Background The World Health Organisation recommends a daily intake of ≥400 g of fruit and vegetables (F&V) to reduce disease risk, publicised in the UK as the ‘5 A Day’ campaign since 2003. Low F&V intake in England is associated with deprivation and lower incomes. In November 2006, Healthy Start (HS) was introduced to provide vouchers to pregnant women and families with children under 4 y in receipt of qualifying benefits. Vouchers can be spent on milk (including infant formula) and plain fresh or frozen F&V. We sought to quantify the impact of the Healthy Start scheme on F&V intake.
Methods We used repeated cross-sectional data from the Health Survey for England, 2001–2014. Participants were classified into four groups: 1: HS eligible families, 2: households with qualifying children or pregnant women but without qualifying benefits, 3: households receiving qualifying benefits but without qualifying children or pregnant women, and 4: all others. Analysis was run separately for 38,058 children (5–15 y) and 62,874 adults (16–49 y). Outcome measures were daily mean portions F&V consumed, and proportions consuming 3+ portions per day. We compared the four groups in four time periods: 2001–2003 (pre 5 a day), 2004–2006 (pre HS), 2007–2009 (post HS) and 2010–2014; adjusting for potential confounders (age-group, sex, area deprivation, ethnicity, income and education) using multivariable regression. Interaction terms between time-periods and eligibility group were used to examine whether changes in group 1 outcomes were at a significantly different trajectory from those in the control groups.
Results Adults in group 2 had the highest mean F&V consumption, and group 3 the lowest. Children’s mean F&V consumption was similar in all 4 groups. Changes in mean F&V consumption did not vary with time-period in a significantly different way among group 1 participants compared to control groups for adults or children. Children’s mean daily F&V intake increased significantly between 2001–3 and 2004–6 (by 0.5 portions); followed by increases of 0.1 portions from 2004–6 to 2007–9, and 2007–09 to 2010–14. Adults’ mean daily F&V intake increased significantly between 2001–3 and 2004–6 (by 0.2 portions), but decreased by 0.2 portions by 2010–14.
Conclusion The change in F&V intake over time was not significantly different in HS eligible families compared to other groups. This may be explained by use of vouchers on other eligible products, low uptake, or other reasons. Further research is required to understand this. Increased F&V consumption from 2001–03 to 2004–06 may relate to the national 5 A Day campaign.
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