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Modifiable Risk Factors – Inadequate Vegetable and Fruit Consumption

Key findings

In 2017, more than three-quarters (78%) of Ontario adults reported eating less than 5 servings of vegetables or fruits per day. During this same time period, rates of inadequate consumption were significantly higher in men than women, lower-income households than higher income households and those with high-school or lower education compared with post-secondary graduates. The rates did not differ by residence (urban/rural) or immigration status.

Why is this important to Ontarians?

  • Modifiable risk factors are behaviours and exposures that can lower or raise a person’s risk of cancer and that can be changed. Eating at least 5 servings of vegetables (excluding potatoes) and fruit a day has been shown to be a good marker of overall diet quality.[1] A comprehensive World Cancer Research Fund/American Institute for Cancer Research review found that consumption of plant foods (like non-starchy vegetables and fruit), which contain fibre and other nutrients, can reduce the risk of certain cancers.[1] Evidence suggests that eating foods containing dietary fibre probably decreases the risk of colorectal cancer.
  • Reporting on risk factor prevalence in Ontario is important to effectively monitor trends over time, support the development of health promotion and disease prevention strategies, and evaluate outcomes of provincial interventions.

See Modifiable Risk Factors Methodology for technical information.

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Inadequate vegetable and fruit consumption (adults ages 18 and older): Respondents who reported eating vegetables (excluding potatoes) and fruit less than 5 times per day.

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Inadequate vegetable and fruit consumption (adults aged 25 and older): Respondents who reported eating vegetables (excluding potatoes) and fruit less than 5 times per day.
  3. Secondary graduate category includes those with some post-secondary education.
Data Table 1. Percentage of Ontario adults (ages 18 and older) consuming vegetables (excluding potatoes) or fruit less than 5 times a day, by sex, 2015 to 2017
  2015 Estimate (%) 2015 Lower 95% Confidence Interval (%) 2015 Upper 95% Confidence Interval (%) 2016 Estimate (%) 2016 Lower 95% Confidence Interval (%) 2016 Upper 95% Confidence Interval (%) 2017 Estimate (%) 2017 Lower 95% Confidence Interval (%) 2017 Upper 95% Confidence Interval (%)
Both sexes 75.3 74.0 76.7 77.7 76.6 78.9 78.1 77.0 79.2
Male 81.7 80.0 83.5 84.6 83.0 86.2 82.6 81.1 84.2
Female 69.2 67.3 71.2 71.4 69.8 73.1 73.9 72.2 75.6

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Inadequate vegetable and fruit consumption (adults ages 18 and older): Respondents who reported eating vegetables (excluding potatoes) and fruit less than 5 times per day.
Data Table 2. Percentage of Ontario adults (ages 25 and older) consuming vegetables (excluding potatoes) or fruit less than 5 times a day, by selected socio-demographic factors, 2015 to 2017 combined
  Inadequate vegetable and fruit consumption, Estimate (%) Inadequate vegetable and fruit consumption, Lower 95% Confidence Interval (%) Inadequate vegetable and fruit consumption, upper 95% confidence interval (%)
Residence - rural 77.7 76.1 79.3
Residence - urban 76.2 75.3 77.0
Household income quintile - Q1 (lowest) 81.6 80.0 83.3
Household income quintile - Q2 77.3 75.2 79.5
Household income quintile - Q3 74.8 73.0 76.7
Household income quintile - Q4 75.3 73.7 76.9
Household income quintile - Q5 (highest) 73.5 71.9 75.1
Education status - less than secondary 86.3 84.0 88.7
Education status - secondary graduate 80.6 79.1 82.1
Education status - Post-secondary graduate 74.0 73.0 75.0
Immigration status - <=10yrs in Canada 71.7 67.1 76.4
Immigration status - >10yrs in Canada 77.1 75.0 79.2
Immigration status - Canadian born 75.7 74.8 76.5

Report date: April 2019
Data source: Canadian Community Health Survey, 2015–2017 (Statistics Canada)
Prepared by: Cancer Care Ontario, Prevention and Cancer Control (Population Health and Prevention)
Notes:

  1. Estimates are adjusted to the age distribution of the 2011 Canadian population.
  2. Inadequate vegetable and fruit consumption (adults aged 25 and older): Respondents who reported eating vegetables (excluding potatoes) and fruit less than 5 times per day.
  3. Secondary graduate category includes those with some post-secondary education.
  4. Bolded estimates are significantly different from the rates in: urban areas for analyses by urban/rural residence; income quintile 5 (Q5) for analyses by income quintile; post-secondary graduate for analyses by education status; and Canadian born for analyses by immigration status.

Results

  • Between 2015 and 2017, the proportion of Ontario adults ages 18 and older who ate vegetables and fruit fewer than 5 times a day increased from 75.3% in 2015 to 78.1% in 2017. Men were significantly more likely to eat vegetables and fruit fewer than 5 times a day.
  • From 2015 to 2017, the rate of inadequate vegetable and fruit consumption in Ontario adults ages 25 and older were:
    • higher in the lowest income quintile (81.6% in Q1) than in the highest income quintile (73.5% in Q5)
    • higher among people with less than secondary and secondary education (86.3% and 80.6% respectively) than among post-secondary graduates (74.0%)
  • Rates did not differ significantly by residence (urban/rural) or immigration status.

     

Opportunities

  • This indicator needs improvement because the rates of inadequate vegetable and fruit consumption have been increasing and show differences by socio-demographic factors. Exposure to some risk factors is higher in particular social, economic or geographic populations. Populations facing health inequities experience higher incidence and mortality rates for certain cancers.
  • Improving food environments through economic and physical access to healthy food, and improving food skills education are key to increasing consumption of healthy foods including vegetables and fruits.
  • Cancer Care Ontario co-led the development of the Ontario Food and Nutrition Strategy, a plan for healthy food and food systems in Ontario using a coordinated cross-government and cross-sectoral approach to developing evidence-based food policy. Published in 2017, the strategy was developed by 26 organizations with roles in food systems and health. Although the strategy has not been endorsed by the provincial government, organizations are working to collectively advance the goals of the strategy.[2]
  • Evidence shows that healthy public policy and community-wide programs work better to reduce the prevalence of modifiable risk factors at a population-level than those that focus on changing individuals’ behaviours.
  • The Prevention System Quality Index is a series of reports that monitor population-level policies and programs that can reduce cancer risk factors and exposures in the Ontario population. The reports include evidence-based recommendations to strengthen cancer prevention in Ontario.[3]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective [Internet]. Continuous Update Project Expert Report 2018 [cited 2019 May 17]. Available at: https://www.wcrf.org/dietandcancer
  2. Ontario Food and Nutrition Strategy Group. Ontario Food and Nutrition Strategy: a comprehensive evidence-informed plan for healthy food and food systems in Ontario. Toronto: Ontario Food and Nutrition Strategy Group; 2017.
  3. Cancer Care Ontario. Prevention System Quality Index: health equity. Toronto: Queen's Printer for Ontario; 2018.