Taste preferences, liking and other factors related to fruit and vegetable intakes among schoolchildren: results from observational studies

Validity and reliability of the Persian version of food preferences questionnaire (Persian-FPQ) in Iranian adolescents

The assessment of dietary intakes and habits using reliable and youth-specific measurement tools during adolescence is essential. The aim of the present study was to culturally adapt and investigate the psychometric properties of the Persian version of the food preferences questionnaire (Persian-FPQ) among Iranian adolescents. This methodological cross-sectional study was conducted among 452 Persian-speaking adolescents, living in Isfahan, Iran. Translation of the FPQ was performed using forward-backward method. Intra Class Correlation (ICC) and Cronbach's α were used to assess test-retest reliability and internal consistency, respectively. Construct validity was investigated by using exploratory factor analysis (EFA). Divergent validity was determined using correlation analysis with Kessler Psychological Distress Scale (K-10). Known-group validity was assessed based on differences in mean food preference score between boys and girls and different categories of body mass index (BMI). The internal and external reliabilities for the Persian-FPQ were in the range of good to excellent in all domains (Cronbach's α: 0.76-0.96 and ICCs: 0.982-0.998). Boys had higher scores of food preferences than girls, indicating good known-group validity. Construct validity evaluated by EFA led to extraction of seven factors ("Vegetables", "Fruit", "Dairy", "Snacks", "Meat/Fish", "Starches" and "Miscellaneous foods"), explaining 37.8% of the variance. Divergent validity revealed significant negative correlations between five sub-scales of the Persian-FPQ and psychological distress. The Persian version of the FPQ is a reliable and valid instrument with applicability in a broad range of the population of Persian-speaking adolescents for assessing food preferences in community-based research projects.

Neophobia, sensory experience and child's schemata contribute to food choices

PURPOSE

The aim of the present review is to analyze dynamic interactions between nutrigenomics, environmental cues, and parental influence, which can all lead to children's neophobic reactions and its persistence in time.

METHODS

We reviewed studies available on electronic databases, conducted on children aged from birth to 18 years. We also considered official websites of Italian Institutions, providing advice on healthy eating during infancy.

RESULTS

Modern day societies are faced with an eating paradox, which has severe and ever-growing implications for health. In face of a wider availability of healthy foods, individuals instead often choose processed foods high in fat, salt and sugar content. Economic reasons surely influence consumers' access to foods. However, there is mounting evidence that food choices depend on the interplay between social learning and genetic predispositions (e.g., individual eating traits and food schemata). Neophobia, the behavioral avoidance of new foods, represents an interesting trait, which can significantly influence children's food refusal. Early sensory experiences and negative cognitive schemata, in the context of primary caregiver-child interactions, importantly contribute to the priming of children's food rejection.

CONCLUSIONS

As neophobia strongly affects consumption of healthy foods, it will be relevant to rule definitively out its role in the genesis of maladaptive food choices and weight status in longitudinal studies tracking to adulthood and, in meanwhile, implement early in life effective social learning strategies, to reduce long-term effects of neophobia on dietary patterns and weight status.

LEVEL OF EVIDENCE

Level II, controlled trials without randomization.

Interventions based on sensory-hedonic strategies and on nudging to facilitate vegetable and pulses consumption in the school environment

Childhood and adolescence shape lifelong taste preferences and dietary habits, making them crucial periods for promoting healthy and sustainable eating. As students consume up to half of their daily energy intake at school, school interventions can have a significant impact on promoting plant-based diets. Although the benefits of promoting plant-based diets on children's and adolescents' health and environmental sustainability are well established and various studies report promising effects of interventions based on sensory-hedonic strategies and on nudging in promoting vegetables and pulses in schools, a comprehensive collection of those reports is lacking. Therefore, this systematic review aims to collect published literature on the above interventions in schools that focus on promoting the consumption of vegetables and pulses to children and adolescents. Three databases-PubMed, Scopus, and Web of Science-were searched over all years until March 2022 using pre-specified terms. From the 10.488 studies identified, a total of 57 studies reporting sensory-hedonic (e.g., manipulating food sensory properties or their hedonic value) or nudging (e.g., changing the presentation) interventions targeting children and/or adolescents in schools and aiming at promoting vegetables and/or pulses were included. Overall, interventions based on sensory-hedonic strategies (either enhancing the perception of well-accepted flavor and texture or manipulating their hedonic value) and on nudging (through incentives and prompts) are effective in promoting vegetables and pulses. A gap in the literature was identified for interventions targeting adolescents and promoting pulses. Finally, multicomponent interventions, rather than using one strategy alone, could be more successful.

Mediators and moderators of the effects of a school-based intervention on adolescents' fruit and vegetable consumption: the HEIA study

OBJECTIVE

To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status.

DESIGN

Cluster-randomised controlled trial.

SETTING

The HEIA study (2007-2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months).

PARTICIPANTS

Adolescents (11-13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375).

RESULTS

At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (β: -0·1, 95 % CI -0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths.

CONCLUSIONS

Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.

Children's Perceptions of the Ontario Student Nutrition Program (OSNP) in Southwestern Ontario, Canada

Purpose: This study aimed to explore children's lived experiences with the Ontario Student Nutrition Program (OSNP), a free, school-based snack program implemented in elementary schools in Southwestern, Ontario, Canada, to gain insights into future school food programs (SFP).Methods: Focus group discussions (n=17) were conducted with 105 children in Grades 5 to 8 in seven elementary schools. Focus groups were audio-recorded, transcribed, and coded for themes using inductive content analysis.Results: Overall, children appreciated the OSNP and felt that it filled a need in students. Children also reported a willingness to try novel food items. For future SFPs, participants recommended that input be sought from children to ensure food preferences were considered. Children also discussed wanting more appealing food offerings that may include some choice. Finally, children also mentioned wanting a fair and equitable distribution of food in classrooms.Conclusions: Children appreciated the OSNP and reported benefits to themselves and their peers. They also provided some valuable recommendations for future SFPs. If a nationally funded SFP is to be considered in Canada, children expressed the need to make the program equitable, while still allowing schools the flexibility to meet their unique needs and preferences.

Three-Year School-Based Multicomponent Intervention May Change Fruit and Vegetable Preferences in Primary School Children-A Quasi-Randomized Trial

Preference could be the trigger for fruit and vegetable (FV) consumption in children and could be modified by appropriate intervention to increase the acceptance of FVs. The primary objective of this study was to investigate the effects of the three-year school-based multicomponent intervention "Nutri-školica" on the FV preferences of primary school children. It also aimed to explore whether a positive change in FV preferences could lead to an increase in actual FV consumption. The study was conducted in 14 primary schools from the city of Zagreb on 193 children (52.3% boys; age, 7.7 ± 0.4 years; n = 85 in the control group and n = 108 in the intervention group) who completed a preference questionnaire before and after the intervention with a 5-point hedonic smiley-face scale, where 5 means "I like it a lot." The per-protocol approach was used for data analysis (28.3% of children from the study sample). After the intervention, children in the intervention group (before: 3.1 ± 0.8; after: 3.5 ± 0.8) increased their FV preferences significantly more than children in the control group (before: 3.2 ± 0.8; after: 3.3 ± 0.7). Children's FV preferences changed most toward the varieties for which they had the least preferences at the beginning of the study. Participation in the intervention had a stronger effect on changing FV intake than change in FV preferences among primary school children. In summary, the present study highlighted that a targeted intervention can increase children's FV preferences, but that participation in the intervention is substantial for increasing FV intake.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation

BACKGROUND

Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators.

METHODS

The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms.

RESULTS

Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09).

CONCLUSIONS

Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior.

TRIAL REGISTRATION

ISRCTN57165350 (8 January, 2015).

The Effects of a Multi-Component School-Based Nutrition Education Intervention on Children's Determinants of Fruit and Vegetable Intake

Evidence suggests that multi-component school-based health-promoting interventions have great potential to improve children's fruit and vegetable intake. However, interventions that combine classroom-based curricula with experiential learning strategies (e.g., cooking) are relatively seldom described. This study investigates the short-term and longer-term effects of a multi-component school-based nutrition education intervention combining classroom-based and experiential learning strategies on children's determinants of their fruit and vegetable intake (knowledge, taste preferences, attitudes, and intention). Using a comparative quasi-experimental study design, data were collected, via child-reported questionnaires, at the baseline, directly after the intervention, and three months after the intervention from 4 control and 15 intervention classes from Dutch primary schools. A total of 192 children in grades three and four (aged 8-10 years) constituted the participants. After correction for the baseline, sex, age, and the fruit or vegetable product assessed in the questionnaire; the intervention group showed a significant increase in knowledge (p = 0.001; standardized effect size (ES = 0.60), taste preference (p = 0.002; ES = 0.52), attitude towards the assessed fruit or vegetable product (p = 0.004; ES = 0.48), and general attitude towards healthy products (p = 0.01; ES = 0.39) over the short term, when compared to the control group. The effects of the intervention did not continue to be significant over the longer term. The findings implicate short-term intervention success, although more research and intervention adaptations are recommended to increase the impact of such programs, especially over the long term.

Increasing Fruit and Vegetable Intake of Primary School Children in a Quasi-Randomized Trial: Evaluation of the Three-Year School-Based Multicomponent Intervention

Insufficient consumption of fruit and vegetables was found in primary school children. To address this problem, a three-year school-based multicomponent intervention was conducted in 14 primary schools in the City of Zagreb. The aim of the study was therefore to evaluate one of the primary goals of the intervention—the increase in fruit and vegetable intake among primary school children. A total of 681 children were allocated to the intervention (n = 300 in the control group and n = 381 in the intervention group). The intervention included 23 interactive classroom workshops, 10 cross-curricular activities, 13 homework challenges, visual exposure with educational posters in classrooms, parent education via the website, and the implementation of new dishes into the school food system. Fruit and vegetable intake was assessed using a semi-quantitative food frequency questionnaire at baseline and after the intervention. Data were analyzed by per-protocol analysis. The study involved 259 children (50.2% girls; age 7.7 ± 0.4 years; n = 116 in the control group and n = 143 in the intervention group) who completed a food intake frequency questionnaire at both time points. Children in the intervention group showed a significant increase (p < 0.001) in total daily fruit and vegetable intake (before: 332.1 ± 164.9 g; after: 430.1 ± 186.7 g) compared to the control group (before: 350.2 ± 187.5; after: 382.6 ± 196.8) after the intervention. The increase in fruit and vegetable intake was achieved in 89% of children, while 25% more children reached the daily recommendation of 400 g. The use of the multicomponent intervention showed potential to increase fruit and vegetable intake in primary school children.

Dietary intake in children on the autism spectrum is altered and linked to differences in autistic traits and sensory processing styles

Diets of children and adolescents on the autism spectrum often differ when compared to their non-autistic peers. Most dietary studies have been limited by small sample sizes and rarely assess the heterogeneity of autism. Addressing this gap, this study compared the anthropometrics, dietary composition, dietary quality, and food variety of 154 Australian children and adolescents on the spectrum and 213 non-autistic children (71 siblings and 142 unrelated controls). Beyond the case-control approach, within-group comparisons assessed the influence of autism clinical presentations and sensory processing styles on body mass index (BMI) and measures of dietary intake among those on the spectrum. In this word first study of diet that included between-group comparisons with non-autistic peers (siblings and an unrelated comparison group) and within-autism group comparisons, we found that children on the spectrum consumed limited variety and lower quality of food and non-autistic siblings also ate comparably higher levels of energy-dense, nutrient poor food, and less diary. This may be due to autistic traits influencing family's diets or shared sensory sensitivities driving dietary intake. Within the autism group, higher autistic traits were associated with lower BMIs and a specific dietary pattern higher in simple carbohydrates and lower in unprocessed protein. Contrastingly, greater sensitivity to sensory stimuli was associated with a healthier diet. Increased age was linked to more varied diets but also diets higher in saturated fats and energy-dense, nutrient poor foods. Overall, this research highlights that potential mediators of dietary intake, such as familial influences, autistic traits, sensory processing styles, age and sex, need to be considered when assessing diet in the autistic population. LAY SUMMARY: In this study of dietary differences linked to autism, children, and teenagers on the spectrum ate fewer different foods and were less likely to eat recommended amounts of fruits and vegetables when compared to non-autistic siblings and unrelated children and teenagers. There were also family differences, in that those on the spectrum and their siblings ate more unhealthy foods and less dairy. Among those on the spectrum, dietary differences were linked to age, sex, autistic traits and sensory processing styles.

Study protocol: Evaluation of the 'Flavour School' sensory food education programme: a cluster-randomised controlled trial in UK primary school children, aged 4-7 years, to determine impact on confidence and curiosity in tasting vegetables and fruit

BACKGROUND

Many children would benefit from a diet richer in vegetables and fruit. 'Flavour School' is a programme of 'sensory food education', which aims to increase children's confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This study will conduct a cluster-randomised controlled trial to assess the outcomes of the Flavour School programme in primary school children aged 4-7 years.

METHODS

Four hundred plus children from 4+ schools will either complete the Flavour School programme (experimental group) or have no intervention with normal school teaching (control group), cluster-randomised within-schools, by school class. Baseline data collection will consist of video recorded behavioural observation during a tasting activity, and post-intervention data collection will repeat this activity after the experimental group have completed the intervention. Process measures will be assessed using a teacher engagement feedback questionnaire.

DISCUSSION

This study will provide causal data on the efficacy of a sensory food education intervention for increasing children's confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This new knowledge will help educators and policy makers to make evidence based decisions on uptake of sensory food education.

TRIAL REGISTRATION

ISRCTN: 40249947 Date assigned 17 March 2020 Last edited 22 September 2021 Version 1.2 Trial Acronym OASES (Outcomes Assessment of Sensory Education in Schools).

Sex-Based Differences in Factors Associated With Sugar-Sweetened Beverage Consumption Among Korean High School Students

This study aimed to identify sex-based differences in the individual and environmental factors associated with sugar-sweetened beverage (SSB) consumption among Korean high school students. Secondary data were obtained from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. In this study, we analyzed data from 13,066 high school students (5,874 boys and 7,192 girls) who answered questions regarding SSB consumption and individual and environmental factors. Complex sampling analysis (descriptive statistics and logistic regression analysis) was conducted using the SPSS Statistics 26.0 software. Most adolescents (97% boys and 95.2% girls) reported having consumed SSBs in the last seven days. Individual factors, such as increased stress, sleep dissatisfaction, and fast-food intake (more than thrice a week) were positively associated with SSB consumption among adolescent boys and girls. Environmental factors like high education levels (above college) of mothers were negatively associated with SSB consumption among both boys and girls. Furthermore, current alcohol consumption, smoking, low vegetable intake (less than thrice a week) in boys, and more than 2 h a day of screen-based sedentary behavior in girls were positively associated with SSB consumption. According to the results, individual factors associated with SSB consumption varied according to the sex of adolescents. Thus, sex differences in factors associated with SSB consumption in adolescents should be considered as basic knowledge for developing strategies for reducing SSB consumption.

Determinants of vegetable intake among urban socio-economically disadvantaged adolescents: a systematic review of quantitative studies

OBJECTIVE

To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme.

DESIGN

A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12-18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health.

SETTING

Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1).

PARTICIPANTS

Adolescents aged 12-18 years from socio-economically disadvantaged backgrounds living in urban settings.

RESULTS

Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings.

CONCLUSIONS

There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.

Perspective: Utilizing High Amylose Wheat Flour to Increase Dietary Fiber Intake of Children and Adolescents: A Health by Stealth Approach

Children and adolescents have consistently failed to meet recommended levels of dietary fiber consumption, thus making fiber a nutrient of concern. The importance of adequate dietary fiber intake to attain a healthy diet necessitates the identification of fiber-rich and readily consumed food sources by youth. Grain-based foods derived from whole grains represent a strategic initiative to increase dietary fiber consumption and is consistent with the American diet pattern. Increased intake of foods made from whole grains have been positively associated with improved health outcomes but are also less preferred among youth compared to refined grain products, which make up the majority of their carbohydrate intake. Advances in the commercialization and availability of high amylose wheat flour, a source of resistant starch fiber, provides an opportunity to remedy the suggested acceptability issues of whole grain products indicative of sensory factors, without compromising the amount of fiber ingested. Resistant starch fiber consumption has been associated with health benefits including improved blood sugar management, improved markers of digestive and gut health, increased satiety, and a reduced inflammatory response among adults. The limited studies that indicate fiber's direct benefit among youth are largely observational, thereby necessitating the need for more controlled trials for these age groups. Replacing traditional refined wheat flour with refined high amylose wheat flour has the unique ability to increase dietary fiber consumption without compromising desired sensory and finished product characteristics and thus can help increase dietary fiber consumption in children and adolescents who struggle to meet adequate intakes of fiber.

Relationship between erosive tooth wear and possible etiological factors among dental students

OBJECTIVES

The aim of this study was to assess the relationship between erosive tooth wear (ETW) and possible etiological factors in a group of dental students.

MATERIALS AND METHODS

A total of 126 dental students from a public dental school were included in this study. A questionnaire was used to investigate the possible etiological factors related to ETW. The Basic Erosive Wear Examination (BEWE) criteria were used to examine the status of ETW. A univariable and multivariable logistic regression models were used to assess the relationship between the presence of ETW and explanatory variables.

RESULTS

Univariable analysis revealed that taking acidic foods and alcohol more than 4-5 times per week increases the odds of ETW by 6.043 and 2.532 times, respectively, and taking dairy products, fruit juice, and milk more than 4-5 times per week decreases the likelihood of ETW by 61%, 66%, and 80%, respectively. The results of multivariable regression analysis showed that the frequency of consumption of especially acidic foods significantly increased the risk of ETW (OR = 9.981, 95% CI 3.577-27.849, p < 0.001).

CONCLUSIONS

Although the ETW status of dental students, who are the future dentists, varies depending on different possible etiological factors, especially the consumption of acidic foods has increased the risk of ETW approximately 10 times.

CLINICAL RELEVANCE

The findings highlight the high relevance of ETW, especially with acidic food consumption, and the importance of controlling potential etiological factors in dental students.

Can the School Fruit and Vegetable Scheme Be an Effective Strategy Leading to Positive Changes in Children's Eating Behaviours? Polish Evaluation Results

Background: The School Fruit and Vegetable Scheme (SFVS) was developed to form the habit of eating fruit and vegetables (F&V) among children. The survey aimed to identify both the strengths of the scheme and areas that required support and strengthening in the further implementation of school schemes. Methods: The study was conducted from 2012 to 2015 among students of randomly selected 85 primary schools that participated in the programme (intervention group) or did not participate therein (control group). The F&V consumption among the students was evaluated based on the 3 day food record method. Other behaviours were evaluated via frequency and preference questionnaires. Results: Over the three years of implementing SFVS, fruit consumption significantly increased by approximately 30 g/day, i.e., by 18%. In the control group, it increased only by approximately 4%. At the same time, no increase in vegetable consumption was observed. A number of other positive effects of SFVS were also found. These concerned students’ nutritional attitudes and behaviours, such as a further increase in the children’s knowledge on the health aspects of F&V consumption, the levels of their consumption and an increased preference for fruit in general. Conclusions: The results indicate that providing F&V in schools free of charge can be an effective strategy for enhancing F&V consumption among children, in particular by raising the awareness of the health importance of F&V consumption and gradually influencing children’s eating habits, especially when it comes to the habit of fruit consumption. The issue of vegetable consumption is an area for intervention enhancement. There is also a need for further, in-depth analyses, taking into account the impact of potential confounding factors.

Impact of the Cross-Curricular Education Program on Food Intake, Physical Activity, and Body Mass Index of School Children in a Local Community in Northern Serbia

Introduction: The trends in the state of nutrition and physical activity of school-age children in Serbia impose a need to create and evaluate programs to improve their nutrition and physical activity. The purpose of this study was to evaluate the impact of the cross-curricular nutrition and physical activity education program (NPAEP) on food intake, physical activity, and body mass index in first–fourth-grade primary school children. Material and methods: The study used an experimental pre-test (t1) post-test (t2) design. The sample included 167 participants in t1 and 178 in t2. The differences in food intake, physical activity, and body mass index before and after implementation of the cross-curricular nutrition and physical activity education program were analyzed using the Mann–Whitney U test, the Chi-squared test, and the Wilcoxon signed-rank test. Values p < 0.05 were considered statistically significant. Results: Fruit (t1 = 0.70 ± 0.55; t2 = 1.26 ± 0.65; p < 0.001) and dairy intake (t1 = 1.52; t2 = 1.79; p = 0.005) significantly increased in the intervention group. A significant reduction in time spent watching television (t1 = 78.0; t2 = 56.7; p = 0.005) and playing on the computer (t1 = 32.3; t2 = 25.8; p = 0.047) was achieved in the intervention group. Time spent in organized sports activities significantly increased only in the intervention group (t1 = 21.9; t2 = 30.5; p = 0.046). Body mass index did not change significantly in the intervention group after the implementation of the NPAEP. Conclusions: The nutrition and physical activity education program contributed to an increase in fruit and dairy intake and time spent in intense physical activities and a reduction in screen time. The presented results justify the application of the NPAEP in improving the nutrition and physical activity of first–fourth-grade primary school children.

Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

OBJECTIVE

Fruits and vegetables (FV) distribution interventions have been implemented as a public health strategy to increase children's intake of FV at school settings. The purpose of this review was to examine whether snack-based FV distribution interventions can improve school-aged children's consumption of FV.

DESIGN

Systematic review and meta-analysis of articles published in English, in a peer-reviewed journals, were identified by searching six databases up to August 2020. Standardised mean differences (SMD) and 95 % CI were calculated using a random effects model. Heterogeneity was quantified using I2 statistics.

SETTING

Population-based studies of interventions where the main focus was the effectiveness of distributed FV as snacks to schoolchildren in North America, Europe and Pacific were included.

RESULTS

Forty-seven studies, reporting on fifteen different interventions, were identified; ten studies were included in the meta-analysis. All interventions were effective in increasing children's consumption of FV, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children's consumption of FV, particularly for multi-component interventions at post-intervention (SMD 0·20, 95 % CI 0·13, 0·27) and free distribution interventions at follow-up (SMD 0·19, 95 % CI 0·12, 0·27).

CONCLUSIONS

Findings suggest that FV distribution interventions provide a promising avenue by which children's consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration and follow-up evaluation are needed to improve comparability across studies.

The Effects of the Healthy Primary School of the Future on Children's Fruit and Vegetable Preferences, Familiarity and Intake

Mere exposure is an often-described strategy to increase children’s food familiarity, preferences, and intake. Research investigating this method in less controlled settings is scarce. This study investigates the effects of repeated fruit and vegetable (FV) exposure through the Healthy Primary School of the Future (HPSF) on children’s FV familiarity, preferences, and intake. The study had a longitudinal quasi-experimental design comparing two full HPSFs (focus: nutrition and physical activity) with two partial HPSFs (focus: physical activity) in the Netherlands. Annual measurements (child-reported questionnaires) were conducted during 2015–2019 in 833 7–12-year-old children. The study was registered on ClinicalTrials.gov (NCT02800616). After correction for baseline, full HPSFs had, on average, a lower number of unfamiliar vegetable items after one (effect size (ES) = −0.28) and three years (ES = −0.35) and a higher number of disliked vegetable items after one year (ES = 0.24) than partial HPSFs. Unfavorable intervention effects were observed for fruit intake after one (odds ratio (OR) = 0.609) and four years (OR = 0.451). Repeated FV exposure had limited effects on children’s FV familiarity, preferences, and intake, likely due to insufficient taste exposure. Considering the widespread implementation of school-based mere exposure efforts, it is highly relevant to further investigate under which circumstances mere exposure effectively contributes to improvements in (determinants of) FV intake.

Caregiver Feeding Practices as Predictors for Child Dietary Intake in Low-Income, Appalachian Communities

The Appalachian region of the U.S. is disproportionately impacted by poverty, obesity, and nutrition-related chronic diseases. Evidence suggests that caregiver feeding practices may promote healthful eating behaviors among children; however, this has not been examined in low-income, rural, Appalachian populations. This study examines caregiver feeding practices as predictors for child diet in low-income Appalachian families, using a cross-sectional analysis of 178 caregivers of young children (ages 2–10 years old), that were recruited from low-income, rural communities in East Tennessee, from November 2017 to June 2018. Caregivers self-reported measures of demographics, feeding practices, and child dietary intake. Multiple linear regression analyses were run, and found that higher use of caregiver modeling positively predicted child vegetable consumption (Beta = 1.02; p = 0.04). Higher caregiver intake of fruits and vegetables positively predicted child fruit consumption (Beta = 0.29; p = 0.02) and vegetable consumption (Beta = 1.56; p < 0.001), respectively. Higher home availability of healthier foods positively predicted child fruit consumption (Beta = 0.06; p = 0.002) and vegetable consumption (Beta = 0.09; p = 0.05). Higher home availability of less healthy foods positively predicted child consumption of high-sugar/high-fat snack foods (Beta = 0.59; p = 0.003). The findings of this study indicate that caregiver modeling, healthy caregiver dietary intake, and healthful home food availability are associated with healthier child dietary intake among young children in low-income, rural, Appalachian areas. Promoting these practices among caregivers may be an important strategy to enhancing dietary intake of children in this hard-to-reach, underserved population.

Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.

Fussy Eating among Children and Their Parents: Associations in Parent-Child Dyads, in a Sample of Children with and without Neurodevelopmental Disorders

Parents are important agents in shaping children's eating habits. However, the associations between children's and parents' eating behaviors are complex and may be convoluted for various reasons, such as parenting feeding styles, stressful mealtimes, and children's neurodevelopmental disorders (ND), such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). The purpose of this study was to analyze associations between parents and their children's fussy eating, in a cross-sectional sample of children, with and without ND. Ninety-seven parents answered screening questionnaires prior to an intervention study. Associations were investigated using two-way ANOVAs and chi-square analyses. Overall, children with ND accepted fewer food items and consumed unhealthier foods more frequently than children without ND. Fussy eating parents had children who accepted fewer food items and consumed unhealthier foods more frequently than children whose parents were not fussy eaters. Interaction effects were not significant. A higher proportion of fussy eating parents, than non-fussy eating parents, had children who had difficulties with combined foods and hidden ingredients. The findings highlight the need for further investigation into the relationships between parents' influence on their children's eating behavior and food consumption, as well as possible reciprocal impacts.

Do children favor snacks and dislike vegetables? Exploring children's food preferences using drawing as a projective technique. A cross-cultural study

OBJECTIVE

To avoid the rising spread of childhood obesity and preserve resources within planetary boundaries, healthy and sustainable eating habits and the consumption of adequate amounts of fruits and vegetables should be encouraged. Children's food preference was found to be an important determinant for food choice and consumption. The aim of this study was to explore children's food preferences using drawing as a projective technique in terms of healthy and sustainable eating and compare food preference patterns in Denmark and Lithuania.

METHOD

In total 484 children, aged between 8 and 13 years old, participated in the study (147 in Denmark and 337 in Lithuania). Participants were asked to fill the food preference questionnaire and answer questions about their daily intake of fruits, vegetables, and snacks and draw their favorite meal afterward. Sociodemographic questions about children's age, gender, parents' employment, and family composition were also included in the questionnaire.

RESULTS

Fruits, vegetables, highly-processed and animal-based foods were not included in a large part of children's most preferred meal composition. Favorite meals' composition varied among children in both countries and included different products from separate food groups. Vegetables were more likely to be present in the children's favorite meals together with meat products. Girls in both countries had more expressed vegetable preferences than boys. Boys in Lithuania had a relatively more expressed preference for highly-processed foods, while Danish girls had a more expressed preference for animal-based products.

CONCLUSIONS

Children's preferences for foods such as meat and animal-based products expressed in children's drawings, might be considered as relatively positive in terms of sustainable eating. However, children's preferences and intake of fruits and vegetables should still be encouraged among young consumers. Cultural and gender differences in children's food preferences should be considered while creating interventions and marketing strategies for promoting healthy and sustainable eating among young consumers.

Rewarding behavior with a sweet food strengthens its valuation

Sweet foods are commonly used as rewards for desirable behavior, specifically among children. This study examines whether such practice may contribute to reinforce the valuation of these foods. Two experiments were conducted, one with children, the other with rats. The first study, conducted with first graders (n = 214), shows that children who receive a food reward for performing a cognitive task subsequently value the food more compared to a control group who received the same food without performing any task. The second study, conducted on rats (n = 64), shows that rewarding with food also translates into higher calorie intake over a 24-hour period. These results suggest that the common practice of rewarding children with calorie-dense sweet foods is a plausible contributing factor to obesity and might therefore be ill advised.

Adherence to food-based dietary guidelines among adolescents in Germany according to socio-economic status and region: results from Eating Study as a KiGGS Module (EsKiMo) II

OBJECTIVE

Dietary habits developed during childhood and adolescence are likely to continue into adulthood. An unbalanced diet may cause nutrient deficiencies and excessive energy intake; these enhance the risk for developing overweight and obesity and their co-morbidities. In the present analysis, food consumption of adolescents is described and evaluated against German food-based dietary guidelines with special focus on socio-economic status (SES) and region of residence.

DESIGN

Within the 'German Health Interview and Examination Survey for Children and Adolescents' (KiGGS Wave 2), the cross-sectional 'Eating Study as a KiGGS Module' (EsKiMo II) was conducted from 2015 until 2017 to provide data about dietary behaviour.

SETTING

Germany.

PARTICIPANTS

1353 adolescents aged 12-17 years from a nationwide representative sample with food consumption data from computer-assisted dietary history interviews.

RESULTS

The median consumption of fruits, vegetables, starchy foods and milk/dairy products among adolescents in Germany was below the recommendation. The median consumption of both meat/meat products and unfavourable foods, like confectionery, which should be consumed sparingly, was about 1·5 times the recommended amount. The total amount of beverages consumed by most adolescents was above the minimum amount recommended. Soft drink consumption of adolescents with a low SES was three to five times higher than soft drink consumption of adolescents with a high SES.

CONCLUSIONS

The results indicate the need for an improvement of dietary habits among adolescents in Germany. Further approaches to promote healthy diets in Germany should be continued, and the focus on social inequalities should be strengthened.

Food Choice and Waste in University Dining Commons-A Menus of Change University Research Collaborative Study

The purpose of this multi-campus research was to investigate the relationships of food type and personal factors with food choice, consumption, and waste behaviors of college students at all-you-care-to-eat dining facilities. The amount of food taken and wasted was indirectly measured in units relative to the plate size using before and after photos taken by the diners themselves. Animal protein and mixed dishes (e.g., stir fry, sandwich) took up more of diners’ plate space and these items were correlated to both greater hedonic appeal as well as a higher likelihood of the item being pre-plated. Greater confidence in liking an item before choosing it was correlated to a larger portion being taken. Finally, increased satisfaction with the meal and frequency of visiting the dining commons was correlated to less food waste. Understanding these potential food choice drivers can help dining facilities better target healthier meals to diners while reducing food waste.

Mothers' Perceptions and Attitudes towards Children's Vegetable Consumption-A Qualitative, Cross-cultural Study of Chilean, Chinese and American Mothers Living in Northern California

This exploratory research focused on the cultural variables involved in children’s vegetable consumption, through the analysis of mothers’ perceptions, attitudes, and feeding practices regarding their children’s intake, using qualitative consumer research methods. Twelve focus groups of mothers with children between 2–12 years old (Euro-Americans n = 20, Chinese n = 19, and Chilean n = 19) were conducted. All participants lived in Northern California, had higher education, and incomes that did not limit their vegetable purchase. Intercultural differences in vegetable preferences and consumption habits were found. Mothers across all groups agreed on the importance of children’s vegetable consumption, the influence that mothers have over their children’s vegetable intake, and how challenging it is to get children to eat a variety of vegetables. The ethnic groups differed regarding how they perceived the level of mothers’ responsibility over children’s vegetable intake, the way that mothers defined the amount of vegetables that children should eat, the constraints that mothers had on increasing their children’s vegetable intake and mothers’ recommendations to encourage vegetable consumption. Our study suggests that under similar socio-economic and parental education levels, culture-specific strategies should be considered to foster healthy dietary habits in children.

Sensory characteristics of vegetables consumed by Australian children

OBJECTIVES

Consumption is driven by children's sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety.

DESIGN

Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel.

SETTING

Australia.

PARTICIPANTS

A nationally representative sample of Australian children and adolescents aged 2-17·9 years (n 2812).

RESULTS

While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables.

CONCLUSION

Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.

Is it possible to obtain food consumption information through children's drawings? Comparison with the Free Listing

The aims of this research were 1) to study the children's drawings to obtain scientific information about food consumption; 2) to compare this method with an existing one (Free Listing); and 3) to compare fruits- and vegetables-consumed by children of different cultural groups within a same country. Children (n = 105) from two Argentinian cities (Salta in the northwest and 9 de Julio in the Pampean region), reported the fruits and vegetables they consumed, with the Free Listing and the new Free Drawing methods. Contingency tables were built and cognitive saliency indexes (CSI) were calculated. Children evoked 57 fruits and 54 vegetables by both methods, which were then grouped into 31 fruit and 27 vegetable categories. The advantages and limitations of the methods are discussed. Throughout Free Drawing, each food was defined by its name, shape and colour, which allowed better discrimination between varieties. Children from Salta reported consuming more fruits (63.7%) and vegetables (68.6%) than those from 9 de Julio (p < 0.05). Differences between cultural groups were found in 10 fruits and 7 vegetables, mentioned more frequently in Salta, where regional crops arose principally by Free Listing. The CSI did not depend on the method used but, for vegetables, they were affected by the cultural group. The fruits with the greatest CSI were banana and apples followed by orange (CSI≥0.19). Tomatoes, carrot and pumpkins showed the highest CSI in 9 de Julio; while carrot, tomatoes, varieties of lettuce and potatoes had the highest CSI in Salta (0.17 ≤ CSI≤0.33). Free Drawing is a qualitative alternative to study food consumption in children populations through a fun activity without the need for assistants.

The taste of biodiversity: science and sensory education with different varieties of a vegetable to promote acceptance among primary school children

OBJECTIVE

To determine the impact of an educational programme for primary schools that explored the biodiversity of tomato, by promoting science and sensory education with three distinct varieties of it, in the acceptance of vegetables.

DESIGN

A randomised controlled study in which children were exposed to the educational programme (intervention group) or remained in the class, as usual (control group). The educational programme consisted of three sessions where children explained the observed differences between the three varieties of tomato and individual perceptions of their flavours based on sensory-based food education and by planning and implementing experiments to explain those differences. We tested the effects on both children's willingness to try and their liking for tomato, and for lettuce and cabbage to study the carry-over effect, compared with the control group (Mann-Whitney U test; P < 0·05).

SETTING

The study took place in public primary schools in Porto, Portugal.

PARTICIPANTS

Children in the third grade (8-13-year-old children) (n 136) were randomly assigned to intervention or control group.

RESULTS

Children in the intervention group reported significant increases in their willingness to try and liking for tomato compared to the control group (P < 0·05), but not for lettuce and cabbage (P > 0·05).

CONCLUSIONS

These results highlight the potential for fostering children's acceptance of a vegetable by exploring biodiversity through science education. Further work may clarify the effects of exploring biodiversity on the consumption of vegetables and establish whether the results are stable over time and replicable across contexts and populations.

Effect of cassava flour on the lipidic and redox profile of Wistar rats with dyslipidemia

One of the major risk factors for cardiovascular disease is high total cholesterol. It is known that some foods can reduce plasma cholesterol, such as oats. Cassava flour has a similar amount of fiber when compared to oats. The objective of this study was to evaluate the hypocholesterolemic potential of cassava flour. Thirty Wistar rats (eight weeks old) were divided into three groups: control, high-cholesterol diet, high-cholesterol diet + cassava flour, and were treated for 8 weeks. The weight and food consumption of the animals were evaluated weekly. After euthanasia, analyzes of biochemical and oxidative stress profiles were performed, besides the histological analysis of the liver. Cassava flour protected animals from lipoperoxidation, according to thiobarbituric acid-reactive substances results and improved superoxide dismutase activity and thiol content; however, failed to improve the lipid profile and catalase. Cassava flour was possibly able to slow the progression of NASH according to liver histology. PRACTICAL APPLICATIONS: Lifestyle and nutritional habits have been considered important factors associated with the development of dyslipidemia and other chronic diseases. Medicines for chronic diseases are often expensive and have present side effects, and therefore, it is preferable to prevent them through food. Cassava flour is a food widely consumed by Brazilians, which is inexpensive and contains no gluten. Understanding more about one of the most used foods in Brazil is important for health professionals to be able to prescribe it for the correct purposes.

Development and validation of a food literacy instrument for school children in a Danish context

Food literacy (FL) is an aim of food education and cooking interventions, but is defined and measured in different ways. In this study we developed, tested, and validated a FL instrument targeting children aged 12-14 years that builds on a broad 5-dimensional FL concept that includes the competencies of knowing and doing, as well as the rarely investigated competencies of using the senses, caring for others, and wanting to participate as a citizen regarding food issues. The study had 3 phases: 1) item development involving an expert panel; 2) scale testing comprising a face validity test with 12 pupils and a test with 817 pupils, of which 267 took part in a retest; and 3) scale validation including testing dimensionality by confirmatory factor analysis (CFA), internal reliability by Cronbach α, external reliability by intraclass coefficient (ICC), and convergent and predictive validity by regression analysis. CFA showed an acceptable model fit, confirming the concept of FL as 1 factor and its 5 distinct competencies as subfactors. There was good internal reliability for total FL score (α = 0.85) and good external test-retest reliability (ICC = 0.92). Convergent validity for a similar health literacy construct was significant for the total FL scale and its 5 competencies; this was also true for the predictive validity of FL with food intake as an outcome. This 37-item, 5-dimensional FL instrument can be used to assess FL levels in children and can guide food and nutrition education.

Altering the availability of products within physical micro-environments: a conceptual framework

Altering the availability of products (e.g. food, alcohol or tobacco products) is one potential intervention to change behaviours to help reduce preventable premature deaths worldwide. However, research on these interventions lacks consistent conceptualisation, hindering clear reporting and cumulative synthesis. This paper proposes a conceptual framework – categorising intervention types and summarising constituent components – with which interventions can be reliably described and evidence synthesised. Three principal distinctions are proposed: interventions altering: (i) Absolute Availability (changing the overall number of options, while keeping the proportions comprised by any subsets of options constant); (ii) Relative Availability (changing the proportion comprised by a subset of options, yet keeping the overall number of options constant); (iii) Absolute and Relative Availability (changing both the overall number of options and the proportions comprised by subsets of options). These are subdivided into those targeting (a) a product or (b) a category of products. Mechanisms that might underlie each of these intervention types are discussed, and implications for future research highlighted. The proposed framework aims to facilitate study of a set of interventions that could contribute significantly to healthier behaviour across populations.

Cooking together: The IKEA effect on family vegetable intake

OBJECTIVE

Based on the idea of the 'IKEA effect', assuming that individuals like self-created objects more than objects created by someone else, this study hypothesizes that parents' involvement of their children in meal planning and preparation is positively related to vegetable intake, mediated via liking vegetables.

DESIGN

Longitudinal observational study with two time points (10-month interval).

METHOD

Nine hundred and twenty-four parent-child dyads filled out questionnaires measuring involvement, vegetable liking, vegetable intake, and further environmental and food-related determinants of vegetable intake. On average, parents were M = 36.10 (SD = 5.43) and children (54.3% girls) M = 8.24 (SD = 1.44; range 6-11) years old. Hypotheses were tested with path analyses, accounting for intra-dyadic associations among respective constructs (e.g., parents' and children's liking vegetables).

RESULTS

Two direct effects were found: (1) parents' involvement of their children in cooking activities impacted children's liking of vegetables and vegetable intake, and (2) liking vegetables impacted vegetable intake. The effect of involvement on vegetable intake was mediated via liking vegetables, but only for children and not for parents.

CONCLUSIONS

The findings emphasize the importance of parents' encouragement for involving children in the preparation of healthy meals, as this improves liking of vegetables and, thereby, increases their vegetable intake. Statement of contribution What is already known on this subject? Processes behind the effectiveness of shared cooking activities to increase vegetable intake are unclear. Previous research suggests the IKEA effect as an explanation. It assumes a higher consumption of self-created products due to a higher liking compared to third-party products. What does this study add? First test of the IKEA effect for joint cooking activities under consideration of spillover effects in families. Affirmation of the IKEA effect was found for children, not for parents. Interventions should focus on the involvement of children in cooking activities to improve vegetable intake.

An in-home intervention of parent-implemented strategies to increase child vegetable intake: results from a non-randomized cluster-allocated community trial

Background

Less than 2% of children in the U.S., ages 9–13, meet the minimum dietary recommendations for vegetable intake. The home setting provides potential opportunities to promote dietary behavior change among children, yet limited trials exist with child vegetable intake as a primary outcome. Strategies to increase vegetable intake grounded in behavioral economics are no/low cost and may be easily implemented in the home by parents.

Methods

This non-randomized, controlled study tested whether an intervention of parent-led strategies informed by behavioral economics and implemented within a series of 6 weekly parent-child vegetable cooking skills classes, improved dietary outcomes of a diverse sample of low-income children (ages 9–12) more than the vegetable cooking skills classes alone. The primary outcomes were total vegetable intake, dietary quality (HEI scores), total energy intake, vegetable liking, variety of vegetables tried, child BMI-z score, and home availability of vegetables. Outcome measures were collected at baseline, immediate post-treatment, 6 and 12 months follow-up. Mixed model regression analyses with fixed independent effects (treatment condition, time point and treatment condition x time interaction) were used to compare outcomes between treatment conditions.

Results

A total of 103 parent/child pairs (intervention = 49, control = 54) were enrolled and 91 (intervention = 44, control = 47) completed the weekly cooking skills program. The intervention did not improve child total vegetable intake. Intervention children increased dark green vegetable intake from immediate post-treatment to 12 months. The number of vegetables children tried increased and mean vegetable liking decreased over time for both control and intervention children.

Conclusions

Findings from this study suggest that the strategies and the manner in which they were implemented may not be effective in low-income populations. The burden of implementing a number of strategies with potentially higher food costs may have constrained the ability of families in the current study to use the strategies as intended.

Trial registration

This trial has been retrospectively registered at : #NCT03641521 on August 21, 2018.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7079-4) contains supplementary material, which is available to authorized users.

Barreiras percebidas para o consumo de frutas e de verduras ou legumes em adultos brasileiros

Resumo Buscou-se verificar a associação entre barreiras percebidas para o consumo de frutas (CF) e de verduras ou legumes (CV/L) com características demográficas. Foi realizado estudo transversal (n = 877 pessoas com ≤ 44 anos de Cambé/PR). Investigaram-se 5 barreiras para o CF e CV/L. Foi utilizada análise de regressão logística binária ajustada para variáveis demográficas. “Custo pesa no orçamento familiar” foi a barreira mais prevalente (CF 57,7%; CV/L 49,9%), com maior chance da barreira no CF nas mulheres e pessoas com menor escolaridade (0 a 4 anos de estudo) e no CV/L nas mulheres, pessoas com menor escolaridade e de nível econômico B/C. A prevalência da barreira “Família não tem hábito”, foi de 16,4% para CF e 10,9% no CV/L, com maior chance para pessoas com 50 a 59 anos no CF. “Falta de tempo para comprar alimentos frescos”, foi citada por 8,0% (CF) e 7,6% (CV/L), com maior chance da barreira no CF em mulheres e indivíduos sem companheiro. A barreira “Necessidade de preparo” teve prevalência de 7,6% para CF, com maior chance para pessoas com idade entre 44 e 59 anos e no CV/L (9,7%), maior nas mulheres. A prevalência de “Não gostar do sabor” foi de 6,2% para o CF e 6,6% CV/L, e observou-se maior chance nos negros/pardos/indígenas (para CV/L).

Using repeated visual exposure, rewards and modelling in a mobile application to increase vegetable acceptance in children

Children are not consuming the recommended amounts of fruit and vegetables. Repeated visual exposure, modelling, and rewards have been shown to be effective at increasing vegetable acceptance in young children. The aim of this study was to assess the effectiveness of an evidence-based mobile application (Vegetable Maths Masters) which builds on these principles to increase children's liking and acceptance of vegetables. Seventy-four children (37 male, 37 female) aged 3-6 years old were randomised to play with either the vegetable app or a similar control app that did not include any foods. Children played their allocated game for 10 min. Liking and acceptance of the vegetables used in Vegetable Maths Masters (carrot and sweetcorn) and other vegetables which were not used in the game (yellow pepper and tomato) were measured pre- and post-play in both groups. Parents provided data about their child's food fussiness and previous exposure to the foods being used. Children who played with the Vegetable Maths Masters app consumed significantly more vegetables after playing with the app and reported significant increases in their liking of vegetables, relative to the control group. The effect of the Vegetable Maths Masters app on the change in consumption of vegetables was mediated by the change in liking of vegetables. These findings suggest that evidence-based mobile apps can provide an effective tool for increasing children's liking and consumption of vegetables in the short-term. Further work is now required to establish whether these effects are maintained over time.

Short sleep duration is associated with specific food intake increase among school-aged children in China: a national cross-sectional study

Background

The relationship between sleep duration and food intake is unclear. This study aims to examine the relationship among children aged 6–17 years in China.

Methods

The sample consisted of 70,519 children aged 6–17 years, which were randomly selected from 7 representative areas from China, from September to November, 2013. In the structured questionnaire, children reported daily sleep hours (less than 7 h, 7–9 h and more than 9 h), weekly food intake amount (including vegetables, fruit, sugar beverages and meat), physical activity and sedentary time. The relationship of sleep duration with vegetable, sugar beverage, fruit and meat intake was evaluated by multi-nominal logistic regression and multi-variable adjusted.

Results

A total of 62,517 children (51.6% boys) completed the study. Short sleep duration (SSD, < 7 h) was independently associated with increased sugar beverage intake (SBI, Odd Ratio, OR: 1.29, 95% CI: 1.19–1.40) but decreased vegetable (VI, OR: 0.94, 95% CI: 0.90–0.98) & fruit intake (FI, OR: 0.94, 95% CI: 0.88–0.99). Stratified by age and gender, SSD increased SBI for boys of both young (6–12 years) & older (13–17 years) groups and older girls (ORs: 1.25, 1.25, 1.49, 95% CI: 1.08–1.44, 1.04–1.50, 1.22–1.81, respectively), but decreased VI and FI for older girls (ORs: 0.84& 0.81, 95% CI: 0.74–0.96& 0.68–0.96, respectively).

Conclusions

Among school-aged children in China, short sleep duration was associated with increased risks of more sugar beverage intake among those younger and boys but less vegetable & fruit intake among those older and girls. Longitudinal research is needed to clarify the causation in between.

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.

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Impact of a school-based culinary nutrition education program on vegetable consumption behavior, intention, and personal factors among Korean second-graders

BACKGROUND/OBJECTIVES

Veggiecation was developed to improve children's vegetable consumption through classroom lecture and cooking activities. In this study, we explored potential determinants of vegetable consumption behavior and intention, and examined the impact of Veggiecation on vegetable consumption behavior, intention and personal factors among Korean children.

MATERIALS/METHODS

The 4-week Veggiecation program was implemented for second-graders in South Korea (35 children in the intervention group, 36 in the control group). We identified personal and environmental factors influencing vegetable consumption behavior and intention using multiple regression analyses. Consumption behavior, intention and, personal factors such as preference, attitude, and self-efficacy were compared between the groups before and after the intervention.

RESULTS

Children's vegetable consumption behavior was significantly correlated with personal, social-, and physical-environmental factors as well as intention. Among the variables, preference was the most influential factor on intention, and attitude and intention had great influence on the behavior. After the program, children in the intervention group demonstrated significant improvements in vegetable consumption, intention, attitude, preference, and self-efficacy compared with children in the control group.

CONCLUSION

Veggiecation, a school-based culinary nutrition education program, improved vegetable consumption and intention, as well as preference, attitude, and self-efficacy, in second-graders. Veggiecation has great potential, as a global program, to increase children's vegetable consumption. This program can be expanded through various channels, such as after-school programs or camps, to provide a positive impact for children.

Changes in diet, and the relationship between diet and physical activity within and across the lifetime of current ultra-endurance exercisers

BACKGROUND

There is currently no information on the lifetime diet of ultra-endurance exercisers. This study describes changes in diet across the lifetime of current ultra-endurance exercisers and the relationship between diet and physical activity (specifically ultra-endurance exercise [UEE]).

METHODS

Lifetime physical activity and diet were assessed in current ultra-endurance exercisers (N.=120; ages 21-74 years) over six life periods (5-12, 13-18, 19-30, 31-45, 46-60, 61-75 years). Using the life period having the largest absolute increase in UEE (IUEE), diet was assessed according to food category scores and dietary patterns. Changes in lifetime diet were described by comparing food category scores between adjacent life periods. Differences in food category scores were investigated between the life period for each IUEE group and the preceding life period and associations between dietary patterns and UEE were investigated within each IUEE group. Relationships between lifetime diet and UEE were investigated by examining associations between lifetime food category scores and lifetime UEE.

RESULTS

The participant group had significant increases in all food category scores from 13-18 to 19-30 years and significant decreases in all food category scores from 19-30 to 31-45 years. UEE correlated negatively with the Western style dietary pattern in the IUEE19-30 group and positively with the fruit and vegetable dietary pattern in the IUEE31-45 group. There was a positive correlation between lifetime UEE and lifetime vegetables and fruit category scores.

CONCLUSIONS

The ultra-endurance exercisers in this study exhibited changes in diet similar to general populations, which appear to reflect typical nutritional requirements across the lifespan.

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.