Abstract
BackgroundVegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children. Yet few studies have investigated the impact of a ”vegetables first” approach to complementary feeding, especially in New Zealand. The purpose of this randomised control trial is to investigate the effect of starting complementary feeding with vegetables only on infants’ later intake and liking of vegetables, compared to those starting with fruit and vegetables.Methods/designOne-hundred and twenty mother-infant pairs living in Auckland, New Zealand, will be randomised to receive either vegetables only (intervention) or fruit and vegetables (control) for 28 days, starting from the first day of complementary feeding at around 4–6 months of age. Infants will be presented with a brassica (broccoli), followed by a green leafy vegetable (spinach) and sweet fruit (pear) at 9 months of age. The primary outcome measures of intake of each food will be assessed using a weighed food diary. Secondary outcome measures of overall intake, liking and wanting of vegetables will be assessed using a food frequency questionnaire, liking tool and video coding tool, respectively, at 9, 12, and 24 months of age. Infant growth and iron status will be assessed as part of health screening and monitoring at baseline, post intervention and 9 months of age. Other biological samples to be collected include infant stool samples, vitamin D (mother and infant), iron status (mother), and mothers’ diet.DiscussionThis randomised, controlled trial will be the first to our knowledge to investigate a “vegetables first” approach to complementary feeding on infants’ liking and intake of vegetables in New Zealand. Comparison against standard practice (fruit and vegetables as first foods) should complement other trials underway, such as the Baby’s First Bites and Nordic OTIS trial. Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12619000737134. Registered on 16 May 2019.
Highlights
Vegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children
Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide
Children with adequate vegetable intake may have a lower risk of obesity [3] and cardiovascular disease in adulthood [4, 5], and be more likely to develop healthy eating habits for life [6, 7]
Summary
Despite the known health benefits of a diet rich in vegetables and fruit [2, 68, 69], children’s vegetable consumption remains lower than recommended worldwide [8,9,10,11,12]. The main purpose of this randomised controlled trial is to address this research gap by determining whether exposure to vegetables only during the first 4 weeks of complementary feeding increases later intake and liking of vegetables in infants, compared to a control group which includes both fruit and vegetables. Strengths of this study include the randomisation of infants, longitudinal design that follows infants until 24 months of age, use of diverse and complementary methods to assess outcome measures, a relatively large sample size, improved ecological validity (e.g. conducted in the home environment for the outcomes of interest), and using a control that mimics current practice. Possible limitations include difficulties for families to adhere to study procedures and remain engaged for up to 24 months of age. Since this is a convenience sample, Supplementary Information.
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