Thursday, July 17, 2014

Guest Post: Newsflash! Fruits are NOT Vegetables.

Today's guest post comes from our office's own RD Rob Lazzinnaro and why he thinks it important to differentiate between fruit and vegetable.
The title of this post may seem like an obvious observation, yet a surprisingly important one. I’m not talking plant taxonomy, no, I want to explain why fruits and vegetables are essential to differentiate nutritionally.

How many times have we heard the saying “eat your fruits and vegetables!” They have become synonymous with one another, and often translated to mean they are one and the same. The idea is so entrenched that fruits, like vegetables, should be eaten in abundance that it is a common recommendation like “half your plate campaign” and Weight Watchers new fruit doesn't count (zero points) system. It started with Canada's Food Guide (CFG), and to be fair most every government food guide. Fruits and vegetable recommendations are provided as a single categorical entity without any serious distinction between the two.

It needs to stop, and here's why - most food guides recommend a minimum number of servings for the category of fruits and vegetables. CFG recommends 8-10 Fruits and veg for a male 19-50. They do not specify how to get this minimum recommendation in on the basic form, and on their detailed instructions simply recommend a minimum of one dark green vegetable every day.
Here are two scenarios:

Scenario 1
I eat 1 cup of cooked greens, 2 apples, 2 oranges, 1 banana, 1 pear.
= 8 servings of fruits and veg.
= ~700 calories (Potentially an underestimation considering I used large fruit while many of the Frankenfruit found in today's supermarkets actually way in far larger than large).

Scenario 2
I eat 1.5 cups of cooked greens, 2 cups of bell peppers, half a cup of carrots
= 8 servings of Fruits & veg
= ~100 Calories.

That is a potential difference of ~600 calories between two examples that would both allow me to meet the CFG recommendations. You might ask who in the heck is scarfing down all that fruit, and you might be correct in thinking not many are, however, it's easy to substitute four of those servings with two cups of say apple and/or orange juice (as many do) leaving a person thinking they were making healthful choices. Most Canadians do not follow food guides, but many have had its recommendations established in their thinking in some shape or form from institutions that use it as a guiding principle - primary/elementary/high school, hospitals, day care, etc.

Fruit or whole fruit anyway is certainly not “bad” or the crux of any major nutritional issue, but using it interchangeably with vegetables is nutritionally misleading and a serious error. An error that has been manipulated by advertisers for years; how?: 1. Fruit is much more palatable than vegetables 2. It comes with high recommendations by health professionals. Virtual gold for marketers! Gather round and get your 5-10 fruit or vegetable servings easily from “healthy” fruit muffins, juice, fruit gummies, fruit leather, fruit filling, fruit ice cream, fruit bars, dried sweetened fruit, fruit filled granola bars; hooray!

Here’s to an abundance of vegetables.

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  1. Could you comment on children and vegetables. I do not subscribe to the idea that kids naturally hate them and find it silly to hide them in high sugar or fat sauce in an attempt to sneak them in. I do find it impossible for them to eat even five+ 1/2 cup serving per day due to volume. What I have read online gives a child's serving after age 4(my youngest is nearly 7 and very small for her age). is the same as an adult. How is it appropriate for someone 45 pounds and not even 4 feet tall to eat as much volume as an adult? If the child is served 1 ounce of meat(and 2-3 ounces per day seems low), say 1/2 cup of a starch(which is less than recommended) and 1.5 cups veggies, and drinks a glass of water, that is nearly a quart of food, which just isn't going to fit into a small child without tummy distress. Honestly, when I eat 7 servings I have trouble getting enough calories to maintain my weight and end up eating low carb which has its own issues. I get that this is about getting enough nutrients to meet government rda but isn't a more moderate amount of veggies and a good multivitamin is more doable solution?

    1. I would both present vegetables in their whole form and hide them in dishes. In terms of recommendations, try to have some vegetables at lunch, dinner and one snack; forget the multivitamin and the minimums.

  2. "You might ask who in the heck is scarfing down all that fruit..."
    'Cos if 8 portions of fruit & vegetables a day is good, 50 portions of fruit & vegetables a day must be even better! :-/

  3. I thought it would be interesting to add up the carb content of the 2 different scenarios. tallies it as follows:

    #1 provides 39g, with 14g of fibre for a net of 25g
    #2 provides 177g of carbohydrate. After 37g of fibre, the net is 140g

    That's a massive sugar difference! A dietician I was talking with recently suggested we change the terminology to "vegetables and fruits", which I think is a great start.

  4. The message that I got from this article is that the main difference between fruits and vegetables is that fruit is much higher in calories. Does this mean that if calorie intake is not a concern, then by all means, eat as much fruit as you want? It seems like that is not the case you were trying to make, but I can't see any other points that you make.

    This is a topic that I consider frequently, as I have a 5 year old and 7 year old that would happily eat their weight in fruit on a daily basis. They eat zero processed food, and get a good portion of vegetables most days, but since they have very little access to added sugar, and we live in California, land of abundant and delicious year round local fruit, they eat A LOT of fruit.

    "Fruit ... is certainly not “bad”... but using it interchangeably with vegetables is nutritionally misleading and a serious error" - is the only thing nutritionally misleading about it that there is a big calorie difference? I wish you would better explain the "nutritionally misleading" issue.

    1. I agree with you. Furthermore, even though fruits maybe relatively high calorie compared to broccoli, they're not high calorie compared to most foods that are associated with obesity. I seriously doubt that our obesity epidemic is being worsened by people eating too many whole fruits. Most people who are obese are eating too much processed food. They would probably greatly benefit from eating more fruit per day.

    2. Well yes, BUT someone with Type 2 diabetes or even borderline diabetes (as most obese patients are) would be safer and healthier working within the parameters of scenario 2.

  5. Again it's a problem with oversimplification. Information gets lost in the process. Calories are part of it, but so are the types of nutrients. When it comes to delivering a "simple" message regarding fruits and vegetables, the best I've heard so far is to "eat a range of colors" of them.

  6. Agreed about oversimplification.
    Keeping calories constant won't lead to weight loss as noted in this abstract.

    Am J Clin Nutr. 2012 Jan;95(1):184-93. doi: 10.3945/ajcn.111.019968. Epub 2011 Dec 14.
    Fruit and vegetable consumption and prospective weight change in participants of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity study.

    Fruit and vegetable consumption might prevent weight gain through their low energy density and high dietary fiber content.

    We assessed the association between the baseline consumption of fruit and vegetables and weight change in participants from 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition study.

    Diet was assessed at baseline in 373,803 participants by using country-specific validated questionnaires. Weight was measured at baseline and self-reported at follow-up in most centers. Associations between baseline fruit and vegetable intakes (per 100 g/d) and weight change (g/y) after a mean follow-up of 5 y were assessed by using linear mixed-models, with age, sex, total energy intake, and other potential confounders controlled for.

    After exclusion of subjects with chronic diseases at baseline and subjects who were likely to misreport energy intakes, baseline fruit and vegetable intakes were not associated with weight change overall. However, baseline fruit and vegetable intakes were inversely associated with weight change in men and women who quit smoking during follow-up. We observed weak positive associations between vegetable intake and weight change in women who were overweight, were former smokers, or had high prudent dietary pattern scores and weak inverse associations between fruit intake and weight change in women who were >50 y of age, were of normal weight, were never smokers, or had low prudent dietary pattern scores.

    In this large study, higher baseline fruit and vegetable intakes, while maintaining total energy intakes constant, did not substantially influence midterm weight change overall but could help to reduce risk of weight gain in persons who stop smoking. The interactions observed in women deserve additional attention.

  7. Another meta-analysis article that doesn't show weight loss with increased V&F consumption - in general.

    Am J Clin Nutr. 2014 Jun 25;100(2):567-576. [Epub ahead of print]
    Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis.

    A common dietary recommendation for weight loss, especially in lay public outlets, is to eat more fruit and vegetables (F/Vs). Without a compensatory reduction in total energy intake, significant weight loss would be unlikely.OBJECTIVE: We aimed to synthesize the best available evidence on the effectiveness of the general recommendation to eat more F/Vs for weight loss or the prevention of weight gain.

    DESIGN: We searched multiple databases for human randomized controlled trials that evaluated the effect of increased F/V intake on body weight. Inclusion criteria were as follows: ≥15 subjects/ treatment arm, ≥8-wk intervention, a stated primary or secondary outcome of body weight, the stated goal of the intervention was weight or fat loss or the prevention of weight or fat gain, and food intake provided or prescribed was of a variety of F/Vs that remained minimally processed.

    RESULTS : Two studies met all criteria; 5 other studies met all criteria but one. The primary analysis indicated an effect size of weight change (outcome of interest) from baseline [standardized mean difference (SMD) for studies that met all criteria] of -0.16 (95% CI: -0.78, 0.46) (P = 0.60). The SMD for 7 studies that met all or most criteria was 0.04 (95% CI: -0.10, 0.17) (P = 0.62).

    Studies to date do not support the proposition that recommendations to increase F/V intake or the home delivery or provision of F/Vs will cause weight loss. On the basis of the current evidence, recommending increased F/V consumption to treat or prevent obesity without explicitly combining this approach with efforts to reduce intake of other energy sources is unwarranted. This systematic review and meta-analysis was registered at as CRD42013004688

  8. Last comment, but 2 abstracts below were also interesting.
    One article suggested fruit intake might be overall beneficial for body weight management, whereas the other abstract suggested that fruit intake might not associated with BMI, but lower fruit intake might be associated with lower skin folds number - although I'm not sure of the significance of that.

    The data is a little confusing, but overall many studies suggest increased intake of fruit isn't the obvious weight gainer that one would expect.
    Although, I suspect much of the issue comes down to total caloric intake and one can certainly game the system by overeating fruits to the point of (+) caloric intake leading to weight gain.

    Obes Rev. 2009 Nov;10(6):639-47. doi: 10.1111/j.1467-789X.2009.00582.x. Epub 2009 Apr 1.

    The potential association between fruit intake and body weight--a review.
    Alinia S1, Hels O, Tetens I.
    Author information

    Both national and international bodies recommend an increased intake of fruits and vegetables in order to decrease the risk of overweight and obesity. However, there is a rationale to investigate the separate role of fruits. The aim of this paper was to systematically review and analyse published human intervention, prospective observational and cross-sectional studies on fruit intake and body weight in adults. We identified three intervention, eight prospective observational and five cross-sectional studies that explored this relationship.

    Two of the intervention studies showed that fruit intake reduced body weight,
    five of the prospective observational studies showed that fruit consumption reduced the risk of developing overweight and obesity, and
    four of the cross-sectional studies found an inverse association between fruit intake and body weight.

    Important methodological differences and limitations in the studies make it difficult to compare results.

    However, the majority of the evidence points towards a possible inverse association between fruit intake and overweight.

    Future intervention and prospective observational studies examining the direct and independent role of fruit in body-weight management in free-living individuals are needed.

    Moreover, important determinants such as energy density, energy content, fruit and vegetable consumption, physical form of fruit and preparation methods need to be included in future studies.


  9. had to publish the 2nd abstract separately...

    Br J Nutr. 2007 Aug;98(2):431-8. Epub 2007 Apr 16.

    Tracking of fruit and vegetable consumption from adolescence into adulthood and its longitudinal association with overweight.

    Br J Nutr. 2007 Oct;98(4):871.

    The objective of the present study was to assess to what extent fruit and vegetable intakes track over a 24-year time period and to assess longitudinal associations between fruit and vegetable intakes and (change in) BMI and sum of skinfolds.

    Dietary intake and anthropometrics were repeatedly assessed for 168 men and women between the ages of 12 and 36 years.

    Linear general estimating equations analyses were applied
    (1) to estimate tracking coefficients,
    (2) to estimate predictability for meeting the national recommendation for fruit and vegetable intake and for being in the highest quartile for fruit and vegetable intake, and
    (3) to estimate the association between fruit and vegetable intake and BMI and sum of skinfolds.

    We found that tracking coefficients were 0.33 (P < 0.001) for fruit intake and 0.27 (P < 0.001) for vegetable intake.

    Mean fruit intake decreased over a 24-year period.

    For fruit intake, predictability was higher in men than in women (OR 6.02 (P < 0.001) and 2.33 (P = 0.001) for meeting the recommendation for men and women respectively).

    After adjustment, fruit intake was not associated with BMI,

    but being in the lowest quartile of fruit intake was significantly associated with a lower sum of skinfolds.

    Women in the lowest quartiles of vegetable intake had significantly higher BMI and sum of skinfolds and
    also greater positive changes in these parameters.

    In conclusion,
    tracking and predictability for fruit and vegetable intake appear to be low to moderate,
    which might indicate that fruit and vegetable promotion should be started at an early age and continued into adulthood.

    Despite the fact that we only observed beneficial weight-maintaining effects of vegetable intake in women,
    promoting vegetables is important for both sexes because of other positive properties of vegetables.

    No evidence was found for promoting fruit intake as a means of weight maintenance.