Teaching children to like and eat vegetables

Association between youth blood pressure and exposure to pediatric fruit and vegetable prescriptions

BACKGROUND

Health impacts of pediatric fruit and vegetable prescription programs (FVPPs) are unclear. This study assessed whether exposure to an FVPP that provided $15 produce prescriptions during pediatric visits was associated with differences in child diet, food security, physical activity, weight status, and blood pressure.

METHODS

This cross-sectional analysis included data from caregiver-child dyads with varying levels of exposure to the FVPP. Dyads completed surveys at pediatric offices. Trained research assistants measured height and weight of children and recorded blood pressure through chart review. Causal inference analyses using propensity score adjustments compared outcomes of exposure groups.

RESULTS

680 dyads enrolled. Youth who received ≥1 prescription (exposed) reported greater physical activity compared to youth who received no prescriptions (unexposed). Blood pressure percentiles were lower among exposed when compared to unexposed youth (63.273 versus 75.060 for SBP; 71.472 versus 77.548 for DBP); and fewer exposed children recorded elevated blood pressure when compared to unexposed (0.141 versus 0.343 for SBP; 0.199 versus 0.344 for DBP; and 0.286 versus 0.531 overall). Similar findings were obtained using duration as a measure of exposure.

CONCLUSION

Youth exposed to the FVPP experienced greater physical activity and healthier blood pressure. Findings may indicate novel health-promoting effects of pediatric FVPPs.

IMPACT

When compared to youth with no exposure, youth exposed to a pediatric fruit and vegetable prescription program recorded greater physical activity and healthier blood pressure. Youth with high exposure (≥24 months) to the fruit and vegetable prescription program experienced greater physical activity and healthier blood pressure when compared to youth with low exposure (<24 months). This extends evaluation of pediatric fruit and vegetable prescription programs beyond feasibility and preliminary effectiveness to indicate potential of such programs in positively influencing physical activity and blood pressure of participating youth. Findings indicate novel health-promoting effects of pediatric fruit and vegetable prescription programs.

'There are healthy things inside': Children's thoughts about, experiences with and approaches to vegetable and fruit consumption

Children's vegetable and fruit (V&F) consumption is generally lower than dietary recommendations. Thus, this study explored 15 Swedish children's thoughts, experiences and approaches to V&F consumption. Individual interviews were conducted with 10- to 12-year-old children (eight girls and seven boys) of diverse cultural backgrounds. The interviews were thematically analysed, and a final step adopted a phenomenographic approach. The results reveal that the children thought of V&F as healthy, but their knowledge of V&F's health effects was fragmented and lacked context. They named both adults and their peers as important in encouraging or discouraging them from consuming V&F. Many of them also described creative and playful uses of V&F. From the children's thoughts and experiences, the following elements were identified as influencing their V&F consumption: (1) the V&F's taste and serving style, (2) the impact of others, (3) beliefs about V&F's healthiness and (4) their conscious habits and choices. The researchers categorised the children's different ways of relating to the elements as the following approaches to children's V&F consumption: 'The food determines what I eat', 'Other people determine what I eat', 'My knowledge determines what I eat' and 'My conscious habits determine what I eat'. We suggest that future efforts to promote children's V&F consumption consider these approaches, for example by supporting peer norms, sensory play and training and more comprehensive age-appropriate explanations of V&F's health effects as well as educational tools that empower children to self-monitor habits that facilitate their adequate consumption of V&F.

Repeated exposure to models' positive facial expressions whilst eating a raw vegetable increases children's consumption of the modelled vegetable

Exposing children to adults eating a raw vegetable with positive facial expressions ('positive modelling') increases children's consumption of the modelled vegetable. However, whether repeated versus a single exposure to positive modelling enhances this effect, and whether it generalises to a non-modelled vegetable, remains to be examined. Hence, this study examined the effect of a single exposure, versus repeated, exposure to positive modelling on children's acceptance and intake of a modelled and non-modelled vegetable. Children aged 5-6 years (N = 153; 81 males, 72 females) were randomised to one of three conditions in which they had i) a single or ii) repeated exposure to a video of adults eating raw broccoli with positive facial expressions or iii) were exposed to a no-food control video. Children's acceptance (measured as willingness to try and number of tastes), intake and liking of a modelled (raw broccoli) and non-modelled vegetable (raw mangetout) were measured. Children had greater raw broccoli consumption and liking if they had received repeated exposure to positive modelling, compared to children who had received a single exposure, but not compared to children in the control condition. Children's mangetout intake was greater in the single (versus repeated) positive condition, but this effect was not dependent on time. There was no effect on children's vegetable acceptance. Repeatedly exposing children to adults enjoying a vegetable encourages children's intake of the modelled vegetable in comparison to a single exposure. Thus, repeated exposure to others' food enjoyment may be a practical and useful strategy to encourage children's vegetable consumption.

Daily Saturated Fat and Sodium Content of Elementary School Meals in a Large Sample of 128 Geographically Diverse School Systems in the United States

BACKGROUND

Despite federal regulations limiting saturated fat and sodium levels on a weekly average basis, daily nutrient content of school meals in the United States is not regulated, leading to potential large fluctuations and intake well in excess of dietary recommendations.

OBJECTIVE

To assess the daily prevalence of potential public elementary school meal combinations that were high in saturated fat and sodium (using cutoffs based on the US Department of Agriculture weekly average reimbursable meal thresholds), and to identify saturated fat and sodium thresholds for entrées to limit full meals exceeding those cutoffs.

DESIGN

Cross-sectional.

PARTICIPANTS AND SETTING

Four weeks of publicly available public elementary school (kindergarten through grade five) breakfast and lunch menus with associated nutrition data were collected from a national stratified random sample of 128 school districts during fall 2019.

MAIN OUTCOME MEASURES

Percent of meal combinations exceeding the saturated fat and Target 1 sodium thresholds were calculated, as well as thresholds for saturated fat and sodium levels in breakfast and lunch entrées.

STATISTICAL ANALYSES

Descriptive statistics and logistic regression were used to examine the odds of alignment with sodium and saturated fat US Department of Agriculture thresholds.

RESULTS

The prevalence of elementary breakfast and lunch meal combinations that were high in sodium was on average 11% and 12.4%, respectively, and for saturated fat was 10.6% and 34%, respectively. Entrées above certain thresholds (≥400 and ≥1,000 mg sodium and ≥4.5 and ≥6 g saturated fat for breakfast and lunch, respectively) had a higher odds of producing a reimbursable meal that was high in sodium and saturated fat.

CONCLUSIONS

There is widespread availability of high-saturated fat and sodium elementary school meal combinations on a daily basis. Daily thresholds, in addition to weekly nutrient thresholds, as well as limits on sodium and saturated fat for entrées, may therefore be needed to prevent daily excess intake of saturated fat and sodium among elementary students.

Optogenetic induction of appetitive and aversive taste memories in Drosophila

Tastes typically evoke innate behavioral responses that can be broadly categorized as acceptance or rejection. However, research in Drosophila melanogaster indicates that taste responses also exhibit plasticity through experience-dependent changes in mushroom body circuits. In this study, we develop a novel taste learning paradigm using closed-loop optogenetics. We find that appetitive and aversive taste memories can be formed by pairing gustatory stimuli with optogenetic activation of sensory neurons or dopaminergic neurons encoding reward or punishment. As with olfactory memories, distinct dopaminergic subpopulations drive the parallel formation of short- and long-term appetitive memories. Long-term memories are protein synthesis-dependent and have energetic requirements that are satisfied by a variety of caloric food sources or by direct stimulation of MB-MP1 dopaminergic neurons. Our paradigm affords new opportunities to probe plasticity mechanisms within the taste system and understand the extent to which taste responses depend on experience.

A role for enjoyment for encouraging fruit consumption

This work investigated the value of highlighting the enjoyment conferred by fruit for encouraging fruit consumption. Study 1 investigated the effects on fruit consumption of visualizing eating fruit that was either enjoyable, not enjoyable, or was unassociated with enjoyment. Study 2 investigated the effects on fruit consumption of health promotion posters that featured either enjoyable or less enjoyable fruit. Both studies used an independent-groups design, where young adults (Study 1, N = 142; Study 2, N = 221) were randomized to conditions, and outcomes: intentions to consume fruit, attitudes towards fruit, immediate fruit selection, subsequent fruit consumption; and a range of characteristics likely to be associated with fruit and vegetable consumption were assessed. In Study 1, higher intentions to consume fruit and more positive attitudes towards fruit were associated with higher likely enjoyment of the fruit visualized, higher fruit liking in general and higher fruit-related self-efficacy (smallest Beta = 0.270, p = 0.02). In Study 2, similar effects were found for likely enjoyment of the fruit featured on a poster; higher likely enjoyment also predicted greater immediate fruit selection (smallest Beta = 0.122, p = 0.03). These outcomes were also associated with variables often associated with fruit and vegetable consumption. Subsequent fruit consumption was only associated with past fruit consumption (smallest Beta = 0.340, p = 0.05). These two studies (Study 1 using visualisation, Study 2 using health promotion posters) highlight a role for enjoyment for encouraging fruit consumption. The value of enjoyment and the simplicity of the poster intervention particularly should be noted.

How infant food likes become established as knowledge: Parental food assessments during infant mealtimes in the home

Early infancy is a critical period for the development of food likes and dislikes, but very little is known about the role of the social context and parent-child interaction within this process, and even less about what happens in the home environment. The current paper addresses this issue by examining how and when parents utter food assessments about their infants' eating practices during mealtimes in the home, and the practices through which infant likes become established as knowledge. A data corpus of 77 video-recorded infant mealtimes from six infants (aged 5-9 months) and their parents was analysed using discursive psychology, with a specific focus on the use of object-side and subject-side assessments. Data were recorded in English-speaking family homes in Scotland and Sweden. The analysis highlights three key findings: (1) infants' interactional rights to assess food are invoked during first tastes, (2) infants' food likes are established through anchoring in family food preferences and as shared knowledge among family members, and (3) infants' potential food dislikes are challenged by parents using object-side assessments and claims about previous likes. Parents thus play a crucial role in the establishment of infant food likes through the formulation of subject-side category assessments during early infant mealtimes. The research suggests that more focus should be placed on examining infant eating practices as collaborative and interactional events in everyday contexts.

A Pavlovian Intervention to Condition Comforting Effects of Fruits

OBJECTIVE

Perceived stress, lower fruit intake, and comfort eating are all risk factors for chronic disease. The present pilot study aimed to simultaneously mitigate all three risk factors by applying Pavlovian conditioning to change the nature of comfort eating. Specifically, stressed participants underwent a Pavlovian conditioning intervention designed to elicit comforting effects of fruit intake and thereby reduce negative mood while promoting fruit intake.

METHODS

We developed a seven-dose Pavlovian conditioning intervention wherein participants temporally paired together Progressive Muscle Relaxation (unconditioned stimulus) with fruit intake (conditioned stimulus) daily for 1 week. Participants (N = 100, mean [standard deviation] age = 20.7 [4.6] years; 74% female) with moderate to high levels of baseline perceived stress were randomized to the intervention or an active explicitly unpaired control group, wherein the Progressive Muscle Relaxation and fruit intake also occurred but were not temporally paired together. After the intervention, participants' negative mood was assessed immediately before and after fruit intake to assess conditioning effects. Then, participants logged their regular food intake for 4 days using the MyFitnessPal smartphone app.

RESULTS

After the intervention, fruit intake acutely improved negative mood to a greater extent among the intervention versus control group (F(1,98) = 3.99, p = .048, = 0.039). However, there was not a significant between-group difference in intake of fruit or traditional comfort foods at postintervention.

CONCLUSIONS

Repeated pairing of fruit intake with a reliable distress-reducing activity led to the conditioning of comforting effects of fruit intake. Further refinement of the intervention design is necessary to translate this conditioned association to actual intake of fruit and other foods.

Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security

Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p < 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p < 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children.

Utilising an integrated approach to developing liking for and consumption of vegetables in children

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.

Optimising Repeated Exposure: Determining Optimal Exposure Frequency for Introducing a Novel Vegetable among Children

Fruit and vegetables are important components of a healthy diet, but unfortunately many children are not consuming enough to meet the recommendations. Therefore, it is crucial to develop strategies towards increasing the acceptance of this food group. This study aims to investigate the effect of different repeated exposure frequencies on fruit and vegetable acceptance using a novel vegetable, daikon, among 3–6-year-old children. One hundred and fifty-nine children participated in this study. Eight kindergarten teams were assigned to one of the following groups: Three different intervention groups with varying exposure frequencies, but all receiving seven exposures: Twice a week (n = 47), once a week (n = 32) and once every second week (n = 30), and a control group (n = 50). Liking and familiarity of daikon and other vegetables (cucumber, celery, celeriac, broccoli, cauliflower and beetroot) were assessed at baseline, post-intervention and two follow up sessions (3 and 6 months) to test for potential generalisation effects and observe the longevity of the obtained effects. Intake of daikon was measured at all exposures and test sessions. Results showed significant increases (p ≤ 0.05) in liking and intake of daikon for all three frequencies and the control group. Over the exposures, intake of daikon increased until the 4th exposure for all the groups, where a plateau was reached. No systematic generalisation effects were found. Repeated exposure was a successful approach to increase liking and intake of a novel vegetable with all exposure frequencies to be effective, and no particular exposure frequency can be recommended. Even the few exposures the control group received were found to be sufficient to improve intake and liking over 6 months (p ≤ 0.05), indicating that exposures to low quantities of an unfamiliar vegetable may be sufficient.

Identifying the links between consumer food waste, nutrition, and environmental sustainability: a narrative review

Emerging research demonstrates unexpected relationships between food waste, nutrition, and environmental sustainability that should be considered when developing waste reduction strategies. In this narrative review, we synthesize these linkages and the evidence related to drivers of food waste and reduction strategies at the consumer level in the United States. Higher diet quality is associated with greater food waste, which results in significant quantities of wasted resources (e.g., energy, fertilizer) and greenhouse gas emissions. Food waste also represents waste of micronutrients that could otherwise theoretically fill nutritional gaps for millions of people. To make progress on these multiple fronts simultaneously, nutrition professionals must expand beyond their traditional purview, into more interdisciplinary arenas that make connections with food waste and environmental sustainability.

Examining associative conditioning with a positive peer context as a strategy to increase children's vegetable acceptance

BACKGROUND

Children's vegetable acceptance increases following repeated exposure and associative conditioning pairing a target vegetable with a well-liked food. Yet traditional pairings may increase energy intake when well-liked foods are calorie-rich.

OBJECTIVES

To examine whether pairing a non-food stimulus with target vegetables increases children's vegetable acceptance and whether effects exceed those of repeated exposure.

METHODS

Twenty-three 6-to-8-year-old children participated in twice-weekly sessions across 6 weeks of a summer camp serving children from low-income families. First- and second-grade camp classrooms were randomly assigned to associative conditioning and repeated exposure groups, respectively. Liking and preference were assessed for seven vegetables at pre/post-test. For each child, two non-preferred vegetables were randomly assigned as the target or control. During exposures, associative conditioning group children experienced a positive peer context (involving group games) paired with tasting their target vegetable. The repeated exposure group received only taste exposures; target vegetable liking was assessed.

RESULTS

Preferences for target vegetables increased from pre- (Median = 6.00) to post-test (Median = 3.00) overall (P = .007), but did not differ by group (P = .59). Group, time and interaction effects on vegetable liking were non-significant overall (P ≥ .29), with some evidence of group differences when examining select time points.

CONCLUSIONS

Findings can inform future research aiming to increase vegetable preferences in community settings.

Nudging children toward healthier food choices: An experiment combining school and home gardens

School gardens have become a widely used approach to influence children's food knowledge, preferences and choices in low- and high-income countries alike. However, evidence indicates that such programs are more effective at influencing food knowledge and preferences than actual food choices. Such finding may occur because school gardens insufficiently influence the food behavior of parents and because healthy food items are not always available in children's homes. We tested this hypothesis using a one-year cluster randomized controlled trial in Nepal with 15 treatment and 15 control schools and a matched sample of 779 schoolchildren (aged 8-12) and their caregivers. Data were collected before and after the intervention during the 2018-2019 school year. In addition, children's food consumption was monitored using a monthly food logbook. Average treatment effects were quantified with a double-difference estimator. For caregivers, the intervention led to a 26% increase in their food and nutrition knowledge (p < 0.001), a 5% increase in their agricultural knowledge (p = 0.022), a 10% increase in their liking for vegetables (p < 0.001), and a 15% increase in home garden productivity (p = 0.073). For children, the intervention had no discernible effect on food and nutrition knowledge (p = 0.666) but led to a 6% increase in their liking for vegetables (p = 0.070), healthy food practices (p < 0.001), and vegetable consumption (October-December +15%; p = 0.084; January-March +26%; p = 0.017; April-June +26%; p = 0.088). The results therefore indicate both schools and parents matter for nudging children toward healthier food choices.

What Should I Eat and Why? The Environmental, Genetic, and Behavioral Determinants of Food Choice: Summary from a Pennington Scientific Symposium

This review details the proceedings of a Pennington Biomedical scientific symposium titled, "What Should I Eat and Why? The Environmental, Genetic, and Behavioral Determinants of Food Choice." The symposium was designed to review the literature about energy homeostasis, particularly related to food choice and feeding behaviors, from psychology to physiology. This review discusses the intrinsic determinants of food choice, including biological mechanisms (genetics), peripheral and central signals, brain correlates, and the potential role of the microbiome. This review also address the extrinsic determinants (environment) of food choice within our physical and social environments. Finally, this review reports the current treatment practices for the clinical management of eating-induced overweight and obesity. An improved understanding of these determinants will inform best practices for the clinical treatment and prevention of obesity. Strategies paired with systemic shifts in our public health policies and changes in our "obesogenic" environment will be most effective at attenuating the obesity epidemic.

New insights into the ontogeny of human vegetable consumption: From developmental brain and cognitive changes to behavior

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There is research gap regarding how mental growth and brain maturation may impact on vegetable consumption.

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We have identified particular brain maturation and mental growth patterns that may affect child vegetable consumption.

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Both of these developmental patterns partially match with the Piagetian theory of development.

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We have identified a series of potential modulating factors.

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The 3–4 and 4−5 age ranges might potential sensitive periods for acquisition of brand knowledge of foods and health-related abstract concepts.

Relatively little is known about how mental development during childhood parallels brain maturation, and how these processes may have an impact on changes in eating behavior: in particular in vegetable consumption. This review aims to bridge this research gap by integrating both recent findings from the study on brain maturation with recent results from research on cognitive development. Developmental human neuroscientific research in the field of the sensory systems and on the relationship between children’s cognitive development and vegetable consumption serve as benchmarks. We have identified brain maturation and mental growth patterns that may affect child vegetable consumption and conclude that both of these developmental patterns partially match with the Piagetian theory of development. Additionally, we conclude that a series of potential modulating factors, such as learning-related experiences, may lead to fluctuations in the course of those particular developmental patterns, and thus vegetable consumption patterns. Therefore, we propose a theoretical predictive model of child vegetable consumption in which the nature of the relationship between its correlational and/or causal components should be studied in the future by adopting an integral research perspective of the three targeted study levels: brain, cognition and behavior.

A new look at early exposure to the flavors of the available vegetables as foundational mechanism of vegetable consumption habits and recipes of vegetables-based dishes

The flavor of the maternal diet is transferred to women's amniotic fluid and breast milk, so that the amniotic fluid and breast milk become natural transmitters of flavor-related information developing babies are exposed to at early stages of development. We aimed to review the available evidence regarding the impact of early exposure to flavor on child vegetable intake, and to discuss for the first time possible effects of availability or unavailability of particular vegetables because of geographic reasons on these exposures, a variable that has been forgotten in the literature. We have focused on studies that have examined the association of prenatal and early postnatal -at breastfeeding- exposures to vegetable-related flavors with vegetable consumption in children. We have identified that this particular kind of exposures may lead to increases in children's acceptance, liking of and preference for the vegetables. Especially novel has been to identify that these effects might be modulated not only by the particular flavor of the vegetable -bitter vs. sweet- and the time of exposure -prenatal vs. breastfeeding- but also by vegetable availability because of geographic reasons of the place of residence of the mother, a variable that should be taken into account in future research. This would give rise to a new research line aimed at solving the mentioned gap. Finally, a theoretical model of cyclical processes that might explain the origin and perpetuation of transmission of particular patterns of vegetable consumption and vegetables-composed dishes over time in a given population is also included here as another new contribution.

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.

Liking of food textures and its relationship with oral physiological parameters and mouth-behavior groups

Researchers have categorized people into four "mouth-behavior" groups based on their oral processing preferences, and claimed that members of those mouth-behavior groups differ in their food texture preferences. If people could be classified into groups based on their liking of different textures, food products could be targeted to specific subgroups, potentially enhancing consumer acceptability. In the first part of our study, we grouped people based on their liking ratings of a wide variety of food textures by asking 288 participants to rate their liking of 106 food texture attributes in an online survey. In the second part of our study, we further examined relationships among individuals' food texture liking ratings, mouth-behavior group membership, and measurements of four oral physiological parameters (saliva flow rate, chewing efficiency, biting force, and particle size sensitivity). One-hundred participants completed the online survey on food texture liking, classified themselves into one of four mouth-behavior groups (Chewers, Crunchers, Smooshers, and Suckers), and were measured for four oral physiological parameters. We refuted the idea that large texture-liking subgroups exist. Although our participants self-categorized themselves into the four mouth-behavior groups similarly to previous researchers, our texture liking measurements did not support the presumed preferences of those mouth-behavior groups. Clustering of participants on their oral physiological measurements produced a "low particle-size sensitivity" cluster, a "high biting force" cluster, a "high saliva flow rate" cluster, and a "low saliva flow and low chewing efficiency" cluster. Neither our texture liking nor our oral physiological measurements predicted membership in the four mouth-behavior groups.

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.

Food preferences before and during treatment for a pediatric feeding disorder

Little is known about the food preferences of children with a feeding disorder and medical diagnoses. Therefore, we conducted repeated paired-stimulus-preference assessments with foods to which we either exposed or did not expose 3 children with a feeding disorder and medical diagnoses during clinical treatment. Responding was relatively equivalent for exposure and nonexposure foods throughout the preference assessments, suggesting that preferences for foods did not change due to exposure during treatment.

Implementation of Parental Strategies to Improve Child Vegetable Intake: Barriers and Facilitators

Purpose. To qualitatively assess barriers and facilitators to implementing specific behavioral strategies to increase child vegetable intake during home dinner meals by low-income parents. Method. Parents (n = 49) of children (9-12 years) were asked to implement 1 behavioral strategy following each of 6 weekly cooking classes at community centers. Example strategies included serving vegetables first, serving 2 vegetables, and using a bigger spoon to serve vegetables. The following week, parents discussed how they used the strategy and barriers and facilitators to its use. Discussions were recorded, transcribed verbatim, and coded separately by strategy using NVivo Pro 11 software. Inductive, comparative thematic analyses were used to identify themes by strategy. Results. Most participants were multiethnic women aged 30 to 39 years with low food security. Time and scheduling conflicts limited involvement of children in vegetable preparation (Child Help strategy). The type of foods served and an unfamiliar serving style inhibited use of the MyPlate and Available/Visible strategies, respectively. Children's dislike of vegetables limited use of the Serve Vegetables First and Serve 2 Vegetables strategies. Ease of use promoted use of the Bigger Spoon strategy. Conclusion. Educators could tailor application of specific parent strategies for low-income families based on child and environmental characteristics.

Modelling positive consequences: Increased vegetable intakes following modelled enjoyment versus modelled intake

OBJECTIVE

Modelling has previously been demonstrated to encourage healthy eating, but the importance of modelling the behaviour versus modelling the positive consequences of the behaviour is unknown. This work investigated the impact of modelling carrot intake (the behaviour) and modelling carrot enjoyment (the positive consequences) on subsequent liking and consumption of carrots and sweetcorn.

METHODS

155 children aged 7-10 years were randomized to hear a story where fictional characters consumed a picnic with either: no mention of carrot sticks (control) (N = 45); mention of carrot sticks that all characters ate (modelling intake) (N = 60); or mention of carrot sticks that the characters like (modelling enjoyment) (N = 50). Carrot and sweetcorn liking and intake were measured before and after the story during a 5 min task.

RESULTS

Carrot liking and intake after a story were higher following the story modelling carrot enjoyment compared to the stories not modelling enjoyment (smallest β = 0.16, p = 0.05), and in those with higher pre-story carrot liking and intake (smallest β = 0.25, p < 0.01). Sweetcorn liking and intake after a story were associated with pre-story sweetcorn liking and intake (smallest β = 0.28, p < 0.01), and sweetcorn intake was lower following the story modelling carrot enjoyment compared to the stories not modelling enjoyment (β = -0.17, p = 0.04).

CONCLUSIONS

These findings demonstrate a role for modelling enjoyment to encourage vegetable liking and intake, although effects sizes were small. These findings also suggest a benefit from modelling the positive consequences of a behaviour for encouraging healthy food intake in children, while limited effects were found for modelling the behaviour itself.

Design and rationale for evaluating salad bars and students' fruit and vegetable consumption: A cluster randomized factorial trial with objective assessments

Building healthy fruit and vegetable (FV) consumption habits early in life is critical for primary prevention. However, U.S. youth do not come close to meeting national recommendations for FV intake. School-lunch salad bars are one of the most heavily promoted ways to meet FV guidelines. Contrary to popular belief, no rigorous randomized trials have examined whether salad bars increase students' FV consumption. This paper describes the design and rationale of a federally funded trial to evaluate whether introducing salad bars in elementary, middle, and high schools affects students' FV consumption and waste during lunch. A cluster factorial randomized trial will test new salad bars against waitlist controls, with and without an additional marketing intervention (N = 36 schools, N = 6804 students: n = 12 elementary, n = 12 middle and n = 12 high schools). Objective plate waste measurements of individual student's selection of FVs, consumption, and waste will be conducted using digital scales. Primary aim includes comparing FV consumption in schools without salad bars to those with new salad bars by grade level. Secondary aims include: a) whether FV marketing impacts the success of salad bars for FV consumption; b) whether salad bars differentially result in more FV waste compared to traditional serving methods; c) cost-benefit of using salad bars for consumption over traditional serving methods. When complete, this study stands to be one of the most definitive on the effectiveness of salad bars and contextual factors impacting their success. Findings will provide evidence for how to best spend limited federal dollars to improve FV intake in schools. Trial registration: ClinicalTrials.gov Identifier: NCT03283033 (date of registration: 9/14/2017).

The effect of gendered presentation on children's food choice

Children at the peak age of cognitive gender rigidity (age 3-6 years) demonstrate preference for gender-typed activities, toys, and peers. This study explores whether this preference extends to gender-typed food. A total of 212 Virginia preschool and elementary school children performed a card sort of food images and chose between snacks with gender-consistent and gender-inconsistent packaging. Chi-squared analyses revealed that children were more likely to choose a snack in gender-consistent packaging, even when a tastier snack in gender-inconsistent packaging was available. Further, children consistently sorted pink-frosted cupcakes for girls and blue-frosted cupcakes for boys; and a subset of children who imposed gender onto other foods did so consistently (e.g., hamburgers for boys). Consistent with other evidence of children's gender rigidity, these findings support cognitive developmental theories of gender and add a gender-based explanation of children's food choice.

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.

Children Residing in Low-Income Households Like a Variety of Vegetables

Child vegetable intake falls far below the minimum recommended levels. Knowing which vegetables children may like help those responsible for providing vegetables to children to improve intake. The objective of this study was to measure vegetable liking for a wide variety of vegetables by a racially and ethnically diverse population of 9–12-year old children from low-income families. Children rated their liking of 35 vegetables using a 10-point hedonic scale. We tabulated the number of children that found each vegetable acceptable (ratings of ‘okay’ or above) and the number that found each vegetable unacceptable (ratings below ‘okay’). More than 50% of children who had tried a vegetable considered it acceptable. A large majority of the vegetables had mean ratings in the acceptable range. Corn was the most liked vegetable, closely followed by potatoes, lettuce, and carrots. Artichoke had the lowest mean liking, followed by onion and beets. We found children liked a wide variety of vegetables which offers counter evidence to the commonly held perception that children do not like vegetables.

Fifteen-minute consultation: The healthy child: "My child is a fussy eater!"

Feeding a child is an emotive experience. Selective eating (often referred to as fussy eating) is a typical part of early childhood but can cause significant anxiety to parents. This article covers the factors that influence the development of selective eating, the key points to elicit in history and examination, and evidence-based advice for parents.

The Development and Public Health Implications of Food Preferences in Children

Food preferences are a primary determinant of dietary intake and behaviors, and they persist from early childhood into later life. As such, establishing preferences for healthy foods from a young age is a promising approach to improving diet quality, a leading contributor to cardiometabolic health. This narrative review first describes the critical period for food preference development starting in utero and continuing through early childhood. Infants’ innate aversion to sour and bitter tastes can lead them to initially reject some healthy foods such as vegetables. Infants can learn to like these foods through exposures to their flavors in utero and through breastmilk. As solid foods are introduced through toddlerhood, children’s food preferences are shaped by parent feeding practices and environmental factors such as food advertising. Next, we discuss two key focus areas to improve diet quality highlighted by the current understanding of food preferences: (1) promoting healthy food preferences through breastfeeding and early exposures to healthy foods and (2) limiting the extent to which innate preferences for sweet and salty tastes lead to poor diet quality. We use an ecological framework to summarize potential points of intervention and provide recommendations for these focus areas, such as worksite benefits that promote breastfeeding, and changes in food retail and service environments. Individuals’ choices around breastfeeding and diet may ultimately be influenced by policy and community-level factors. It is thus crucial to take a multilevel approach to establish healthy food preferences from a young age, which have the potential to translate into lifelong healthy diet.

Early Taste Experiences and Later Food Choices

Background. Nutrition in early life is increasingly considered to be an important factor influencing later health. Food preferences are formed in infancy, are tracked into childhood and beyond, and complementary feeding practices are crucial to prevent obesity later in life. Methods. Through a literature search strategy, we have investigated the role of breastfeeding, of complementary feeding, and the parental and sociocultural factors which contribute to set food preferences early in life. Results. Children are predisposed to prefer high-energy, -sugar, and -salt foods, and in pre-school age to reject new foods (food neophobia). While genetically determined individual differences exist, repeated offering of foods can modify innate preferences. Conclusions. Starting in the prenatal period, a varied exposure through amniotic fluid and repeated experiences with novel flavors during breastfeeding and complementary feeding increase children’s willingness to try new foods within a positive social environment.

Modeling eating behaviors: The role of environment and positive food association learning via a Ratatouille effect

Eating behaviors among a large population of children are studied as a dynamic process driven by nonlinear interactions in the sociocultural school environment. The impact of food association learning on diet dynamics, inspired by a pilot study conducted among Arizona children in Pre-Kindergarten to 8th grades, is used to build simple population-level learning models. Qualitatively, mathematical studies are used to highlight the possible ramifications of instruction, learning in nutrition, and health at the community level. Model results suggest that nutrition education programs at the population-level have minimal impact on improving eating behaviors, findings that agree with prior field studies. Hence, the incorporation of food association learning may be a better strategy for creating resilient communities of healthy and non-healthy eaters. A Ratatouille effect can be observed when food association learners become food preference learners, a potential sustainable behavioral change, which in turn, may impact the overall distribution of healthy eaters. In short, this work evaluates the effectiveness of population-level intervention strategies and the importance of institutionalizing nutrition programs that factor in economical, social, cultural, and environmental elements that mesh well with the norms and values in the community.