Background: Adequate fruit and vegetable (F&V) intake is important for health, yet populations globally are failing to meet recommendations. Objective: A scoping review to summarize available evidence of evaluations of interventions to increase F&V intake globally, focusing on target populations, intervention strategies, research methods, and summarizing their evaluated impacts. Methods: We searched PubMed and Web of Science in February 2023 for intervention studies in which dietary intake of fruit and/or vegetables were documented. Eligible studies included all age groups, excluding those targeting populations with specific disease-related conditions, such as cancer patients/survivors. Only articles published in English since 2012 were included in the review. Results: We identified 6338 articles, with 226 meeting inclusion criteria, comprising 223 unique studies and 284 intervention comparisons. Most comparisons occurred in high-income countries ( n = 192) compared to low- and middle-income countries ( n = 92). Randomized controlled trials (RCTs; 37.3%) and cluster RCTs (52.5%) were predominant. Interventions primarily targeted adults (31.7%), school-aged children (18.0%), children under-five (14.4%), and adolescents (13.7%), lasting an average of 24 weeks (range: 2 weeks to 20 years). Food-frequency questionnaires (59.2%) and 24-h recalls (26.8%) were the most used dietary assessment method. Health and nutrition communication (75.9%) was the most common intervention, utilizing interpersonal communication, mass media, and information-communication technology, often in combinations. Positive impacts on fruit (43.9%), vegetable (40.2%), and combined F&V intake (53.0%) were observed in nearly half the intervention comparisons. Conclusions: These findings highlight the predominance of health and nutrition communication interventions, predominantly in high-income countries, showing mixed success in improving F&V intake, emphasizing the need for context-specific strategies and standardized methodologies to design sustainable, cost-effective interventions for better diet quality and health outcomes. Plain language title: A literature review assessing what we know and do not know about efforts to improve fruit and vegetable intake across the world.

Background: Despite well-documented health benefits, fruit and vegetable (F&V) intake remains below recommended levels globally. Objectives: This scoping review aimed to identify effective intervention strategies to increase F&V intake. Methods: We searched PubMed and Web of Science (February 2023) for intervention studies assessing impact on F&V intake. Eligibility criteria included studies published in English since 2012, a valid control group, ≥2 weeks duration, and ≥50 participants per intervention arm. Analysis was done by intervention comparison. Findings were described by summarizing proportion of intervention comparisons reporting statistically significant increases in fruit, vegetable and/or combined F&V intake across standalone (nutrition communication, social protection, agriculture or food environment restructuring) and multi-component strategies. Results: A total of 284 intervention comparisons (223 unique studies) were included. The majority of comparisons (191/284) came from high-income countries (HICs) and 93/284 from low- and middle-income countries (LMICs). Nutrition communication was the most common standalone strategy, with 121/218 comparisons reporting positive impacts on fruit, vegetable and/or combined F&V intake. Fewer studies evaluated standalone social protection (13/284), food environment restructuring (4/284), or agriculture strategies (3/284). Among the limited interventions, 7/13 social protection and 3/4 food environment restructuring comparisons reported positive impacts, while none of the 3 standalone agricultural interventions did. Multi-component interventions demonstrated potential with 28/46 comparisons having positive impacts. Conclusions: Some of the intervention strategies showed potential for increasing fruit and/or vegetable intake. However, given the heterogeneity of the interventions, small number of studies for some strategies and limited evidence from LMICs, more rigorous, context-specific research is needed.

The majority of research on linear growth among children is confined to South Asia and focuses on iron and folic acid (IFA) supplementation during pregnancy, without considering malaria prophylaxis. Similarly, there is limited evidence on the association of antenatal IFA supplementation and malaria prophylaxis with neonatal mortality in sub-Saharan Africa (SSA). This study aims to address these gaps. A pooled analysis of demographic and health survey (DHS) data from 19 countries in SSA was conducted to study the association between IFA supplementation and malaria prophylaxis and linear growth and neonatal mortality. Multivariate logistic and linear regression models were used. Malaria prophylaxis was significantly associated with stunting, height-for-age Z scores (HAZ scores), and neonatal mortality, but IFA supplementation was not associated with these outcomes. When women’s height and body mass index (BMI) were introduced in the model, a significant association between combined malaria prophylaxis and IFA supplementation was found with HAZ scores only. For severe stunting, no significant association was found with either in the two models. In conclusion, this study underscores the importance of antenatal malaria prophylaxis as a potential intervention for nutrition outcomes (linear growth) and neonatal mortality, as well as the importance of coordinating efforts between malaria and the health and nutrition sectors to improve these outcomes in the countries of SSA.

Low coverage of effective nutrition interventions in many high‐burden countries, due to service provision and demand factors, result in poor uptake of recommended practices and nutrition outcomes. We examined the factors that influence maternal nutrition and early breastfeeding practices and determined the extent that the key factors could improve these practices in two regions in Burkina Faso. We used household survey data among pregnant (n = 920) and recently delivered women (n = 1840). Multivariable regression analyses were conducted to identify the determinants of a diverse diet and iron‐folic acid (IFA) supplement consumption, weight monitoring during pregnancy and early initiation of breastfeeding (EIBF). Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal conditions of interventions that address the modifiable determinants. During pregnancy, 21% of women achieved minimum diet diversity (MDD‐W), 70% consumed 90+ IFA tablets and 65% were weighed 4+ times; EIBF was 40%. Nutrition knowledge was associated with MDD‐W (odds ratio [OR]: 3.2), 90+ IFA (OR: 1.5) and EIBF (OR: 1.9). Positive social norms and family support were associated with 90+ IFA (OR: 1.5). Early and 4+ ANC visits were associated with 90+ IFA (OR: 1.5 and 10) and 4+ weight monitoring (OR: 6.2). Nutrition counselling was associated with 90+ IFA (OR: 2.5) and EIBF (OR: 1.5). Under optimal programme conditions, 41% of women would achieve MDD‐W, 93% would consume 90+ IFA, 93% would be weighed 4+ times and 57% would practice EIBF. Strengthening the delivery and uptake of interventions targeted at these modifiable factors has the potential to improve maternal nutrition practices.

Adequate amounts of fruit and vegetables (F&V) are an important part of a healthy diet, yet intake is suboptimal in most population groups worldwide. To better understand the evidence of strategies aiming to improve F&V intake, we conducted a scoping review of interventions assessing the impact on F&V intake, including those aiming to improve F&V intake explicitly and those targeting diet, health, lifestyle, or food environment generally. Among all eligible interventions reviewed, most of which were implemented in high-income countries, about half reported a significant positive impact on fruit and/or vegetable intake. Interventions that used a multicomponent strategy (61%) and those that focused on F&V specifically (72%) were most likely to find a significant increase in fruit and/or vegetable intake. Detailed summaries are provided in 2 accompanying articles. In the present article, we put these findings into perspective. Specifically, we considered the evidence for 4 target countries of the Fruit and Vegetables for Sustainable Healthy Diets Initiative: Benin, the Philippines, Sri Lanka, and Tanzania. When considering available evidence at the national level, there is a paucity of information from intervention trials despite evidence of inadequate F&V intakes in each of these countries. When considering available evidence at the global level, and especially for low-and-middle income countries, there is a critical need to strengthen the evidence across various intervention strategies, particularly related to targeting, timing, intensity, duration, frequency, and other key characteristics, to better understand how to enhance their impact on F&V intake in various population groups and contexts.

Poor dietary quality, particularly inadequate fruit and vegetable (F&V) intake, remains a significant public health challenge globally. This article synthesizes findings from scoping reviews examining diet and F&V intake, and interventions to increase F&V consumption among population groups in five countries: Benin, Fiji, the Philippines, Sri Lanka and Tanzania. Our analysis confirms previous findings of inadequate F&V intake across all five countries, with most adults consuming well below the WHO recommendations of 400 g per day. Across the five countries, the identified scientific evidence is limited due to heterogeneous dietary assessment methods, limited coverage of population groups in national surveys and smaller studies, and limited data from rigorous evaluations of interventions aiming to increase F&V intake. Although all five countries have developed food‐based dietary guidelines promoting F&V intake, research on their implementation and effectiveness remains limited. To build evidence for effective programmes and policies to improve both quantity and diversity of F&V intake, we identify three priority areas for future research: standardizing dietary assessment methods for use in surveys and evaluations, understanding context‐specific drivers and determinants of F&V intake and strengthening intervention research in low‐resource settings.