Children's Fruit Research Articles

Socioeconomic and household framework influences in school-aged children's eating habits: Understanding the parental roles

Maternal influences on children's diet have been widely studied, while paternal and household frameworks require further research. This study aimed to evaluate how individual, socioeconomic and household characteristics at birth and 7 years (y) impact children's fruit and vegetable (FV) and energy-dense foods (EDF) intake at 10y, distinguishing maternal and paternal effects. The sample included 2750 children evaluated at 7 and 10y in the Portuguese birth cohort Generation XXI. The children's food intake was assessed through a Food Frequency Questionnaire at both ages, where 4 food groups were defined: FV, ‘Sweet foods’, ‘Salty snacks’, and ‘Soft drinks’. The associations between food intake at 7y, parents' and children's characteristics, and food intake at 10y were evaluated via binary logistic regression models. Offspring of older mothers with higher age and education, who live with siblings and had higher family income were likelier to have 5 servings of FV daily at 10y. Children eating 5 portions/day of FV at 7y had higher odds of keeping this pattern at 10y. Higher maternal age and education, and father's education decreased the odds of having soft drinks daily at 10y. Higher family income was linked with lower odds of weekly salty snacks and daily sweet foods at 10y. In conclusion, parental education, maternal age, living with siblings, and higher family income influenced children's FV and EDF intake at 10y. Mothers' effects appear to impact children's food intake more than fathers'.

Individual and family factors correlated with children's fruit consumption.

Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors. A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively. Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667). The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

Eating competence in caregivers of celiac children: A cross-sectional study performed in Brazil

ObjectivesEating competence is an intraindividual approach to eating, behaviors, and attitudes related to eating, with repercussions on the individual and family. In pediatric celiac disease, the family is involved in the gluten-free diet management, the only treatment available. A gluten-free diet might affect eating competence because gluten-free diet compliance requires knowledge about food, meal planning, and attention to food choices. The objective is to access eating competence in caregivers of children with celiac disease and the association between caregivers’ eating competence, children's adherence to a gluten-free diet, and sociodemographic data of participants. MethodsThis cross-sectional study used a snowball spread method by applying a questionnaire, including sociodemographic data, data related to health, eating habits, and the Satter Eating Competence Inventory version validated for the Brazilian population. The sample consisted of 220 Brazilian parents or caregivers of celiac disease children. The scores of the Satter Eating Competence Inventory version validated for the Brazilian population were described in terms of means, SDs, medians, and interquartile range. Student's t test and analysis of variance followed by Tukey's post hoc tests were applied, and the association with the variables of interest was analyzed using Pearson χ2 tests. The tests were conducted considering bilateral hypotheses and a 5% significance level. ResultsParticipants’ sex, schooling level, and income did not affect their eating competence. Competent eaters were mostly those with normal weight, following a gluten-free diet, with children complying with a gluten-free diet, and who have meals with family and prepare them at home. Different from vegetable consumption, participants’ eating competence did not differ considering the frequency of children's fruit consumption. ConclusionsThe caregivers of children with celiac disease have greater eating competence scores than general Brazilian adults, and caregivers of children with celiac disease who comply with the gluten-free diet have higher eating competence scores.

Multilevel needs assessment of physical activity, sport, psychological needs, and nutrition in rural children and adults.

Physical activity yields significant benefits, yet fewer than 1 in 4 youth meet federal guidelines. Children in rural areas from low socioeconomic (SES) backgrounds face unique physical activity contextual challenges. In line with Stage 0 with the NIH Stage Model for Behavioral Intervention Development, the objective of the present study was to conduct a community-engaged needs assessment survey with middle school children and adults to identify perceptions, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition from a multi-level lens. A cross-sectional survey data collection was conducted with children (n = 39) and adults (n = 63) from one middle school community in the Midwestern United States. The child sample was 33% 6th grade; 51% 7th grade and was 49% female. The adult sample was primarily between 30 and 39 years old (70%) and comprised predominantly of females (85%). Multi-level survey design was guided by the psychological needs mini-theory within self-determination theory and aimed to identify individual perceptions, barriers, and facilitators in line with the unique context of the community. At the individual level, 71.8% of children and 82.2% of the overall sample (children and adults) were interested in new physical activity/sport programming for their school. Likewise, 89.7% of children and 96.8% of adults agree that PA is good for physical health. For basic psychological needs in the overall sample, relatedness was significantly greater than the autonomy and competence subscales. Children's fruit and vegetable intake were below recommended levels, yet only 43.6% of children were interested in nutritional programming. Conversely, 61.5% indicated interest at increasing leadership skills. At the policy-systems-environmental level, the respondents' feedback indicated that the condition and availability of equipment are areas in need of improvement to encourage more physical activity. Qualitative responses are presented within for physical activity-related school policy changes. Interventions addressing children's physical activity lack sustainability, scalability, and impact due to limited stakeholder involvement and often neglect early behavioral intervention stages. The present study identified perspectives, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition in a multi-level context and forms the initial campus-community partnership between scientists and community stakeholders.

Increasing fruit and vegetables consumption among children: a systematic review of animated nutrition interventions

Background: Low consumption of fruits and vegetables among children can lead to deprivation of micronutrients necessary for growth and development and predispose them to NCDs later in life. Low consumption of these nutrient-rich foods is related to high consumption of nutrient-poor, high-energy foods, which leads to childhood overweight and obesity. Many children do not consume enough fruits and vegetables to meet recommendations. This review aims to assess the effectiveness of animated interventions in increasing children's fruit and vegetable consumption.
 Methods: Articles on animated interventions for increasing fruit and vegetable consumption among children were systematically reviewed from Web of Science, PubMed, and Google Scholar. For the literature searches, inclusion and exclusion criteria were established, and the methodology followed the PRISMA recommendations. Extracted data were synthesized to show the effectiveness of interventions.
 Results: Thirteen studies (2003-2017) of animated interventions targeting children (3-12 years) designed to increase their consumption of fruits and vegetables met the criteria for inclusion in the systematic review. Most of the studies (69.2%) were in the United States, with no studies in LMICs identified. The animation interventions used games (46.2%), characters (23.1%), adventures (23.1%), and comic books (7.7 %). 11 of the analysed studies revealed positive or neutral effects of interventions on fruit and vegetable consumption. Parental participation, goal setting, and rewards were identified as facilitators of success. Identified interventions were effective in the short term (follow-up <12months). The games and adventure interventions had the greatest effect, with multi-component interventions most effective in increasing fruit and vegetable intake.
 Conclusion: There is a need for more research to determine the effectiveness of such interventions over extended periods. Multi-component interventions especially including parental involvement, goal setting, and rewards should be leveraged in designing similar interventions in LMICs since there was a conspicuous absence of such studies found in the literature.

CAKRAM GIZI SEBAGAI MEDIA PENYULUHAN UNTUK MENINGKATKAN PENGETAHUAN DAN POLA KONSUMSI BUAH DAN SAYUR PADA ANAK

Abstract One of the problems related to eating behavior is the lack of consumption of fruits and vegetables. Consumption of fruits and vegetables with a proportion of 1-2 servings/day was 67.16%, while fruit and vegetable consumption was 3-4 servings/day a week for the age group ≥5 years of 5.00%. The purpose of this study was to determine the effect of using nutritional discs in the nutrition education process on maternal knowledge and consumption patterns of fruits and vegetables for children. This type of research is an experiment with a pretest-posttest control group design. Sampling using simple random sampling technique as many as 32 people. The grouping of sample members into two different treatment groups, namely the first treatment group using nutritional disc media and the second the control group using leaflet media. Based on the results of the study, it shows that there is an increase in the average knowledge of mothers and children's consumption patterns through nutrition discs media before and after nutrition education. There was an effect of nutrition education in the intervention group on maternal knowledge, and there was an effect of nutrition education in the intervention group on children's fruit and vegetable consumption patterns. It is hoped that respondents can apply the knowledge that has been obtained after giving nutrition education using nutrition disc media.Keywords: Nutritional Discs Media, Fruit and Vegetable Consumption Patterns

Applying a systems perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme.

For the past two decades, the percentage of European children who consume fruit daily has remained at around 40%, despite numerous school-based policy efforts and interventions. This study aimed to apply a systems approach to provide an integrated perspective of the mechanisms of the European School Fruit and Vegetable Scheme (the Scheme) to understand better how to increase its long-term impact on children's fruit and vegetable consumption. We developed a causal loop diagram by synthesizing peer-reviewed articles and national government documents related to the Scheme, following the conceptualization steps of system dynamics. The initial causal loop diagrams were then validated in three stages by consulting with experts (two individuals and a group) in school-based fruit and vegetable programmes, children's fruit and vegetable consumption and the Scheme, using disconfirmatory interview guidelines. The findings suggest that a central self-reinforcing mechanism through which children socialize during fruit and vegetable consumption is critical in the habituation process. Additionally, the initial increase in children's fruit and vegetable consumption following the Scheme implementation is due to growth in three self-reinforcing loops related to motivation and capability mechanisms; however, this trend gradually slows and stops due to four balancing feedback loops with alternative goals related to opportunity mechanisms that reach their limits. The scheme's design should incorporate activities that align the objectives of the implementers and recipients of the Scheme at all levels. This alignment should provide children with ongoing opportunities to consume fruits and vegetables and strengthen the motivation and capability mechanisms.

Implementation of four strategies in Dutch day-care centres to stimulate young children's fruit and vegetable consumption

The day-care setting is an ideal place to encourage children's fruit and vegetable (=F&V) eating. Whereas many studies have focused on the effectiveness to increase F&V consumption, little is known about how to successfully implement effective strategies in daily practice. This study aimed to investigate how day-care professionals evaluated the implementation of a self-chosen strategy to support children's F&V eating. Thirteen day-care locations chose one out of five promising strategies and implemented this strategy for 10–12 weeks. Before (N = 98) and after the study (N = 49), day-care professionals completed a questionnaire to assess their implementation experiences, the impact on children's F&V eating as well as their future intention to use the strategy (on a 5-point scale). Parents (N = 152) completed a short questionnaire at the end of the study to capture their experiences and potential transfer effects to the home situation. Results showed that acceptability, appropriateness, feasibility and sustainability of the strategies were generally satisfactory (scores ≥3.5 on a 5-point scale), but the strategy of cooking scored less favourable on appropriateness and sustained implementation. Children's willingness to taste F&V varieties (3.4 ± 0.7 vs. 2.8 ± 0.8; p < 0.001) and eating pleasure for vegetables (3.4 ± 0.6 vs. 3.1 ± 0.8; p = 0.01) increased, whereas children's F&V consumption did not change (p > 0.14). Parents valued the day-cares’ efforts to encourage children's F&V consumption and a small group (∼20%) experienced positive effects at home. This study shows that implementing a self-chosen F&V strategy at the day-care is acceptable, appropriate and feasible for day-care professionals and has potential to positively impact children's F&V eating behaviour. Future research should investigate the effects of long-term implementation on children's eating behaviour and examine how structural implementation can be further supported.

P100 Current Field Use of Reflection Spectroscopy Based Skin Carotenoid Assessment in Children: A Systematic Review

<h3>Background</h3> Determining skin-carotenoid scores (SCS) via reflectance spectroscopy (RS) has become a widely acceptable method to quantify children's fruit and vegetable consumption (FVC) in research and public health screening due to its ease of use, portability, and non-invasiveness. However, to date, no studies have systematically evaluated the field use of RS instruments in children. <h3>Objectives</h3> Objectives are to summarize research use of RS-based SCS assessment in children (1-10-year-old) and its reliability and validity as a proxy for children's FVC and to identify areas and opportunities for future research. <h3>Study Design, Settings, Participants</h3> The research team performed a comprehensive literature search in eight databases in June 2021 yielding 4467 citations. Abstracts of peer-reviewed studies assessing SCS using RS instruments in children were identified. Studies were reviewed independently by two reviewers to determine eligibility for inclusion. <h3>Results</h3> Eight articles (Intervention = 1; Cross-sectional=7) were included. Veggie Meter® was used in seven studies as an RS instrument. FVC was measured using 24-hour dietary recall, Pictorial Liking tool, Self-reported School Physical Activity and Nutrition (SPAN) survey, parent reported availability and accessibility survey, and electronic food photos. SCS was associated with total FVC; but not with orange and green vegetable consumption, fruit consumption, and liking. Age, gender, ethnicity, income, and seasonal variation were significant covariates. No study reported validity and reliability of RS-based SCS in children compared to other standardized carotenoid measures. Additionally, adherence to recommended RS-based SCS protocol for field use in children has not been fully reported in included studies. <h3>Conclusions</h3> While the RS has been established as a valid and reliable instrument to measure SCS in adults, present review found small correlation of SCS with total FVC and null relationship when considering only orange and green vegetables or fruit consumption. Therefore, further validation will be beneficial to evaluate reliability and validity of RS-based SCS as a proxy measure to assess children's FVC. <h3>Funding</h3> Buffett Early Childhood Institute Graduate Scholars Program

Playing with fruit: An experimental study to test the effectiveness of an online memory advergame to promote children's fruit consumption

ObjectiveLiterature on food marketing targeting young people reveals that in the last years, sophisticated marketing techniques have been developed to market predominantly unhealthy food products. Much research has been conducted to test the impact of these techniques on subsequent product selection and intake. Less is known about the effects of promoting healthier foods, although the health-related benefits of eating more fruit and vegetables for children are important. The main aim of the present experiment was to examine if an online advergame promoting a fruit brand with food products increased subsequent fruit intake by children. MethodsWe used a randomized between-subject design with 123 children (age: 7–13 years) who played an advergame that promoted fruit (n = 43), non-food products (n = 40), or were in the control condition (n = 40). Subsequently, we measured the free intake of fruit as main outcome. ResultsPlaying the advergame promoting fruit did not stimulate the subsequent intake of fruit. Children in the advergame with fruit ate similar amounts of fruit than children in the control condition. No moderation effects of BMI, hunger, sex and game attitude were found. In addition, Bayesian analyses have been conducted that support the null hypothesis. DiscussionPrevious research has shown that marketing of unhealthy products via advergames affects subsequent intake of the promoted product, but the same effect is not found for healthier foods. We suggest that future research should examine if longer exposure or different forms of novel food marketing are effective in increasing the intake of healthier foods. Until now, it is unclear if advergames as a marketing technique for healthy foods have the same effectiveness on the intake of healthier food products.

The effect of parental food neophobia on children's fruit and vegetable consumption: A serial mediation model

Children in the United States do not consume the recommended amounts of healthful foods such as fruits and vegetables. In order to investigate factors associated with children's fruit and vegetable consumption, we used serial mediation models based on a theoretical model proposed by Kaar et al., [Food Quality & Preference, 50, 57–64 (2016)] to assess the indirect effect of parental food neophobia (X) on children's consumption (Y) of fruits and vegetables through two serial mediators, variety of fruits and vegetables offered at home (variety offered; M1) and child food neophobia (M2). This was accomplished with a sample of 148 children between 5 and 10 years of age (Mage = 7.71 years, 44.7% female). We measured parental and child food neophobia and parents' reports of the frequency with which they regularly offered a variety of fruits and vegetables. In addition, children completed a laboratory task in which they were presented with four different fruits and vegetables and were asked to try the foods. Analyses revealed a significant indirect effect of parents' food neophobia on consumption of fruits and vegetables through variety offered (M1) and child food neophobia (M2). There was also a significant serial indirect effect of parent food neophobia on consumption through variety offered and child food neophobia. The results provide further evidence to support the contention that parent and child neophobia and the feeding environment exert a strong influence on children's fruit and vegetable consumption.

THE EFFECT OF THE USE OF NUTRITION DISCS IN THE NUTRITION EDUCATION PROCESS ON MOTHER KNOWLEDGE AND THE CONSUMPTION PATTERN OF FRUIT AND VEGETABLES IN CHILDREN 5-9 YEARS OLD

One of the problems related to eating behavior is the lack of consumption of fruits and vegetables. Consumption of fruits and vegetables with a proportion of 1-2 servings/day was 67.16%, while fruit and vegetable consumption was 3-4 servings/day a week for the age group ≥5 years of 5.00%. This shows that the consumption of fruits and vegetables of the people of Hulu Sungai Utara Regency is still insufficient. The purpose of this study was to determine the effect of using nutritional discs in the nutrition education process on maternal knowledge and consumption patterns of fruits and vegetables for children aged 5-9 years in Mamar Village, Hulu Sungai Utara Regency.This type of research is an experiment with a pretest-posttest control group design. The study population was all mothers who had children aged 5-9 years in Mamar Village. Sampling using simple random sampling technique as many as 32 people. The grouping of sample members into two different treatment groups, namely the first treatment group using nutritional disc media and the second the control group using leaflet media. This study began with a pre-test for both groups, namely measuring the mother's level of knowledge using a questionnaire and assessing children's fruit and vegetable consumption patterns using the semi-quantitative FFQ form. Then carried out nutrition education. The following week a post-test was carried out. Data analysis used Paired Sample T-test and Wilcoxon Sign Rank Test.Based on the results of the study, it shows that there is an increase in the average knowledge of mothers and children's consumption patterns through nutrition discs media before and after nutrition education. There was an effect of nutrition education in the intervention group on maternal knowledge, indicating that the value of ρ was 0,000. And there was an effect of nutrition education in the intervention group on children's fruit and vegetable consumption patterns, indicating the value of ρ was 0.003.It is hoped that respondents can apply the knowledge that has been obtained after giving nutrition education using nutrition disc media.

U.S. Households’ Children's Drink Purchases: 2006–2017 Trends and Associations With Marketing

Sugar-sweetened beverages contribute a large proportion of added sugar in young children's diets; yet, companies market sugar-sweetened children's drinks extensively to children and parents. This study examines the changes in children's drink purchases by U.S. households with young children and the associations with marketing practices. Longitudinal Nielsen U.S. household panel data provided monthly volume purchases by children's drink category (sugar-sweetened fruit drinks and flavored water and unsweetened juices) among households with young children (aged 1-5 years) from 2006 to 2017. Differences by household race/ethnicity and income were assessed. The 2-part models examined the associations between household purchases and marketing (including price and brand TV advertising) for each category, controlling for sociodemographics. Data were collected and analyzed in 2019-2020. Households' volume purchases of children's fruit drinks and unsweetened juices declined from 2006 to 2017, whereas flavored water purchases increased. Non-Hispanic Black households purchased significantly more fruit drinks (351.23 fluid ounces/month, 95% CI=342.63, 359.82) than non-Hispanic White (204.43 fluid ounces/month, 95% CI=201.81, 207.05) and Hispanic (222.63 fluid ounces/month, 95% CI=217.11, 228.15) households. Low-income households purchased more fruit drinks and fewer unsweetened juices than higher-income households (p<0.001). TV brand advertising was positively associated with purchases across all categories, and this relationship was stronger for low-income households (p<0.05). Despite expert recommendations that young children do not consume Sugar-sweetened beverages, households with young children purchase more sweetened fruit drinks than unsweetened juices. Extensive TV advertising for children's drink brands may exacerbate the racial and income disparities in sugar-sweetened beverage purchases. Public health initiatives to address sugar-sweetened beverage consumption by young children and restrictions on marketing sugar-sweetened beverages to children are necessary.

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.

Fathers' daily intake of fruit and vegetables is positively associated with children's fruit and vegetable consumption patterns in Europe: The Feel4Diabetes Study.

Past research has focused on the relationship between mothers' and children's eating habits, although little is known about fathers as potential agents. The present study aimed to investigate the relationship between fathers' and children's fruit and vegetable (FV) intake in the context of fathers' education level and family income insecurity. Cross-sectional analysis using baseline data from the multicentre Feel4Diabetes Study were collected in 2016. Participants were parent-dyads (fathers, n = 10,038) and school children (n = 12,041) from six European countries. Socio-demographic and dietary data were collected using questionnaires. Associations were assessed applying the multinomial logistic regression model. Overall, European children have low FV intake, especially in Southern European countries (Greece, Spain and Hungary). Children with fathers consuming FV daily were more likely to consume fresh fruit (odds ratio [OR] = 2.75; 95% confidence interval [CI] = 1.95-3.88) and vegetables (OR = 2.55; 95% CI = 1.80-3.60) 1-2 times per day. After adjusting for paternal educational level and family income insecurity significant associations remained for fresh fruit (ORadj = 2.59; 95% CI = 1.82-3.69) and vegetables (ORadj = 1.98; 95% CI = 1.38-2.86). Country differences showed that fathers' educational level and income insecurity might be important factors worth considering for FV intake in Greece. The present study showed that fathers' FV intake was positively associated with children's daily intake of these foods. Implementation of future population-based strategies promoting FV intake not only in mothers, but also in fathers could be an effective public health initiative to increase FV intake in children. Policy-makers should give special attention to families dwelling in Southern European regions.

Fruit and vegetable intake at and away from school during participation in the FIT Game.

The FIT Game is a multicomponent school-based incentive program aimed at increasing children's fruit and vegetable (FV) intake. There has been no previous report on how playing the game at school influences FV intake away from school. To examine children's (n=37) FV intake away from school while participating in the FIT Game program at school. FV intake away from school was assessed using the ASA24-Kids-2014 Dietary Assessment Tool. Paired samples t-tests and the generalized linear model repeated measures analysis of variance were used to examine the difference in children's mean FV intake away from school. During the final three days of the FIT Game intervention, we observed no change in FV consumption away from school (p=0.30). Similarly, no differences were observed between FV intake away from school before the implementation of the FIT Game and during the final three days (p=0.81). The FIT Game modestly decreased the children's FV intake in a nonstatistically significant manner away from school. Our previous report showed an increase in children's FV intake at school; thus, the net effect of the game was a significant increase in total daily FV intake.

Strategies to increase primary school children's fruit and vegetable intake during 10AM snack time

In this observational study, children's fruit and vegetable (F&V) consumption during the 10AM school break was assessed for two promising strategies: a 5-day-a-week F&V policy and free provision of F&V presented in an attractive fruit bowl. Schools without a school food policy served as reference group. A secondary aim was to explore the feasibility of the two strategies. A total of 569 children aged 6–9 years participated. Children's F&V consumption at school was assessed on two different week days via observations and weighing snack portions. Parents completed an online-questionnaire on their perceptions and experiences with the two strategies. Main outcomes were the proportion of children and frequency of eating F&V, and children's F&V portion sizes. Data were analysed via ANOVA and Chi-Square (p < 0.05). Average F&V consumption differed significantly between the three situations (p < 0.001): 250 g in the fruit bowl situation, 130 g in the 5-day-policy situation and 60 g in the no-policy situation. The proportion of children eating F&V was high for the 5-day-policy (97–98%) and fruit bowl situation (87–97%), whereas this was substantially lower (50–60%; p < 0.001) in the no-policy situation. The majority of parents considered both strategies as feasible. A 5-day-a-week F&V policy seems an effective, feasible and structural strategy to support children's fruit and vegetable consumption at school. The fruit bowl strategy with an additional eating moment may enhance children's intake even further, although additional requirements are needed for structural implementation at school.

Evaluation of Preferences Among Students Participating in the US Department of Agriculture Fresh Fruit and Vegetable Program

Improving children's fruit and vegetable (FV) preferences may be important as preferences can predict FV consumption. The purpose of this study was to evaluate FV preferences over time, with repeated experience, as part of the Fresh Fruit and Vegetable Program (FFVP). Fruits (F; N=28) and vegetables (V; N=29) were distributed twice a week, over 35 weeks, at a participating FFVP school (N=236 students, 12 teachers, K-2nd grade). Preference ratings using 3-point Likert scale were analyzed over 35 weeks. For 57 FVs rated for preference, ratings revealed that F had higher frequency of children choosing "I like it" than for V (78% F; 38.2% V; p < .05) and liking distribution was different between F and V (p < .001). Significant relations were found between liking and: (1) grade (r=-0.02, p=.02), and (2) time (r=-0.09, p < .001). Models indicated that V served (β=-0.40), timepoint (β=-0.07), and grade level (β=-0.02) accounted for significant variance for preference ratings (R2 =0.17, p < .001), indicating that preference ratings declined over time. Fruits were preferred over vegetables. Overall preference ratings were negatively impacted by time, grade level, and vegetables served. Being exposed one time to a variety of FVs did not improve ratings for vegetables.

Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial.

BackgroundIn Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet.ObjectiveIn this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment.MethodsThe Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed.ResultsAt follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group.ConclusionsA positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420

Children's Fruit and Vegetable Preferences Are Associated with Their Mothers' and Fathers' Preferences.

Children’s preference for fruit and vegetables must emerge during childhood. At children’s homes, mothers and fathers influence children’s developing food preferences with their own preferences and actions. The purpose of the study was to reveal the association parents have with their children’s fruit and vegetable preferences. The study was conducted in a sample of Finnish mothers and fathers of 3–5-year-old children. The participants were recruited, and questionnaires distributed through early childhood education and care centers in 2014 and 2015. The results showed considerable variance in the children’s preferences, and were more similar with their father’s, than their mother’s preference. There was an association between mother’s and children’s preference for “strong-tasting vegetables and berries“ (p = 0.005), “sweet-tasting fruit“ (p < 0.001) and “common vegetables“ (p = 0.037). Fathers preferences associated with children’s preferences for “strong-tasting vegetables and berries“ (p = 0.003). Food neophobia decreased children’s “strong-tasting vegetables and berries“ (p < 0.001) and “sweet-tasting fruit“ (p < 0.001) preferences. The father’s more relaxed attitude towards eating decreased children’s preferences for “strong-tasting vegetables and berries“ (p = 0.031) and “sweet-tasting fruit“ (p = 0.003). These findings indicate a need for more targeted strategies for increasing children’s preferences for fruit and vegetables and highlight the importance of taking both parents equally into account.