Abstract
BackgroundMost children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important. ObjectiveTo identify the most successful strategies to enhance vegetable intake in preschool children aged 2–5 years. DesignThe research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005–January 2016, specifically with measured vegetable consumption were included. Results30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. ConclusionsRepeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8–10 exposures.The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).
Highlights
The World Health Organization suggests consuming 400 g or more of fruit and vegetables per day to improve overall health; current recommendations for adults vary between countries from 400 g to 800 g (Aune et al, 2017; WHO, April 2011)
As the food environment and food habits have changed over time and the International Health Regulation (IHR) framework was introduced in 2005 (WHO, 2007), contemporary evidence of studies published since the year 2005 were sought
The analysis indicated that the number of taste exposures was positively associated with effect size (B = 0.035 (SE 0.01, CI 0.00–0.06, p = 0.01)
Summary
The World Health Organization suggests consuming 400 g or more of fruit and vegetables per day to improve overall health; current recommendations for adults vary between countries from 400 g to 800 g (Aune et al, 2017; WHO, April 2011). In the UK preschool children are recommended to eat a variety and minimum of five 40 g portions (200 g) of fruit and vegetable a day The Vital Signs report by the Centers for Disease Control and Prevention showed that while US children aged 2–18 years were eating more fruits in 2010 than they did in 2003, vegetable intake remained low and unchanged as 93% of the children did not meet the daily recommended intake (Kim et al, 2014). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. Health policy could target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8–10 exposures
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