Fruits and vegetables at home (FLAM): a randomized controlled trial of the impact of fruits and vegetables vouchers in children from low-income families in an urban district of France

Camille Buscail,Aurore Margat,Paul Daval,Pierre Lombrail,Serge Hercberg,Stéphanie Petit,Aurélie Maurice,Judith Gendreau,Paule Latino-Martel,Chantal Julia

doi:10.1186/s12889-018-5908-5

Abstract

BackgroundFruits and Vegetables (FV) consumption is considered a marker of social inequalities in health since it is considerably decreased in disadvantaged populations. The main objective of this trial was to evaluate the impact of vouchers for FV purchase on the consumption of FV among children living in disadvantaged families in a French urban district.MethodsThe FLAM study was a controlled randomized intervention trial, performed in Saint-Denis (North suburbs of Paris). The study group (intervention or control) was randomly attributed to parent-child pairs at inclusion. The intervention group received vouchers exchangeable for FV over a 1 year period. Nutritional education through workshops was available for both groups. FV consumption was assessed through face-to-face food frequency questionnaires. Participants who reported eating less than 3.5 FV per day were considered low FV consumers.ResultsA total of 92 parent-child pairs were included, in which 45 were allocated to the intervention group and 47 to the control group. Amongst them, 64 completed the final follow-up questionnaire (30% lost to follow-up). After one year, the proportion of low FV consumers in children was significantly lower in the intervention group (29.4%) compared to the control group (66.7%, p = 0.005). Overall, 82% of the vouchers were used by the families.ConclusionsThis study found a decreased proportion of small consumers in children after 1 year of distribution of FV vouchers compared to the control group. FV vouchers could be an effective lever to increase FV consumption among children from disadvantaged households.Trial registrationClinicalTrials.gov identifier no. NCT02461238.

Highlights

Fruits and Vegetables (FV) consumption is considered a marker of social inequalities in health since it is considerably decreased in disadvantaged populations
A sufficient fruits and vegetables (FV) consumption contributes to reducing the risk of non-communicable diseases, including obesity, type 2 diabetes, cardiovascular diseases (CVD) and several cancers [1,2,3,4,5,6,7]
The findings showed that vouchers were associated with an increased consumption of FV, with a higher consumption when combining nutritional education [34, 36,37,38,39,40]

Summary

Introduction

Fruits and Vegetables (FV) consumption is considered a marker of social inequalities in health since it is considerably decreased in disadvantaged populations. An insufficient consumption of FV has been estimated to be responsible for 19% of gastrointestinal cancers, 30% of ischemic heart diseases and 11% of strokes worldwide [3]. It is considered as one of the top 10 factors leading to mortality worldwide, including in developed countries in which inadequate nutrition has become one of the leading mortality risk factors [3]. Low consumers of FV are defined as such when consuming less than 3.5 servings of FV per day [10]

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Conclusion