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Edwards KL, Thomas JM, Higgs S, Blissett J. Repeated exposure to models' positive facial expressions whilst eating a raw vegetable increases children's consumption of the modelled vegetable. Eat Behav 2024; 53:101872. [PMID: 38537417 DOI: 10.1016/j.eatbeh.2024.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 06/03/2024]
Abstract
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.
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Affiliation(s)
- Katie L Edwards
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK.
| | - Jason M Thomas
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Jacqueline Blissett
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham B4 7ET, UK
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Barrett KJ, Moding KJ, Flesher A, Johnson SL. "The Kale Is Green" and Other Things Caregivers Say when Feeding Infants and Toddlers Are Associated with Child Rate of Acceptance. J Nutr 2023; 153:1297-1304. [PMID: 36803576 DOI: 10.1016/j.tjnut.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Responsive feeding is important for helping children to develop healthy eating behaviors. Verbal feeding interactions between caregivers and children may reflect caregiver's responsiveness and contribute to children's developing lexical networks related to food and eating. OBJECTIVES This project aimed to: 1) characterize what caregivers say to infants and toddlers during a single feeding session and 2) test the associations between caregiver's verbal prompts and food acceptance by children. METHODS Filmed interactions of caregivers and their infants (N = 46 infants aged 6-11 mo) and toddlers (N = 60 toddlers aged 12-24 mo) were coded and analyzed to explore the following: 1) what caregivers said during a single feeding session and 2) whether caregiver's verbalizations were associated with child food acceptance. Caregiver verbal prompts were coded during each food offer and summed across the feeding session; prompts were categorized as supportive, engaging, and unsupportive. Outcomes included accepted tastes, rejected tastes, and rate of acceptance. Mann-Whitney's U tests and Spearman's correlations tested bivariate associations. Multilevel ordered logistic regression tested associations between verbal prompt categories and the rate of acceptance across offers. RESULTS Verbal prompts were largely supportive (41%) and engaging (46%), and caregivers of toddlers used significantly more verbal prompts than caregivers of infants (mean ± SD: 34.5 ± 16.9 compared with 25.2 ± 11.6; P = 0.006). Among toddlers, more engaging and unsupportive prompts were associated with a lower rate of acceptance (ρ = -0.30, P = 0.02; ρ = -0.37, P = 0.004). For all children, multilevel analyses revealed that more unsupportive verbal prompts were associated with a lower rate of acceptance (b = -1.52; SE = 0.62; P = 0.01) and individual caregiver use of more engaging and unsupportive prompts than usual was associated with a lower rate of acceptance (b = -0.33; SE = 0.08; P < 0.001: b = -0.58; SE = 0.11; P < 0.001). CONCLUSIONS These findings suggest that caregivers may strive for a supportive and engaging emotional setting during feeding, although verbalization category may change as children exhibit more rejection. Furthermore, what caregivers say may change as children develop more advanced language capabilities.
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Affiliation(s)
- Katherine J Barrett
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States.
| | - Kameron J Moding
- Purdue University, Department of Human Development and Family Studies, West Lafayette, IN, United States
| | - Abigail Flesher
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States
| | - Susan L Johnson
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States
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Öz S, Bayhan P. An investigation of the relationship between the eating behaviours of children with typical development and autism spectrum disorders and parent attitudes during mealtime eating behaviours and parent attitudes during mealtime. Child Care Health Dev 2021; 47:877-885. [PMID: 34273188 DOI: 10.1111/cch.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nutrition has significant importance in the course of growth and development in early childhood. Selective and fussy eating is prevalent among children with autism spectrum disorder and can have a profound impact on parents' mealtime actions. AIMS The study aimed to investigate the relationship between parental mealtime actions and the eating behaviours of children aged 3-5 years with typical development (TD) and autism spectrum disorder (ASD). METHODS A total of 180 parents of children between 3 and 5 years in Ankara participated in the study; 90 were parents of children with TD, and 90 were parents of children with ASD. We measured the variables using the Brief Assessment of Mealtime Behaviour in Children (BAMBIC), Children's Eating Behaviour Questionnaire (CEBQ), and Parent Mealtime Action Scale (PMAS). RESULTS The results revealed that food refusal, disruptive behaviours, and limited variety in TD children were related to parental actions, such as the use of rewards. We also found a negative correlation between enjoyment of food and the use of rewards. Children with ASD displayed differences concerning food refusal, and their parents were found to prepare more special meals for them compared with children with TD. CONCLUSION Despite differences, the eating behaviours of children with TD and ASD show similarities in some cases. If a child has a low interest in eating, then their parents tend to be more insistent, use more rewards, and offer special meals. On the contrary, a child's high interest in eating harms such parental behaviours. Because an acknowledgement that a relationship exists between the eating behaviours of children and parental actions would make intervening to shape parental attitudes easier, it is recommended that future studies should be carried out to respond to the eating problems of children by working with parents.
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Affiliation(s)
- Sena Öz
- Faculty of Health Sciences, Department of Child Development, Ankara University, Keçiören, Ankara, Turkey
| | - Pınar Bayhan
- Faculty of Health Sciences, Department of Child Development, Hacettepe University, Altındağ, Ankara, Turkey
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Edwards KL, Thomas JM, Higgs S, Blissett J. Exposure to models' positive facial expressions whilst eating a raw vegetable increases children's acceptance and consumption of the modelled vegetable. Appetite 2021; 168:105779. [PMID: 34756937 DOI: 10.1016/j.appet.2021.105779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
Research has shown that seeing positive facial expressions (FEs) towards food increased children's desire to eat foods rated as disliked. However, the effect of adults' positive FEs whilst eating a raw vegetable on children's acceptance and intake of nutritious foods that are less preferred (e.g., vegetables) remains to be established. This study aimed to examine the effect of models' FEs eating raw broccoli on children's acceptance and intake of raw broccoli. 111 children aged 4-6 years (64 male, 47 female) were randomised to watch a video of unfamiliar adult models eating raw broccoli with a positive or neutral facial expression (FE), or a non-food control video. Children's acceptance and intake of raw broccoli was assessed. Data about parent and child characteristics was provided by parents. There was a main effect of FE type on children's frequency of tastes (p = .03) and intake of broccoli (p = .02). Children who were exposed to models eating broccoli with positive FEs had greater frequency of tastes (p = .04) and intake of broccoli (p = .03), than children in the control condition, but not compared to children in the neutral FE condition (p > .05). There was no effect of positive FEs on children's willingness to try broccoli (p > .05). These findings suggest that observing others enjoy a commonly disliked vegetable can encourage children's tastes and intake of the vegetable. Thus, exposing children to others enjoying vegetables could be a useful strategy for encouraging healthier eating in children. Further work is needed to determine whether a single exposure is sufficient and whether these effects are sustained over time.
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Affiliation(s)
| | | | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, UK
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Rendall S, Dodd H, Harvey K. Behavioural validation of a parent-report measure of child food fussiness. Appetite 2020; 154:104796. [PMID: 32712195 DOI: 10.1016/j.appet.2020.104796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/28/2022]
Abstract
Food fussiness is the rejection of familiar and novel foods leading to consumption that is insufficient and/or inadequately varied. Its importance to children's nutrition and the development of food preferences means it has been the focus of extensive research. To measure food fussiness, research has predominantly relied on parent-report, though parents' reporting of their child's eating behaviour can be reliable, responses may also be subject to bias. Utilising data from video-recordings of sixty-seven mother-child dyads during a meal in the home environment, this study aimed to validate the most widely used parent-report questionnaire measuring food fussiness against independent observations of children's eating behaviour and, in so doing, determine its accuracy. Maternal reported food fussiness, assessed using the Food Fussiness subscale of the Children's Eating Behaviour Questionnaire (CEBQ; Wardle, Guthrie, Sanderson, & Rapoport, 2001) was compared to children's observed food rejection and acceptance behaviours. Bootstrapped Pearson's correlations revealed that maternal reports of food fussiness were significantly positively related to food rejection behaviours and significantly negatively related to food acceptance behaviours. Maternal reports of food fussiness were also found to be significantly negatively related to the proportion of familiar/appealing of familiar foods consumed by the child. There was no significant association between maternal reported food fussiness and the proportion of familiar/unappealing, unfamiliar/appealing and unfamiliar/unappealing foods consumed by the child or the meal duration. These findings support the CEBQ FF as a valid measure of food fussiness.
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Affiliation(s)
- Stella Rendall
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Helen Dodd
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK.
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Sitarik AR, Kerver JM, Havstad SL, Zoratti EM, Ownby DR, Wegienka G, Johnson CC, Cassidy-Bushrow AE. Infant Feeding Practices and Subsequent Dietary Patterns of School-Aged Children in a US Birth Cohort. J Acad Nutr Diet 2020; 121:1064-1079. [PMID: 33544667 DOI: 10.1016/j.jand.2020.08.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Infant feeding practices are thought to shape food acceptance and preferences. However, few studies have evaluated whether these affect child diet later in life. OBJECTIVE The study objective was to examine the association between infant feeding practices and dietary patterns (DPs) in school-aged children. DESIGN A secondary analysis of data from a diverse prospective birth cohort with 10 years of follow-up (WHEALS [Wayne County Health Environment Allergy and Asthma Longitudinal Study]) was conducted. PARTICIPANTS/SETTING Children from the WHEALS (Detroit, MI, born 2003 through 2007) who completed a food screener at age 10 years were included (471 of 1,258 original participants). MAIN OUTCOME MEASURES The main outcome was DPs at age 10 years, identified using the Block Kids Food Screener. STATISTICAL ANALYSIS PERFORMED Latent class analysis was applied for DP identification. Breastfeeding and age at solid food introduction were associated with DPs using a 3-step approach for latent class modeling based on multinomial logistic regression models. RESULTS The following childhood DPs were identified: processed/energy-dense food (35%), variety plus high intake (41%), and healthy (24%). After weighting for loss to follow-up and covariate adjustment, compared with formula-fed children at 1 month, breastfed children had 0.41 times lower odds of the processed/energy-dense food DP vs the healthy DP (95% CI 0.14 to 1.25) and 0.53 times lower odds of the variety plus high intake DP (95% CI 0.17 to 1.61), neither of which were statistically significant. Results were similar, but more imprecise, for breastfeeding at 6 months. In addition, the association between age at solid food introduction and DP was nonsignificant, with each 1-month increase in age at solid food introduction associated with 0.81 times lower odds of the processed/energy-dense food DP relative to the healthy DP (95% CI 0.64 to 1.02). CONCLUSIONS A significant association between early life feeding practices and dietary patterns at school age was not detected. Large studies with follow-up beyond early childhood that can also adjust for the multitude of potential confounders associated with breastfeeding are needed.
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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A longitudinal examination of the role of sensory exploratory behaviors in young children's acceptance of new foods. Physiol Behav 2020; 218:112821. [PMID: 32001305 DOI: 10.1016/j.physbeh.2020.112821] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prompted engagement with a new food's sensory properties (smell, texture) has been associated with young children's acceptance of new foods. However, little is known about the prevalence and stability of children's sensory exploratory behaviors exhibited spontaneously when trying new foods. The aim of this analysis was to examine developmental trajectories of sensory exploratory behaviors (i.e., smelling, licking, spitting) in response to new foods. METHOD This 3-year longitudinal study included observational data collected from 244 preschoolers. At age 4 years, children were asked to taste four novel foods. An experimenter recorded the child's displays of smelling, licking, spitting, refusals, and acceptance. Assessments were repeated at 4.5, 5.5, and 6.5 years of age. Summary scores were created for each child by totaling the number of foods smelled, licked, spit out, refused, and accepted at each time point. A series of growth models were fit to the summary scores to examine individual sensory behavior trajectories and associations between trajectories of sensory behaviors and acceptance. RESULTS Linear growth model parameters indicated that spitting and refusals decreased over time (p-values < 0.01), whereas acceptances increased (p < 0.01). Licking and smelling showed non-significant change (p-values > 0.01) Furthermore, decreases in licking, spitting, and refusals were associated with increases in acceptance across the study period (p-values < 0.01). DISCUSSION The decline in young children's sensory exploratory behaviors in response to new foods was associated with increases in food acceptance. Our findings suggest that sensory exploratory behaviors may promote familiarity and help children learn that new foods are acceptable and safe to consume.
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Jordan AA, Appugliese DP, Miller AL, Lumeng JC, Rosenblum KL, Pesch MH. Maternal prompting types and child vegetable intake: Exploring the moderating role of picky eating. Appetite 2019; 146:104518. [PMID: 31734294 DOI: 10.1016/j.appet.2019.104518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unknown if using different maternal prompting types is associated with vegetable intake in children perceived to be picky versus non-picky. OBJECTIVES 1) To test the correlation of counts of maternal prompting types with child vegetable intake, and picky eating, 2) to examine the interaction of prompting types and picky eating status on vegetable intake. DESIGN/METHODS Low-income mother-child dyads (N = 199, mean child age 6.0 years) participated in a videotaped laboratory eating protocol with green beans, a familiar vegetable. A coding scheme was developed and reliably applied to categorize mothers' prompting types. The prompting types were: Coercive Control (Sub-Categories: Reward and Pressure-to-Eat), Autonomy Promotion (Sub-Categories: Modeling, Reasoning, Praise, and Question), and Total Prompts (sum of all prompts). Mothers completed questionnaires. Bivariate analyses tested the association between counts of maternal prompting types with amount of green beans eaten, and picky eating. Regression analyses examined the interaction of picky eating status with counts of maternal prompting type on amount of green beans eaten. RESULTS Mothers used on average 1.66 prompts. Greater use of Coercive Control, Autonomy Promotion-Modeling, and Total Prompts were all inversely correlated with amount of green beans eaten. Greater use of Autonomy Promotion-Praise was directly correlated with amount of green beans eaten. In stratified models, greater use of Coercive Control prompts was negatively associated with amount of green beans eaten by the child in non-picky eaters, but not in picky eaters. There was no interaction between other prompting types and child picky eating status in predicting amount eaten. All p-values <0.05. CONCLUSIONS Mothers use different prompting types to encourage their children to eat vegetables depending on their picky eating status, most of which may be correlated with reduced intake.
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Affiliation(s)
- Ariel A Jordan
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, USA.
| | | | - Alison L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Julie C Lumeng
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Center for Human Growth and Development, University of Michigan, Department of Nutritional Sciences, School of Public Health, University of Michigan, 300 N. Ingalls Street, 10th Floor, Ann Arbor, MI, 48109-5406, USA.
| | - Katherine L Rosenblum
- Department of Psychiatry, Medical School, University of Michigan, Center for Human Growth and Development, University of Michigan. 4250 Plymouth Road, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA.
| | - Megan H Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Center for Human Growth and Development, University of Michigan, 300 N. Ingalls Street, 1111 SE, Ann Arbor, MI, 48109-5456, USA.
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10
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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11
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Predictors of fruit and vegetable intake in low-income and racially diverse preschoolers: does parental feeding style matter? J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0976-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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12
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Momin SR, Hughes SO, Elias C, Papaioannou MA, Phan M, Vides D, Wood AC. Observations of Toddlers' sensory-based exploratory behaviors with a novel food. Appetite 2018; 131:108-116. [PMID: 30171913 DOI: 10.1016/j.appet.2018.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/17/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Food neophobia hinders the acceptance of healthy foods in young children, and may be overcome by repeated food exposure. Prevalent literature states that children exhibit five sensory-based exploratory behaviors (SBEBs): smelling, licking, spitting, manipulating and/or swallowing as they progress towards accepting a novel food, yet there is a paucity of research on these behaviors. This study aimed to use direct observations of SBEBs across first-time exposures to hummus to (1) determine the prevalence of five SBEBs (smelling, licking, spitting, manipulating and swallowing) in 12-35 month olds, (2) quantify the psychometric properties of the SBEB assessment; and (3) examine the association of SBEBs with parent-assessed food fussiness, and consumption of the novel food. METHODS Direct observations of SBEBs during a 15-20 min snack time were conducted by trained staff members for 55 hummus-naïve toddlers ages 12-35 months, across 16 exposures to a novel food (hummus). Parents completed the child eating behavior questionnaire. Hummus consumption was measured using digital plate waste method. RESULTS Very low base rates of spitting (0.06%), smelling (0.97%) and licking (1.95%) were observed but manipulation (26.36%) and swallowing (62.15%) were more prevalent. Observation data on two behaviors over 16 occasions gave rise to a reliability coefficient from our G study portion of our generalizability analyses of Eρ2 = 0.65. SBEBs did not significantly associate with parent-assessed food fussiness, nor hummus consumption. CONCLUSIONS Although literature refers to the prevalence of SBEBs, we did not observe this for three proposed behaviors. We did observe manipulation, but more research is needed to determine if there are additional SBEBs not noted in the literature, and to better delineate the process that leads to acceptance/rejection of novel food.
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Affiliation(s)
- Shabnam R Momin
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Sheryl O Hughes
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Cindy Elias
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Maria A Papaioannou
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Mimi Phan
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - David Vides
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Alexis C Wood
- USDA / ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA.
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13
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Strategies to increase preschoolers' vegetable liking and consumption: The role of reward sensitivity. Food Qual Prefer 2018. [DOI: 10.1016/j.foodqual.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Rogers S, Ramsay M, Blissett J. The Montreal Children’s Hospital Feeding Scale: Relationships with parental report of child eating behaviours and observed feeding interactions. Appetite 2018; 125:201-209. [DOI: 10.1016/j.appet.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 02/02/2018] [Accepted: 02/07/2018] [Indexed: 01/21/2023]
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15
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Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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16
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Hodder RK, Stacey FG, O'Brien KM, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 1:CD008552. [PMID: 29365346 PMCID: PMC6491117 DOI: 10.1002/14651858.cd008552.pub4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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17
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Hodder RK, Stacey FG, Wyse RJ, O'Brien KM, Clinton‐McHarg T, Tzelepis F, Nathan NK, James EL, Bartlem KM, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2017; 9:CD008552. [PMID: 28945919 PMCID: PMC6483688 DOI: 10.1002/14651858.cd008552.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | | | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter Population HealthLocked Bag 10WallsendAustralia
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Holley CE, Farrow C, Haycraft E. Investigating offering of vegetables by caregivers of preschool age children. Child Care Health Dev 2017; 43:240-249. [PMID: 27554997 DOI: 10.1111/cch.12400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research into the methods which caregivers use to encourage children to eat vegetables is limited, with minimal evidence about what the barriers are to offering these foods. Vegetable consumption in children is typically low, and so gaining information on these factors is vital in order to develop further caregiver-centred interventions to increase children's vegetable consumption. This study aimed to investigate the methods caregivers use to offer vegetables to preschool aged children, as well as the factors which influence whether and how caregivers present vegetables to their children. METHOD Seventeen caregivers with a preschool aged child participated in focus groups to assess these questions. RESULTS Thematic analysis indicated that caregivers use a range of methods to offer their children vegetables, with these methods falling into three broad categories: behavioural/active methods, passive methods and food manipulations. Influences on caregiver offering which emerged from the focus groups formed four categories: information, cost, parent factors and child factors. CONCLUSIONS Together with large-scale quantitative data, this information can be used to shape future interventions aiming to increase children's vegetable intake as well as to tailor advice given to caregivers striving to achieve a healthful diet for their children.
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Affiliation(s)
- C E Holley
- Loughborough University, Leicestershire, UK
| | - C Farrow
- Aston University, Birmingham, UK
| | - E Haycraft
- Loughborough University, Leicestershire, UK
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Coulthard H, Harris G, Fogel A. Association between tactile over-responsivity and vegetable consumption early in the introduction of solid foods and its variation with age. MATERNAL & CHILD NUTRITION 2016; 12:848-59. [PMID: 26792423 PMCID: PMC6860046 DOI: 10.1111/mcn.12228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/29/2015] [Accepted: 09/03/2015] [Indexed: 12/25/2022]
Abstract
The main aim of the current study was to test the hypothesis that early reactions to a vegetable in infants may be associated with sensory processing, in particular, tactile over-responsivity. A secondary aim was to see whether the relationship between sensory over-responsivity and vegetable consumption would be moderated by the age of the infant. A sample of 61 infants was recruited from children's centres and playgroups in South Birmingham, UK. Infant's acceptance of carrot was measured in grams during the first week of complementary feeding in one testing situation. Mothers filled in self-report measures of infant sensory processing, as well as their own fruit and vegetable consumption. Infant carrot consumption in the first week of solid food consumption was negatively associated with total sensory over-responsivity across different sensory domains (P < 0.01). Across the sensory domains only tactile over-responsivity predicted carrot consumption, accounting for 10.7% of the variance in consumption scores. Across the sample as a whole, the relationship between carrot consumption and tactile over-responsivity varied according to the age of introduction to solid foods. In particular, those who were weaned later and had high tactile over-responsivity ate less carrot (P < 0.001). Infants who were weaned early ate a similar amount of carrot, regardless of their tactile responsivity (P > 0.05). This study constitutes some of the first evidence to suggest that sensory processing styles be associated with early vegetable acceptance; however, more research is needed to evaluate the best strategies to use when feeding infants who are sensitive to tactile information.
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Affiliation(s)
- Helen Coulthard
- Division of Psychology, Faculty of Health and Life Sciences, Hawthorn Building, De Montfort University, Leicester, LE1 9BH, UK.
| | - Gillian Harris
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anna Fogel
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Harris G, Coulthard H. Early Eating Behaviours and Food Acceptance Revisited: Breastfeeding and Introduction of Complementary Foods as Predictive of Food Acceptance. Curr Obes Rep 2016; 5:113-20. [PMID: 26956951 PMCID: PMC4796330 DOI: 10.1007/s13679-016-0202-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Current dietary advice for children is that they should eat at least five portions of fruit and vegetables a day (Department of Health. National Diet and Nutrition Survey, 2014). However, many parents report that children are reluctant to eat vegetables and often fail to comply with the five-a-day rule. In fact, in surveys carried out in areas in the UK, the number of children eating according to the five-a-day rule has been found to be as low as 16 % (Cockroft et al. Public Health Nutr 8(7):861-69, 2005). This narrative review looks at those factors which contribute to food acceptance, especially fruit and vegetables, and how acceptance might be enhanced to contribute to a wider dietary range in infancy and later childhood. The questions we address are whether the range of foods accepted is determined by the following: innate predispositions interacting with early experience with taste and textures, sensitive periods in infancy for introduction, breastfeeding and the pattern of introduction of complementary foods. Our conclusions are that all of these factors affect dietary range, and that both breastfeeding and the timely introduction of complementary foods predict subsequent food acceptance.
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Affiliation(s)
- Gillian Harris
- />School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Helen Coulthard
- />Division of Psychology, De Montfort University, Leicester, LE1 9BH UK
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Parental modelling and prompting effects on acceptance of a novel fruit in 2–4-year-old children are dependent on children’s food responsiveness. Br J Nutr 2015; 115:554-64. [DOI: 10.1017/s0007114515004651] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractFew children consume the recommended portions of fruit or vegetables. This study examined the effects of parental physical prompting and parental modelling in children’s acceptance of a novel fruit (NF) and examined the role of children’s food-approach and food-avoidance traits on NF engagement and consumption. A total of 120 caregiver–child dyads (fifty-four girls, sixty-six boys) participated in this study. Dyads were allocated to one of the following three conditions: physical prompting but no modelling, physical prompting and modelling or a modelling only control condition. Dyads ate a standardised meal containing a portion of a fruit new to the child. Parents completed measures of children’s food approach and avoidance. Willingness to try the NF was observed, and the amount of the NF consumed was measured. Physical prompting but no modelling resulted in greater physical refusal of the NF. There were main effects of enjoyment of food and food fussiness on acceptance. Food responsiveness interacted with condition such that children who were more food responsive had greater NF acceptance in the prompting and modelling conditions in comparison with the modelling only condition. In contrast, children with low food responsiveness had greater acceptance in the modelling control condition than in the prompting but no modelling condition. Physical prompting in the absence of modelling is likely to be detrimental to NF acceptance. Parental use of physical prompting strategies, in combination with modelling of NF intake, may facilitate acceptance of NF, but only in food-responsive children. Modelling consumption best promotes acceptance in children with low food responsiveness.
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How parental dietary behavior and food parenting practices affect children's dietary behavior. Interacting sources of influence? Appetite 2015; 89:246-57. [DOI: 10.1016/j.appet.2015.02.012] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/27/2015] [Accepted: 02/08/2015] [Indexed: 01/16/2023]
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Coulthard H, Thakker D. Enjoyment of tactile play is associated with lower food neophobia in preschool children. J Acad Nutr Diet 2015; 115:1134-40. [PMID: 25935569 DOI: 10.1016/j.jand.2015.02.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
Previous research has shown that parental reports of food neophobia and tactile sensitivity are associated with lower fruit and vegetable (F/V) intake in children. This study aimed to pilot a behavioral observation measure of tactile play in young children. The primary aim of the study was to see whether children's enjoyment of tactile play was associated with higher F/V consumption, as well as lower food neophobia. Seventy 2- to 5-year-old children (37 males and 33 females) and their parents were recruited through children's centers in the Leicester region of the United Kingdom during July to October 2012. Children's engagement in two tactile play tasks using sticky foods (mashed potatoes and vegetarian gelatin) was observed and rated by both the researcher and parent. Parents were asked to complete a series of questionnaires measuring F/V consumption, food neophobia, and sensory processing. It was found that lower child food neophobia was significantly related to enjoyment of tactile play, whereas child F/V consumption was associated with parental F/V consumption, but not enjoyment of tactile play. The findings strengthen the idea that tactile processing may be associated with the acceptance of food variety, but not the total amount of F/V consumed. Additional research is indicated to determine whether tactile play tasks can be used to lower child food neophobia.
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Ramsay SA, Eskelsen AK, Branen LJ, Armstrong Shultz J, Plumb J. Nutrient Intake and Consumption of Fruit and Vegetables in Young Children. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/1941406414549622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children’s fruit and vegetable consumption (FVC) is below recommendations. Objectives of the study were to (a) describe the type and frequency of FVC, (b) analyze the average nutrient intake from young children’s fruit consumption and vegetable consumption separately, and (c) determine the contribution of demographic factors on FVC. Children aged 2 to 5 years (n = 821) were identified using the 2009-2010 National Health and Nutrition Examination Survey. Average servings and nutrient intake from FVC were estimated. Multiple comparisons among age, gender, body mass index (BMI), ethnicity, and poverty index ratio (PIR) were analyzed using an ANCOVA. Akaike’s information criterion determined relative contribution of each factor to FVC. Children consumed 3 times as many fruit servings as vegetable servings regardless of age, gender, BMI, ethnicity, and PIR. Potato products and fruit juice were consumed most frequently and in the greatest amounts. In general, children obtained more nutrients from fruits than vegetables. No differences in total fruit consumption were identified for age, gender, and BMI. Total vegetable consumption did not differ for age, gender, ethnicity, BMI, and PIR. Health care professionals should promote a variety of both fruits and vegetables for children but also recognize the nutrient value of fruit in building the recommended fruit and vegetable base for young children’s diets.
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Affiliation(s)
- Samantha A. Ramsay
- School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho (SAR, AKE, LJB)
- Department of Extension, Washington State University, Pullman, Washington (JAS)
- Private Practice Statistician, Cook, Washington (JP)
| | - Ashlee K. Eskelsen
- School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho (SAR, AKE, LJB)
- Department of Extension, Washington State University, Pullman, Washington (JAS)
- Private Practice Statistician, Cook, Washington (JP)
| | - Laurel J. Branen
- School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho (SAR, AKE, LJB)
- Department of Extension, Washington State University, Pullman, Washington (JAS)
- Private Practice Statistician, Cook, Washington (JP)
| | - Jill Armstrong Shultz
- School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho (SAR, AKE, LJB)
- Department of Extension, Washington State University, Pullman, Washington (JAS)
- Private Practice Statistician, Cook, Washington (JP)
| | - John Plumb
- School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho (SAR, AKE, LJB)
- Department of Extension, Washington State University, Pullman, Washington (JAS)
- Private Practice Statistician, Cook, Washington (JP)
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Moding KJ, Birch LL, Stifter CA. Infant temperament and feeding history predict infants' responses to novel foods. Appetite 2014; 83:218-225. [PMID: 25173062 DOI: 10.1016/j.appet.2014.08.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/20/2014] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
Abstract
The purpose of the present study was to investigate whether infant temperament and previous feeding history were associated with infants' acceptance and rejection of a novel food at 12 months of age. Mother-infant dyads (n = 89) were video-recorded during a novel food (hummus, cottage cheese) feeding task. Infants' reactions (acceptance and rejection behaviors) and maternal responsiveness and affect during the interaction were coded from the recordings by teams of coders. Mothers reported on their infants' temperamental approach via the Infant Behavior Questionnaire-Revised (IBQ-R) and their infants' feeding history (previous exposure to solid foods and exclusive breastfeeding). Regression analyses revealed that infants rated lower on approach showed less acceptance of the first offer of novel food than infants rated higher on approach. Additionally, low approach infants who were previously exposed to a greater number of solid foods showed fewer rejection behaviors in response to the later offers of food. Exclusive breastfeeding for 4 months did not appear to have an effect on acceptance or rejection. Finally, greater maternal responsiveness was related to the infants' acceptance of the new food whereas lower maternal responsiveness was associated with rejection of the novel food. These results suggest that the acceptance and rejection of new foods by infants is dependent upon their temperament and previous exposure to solid foods, as well as the manner in which mothers present the novel food.
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Affiliation(s)
- Kameron J Moding
- Department of Human Development and Family Studies, 315 Health and Human Development East Building, Pennsylvania State University, University Park, PA 16802, USA.
| | - Leann L Birch
- Department of Foods and Nutrition, 176 Dawson Hall, University of Georgia, Athens, GA 30602-3632, USA
| | - Cynthia A Stifter
- Department of Human Development and Family Studies, 315 Health and Human Development East Building, Pennsylvania State University, University Park, PA 16802, USA
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Coulthard H, Harris G, Fogel A. Exposure to vegetable variety in infants weaned at different ages. Appetite 2014; 78:89-94. [PMID: 24685457 DOI: 10.1016/j.appet.2014.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 11/19/2022]
Abstract
The aim of the current study was to examine the effectiveness of different vegetable exposure methods (variety versus single taste) over a 9 day period in two groups of infants; those introduced to solids prior to the age of 5.5 months, and those introduced after 5.5 months. Sixty parent-infant dyads were recruited in South Birmingham, UK. Infants' acceptance of a novel vegetable (pea puree) was measured after a 9 day exposure period in the infants a week after they were first introduced to solid foods. During the exposure period half of each age group was given carrot every day, and the other half was given a variety pack of courgette, parsnip and sweet potato. A baseline measurement of the infants' acceptance of a vegetable (carrot) was taken prior to the exposure period. There was no difference between the groups in consumption of the baseline vegetable (carrot). There were no main effects of exposure group or age group on consumption of pea after the exposure period. There was, however, an interaction between the age of introduction and exposure group on consumption of the new vegetable (pea). In particular, infants weaned at 6 months in the single taste group ate significantly less pea puree than those in the variety group. These findings suggest that infants, who are weaned at 6 months or later, may benefit from being weaned onto a variety of tastes rapidly to ensure adequate exposure to taste. This study constitutes some of the first evidence to suggest that there may be a sensitive period for the acceptance of tastes between the ages of 4 and 6 months.
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Affiliation(s)
- Helen Coulthard
- Division of Psychology, School of Applied Social Sciences, Faculty of Health & Life Sciences, De Montfort University, Hawthorn Building, Leicester, LE1 9BH, UK.
| | - Gillian Harris
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anna Fogel
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Satter E, Lohse B. The quest for children's food acceptance. J Acad Nutr Diet 2013; 113:508-9. [PMID: 23522575 DOI: 10.1016/j.jand.2013.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Indexed: 11/25/2022]
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Blissett J, Fogel A. Intrinsic and extrinsic influences on children's acceptance of new foods. Physiol Behav 2013; 121:89-95. [PMID: 23458629 DOI: 10.1016/j.physbeh.2013.02.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Jackie Blissett
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
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