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Protocol - Fruits and Vegetables Intake

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Description

These questions from the Five-Factor Screener may be useful to assess an individual’s approximate intake of several foods. These particular questions address fruit and vegetable intake. No portion-size questions are asked. This screener does not attempt to assess total diet.

Specific Instructions

None

Availability

Available

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Protocol

These questions are about the different kinds of foods you ate or drank during the PAST MONTH, that is, the past 30 days. When answering, please include meals and snacks eaten at home, at work or school, in restaurants, and anyplace else. *Read text if the respondent needs further clarification about the information requested.

1. During the past month, how often did you drink 100% FRUIT JUICE, such as orange, mango, apple, and grape juices? Do NOT count fruit drinks. *Read if necessary: INCLUDE only 100% pure juices. Do NOT include fruit drinks with added sugar, like Kool-Aid®, Hi-C®, lemonade, cranberry cocktail, Gatorade®, Tampico®, and Sunny Delight®.

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

2. During the past month . . . How often did you eat FRUIT? COUNT fresh, frozen, or canned fruit. Do NOT count juices. *Read if necessary: Include fruits such as apples, bananas, applesauce, melon, berries, fruit salad, mangos, papayas, oranges, and grapes.

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

3. During the past month, how often did you eat a green leafy or lettuce SALAD, with or without other vegetables? *Read if necessary: INCLUDE spinach salads

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

4. During the past month . . . How often did you eat FRENCH FRIES, home fries, or hash brown potatoes?

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

5. During the past month . . . How often did you eat other WHITE POTATOES? COUNT baked potatoes, boiled potatoes, mashed potatoes and potato salad. *Read if necessary: Do NOT include yams or sweet potatoes. INCLUDE red-skinned and Yukon Gold potatoes.

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

6. During the past month . . . How often did you eat COOKED DRIED BEANS, such as refried beans, baked beans, bean soup, and pork and beans? Do NOT include green beans.

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

7. During the past month . . . Not counting what you just told me about (lettuce salads, white potatoes, cooked dried beans), and not counting rice, how often did you eat OTHER VEGETABLES? *Read if necessary: Examples of other vegetables include tomatoes, string beans, carrots, corn, sweet potatoes, cabbage, bean sprouts, collard greens, and broccoli.

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

8. During the past month . . . How often did you have TOMATO SAUCES such as spaghetti sauce or pizza with tomato sauce?

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

9. During the past month . . . How often did you have SALSA?

00 [ ] Never

01 [ ] 1-3 times last month

02 [ ] 1-2 times per week

03 [ ] 3-4 times per week

04 [ ] 5-6 times per week

05 [ ] 1 time per day

06 [ ] 2 times per day

07 [ ] 3 times per day

08 [ ] 4 times per day

09 [ ] 5 or more times per day

97 [ ] Refused

99 [ ] Don’t know

Scoring Procedures

For fruits and vegetables, a Pyramid serving was defined by the U.S. Department of Agriculture (USDA) in the 1992 Dietary Guidelines Food Guide Pyramid as:

Vegetables: 1 cup raw leafy, 1/2 cup of other vegetables, or 3/4 cup vegetable juice; and

Fruits: 1 whole fruit, 1/2 cup of cut-up fruit, or 3/4 cup fruit juice.

More recently, the 2005 Dietary Guidelines measure fruits and vegetables in cup equivalents. Scoring using both metrics is provided.

The following procedures are used to convert an individual’s responses to an estimate of that individual’s daily intake of servings of fruits and vegetables.

1. The frequency reported categorically on the questionnaire is converted to the number of times consumed per day, as shown in Table 1. In general, the midpoint of the frequency range was used.

Table 1. Conversion of Frequency Response to Times per Day

Frequency Response

Times per Day

Never

0

1-3 times per month

0.067

1-2 times per week

0.214

3-4 times per week

0.5

5-6 times per week

0.786

1 time per day

1

2 times per day

2

3 times per day

3

4 times per day

4

5 or more times per day

5

2. The age- and gender-specific portion sizes (see Table 2a and 2b) for each food are multiplied by the frequency calculated in Step 1.

Table 2a. Median Portion Size (Pk) in Pyramid Servings* per Mention by Gender and Age for Fruits and Vegetables

Food Group

Age Group

18-27

28-37

38-47

48-57

58-67

68-77

78-99

Men

100% fruit juice (P1)

2.000000

1.667500

1.335000

1.335000

1.334000

1.001000

1.001000

Fruit (P2)

1.301000

1.301000

1.229571

1.227333

1.168000

1.168000

1.052333

Salad (P3)

0.545000

0.708000

0.754500

0.750000

0.833500

0.750000

0.822500

Fried potatoes (P4)

2.000000

2.000000

1.773000

1.710000

1.400000

1.250000

1.250000

Other potatoes (P5)

2.000000

2.000000

1.999000

1.999000

1.914000

1.544000

1.508000

Dried beans (P6)

1.374000

1.047000

1.065000

1.227000

1.000000

1.000000

1.114000

Other Vegetables (P7)

0.750000

0.906000

0.974500

1.000000

1.000000

0.880000

0.833333

Tomato sauce (P8)

0.500000

0.541000

0.541000

0.812000

0.541000

0.541000

0.541000

Salsa (P9)

0.533000

0.533000

0.421500

0.386500

0.137000

0.266000

0.266000

Women

100% fruit juice (P1)

1.500500

1.334000

1.334000

1.251250

1.019500

1.000500

1.000500

Fruit (P2)

1.168000

1.168000

1.168000

1.168000

1.150500

1.083833

1.000000

Salad (P3)

0.613500

0.572500

0.833333

1.000000

0.795500

0.625000

0.750000

Fried potatoes (P4)

1.481000

1.365500

1.272000

1.400000

1.000000

1.026000

1.000000

Other white potatoes (P5)

1.544000

1.544000

1.528000

1.544000

1.499000

1.516000

1.272000

Dried beans (P6)

0.964000

0.684000

0.800000

0.687000

0.822000

0.807000

1.000000

Other Vegetables (P7)

0.702200

0.779333

0.792500

0.788500

0.774000

0.833000

0.856750

Tomato sauce (P8)

0.541000

0.541000

0.273000

0.541000

0.500000

0.500000

0.500000

Salsa (P9)

0.274000

0.266000

0.322500

0.238250

0.266000

0.137000

0.137000

Table 2b. Median Portion Size (Pk) in Cup Servings** per Mention by Gender and Age for Fruits and Vegetables

Food Group

Age Group

18-27

28-37

38-47

48-57

58-67

68-77

78-99

Men

100% fruit juice (P1)

1.499160

1.250580

1.000980

1.000980

1.000176

0.750735

0.750735

Fruit (P2)

0.999580

0.933450

0.867300

0.867300

0.867300

0.774916

0.657060

Salad (P3)

0.272700

0.353970

0.377235

0.374963

0.416640

0.375000

0.411323

Fried potatoes (P4)

0.721125

0.727700

0.641000

0.641000

0.548055

0.480750

0.499980

Other potatoes (P5)

1.000400

1.140030

0.999600

0.999600

0.999490

0.833175

0.754400

Dried beans (P6)

0.717550

0.551540

0.566720

0.612360

0.500250

0.502285

0.575360

Other Vegetables (P7)

0.387675

0.473920

0.499840

0.500240

0.499905

0.460585

0.416899

Tomato sauce (P8)

0.249900

0.271250

0.271250

0.406875

0.271250

0.271250

0.271250

Salsa (P9)

0.266430

0.266430

0.210897

0.195683

0.068480

0.133236

0.133236

Women

100% fruit juice (P1)

1.124370

1.000960

1.000176

0.938130

0.764776

0.750728

0.750434

Fruit (P2)

0.749235

0.867300

0.844838

0.789970

0.742350

0.712640

0.620475

Salad (P3)

0.306788

0.286335

0.416625

0.499950

0.397688

0.312469

0.374963

Fried potatoes (P4)

0.509595

0.455110

0.448700

0.448700

0.394856

0.444260

0.444260

Other white potatoes (P5)

0.782020

0.876945

0.771260

0.771260

0.749700

0.771260

0.644235

Dried beans (P6)

0.492150

0.341550

0.430530

0.345763

0.430685

0.430530

0.500400

Other Vegetables (P7)

0.364468

0.395882

0.404303

0.408330

0.416913

0.436560

0.452214

Tomato sauce (P8)

0.271250

0.271250

0.136710

0.271250

0.249900

0.249900

0.249900

Salsa (P9)

0.136960

0.133236

0.163080

0.119187

0.133236

0.068480

0.068480

3. For Pyramid servings of fruits and vegetables, including and excluding French fries, for each gender, the estimated regression coefficients are listed in Table 3a.

Table 3a. Estimated Regression Coefficients for Sum of Foods Predicting Servings of Total Fruits and Vegetables and Fruits and Vegetables Excluding French Fries, by Gender

Parameter

Men

Women

Summary Variable with French fries

Intercept (b0)

0.704319

0.658819

b1

0.835532

0.796243

Summary Variable excluding French fries

Intercept (b0)

0.729653

0.639540

b1

0.822694

0.804796

For cups of fruits and vegetables (2005 MyPyramid definition), including and excluding French fries, for each gender, the estimated regression coefficients are listed in Table 3b.

Table 3b. Estimated Regression Coefficients for Sum of Foods Predicting Cups of Total Fruits and Vegetables and Fruits and Vegetables Excluding French Fries, by Gender

Parameter

Men

Women

Summary Variable with French fries

Intercept (b0)

0.529258

0.502480

b1

0.839721

0.792683

Summary Variable excluding French fries

Intercept (b0)

0.559458

0.495205

b1

0.819797

0.794978

For both metrics, these regression coefficients are applied according to the following equation:

E (Fruits and Veg1/2) = b0 + b1 (NFG1P1 + NFG2P2 + ... + NFG9P9)1/2

For men: Cube root of daily cup equivalents of fruits and vegetables = 0.529258 + 0.839721 (cube root of (Daily Frequency * Gender/Age Specific Portion Size per Mention for 100% fruit juice + Daily Frequency * Gender/Age Specific Portion Size per Mention for Fruit + ... + Daily Frequency * Gender/Age Specific Portion Size per Mention for salsa))

For women: Cube root of daily cup equivalents of fruits and vegetables = 0.502480 + 0.792683 (cube root of (Daily Frequency * Gender/Age Specific Portion Size per Mention for 100% fruit juice + Daily Frequency * Gender/Age Specific Portion Size per Mention for Fruit + ... + Daily Frequency * Gender/Age Specific Portion Size per Mention for salsa))

*Using 1992 Food Guide Pyramid definitions of servings.

**Using 2005 MyPyramid definitions of cups of fruits and vegetables.

Kool-Aid® is a registered trademark of Kraft Foods Inc.; Hi-C® is a registered trademark of The Coca-Cola Company; Gatorade® is a registered trademark of PepsiCo Inc.; Tampico® is a registered trademark of Tampico Beverages, Inc.; and Sunny Delight® is a registered trademark of Sunny Delight Beverages Co.

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided. There are multiple modes to administer this question (e.g., paper-and-pencil and computer-assisted interviews).

Equipment Needs

While the source instrument was developed to be administered by computer, the PhenX Working Group acknowledges these questions can be administered in a non-computerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Lifestage

Adult, Senior

Participants

Ages 18 years and older

Selection Rationale

Vetted against several other fruit and vegetable questionnaires, these questions from the National Cancer Institute (NCI) Five-Factor Screener were selected because they are low burden and have been validated against the 24-hour dietary recall.

Language

Chinese, English, Spanish

Standards
StandardNameIDSource
Logical Observation Identifiers Names and Codes (LOINC) PhenX - fruits and veg protocol 62284-5 LOINC
caDSR Form PhenX PX050701 - Fruits And Vegetables Intake 5850344 caDSR Form
Derived Variables

None

Process and Review

The Expert Review Panel #1 reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.

Guidance from the ERP includes:

• No significant changes to measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive (link)

Protocol Name from Source

National Health Interview Survey (NHIS) Diet and Nutrition Questionnaire, 2005

Source

Centers for Disease Control and Prevention, National Center for Health Statistics. (2005). National Health Interview Survey (NHIS): Diet and nutrition questionnaire. Questions NAC.040_00.00 (question 1), NAC.070_00.00 (question 2), NAC.090_00.00 (question 3), NAC.100_00.00 (question 4), NAC.110_00.00 (question 5), NAC.120_00.00 (question 6), NAC.130_00.00 (question 7), NAC.131_00.00 (question 8), and NAC.132_00.00 (question 9).

National Cancer Institute. (2005). Five-factor screener: National Health Interview Survey (NHIS) diet and nutrition. NAC.010-NAC.138.

General References

Five-Factor Screener: Validation Results

Protocol ID

50701

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX050701_Bean_Frequency
PX050701060000 During the past month... How often did you more
eat COOKED DRIED BEANS, such as refried beans, baked beans, bean soup, and pork and beans? Do NOT include green beans. show less
N/A
PX050701_French_Fries_Frequency
PX050701040000 During the past month... How often did you more
eat FRENCH FRIES, home fries, or hash brown potatoes? show less
N/A
PX050701_Fruit_Frequency
PX050701020000 During the past month... How often did you more
eat FRUIT? COUNT fresh, frozen, or canned fruit. Do NOT count juices. *Read if necessary: Include fruits such as apples, bananas, applesauce, melon, berries, fruit salad, mangos, papayas, oranges, and grapes show less
N/A
PX050701_Fruit_Juice_Frequency
PX050701010000 During the past month, how often did you more
drink 100% FRUIT JUICE, such as orange, mango, apple, and grape juices? Do NOT count fruit drinks. *Read if necessary: INCLUDE only 100% pure juices. Do NOT include fruit drinks with added sugar, like Kool-aid show less
N/A
PX050701_Other_Vegetable_Frequency
PX050701070000 During the past month... Not counting what more
you just told me about (lettuce salads, white potatoes, cooked dried beans), and not counting rice, how often did you eat OTHER VEGETABLES? *Read if necessary: Examples of other vegetables include tomatoes, show less
N/A
PX050701_Salad_Frequency
PX050701030000 During the past month, how often did you eat more
a green leafy or lettuce SALAD, with or without other vegetables? *Read if necessary: INCLUDE spinach salads show less
N/A
PX050701_Salsa_Frequency
PX050701090000 During the past month... How often did you more
have SALSA? show less
Variable Mapping
PX050701_Tomato_Sauce_Frequency
PX050701080000 During the past month... How often did you more
have TOMATO SAUCES such as spaghetti sauce or pizza with tomato sauce? show less
Variable Mapping
PX050701_White_Potato_Frequency
PX050701050000 During the past month... How often did you more
eat other WHITE POTATOES? COUNT baked potatoes, boiled potatoes, mashed potatoes and potato salad. *Read if necessary: Do NOT include yams or sweet potatoes. INCLUDE red-skinned and Yukon Gold potatoes show less
N/A
Nutrition and Dietary Supplements
Measure Name

Fruits and Vegetables Intake

Release Date

October 30, 2009

Definition

A measure to estimate an individual’s daily average intake of fruits and vegetables over the last 30 days as measured in cup equivalents.

Purpose

A diet rich in fruits and vegetables has been known to have many health benefits, including lower blood pressure; reduced risk of heart disease, stroke, and probably some cancers; lower risk of eye and digestive problems; and a blunting effect on blood sugar that can help keep appetite in check.

Keywords

Nutrition and Dietary Supplements, obesity, NHIS

Measure Protocols
Protocol ID Protocol Name
50701 Fruits and Vegetables Intake
Publications

Bruellman, R., et al. (2024) A twin-driven analysis on early aging biomarkers and associations with sitting-time and physical activity PLoS One. 2024 September; 19(9): e0308660. doi: 10.1371/journal.pone.0308660

Barbirou, M., et al. (2020) Western influenced lifestyle and Kv2.1 association as predicted biomarkers for Tunisian colorectal cancer. BMC Cancer. 2020 November; 20: Article Number: 1086. doi: 10.1186/s12885-020-07605-7

Sapkota, B. R., et al. (2016) Genome-wide association study of 25(OH) Vitamin D concentrations in Punjabi Sikhs: Results of the Asian Indian diabetic heart study. J Steroid Biochem Mol Biol. 2016 April; 158: 149-156. doi: 10.1016/j.jsbmb.2015.12.014

Hitz, M.M., Conway, P.G, Palcher, J.A., McCarty, C.A. (2014) Using PhenX toolkit measures and other tools to assess urban/rural differences in health behaviors: recruitment methods and outcomes. BMC Research Notes. 2014 November; 7(847). doi: 10.1186/1756-0500-7-847