Impact of food system interventions to increase fruit and vegetable intake among urban adults in Nigeria and Vietnam

Abstract

Fruit and vegetable consumption is below the WHO recommendations, globally, in Southeast Asia, and in West Africa. Affordability, accessibility, and acceptability are the main drivers of consumption. Nutrition-sensitive food system interventions that address these drivers may be effective in increasing fruit and vegetable consumption. This study evaluates the effect of an integrated nutrition-sensitive program that aimed to increase fruit and vegetable consumption in low-income urban adults in Hanoi, Vietnam (n = 582), and Ibadan, Nigeria (n = 626), through the simultaneous implementation of three interventions at the market and consumer levels. Fruit and vegetable intake data were collected after eight months of exposure to the program with repeated quantitative 24-hour recalls and exposure effect was estimated with inverse probability weighting with regression adjustment, adjusting for potential confounders. The impact size on total fruits and vegetables (144 g/d, 95%CI 93, 196), fruits (137 g/d, 95%CI 93, 183) and vegetables (6 g/d, 95%CI -12, 24) showed that intake was higher in the exposed Nigerian population than the control group. In Vietnam, intakes of fruits and vegetables in the exposed group did not statistically differ from the control group when controlling for differences between groups with propensity scores. Participants exposed to all three interventions reported slightly higher intakes compared to those who were exposed to fewer interventions, but these differences were not statistically significant. Integrated approaches of nutrition-sensitive food system interventions need to be implemented to increase fruit and vegetable consumption. Co-creation of interventions provides the possibility to address the different drivers and barriers of healthy diets specific of the context.