Is Self‐Reported Fruit and Vegetable Consumption Associated with BioPhotonic Skin Scan Score in Women 40 Years and Older?
Authors: Graham Meredith L , Morgan Emily H , Seguin Rebecca A 
Published: November 2023

A dietary pattern rich in fruit and vegetables (FV) is essential to human health and yet only 13% of American adults eat the fruits recommended per day and only 9% eat the recommended vegetables per day. Considerable resources are spent on interventions aimed at increasing FV consumption. Dietary self‐report is a common assessment approach, however, it is time‐burdensome to participants and suffers from methodological challenges including notable bias and measurement error. Analysis of blood samples to examine FV consumption biomarkers is more reliable but is often not feasible in community interventions and large observational studies due to cost. Resonance Raman Spectroscopy (RRS), a relatively new biomarker assessment technology that measures carotenoid levels in the skin, demonstrated acceptable validity with serum and plasma carotenoid measures and is non‐invasive and less burdensome to participants. This study examines whether RRS as measured through the commercially available Pharmanex® BioPhotonic Scanner (S3) is associated with: (1) self‐reported measures of total FV vegetable as captured through the ASA‐24 online dietary recall or (2) with self‐reported cups of FV consumed daily through the baseline questionnaire.This study utilizes the baseline data collected in a community‐based diet and exercise intervention trial with 144 women who are 40 years and older, sedentary, overweight, and residing in rural medically underserved towns. The mean age of study participants is 58 years. The mean body mass index (BMI) of participants is 34.4 (31.0% overweight, 26.8% obese class 1, and 42.3% obese class 2). 113 women (78.5%) completed the baseline questionnaire and had four dietary recalls or more.The ASA‐24 captures total FV consumption per day. We calculated the mean across four days of self‐reported intake. We examined the correlation between the skin scan score and the following variables: 1) mean cups of fruit; 2) mean cups of vegetables; 3) combined FV consumption; and 4) whether consumption met the current recommendations (at least 1.5 cups for fruit and 2 cups for vegetables). The skin scan scores can range from 10,000 to 90,000 and the moderate fruit and vegetable consumption range is from 30,000 to 50,000. We also examined the dichotomous outcome of whether the skin scan score was above or below the midpoint of the moderate range (40,000) of the skin scan score. Analysis was completed in SAS version 9.2.Consumption of fruit and vegetables was generally low by all measures: 19.4% consumed adequate fruit and 20.8% consumed adequate vegetables as captured by the ASA24; 31.3% consumed recommended fruit and 36.8% consumed the recommended amount of vegetables as captured by the questionnaire; and 22.9% had the skin scan scores greater than 40,000.Skin scan scores of >40,000 were significantly associated with both the questionnaire and ASA‐24 recommended FV consumption (p<0.05). ASA‐24 recommended fruit consumption was significantly associated with skin scan scores ≥40,000 (p<0.05) and questionnaire recommended fruit consumption trended towards significance (p=0.11). ASA‐24 and questionnaire vegetable consumption was not associated with skin scan scores. In addition, ASA‐24 continuous variables were not associated with continuous skin scan scores.Additional understanding of the Pharmanex® BioPhotonic Scanner (S3) and its score equivalents, as well as validation of the commercial tool with carotenoid blood measures may be needed.Support or Funding InformationStrong Hearts, Healthy Communities is funded by the National Heart, Lung and Blood Institute. Grant Number: R01 HL120702

Less than 40,000 Skin Scan Score
40,000 or Greater Skin Scan Score

Online 24‐hour dietary recall (ASA‐24)

Less than 1.5 cups of fruit (p=.022)
94 (81%)
22 (19%)

1.5 or more cups of fruit
17 (61%)
11 (39%)

Less than 2 cups of vegetables (p=.95)
88 (77%)
26 (23%)

2 cups or more of vegetables
23 (77%)
7 (23%)

Less than 3.5 cups of fruits & vegetables (p=.044)
72 (85%)
13 (15%)

3.5 cups or more of fruits & vegetables
39 (66%)
20 (34%)

Baseline Questionnaire

Less than 1.5 cups of fruit (p=.12)
80 (81%)
19 (19%)

1.5 or more cups of fruit
31 (69%)
14 (31%)

Less than 2 cups of vegetables (p=.24)
73 (80%)
18 (20%)

2 cups or more of vegetables
38 (72%)
15 (28%)

Less than 3.5 cups of fruits & vegetables (p=.045)
81 (82%)
18 (18%)

3.5 cups or more of fruits & vegetables
30 (67%)
15 (33%)