Effects of 1 y of free school fruit on intake of fruits, vegetables, and unhealthy snacks: 14 y later

Abstract

There are not many studies evaluating the long-term effects of fruit and vegetable interventions. We examined the effects of 1 y of free fruit in elementary school on long-term consumption of fruit, vegetables, and unhealthy snacks, according to sex and educational attainment, 14 y after the intervention period. In 2001, the baseline survey of the longitudinal cohort, Fruits and Vegetables Make the Marks (FVMM), included 1950 children (mean age: 11.8 y) attending 38 randomly drawn elementary schools from 2 counties in Norway. In the following 10 mo, 9 schools served as intervention schools by participating in the Norwegian School Fruit Program for free, whereas 29 schools served as control schools. A follow-up survey conducted in 2016 included 982 participants (50%) from the original study sample (mean age: 26.5 y). The consumption of fruit and vegetables was measured by a 24-h recall (portions per day), and the consumption of unhealthy snacks was measured by food-frequency questions (portions per week). Linear mixed models were performed to test possible intervention effects on the consumption of fruit, vegetables, and unhealthy snacks 14 y after the intervention period. No overall intervention effects after 14 y due to the free-fruit scheme on the consumption of fruit, vegetables, and unhealthy snacks were observed, but significant interactions showed a sustained higher frequency of fruit consumption among females in the intervention group compared with the control group [mean difference (MD): 0.38 portions/d; P=0.023] and that this effect was only significant among less-educated females (MD: 0.73 portions/d; P=0.043). No significant long-term intervention effects were observed in the consumption of fruit among highly educated females and males nor in the consumption of vegetables or unhealthy snacks. Results from the present study indicate that receiving free fruit at school for 1 y may have positive long-term effects for females without higher education.