1. Does Diet Environment Affect Our Fruit and Vegetable Consumption?
A community Based diet environment assessment for non communicable disease
Dr. Rama Shankar Rath (Presenter), Dr. K. Anand, Dr. Baridalyne N., Dr. Puneet Misra
All India Institute of Medical Sciences, New Delhi

2. Introduction:
Diet is related to the health and disease both communicable and non communicable
Environment also have direct impact on the communicable diseases and risk factors
Role of environment on the Non communicable diseases and its risk factors is not clear
Fruit and vegetable consumption is one of the protective factors for the Non communicable disease

3. Objective
To assess the community environment for its conduciveness to fruit and vegetable consumption
To relate this community environment to the fruit and vegetable consumption

4. Study Settings Study Type: Community based cross-sectional study
Study area: Rural and Urban areas in the Ballabgarh Sub-district of Faridabad, Haryana, India
Study Participants:
20 communities 10 Rural and 10 Urban
All establishments in selected communities
30 participants in each community selected by EPI method
Study Tool: A self prepared study tool specifically designed for Indian settings called Neighborhood Environment Assessment Tool (NEAT)

5. Tool Description (NEAT)
Individual
General
Tobacco consuming status
Knowledge about laws
Dietary pattern
Physical activity status
Media exposure
Attitude assessment
NEAT
Community
Weekly market
General
Street
Establishment
Tobacco Environment
General store
Restaurant
PA sites
Street vendor

6. Methodology: Community (Randomly selected from list of communities)
Community Audit was conducted to find
Establishments selling food products from this density of various food stores were calculated
Advertisements promoting the fruit and vegetable consumption and other unhealthy food products
SES status and distribution of stores in the community
Establishments (All in Area)
All establishments selling food products were studied
Type of food product they are selling
Advertisement of food products at the counter
Display of food products at the counter
Individuals (30 participants from each area)
Each participant was asked about
The fruit and vegetable consumption status
All the non healthy food product consumption
Attitude about fruit and vegetable consumption
Media exposure for both healthy and unhealthy food products

7. Analysis
Outcome
Consuming fruit and vegetable more than 3/4th of the population
Independent factors
Community level
Family level
Individual level
Density of Food stores
Urban / rural community
Community diet attitude
Type of Ration Card
Income category
Ownership of House
Having Motorized vehicle
Age
Gender
Educational status
Marital Status
Media exposure
Attitude towards diet
Type of Analysis
Multi- level analysis with above mentioned variables
Model-1 : Community level variables
Model-2: Community level and Household level
Model-3 : Community, Household & Individual level

8. Results: Comparison of Community level factors
Rural (S.D)
Urban (S.D)
Density of fruit and vegetable stores per Km2
36.7(20.2)
13.6(19.0)
Density of Eating joints per Km2
10.0 (9.5)
7.2(8.3)
Density of general stores selling unhealthy foods per Km2
92.6(51.9)
122.2(176.9)
Diet media exposure
4.5(0.5)
4.4(0.4)
Diet attitude score
26.2 (1.8)
26.1(1.4)

9. Results: Conduciveness of environment to fruit and vegetable Consumption

10. Results: Stores selling and promoting various food items
% of total food establishments (n=278)
Chips and other unhealthy foods
85.6
Aerated sugary drinks
77.0
Fruits
17.3
Vegetables
16.9
Display of unhealthy foods
41.0
Free gifts with unhealthy foods
56.8

11. Results: Individual level
Characters
Total (n=552)
Urban (n=256)
Rural (n=296)
Median number of fruits and vegetable servings (Median, IQR)
2.0( )
2.0( )
2.0( )
More than 5 fruit and vegetable servings (%)
0.5%
1.2%
0.0%
% of people consuming daily chips and namkeens (%)
14.0%
14.8%
13.3%
% of people consuming aerated drinks (%)
3.6%
4.7%
2.3%
Median score of Media exposure (IQR) (Out of 9)
5.0( )
4.0( )
Median attitude score (IQR) (Out of 64)
49.0( )
50.0 ( )

12. Results: Multilevel model for association between the fruit and vegetable consumption with other variables
Model-1
Model-2
Model-3
Levels of variable
Variable
OR (95% CI)
OR(95% CI)
Community level variables
Urban community
5.4( )*
4.5( )*
3.5( )*
General store / sq km more than median
0.9( )
1.0( )
1.3( )
Fast-food store / sq.km.
0.8( )
0.9( )
0.9( )
Number of vegetables and fruit store/sq km
1.2( )
0.9( )
1.0( )
Community diet attitude
1.0( )
0.8( )
0.7( )
Household level variables
Having BPL ration card
- NA -
0.8( )
Not owner of house
0.9( )
1.1( )
High per-capita income
1.5( )
1.6( )
Individual level variables
Age >40yrs
1.2( )*
Female gender
0.2( )*
Education > 10th class
2.2( )*
Living single
0.7( )
Self employed
0.5( )*
Media exposure score > median
Attitude towards diet> median
0.9( )
Model Fitness (R2)
0.13
0.15
0.22

13. Conclusion
The density of stores offering healthy food products were less as compared to unhealthy stores
Fruit and vegetable consumption is related to the urban or rural locality but not with other community environment factors
Individual level determinants played a major role
Need of further research on community environment for Non communicable disease

14. Thank You