USDA’s Food Guide Pyramid visually depicts federal guidance for the number of servings needed in each of five food groups to provide a healthy diet. (See fig. 1.) For example, the Pyramid recommends eating from 2 to 4 servings of fruit and 3 to 5 servings of vegetables daily. The specific number of servings of fruits and vegetables is based on nutrient requirements and energy needs, which are associated with gender, age, and activity level. (See table 1.) For example, most children and many teenagers and adults should consume 7 servings daily—4 of vegetables and 3 of fruit. All federal nutrition education and food assistance programs are required to promote the Dietary Guidelines for Americans. USDA uses the guidelines and the Food Guide Pyramid as the science base for nutrition education efforts in the food assistance programs. Table 2 provides information on participation, benefits, and nutrition education funding for the Food Stamp Program, WIC, and the School Lunch and Breakfast Programs, as well as the WIC and seniors farmers’ market programs. USDA’s food assistance programs serve one in six Americans each year. As table 2 shows, in terms of funding, the Food Stamp Program is by far the largest, having over $17.8 billion in funding in fiscal year 2001. Slightly over half of the recipients are children, and about 20 percent are elderly or disabled. In terms of participation, the School Lunch and Breakfast Programs serve the greatest number of people (27.5 million and 7.8 million, respectively)—and are available to nearly 48 million school children. As a result of school meals, participants in these programs consume greater amounts of several important nutrients, such as calcium. WIC has seven food packages—three for pregnant or postpartum women, two for children, and two for infants. Depending on the package, WIC benefits may be used to purchase cereals, 100 percent fruit (or vegetable) juice, eggs, milk, cheese, peanut butter, dried beans, infant formula, tuna, and carrots. WIC serves about half of all infants and a quarter of all children from 1 through 4 years old in the United States. WIC is considered one of the most successful nutrition interventions, increasing birth weights and providing other health benefits. Regarding nutrition education, USDA provides the lion’s share of federal funding, although HHS, DOD, and other federal agencies fund nutrition education efforts as well. For food assistance participants, USDA obligated about $398 million toward nutrition education in fiscal year 2001. Nutrition education for WIC participants accounted for about half of USDA’s total nutrition education funding. As table 2 shows, funding per participant for nutrition education varied greatly—from $32 per WIC participant to less than $0.27 per child in the school meal programs. In fiscal year 2001 CDC spent $16.2 million for nutrition, obesity, and physical activity efforts; the National Cancer Institute spent $3.6 million for 5 A Day initiatives; DOD spent $3.5 million for nutrition education activities for the services. In addition to food assistance and nutrition education programs, other federal programs and policies—such as trade restrictions and environmental regulations—have the potential for affecting the consumption of fruits and vegetables. For example, trade restrictions in the form of tariffs on some fruits and vegetables result in higher prices that could reduce U.S. consumption of those fruits and vegetables. Likewise, environmental regulations limiting pesticides use may increase farm costs, which can reduce the quantities of fruits and vegetables sent to market, thereby increasing price and lowering consumption. However, the effect of trade restrictions and environmental regulations on farm-level prices would have to be substantial to have a large impact on consumption, because farm-level prices account for about one-third of retail prices for fruits and vegetables. Appendix III provides more detail on how these programs and regulations can affect fruit and vegetable consumption. The food “environment” is a major factor that affects the consumption of fruits and vegetables. The food environment includes prices set by retailers; access to and availability (year-round or seasonal) in local groceries, markets, and restaurants; the quality of fresh produce; the time available for shopping, preparation, and eating; and the ready availability, appeal, and advertising for and prices of other foods. Taste preferences and familiarity with foods of a particular culture are other important factors in food choices. Heart disease, cancer, stroke, and diabetes are among the leading causes of death for Americans. In fact, medical experts, including the Surgeon General, have noted that physical inactivity and poor diet—of which low consumption of fruits and vegetables is a key component—cause diseases that result in the death of more than 300,000 Americans each year.Studying the relationship between diet and chronic diseases is challenging because, among other things, it is difficult to measure and account for all potential risk factors; this challenge is compounded because chronic diseases may take many years to develop. However, extensive and consistent evidence shows that diet is one of the leading risk factors for these diseases. Although no diet can guarantee full protection against any disease, the recommendations from HHS and USDA and health organizations such as the American Cancer Society and American Heart Association indicate that consuming the recommended 5 to 9 daily servings of fruits and vegetables as part of a healthy diet provides some of the best dietary protection against disease. Research links increased fruit and vegetable consumption to reduction in the risk of heart disease and many types of cancer. Research also suggests their potential benefits for reducing the risk of stroke, diabetes, diverticulosis, and obesity, according to reviews by NIH, CDC, and academic experts. Fruits and vegetables are among the most concentrated natural sources of over 100 beneficial vitamins, minerals, and other dietary compounds such as fiber and antioxidants important to disease prevention. With regard to the specific health benefits of fruits and vegetables, studies show that people who consume 5 or more servings daily have about one-half the cancer risk of those who consume 2 or fewer servings, according to a National Institutes of Health report. That report also stated that, according to studies, diets high in fruits and vegetables are associated with a 20 to 40 percent reduction in the occurrence of coronary heart disease. Appendix IV describes some of the evidence that links fruit and vegetable consumption to reducing the risk for heart disease and cancer as well as possible links to reducing the risk for stroke, diabetes, obesity, and diverticulosis. Because it is not clear how single nutrients, combinations of nutrients, the over consumption of nutrients, or age affect one’s risk of specific diseases such as cancer, experts advise consuming a variety of fruits and vegetables to ensure an adequate intake of all known and as yet unidentified dietary compounds. A variety of deeply colored fruits, such as apricots, blueberries, and citrus fruits, and dark green or orange vegetables, such as spinach and carrots, are particularly rich in vitamins, minerals, antioxidants, other phytochemicals, and fiber. Under current federal policy, guidance, and nutrition education programs, the consumption of fruits and vegetables by the general public as a whole has increased somewhat, yet most Americans consume fruits and vegetables below recommended levels. The most widely recognized nutrition guidance—the Food Guide Pyramid graphic—does not clearly convey some important nutrition guidance that could help Americans close this consumption gap, and USDA is currently assessing the Pyramid for possible updates. In recognition of the diet shortfall in fruits and vegetables, HHS’s strategic plan identifies 5 A Day as one strategy for achieving its objective of improving the diet of Americans. Moreover, the April 2002 announcement by HHS and USDA to expand 5 A Day may further encourage Americans to consume the recommended 5 to 9 daily servings. Under federal policy and guidance—Dietary Guidelines for Americans, Healthy People 2010, and the Food Guide Pyramid—the consumption of fruits and vegetables has improved somewhat. Between the 1989-91 and 1994-96 time frames, the most recent years for which consumption data are available, fruit and vegetable consumption each increased by 0.2 serving (or nearly half a serving in total), such that the average consumption of fruits and vegetables is near the minimum recommended 5 servings a day. In addition to federal policy and guidance, USDA’s Economic Research Service points to the increased year-round availability of fruits and vegetables as another factor influencing consumption. Nonetheless, most Americans still fall short of consuming the recommended levels for health promotion and disease prevention. As table 3 shows, even with the increase, only 23 percent of Americans get their recommended servings of fruits, and 41 percent, their recommended servings of vegetables. According to USDA and NIH researchers, consumption of the deeply colored fruits and deep green or orange vegetables falls far short of what is recommended for disease prevention. USDA’s data for dark green or orange vegetables indicates that consumption increased by less than one- tenth of a serving between the 1989-91 and 1994-96 surveys. Indeed, only about 8 percent of Americans get the recommended daily 1 or more servings of dark green or orange vegetables. Moreover, only 3 percent of Americans get both the recommended number of servings of vegetables and at least 1 serving daily of a dark green or orange vegetable. There may be many reasons why the consumption of fruits and vegetables, particularly deeply colored ones, is low. For example, many people may not be aware of the importance of eating deeply colored fruits and vegetables. In addition, taste, price, and seasonal availability, among other factors, may affect consumption, as might the ready availability of other foods. Many Americans do not incorporate adequate variety into their daily diet. As noted earlier, eating a wide variety of fruits and vegetables is important because different fruits and vegetables are rich in different nutrients. For example, fruits such as apricots and blueberries, are excellent sources of protective phytochemicals and, although most citrus is consumed as juice, a fresh orange has 27 times the fiber content of orange juice.