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Food and Health

Tomato Consumption in the United States and Its Relationship to the US Department of Agriculture Food Pattern

Results From What We Eat in America 2005–2010

Reimers, Kristin J. PhD, RD; Keast, Debra R. PhD

Author Information
doi: 10.1097/NT.0000000000000152
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Abstract

Tomatoes (Solanum lycopersicum L), members of the nightshade family, are nutritionally dense, widely available, and affordable; used extensively in diverse cuisines; and preferred by all ages. Over $2 billion worth of commercial tomatoes are produced in the United States each year, mostly in California (leader in processing market) and Florida (leader in fresh market). Although the fresh tomato market is robust, most tomatoes are produced to be prepared into paste and sauce. Economic Research Service data show that 89% of tomatoes are grown for canning.1 Commercial tomatoes for canning are primarily the plum variety, bred to have more soluble solids for paste. More than 10 fresh tomato varieties are available at retail, ranging from cherry to vine-ripened, and more than 400 tomato varieties are available for home gardens. Choosing the “right” tomato depends on personal preference and intended use.

Tomatoes Are Part of the Ongoing Effort to Increase Vegetable Consumption

Tomatoes comprise 19% of all vegetable consumption, second only to potatoes at 23%.2 Leveraging the popularity of tomatoes to increase vegetable consumption was a goal of the 2010 Dietary Guidelines Advisory Committee (DGAC) as it considered realigning the vegetable subgroups.3 Their recommendation to create the red and orange vegetable subgroup was subsequently incorporated into the US Department of Agriculture (USDA) Food Pattern and MyPlate.4 In fact, the red and orange subgroup is the largest vegetable subgroup in MyPlate, and tomatoes are the main vegetable in the subgroup.4 The formation of the new subgroup was designed in part to “provide more focus on tomatoes, previously part of the “other vegetables” subgroup, as a vegetable choice in recognition of its nutrient contributions.”3

Feasible, achievable strategies to increase vegetable intake can potentially improve dietary patterns and health outcomes. As noted by the 2015 DGAC, vegetables and fruits are the only components of the diet that were consistently identified in the patterns related to more favorable health outcomes. But instead of seeing upward trends in consumption, vegetable intake is declining. The 2015 DGAC report states, “To meet total vegetable recommendations, higher intakes of all vegetable subgroups are needed, particularly those subgroups where intake is minimal, such as dark green and orange and red vegetables, which are excellent sources of vitamin C, folate, magnesium, and potassium.”5 Although it seems paradoxical that tomatoes are the most consumed nonstarchy vegetable and are part of the orange and red vegetables referred to by the DGAC as having minimal intake, both points are true. Even popular vegetables are underconsumed. The average usual intake of tomatoes is 0.31 cup per day, about half the amount modeled in the red and orange vegetable subgroup.2,3 Moreover, this DGAC comment is referring to the entire orange and red vegetable subgroup, which includes squash, sweet potatoes, and carrots—where total intake can certainly be characterized as “minimal.”

Average usual vegetable intake of US adults is 1.59 cup equivalents (cups), well below the 2.5 cups target in the USDA Food Pattern.*2,4 The red and orange subgroup recommended amount is 5.5 cups per week and was modeled to be composed of 82.4% tomatoes, equaling 4.5 cups per week or 0.65 cup per day.3 This is largest recommended vegetable volume compared to any other vegetable modeled in the USDA Food Pattern.

The need to increase vegetable intake in the US population and the predominance of tomatoes in the USDA Food Pattern raises several relevant questions about tomatoes. What forms (eg, canned, raw, condiments, juice) are most commonly consumed by heavy tomato consumers, and in what recipes? What are the differences between diets that contain tomatoes and diets that do not in terms of the USDA Food Pattern? Is there a relationship between greater tomato intake and greater total vegetable intake, suggesting an enabling role for tomatoes to encourage other varieties of vegetables? To begin to answer these questions, this report describes (1) the forms of tomato intake by US adults who were heavy or typical tomato consumers and (2) the USDA Food Pattern intakes of heavy, typical, and non–tomato consumers, using the What We Eat In America diet survey from 3 National Health and Nutrition Examination Survey (NHANES) datasets (2005–2006, 2007–2008, and 2009–2010).6

APPROACH

Tomato intake was determined by examining valid 24-hour recall records collected from nonpregnant, nonlactating adults 19 years or older (n = 16 252). Energy intakes were calculated using the USDA Food and Nutrient Database for Dietary Studies (FNDDS) versions 3.0, 4.1, and 5.0, and the USDA Food Patterns Equivalents database was used to determine the intake of food groups and components.7,8

Defining Tomato Forms and Recipes

The forms of tomatoes contained in mixed dishes were determined by reviewing recipes accessed through the SR link of the FNDDS. Tomato forms were divided into 2 categories, tomato products and fresh tomatoes. Tomato products were further divided into 4 subgroups: (1) canned tomatoes and sauces used as main ingredients in FNDDS recipes (main ingredients), (2) canned tomatoes and sauces used as minor ingredients in FNDDS recipes (minor ingredients), (3) juice, and (4) condiments/salad dressings (condiments). Raw tomatoes reported as individual items, rather than as ingredients of recipes, were classified as such, although they might have been combined with other individual items to form sandwiches, salads, or other food combinations. Raw and cooked-from-fresh tomatoes reported as an ingredient of a recipe were also classified as such, and subcategories of raw tomato-containing mixtures included sandwiches, salads, condiments, tomatoes cooked-from-fresh, or miscellaneous mixed dishes (Table 1).

TABLE 1
TABLE 1:
Mean (SE) and Percentage Tomato Intake From Forms Consumed by Typical and Heavy Consumers in WWEIA/NHANES, 2005–2010

Defining Heavy and Typical Consumers and Nonconsumers

Participants were divided into 3 groups based on their tomato intake: heavy, typical, and nonconsumers. To create applicability to the USDA Food Pattern, heavy consumers were defined as those who consumed 0.65 cup per day or more, the amount of tomato included in the USDA Food Pattern.3 Typical consumers were those who consumed 0.01 to 0.64 cup per day, and the nonconsumers reported no tomato intake on the day of dietary recall. Intakes of the various tomato forms and USDA Food Pattern food groups and food components were then compared among these 3 groups.

The data were weighted using the appropriate What We Eat in America/NHANES dietary sampling weights to produce nationally representative estimates, and analyses were performed using SUDAAN Release 11.0.0 (Research Triangle Institute, Research Triangle Park, North Carolina) to adjust the standard error (SE) for the complex sample design of NHANES. Least-square means and SEs were determined using a generalized multiple regression procedure, Proc Regress, of SUDAAN to control for potential confounders of the associations between food group intake and tomato consumption. Using regression analysis, mean intake by tomato consumption groups was thus adjusted for between-group differences in food energy intake, age, gender, ethnicity, and poverty income ratio to allow for generalizability. When testing for statistical differences between tomato consumption groups, the Bonferroni method was used to adjust the .05 level of significance for multiple comparisons.

FINDINGS

Comparison of Tomato Intake Between Typical and Heavy Consumers

Most (55%) participants were classified as typical consumers, and 15% were heavy consumers (Table 1). Heavy tomato consumers skewed to adults younger than 50 years, white non-Hispanics, men, and greater than 185% poverty income ratio, whereas the group reporting no tomato consumption skewed to adults 51 years or older, women, Black non-Hispanics, and 185% or less poverty income ratio (data not shown). Among heavy tomato consumers, 68% of tomatoes consumed were in the form of tomato products, mostly consumed alone or as a main ingredient (42%), and lesser amounts were consumed as juice (12%), minor ingredients (7%), and condiments (6%). Tomato products used to prepare pasta with tomato sauce were the primary contributors of tomato intake by heavy consumers, accounting for 21% of total tomato consumption. As shown in the Figure 1, compared with typical consumers, heavy consumers’ intakes reflected greater proportions of total tomato intake from main ingredients and juice and lesser proportions from minor ingredients, condiments, and raw tomatoes (P < .01).

FIGURE 1
FIGURE 1:
Proportion of tomato intake from forms consumed by heavy and typical consumers.

Relationship of Tomato Consumption to the USDA Food Pattern

The adjusted mean tomato intake of heavy consumers was 1.11 cups, which was greater than the 0.65 cup in the USDA Food Pattern, and significantly greater than typical consumers’ intake of 0.25 cup of tomatoes (P < .01, Table 2). Heavy consumers reported higher (2.47 cups) total vegetable intake than typical consumers (1.48 cups) and nonconsumers (1.23 cups) (P < .05). As expected, the higher intake of total vegetables was because of the contribution from tomatoes, but intakes of vegetables from the other subgroup and legumes were also higher in heavy consumers (P < .05). Heavy consumers reported lesser amounts of starchy vegetables, specifically, potatoes. Total protein foods intake by both groups of tomato consumers were lower compared with nonconsumers’ protein foods intake. The decreased total protein foods intake was related to differences in all protein subgroups except seafood and soy foods, which did not differ between groups. Total and nonwhole grain consumption by heavy consumers was higher, but whole grain intake by groups was not different. Total dairy intake by groups remained constant; however, the food mix changed, with less fluid milk and more cheese consumed by tomato consumers compared with nonconsumers. Oils and alcoholic beverage intakes among groups were not different, whereas solid fat and added sugars were lowest in heavy consumers. Lower solid fat may be related to lower meat consumption, while this analysis did not examine added sugar sources to discern differences among groups.

TABLE 2
TABLE 2:
Food Pattern Equivalent Intakes by Tomato Consumption Groups of Adults in WWEIA/NHANES, 2005–2010

Tomato Form and Recipes Related to Higher Total Vegetable Intake

Heavy tomato consumption was associated with higher total vegetable intake in an amount approximating 2.5 cups per day, the amount recommended by the USDA Food Pattern. In contrast, typical consumers’ and nonconsumers’ total vegetable intakes of 1.23 and 1.48 cups per day, respectively, fell well below the USDA Food Pattern. This observation underscores the relationship between increased tomato intake and total vegetable intake.

The form of tomato consumption was a key differentiator between heavy and typical tomato consumers (Figure 1). Most tomato consumption in both groups was from tomato products, but a relatively greater proportion of tomato products was consumed by heavy consumers. Heavy consumers ate more foods made with tomato sauce, paste, or whole or diced tomatoes as the main ingredient, and the predominant mixed dish was pasta with sauce. The heavy consumers ate half of their main ingredient recipes as pasta with sauce, with much smaller contributions from recipes like chili or soups. Alternately, typical consumers ate mostly foods containing raw/cooked-from-fresh tomatoes, salad dressings/condiments, or foods containing tomatoes as a minor ingredient, such as pizza. These differences suggest that the recipe matters: consuming foods with tomato products as the main ingredient may be associated with greater total vegetable intake, whereas consuming foods with tomatoes as a minor ingredient, tomato-based salad dressing/condiments, or raw/cooked-from-fresh tomatoes may not be associated with greater total vegetable intake.

These findings add to the findings of Lin et al,9 who suggested that nutrition education and labeling efforts must go beyond basic advice to eat more vegetables and include helping Americans eat their favorite vegetables in different ways to achieve increased vegetable intake within a nutrient-dense diet. An example of making recommendations about eating favorite vegetables in different ways based on this study would be to recommend more frequent consumption of nutrient-dense recipes containing tomatoes as a main ingredient, such as simple spaghetti with sauce.

Implications for Healthier Dietary Patterns and Reduced Disease Risk

Heavy tomato consumers displayed significantly higher nontomato vegetable intake, demonstrating that tomato consumption did not displace nontomato vegetables, other than potatoes. The potato displacement did not negate the overall vegetable increase and instead led to more diverse vegetable intake by heavy consumers compared with typical consumers and nonconsumers. Solid fat and added sugar food components exceeded USDA Food Pattern recommendations in all 3 groups, but both solid fat and added sugar intakes by heavy tomato consumers were significantly lower compared with those of typical and non–tomato consumers. The relatively lower sugar intake suggests that the increased nonwhole grains consumed by heavy consumers were not grain-based desserts but were probably pasta, crust, and bread that commonly accompany tomato-based meals. Overall, the food groups and components in diets achieving the highest tomato intake emulated the USDA food pattern more closely than did diets contributing typical or no tomato intake.

Tomatoes have the dual benefit of being a highly preferred vegetable as well as having an association with reduced disease risk. Because tomatoes are one of a limited number of foods that provide lycopene, tomatoes provide 85% of the lycopene in the American diet,10 leading to higher lycopene levels in heavy tomato consumers. Findings from epidemiological and clinical studies have shown an inverse association between tomato intake or serum lycopene and cardiovascular risk11–14 and reduced risk of certain cancers.15–17 Although canned vegetables are sometimes considered inferior to fresh vegetables because of nutrient losses, in the case of tomatoes, the canning process can be nutritionally beneficial. Lycopene becomes more bioavailable because of the thermal and mechanical disruption to cell walls and because of the conversion of trans to the more bioavailable cis-lycopene isomers during the heating process.18,19 This assessment of tomato consumers did not compare sodium intakes. As shown by the recipes currently consumed among heavy consumers, replacing other mixed dishes or sandwiches with entrees like pasta with sauce would not necessarily increase total dietary sodium. In fact, the higher water content of tomato products could theoretically reduce the sodium per kilocalorie compared to more energy-dense foods. In addition, tomato products are available with no salt added, if that is a concern for the consumer.

Implications for Research and Practice

Based on this analysis, higher tomato intake, primarily in the form of canned tomato products, was associated with favorable dietary characteristics including higher total vegetable intake, greater vegetable variety, and lower solid fat and added sugar intakes. Increasing tomato consumption may be a feasible pathway for increasing total vegetable consumption while enhancing dietary patterns. This report provides support for practical strategies and tips that dietitians and educators can offer to clients and that consumers can apply themselves to help increase vegetable intake:

  • Make tradeoffs between favorite tomato-containing mixed dishes. For example, instead of pizza, have pasta with sauce more frequently.
  • Use all forms of tomatoes as preferred, but keep in mind that more frequent consumption of canned sauces, paste, and tomatoes as main ingredients in recipes may be a more effective way to increase total tomato consumption than by eating raw tomatoes in salads, as condiments, or in recipes where tomato is a minor ingredient.
  • Choose recipes that add vegetables to the tomato component, such as onions, peppers, carrots, and mushrooms, for greater variety.
  • Plan menus that feature tomatoes as well as another vegetable, such as pasta with sauce and a green salad, or chili plus carrot and celery sticks.

These practical and familiar approaches may be more achievable than other common tips such as adding unfamiliar vegetables or preparing more vegetables from raw.

Encouraging tomato consumption may be one strategy to help increase overall vegetable intake and improve dietary patterns for Americans. Future research should test these observed findings by conducting prospective interventions comparing the effects of tomato consumption on USDA Food Pattern food groups and components.

REFERENCES

1. US Department of Agriculture, Economic Research Service. Tomatoes. http://www.ers.usda.gov/topics/crops/vegetables-pulses/tomatoes.aspx. Accessed May 5, 2015.
2. US Department of Agriculture, Economic Research Service. Food Consumption and Nutrient Intakes. 2014. http://www.ers.usda.gov/data-products/food-consumption-and-nutrient-intakes.aspx. Accessed May 6, 2015.
3. 2010 Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. 2010. http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm.
4. US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans. Washington, DC: US Government Printing Office; 2010.
5. 2015 Dietary Guidelines Advisory Committee. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. 2015. http://www.health.gov/dietaryguidelines/2015-scientific-report/. Accessed May 5, 2015.
6. US Department of Agriculture. What We Eat in America overview. http://www.ars.usda.gov/News/docs.htm?docid=13793. Accessed May 5, 2015.
7. US Department of Agriculture, Agricultural Research Service. FNDDS Versions and Citations. http://www.ars.usda.gov/News/docs.htm?docid=12085. Accessed May 6, 2015.
8. US Department of Agriculture. Food patterns equivalents database. http://www.ars.usda.gov/Services/docs.htm?docid=23871. Accessed May 6, 2015.
9. Lin BH, Wendt M, Guthrie JF. Impact on energy, sodium and dietary fibre intakes of vegetables prepared at home and away from home in the U.S.A. Public Health Nutr. 2013;16(11):1937–1943.
10. Rao AV, Agarwal S. Role of lycopene as antioxidant carotenoid in the prevention of chronic diseases: a review. Nutr Res. 1999;19(2):305–323.
11. Agarwal S, Rao AV. Tomato lycopene and low density lipoprotein oxidation: a human dietary intervention study. Lipids. 1998;33(10):981–984.
12. Bub A, Watzl B, Abrahamse L, et al. Moderate intervention with carotenoid-rich vegetable products reduces lipid peroxidation in men. J Nutr. 2000;130(9):2200–2206.
13. Bose KS, Agrawal BK. Effect of lycopene from tomatoes (cooked) on plasma antioxidant enzymes, lipid peroxidation rate and lipid profile in grade-I hypertension. Ann Nutr Metab. 2007;51(5):477–481.
14. Burton-Freeman B, Sesso HD. Whole food versus supplement: comparing the clinical evidence of tomato intake and lycopene supplementation on cardiovascular risk factors. Adv Nutr. 2014;5(5):457–485.
15. Chen L, Stacewicz-Sapuntzakis M, Duncan C, et al. Oxidative DNA damage in prostate cancer patients consuming tomato sauce-based entrees as a whole-food intervention. J Natl Cancer Inst. 2001;93(24):1872–1879.
16. Giovannucci E, Rimm EB, Liu Y, Stampfer MJ, Willett WC. A prospective study of tomato products, lycopene, and prostate cancer risk. J Natl Cancer Inst. 2002;94(5):391–398.
17. Edinger MS, Koff WJ. Effect of the consumption of tomato paste on plasma prostate-specific antigen levels in patients with benign prostate hyperplasia. Braz J Med Biol Res. 2006;39(8):1115–1119.
18. Gärtner C, Stahl W, Sies H. Lycopene is more bioavailable from tomato paste than from fresh tomatoes. Am J Clin Nutr. 1997;66(1):116–122.
19. Nguyen M, Francis D, Schwartz S. Thermal isomerisation susceptibility of carotenoids in different tomato varieties. J Food Sci Agr. 2001;81(9):910–917.

* In this report, USDA Food Pattern and MyPlate refer to the 2000 kcal level.

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