Child Consumption of Whole Fruit and Fruit Juice Following Six Months of Exposure to a Pediatric Fruit and Vegetable Prescription Program

Abstract

Public health recommendations suggest limiting child consumption of fruit juice in favor of whole fruit due to juice's high sugar content, lack of fruit fiber, and potential for excess intake. However, replacing juice with whole fruit may be particularly challenging for low-income and minority children, who report the highest intake of 100% juice. To address access and affordability challenges among low-income children, researchers partnered with pediatricians in an urban food desert community, to introduce a fruit and vegetable prescription program (FVPP) that provided a $15 prescription for fresh produce to every child during each office visit. Participating vendors included a farmers' market and local mobile market. This study assessed changes in daily consumption of total fruit and whole fruit among 108 pediatric patients following six months of exposure to the FVPP. Child-reported mean daily intake of whole fruit increased significantly from the baseline to the 6-month follow-up (p = 0.03): 44% of children reported an increased intake of at least 1 4 cup per day, and 30% reported an increased intake of at least 1 2 cup per day. Changes in total fruit intake (including fruit juice) were not significant. Results suggest a pediatric FVPP may have meaningful impacts on children's dietary behaviors, particularly with regard to the intake of whole fruits.

An exploration of key barriers to healthcare providers’ use of food prescription (FRx) interventions in the rural South

“…Current healthcare literature generally identifies fruit and vegetable food prescriptions (FRx) as a viable clinical intervention for improving patients' dietary consumption patterns, improving patient health outcomes and aiding in the prevention or management of nutrition-related chronic diseases, such as obesity, diabetes and CVD. While there is no universal protocol or standard of practice specific to FRx, for the purposes of the current study, based on existing interventions and the literature, the authors define FRx as a health focused intervention used by clinical healthcare providers to encourage their patients to improve their dietary consumption patterns by increasing patient access to healthier foods and improving their nutritional literacy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) . An emphasis on food access for food insecure individuals and disease management are also important provisions in FRx interventions.…”

“…Each of these methods is designed to add money to the household food budget, specifically for fresh fruits and vegetables. Eligibility for these interventions ranges from poor food security status to the presence of a chronic health conditions (obesity, diabetes, pre-diabetes) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) .…”

“…FRx interventions can have substantial short-and longterm effects on patient health, aiding in the management of chronic conditions, in the prevention of diseases and reducing long-term health costs (13)(14) . Patients with diabetes, in particular, have been targeted in FRx programming.…”

“…As currently implemented in the USA, FRx interventions rarely recruit through a medical provider but often rely on poor health or presence of a medical condition to determine eligibility (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Yet, studies that have evaluated interventions incorporating clinicians indicate that prescriptions supplied by physicians are generally more highly valued by patients because of the symbolic power and patientperceived authority of the recommendation (10) .…”

“…However, there are few studies that have examined how clinicians and other healthcare providers involved in primary care perceive these interventions and little is known about the level of awareness of the logistics and the interventions' potential influence on patient outcomes. Further, studies that examine the usefulness of FRx interventions have an urban bias, with relatively few interventions being implemented in rural spaces (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Little is currently known about the potential for these interventions in rural settings, which often lack the clinical staff for intervention implementation, specifically those with formal nutrition science training, or the infrastructure for food procurement, such as farmers' markets (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) .…”