouraging the sustained increase in vegetables. Conversely, high levels may be 97 indicative of social desirability bias due to the interview administered dietary assessment used as 98 well as characteristics associated with misreporting (overweight females).(6)                                                                                                                             99 Approximately 75% of reported vegetables represented only ~30% of vegetable categories 100 suggesting a reluctance to expand vegetable choices. Variety offers synergistic effects and does not 101 increase energy as choice is independent of increased total energy of a meal.(7) Confidence to cook 102 may also have implications for choice also influenced by family members.   103 Vegetable popularity fluctuated though energy contributions were consistent after the intervention 104 advice. Although in Australia, a wide variety of fresh vegetables are available year round, seasonality 105 should be paralleled. The least popular vegetables (parsnip, turnip or swede) were less available 106 during summer months and it is suggested that the year round popularity of tomatoes and potatoes 107 could be explained by the versatility of these vegetables.  108 Tomatoes are culturally eaten as a vegetable, available in many varieties and used in dishes across 109 different cuisines. Similarly, in America, tomatoes are the non-starchy vegetable consumed in the 110 highest quantity.(8) Decreased in potato consumption was seen though boiled potatoes did not decline 111 likely due to the intervention advice related to a positive relationship between weight gain and fried, 112 boiled, baked or mashed potato consumption. An inverse association is seen for increased vegetable 113 consumption.(9)                                                                                                                              114 6  Limitations to this analysis include the convenience clinical cohort sample, but the context enabled 115 observations as a result of advice promoting vegetables. Collapsing vegetables into categories and 116 limitations to food composition data required alternate choices as growing conditions would impact 117 the nutrient data overall.(10) The mixed vegetable category included unknown mix combinations and 118 weight may skew results for lighter vegetables contributing to lower rankings. 119 Despite already high reported consumption, participants increased and maintained vegetable 120 intakes for one year though even for a motivated, educated cohort, expanding the variety of 121 vegetables was difficult. While variety expanded lower intakes of the less popular vegetables 122 continued. Repeated exposure with novel ways to introduce vegetables, may increase variety of 123 less popular vegetables eaten in households.  124  125 ACKNOWLEDGEMENTS 126 The authors would like to thank the participants of the HEAL trial. The trial was funded by 127 Horticulture Australia Limited using the vegetable levy and matched funding from the Australian 128 Government.  129  130 CONFLICT OF INTEREST 131 The authors declare no conflict of interest.  132 7  REFERENCES 133 1. Bertoia ML, Mukamal KJ, Cahill LE, Hou T, Ludwig DS, Mozaffarian D, et al. Changes in 134 Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for 135 Up to 24 Years: Analysis from Three Prospective Cohort Studies. PLoS Med. 2015;12(9):e1001878. 136 2. Raynor HA, Jeffery RW, Tate DF, Wing RR. Relationship between changes in food group 137 variety, dietary intake, and weight during obesity treatment. Int J Obes Relat Metab Disord. 138 2004;28(6):813-20. 139 3. Ciliska D, Miles E, O’brien MA, Turl C, Hale Tomasik H, Donovan U, et al. Effectiveness of 140 Community-Based Interventions to Increase Fruit and Vegetable Consumption. Journal of Nutrition 141 Education. 2000;32(6):341-52. 142 4. Tapsell LC, Batterham MJ, Thorne RL, O'Shea JE, Grafenauer SJ, Probst YC. Weight loss 143 effects from vegetable intake: a 12-month randomised controlled trial. Eur J Clin Nutr. 2014 144 03/26/online;68:778. 145 5. AUSNUT 2007 [database on the Internet]2007 [cited 31/08/10]. Available from: 146 http://www.foodstandards.gov.au/consumerinformation/ausnut2007/. 147 6. Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002 148 Jan 19;359(9302):248-52. 149 7. Bucher T, van der Horst K, Siegrist M. Improvement of meal composition by vegetable 150 variety. Public Health Nutrition. 2011;14(8):1357-63. 151 8. Burton-Freeman B, Reimers K. Tomato consumption and health: Emerging benefits. 152 American Journal of Lifestyle Medicine. 2010. 153 9. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in Diet and Lifestyle and 154 Long-Term Weight Gain in Women and Men. New England Journal of Medicine. 155 2011;364(25):2392-404. 156 8  10. Probst YC, Cunningham J. An overview of the influential developments and stakeholders 157 within the food composition program of Australia. Trends in Food Science & Technology. 2015 158 2015/04/01/;42(2):173-82. 159   160 9  Figure legends 161  162 Figure 1: Total energy contribution from vegetable consumption (g) (mean ±SD) between t= 0 and 163 t=12 months (n=113) 164 1  Table 1: Vegetables by weight, number of serves and category consumed per participant per day including top ranked vegetables by weight  Baseline n=113 3 months  n=109 6 months n=97 9 months  n=89 12 months  n=92 Season Spring- Summer Summer- Autumn Autumn- Winter Winter- Spring Spring- Summer Total,a g 345±170 498±180* 466±176 462±188 475±169 > 5 serves, % 33.6 72.4 69.0 66.2 71.7 > 4 serves, % 54.8 85.3 81.4 82.0 85.9 > 3 serves, % 69.9 97.2 96.9 91.0 93.4 No. categoriesb 12 (5-19) 14 (6-20) 15 (7-20) 14 (8-23) 14 (7-23) Tomato 1 1 1 1 1 Potato 2 4 4 3 3 Cucumber 3 3 10 7 4 Carrot 4 2 3 2 2 Broccoli 5 8 7 6 6 Lettuce 6 9 15 10 7 Leafy green/cabbage 7 10 9 8 10 Onion/leek 8   11 9 Capsicum 9 7 8 9 8 Avocado 10     Legume 11 6 5 5 5 Mixed veg 12 5 2 4  Sweet potato 13 12 14 12 11 Pumpkin 14 13 6 14 15 Peas 15     a mean±SD, b median, IQR, *p<0.05 RMANOVA, one serve = 0.5C cooked vegetable.  

Translating advice to eat more vegetables into practice: observations from a 12-month weight loss trial

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Translating advice to eat more vegetables into practice: observations from a 12-month weight loss trial

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