The 2020-2025 Dietary Guidelines for Americans* advise incorporating more fruits and vegetables into U.S. residents’ diets as part of healthy dietary patterns. Adults should consume 1.5-2 cup-equivalents of fruits and 2-3 cup-equivalents of vegetables daily.† A healthy diet supports healthy immune function (1) and helps to prevent obesity, type 2 diabetes, cardiovascular diseases, and some cancers (2); having some of these conditions can predispose persons to more severe illness and death from COVID-19 (3). CDC used the most recent 2019 Behavioral Risk Factor Surveillance system (BRFSS) data to estimate the percentage of states’ adult population who met intake recommendations overall and by sociodemographic characteristics for 49 states and the District of Columbia (DC). Overall, 12.3% of adults met fruit recommendations, ranging from 8.4% in West Virginia to 16.1% in Connecticut, and 10.0% met vegetable recommendations, ranging from 5.6% in Kentucky to 16.0% in Vermont. The prevalence of meeting fruit intake recommendations was highest among Hispanic adults (16.4%) and lowest among males (10.1%); meeting vegetable intake recommendations was highest among adults aged ≥51 years (12.5%) and lowest among those living below or close to the poverty level (income to poverty ratio [IPR] <1.25) (6.8%). Additional policies§ and programs that will increase access to fruits and vegetables in places where U.S. residents live, learn, work, and play, might increase consumption and improve health.
BRFSS is an annual, state-based, random-digit-dialed telephone survey of health-related behaviors representative of noninstitutionalized adults aged ≥18 years in the United States and participating territories.¶ Since 1989, BRFSS has collected information on respondents’ frequency of fruit and vegetable consumption. The current module assesses the number of times per day, week, or month a respondent consumed whole fruit, 100% fruit juice, salads, fried potatoes, other potatoes, and other vegetables during the past 30 days. In 2019, New Jersey data did not meet the minimum requirements for inclusion** and were excluded. Among 418,268 respondents to the current BRFSS, 8,458 residents of Guam and Puerto Rico were excluded, because the scoring algorithms were derived from the National Health and Nutrition Examination Survey (NHANES), which excludes territories, as were 59,589 respondents who did not answer one or more questions in the fruit and vegetable module, 1,347 with implausible reported values of fruit or vegetable intake (>16 times and >23 times per day, respectively), 54,306 who did not report income, and two who did not report race. The resulting analytic sample included 294,566 (70%) participants. Among states included in the analysis, the median state response rate was 49.4% and ranged from 37.3% to 73.1%.††
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Previously developed scoring algorithms were used to estimate the percentage of each state’s population who met fruit and vegetable intake recommendations. Development of the methodology (4) and application of the prediction algorithm have been previously reported.§§ Twenty-four-hour dietary recall data from 2013-2016 NHANES were used to fit age- and sex-specific logistic regression models that estimate probabilities of meeting recommendations as functions of reported daily frequency of consumption, race/ethnicity, and IPR, adjusting for day-to-day variation (4). Consistent with previous studies (4,5), analyses accounted for the complex survey design and nonresponse, and balanced repeated replication was used to calculate standard errors and 95% CIs with SAS (version 9.4; SAS Institute). T-tests were used to compare differences by sociodemographic groups with Stata (version 17.0; StataCorp). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶¶
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In 2019, the median frequency of reported fruit intake was once per day; this was consistent across all jurisdictions (Table 1). The median frequency of reported vegetable intake was 1.6 times per day, ranging from 1.5 times per day in Louisiana, Mississippi, Nevada, and New Mexico to 1.9 times per day in Maine and Vermont. Among all respondents, 12.3% of adults met fruit intake recommendations, ranging from 8.4% in West Virginia to 16.1% in Connecticut, and 10.0% met vegetable intake recommendations, ranging from 5.6% in Kentucky to 16.0% in Vermont.
Fruit intake (Table 2) and vegetable intake (Table 3) varied by sociodemographic characteristics. Overall, a higher proportion of women met both fruit and vegetable recommendations (14.5% and 12.4%, respectively) than did men (10.1% and 7.6%, respectively); a similar pattern was observed across most states. A significantly higher proportion of adults aged ≥51 years (12.5%) met vegetable recommendations compared with younger adults aged 18-30 years (7.1%) and 31-50 years (8.7%). This pattern was also observed in 37 states. A significantly higher proportion of Hispanic adults (16.4%) met fruit intake recommendations compared with those who were non-Hispanic White overall (11.1%); this pattern was observed in 14 states (Table 2). Overall, a significantly lower proportion of non-Hispanic Black adults (6.9%) met vegetable intake recommendations than did their non-Hispanic White counterparts (10.1%); however, this pattern was statistically significant in only three states (California, Massachusetts, and Nevada). Overall, a significantly higher proportion of adults living in households with the highest income category met vegetable intake recommendations (12.2%) than did adults living in middle income households (7.7%) and with the lowest income categories (6.8%); patterns were similar in most states.
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