Hostname: page-component-cd4964975-xtmlv Total loading time: 0 Render date: 2023-03-31T02:38:44.252Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Quality of life and self-rated health in relation to changes in fruit and vegetable intake and in plasma vitamins C and E in a randomised trial of behavioural and nutritional education counselling

Published online by Cambridge University Press:  09 March 2007

Andrew Steptoe*
Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
Linda Perkins-Porras
Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
Sean Hilton
Department of General Practice and Primary Care, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
Elizabeth Rink
Department of General Practice and Primary Care, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
Francesco P. Cappuccio
Department of General Practice and Primary Care, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
*Corresponding author: fax +44 20 7916 8542, Email
Rights & Permissions[Opens in a new window]


HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

We have carried out a randomised trial comparing brief behavioural counselling with nutritional education counselling to increase fruit and vegetable consumption and associated biomarkers in adults from a low-income neighbourhood. The objective of the present analysis was to assess the impact of interventions on quality of life and health status, and associations between changes in fruit and vegetable consumption, plasma vitamins C and E, and quality of life. Behavioural counselling and nutritional education counselling were carried out in 271 adults in two 15 min sessions in a primary-care setting. Physical and mental health status (medical outcome study short form 36) and self-rated health were assessed at baseline, 8 weeks and 12 months, and analysed on an intention-to-treat basis. Both groups reported increased fruit and vegetable consumption; plasma vitamin E and β-carotene also increased, with significantly greater changes in consumption and plasma β-carotene in the behavioural counselling condition. Physical and mental health status, and the proportion of participants in good self-rated health, increased in both groups to a similar extent. Individual differences in improvements in physical health status and self-rated health were correlated with increases in fruit and vegetable intake and in plasma vitamins C and E, independently of age, gender, ethnicity, financial status, smoking, BMI and use of vitamin supplements. We conclude that participation in the present study was associated with improved health-related quality of life. Increases in fruit and vegetable intake and plasma vitamin levels may stimulate beneficial changes in physical health status in socio-economically deprived adults.

Research Article
Copyright © The Nutrition Society 2004


1Armstrong, NC, Paganga, G, Brunner, E. et al. Reference values for alpha-tocopherol and beta-carotene in the Whitehall II study. Free Radic Res 1997 27, 207219.CrossRefGoogle ScholarPubMed
2Barringer, TA, Kirk, JK, Santaniello, AC, Foley, KL & Michielutte, REffect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003 138, 365371.CrossRefGoogle ScholarPubMed
3Benton, D, Haller, J & Fordy, JVitamin supplementation for 1 year improves mood. Neuropsychobiology 1995 32, 98105.CrossRefGoogle ScholarPubMed
4Burstrom, B & Fredlund, PSelf rated health: Is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Community Health 2001 55, 836840.CrossRefGoogle Scholar
5Cappuccio, FP, Rink, E, Perkins-Porras, L, McKay, C, Hilton, S & Steptoe, AEstimation of fruit and vegetable intake using a two-item dietary questionnaire: a potential tool for primary health care workers. Nutr Metab Cardiovasc Dis 2003 13, 1219.CrossRefGoogle ScholarPubMed
6Corle, DK, Sharbaugh, C, Mateski, DJ, et al. Self-rated quality of life measures: effect of change to a low-fat, high-fiber, fruit and vegetable enriched diet. Ann Behav Med 2001 23, 198207.CrossRefGoogle ScholarPubMed
7Department of Health, (2003) Five a Day: Increasing Fruit and Vegetable Consumption – A National Priority. Scholar
8Down, DFamily Spending: A Report on the 1999–2000 Family Expenditure Survey. London: The Stationery Office. 2000Google Scholar
9Erens, B & Primatesta, PHealth Survey for England: Cardiovascular Disease '98. London: The Stationery Office. 1999Google Scholar
10Franks, P, Gold, MR & Fiscella, KSociodemographics, self-rated health, and mortality in the US. Soc Sci Med 2003 56, 25052514.CrossRefGoogle ScholarPubMed
11Henderson, L, Gregory, J & Swan, GThe National Diet and Nutrition Survey: Adults Aged 19 to 64 years. Volume 1: Types and Quantities of Foods Consumed. London: The Stationery Office. 2002Google Scholar
12Hunt, P & Hillsdon, MEating and Exercise Behaviour: A Handbook for Professionals. Oxford: Blackwell Science. 1996Google Scholar
13Idler, EL & Benyamini, YSelf-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997 38, 2137.CrossRefGoogle ScholarPubMed
14Idler, EL, Russell, LB & Davis, DSurvival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. Am J Epidemiol 2000 152, 874883.CrossRefGoogle ScholarPubMed
15Jenkinson, C, Coulter, A & Wright, LShort form 36 (SF36) health survey questionnaire: normative data for adults of working age. Br Med J 1993 306, 14371440.CrossRefGoogle ScholarPubMed
16Jenkinson, C, Layte, R, Wright, L & Coulter, AThe U.K. SF-36: An Analysis and Interpretation Manual. Oxford: Health Services Research Unit. 1996Google Scholar
17Kawada, TSelf-rated health and life prognosis. Arch Med Res 2003 34, 343347.CrossRefGoogle ScholarPubMed
18Maes, M, De Vos, N, Pioli, R, et al.. Lower serum vitamin E concentrations in major depression. Another marker of lowered antioxidant defenses in that illness. J Affect Disord 2000 58, 241246.CrossRefGoogle ScholarPubMed
19Martin, A, Cherubini, A, Andres-Lacueva, C, Paniagua, M & Joseph, JEffects of fruits and vegetables on levels of vitamins E and C in the brain and their association with cognitive performance. J Nutr Health Aging 2002 6, 392404.Google Scholar
20Miller, GD, Rejeski, WJ, Williamson, JD, et al.. The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. Control Clin Trials 2003 24, 462480.CrossRefGoogle ScholarPubMed
21Ministry of Agriculture, Fisheries and Food National Food Survey 1999. London: The Stationery Office. 2000Google Scholar
22Morris, MC, Evans, DA, Bienias, JL, Tangney, CC & Wilson, RSVitamin E and cognitive decline in older persons. Arch Neurol 2002 59, 11251132.CrossRefGoogle ScholarPubMed
23Muldoon, MF, Manuck, SB & Matthews, KALowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. Br Med J 1990 301, 309314.CrossRefGoogle ScholarPubMed
24Muldoon, MF, Manuck, SB, Mendelsohn, AB, Kaplan, JR & Belle, SHCholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. Br Med J 2001 322, 1115.CrossRefGoogle ScholarPubMed
25Ortega, RM, Requejo, AM, Andres, P, et al.. Dietary intake and cognitive function in a group of elderly people. Am J Clin Nutr 1997 66, 803809.CrossRefGoogle Scholar
26Osler, M, Heitmann, BL, Gerdes, LU, Jorgensen, LM & Schroll, MDietary patterns and mortality in Danish men and women: a prospective observational study. Br J Nutr 2001 85, 219225.CrossRefGoogle ScholarPubMed
27Paleologos, M, Cumming, RG & Lazarus, RCohort study of vitamin C intake and cognitive impairment. Am J Epidemiol 1998 148, 4550.CrossRefGoogle ScholarPubMed
28Pierce, JP, Faerber, S, Wright, FA, et al.. A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study. Control Clin Trials 2002 23, 728756.CrossRefGoogle ScholarPubMed
29Plaisted, CS, Lin, PH, Ard, JD, McClure, ML & Svetkey, LPThe effects of dietary patterns on quality of life: a substudy of the Dietary Approaches to Stop Hypertension trial. J Am Diet Assoc 1999 99, S84S89.CrossRefGoogle ScholarPubMed
30Prochaska, JO & Velicer, WFThe transtheoretical model of health behavior change. Am J Health Promot 1997 12, 3848.CrossRefGoogle ScholarPubMed
31Shibata, H, Kumagai, S, Watanabe, S & Suzuki, TRelationship of serum cholesterols and vitamin E to depressive status in the elderly. J Epidemiol 1999 9, 261267.CrossRefGoogle ScholarPubMed
32Smith-Warner, SA, Elmer, PJ, Tharp, TM, et al.. Increasing vegetable and fruit intake: randomized intervention and monitoring in an at-risk population. Cancer Epidemiol Biomarkers Prev 2000 9, 307317.Google Scholar
33Steptoe, A, Perkins-Porras, L, McKay, C, Rink, E, Hilton, S & Cappuccio, FPBehavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. Br Med J 2003 a 326, 855858.CrossRefGoogle ScholarPubMed
34Steptoe, A, Perkins-Porras, L, McKay, C, Rink, E, Hilton, S & Cappuccio, FPPsychological factors associated with fruit and vegetable intake and with biomarkers in adults from a low-income neighborhood. Health Psychol 2003 b 22, 148155.CrossRefGoogle ScholarPubMed
35Tiemeier, H, Hofman, A, Kiliaan, AJ, Meijer, J & Breteler, MMVitamin E and depressive symptoms are not related. The Rotterdam Study. J Affect Disord 2002 72, 7983.CrossRefGoogle Scholar
36Toobert, DJ, Glasgow, RE, Strycker, LA, Barrera, M Jr, Radcliffe, JL, Wander, RC & Bagdade, JDBiologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Diabetes Care 2003 26, 22882293.CrossRefGoogle ScholarPubMed
37Toobert, DJ, Strycker, LA, Glasgow, RE, Barrera, M & Bagdade, JDEnhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial. Health Educ Res 2002 17, 574585.CrossRefGoogle ScholarPubMed
38Treasure, T & MacRae, KDMinimisation: the platinum standard for trials? Randomisation doesn't guarantee similarity of groups; minimisation does. Br Med J 1998 317, 362363.CrossRefGoogle Scholar
39Vuilleumier, J & Keck, EFluorometric assay of vitamin C in biological materials using a centrifugal analyser with fluorescence attachment. J Micronutr Anal 1989 5, 2534.Google Scholar
40Wardle, J, Parmenter, K & Waller, JNutrition knowledge and food intake. Appetite 2000 34, 269275.CrossRefGoogle ScholarPubMed
41Ware, JE, Kosinski, M & Keller, SDSF-36 Physical and Mental Health Summary Scales: A User Manual Boston, MA The Health Institute, New England Medical Center. 1994Google Scholar
42Ware, JE & Sherbourne, CDThe MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992 30, 473483.CrossRefGoogle ScholarPubMed
43World Health Organization (2002) WHO Mega Country Health Promotion Network. Scholar