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Time for ten-a-day? UK scientists formulate compelling argument to extend ‘five a day’ message

By Nicola Cottam , 03-Apr-2014

Time for ten-a-day? UK scientists formulate compelling argument to extend ‘five a day’ message

Eating five portions of fruit and vegetables per day is not enough to ward off killer diseases like cancer and cardiovascular disease, warn researchers.

More should be done to increase consumption of fruit and vegetables in England, says scientists at the University of Liverpool, including a major rethink of the UK government’s five-a-day policy.

Lifestyle analysis of 65,000 adults in England aged at least 35 confirmed the positive effects of fruit and vegetables in reducing deaths from heart disease, stroke and cancer, but suggested the benefits are much greater with at least seven portions a day - rather than the government’s recommended 5-a-day.

“This research clearly shows that there is no point in stopping at five a day. Seven or even 10 would save a lot more lives. It provides useful messages for public health practitioners and policy makers,” said Simon Capewell, Professor of Clinical Epidemiology at the University – who led the research.

The results, published in the Journal of Epidemiology & Community Health, also suggest vegetables are much more effective than fruit at staving off disease with mortality decreasing exponentially with each additional serving.

Two to three daily portions were linked to a 19% lower risk of death, compared with a 10% risk for the same amount of fruit, and for each individual portion of salad or vegetables the risk falls by 12-15%.

Rethink needed on quality and quantity

In addition, seven or more daily portions of fruit and vegetables was found to lower overall mortality rates by 42%, and cancer, heart disease and stroke by 25% and 31% respectively.

Capewell continued: “A ‘2 plus 5’ campaign in Australia - 2 fruit plus 5 vegetables - has been well received by the public and all the indications are that seven a day is achievable here as well. The government and Public Health England (PHE) are already talking about subsidising fruit and vegetables, especially for children, but we would like to see the government introduce a duty on sugary drinks, and use the billion pounds annual revenue to subsidise cheaper vegetables and fruit.”

Researchers also urged a rethink on what constitutes a healthy fruit portion since their findings revealed a positive correlation between consumption of frozen and tinned fruit and an increased risk of death.

Co-author, Dr Chris Kypridemos commented: “Current NHS guidance suggests that dried, tinned or canned fruit, smoothies and up to 150ml of fruit juice, all legitimately count towards the ‘5 a day’, while also silently delivering large amounts of refined sugar. However this might need to be revised as many of these contain more sugar than a 500ml bottle of cola."

Only 25% of the adult population in England have adopted a healthy 5-a-day diet and there needs to be a major policy rethink to entice the remaining 75%, concluded the report. The 5-a-day target may be pragmatic but it also risks complacency among the quarter of the population who do follow the advice.

Source: J Epidemiol Community Health
Published online, Open Access, doi: 10.1136/jech-2014-203981
“Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data”
Authors: Oyinlola Oyebode, Vanessa Gordon-Dseagu, Alice Walker,  Jennifer S Mindell

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