Children's hard-wired aversion to pure vegetable tastes. A ‘failed’ flavour–nutrient learning study

Implementing a 'Vegetables First' Approach to Complementary Feeding

Purpose of Review

To provide a rationale for promoting a vegetables first approach to complementary feeding (CF), building on prior exposure to vegetable flavours experienced in utero and via breastfeeding (chemosensory continuity).

Recent Findings

Vegetables confer selective health benefits but population intakes are below recommendations globally; maternal intake of vegetables during both pregnancy and lactation promotes familiarity with some vegetable flavours. Building on this exposure, vegetables as a first food during CF further promote acceptance. However, experiments testing efficacy of a vegetables first approach to CF demonstrate increased liking and intake, some evidence of generalisability but little evidence of sustained effects beyond infancy.

Summary

The aim to increase the quantity and variety of vegetables eaten by children is both desirable, to improve nutrient quality of the diet, and achievable. However, longer, larger, randomised control trials are needed to evidence any longer term, sustainable benefits to liking and intake of vegetables.

Development and Proof-of-Concept Evaluation of a Sensory Science-Based Model for Product Development of Vegetable-Based Products for Children

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.

How to promote healthy eating in preschool children: Evidence from an associative conditioning procedure with non-food stimuli

Given the increasing rates and severe consequences of childhood obesity, how to encourage children to eat low-calorie and healthy foods is an important question. Building on evaluative conditioning research, this study investigated how associating fruits and vegetables with positive, non-food stimuli influences preschool children's food choice and consumption. Consistent with this idea, it was found in two experiments that 3- to 6-year-old children's healthy food choice and consumption increased by pairing a healthy food's picture systematically with a positive, non-food image. These findings highlight a simple yet effective means of changing young children's eating behavior, which may complement existing intervention procedures.

Smiling faces on food packages can increase adults' purchase likelihood for children

Manufacturers often include smiling faces on food packages, especially those targeted towards children. Prior research suggests that anthropomorphized images in general, and smiling faces in particular, are an effective marketing tool that encourage food choice and consumption among children. However, it is not clear how adult consumers, who often make food purchases for children, respond to smiling faces on packaging when making decisions for a child recipient. The results of four experiments show that food packages with (vs. without) smiling faces activate child-related thoughts which leads to expectations of making a child happy with the food and ultimately greater purchase likelihood for the child recipient. The serial effects of smiling faces on purchase likelihood through child-related thoughts and the expectations of a child's emotional reaction are robust to an array of products with more and less appealing flavors. Further, a smile line in the absence of eyes does not catalyze the same serial mechanism. Overall, our findings suggest that marketers should exercise caution when utilizing smiling faces on food packages, especially when packages contain unhealthy foods; and, consumers should be aware of the effects that this seemingly innocent packaging feature can have on their product responses.

Preschoolers will drink their GREENS! Children accept, like, and drink novel smoothies containing dark green vegetables (DGVs)

Dark green vegetables (DGVs; e.g., spinach) are a nutrient rich source of essential vitamins and minerals; yet, children's intakes of DGVs fall well below dietary recommendations and creative solutions are needed. This study describes preschoolers (3-5 y) willingness to taste, liking, and intake of fruit-based smoothies containing DGVs (i.e., spinach, collards, kale), commonly referred to as "green smoothies," and explores individual differences in children's eating responses. Using a between-subjects design, preschoolers were randomized to either a FRUIT ONLY smoothie condition (n = 36) or FRUIT+DGV smoothie condition (n = 32). Children's acceptance and intake were collected in one tasting session and one ad libitum snack session, respectively. Parents reported on child food pickiness, food responsiveness, and approach, and children's intake of fruits and DGVs. Children self-reported on previous experience with the study fruits and DGVs. The initial tasting session revealed that the majority of children (84.3%) in the FRUIT+DGV condition willingly tasted all five green smoothies and rated the green smoothies as moderately liked (2.3 ± 0.1). Children in the FRUIT+DGV condition consumed 225.7 ± 31.4 g (9.0 ± 1.3 oz; 1.1 ± 0.2 cups; 91.9 ± 12.9 kcals) of their most preferred green smoothie, providing 18.3 ± 3.7 g (or 0.7 ± 0.1 cups) of DGVs. Children's willingness to try, liking, and intake did not differ by smoothie condition. Individual differences in children's intake are reported. In conclusion, children were willing to try fruit smoothies supplemented with DGVs. Children rated the green smoothies as moderately-liked and children's intake during snack met 31% of their weekly USDA recommendations for DGVs. Adding DGVs to fruit-based smoothies may compliment other effective feeding strategies for increasing children's vegetable consumption.

Blending dark green vegetables with fruits in commercially available infant foods makes them taste like fruit

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.

RYGB and flavor-consequence learning

Flavor-consequence learning refers to learned associations between flavor stimuli and post-oral consequences of food that affect food selection, amount eaten and affect. Forms of flavor-consequence learning include flavor aversions, flavor avoidance, conditioned satiety, expected satiety and appetition. Roux-en-Y gastric bypass surgery (RYGB) and other bariatric procedures alter gastrointestinal processing of food in a number of ways. Thus, it is plausible that these procedures alter post-oral unconditioned stimuli that support flavor-consequence learning, leading to altered food selection, amount eaten, and affect. Surprisingly, however, there is almost no research on the role of flavor-consequence learning in the effects of bariatric surgery on appetite. This issue urgently warrants investigation.

Healthy eating and restaurants. A review of recent evidence in the literature

Food environments influence food consumption and population health. This study sought to establish the outstanding themes in recent scientific literature about healthy eating and restaurants. Studies about the topic published from 2011 to 2016 in seven recognized databases were reviewed systematically. From 999 titles, 20 articles were selected. Content analysis through an inductive method by two independent investigators was performed using Nvivo 10.0. Three dominant subjects were identified: Food supply modifications, promotion of healthy choices and barriers against healthy eating promotion. The findings describe research opportunities in the area, particularly in the Latin American context. It is necessary to make interventions that result in healthy food environments given the impact on collective health.

Repeated exposure and conditioning strategies for increasing vegetable liking and intake: systematic review and meta-analyses of the published literature

Background

Vegetable intakes are typically lower than recommended for health. Although repeated exposure has been advocated to increase vegetable liking and consumption, no combination of the evidence yet provides a measure of benefit from repeated exposure or alternative conditioning strategies.

Objective

This work aimed to identify and synthesize the current evidence for the use of repeated exposure and conditioning strategies for increasing vegetable liking and consumption.

Design

Three academic databases were searched over all years of records using prespecified search terms. Published data from all suitable articles were tabulated in relation to 3 research questions and combined via meta-analyses.

Results

Forty-three articles detailing 117 comparisons investigating the use of repeated exposure and conditioning strategies for increasing liking and intakes of vegetables were found. Our analyses demonstrate: 1) increased liking and intakes of the exposed vegetable after repeated exposure compared with no exposure; 2) increased liking for the exposed vegetable after conditioning compared with repeated exposure, increased intakes after the use of rewards, and some suggestion of decreased intakes after flavor-nutrient conditioning; and 3) increased liking and intakes of a novel vegetable after repeated exposure to a variety of other vegetables compared with no exposure or repeated exposure to one other vegetable. Effect sizes, however, are small, and limited evidence suggests long-term benefits. Our analyses, furthermore, are limited by limitations in study design, compliance, and/or reporting.

Conclusions

Based on our findings, we recommend the use of repeated exposure to one and a variety of vegetables, and the use of rewards, for increasing vegetable liking and consumption. Confirmation from further large, well-conducted studies that use realistic scenarios, however, is also required. This study was registered at PROSPERO as CRD42017056919.

Breast-feeding duration and child eating characteristics in relation to later vegetable intake in 2-6-year-old children in ten studies throughout Europe

OBJECTIVE

Breast-feeding is thought to facilitate young children's acceptance of new foods, including vegetables, but the evidence for this relationship appears inconsistent across studies. Increasing children's vegetable intake remains challenging; therefore the present study aimed to investigate whether breast-feeding duration predicts vegetable intake in 2-6-year-old children.

DESIGN

Actual vegetable intake was measured in studies across three European countries. General linear model analyses with breast-feeding duration, sex and age of the child and maternal education as variables were used to predict children's vegetable intake per country. Additionally, the relationships between child eating behaviour characteristics (asked through the Child Eating Behaviour Questionnaire) and vegetable intake were investigated via Pearson correlations.

SETTING

Daycare centres, schools and home settings in Denmark, Greece and the Netherlands.

SUBJECTS

Children aged 2-6 years (n 750).

RESULTS

Breast-feeding duration was positively associated with children's vegetable intake at 2-6 years old in Denmark (P<0·01) and the Netherlands (P<0·05), but not in Greece (P=0·17). Age of the child, maternal education and sex of the child did not predict vegetable intake in our sample. All countries showed an inverse relationship between food neophobia and children's vegetable intake and a positive relationship between vegetable liking and intake.

CONCLUSIONS

The present study found that breast-feeding duration is a predictor of later vegetable intake, but that current child eating behaviour characteristics, such as vegetable liking, food neophobia and enjoyment of food, also influence vegetable intake. Besides encouragement of breast-feeding duration, strategies that support vegetable liking and food enjoyment and decrease food neophobia are needed to support young children's vegetable intake.

Biochar reduces nitrate level in red beet

Impacts of red beet consumption both on human and animal health are subject of intense research. In particular, products that are not heat-processed contain plethora of bioactive compounds that hold promise against numerous degenerative and aging-associated diseases. However, high level of nitrates (typically more than 2 g NO₃^- kg^-1) whose health effects are perceived with reasoned objections counterbalance these benefits. Following the above, from a certain level, the increased consumption of red beet has contrary impacts, creating a limiting factor not only from the economic point of view but also in terms of beneficial compounds intake. Reduction of NO₃^- levels (- 35%) has been achieved by soil amendment via increased doses of biochar. The data obtained indicates that the mechanism can be explained as follows. The soil improvement reduces soil density, increases soil temperature, improves water retention, and other prerequisites for increased activity of soil microorganisms. Accelerated metabolism of soil biota turned more nitrogen from fertilizers into organic forms. Hence, less mineral nitrogen is left for red beet intake.

Knowing too much: Knowledge of energy content prevents liking change through flavour-nutrient associations

Associations between flavours and the consequences of ingestion can lead to changes in flavour liking depending on nutrient content, an example of flavour-nutrient learning (FNL). Expectations about the consequences of ingestion can be modified by information at the point of ingestion, such as nutritional labelling. What is unknown is the extent to which these label-based expectations modify FNL. Since nutrient information can alter expectations about how filling a product would be, we hypothesised that labels predicting higher energy (HE) content would enhance satiety and so promote more rapid flavour learning. To test this, participants consumed either a lower energy (LE: 164 kcal) or HE (330 kcal) yoghurt breakfast on four separate days, either with no product label or with labels displaying either the actual energy content (Congruent label) or inaccurate energy (Incongruent label). Participants rated liking on all four days: on Days 1 and 4, they could also consume as much as they liked, but consumed a fixed amount (300 g) on Days 2 and 3. Both liking and intake increased with exposure in the HE, and decreased in the LE, condition when unlabelled in line with FNL. In contrast, no significant changes were seen in either the Congruent or Incongruent label conditions. Contrary to predictions, these data suggest that FNL occurs when there is an absence of explicit expectations of actual nutrient content, with both accurate and inaccurate information on nutrient content disrupting learning.

Parent packs, child eats: Surprising results of Lunch is in the Bag's efficacy trial

Early care and education (ECE) centers that require lunch brought from home provide an uncluttered view of parent-child dietary interactions in early childhood. Children's eating from parent-provided bag lunches was observed at 30 ECE centers in Texas, with 15 randomly assigned to the Lunch is in the Bag intervention to improve the lunch meal and 15 to a wait-list control condition. Study participants were parent and child aged 3-5 years (N = 633 dyads). Data were collected at baseline (pre-intervention) and follow-ups at weeks 6 (post-intervention), 22 (pre-booster), and 28 (post-booster). Changes effected in the children's lunch eating-e.g., increase of 14 percent in prevalence of children eating vegetables (SE = 5, P = 0.0063)-reciprocated changes in parent lunch-packing. Irrespective of intervention, however, the children consumed one-half to two-thirds of the amounts of whatever foods the parents packed, and the eat-to-pack ratio did not change across time. Thus, children's lunch eating at the ECE centers appeared to be regulated by perceptual cues of food availability rather than food preferences or internal cues of hunger and satiety.

Strategies to increase children's vegetable intake in home and community settings: a systematic review of literature

A systematic review was undertaken to identify intervention characteristics associated with increasing consumption of vegetables in children (2-12 years). PubMed, PsychINFO and CABabstracts were used to identify studies published between 2004-2014 that had measures of vegetable consumption, a minimum of 3-month follow-up and were conducted in home and community settings (outside of schools). Twenty-two studies were included in the review. Details of the study design, population, setting, intervention characteristics, target behaviour, behaviour change techniques used and vegetable intake were extracted. Study quality and intensity were scored. Overall, 12/22 studies were effective short-term, and 6/10 were effective long-term (6 + months); mean short-term change in vegetable intake was 29%, equating to an increase of a quarter to a half of a serving of vegetables. Intervention effectiveness was associated with number of settings targeted and frequency of contact but not length of intervention. Planning for social support, vegetable exposure and provision of staff training were commonly used behaviour change techniques in effective interventions. This review has identified strategies that may optimise effectiveness of future home-based and community-based interventions aiming to increase vegetable intake in young children.

Increasing vegetable intakes: rationale and systematic review of published interventions

Purpose

While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group.

Methods

Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms.

Results

Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent.

Conclusions

Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions.

Efficacy of the Lunch is in the Bag intervention to increase parents' packing of healthy bag lunches for young children: a cluster-randomized trial in early care and education centers

BACKGROUND

Lunches that parents pack for their young children to eat at school or the Early Care and Education (ECE) center fall short of recommended standards. Lunch is in the Bag is a multi-level behavioral nutrition intervention to increase parents' packing of fruit, vegetables, and whole grains in their children's lunches. Designed for implementation in ECE centers, the five-week long intervention is followed three months later with a one-week booster.

METHODS

Efficacy of Lunch is in the Bag was tested in cluster randomized trial. Participants were 633 families from 30 ECE centers (15 intervention, 15 control) across Austin, San Antonio, and Houston, Texas, USA. Primary outcomes were servings of fruit, vegetables, and whole grains observed in the children's parent-packed bag lunches. Servings of refined grains, meats/beans/eggs/nuts, dairy, chips, and sweets also were observed. Data were collected at baseline, post-intervention (6-week follow-up), pre-booster (22-weeks follow-up), and post-booster (28-week follow-up). Time-by-treatment interactions were analyzed separately for each of the food groups using multi-level models to compare changes from baseline. Analyses were adjusted for relevant demographic variables and clustering within centers and parents.

RESULTS

The intervention effected increases from baseline to 6-week follow-up in vegetables (0.17 servings, SE = 0.04, P < 0.001) and whole grains (0.30 servings, SE = 0.13, P = 0.018). The increase in whole grains was maintained through the 28-week follow-up (0.34 servings, SE = 0.13, P = 0.009). Fruit averaged more than 1.40 servings with no differences between groups or across time. The intervention prevented increase in sweets (-0.43 servings, SE = 0.11, P < .001, at the 22-week follow-up). Parents persisted, however, in packing small amounts of vegetables (averages of 0.41 to 0.52 servings) and large amounts of sweets and chips (averages of 1.75 to 1.99 servings).

CONCLUSIONS

The need for and positive effects of the Lunch is in the Bag intervention at ECE centers where parents send bag lunch for their preschool-aged children was confirmed. An important direction for future research is discovery of more options for leveraging the partnership of ECE centers and families to help young children learn to eat and enjoy vegetables and other healthy foods in preference to less healthy choices such as chips and sweets.

TRIAL REGISTRATION

The Clinical Trials Number is NCT01292434 .

A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure

Breastfeeding (BF) is associated with willingness to accept vegetables. This may be due to the variety of flavours delivered via breast milk. Some mothers add vegetables to milk during complementary feeding (CF) to enhance acceptance. The present study tested a step-by-step exposure to vegetables in milk then rice during CF, on intake and liking of vegetables. Just before CF, enrolled mothers were randomised to an intervention (IG, n = 18; 6 BF) or control group (CG, n = 18; 6 BF). IG infants received 12 daily exposures to vegetable puree added to milk (days 1-12), then 12 × 2 daily exposures to vegetable puree added to rice at home (days 13-24). Plain milk and rice were given to CG. Then both received 11 daily exposures to vegetable puree. Intake was weighed and liking rated on days 25-26 and 33-35 after the start of CF in the laboratory, supplemented by the same data recorded at home. Vegetables were rotated daily (carrots, green beans, spinach, broccoli). Intake, liking and pace of eating were greater for IG than CG infants. Intake and liking of carrots were greater than green beans. However, at 6m then 18m follow up, vegetable (carrot > green beans) but not group differences were observed. Mothers reported appreciation of the structure and guidance of this systematic approach. Early exposure to vegetables in a step-by-step method could be included in CF guidelines and longer term benefits assessed by extending the exposure period.

Learning to eat vegetables in early life: the role of timing, age and individual eating traits

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4–38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were “learners” (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled “plate-clearers”. 16% were considered “non-eaters” eating less than 10 g by the 5^th exposure and the remainder were classified as “others” (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children.

An attempt to condition flavour preference induced by oral and/or postoral administration of 16% sucrose in pigs

The present study investigated the acquisition of conditioned flavour preferences in pigs using the caloric value and/or sweet taste of sucrose. Nine water-deprived juvenile pigs were given four three-day conditioning sessions during which they received flavoured solutions as conditioned stimuli (CS). The CS solutions were paired with three treatments that generated a gustatory and/or a caloric reinforcement (US). The CS++ solution was added with 16% sucrose and paired with an intraduodenal (ID) infusion of water, the CS+ solution was paired with an ID infusion of 16% sucrose and the CS- solution was paired with an ID infusion of water. One and two weeks after conditioning, the water-deprived pigs were subjected to two-choice preference tests with the unreinforced CS solutions. Solutions intake, behavioural activity and some drinking parameters were measured. Despite no difference in CS intake during conditioning, the animals spent less time inactive and more time standing during CS++ than CS+ conditioning. When receiving CS++, the pigs explored the drinking trough more than when receiving CS-. Compared to the CS- condition, the numbers of drinking episodes and intra-drinking episode (IDE) pauses were also 36% and 49% lesser in the CS++ condition, but these differences were not significant. During the two-choice tests, the pigs did not show significant preferences. Nevertheless, during the first session, the pigs seemed to show a slight preference for the CS++ (57% of total intake) compared to CS+. The duration of CS++ drinking episodes represented 64% of the total duration compared to CS+ and CS- . The total time spent drinking the CS++ also represented 57% of the total time in the CS++ vs. CS- test. To conclude, although no clear-cut preferences were found during two-choice tests, the oral perception of 16% sucrose during conditioning induced changes in behavioural activities, motivational responses and microstructure of CS intake, suggesting the importance of oral food perception for food selection processes in pigs. Further studies are needed to investigate the impact of water deprivation on the expression of flavour preferences in pigs.

Eating a rainbow. Introducing vegetables in the first years of life in 3 European countries

Low vegetable consumption in children is a concern in many EU countries, fewer than one fifth of children in Europe consume the WHO recommended amounts. Systematic studies demonstrate that experience with a variety of vegetables early in childhood can promote later consumption as early dietary habits often track into adulthood. This study examined pre-school children's experience with vegetables across three European countries in order to assess cultural differences, effects of age and culinary practices. Mothers of pre-school children (N=234) in the UK (N=71), Denmark (N=93) and France (N=70) completed a survey assessing parental and infant familiarity, frequency of offering and liking for 56 vegetables as well as preparation techniques for these vegetables. Analyses revealed that although children aged 25-36 months had been introduced to the greatest number of vegetables, children aged 6-12 months were offered vegetables more frequently and had a higher reported liking for these vegetables. UK children's liking was related to frequency of maternal intake and frequency of offering. Denmark had introduced the greatest number of vegetables and offered vegetables more frequently than both the UK and France. Choice of preparation methods differed between countries while choice of seasonings was similar. Results suggest increasing variety and frequency of vegetable offering between 6 and 12 months, when children are most receptive, may promote vegetable consumption in children.

Repeated exposure of infants at complementary feeding to a vegetable puree increases acceptance as effectively as flavor-flavor learning and more effectively than flavor-nutrient learning

Children's vegetable consumption is below the public health recommendations. This study aimed to compare learning mechanisms to increase vegetable acceptance in infants at complementary feeding, namely repeated exposure (RE), flavor-flavor learning (FFL), and flavor-nutrient learning (FNL); measure the stability of the learning effect; and examine the impact of infants' feeding history on vegetable acceptance. The study was composed of a preexposure test, an exposure period, a postexposure test, and tests at 2-wk, 3-mo, and 6-mo follow-ups. At pre- and postexposure, a basic artichoke purée and carrot purée were presented to 95 French infants (6.4 ± 0.8 mo). During the exposure period, infants were randomly split into 3 groups and were exposed 10 times to the basic (RE group; 2 kJ/g; n = 32), a sweet (FFL group; 2 kJ/g; n = 32), or an energy-dense (FNL group; 6 kJ/g; n = 31) artichoke purée 2 or 3 times/wk. To evaluate acceptance, intake (g) and liking were recorded at home by parents. Between pre- and postexposure, intake of the basic artichoke purée significantly increased in the RE (+63%) and FFL (+39%) groups but not in the FNL group; liking increased only in the RE group (+21%). After exposure, artichoke was as much consumed and as much liked as carrot only in the RE group. Learning of artichoke acceptance was stable up to 3 mo postexposure. Initial artichoke intake was significantly related to the number of vegetables offered before the study started. RE is as effective as and simpler to implement than FFL and more effective than FNL for increasing vegetable acceptance at complementary feeding.

Intrinsic and extrinsic influences on children's acceptance of new foods

The foods that tend to be rejected by children include those which may have greatest importance for later health. This paper reviews some of the intrinsic and extrinsic influences on preschool children's eating behavior, with particular reference to their acceptance of new foods into their diet. Factors conceptualized as intrinsic to the child in this review include sensory processing, taste perception, neophobia, and temperament. The important extrinsic determinants of children's food acceptance which are reviewed include parental and peer modeling, the family food environment, infant feeding practices including breastfeeding and age at weaning, concurrent feeding practices including restriction, pressure to eat, prompting and reward, and the taste & energy content of foods. Children's willingness to accept new foods is influenced by a wide range of factors that likely have individual and also interactive effects on children's willingness to taste, and then continue to eat, new foods. The literature lacks longitudinal and experimental studies, which will be particularly important in determining interventions most likely to be effective in facilitating children's acceptance of healthy foods.

Assessing the effect of food exposure on children's identification and acceptance of fruit and vegetables

Currently, fewer than 15% of children between the ages of 4-8 years consume the recommended levels of fruit and vegetables. In order to address this serious public health issue, a variety of nutrition programs have been implemented across the United States which have varied in their success. The present research analyzed the effectiveness of providing fruit and vegetable exposure as part of a school nutrition program. Kindergarten students at two schools (N=59) were exposed to interactive activities about healthy eating and physical activity. In addition, those at one school (n=29) were exposed to a variety of fruits and vegetables as part of this program. Assessment of children's ability to identify and their willingness to try fruit and vegetables before and after the program indicated that while all children were better able to identify a range of fruit, only those who received exposure to healthful foods were more willing to try fruit after the program. There were no changes in their identification or willingness to eat vegetables. These results suggest that schools should provide exposure to a variety of healthy foods as part of their nutrition programs. Such programs should focus specifically on exposing children to vegetables because increasing children's willingness to try foods that are typically considered unpalatable may be especially challenging.

Repetition counts: repeated exposure increases intake of a novel vegetable in UK pre-school children compared to flavour–flavour and flavour–nutrient learning

Children are not consuming sufficient amounts of fruits and vegetables in their habitual diet. Methods derived from associative learning theories could be effective at promoting vegetable intake in pre-school children. The objective of the present study was to compare the effectiveness of different learning strategies in promoting the intake of a novel vegetable. Children aged between 9 and 38 months were recruited from UK nurseries. The children (n 72) were randomly assigned to one of three conditions (repeated exposure, flavour–flavour learning or flavour–nutrient learning). Each child was offered ten exposures to their respective version of a novel vegetable (artichoke). Pre- and post-intervention measures of artichoke purée and carrot purée (control vegetable) intake were taken. At pre-intervention, carrot intake was significantly higher than artichoke intake (P< 0·05). Intake of both vegetables increased over time (P< 0·001); however, when changes in intake were investigated, artichoke intake increased significantly more than carrot intake (P< 0·001). Artichoke intake increased to the same extent in all three conditions, and this effect was persistent up to 5 weeks post-intervention. Five exposures were sufficient to increase intake compared to the first exposure (P< 0·001). Repeated exposure to three variants of a novel vegetable was sufficient to increase intake of this vegetable, regardless of the addition of a familiar taste or energy. Repetition is therefore a critical factor for promoting novel vegetable intake in pre-school children.

Unbundling outcomes of a multilevel intervention to increase fruit, vegetables, and whole grains parents pack for their preschool children in sack lunches

BACKGROUND: Packing fruit, vegetables, and whole grains in preschool children's sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. PURPOSE: Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. METHODS: Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N=81) and comparison (N=51) parent-child dyads were evaluated in multilevel modeling. RESULTS: The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. DISCUSSION: Tailored options were identified for further strategies to increase vegetables and whole grains in parent-packed sack lunches. TRANSLATION TO HEALTH EDUCATION PRACTICE: Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.

Successful development of satiety enhancing food products: towards a multidisciplinary agenda of research challenges

In the context of increasing prevalence of overweight and obesity in societies worldwide, enhancing the satiating capacity of foods may help people control their energy intake and weight. This requires an integrated approach between various food-related disciplines. By structuring this approach around the new product development process, this paper aims to present the contours of such an integrative approach by going through the current state of the art around satiety enhancing foods. It portrays actual food choice as the end result of a complex interaction between internal satiety signals, other food benefits, and environmental cues. Three interrelated routes to satiating enhancement are to change the food composition to develop stronger physiological satiation and satiety signals, anticipate and build on smart external stimuli at the moment of purchase and consumption, and improve palatability and acceptance of satiety enhanced foods. Key research challenges in achieving these routes in the field of nutrition, food technology, consumer, marketing, and communication are outlined.

Repeated exposure and associative conditioning promote preschool children's liking of vegetables

Most young children do not meet current dietary recommendations, consuming too many energy-dense foods and too few nutrient-dense foods like vegetables. We compared two approaches to increasing children's liking of vegetables by having them repeatedly taste small portions of vegetables that were initially not liked, presented either alone (repeated exposure; RE) or with a liked dip (associative conditioning; AC). We first conducted a between-subjects experiment, where classrooms at a childcare center were each assigned a vegetable that most children did not like, and individual children were assigned to either the RE or AC condition. A second experiment was conducted to test whether the same results would be obtained using a within-subjects design, in which each child was assigned to repeatedly taste two vegetables that were not liked, one presented with dip and one without. In both experiments, vegetable liking was assessed before, during, and after a series of eight tasting trials, and vegetable intake was measured before and after the tasting trials in Experiment 1. In both experiments, children's vegetable liking increased from pre- to post-test, but there was no evidence of associative conditioning effects. Increases in vegetable liking, as well as intake, were similar across conditions. Although the addition of the liked dip did not augment overall effects on vegetable liking, there was some evidence that the liked dips could be used to encourage initial tasting of vegetables. In both experiments and both conditions, increases in liking were detected by the sixth exposure to the vegetable. Additional tasting trials did not produce additional increases in liking, but the increases in liking were sustained throughout the experiments. The current evidence suggests that administering few small tastes of vegetables that are initially not liked can have a lasting impact on preschool children's liking and intake of those vegetables.