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Hodder RK, O'Brien KM, Wyse RJ, Tzelepis F, Yoong S, Stacey FG, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2024; 9:CD008552. [PMID: 39312396 PMCID: PMC11418976 DOI: 10.1002/14651858.cd008552.pub8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-randomised controlled trials (C-RCTs) and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no-intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child-feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Seventeen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children only in increasing child fruit and vegetable intake and one each examined a child-focused mindfulness intervention or providing families with fruit and vegetable interventions. We judged nine of the 53 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is moderate-certainty evidence that child-feeding practice interventions versus no-intervention control probably have a small positive effect on child vegetable consumption, equivalent to an increase of 15.5 grams as-desired consumption of vegetables (SMD 0.44, 95% confidence interval (CI) 0.24 to 0.65; 15 trials, 1976 participants; mean post-intervention follow-up = 12.3 weeks). No trials in this comparison reported information about intervention costs. One trial reported no harms or serious unintended adverse consequences (low-certainty evidence). Multicomponent interventions versus no-intervention control probably have a small effect on child consumption of fruit and vegetables (SMD 0.27, 95% CI 0.11 to 0.43; 14 trials, 4318 participants; moderate-certainty evidence; mean post-intervention follow-up = 4.0 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. One trial, which tested a multicomponent garden-based intervention, reported the installation of the garden as part of the intervention to be USD 1500 per childcare centre (low-certainty evidence). No trials in this comparison reported information about unintended adverse consequences of interventions. Parent nutrition education interventions may have little to no short-term impact on child consumption of fruit and vegetables versus no-intervention control (SMD 0.10, 95% CI -0.02 to 0.22; 14 trials, 4122 participants; low-certainty evidence; mean post-intervention follow-up = 6.4 weeks). One trial reported the total estimated cost of delivering a parent nutrition education intervention for infant feeding, physical activity and sedentary behaviours delivered by a dietitian as approximately AUD 500 per family (low-certainty evidence). One trial reported no unintended adverse consequences on family food expenditure following implementation of an intervention delivered over the telephone to improve parental knowledge and skills about the home food environment (low-certainty evidence). Trials reported receiving governmental or charitable funds, except for one trial reporting industry funding. AUTHORS' CONCLUSIONS There was moderate-certainty evidence that child-feeding practice interventions and multicomponent interventions probably lead to only small increases in fruit and vegetable consumption in children aged five years and under. Parent nutrition education interventions may have little or no effect on increasing fruit and vegetable consumption in children aged five years and under. Future research should be prioritised on assessment and reporting of both intervention cost and adverse effects, and development and evaluation of interventions in research gaps, including in a broader range of settings and in low- and middle-income countries. This review continues to be maintained as a living systematic review with monthly searches for new evidence and incorporation of relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
| | - Serene Yoong
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
- Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Fiona G Stacey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
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Porter L, Chater AM, Haycraft E, Farrow C, Holley CE. Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families' use of evidence-based vegetable feeding practices. Appetite 2023; 189:106764. [PMID: 37442525 DOI: 10.1016/j.appet.2023.106764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: 'Child factors', 'Eating beliefs', 'Effectiveness beliefs', 'Past experience', 'Current family behaviours', 'Harms', 'Knowledge', 'Need for change', 'Parent effort', 'Parent values' and 'Practical issues'. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a "protective mindset" that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake.
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Affiliation(s)
- Lucy Porter
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Angel M Chater
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK; Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Claire Farrow
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Clare E Holley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
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Brunstrom JM, Flynn AN, Rogers PJ, Zhai Y, Schatzker M. Human nutritional intelligence underestimated? Exposing sensitivities to food composition in everyday dietary decisions. Physiol Behav 2023; 263:114127. [PMID: 36787811 DOI: 10.1016/j.physbeh.2023.114127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
The social and cultural significance of food is woven into every aspect of our dietary behaviour, and it contributes to our complex interaction with food. To find order within this complexity scientists often look for dietary 'universals' - phenomena or basic principles that guide our food choice and meal size, irrespective of wider context. One such idea is that taste characteristics provide a signal for dietary composition (e.g., sweet taste signals carbohydrate). Others have suggested that behaviour is guided by learning and is based on associations that form between the flavour of a food and its post-ingestive effects. Despite a large body of research, evidence supporting both processes is equivocal, leading some to conclude that humans are largely indifferent to food composition. Here, we argue that human abilities to gauge the nutritional composition or value of food have been underestimated, and that they can be exposed by embracing alternative methods, including cross-cultural comparisons, large nutrition surveys, and the use of virtual portion-selection tools. Our group has focused on assessments of food choice and expected satiety, and how comparisons across everyday foods can reveal non-linear relationships with food energy density, and even the potential for sensitivity to micronutrient composition. We suggest that these abilities might reflect a complex form of social learning, in which flavour-nutrient associations are not only formed but communicated and amplified across individuals in the form of a cuisine. Thus, rather than disregarding sociocultural influences as extraneous, we might reimagine their role as central to a process that creates and imbues a 'collective dietary wisdom.' In turn, this raises questions about whether rapid dietary, technological, and cultural change disrupts a fundamental process, such that it no longer guarantees a 'nutritional intelligence' that confers benefits for health.
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Affiliation(s)
- Jeffrey M Brunstrom
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston, NHS Foundation Trust and University of Bristol, United Kingdom.
| | - Annika N Flynn
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Yujia Zhai
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Mark Schatzker
- Modern Diet and Physiology Research Center, Affiliated with Yale School of Medicine, Yale University, United States
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Roe LS, Keller KL, Rolls BJ. Food Properties and Individual Characteristics Influence Children's Intake Across Multiple Days of Weighed Assessments in Childcare Programs. J Nutr 2023; 153:1646-1655. [PMID: 36965692 PMCID: PMC10367225 DOI: 10.1016/j.tjnut.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Because children often consume substantial proportions of their diets in childcare programs, it is critical to determine what they eat when served menus meeting dietary recommendations and how intake is related to individual characteristics. OBJECTIVES Using weighed assessments, we characterized children's consumption across 15 daily menus and investigated the relationship between properties of the food consumed and child characteristics. METHODS In 3 crossover trials in childcare centers that followed dietary guidelines, we provided and weighed all meals and snacks for 5 consecutive days. For this descriptive secondary analysis, we characterized primary outcomes (daily food weight, energy density, and energy intake) by including the most typical set of menus from each trial, yielding 603 daily intakes for 128 preschool children (15% with overweight or obesity). Physical activity was measured by accelerometry during childcare sessions. Children's appetitive traits were assessed by parental questionnaires. RESULTS Both food properties and child characteristics were related to daily intake. More food was consumed from menus with greater food weight, and the energy density of consumed food was greater from menus with higher energy density (both P < 0.0001); these menu differences resulted in greater energy intake (P = 0.009). Children with overweight and obesity had greater energy intake as a proportion of requirements than did children with healthy weight (113 ± 6% versus 101 ± 2%; P = 0.039). Vegetable intake was 39 ± 2% of the recommended amounts and boys had lower consumption than girls (P = 0.004). Children with appetitive traits of lower satiety responsiveness or higher food responsiveness had greater daily energy intake (both P < 0.003). CONCLUSIONS Weighed intakes showed that when children were served daily menus with substantial portions of foods that met dietary recommendations, they selectively consumed higher-energy-dense items and ate few vegetables. A particular concern was that children with overweight ate amounts that exceeded their energy needs. The trials were registered at clinicaltrials.gov (NCT02963987, NCT03010501, NCT03242863).
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Affiliation(s)
- Liane S Roe
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Kathleen L Keller
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States; Department of Food Science, The Pennsylvania State University, University Park, PA, United States
| | - Barbara J Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States.
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Bel-Serrat S, Klingenstein P, Marques-Previ M, Hennessy E, Murrin C. Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers. Physiol Behav 2023; 262:114074. [PMID: 36623744 DOI: 10.1016/j.physbeh.2023.114074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.
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Affiliation(s)
- Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | - Pauline Klingenstein
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Maria Marques-Previ
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Eilis Hennessy
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Celine Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Beals E, Deierlein A, Katzow M. Clinical interventions to increase vegetable intake in children. Curr Opin Pediatr 2023; 35:138-146. [PMID: 36385196 PMCID: PMC10241539 DOI: 10.1097/mop.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake. RECENT FINDINGS Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach. SUMMARY Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.
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Affiliation(s)
- Elizabeth Beals
- Cohen Children’s Medical Center at Northwell Health, Queens, New York, USA
| | | | - Michelle Katzow
- Cohen Children’s Medical Center at Northwell Health, Queens, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, New York, USA
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Chawner LR, Blundell-Birtill P, Hetherington MM. Parental intentions to implement vegetable feeding strategies at home: A cross sectional study. Appetite 2023; 181:106387. [PMID: 36427564 DOI: 10.1016/j.appet.2022.106387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
In order to increase vegetable intake by children, parents are encouraged to implement strategies that promote trying and eating vegetables at mealtimes. Qualitative studies have previously highlighted barriers parents face in implementing healthy eating practices, such as time, monetary costs and child factors (e.g. fussy eaters). This study aimed to specify the relationships between child and parent factors and their effects on parental intentions to implement vegetable feeding strategies at mealtimes. Parental intentions to implement meal service (serving larger portions, offering variety, serving vegetables first) and experiential learning (repeated exposure, games, sensory play) strategies were examined. Parents (N = 302, 73 male, Mage = 33.5) also explained reasons why certain strategies may or may not work for their child (4-7y). For both types of strategy, higher food fussiness of the child predicted higher parental intentions to implement strategies at home. However, this was competitively mediated by low beliefs that the strategy would work for their child, resulting in weaker overall positive effects on intentions. In the meal service model, parental beliefs that healthy eating is important for their child had a positive, indirect effect on higher intentions, through involved parental feeding practices. However, this was not significant in the experiential learning strategies model. Written parental responses suggest that this may be due to meal service approaches being viewed as easier to implement, with little additional effort required. Increasing parental confidence to implement strategies successfully and managing expectations around successful outcomes of strategies (e.g. tasting, eating) may be important focuses of future interventions to support parents implementing vegetable feeding strategies at mealtimes.
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Affiliation(s)
- L R Chawner
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK.
| | | | - M M Hetherington
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
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Implementation of four strategies in Dutch day-care centres to stimulate young children's fruit and vegetable consumption. Appetite 2023; 181:106378. [PMID: 36402413 DOI: 10.1016/j.appet.2022.106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
The day-care setting is an ideal place to encourage children's fruit and vegetable (=F&V) eating. Whereas many studies have focused on the effectiveness to increase F&V consumption, little is known about how to successfully implement effective strategies in daily practice. This study aimed to investigate how day-care professionals evaluated the implementation of a self-chosen strategy to support children's F&V eating. Thirteen day-care locations chose one out of five promising strategies and implemented this strategy for 10-12 weeks. Before (N = 98) and after the study (N = 49), day-care professionals completed a questionnaire to assess their implementation experiences, the impact on children's F&V eating as well as their future intention to use the strategy (on a 5-point scale). Parents (N = 152) completed a short questionnaire at the end of the study to capture their experiences and potential transfer effects to the home situation. Results showed that acceptability, appropriateness, feasibility and sustainability of the strategies were generally satisfactory (scores ≥3.5 on a 5-point scale), but the strategy of cooking scored less favourable on appropriateness and sustained implementation. Children's willingness to taste F&V varieties (3.4 ± 0.7 vs. 2.8 ± 0.8; p < 0.001) and eating pleasure for vegetables (3.4 ± 0.6 vs. 3.1 ± 0.8; p = 0.01) increased, whereas children's F&V consumption did not change (p > 0.14). Parents valued the day-cares' efforts to encourage children's F&V consumption and a small group (∼20%) experienced positive effects at home. This study shows that implementing a self-chosen F&V strategy at the day-care is acceptable, appropriate and feasible for day-care professionals and has potential to positively impact children's F&V eating behaviour. Future research should investigate the effects of long-term implementation on children's eating behaviour and examine how structural implementation can be further supported.
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Viera SB, Vivekanandan N, Cheney M, Le D, Lora KR. Hispanic caregivers' preferences for content, delivery methods, and sources of nutrition education from their child's preschool: Qualitative research findings. Nutr Health 2023:2601060221146321. [PMID: 36637248 DOI: 10.1177/02601060221146321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: With the obesity epidemic disproportionately affecting Hispanic children and preschool being a critical period when interventions may be effective to prevent it, nutrition education interventions in the preschool setting have the potential to stem obesity's spread. However, the nutrition education needs of low-income Hispanic populations and methods of delivery of that information require further exploration as culturally tailored approaches have seen limited reach to the target audience. Aim: To explore content, delivery methods, and sources of nutrition education that Hispanic caregivers prefer to receive from their child's preschool. Methods: Qualitative interviews with 25 self-identified Hispanic caregivers (≥18 years of age) of 3- to 5-year-old children at Head Start centers in the Washington, D.C., area. Caregivers were interviewed about preferred nutrition education topics, how nutrition education should be delivered, and by whom. Audio-recorded interviews were transcribed verbatim. Transcripts were analyzed using thematic analysis in NVivo v12. Results: Caregivers wanted to know about healthy foods and appropriate portion sizes to feed their children, fruit and vegetable feeding strategies, and how to incorporate Hispanic foods in healthy meals. Preferred delivery methods included receiving nutrition education and recipes in print and digital formats and in-person nutrition classes. Special Supplemental Nutrition Program for Women, Infants, and Children educators were regarded as trusted nutrition education sources. Conclusion: Tailored nutrition education messages combined with multiple delivery methods could be an effective way to reach Hispanic caregivers of preschoolers to increase their nutrition knowledge.
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Affiliation(s)
- Stacey B Viera
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
| | - Nikita Vivekanandan
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
| | - Marshall Cheney
- Department of Health and Exercise Science, 6187University of Oklahoma, Norman, OK, USA
| | - Daisy Le
- School of Nursing, Policy, Populations and Systems Community, 8367The George Washington University, Washington, DC, USA
| | - Karina R Lora
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
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Bel-Serrat S, von der Schulenburg A, Marques-Previ M, Mullee A, Murrin CM. What are the determinants of vegetable intake among adolescents from socioeconomically disadvantaged urban areas? A systematic review of qualitative studies. Int J Behav Nutr Phys Act 2022; 19:158. [PMID: 36572889 PMCID: PMC9793665 DOI: 10.1186/s12966-022-01396-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Evidence available on the determinants of vegetable intake in young populations is inconsistent. Vegetable intake is particularly low in adolescents from less-affluent backgrounds, yet no systematic review of qualitative studies investigating determinants for vegetable intake specifically has been conducted to date in this group. This systematic review aimed to identify determinants of vegetable intake in adolescents from socioeconomically disadvantaged urban areas located in very high-income countries reported in qualitative studies. METHODS Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO and ERIC) were searched until August 2022. The search strategy used combinations of synonyms for vegetable intake, adolescents, and qualitative methodologies. Main inclusion criteria were studies exploring views and experiences of motivators and barriers to vegetable intake in a sample of adolescents aged 12-18 years from socioeconomically disadvantaged urban areas in very high income countries. Study quality assessment was conducted using criteria established in a previous review. RESULTS Sixteen studies were included out of the 984 screened citations and 63 full texts. The synthesis of findings identified the following determinants of vegetable intake: sensory attributes of vegetables; psychosocial factors (nutrition knowledge, preferences/liking, self-efficacy, motivation); lifestyle factors (cost/price, time, convenience); fast food properties (taste, cost, satiety); home environment and parental influence; friends' influence; school food environment, nutrition education and teachers' support; and availability and accessibility of vegetables in the community and community nutrition practices. Studies attained between 18 and 49 out of 61 quality points, with eleven of 16 studies reaching ≥ 40 points. One main reason for lower scores was lack of data validation. CONCLUSION Multiple determinants of vegetable intake were identified complementing those investigated in quantitative studies. Future large scale quantitative studies should attempt to examine the relative importance of these determinants in order to guide the development of successful interventions in adolescents from socioeconomically disadvantaged backgrounds.
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Affiliation(s)
- Silvia Bel-Serrat
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
| | - Antje von der Schulenburg
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
| | - Maria Marques-Previ
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
| | - Amy Mullee
- grid.516689.50000 0005 0713 0550Department of Health and Nutritional Sciences, Atlantic Technological University, Sligo, Ireland
| | - Celine M Murrin
- grid.7886.10000 0001 0768 2743National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin, Ireland
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Masento NA, Dulay KM, Harvey K, Bulgarelli D, Caputi M, Cerrato G, Molina P, Wojtkowska K, Pruszczak D, Barlińska J, Messer D, Houston-Price C. Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers. Front Nutr 2022; 9:958245. [PMID: 36337641 PMCID: PMC9633668 DOI: 10.3389/fnut.2022.958245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.
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Affiliation(s)
- Natalie A. Masento
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Katrina May Dulay
- Department of Psychology, City, University of London, London, United Kingdom
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Marcella Caputi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Paola Molina
- Department of Regional & Urban Studies and Planning, University of Turin, Turin, Italy
| | | | | | | | - David Messer
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, United Kingdom
| | - Carmel Houston-Price
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
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12
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Thorsteinsdottir S, Njardvik U, Bjarnason R, Olafsdottir AS. Changes in Eating Behaviors Following Taste Education Intervention: Focusing on Children with and without Neurodevelopmental Disorders and Their Families: A Randomized Controlled Trial. Nutrients 2022; 14:4000. [PMID: 36235654 PMCID: PMC9571701 DOI: 10.3390/nu14194000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Fussy-eating children often display problematic behaviors around mealtimes, such as irritation, opposition, or may even throw tantrums. This may lead to reduced food variety and poor nutritional profiles, which may increase parents' worries about their children's diet, particularly when the children also have neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD). To investigate the effect of Taste Education on problematic mealtime behaviors, 81 children aged 8-12 years, with ND (n = 33) and without (n = 48), and their parents, participated in a 7-week Taste Education intervention. Children were matched on age, sex, and ND, and allocated at random into Immediate-intervention and Delayed-intervention groups. Parents completed the Meals in Our Household Questionnaire (MiOH). To examine changes in MiOH-scores, repeated-measures analysis-of-variance with time-points were used, with condition as factors (Immediate intervention and Delayed intervention). Baseline measures were adjusted for, and a robust linear mixed-model was fitted. Results showed superior outcomes for Intervention compared to waiting on all measures of MiOH, with stable effects through six-month follow-up. Differences were non-significant between children with and without ND. The Taste Education program suggests a promising, simple, and non-intrusive way to reduce children's problematic mealtime behaviors in the long term.
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Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
| | - Urdur Njardvik
- Faculty of Psychology, School of Health Sciences, University of Iceland, Saemundargata 12, 102 Reykjavik, Iceland
| | - Ragnar Bjarnason
- Faculty of Medicine, School of Health Sciences, University of Iceland, Laeknagardur 4th Floor, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland
- Department of Pediatrics, National University Hospital, Hringbraut, 101 Reykjavik, Iceland
| | - Anna S. Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
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13
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Hetherington MM, Chawner LR. From food preference development to responsive feeding - Selective studies to commemorate the life and work of Dr Leann Birch. Appetite 2022; 175:106051. [PMID: 35436532 DOI: 10.1016/j.appet.2022.106051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/02/2022]
Abstract
Dr Leann Birch was a pioneer in conducting research on infant and child eating behaviour. At the beginning of her research career, Leann recognised a significant gap in the developmental psychology literature, namely that few studies had been conducted to understand infant eating and feeding behaviours. This seems an unusual omission given that food intake is essential and that developmental milestones from milk to solids, and from being fed to becoming an autonomous eater, are obvious to most caregivers. Leann paved the way for interdisciplinary research from psychology, paediatrics and public health to explore and apply this knowledge to infant and child appetite, eating behaviour, dietary patterns, food preferences, and obesity risk. Early studies in her laboratory demonstrated that children form food preferences through experience and socialisation. Experiments published in 1979 tested the role of familiarisation through repeat exposure, and the impact of instrumental and social learning on the acquisition of food preferences. In 1984, a presentation given to the British Feeding and Drinking Group (BFDG) in Brighton set out three organising principles for understanding how children acquire food preferences: genetically pre-programmed behavioural propensities; social constraints on experience with food; and social transmission resulting from direct social interaction. Building on these three organising principles, research on child eating behaviour has flourished, including the intersection between individual differences, food experience and environmental influences on children's food preferences, energy regulation, and weight outcomes. In this review, the initial groundwork set out by Leann Birch on food preference development in children is considered followed by a discussion of how this has since inspired an interdisciplinary, international and expanding field of research on children's food intake, appetite and body weight regulation.
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Affiliation(s)
| | - Liam R Chawner
- School of Psychology, University of Leeds, Leeds, LS2 9JT, England, UK
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14
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Comino I, Soares P, Martínez-Milán MA, Caballero P, Davó-Blanes MC. School Fruit and Vegetables Scheme: Characteristics of Its Implementation in the European Union from 2009/10 to 2016/17. Nutrients 2022; 14:nu14153069. [PMID: 35893920 PMCID: PMC9370373 DOI: 10.3390/nu14153069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
The “School Fruit and Vegetables Scheme” (SFVS) was proposed in 2009/10 as a strategy to support the consumption of Fruit and Vegetables (FV), decrease rates of obesity, improve agricultural income, stabilize markets, and ensure the current and future supply of these foods. However, there is little information about how it was carried out in the EU. Given the potential of the SFVS to support healthier, more sustainable food systems, the objective of this study was to identify the characteristics of SFVS implementation from 2009/10 to 2016/17 in the EU. A longitudinal, observational, and retrospective study was carried out based on secondary data. A total of 186 annual reports of the Member States (MS) participating in the SFVS from 2009/10 to 2016/17 were consulted: European and national budget, funds used from the EU, participating schools and students, duration of the SFVS, FV offered, and application of sustainability criteria, expenditure per student, days of the week, the quantity of FV offered per student and other indicators were calculated. The majority of MS participated in the SFVS during the study period with a heterogeneous implementation pattern in terms of funds used, coverage, duration, quantity (totals and by portion), and cost of FV distributed per student. The sustainability criteria for the FV distribution were also not applied uniformly in all the MS. Establishing minimum recommendations for SFVS implementation are recommended to maximize the benefits of the SFVS. The results may be useful for planning new strategies to help address and improve current health and environmental problems.
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Affiliation(s)
- Iris Comino
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - Panmela Soares
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - María Asunción Martínez-Milán
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Correspondence:
| | - María Carmen Davó-Blanes
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain; (I.C.); (P.S.); (M.A.M.-M.); (M.C.D.-B.)
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
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15
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Preschoolers’ liking of citrus fruits served as a mid-morning snack. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.109159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Patel C, Walasek L, Karasouli E, Meyer C. Content and Validity of Claims Made about Food Parenting Practices in United Kingdom Online News Articles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095053. [PMID: 35564446 PMCID: PMC9105157 DOI: 10.3390/ijerph19095053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
The objective of this study was to qualitatively summarise the content of online news articles pertaining to food parenting practices and determine whether this content is substantiated by the scientific literature. News article data were identified and collected from United Kingdom online news published during 2010–2017 period using the News on the Web corpus. A coding framework was used to categorise the content of news articles to identify information related to food parenting practices. Then, claims made about food parenting practices were extracted from relevant news articles. Each claim was evaluated to determine the extent to which any claims were supported by the available scientific research evidence. The study identified ten claims across thirty-two relevant online news articles. Claims made across the news articles reported on the following food parenting practices: food restrictions, food-based threats and bribes, pressure to eat, use of food to control negative emotions, food availability, food preparation, and meal and snack routines. Eight out of the ten claims identified did not refer to scientific research evidence. News articles frequently lacked detail and information to explain to readers why and how the use of certain food parenting practices could have a lasting impact on children’s health outcomes. Considering the influence that news media has on parents, the reporting of food parenting practices in news articles should aim to provide a balanced view of the published scientific evidence and recognise the difficulties and barriers that prevent the use of helpful and healthy food parenting practices. The study results in this paper could be used to aid and structure of the dissemination of food parenting practice research findings in the media, inform public health education to influence perceptions of unhelpful food parenting practices, and promote parental use of responsive food parenting practices.
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Affiliation(s)
- Chloe Patel
- Warwick Manufacturting Group, Behaviour and Wellbeing Science, University of Warwick, Coventry CV4 7AL, UK;
- Correspondence:
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK;
| | - Eleni Karasouli
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
| | - Caroline Meyer
- Warwick Manufacturting Group, Behaviour and Wellbeing Science, University of Warwick, Coventry CV4 7AL, UK;
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17
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Brunstrom JM, Schatzker M. Micronutrients and food choice: A case of 'nutritional wisdom' in humans? Appetite 2022; 174:106055. [PMID: 35447161 DOI: 10.1016/j.appet.2022.106055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/25/2022]
Abstract
Many reports show that non-human animals have the ability to select foods based on their micronutrient composition. However, it is unclear whether humans also have this ability, and we have lacked appropriate methods to investigate this question. In response to this challenge, we developed an approach that derives evidence from patterns of choices across a range of food images. In two studies (Study 1, N = 45; Study 2, N = 83) adults selected one of two pairs of fruits and vegetables in a series of trials (N = 210). Consistent with variety seeking, they preferred 'varied' over 'monotonous' pairs (same-food pairs were less attractive). However, and even after controlling for explicit nutritional knowledge (Study 2) and food energy density (Study 1 and 2), we observed a significant tendency to select pairings that offered: i) greater total micronutrient intake and ii) greater 'micronutrient complementarity' (MC), i.e., a broader range of micronutrients. In a separate analysis, a similar pattern was observed in two-component meals (e.g., steak and fries) drawn from a large national nutrition survey in the UK (1086 records). Specifically, the MC of these meals was greater than would be predicted by chance (p < .0001) and when a meal provided an excess of micronutrients (>100% daily recommended amount) then this occurred less often than by chance (p < .0001), i.e., 'micronutrient redundancy' was avoided. Together, this work provides new evidence that micronutrient composition influences food choice (a form of 'nutritional wisdom') and it raises questions about whether nutritional requirements are otherwise met through dietary 'variety seeking'. In turn, it also exposes the potential for a complexity in human dietary decision making that has not been recognised previously.
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Affiliation(s)
- Jeffrey M Brunstrom
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, UK.
| | - Mark Schatzker
- Modern Diet and Physiology Research Center, Affiliated with Yale School of Medicine, Yale University, USA
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18
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School lunch acceptance in pre-schoolers. Liking of meals, individual meal components and quantification of leftovers for vegetable and fish dishes in a real eating situation in Italy. Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Jarman M, Edwards K, Blissett J. Influences on the dietary intakes of preschool children: a systematic scoping review. Int J Behav Nutr Phys Act 2022; 19:20. [PMID: 35193587 PMCID: PMC8862251 DOI: 10.1186/s12966-022-01254-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022] Open
Abstract
Background Better diet quality of preschool children is associated with many important health outcomes, but there is significant room for improvement in many children’s dietary intakes. The determinants of children’s dietary intakes are complex and whole systems approaches may be effective tools for changing dietary intake. Collation of all the evidence available on determinants of preschool children’s dietary intake is necessary to ‘map’ the whole system of influence. Therefore, this systematic scoping review of available literature on determinants of dietary intakes in preschool children was undertaken. Methods The Joanna Briggs Institute methods for conducting a systematic scoping review were followed. Articles published since 2000 which assessed influences on the dietary intakes of preschool children were identified, yielding a total of 246 papers. Studies of children with clinical conditions (excluding obesity), or those conducted in middle and low-income countries were excluded, due to the different systems of influence in these populations. Data were extracted and information synthesised based on ecological level (child, parent, household, childcare, or wider determinants). Results Most articles focused on influences at the parental level (n = 118, 48%), followed by those at the child level (n = 73, 30%). Most of the studies were of cross-sectional design (n = 109, 44%). Whilst many studies considered influences at multiple ecological levels (n = 63, 26%) few analyses determined interactions between factors in their relationship with children’s dietary intakes, which is needed going forward using systems methods. Conclusion A wealth of evidence exists examining influences on the dietary intakes of preschool children and this information would benefit from analysis using a systems thinking approach in order to assess effective levers for intervention and what works, for whom, under what circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01254-8.
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Affiliation(s)
- M Jarman
- School of Psychology, College of Health and Life Sciences, and Institute of Health and Neurodevelopment, Aston University, Birmingham, UK.
| | - K Edwards
- School of Psychology, College of Health and Life Sciences, and Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - J Blissett
- School of Psychology, College of Health and Life Sciences, and Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
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20
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de Scudine KG, de Freitas CN, de Moraes KSGN, Prado DA, Silveira PP, Castelo PM. Evaluation of masticatory behavior and taste sensitivity after pacifier removal in preschool children: a 1-year follow-up. Clin Oral Investig 2022; 26:4059-4070. [PMID: 35147790 DOI: 10.1007/s00784-022-04374-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to investigate the influence of pacifier removal on the development of masticatory function and taste sensitivity in preschool children. METHODS Sixty children (mean age 48.2 months) were divided into two groups: pacifier group (n = 28) and a control group (n = 32), which were evaluated and followed up for a period of 12 months (at baseline, 6 months, and 1 year). Masticatory and swallowing functions were assessed using the Mastication Observation and Evaluation (MOE) protocol and Orofacial Myofunctional Rating (MBGR), respectively. Detection thresholds for sucrose and urea were measured by the staircase method. The two-way ANOVA mixed model was used for time*group interaction analysis. RESULTS MOE scores improved significantly over time in both groups, although a significant difference between groups persisted after 1 year. On the other hand, swallowing scores were significantly different at baseline, but within 1 year, the scores were no longer different between groups. Chewing time and the number of cycles were not different between groups and both decreased after 1 year. Sucrose sensitivity was significantly greater in the control group at baseline and changed over time (p < 0.05), being no longer different between groups after 6 months. Bitter sensitivity did not differ over time nor between groups. CONCLUSIONS Detection threshold for sucrose differed significantly between children with and without pacifier habit at a mean age of 42 months. Total masticatory function did not self-correct after sucking habit removal within a 1-year period. CLINICAL RELEVANCE Children with pacifier habit showed important changes in masticatory function that did not self-correct 1 year after cessation of the habit, highlighting the need for prevention and habit interruption as early as possible.
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Affiliation(s)
- Kelly Guedes de Scudine
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Camila Nobre de Freitas
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | | | - Daniela Almeida Prado
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, SP, 13414-903, Brazil
| | - Patrícia Pelufo Silveira
- Douglas Mental Health University Institute, McGill University, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
| | - Paula Midori Castelo
- Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Campus Diadema, R. São Nicolau, 210, Diadema, SP, 09913-030, Brazil.
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21
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Poelman AAM, Heffernan JE, Cochet-Broch M, Beelen J. Development and Proof-of-Concept Evaluation of a Sensory Science-Based Model for Product Development of Vegetable-Based Products for Children. Foods 2021; 11:96. [PMID: 35010224 PMCID: PMC8750587 DOI: 10.3390/foods11010096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 01/21/2023] Open
Abstract
Children's vegetable intake is too low, and a key barrier to the inadequate intake is low acceptance. To facilitate successful development of new vegetable-based products for children, a sensory science approach to product development has been taken. A new theoretical model is proposed, the CAMPOV model: Children's Acceptance Model for Product development of Vegetables. The model is informed by scientific literature and considers biological, psychological, and situational, and intrinsic and extrinsic product factors relevant to children's acceptance of vegetables, with a focus on modifiable factors at the product level. Simultaneously, 14 new vegetable-based product concepts for children were developed and evaluated through focus groups with 5-8-year-olds (n = 36) as a proof-of-concept evaluation of the model. Children had high interest in six of the concepts. Factors identified from the literature that positively associated with the children's interest in the concepts included bright colours, bite-sized pieces, good taste, fun eating experience, and familiarity. The CAMPOV model and proof-of-concept evaluation results can guide further sensory and consumer research to increase children's acceptance of food products containing vegetables, which will in turn provide further insights into the validity of the model. The food industry can use the model as a framework for development of new products for children with high sensory appeal.
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Affiliation(s)
- Astrid A. M. Poelman
- Sensory and Consumer Science, CSIRO Agriculture and Food, North Ryde, NSW 2113, Australia; (J.E.H.); (M.C.-B.); (J.B.)
- CSIRO Health & Biosecurity, North Ryde, NSW 2113, Australia
| | - Jessica E. Heffernan
- Sensory and Consumer Science, CSIRO Agriculture and Food, North Ryde, NSW 2113, Australia; (J.E.H.); (M.C.-B.); (J.B.)
| | - Maeva Cochet-Broch
- Sensory and Consumer Science, CSIRO Agriculture and Food, North Ryde, NSW 2113, Australia; (J.E.H.); (M.C.-B.); (J.B.)
| | - Janne Beelen
- Sensory and Consumer Science, CSIRO Agriculture and Food, North Ryde, NSW 2113, Australia; (J.E.H.); (M.C.-B.); (J.B.)
- CSIRO Health & Biosecurity, North Ryde, NSW 2113, Australia
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22
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Blomkvist EAM, Wills AK, Helland SH, Hillesund ER, Øverby NC. Effectiveness of a kindergarten-based intervention to increase vegetable intake and reduce food neophobia amongst 1-year-old children: a cluster randomised controlled trial. Food Nutr Res 2021; 65:7679. [PMID: 34776826 PMCID: PMC8559443 DOI: 10.29219/fnr.v65.7679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/10/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Children's first years of life are crucial to their future health. Studies show that a varied diet with a high intake of vegetables is positive in several domains of health. The present low vegetable intake amongst children is, therefore, a concern. Food neophobia is a common barrier to vegetable intake in children. As most Norwegian children attend kindergarten from an early age, kindergartens could contribute to the prevention of food neophobia and the promotion of vegetable intake. Objective The aim of this study was to assess the effect of a cluster randomised trial amongst 1-year-old children in kindergarten to reduce food neophobia and promote healthy eating. Methods Kindergartens were randomly allocated to either a control group or one of two intervention groups. Both intervention groups (diet and diet + Sapere-method) were served a warm lunch meal including three alternating intervention vegetables, whilst the intervention group 2 (diet + Sapere) in addition received tools for weekly sensory lessons. The intervention was digitally administered via information and recipes on a study website. The control group did not receive any information. Parents completed digitally distributed questionnaires addressing food neophobia and food habits at baseline and post-intervention. Results The parents of 144 1-year-old children in 46 kindergartens completed the questionnaires, which were included in the main analysis. The results suggested a higher intake of the intervention vegetables in group 2 (diet + Sapere) compared to the control group. The effect on total vegetable intake was inconclusive. No effect was observed on the level of food neophobia in either of the intervention group. Conclusion This digitally delivered dietary and sensory intervention promoted the intake of intervention-targeted vegetables with inconclusive effect on total vegetable intake due to large loss to follow-up. No effect on the level of food neophobia was detected.
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Affiliation(s)
- Eli Anne Myrvoll Blomkvist
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Andrew K Wills
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.,Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Sissel Heidi Helland
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Elisabet Rudjord Hillesund
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina Cecilie Øverby
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Mena NZ, Johnson SL, Ferrante MJ, Hobbs SJ, Zeng N, Bellows LL. The SPORKS For Kids: Integrating Movement Into Nutrition Education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:903-906. [PMID: 34393065 DOI: 10.1016/j.jneb.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Noereem Z Mena
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mackenzie J Ferrante
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Savannah J Hobbs
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Nan Zeng
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO; Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Laura L Bellows
- Divison of Nutritional Sciences, Cornell University, Ithaca, NY.
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Opie RS, Zheng M, Torres S, Campbell K. The impact of maternal post-partum depressive symptoms on child diet at 18 months. MATERNAL & CHILD NUTRITION 2021; 17:e13187. [PMID: 34323001 PMCID: PMC8476412 DOI: 10.1111/mcn.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
Post-partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post-partum (baseline) on child diet at 18 months of age (follow-up). This study used longitudinal data from 263 first-time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Women self-reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale [CES-D]) and child diet (fruits, vegetables and discretionary foods). Multiple linear regression analyses were used to explore the relationship between maternal depressive symptoms at baseline and child fruit and vegetable intake and discretionary food intake (g day-1 ) at follow-up. Baseline maternal depressive symptoms were associated with higher childhood consumption of discretionary foods at 18 months of age (β = 0.45, 95% confidence interval [CI] 0.03 to 0.87, P = 0.034 [adjusted]). There was no evidence of association for maternal depressive symptoms and child intake of fruits and vegetables. Further longitudinal studies are warranted to confirm these findings, with the hope of translating this knowledge into optimal clinic care and improved physical and mental health for mother and child.
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Affiliation(s)
- Rachelle S. Opie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Susan Torres
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
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25
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Holley CE, Haycraft E. Mothers' perceptions of self-efficacy and satisfaction with parenting are related to their use of controlling and positive food parenting practices. MATERNAL AND CHILD NUTRITION 2021; 18:e13272. [PMID: 34528391 PMCID: PMC8710089 DOI: 10.1111/mcn.13272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/11/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Perceptions of parenting competence are composed of self‐efficacy and satisfaction with parenting. Parenting competence is linked to differential outcomes across numerous parenting domains. To date, few studies have explored the relationships between maternal self‐efficacy and food parenting practices, deploying different measures and age ranges, and yielding conflicting findings. Therefore, the current study sought to explore relationships between the two dimensions of perceived parenting competence and the use of controlling and positive food parenting practices. UK mothers (N = 269) of 18‐ to 59‐month‐old children completed measures of both dimensions of perceived parenting competence (i.e., parenting self‐efficacy and satisfaction) and of controlling (maladaptive) and positive (health promoting) food parenting practices. Relationships were found between perceptions of competence and use of food parenting practices. Self‐efficacy and satisfaction with parenting were positively associated with the use of most positive food parenting practices. Greater parenting satisfaction, but not parenting efficacy, was associated with lower use of some of the potentially detrimental controlling food parenting practices. Neither parenting self‐efficacy nor satisfaction with parenting were related to mothers' reported use of pressure to eat. In conclusion, supporting and promoting greater maternal self‐efficacy and satisfaction with parenting may be a useful target for public health interventions and for professionals working with families with the aim of promoting optimal parenting to support children's development of healthy eating habits. Future research should seek to further elucidate the current findings with a longitudinal design.
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Affiliation(s)
- Clare E Holley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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26
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Caputi M, Dulay KM, Bulgarelli D, Houston-Price C, Cerrato G, Fanelli M, Masento NA, Molina P. See & Eat! Using E-books to Promote Vegetable Eating Among Preschoolers: Findings From an Italian Sample. Front Psychol 2021; 12:712416. [PMID: 34512470 PMCID: PMC8430236 DOI: 10.3389/fpsyg.2021.712416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Different strategies have been developed to help parents with introducing new or disliked vegetables. Nonetheless, many parents of preschoolers struggle against children's refusal to eat vegetables. In this study, we aimed to evaluate the effectiveness of e-books in promoting positive attitudes toward vegetables through repeated visual exposures. A total of 61 families with preschoolers joined the See & Eat study and received an e-book about one of two vegetables chosen from a list of 24. Parents provided ratings of children's willingness to taste, intake, and liking of the chosen vegetables before and after reading the e-book; parents also evaluated their children's food fussiness and their agreement with respect to three mealtime goals of the family. Using a 2 (vegetable: target or non-target) × 2 (time: pre-test or post-test) within-subjects analysis, results from 53 families revealed a significant increase in children's willingness to taste, intake, and liking at post-test of both target and non-target vegetables. Following a two-week parent-child e-book reading intervention, children's food fussiness and parents' endorsement of positive mealtime goals slightly but significantly increased. Results suggest that e-books are effective in encouraging healthy eating among preschoolers and that the positive effect of e-book reading can generalize to other vegetables.
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Affiliation(s)
- Marcella Caputi
- Department of Psychology, Università degli Studi di Torino, Torino, Italy.,Sigmund Freud University, Milano, Italy
| | - Katrina May Dulay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom.,Department of Education, University of Oxford, Oxford, United Kingdom
| | | | - Carmel Houston-Price
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Giuseppina Cerrato
- Department of Chemistry, Università degli Studi di Torino, Torino, Italy
| | - Mauro Fanelli
- Department of Chemistry, Università degli Studi di Torino, Torino, Italy
| | - Natalie A Masento
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Paola Molina
- Department of Psychology, Università degli Studi di Torino, Torino, Italy.,Interuniversity Department of Regional and Urban Studies and Planning, Università degli Studi di Torino, Torino, Italy
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27
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Glenn ME, Patlan K, Connor P, Stidsen C, Ball S, Peterson KE, Olsho LEW, Gola AAH, Copeland KA. Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days. J Acad Nutr Diet 2021; 122:1141-1157.e3. [PMID: 34455104 DOI: 10.1016/j.jand.2021.08.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early-child-care (ECE) programs may substantially influence child diet quality. OBJECTIVE The Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days. DESIGN Meal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs. PARTICIPANTS/SETTING One thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017. MAIN OUTCOME MEASURES Daily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations. STATISTICAL ANALYSES PERFORMED Regression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days. RESULTS Mean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats. CONCLUSIONS Although there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.
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Affiliation(s)
| | | | - Patricia Connor
- Abt Associates, Cambridge, Massachusetts; Independent Child Nutrition Research Consultant, Massachusetts
| | - Chantal Stidsen
- Abt Associates, Cambridge, Massachusetts; Mathematica, Cambridge, Massachusetts
| | - Sarah Ball
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Alice Ann H Gola
- US Department of Agriculture Food and Nutrition Service, Alexandria, Virginia; Westat, Rockville, Maryland
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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28
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Chawner LR, Hetherington MM. Utilising an integrated approach to developing liking for and consumption of vegetables in children. Physiol Behav 2021; 238:113493. [PMID: 34116053 DOI: 10.1016/j.physbeh.2021.113493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
Children eat too few vegetables and this is attributed to disliked flavours and texture as well as low energy density. Vegetables confer selective health benefits over other foods and so children are encouraged to eat them. Parents and caregivers face a challenge in incorporating vegetables into their child's habitual diet. However, liking and intake may be increased through different forms of learning. Children learn about vegetables across development from exposure to some vegetable flavours in utero, through breastmilk, complementary feeding and transitioning to family diets. Infants aged between 5 and 7 m are most amenable to accepting vegetables. However, a range of biological, social, environmental and individual factors may act independently and in tandem to reduce the appeal of eating vegetables. By applying aspects of learning theory, including social learning, liking and intake of vegetables can be increased. We propose taking an integrated and individualised approach to child feeding in order to achieve optimal learning in the early years. Simple techniques such as repeated exposure, modelling, social praise and creating social norms for eating vegetables can contribute to positive feeding experiences which in turn, contributes to increased acceptance of vegetables. However, there is a mismatch between experimental studies and the ways that children eat vegetables in real world settings. Therefore, current knowledge of the best strategies to increase vegetable liking and intake gained from experimental studies must be adapted and integrated for application to home and care settings, while responding to individual differences.
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Affiliation(s)
- L R Chawner
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
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29
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Kristiansen AL, Himberg-Sundet A, Bjelland M, Lien N, Holst R, Andersen LF. Exploring intervention components in association with changes in preschool children's vegetable intake: the BRA-study. BMC Res Notes 2021; 14:214. [PMID: 34059115 PMCID: PMC8165990 DOI: 10.1186/s13104-021-05629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The present study aimed to explore kindergarten staffs’ perceived usefulness of intervention components in association with changes in children’s vegetable intake and vegetables served in the kindergarten. Assessment of the perceived usefulness of intervention components consisted of a paper-based questionnaire for the kindergarten staff assessing usefulness of posters, supplementary material and 1-day inspirational course. Children’s vegetable intake in the kindergarten was assessed by direct observation, while vegetables served was assessed by a 5-day weighted vegetable diary. Results Seventy-three kindergartens in two counties in Norway participated (response rate 15%) and parental consent was obtained for 633 children 3–5 years of age at baseline (response rate 39%). Mixed effect models indicated a tendency that posters were associated with increased child vegetable intake (P = 0.062). Surprisingly, a low degree of perceived usefulness of supplementary material was associated with the largest increase in child vegetable intake (P = 0.020). No significant associations between perceived usefulness of intervention components and vegetables served in the kindergarten were found. This study indicated a tendency that posters were associated with increased child vegetable intake; however, this may also be due to synergies between multiple intervention components. Trial registration International Standard Randomized Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05629-1.
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Affiliation(s)
- Anne Lene Kristiansen
- Faculty of Humanities, Sports and Educational Science, Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, PO Box 235, 3603, Kongsberg, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway.
| | - Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
| | - René Holst
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1122, 0317, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
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30
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Bell LK, Gardner C, Tian EJ, Cochet-Broch MO, Poelman AAM, Cox DN, Nicklaus S, Matvienko-Sikar K, Daniels LA, Kumar S, Golley RK. Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews. Am J Clin Nutr 2021; 113:1282-1300. [PMID: 33693488 DOI: 10.1093/ajcn/nqaa384] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many children worldwide do not eat recommended amounts of vegetables. Disliking vegetables is a key factor associated with low intake. OBJECTIVE This umbrella review synthesized systematic reviews to determine the effectiveness of sensory and behavioral strategies to facilitate liking of vegetables (primary outcome) in young children up to 5 y of age, as key predictors of vegetable intake (secondary outcome). METHODS Nine databases were searched up to May 2019 (updated in September 2020). Two reviewers independently conducted study screening and selection, data extraction, and assessment of methodological quality using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Eleven reviews (n = 1 rated strong quality, n = 4 moderate quality, n = 6 low/critically low quality) examining 85 primary studies met the review criteria: systematic reviews and meta-analyses of primary studies (any quantitative design) that examined sensory or behavioral strategies on vegetable liking or intake (outcomes reported separately for children ≤5 y). Strategy effectiveness was synthesized into 3 categories based on evidence strength: 1) promising (large and consistent body of moderate quality evidence), 2) emerging (small to moderate body of mixed consistency and quality evidence), and 3) limited (small body of limited consistency and quality evidence). RESULTS Promising evidence was identified for repeated exposure to a single or a variety of vegetables. Emerging evidence was identified for several strategies that increase familiarity with vegetable flavors (e.g., via exposure in utero and through breast milk, and a "vegetable first" approach to complementary feeding) and/or willingness to try vegetables (e.g., via parental role modeling, nonfood rewards, and vegetable-based story books). CONCLUSIONS Current evidence supports incorporation of tailored advice into guideline documents for parents and carers to repeatedly expose their children to a variety of vegetables to increase vegetable intake. Ongoing robust research on strategies to facilitate children's liking of vegetables is warranted to strengthen the evidence base underpinning advice for parents and health professionals.
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Affiliation(s)
- Lucinda K Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Claire Gardner
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Esther J Tian
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Maeva O Cochet-Broch
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, North Ryde, Sydney, Australia
| | - Astrid A M Poelman
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, North Ryde, Sydney, Australia
| | - David N Cox
- CSIRO Health and Biosecurity, Adelaide, Australia
| | - Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | | | - Lynne A Daniels
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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31
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Bell LK, Gardner C, Kumar S, Wong HY, Johnson B, Byrne R, Campbell KJ, Liem DG, Russell C(G, Denney-Wilson E, Netting M, Bishop L, Cox DN, Poelman AAAM, Arguelles J, Golley RK. Identifying opportunities for strengthening advice to enhance vegetable liking in the early years of life: qualitative consensus and triangulation methods. Public Health Nutr 2021; 25:1-16. [PMID: 33934739 PMCID: PMC9991732 DOI: 10.1017/s1368980021001907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences. DESIGN A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70 % agreement) on thirty evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children's vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice. SETTING Australia. PARTICIPANTS A purposeful sample of key stakeholders (NGT workshop, n 8 experts; Delphi survey, n 23 end users). RESULTS Participant consensus identified the most highly ranked priority messages associated with the strategies of: 'in-utero exposure' (perinatal and lactation, n 56 points) and 'vegetable variety' (complementary feeding, n 97 points; family diet, n 139 points). Triangulation revealed two strategies ('repeated exposure' and 'variety') and their associated advice messages suitable for policy and practice, twelve for research and four for food industry. CONCLUSIONS Supported by national and state feeding guideline documents and resources, the advice messages relating to 'repeated exposure' and 'variety' to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
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Affiliation(s)
- Lucinda K Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
| | - Claire Gardner
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Hoi Y Wong
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
| | - Brittany Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Djin Gie Liem
- Deakin University, CASS Food Research Centre, School of Exercise and Nutrition Sciences, Faculty of Health, Burwood, VIC, Australia
| | - Catherine (Georgie) Russell
- Deakin University, CASS Food Research Centre, School of Exercise and Nutrition Sciences, Faculty of Health, Burwood, VIC, Australia
| | - Elizabeth Denney-Wilson
- Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, NSW, Australia
| | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Nutrition Department, Women’s and Children’s Health Network, North Adelaide, SA, Australia
| | - Lola Bishop
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David N Cox
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, SA, Australia
| | - Astrid AAM Poelman
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, North Ryde, NSW, Australia
| | | | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
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32
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Sattar N, Forouhi NG. More Evidence for 5-a-Day for Fruit and Vegetables and a Greater Need for Translating Dietary Research Evidence to Practice. Circulation 2021; 143:1655-1658. [PMID: 33900834 DOI: 10.1161/circulationaha.121.053293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (N.S.)
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, United Kingdom (N.G.F.)
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33
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Karagiannaki K, Ritz C, Andreasen DS, Achtelik R, Møller P, Hausner H, Olsen A. Optimising Repeated Exposure: Determining Optimal Stimulus Shape for Introducing a Novel Vegetable among Children. Foods 2021; 10:foods10050909. [PMID: 33919238 PMCID: PMC8143140 DOI: 10.3390/foods10050909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
Although it is well evident that a healthy diet rich in fruit and vegetables could prevent a number of major chronic diseases, national and international guidelines concerning their intake are not being reached by a large percentage of the population, including children. Thus, it is of interest to investigate how the consumption of this food group by children could be increased. The aim of this study was to examine the impact of serving style on the consumption of a raw snack vegetable (daikon) and the influence of its exposure on liking and intake of the vegetable. A group of 185 children 3–5 years old participated in the study. Two kindergartens served as intervention groups, while the third was assigned to be the control group of the study (n = 50). The intervention groups were repeatedly exposed to one of three different serving styles of daikon: sticks (n = 42), triangles (n = 46) or grated (n = 47), and they were all visited 7 times during the exposure period, on the same frequency (twice per week). Familiarity and liking of the target vegetable, daikon, and six other vegetables (cucumber, celery, celeriac, broccoli, cauliflower and beetroot) were measured at baseline, post-intervention and two follow up sessions (3- and 6-month) to investigate the likelihood of generalisation effects. Intake of daikon was measured at all control sessions and exposures. Moreover, children were asked to rank their favourite serving style of daikon and beetroot, among triangle, stick and grated, towards understanding the influence of shape on the efficacy of the exposure. The results revealed significant changes between liking and intake of daikon for the groups of triangles and sticks and the control group (p < 0.05). The group that received grated daikon did not show significant differences in liking and at intake levels during the exposures but performed well in the long-term. Throughout the exposure period, intake levels followed an overall increasing pattern, with all the groups to demonstrate a decrease of their intake at the last session, which was not found significant for the triangle group. Mere exposure was efficient towards increasing liking and intake of the novel vegetable with all the shapes to deliver positive results, but based on this study no particular serving style can be recommended.
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Affiliation(s)
- Klelia Karagiannaki
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; (K.K.); (D.S.A.); (R.A.); (P.M.); (H.H.)
| | - Christian Ritz
- Department of Nutrition and Exercise Science, Faculty of Science, University of Copenhagen, Rolighedsvej 25, 1958 Frederiksberg C, Denmark;
| | - Ditte Søbye Andreasen
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; (K.K.); (D.S.A.); (R.A.); (P.M.); (H.H.)
| | - Raphaela Achtelik
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; (K.K.); (D.S.A.); (R.A.); (P.M.); (H.H.)
| | - Per Møller
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; (K.K.); (D.S.A.); (R.A.); (P.M.); (H.H.)
| | - Helene Hausner
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; (K.K.); (D.S.A.); (R.A.); (P.M.); (H.H.)
| | - Annemarie Olsen
- Section for Food Design and Consumer Behaviour, Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark; (K.K.); (D.S.A.); (R.A.); (P.M.); (H.H.)
- Correspondence: ; Tel.: +45-35-33-10-18
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The taste of biodiversity: science and sensory education with different varieties of a vegetable to promote acceptance among primary school children. Public Health Nutr 2020; 24:2304-2312. [PMID: 33118896 DOI: 10.1017/s1368980020004371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the impact of an educational programme for primary schools that explored the biodiversity of tomato, by promoting science and sensory education with three distinct varieties of it, in the acceptance of vegetables. DESIGN A randomised controlled study in which children were exposed to the educational programme (intervention group) or remained in the class, as usual (control group). The educational programme consisted of three sessions where children explained the observed differences between the three varieties of tomato and individual perceptions of their flavours based on sensory-based food education and by planning and implementing experiments to explain those differences. We tested the effects on both children's willingness to try and their liking for tomato, and for lettuce and cabbage to study the carry-over effect, compared with the control group (Mann-Whitney U test; P < 0·05). SETTING The study took place in public primary schools in Porto, Portugal. PARTICIPANTS Children in the third grade (8-13-year-old children) (n 136) were randomly assigned to intervention or control group. RESULTS Children in the intervention group reported significant increases in their willingness to try and liking for tomato compared to the control group (P < 0·05), but not for lettuce and cabbage (P > 0·05). CONCLUSIONS These results highlight the potential for fostering children's acceptance of a vegetable by exploring biodiversity through science education. Further work may clarify the effects of exploring biodiversity on the consumption of vegetables and establish whether the results are stable over time and replicable across contexts and populations.
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The GReat-Child Trial TM: A Quasi-Experimental Dietary Intervention among Overweight and Obese Children. Nutrients 2020; 12:nu12102972. [PMID: 33003299 PMCID: PMC7600864 DOI: 10.3390/nu12102972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 01/10/2023] Open
Abstract
Diet composition is a key determinant of childhood obesity. While whole grains and micronutrients are known to decrease the risk of obesity, there are no interventions originating from Southeast Asia that emphasize whole grain as a strategy to improve overall quality of diet in combating childhood obesity. The GReat-Child Trial aimed to improve whole grain intake and quality of diet among overweight and obese children. It is a quasi-experimental intervention based on Social Cognitive Theory. It has a 12-week intervention and 6-month follow-up, consisting of three components that address environmental, personal, and behavioral factors. The intervention consists of: (1) six 30 min lessons on nutrition, using the Malaysian Food Pyramid to emphasize healthy eating, (2) daily deliveries of wholegrain foods to schools so that children can experience and accept wholegrain foods, and (3) diet counseling to parents to increase availability of wholegrain foods at home. Two primary schools with similar demographics in Kuala Lumpur were assigned as control (CG) and intervention (IG) groups. Inclusion criteria were: (1) children aged 9 to 11 years who were overweight/obese; (2) who did not consume whole grain foods; and (3) who had no serious co-morbidity problems. The entire trial was completed by 63 children (31 IG; 32 CG). Study outcomes were measured at baseline and at two time points post intervention (at the 3rd [T1] and 9th [T2] months). IG demonstrated significantly higher intakes of whole grain (mean difference = 9.94, 95%CI: 7.13, 12.75, p < 0.001), fiber (mean difference = 3.07, 95% CI: 1.40, 4.73, p = 0.001), calcium (mean difference = 130.27, 95%CI: 74.15, 186.39, p < 0.001), thiamin (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001), riboflavin (mean difference = 0.84, 95%CI: 0.37, 1.32, p = 0.001), niacin (mean difference = 0.35, 95%CI: 1.91, 5.16, p < 0.001), and vitamin C (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001) compared to CG in T1, after adjusting for covariates. However, T1 results were not sustained in T2 when intervention had been discontinued. The findings indicate that intervention emphasizing whole grains improved overall short-term but not long-term dietary intake among schoolchildren. We hope the present trial will lead to adoption of policies to increase whole grain consumption among Malaysian schoolchildren.
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Farm to Early Care and Education Programming: A Descriptive Study of Challenges and Opportunities to Promote Healthful Foods to Young Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186857. [PMID: 32961768 PMCID: PMC7558968 DOI: 10.3390/ijerph17186857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/04/2022]
Abstract
Interest in farm to early care and education (ECE) programming, which consists of gardening, nutrition education, and local food procurement, has been growing in the United States, as it may be a promising technique for promoting healthful foods to young children. However, there is limited information about current farm to ECE efforts in specific states, including Colorado, to support funding and resource needs. An online survey was distributed to licensed Colorado ECE providers in two phases to understand current participation in the farm to ECE as well as provider perspectives on benefits and barriers to programming. A total of 250 surveys were completed. Approximately 60% of ECE facilities participated in gardening and nutrition education with providers almost unanimously agreeing on the child-centric benefits of programming. Fewer facilities (37%) participated in local food procurement likely due to significant time, cost, and knowledge barriers. To increase participation in farm to ECE as a technique for promoting healthful foods to young children, future efforts should focus on innovative solutions to reduce ECE-specific barriers.
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Schauder S, Thomsen MR, Nayga Jr RM. Agent-based modeling insights into the optimal distribution of the Fresh Fruit and Vegetable Program. Prev Med Rep 2020; 20:101173. [PMID: 32923315 PMCID: PMC7475199 DOI: 10.1016/j.pmedr.2020.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
Agent-based modeling assists in disseminating FFVP in the most cost-effective manner. Early childhood exposure to fruits and vegetables is more effective in influencing preferences than later exposure. More consistent exposure to a fruit and vegetable intervention is more effective than sporadic exposure. Children living in food deserts may benefit most from FFVP.
The Fresh Fruit and Vegetable Program (FFVP) program provides a free fresh fruit or vegetable snack to children in low-income schools between two and five times a week. This is an important nationwide program, but current funding levels are insufficient to reach all eligible schools. Thus, there is a need to develop insight on contextual factors that may impact the effectiveness of FFVP in facilitating the development of childhood food preferences. An agent-based model of preference formation is used to understand how exposure to FFVP in early elementary school may affect preferences for healthy food by 6th grade. Preferences are modeled using the temporal difference learning algorithm used by Hammond et al. (2012). This model simulates habit formation in the context of food by modeling preference formation in terms of positive or negative feedback about the food most recently consumed. The model is designed to provide insights into how different patterns of exposure to FFVP affect preferences, and how living in a food desert changes the effect of FFVP. We use data on 35,981 students from Arkansas elementary schools (from 2008 to 2016) and information about the commercial food environment in Arkansas communities to populate the model. We find that early FFVP exposure is more beneficial than late exposure conditional on the number of years exposed. We also find that FFVP is more beneficial for children who grow up in environments lacking healthy food.
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Affiliation(s)
- Stephanie Schauder
- Department of Economics, Cornell University, Uris 429, Ithaca, NY 14853, United States
- Corresponding author at: Uris 429, Cornell University, Ithaca, NY 14853, United States.
| | - Michael R. Thomsen
- Department of Agricultural Economics and Agribusiness, University of Arkansas Division of Agriculture, Agriculture Building 226, Fayetteville, AR 72701, United States
| | - Rodolfo M. Nayga Jr
- Food Policy Economics, Department of Agricultural Economics & Agribusiness, University of Arkansas Division of Agriculture, Agriculture Building 217, Fayetteville, AR 72701, United States
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Fox K, Gans K, McCurdy K, Risica PM, Jennings E, Gorin A, Papandonatos GD, Tovar A. Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices. Contemp Clin Trials Commun 2020; 19:100583. [PMID: 32637721 PMCID: PMC7327278 DOI: 10.1016/j.conctc.2020.100583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/28/2022] Open
Abstract
There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.
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Affiliation(s)
- Katelyn Fox
- Department of Nutrition and Food Science, University of Rhode Island, 41 Lower College Road, Room 125, Kingston, RI, 02881, USA
| | - Kim Gans
- Department of Human Development and Family Studies, and Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Karen McCurdy
- Department of Human Development & Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | | | - Alison Tovar
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
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Garcia AL, Brown E, Goodale T, McLachlan M, Parrett A. A Nursery-Based Cooking Skills Programme with Parents and Children Reduced Food Fussiness and Increased Willingness to Try Vegetables: A Quasi-Experimental Study. Nutrients 2020; 12:nu12092623. [PMID: 32872123 PMCID: PMC7551038 DOI: 10.3390/nu12092623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
Children's fussy eating is associated with a reduced vegetable intake. This quasi-experimental study evaluated "Big Chef Little Chef" (BCLC), a nursery-based cooking skills programme aimed at reducing food fussiness and increasing willingness to try green vegetables by incorporating repeated exposure and sensory learning. Parent and child (3-5 years) dyads attended BCLC for four/1.5 h weekly sessions. A comparison group was recruited after BCLC completion and attended a single education session at week 1. A questionnaire measured food fussiness at week 1 and week 4. At week 4, all children were offered six green vegetables (raw and cooked) and an average score (1 = did not try; 2 = tried it/ate some; 3 = ate it all) was calculated for willingness to try vegetables. In total, 121 dyads (intervention: n = 64; comparison: n = 57) participated. The food fussiness score (1 min-5 max) in the intervention group decreased significantly from 3.0 to 2.6 (p < 0.01) between time points, while there was no change in the comparison group (3.1 (week 1) and 3.0 (week 4)). The intervention group was more willing to try green vegetables with significantly higher (p < 0.001) median scores for raw and cooked vegetables (2.5 for both) compared with the comparison group (2.0 and 1.7, respectively). The BCLC reduced food fussiness and increased willingness to try green vegetables.
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Affiliation(s)
- Ada L. Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G31 2ER, UK; (E.B.); (A.P.)
- Correspondence: ; Tel.: +44-141-201-8687
| | - Emma Brown
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G31 2ER, UK; (E.B.); (A.P.)
- Lanarkshire Community Food and Health Partnership, Bargeddie G69 7TU, UK;
| | - Tom Goodale
- Academic Achievement Team, Library Services, Liverpool John Moores University, Liverpool L3 5UX, UK;
| | - Mairi McLachlan
- Lanarkshire Community Food and Health Partnership, Bargeddie G69 7TU, UK;
| | - Alison Parrett
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G31 2ER, UK; (E.B.); (A.P.)
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Effect of Experiential Vegetable Education Program on Mediating Factors of Vegetable Consumption in Australian Primary School Students: A Cluster-Randomized Controlled Trial. Nutrients 2020; 12:nu12082343. [PMID: 32764474 PMCID: PMC7468916 DOI: 10.3390/nu12082343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023] Open
Abstract
Schools provide a relevant and equitable environment to influence students towards increased vegetable consumption. This study aimed to evaluate the effectiveness of a Vegetable Education Resource To Increase Children’s Acceptance and Liking (VERTICAL) for Australian primary schools (curriculum aligned and based on a framework of food preference development and sensory experiential learning) on positively influencing factors predisposing children towards increased vegetable consumption. The secondary aim was to evaluate two levels of teacher training intensity on intervention effectiveness. A cluster-RCT amongst schools with three conditions was conducted: 1 = teaching VERTICAL preceded by online teacher training; 2 = as per 1 with additional face-to-face teacher training; 3 = Control. Pre-test, post-test and 3-month follow-up measures (knowledge, verbalization ability, vegetable acceptance, behavioural intentions, willing to taste, new vegetables consumed) were collected from students (n = 1639 from 25 schools in Sydney/Adelaide, Australia). Data were analyzed using mixed model analysis. No difference in intervention effectiveness was found between the two training methods. Compared to the Control, VERTICAL positively affected all outcome measures after intervention (p < 0.01) with knowledge sustained at 3-month follow-up (p < 0.001). In conclusion, VERTICAL was effective in achieving change amongst students in mediating factors known to be positively associated with vegetable consumption.
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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Impact of a nutrition education programme on preschool children's willingness to consume fruits and vegetables. Public Health Nutr 2020; 23:1846-1853. [PMID: 32340640 DOI: 10.1017/s1368980019005032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the impact of a preschool-based nutrition education programme consisting of twelve 'hands on' nutrition education lessons delivered during the school year on young children's willingness to consume fruits and vegetables. DESIGN Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015-2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group. SETTING Centre-based preschool programmes serving low-income families in the Denver metro area. PARTICIPANTS Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015-2016 school year (n 308) and children enrolled in comparison classrooms (n 215). RESULTS Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups. CONCLUSIONS An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.
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Attuquayefio T, Parish S, Rogers PJ, Brunstrom JM. No evidence of flavour-nutrient learning in a two-week 'home exposure' study in humans. Appetite 2020; 147:104536. [PMID: 31765687 DOI: 10.1016/j.appet.2019.104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
Flavour-nutrient learning is robust in animals but remains elusive in humans. Recent evidence suggests flavour-nutrient learning may be more likely to occur with beverages that contain relatively few calories (compared to no calories), while others show that learned associations can influence satiation, without an effect on preference. The objective of this research was to determine whether acquired liking for a caloric drink could be observed in a 'home learning' context over 2 weeks, and whether it is impacted by viscosity. In combination, we also explored changes in learning relating to fullness and expected satiety. In a double-blind study, participants (N = 83; BMI = 23.3 kg/m2) were randomly allocated to one of four groups differing in either calories (0 kcal vs. 112.5 kcal) or viscosity (low vs. high) and consumed a novel-flavoured drink over 15 days. Measures of flavour (10 ml sample) and beverage liking, grip force (a measure of beverage reward value), fullness, and expected satiety were taken at the start and the end of the study. While the high-viscous beverages were less liked (M = 40.3 mm, SD = 24.7) than the low viscous beverages (M = 64.4 mm, SD = 15.3; p = .022), there was no evidence that repeated exposure to a calorie-containing beverage impacted subsequent liking for the flavour (p = .115) or for the beverage (p = .448), grip force (ps > .26), fullness, and expected satiety (ps > .12). Accordingly, we conclude that we found no evidence of flavour-nutrient learning and flavour-satiety learning. This null finding accords with previous observations indicating that humans do not acquire flavour-nutrient associations as readily as some non-human animals.
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Affiliation(s)
- Tuki Attuquayefio
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA.
| | - Suzy Parish
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Rd, Bristol, BS8 1TU, UK
| | - Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Rd, Bristol, BS8 1TU, UK
| | - Jeffrey M Brunstrom
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Rd, Bristol, BS8 1TU, UK
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Holley CE, Haycraft E, Farrow C. Unpacking the relationships between positive feeding practices and children's eating behaviours: The moderating role of child temperament. Appetite 2020; 147:104548. [DOI: 10.1016/j.appet.2019.104548] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
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Bakke AJ, Carney EM, Higgins MJ, Moding K, Johnson SL, Hayes JE. Blending dark green vegetables with fruits in commercially available infant foods makes them taste like fruit. Appetite 2020; 150:104652. [PMID: 32169594 DOI: 10.1016/j.appet.2020.104652] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 08/20/2019] [Accepted: 03/05/2020] [Indexed: 11/19/2022]
Abstract
Vegetables are an important but under consumed part of a healthy diet. There is growing interest in promoting vegetable acceptance and consumption among infants to help establish life-long healthy eating patterns. A recent survey of commercial baby food products in the United States by Moding and colleagues revealed a lack of variety in the types of vegetables offered. Most notably, there were no commercially available single, dark green vegetable products. Instead, dark green vegetables were often mixed with fruits or red/orange vegetables (e.g., squash) that provide additional sweetness. In order for liking for vegetables to be learned, the flavors from the vegetables must still be perceptible within the mixture. Thus, the objective of the research reported here was to understand the sensory profiles of vegetable-containing Stage 2 infant products commercially available in the United States and how ingredient composition affects flavor profiles. We performed descriptive analysis to quantitatively profile the sensory properties of 21 commercial vegetable-containing infant foods and one prepared in our laboratory. Eleven experienced panelists participated in 14.5 h of lexicon generation and training prior to rating all 22 products (in triplicate) for 14 taste, flavor, and texture attributes. Products that contained fruit were not only sweeter than products that did not contain fruit but were also higher in fruit flavors and lower in vegetable flavors. In general, sensory profiles were driven by the first ingredient in the product. Because few products had dark green vegetables as a first ingredient, dark green vegetable flavor was not prevalent in this category. This suggests the sensory profiles of commercially available infant vegetables foods may not be adequate to facilitate increased acceptance of green vegetables.
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Affiliation(s)
- Alyssa J Bakke
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Elizabeth M Carney
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Molly J Higgins
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Kameron Moding
- Department of Pediatrics, Section of Nutrition, School of Medicine, CU-Anschutz, Aurora, CO, USA
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, School of Medicine, CU-Anschutz, Aurora, CO, USA
| | - John E Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA.
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Hughes SO, Power TG, Beck A, Betz D, Goodell LS, Hopwood V, Jaramillo JA, Lanigan J, Martinez AD, Micheli N, Olivera Y, Overath I, Parker L, Ramos G, Thompson YP, Johnson SL. Short-Term Effects of an Obesity Prevention Program Among Low-Income Hispanic Families With Preschoolers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:224-239. [PMID: 31917129 DOI: 10.1016/j.jneb.2019.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the short-term effects of an obesity prevention program promoting eating self-regulation and healthy food preferences in low-income Hispanic children. DESIGN Randomized controlled trial with pretest, posttest, and 6- and 12-month assessments. SETTING AND PARTICIPANTS Head Start and similar early learning institutions in Houston, TX, and Pasco, WA. A total of 255 families with preschoolers randomized into prevention (n = 136) and control (n = 119) groups. INTERVENTION Multicomponent family-based prevention program. Fourteen waves lasted 7 weeks each with 8-10 mother-child dyads in each group. MAIN OUTCOME MEASURES Parent assessments included feeding practices, styles, and knowledge. Child assessments included child eating self-regulation, willingness to try new foods, and parent report of child fruit and vegetable preferences. Parent and child heights and weights were measured. ANALYSIS Multilevel analyses were employed to consider the nested nature of the data: time points within families within waves. RESULTS The program had predicted effects on parental feeding practices, styles, and knowledge in the pre- to post-comparisons. Effects on child eating behavior were minimal; only the number of different vegetables tried showed significant pre-post differences. CONCLUSIONS AND IMPLICATIONS Short-term effects of this prevention program highlight the importance of family-focused feeding approaches to combating child overweight and obesity.
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Affiliation(s)
- Sheryl O Hughes
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
| | - Thomas G Power
- Department of Human Development, Washington State University, Pullman, WA
| | - Ashley Beck
- Department of Human Development, Washington State University, Pullman, WA
| | - Drew Betz
- Department of Human Development, Washington State University, Pullman, WA
| | - L Suzanne Goodell
- Department of Food, Bioprocessing, and Nutritional Sciences, North Carolina State University, Raleigh, NC
| | - Veronica Hopwood
- Department of Human Development, Washington State University, Pullman, WA
| | - J Andrea Jaramillo
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jane Lanigan
- Department of Human Development, Washington State University, Pullman, WA
| | | | - Nilda Micheli
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Yadira Olivera
- Department of Human Development, Washington State University, Pullman, WA
| | - Irene Overath
- Department of Human Development, Washington State University, Pullman, WA
| | - Louise Parker
- Department of Human Development, Washington State University, Pullman, WA
| | - Guadalupe Ramos
- Department of Human Development, Washington State University, Pullman, WA
| | - Yuri Peralta Thompson
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
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Kristiansen AL, Medin AC, Bjelland M, Himberg-Sundet A, Lien N, Holst R, Andersen LF. Long-term effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable intake among Norwegian 3-5-year-olds: the BRA-study. BMC Res Notes 2020; 13:30. [PMID: 31937362 PMCID: PMC6961274 DOI: 10.1186/s13104-020-4892-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/04/2020] [Indexed: 01/23/2023] Open
Abstract
Objective To report on long-term effects of a cluster randomized controlled kindergarten-based intervention trial, which aimed to increase vegetable intake among Norwegian preschool children (3–5 years at baseline). The effects of the intervention at follow-up 1 (immediately post-intervention) have previously been published. This paper presents the effects of the intervention from baseline to follow-up 2 (12 months post-intervention). Results Parental consents were obtained for 633 out of 1631 eligible children (response rate 38.8%). The effects of the intervention from baseline to follow-up 2 were assessed by mixed-model analyses taking the clustering effect of kindergartens into account. Children’s vegetable intake was reported by the parents at baseline (spring 2015), at follow-up 1 (spring 2016) and at follow-up 2 (spring 2017). No significant long-term effects in child vegetable intake were found. A mean difference of − 0.1 times per day (95% CI − 0.5, 0.2) (P = 0.44) was found for the daily frequency of vegetable intake. A mean difference of – 0.2 different kinds of vegetables eaten over a month (95% CI − 1.0, 0.7) (P = 0.70) was found and for daily amount of vegetables a mean difference of − 15.0 g vegetables (95% CI − 38.0, 8.0) (P = 0.19) was found. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered)
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Affiliation(s)
- Anne Lene Kristiansen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway.
| | - Anine Christine Medin
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway.,Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - René Holst
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, 0317, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
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Himberg-Sundet A, Kristiansen AL, Gebremariam MK, Moser T, Andersen LF, Bjelland M, Lien N. Exploring the workplace climate and culture in relation to food environment-related factors in Norwegian kindergartens: The BRA-study. PLoS One 2019; 14:e0225831. [PMID: 31790486 PMCID: PMC6886843 DOI: 10.1371/journal.pone.0225831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kindergartens represent an important arena for promoting vegetable intake when it is essential to establish healthy dietary behaviours early in life. To develop and implement successful interventions targeting dietary behaviours in kindergartens, a good understanding of the factors influencing their food environment and the interplay between these factors is essential. The present study aimed to explore associations between workplace climate and culture in the kindergarten setting and the staff's food-related practices, vegetables served and the possible mediating role of staff's food-related practices. METHOD Vegetables served, staff's food-related practices, and data on workplace climate and culture were collected using a 5-day, weighted, vegetable diary and three paper-based questionnaires. Seventy-three kindergartens in the Norwegian counties of Vestfold and Buskerud participated in the study. Spearman's rho was used to assess the association between workplace climate and culture, and staff's food-related practices and vegetables served. Mediation analyses were conducted to assess the mediating role of staff's food-related practices in the relationship between workplace climate and culture and vegetables served in this setting. RESULTS There was one significant positive correlation between factors in the workplace climate and culture, and staff's food-related practices and vegetables served. The staff's food-related practices were found to mediate the association between support from superior and the variety of vegetables served. They also mediated the association between commitment to the organization and the frequency, as well as the variety, of vegetables served. CONCLUSION The results identified commitment to the organization and support from superior as two important factors in the workplace climate and culture. Furthermore, these two factors seems to be important to target when developing kindergarten-based interventions aimed at increasing the variety and frequency of vegetables served as they were associated with more favourable food-related practices among staff.
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Affiliation(s)
- Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Anne Lene Kristiansen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Mekdes K. Gebremariam
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Moser
- Department of Educational Science, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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49
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Increasing Intake of an Unfamiliar Vegetable in Preschool Children Through Learning Using Storybooks and Sensory Play: A Cluster Randomized Trial. J Acad Nutr Diet 2019; 119:2014-2027. [DOI: 10.1016/j.jand.2019.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 01/14/2023]
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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