1. Introduction
The latest report (2019) of the Supreme Audit Office (SAO) on the healthcare system in Poland shows that there is an urgent need for organisational changes. The importance of investing in the health of citizens through education and health prevention has been emphasised [
1]. According to the Lalonde’s concept (also known as The Health Field Concept), lifestyle has the greatest impact on human health [
2], and diet remains a key component of lifestyle. In Poland, following the guidelines of the National Centre for Nutrition Education, the food group that most significantly lowers the risk of lifestyle-associated diseases is vegetables, followed by fruit [
3]. The recent meta-analysis (2017) associated high intake of fruit and vegetables with a reduced risk of cardiovascular disease and cancers, among other diseases [
4], which is consistent with similar previous studies [
5,
6]. Authors estimated that 5.6 and 7.8 million premature deaths worldwide in 2013 could have resulted from fruit and vegetable intake below the recommended ranges [
4]. Moreover, recent results from two prospective cohort studies of US men and women and a meta-analysis of 26 cohort studies associated higher intake of fruit and vegetable with lower mortality, and the risk reduction plateaued at around five servings of fruit and vegetables per day [
7].
It is widely recognised that a person’s quality of life is closely correlated with one’s health status, and this so-called health-related quality of life (HQoL) should be further associated with nutrition. However, our understanding of this association remains incomplete, but both over- and malnutrition are known to be significantly associated with numerous disorders [
8]. The potential role of pharmacists in patients’ nutrition education has been numerously emphasised [
9,
10,
11,
12]. Adequate nutrition knowledge does not guarantee positive changes in eating behaviour [
13]; however, self-awareness of the importance of healthy dietary habits might be the first step towards eating behaviour improvement [
14]. On the other hand, Kelly et al. stressed that medical personnel with poor dietary habits were characterised by poorer physical and psychological well-being [
15], while Almogbel emphasised that pharmacists’ occupational stress has a negative impact on their quality of life, which consequently could have a potential role in perpetuating poor dietary habits [
16]. Hence, there is a perceived and continuous need to also implement occupational health promotion programs for healthcare workers [
17,
18].
Data regarding a direct association between the frequency of fruit and vegetable intake and HQoL in the healthcare workforce, including Polish and non-Polish pharmacists, is limited. However, based on indications from the general population, it is likely that better nutrition habits should be associated with a better HQoL [
19,
20,
21,
22,
23]. Thus, the aim of the present study was to estimate, using validated questionnaire tools, an association between dietary habits, such as vegetable and fruit consumption, in particular, and health-related quality of life, with Polish pharmacists as the study population.
4. Discussion
The multidimensional concept of health-related quality of life comprises those aspects of overall quality of life that can affect either physical or mental health [
31]. Numerous instruments have been developed to measure this, including the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) to evaluate the health-related quality of life [
24,
25,
32]. Our results showed a significant association between more frequent consumption of fruit and better physical and mental HQoL among Polish pharmacists. So far, many studies have indicated that consumption of plant-derived foods should indeed improve the quality of life in all its indicators [
19,
20]. Lately, Conner et al. also reported that consumption of fresh fruit and vegetables among young adults should provide psychological benefits in particular, even in the short term [
21]. Similarly, diets rich in fruit and vegetables were associated with lower psychological stress in young Saudi women [
22]. However, our results modestly related more frequent consumption of vegetables with higher scores in physical functioning and general health subdomains only.
However, our respondents declared generally higher consumption of both fruit and vegetables in comparison to the Polish population average and relatively high in comparison to populations of several European countries (
Table 6).
It may be assumed that Polish pharmacists’ nutritional habits at least partially correspond with current trends of the plant-based diet [
34]. The diet was proposed in 2019 by researchers of the EAT-Lancet Commission on Food, Planet, and Health. This nutrition model indicates that the daily ratio should include a variety of plant products, which in practice means mainly the consumption of fruit and vegetables, pulses, cereal products, nuts, and seeds [
34,
35]. It is important to note that this model of nutrition is highly recommended not only for health reasons but also for environmental (for example, greenhouse gas emissions coming from ovolactovegetarian and vegan diets are estimated to be around 35% and around 50% lower, respectively, than omnivore diets [
36]) and economic reasons [
37]. Good nutrition knowledge, which we previously reported among Polish pharmacists [
12], together with satisfactory eating behaviours, should also lay the foundations for successful nutrition education of patients.
There are numerous benefits of including fruit and vegetables in the diet. Most of them are potent sources of fibre, vitamins (especially C and A), electrolytes (especially potassium), and antioxidants, while being generally low in energy density. Fruit juices and potatoes are usually contained in separate nutritional categories, because of dietary directives to eat whole fruits and minimise consumption of foods high in fat and sodium (e.g., French fries). Although a boiled potato is a nutrient-dense food, a fried potato may constitute a substantial amount of fat and sodium to a diet [
23]. In our study, only 5.4% of respondents declared eating potatoes ≥ 1 time per day (excluding French fries and chips). In Poland, considering the amount of consumption, the sources of dietary fibre are mainly cereal products, which contribute about 54% of this component, whereas vegetables and potatoes together contribute about 33% [
38]. On the other hand, processing may even increase the fibre content of a product by removal of water. Fruit juices are not entirely devoid of fibre, and for example in the United Kingdom, 1 glass (150 mL) of fruit juice counts as one portion, but juice can only count as a maximum of 1 portion per day [
23]. According to WHO/FAO recommendations, an intake of 25 g of fibre per day allows the body to function properly [
39]. However, recent studies show that the average dietary fibre intake in Poland is 17.5 g/person/day in women and 20.9 g/person/day in men [
40]. Dietary fibre intake provides health benefits related to intestinal function, maintenance of or reduction in blood cholesterol levels, modulation of the postprandial glycaemic response [
41,
42,
43] or protection against various diseases [
44,
45], including cancers [
46,
47]. In our study, over 73% and 66% of pharmacists declared vegetable and fruit intake ≥1 time per day, respectively; however, the majority of respondents declared <1 per day consumption of canned or pickled vegetables as well as foods made from pulses, such as beans, peas, soybeans, lentils. Thus, overall eating habits may partly explain weak association between vegetable intake and general health as well as physical functioning domains only (with no association with other subdomains) despite the frequent consumption of vegetables in our study population.
Among our respondents, 40.6% of female and 30.1% of male pharmacists declared that they snack ≥1 time per day, and for almost half of those who snack, this included the consumption of sweet snacks, e.g., candies, cookies, cakes, chocolate bars, muesli bars, waffles. Unhealthy, energy-dense sugary and salty snacks are known to negatively impact on individuals’ well-being [
48]. Chiou et al. reported that participation in health promotion activities was related to healthier behaviours among hospital staff, but the level of participation was generally low among nurses, pharmacists, and physicians [
17]. According to scientific evidence, work-related outcomes can be positively influenced through more nuanced health promotion efforts (including workplace nutrition) [
49].
It is also worth noticing that pharmacists are vulnerable to professional burnout, and their professional quality of life has been found to be relatively low, especially in comparison to other medical professionals [
12,
16,
50]. The governmental workplace programs for pharmacists might positively contribute to their quality of work-life [
51]. Previously, we reported a relatively low mental HQoL among pharmacists, with the lowest median scores of the mental health domain among the youngest (below 30) respondents and 51- to 60-year-olds [
28]. Thus, considering a positive association between frequent intake of fruit and vegetables and all subdomains of the mental summary score, pharmacists should benefit from a regular and additional intake of fresh, high-quality fruit and vegetables at their workplace.
Limitations and Strengths of the Study
The KomPAN questionnaire is a qualitative food frequency questionnaire only, which limits its interpretation. What is more, the self-reported version used in our study is prone to inaccuracy, and reported values are subject to systematic (intake-related and person-specific) as well as random errors [
52]. Our analysis is only an illustration of some of the trends related to the eating habits of Polish pharmacists. The length of the entire survey with two self-reported versions of questionnaires resulted in diminished sample size due to incomplete data, and likely reduced the accuracy of the assessment. Detailed subtypes of fruits and vegetables and their serving sizes were not determined in our study, but attempts to link any particular food or nutrient to health or disease are generally limited. Thus, to assess direct health benefits or the health-related quality of life in relation to fruit and vegetable intake, prospective cohort studies would be most preferable. However, to our knowledge, this is the first study to examine associations between fruit and vegetable intake in relation to health-related quality of life among Polish pharmacists, using validated tools such as a culture-specific nutrition questionnaire [
26,
27] and RAND-SF-36 [
24,
25].