Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population

Background/Objectives: Lower-income subgroups consume fewer servings of fruit and vegetables (FVs) compared with their more advantaged counterparts. To overcome financial barriers, FV voucher delivery has been proposed. Subjects/Methods: In a 12-month trial, 302 low-income adults 18-60 years old (defined by evaluation of deprivation and inequalities in health examination centers, a specific deprivation score) were randomized into two groups: dietary advice alone ('advice'), or dietary advice plus FV vouchers ('FV vouchers') (10-40 euros/month) exchangeable for fresh fruits and vegetables. Self-reported data were collected on FV consumption and socioeconomic status at baseline, 3, 9 and 12 months. Anthropometric and blood pressure measurements were conducted at these periods, as well as blood samples obtained for determination of vitamins. Descriptive analyses, multiple linear regression and logistic regression were performed to evaluate the impact of FV. Results: Between baseline and 3-month follow-up, mean FV consumption increased significantly in both the 'advice' (0.62 +/- 1.29 times/day, P=0.0004) and 'FV vouchers' groups (0.74 +/- 1.90, P=0.002), with no difference between groups. Subjects in the FV vouchers group had significantly decreased risk of low FV consumption (<1 time/day) compared with those in the advice group (P=0.008). No change was noted in vitamin levels (vitamin C and beta-carotene). The high number of lost-to-follow-up cases did not permit analysis at 9 or 12 months. Conclusion: In the low-income population, FV voucher delivery decreased the proportion of low FV consumers at 3 months. Longer-term studies are needed to assess their impact on nutritional status. European Journal of Clinical Nutrition (2012) 66, 369-375; doi: 10.1038/ejcn.2011.173; published online 12 October 2011