Review Article

Religiosity and Spirituality and the Intake of Fruit, Vegetable, and Fat: A Systematic Review

Table 1

Characteristics of studies included in the systematic review of the associations between R/S and fruit and vegetable or fat intake. Only variables related to this systematic review are reported in this table.
(a) Denominational studies (Adventists versus others)

No. First author (publication year) Location Population Sampling
method
Denominations Dietary measures Dietary assessment methodsFindingControl variables
F/VFat

1 Alexander (1999) [72]Denver, USA94AdultsConvenienceAdventists
Catholics
FFQAdventists
(i) more fruit/vegetable
(ii) less fat
(iii) less saturated fat
(iv) less % energy from saturated fat
Nonsignificant:
(i) polyunsaturated fat
(ii) % energy from polyunsaturated fat
(iii) % energy from fat
Gender

2 Hunt (1988) [73]LA, California, USA290Postmenopausal womenConvenienceAdventists
Methodists
24 hr dietary recallAdventists nonsignificantly more fruit and vegetable ( )None

3 Kent (2009) [74]Melbourne, Australia1054AdultsRandomAdventists
Non-Adventists
FFQAdventists more fruit and vegetableAge

4 Kuczmarski (1994) [75]North Carolina, USA227AdolescentsConvenienceAdventists
Non-Adventists
FFQ Adventists
(i) males & females: more fruit
(ii) females: more fats
None

5 Rouse (1983) [76]Perth, Australia293Adults, 22–44 yrsConvenienceAdventist (vegetarians & omnivores)
Mormons (omnivores)
24 hr dietary recallMormon males more total fat & saturated fat intake than male Adventist vegetarians
Polyunsaturated fat—Adventist vegetarians > Mormons > Adventist omnivores
P : S ratio—low in SDA omnivores and Mormons
None

6 Sabaté (1990) [77]USA1765School children, 1st–10th gradesRandomDenominational school—SDA or public FFQAdventist school children more fruit/vegetableNo

7 Shultz (1983) [78]Oregon, USA23AdultsRandomAdventists (vegetarians)
Non-Adventists (nonvegetarians)
3-day dietary record FFQ3-day dietary record: nonsignificant, though non-Adventists 18% more total fat
FFQ
(i) Non-Adventists more deep fried vegetable
(ii) Non-Adventists more animal fat and more saturated fat
None

8 Fraser (1987) [79]LA & Orange Counties, USA320Non-Hispanic Whites, 35–55 yrsRandom (Adventists) & convenience (non-Adventist neighbors)Adventists
Non-Adventists
FFQAdventists—less fat, less saturated fat, higher P : S ratio; linoleic acid noneNone

(b) Denominational studies (other religions/denominations)

No. First author (publication year) Location Population Sampling methodDenominations Dietary
measures
Dietary assessment methodsFindingControl variables
F/VFat

9 Epstein (1956) [80]New York, USA415Garment workers, >40 yrsRandomItalian
Jewish
Others
24-hr dietary recallItalians and Jews—no difference in fat intake
Jews more animal fats
None

10 Glick (1998) [81]Yates Country, NY, USA149Old order MennonitesUnclearMennonite
USA population
FFQMennonites males & females more fat & oleic acid than USA sample
Mennonite males—similar % calories from fat with USA sample
None

11 Kita (1988) [82]Kyoto, Japan36Adults, 24–35 yrsConvenienceZen monks
University students
24-hr dietary recallZen monks less fat intake & higher P/S ratioNone

12 Lee (2009) [83]Gyeongbuk, Republic of Korea85Females—Buddhist nuns & Catholic nunsConvenienceBuddhists
Catholics
Fat in % kcal
Total fat
Plant fat
Animal fat
No differences in fat in % kcal, total fat, plant fat
Catholics more animal fat
None

13 Mullen (2000) [84]West of Scotland, UK985Adults, >35 yrsStratified randomCatholics
Non-Catholics
FFQCatholics—pure fruit juice
Catholic males—less fruit and vegetable
Sex, occupational class

14 Shatenstein (1993) [85]Greater Montreal, Canada250Hassidic familiesRandomHassidic sects—Outremont Hassidim & Lubavitcher HassidimFood frequency & food habits list
2-day food record
Lubavitcher Hassidim more cooked fruitNone

(c) Denominational + degree of R/S studies

No. First author (publication year) Location PopulationSampling methodR/S measures Dietary measures Dietary
assessment
methods
FindingControl variables
F/VFat

15 Kim (2004) [86]USA546AdultsRandomReligious denomination
Religious attendance
Religious application
Religious commitment
Religious identity
Religious coping
Religious social support
National Cancer Institute's Quick Food ScanConservative Protestant/others/no religion women more fat than Catholic women
Males—none
Age, race, education, marital status, employment

16 Kim (2008) [87]Texas, USA424Non-Hispanic Whites, 58–100 yrsRandomDenomination
Attendance
Religious social support (% network in church & % network in religion)
Interview about fat reduction behaviorAll R/S measures nonsignificant for men
Women—Denomination nonsignificant; more % network in church, less fat reduction behavior; more % network in religion, more fat reduction behavior
Age, SES, urban-rural residence, living with someone, chronic illness, physically disabled, health & disability, general social support

17 McIntosh (1984) [88]Virginia, USA371ElderlyRandomReligious participation
Religious salience
Religious disagreement
Religious preference
24 hr dietary recall+ve for salience and fat intake
+ve for disagreement and fat intake
More localistic, Methodists more fat, Brethren less fat
Sex, income

18 Schlundt (2008) [89]Nashville, Tennessee, USA3014White & African Americans, >18 yrsStratified randomReligious denomination/affiliation
Religious involvement Index (religious attendance, religiosity, perception of religion as a source of strength and comfort)
Eating
Behavior Patterns Questionnaire
Eating Styles Questionnaire
(both Adapted from Behavioral Risk Factor Surveillance System)
Denomination—nonsignificant
Religious involvement index positively associated with healthy eating behaviors and high-fat behaviors
Age, sex, race, education, income & employment

(d) Degree of R/S studies

No. First author (publication year) Location Population Sampling methodR/S measures Dietary measures Dietary assessment methodsFindingControl variables
F/VFat

19 Arredondo (2005) [90]USA211Women, 18–65 yrsRandomChurch attendanceBlock fat & fiber screenerFrequent churchgoers more fiber than nonchurchgoers
Churchgoers (frequent & infrequent) more fiber than nonchurchgoers
Education, marital status, employment, age

20 Baruth (2011) [91]South Carolina, USA1136African Americans, >18 yrsRandomPerceived environmental church support (perceived written informational, perceived spoken informational, perceived instrumental, total perceived church support)National Cancer Institute Fruit and Vegetable screener
Servings of fruit and vegetable
Fat- and Fiber- Related Behavior Questionnaire
More fruit and vegetable
(i) more total perceived church support, perceived written informational support & perceived spoken informational support
More low-fat behavior
(i) more total perceived church support and perceived written informational support
Sex, years of education, health rating, age, BMI, influence of church

21 Benjamins (2012) [92]USA351Jewish students, 5th–8th gradesConvenienceReligious beliefs & healthYouth Risk Behavior Survey (5 fruit and vegetable daily)NonsignificantGender, weight status, dieting, parental involvement, confidence

22 Debnam (2012a) [93]USA2370African Americans, >21 yrsProbability-based but not representativeReligion social support (emotional support received, emotional support provided, anticipated support, negative interaction)National Cancer Institute's Five-A-Day SurveyMore social support, more fruit and vegetable
(i) additive effect: emotional religious support
Age, education, sex, self-rated health status

23 Debnam (2012b) [94]USA2370African Americans, >21 yrsRandomSpiritual Health Locus of Control Scale (active spiritual, passive spiritual)National Cancer Institute's 5-A-Day SurveyOverall:
+ve for active spiritual and daily fruit servings
−ve for passive spiritual and daily vegetable servings
Males: −ve for passive spiritual and daily vegetable servings; nonsignificant for fruit
Females: −ve for passive spiritual and daily vegetable servings; none for fruit
Age, education, health status

24 Fife (2011) [95]Northeast, USA510African American university studentsConvenienceDuke University Religion Index Youth Risk Behavior Survey
(i) Ate no fruit during the past 7 days
(ii) Ate no salad during the past 7 days
(iii) Drank no 100% fruit juice during the past 7 days
Chi-square test:
(i) nonsignificant—ate no fruit during the past 7 days; ate no salad during the past 7 days
(ii) significant—drank no 100% fruit juice during the past 7 days
Logistic regression:
(i) univariate & multivariate—“intrinsic only” group more likely to drink no 100% fruit juice during the past 7 days
Year in school, gender

25 Franklin (2007) [96]USA1273Adults, 18–96 yrsStratified randomReligious health fatalism questionnaireFat-increasing behavior
Fat-decreasing behavior
High fatalism +ve associated with both high fat-increasing behavior & high fat-decreasing behaviorAge, race, gender, income, education

26 Friedlander (1985) [97]Jerusalem, Israel746Jewish adultsMultistage random Degree of religiosity (Orthodox, traditional, secular)24-hr dietary recall+ve for total fat, saturated fat, and P : S ratio in males
Nonsignificant for fruit and vegetable intake
Age, region of origin, BMI, social class, seasonality

27 Hart (2004) [98]USA2375Adults, >35 yrsRandomReligious orientation (intrinsic versus extrinsic)Fat- and Fiber- Related Behavior QuestionnaireNonsignificant for fruit and vegetable
More extrinsic, less fat
Age, sex, race, education, marital status, church size

28 Hart (2006) [99]Seattle, USA2375Adults, >18 yrsRandomCohesiveness of religious organization membersFat- and Fiber- Related Behavior QuestionnaireMore cohesiveness, less fat, but nonsignificant after controlling for age and raceAge, race

29 Hart (2007) [100]Washington, USA1520Adults, >18 yrsRandomSocial environmental (cohesion, leader support, order/organization, leader control)Fat- and Fiber- Related Behavior QuestionnaireMore cohesion, more order/organization, more fruit and vegetable
More cohesion, order/organization, lower fat
Age, race, gender, education marital status, size of religious organization

30 Holt (2005) [101]Missouri, USA1227African American women, 18–65 yrsConvenienceReligiosity (beliefs & behavior)
(i) 4 categories: low religious behavior only, belief only, high religious
National Cancer Institute's 5-a-day surveyFruit/vegetable intake in descending order:
Higher religious, behavior only, belief only, low religious
Education, income examined as potential covariates but not included because they are not associated with religious orientation

31 Lytle (2003) [102]Minnesota, USA3878AdolescentsRandomSpiritual beliefs in health behaviorsFruit and vegetable food frequency scale (from Behavioral Risk Factor Surveillance System)Higher spiritual belief, more fruit and vegetableDemographic & psychosocial variables

32 Obisesan (2006) [103]USA14,094Nonpregnant adults, >20 yrsMultistage random Church attendanceFFQ
24-hr dietary recall
NonsignificantAge, sociodemogra-phic variables, health status

33 Park (2009) [104]Hartford Hospital, USA167Cancer survivors, 18–55 yrsConvenienceReligious service attendance
Daily spiritual experiences
Religious struggle
Spiritual strain scale
Mediator: Self-assurance
5 servings of fruit and vegetable a dayDaily spiritual experiences positively related to daily 5 servings of fruit and vegetable
Self-assurance not related to 5 servings of fruit and vegetable, so no mediation test conducted
No

34 Pitel (2012) [105]Slovakia3674AdolescentsStratified randomReligiosity (religious attendance & self-rated importance of religious faith)No regular fruit and vegetable consumptionNonsignificantAge, parental divorce, parental education, family
affluence, degree of urbanization, ethnicity

35 Reeves (2012) [106]Jackson, USA2378African AmericansRandomOrganized religious activity
Private prayer
Daily spiritual experiences
FFQ—% calories from fatNonsignificantNone

36 Salmoirago-Blotcher (2011) [107]USA71,689Postmenopausal women, 50–79 yrsRandomService attendanceFFQ—saturated fat intakeNonsignificantAge, race, marital status, education, health insurance, enrollment status, physical functioning, self-rated health

37 Shmueli (2007) [108]Israel3056Jews, >18 yrsRandomReligiosity—secular, observant, religiousFFQNonsignificantAge, gender, education, marital status, ethnic origin, socioeconomic status

38 Underwood (2006) [109]Midwest, USA471African Americans, >20 yrsConvenienceReligious intensity/religiousness
Spiritual intensity/spirituality
Religious practices
Public health Service health Style self-testVery/moderately spiritual, very/moderately religious, more collaboration—less fruit and vegetable, more fatNone

39 Wiist (2012) [110]Web-based811Buddhists, >18 yrsConvenienceBuddhist Devoutness Index (Buddhist practices & beliefs)FFQNonsignificantAge, gender, income, disability, social support

Abbreviations:
F/V: fruit/vegetable.
FFQ: food frequency questionnaire.
P : S:polyunsaturated fat : saturated fat.