Children Vegetable Intake Research Articles

Parent-child skin carotenoid level and vegetable intake relationships in users of children's cafeterias in Japan.

Studies on the relationship between parental and child dietary intakes are limited in Asian populations. Here, we examined parent-child relationships in skin carotenoid levels and vegetable intake in a Japanese community. The study participants were 58 children aged 6-15 years and 39 of their guardians (parents) using children's cafeterias. Skin carotenoid levels were measured using the Veggie Meter®, and the number of vegetable dishes (equivalent to a serving of 70 g) was evaluated using a self-administered questionnaire. The mean (standard deviation; SD) skin carotenoid levels were 366.8 (74.0) in children and 315.0 (101.4) in parents. The partial correlation coefficient between parents' and children's skin carotenoid levels, adjusting for cafeteria, sex, parental dietary supplement use, and household financial status, was 0.38 (P = 0.02); after adjustment for smoking status and BMI, the positive correlation was attenuated (r = 0.25, P = 0.14). A positive correlation was observed between parents' and children's vegetable dish intake (r = 0.30, P = 0.02). This cross-sectional study identified a positive correlation between parent-child intake of vegetable dishes, accounting for potential confounders. However, the positive correlation observed between parent-child skin carotenoid levels may have been attenuated by internal factors such as smoking and obesity.

Identifying and characterising digital behaviour change interventions to improve fruit and vegetable intake in low-socioeconomic status primary school children: a systematic review

BackgroundDigital behaviour change interventions aiming to improve dietary intakes; specifically fruit and vegetable intake, in low-socioeconomic children are being developed and tested. However there is currently no synthesis of the characteristics or reported effectiveness of these interventions. This systematic review aims to: (1) identify existing digital interventions targeting fruit and vegetable intake in low-socioeconomic status children, (2) identify and synthesise characteristics and reported effectiveness of these interventions using the Behaviour Change Intervention Ontology.MethodCINAHL, ERIC, PubMed, Cochrane Library, ACM Digital Library and Scopus were searched in December 2021 – February 2022 and in February–March 2024. Inclusion criteria for studies were: 1) children of low-SES families, aged between 5–11 years old; 2) Digital intervention to improve fruit and vegetable intake; 3) Comparison groups could be digital or non-digital; 4) Outcome measures were fruit and vegetable intake and antecedents to diet behaviours; 5) Randomised controlled trials (cluster and parallel designs). Characteristics of identified studies were coded using the Behaviour Change Techniques Taxonomy and Modes of Delivery, Setting and Source ontologies of the Behaviour Change Intervention Ontology.ResultsFive studies met all inclusion criteria, with majority reporting significant effects of interventions on improving fruit and vegetable intake. Most common Behaviour Change Techniques found were Goal Setting (k = 4), Problem Solving (k = 3), Instruction on how to perform a Behaviour (k = 3), and Prompts and Cues (k = 3). Characteristics relating to intervention source were unclear.ConclusionsDigital interventions had positive outcomes in fruit and vegetable intake in children; particularly more for fruit than vegetable intake. Characteristics in digital interventions which have direct effects on child fruit and vegetable intake in low-socioeconomic families should be further investigated. Furthermore, clearer reporting on intervention characteristics is needed.

“A good way to start the day”: UK-based parents’ views about offering vegetables to children for breakfast

Children in the UK do not eat enough vegetables for optimal health and development; therefore, considering methods to increase children's vegetable intake is critical. Currently, if UK children are offered vegetables to eat, this typically occurs at midday/evening meals, and/or for snacks – children are seldom offered vegetables at breakfast time, even though there is no medical, nutritional, or physiological reason not to. Therefore, this study aimed to explore the views and experiences of parents in relation to offering children (aged 18 months to four years) vegetables to eat at breakfast time. Semi-structured interviews were conducted with 18 parents (aged 27–51 years) who were asked for their opinions about offering vegetables to children at breakfast time, and about their perceptions of their child(ren)'s behaviours in relation to vegetables at breakfast. A thematic analysis of the data identified the following themes/sub-themes relating to parents' views and experiences: 1) willingness – there was widespread willingness amongst parents to offer their chid(ren) vegetables at breakfast time; 2) barriers – relating to social/behavioural norms (parent/family and societal), practical challenges, and vegetables being commonly disliked by children; 3) facilitators – relating to young children not yet having developed social norms around foods, various practical solutions, and the need for information and awareness campaigns to highlight how and why vegetables can be incorporated into children's breakfasts. These encouraging findings for optimising children's health via this novel approach suggest that further research and dissemination around the value of offering children vegetables for breakfast is required.

The feasibility, acceptability and potential efficacy of a parental text message and social media program on children's vegetable consumption and movement behaviours: A pilot randomised controlled trial.

Australian children fall short of meeting the dietary, physical activity and sedentary behaviour guidelines. This study aimed to test the feasibility, acceptability and potential efficacy of a parental text message and social media program on, primarily, their school-aged children's vegetable consumption and movement behaviours, and, secondarily, their own. Between August and November 2022, we conducted a two-armed randomised controlled trial with 242 parents/caregivers of primary school-aged children in New South Wales. The 'Adventure & Veg' intervention ran for 8 weeks, promoting vegetable eating behaviours, local outdoor physical activity opportunities and ideas for reducing screen time. Feasibility and acceptability were assessed via recruitment and retention data, intervention metrics and self-reported participant data. Vegetable intake and movement behaviour data were collected via online-surveys and effect sizes were examined. Most participants reported that they enjoyed receiving the text messages (88%) and the delivery frequency was acceptable (94%). Limitations to Facebook as a delivery platform were reported. The majority of participants used the text messages to influence the vegetable eating (65%) and movement (77%) behaviours of their child. Significant effects were observed among intervention child participants compared with control for mean daily vegetable consumption (0.45 serves, CI: .19; .71, p = .001, d = .5); weekly vegetable variety (1.85, CI: .25; 3.45, p < .001, d = .6); and weekly physical activity variety (.64 CI: .09; 1.19, p = .022, d = .3). Parents in the intervention group increased their daily vegetable intake by .44 serves (CI: .11; .78, p = .01, d = .4). A parental text message and social media program has potential to support children's vegetable intake and movement behaviours. Further research is required to explore different online delivery methods to promote local outdoor activity options. SO WHAT?: The Adventure & Veg program holds promise as a stand-alone health promotion intervention or as a useful adjunct to current family or school-based healthy lifestyle programs.

Evaluation of a long day care intervention targeting the mealtime environment and curriculum to increase children's vegetable intake: a cluster randomised controlled trial using the multiphase optimisation strategy framework.

To determine the reach, adoption, implementation and effectiveness of an intervention to increase children's vegetable intake in long day care (LDC). A 12-week pragmatic cluster randomised controlled trial, informed by the multiphase optimisation strategy (MOST), targeting the mealtime environment and curriculum. Children's vegetable intake and variety was measured at follow-up using a modified Short Food Survey for early childhood education and care and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework. Australian LDC centres. Thirty-nine centres, 120 educators and 719 children at follow-up. There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared with non-vegetable consumers for intake (OR = 0·70, (95 % CI 0·34-1·43), P = 0·32) or variety (OR = 0·73 (95 % CI 0·40-1·32), P = 0·29). Among vegetable consumers (n 652), there was no difference between groups in vegetable variety (exp(b): 1·07 (95 % CI:0·88-1·32, P = 0·49) or vegetable intake (exp(b): 1·06 (95 % CI: 0·78, 1·43)), P = 0·71) with an average of 1·51 (95 % CI 1·20-1·82) and 1·40 (95 % CI 1·08-1·72) serves of vegetables per day in the intervention and control group, respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all P < 0·001). Intervention fidelity was moderate (n 16/20 and n 15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22 % eligible centres. The pragmatic self-delivered online intervention positively impacted educator's knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children' vegetable intake.

Healthy helpers: using culinary lessons to improve children's culinary literacy and self-efficacy to cook.

Children do not eat the recommended amounts of vegetables, and school-based nutrition education has not been found to impact this behavior. Cooking education is associated with improved children's culinary literacy (CL) and eating behaviors. This study investigated the impact of a culinary literacy (CL) curriculum on children's acceptance of vegetable-added (mushrooms) recipes, CL, self-efficacy to cook (SE), and willingness to try vegetables (WV). A convenience sample of 39 fourth and fifth graders were exposed to a six-lesson virtual CL curriculum that taught basic cooking skills and how to prepare six recipes, including three traditional recipes and the same recipes with added vegetables. Children who participated in the CL curriculum accepted vegetables added to pizza pockets, but vegetables added to macaroni and cheese and fajitas negatively affected the acceptance of recipes. Children improved their CL and SE but did not show a significant change in their WV. Findings suggest that CL programs focusing on vegetables may drive factors associated with dietary behavior change, SE, and acceptance of vegetables. Future studies should consider CL as a potential method to improve vegetable intake in children in tandem with nutrition education or as a sole intervention. The study was limited by its small sample size, the virtual setting, and the use of mushrooms as the primary vegetable source. Future studies should be conducted with a larger sample size, in a traditional classroom setting, use a variety of vegetables, and collect qualitative data on the sensory characteristics affecting children's WV.

Choice-induced tasting. Evaluating the effect of choice on children's acceptance of an unfamiliar vegetable

Children's vegetable intake is in general below recommendations. It is known that self-selection of vegetables out of multiple options can increase intake in children. However, it is not clear if this effect is driven by a pre-existing preference for the selected food, or purely by having a choice. Allowing children to choose could create a positive bias and endorse feelings of autonomy, which could increase acceptance of the food and promote intake. The aim of the present pre-registered study was to investigate the effect of choice in promoting the acceptance of an unfamiliar vegetable during a blind-choice task. Children aged 4–5 years old (n = 161) were randomly assigned to the choice or no-choice condition. Each child was presented with three closed cups, containing a vegetable. The children were unaware that the cups contained the same vegetable, a piece of raw celeriac. In the choice condition, the children were able to choose a cup themselves whereas in the no-choice condition, the experimenter made the decision. We hypothesized that children in the choice condition would show more acceptance of the vegetable compared to children in the no-choice condition and that higher levels of picky eating would lead to less vegetable acceptance. The results demonstrated that choice indeed significantly increased vegetable acceptance (4.7 ± 1.7 versus 4.0 ± 1.9 on a 6-point scale), irrespective of pickiness in eating. In addition, picky children showed less acceptance of the vegetable compared to non-picky children. The results of this study imply that choice is an important factor in promoting unfamiliar vegetable intake in young children. Including children in the decision process may be a practical strategy for educators and caregivers to increase children's vegetable intake.

”Miffy eats the rainbow!” - Efficacy of stimulating colour consumption as strategy to increase fruit and vegetable intake in children

”Miffy eats the rainbow!” - Efficacy of stimulating colour consumption as strategy to increase fruit and vegetable intake in children

Development of an initiatives package to increase children's vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment.

To inform a package of initiatives to increase children's vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum. Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children's dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability. LDC centres in metropolitan Adelaide, South Australia. 32 centres, 276 staff and 1039 children aged 2-5 years. There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0-50 % completed the menu assessment, 3/5 would recommend). A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children's vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families’ use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: ‘Child factors’, ‘Eating beliefs’, ‘Effectiveness beliefs’, ‘Past experience’, ‘Current family behaviours’, ‘Harms’, ‘Knowledge’, ‘Need for change’, ‘Parent effort’, ‘Parent values’ and ‘Practical issues’. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a “protective mindset” that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake.

Food System for Sustainable Healthy Diets: Global and Local Efforts.

Global efforts for sustainable healthy diets include the Sustainable Development Goals by the United Nations in 2015, the Sustainable Healthy Diets by the Food and Agriculture Organization of the United Nations and the World Health Organization in 2019 and the Planetary Health Diet by the EAT-Lancet Commission. The food system is a dynamic and complex system, and systems approach is useful in providing stakeholders and policymakers with a comprehensive understanding of the broader food system. As local efforts, some of the recent articles using systems approach are introduced. They include systems modelling for local sustainability, policy activities for healthy and sustainable diets, food-related policymaking processes, low fruit and vegetable intake in children, and livestock-derived food system. In light of the existence of various stakeholders and policymakers, redesigning of the food system using systems approach may help mitigate climate change.

Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers.

This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.

The Effects of Increasing Fruit and Vegetable Intake in Children with Asthma on the Modulation of Innate Immune Responses.

Children with asthma are at risk of acute exacerbations triggered mainly by viral infections. A diet high in fruit and vegetables (F&V), a rich source of carotenoids, may improve innate immune responses in children with asthma. Children with asthma (3–11 years) with a history of exacerbations and low F&V intake (≤3 serves/d) were randomly assigned to a high F&V diet or control (usual diet) for 6 months. Outcomes included respiratory-related adverse events and in-vitro cytokine production in peripheral blood mononuclear cells (PBMCs), treated with rhinovirus-1B (RV1B), house dust mite (HDM) and lipopolysaccharide (LPS). During the trial, there were fewer subjects with ≥2 asthma exacerbations in the high F&V diet group (n = 22) compared to the control group (n = 25) (63.6% vs. 88.0%, p = 0.049). Duration and severity of exacerbations were similar between groups. LPS-induced interferon (IFN)-γ and IFN-λ production showed a small but significant increase in the high F&V group after 3 months compared to baseline (p < 0.05). Additionally, RV1B-induced IFN-λ production in PBMCs was positively associated with the change in plasma lycopene at 6 months (rs = 0.35, p = 0.015). A high F&V diet reduced asthma-related illness and modulated in vitro PBMC cytokine production in young children with asthma. Improving diet quality by increasing F&V intake could be an effective non-pharmacological strategy for preventing asthma-related illness by enhancing children’s innate immune responses.

The Baby’s First Bites RCT: Evaluating a Vegetable-Exposure and a Sensitive-Feeding Intervention in Terms of Child Health Outcomes and Maternal Feeding Behavior During Toddlerhood

BackgroundParenting interventions during the first years of life on what and/or how to feed infants during complementary feeding can promote healthy eating habits. ObjectivesAn intervention promoting repeated exposure to a variety of vegetables [repeated vegetable exposure (RVE); what] and an intervention promoting responding sensitively to child signals during mealtime [video-feedback intervention to promote positive parenting–feeding infants (VIPP-FI); how] were compared, separately and combined (COMBI), with an attention control condition (AC). Primary outcomes were vegetable consumption and self-regulation of energy intake; secondary outcomes were child anthropometrics and maternal feeding practices (sensitive feeding, pressure to eat). MethodsOur 4-arm randomized controlled trial included 246 first-time Dutch mothers and their infants. Interventions started when infants were 4–6 mo old and ended at age 16 mo. The present study evaluated effects at 18 (t18) and 24 (t24) mo of age. Vegetable acceptance was assessed using three 24-h dietary recalls, self-regulation of energy intake by an eating-in-the-absence-of-hunger experiment and mother-report, and maternal feeding behavior by observation and mother-report. ResultsLinear mixed model and ANOVA analyses revealed no follow-up group differences regarding child vegetable intake or self-regulatory behavior. The proportion of children with overweight was significantly lower in the COMBI group, compared with the VIPP-FI group at t18 (2% compared with 16%), and with the AC group at t24 (7% compared with 20%), although this finding needs to be interpreted cautiously due to the small number of infants with overweight and nonsignificant effects on the continuous BMI z-score measure (P values: 0.29–0.82). Finally, more sensitive feeding behavior and less pressure to eat was found in the VIPP-FI and COMBI groups, compared with the RVE and AC groups, mostly at t18 (significant effect sizes: d = 0.23–0.64). ConclusionsInterventions were not effective in increasing vegetable intake or self-regulation of energy intake. Future research might usefully focus on risk groups such as families who already experience problems around feeding.This trial is registered at clinicaltrials.gov as NCT03348176.

Selection and use of vegetable parenting practices did not vary by parent feeding styles: Mixed methods investigation

Parents influence their child's vegetable intake through their feeding style, i.e. the emotional tone established around feeding, and vegetable parenting practices (VPPs), i.e. the specific behaviors employed to influence their child's vegetable intake. A model of precision food parenting proposes that child healthy dietary intake could be optimized by the selection and implementation of effective food parenting practices. Parents use and learn from these complex interactions with their child, which are reflective of feeding style. Intervention research has targeted VPPs in general without a delineation of which practices were selected, which were used, or why they were selected. It is not clear how these users were influenced by feeding style, nor what the parent learned from the interaction. The current study used mixed methods wherein middle socioeconomic status parents of 3–5 year old children were categorized within feeding style groups (n = 122), asked to select two VPPs, implemented them for a week (n = 63), and qualitatively interviewed about their experience. Responsiveness VPPs were most commonly selected, primarily due to their perceived ease of implementation. Parents believed there would be long term positive outcomes, e.g. more vegetable intake from using the practices selected. Frequency of use depended in part on opportunity, e.g. food purchase parenting practices could only be employed during intermittent shopping events. Few differences were detected by parent feeding styles in the types of VPPs selected, frequency of use, or effectiveness. Food parenting interventions can encourage selection of specific VPPs to employ and do not appear to have to tailor the types of VPPs offered to parent feeding style. Research is needed with larger, socioeconomically diverse samples to assess optimal categorization into feeding styles and confirm the present results.

Relationship between Maternal Mood Disorders and Dietary Intake of 3-Year-Olds.

Maternal depression affects parenting and children's early development, but its effect on dietary intake is unknown. While husbands' involvement in parenting and having friends to talk to may reduce childcare stress, this has not been thoroughly studied. In this study, mothers were stratified by the presence or absence of mood disorders, and the effects of support from their husbands and friends on the dietary intake of their 3-year-old children were examined. This cross-sectional analysis included 920 mother-child pairs examined at the National Center for Child Health and Development in Japan. Dietary intake was assessed using a brief dietary history questionnaire, and physical measurements were taken when the children were 3 years old. The Kessler Psychological Distress Scale was used to screen for maternal mood disorders, 3 years after delivery. The presence or absence of the husband's assistance with housework and childcare, mental support, and friends was obtained from a self-administered questionnaire when the child was 3 years old. Differences in the children's physical measurements, energy, and food intake with the presence or absence of support for subjects with or without mood disorders were compared. Mothers with support from husbands or friends had significantly fewer mood disorders. Support from friends and family did not affect the children's physical development and whether or not mothers had mood disorder symptoms. However, children's vegetable intake was higher if mothers were supported. Children of mothers with mood disorders had a significantly higher vegetable intake and fruit intake, depending on the support from friends (P=0.046, P=0.037); thus, such support may increase children's vegetable and fruit intake. The results of this study revealed the importance of supportive friends and family regarding childcare.

Effectiveness of a kindergarten-based intervention to increase vegetable intake and reduce food neophobia amongst 1-year-old children: a cluster randomised controlled trial.

BackgroundChildren’s first years of life are crucial to their future health. Studies show that a varied diet with a high intake of vegetables is positive in several domains of health. The present low vegetable intake amongst children is, therefore, a concern. Food neophobia is a common barrier to vegetable intake in children. As most Norwegian children attend kindergarten from an early age, kindergartens could contribute to the prevention of food neophobia and the promotion of vegetable intake.ObjectiveThe aim of this study was to assess the effect of a cluster randomised trial amongst 1-year-old children in kindergarten to reduce food neophobia and promote healthy eating.MethodsKindergartens were randomly allocated to either a control group or one of two intervention groups. Both intervention groups (diet and diet + Sapere-method) were served a warm lunch meal including three alternating intervention vegetables, whilst the intervention group 2 (diet + Sapere) in addition received tools for weekly sensory lessons. The intervention was digitally administered via information and recipes on a study website. The control group did not receive any information. Parents completed digitally distributed questionnaires addressing food neophobia and food habits at baseline and post-intervention.ResultsThe parents of 144 1-year-old children in 46 kindergartens completed the questionnaires, which were included in the main analysis. The results suggested a higher intake of the intervention vegetables in group 2 (diet + Sapere) compared to the control group. The effect on total vegetable intake was inconclusive. No effect was observed on the level of food neophobia in either of the intervention group.ConclusionThis digitally delivered dietary and sensory intervention promoted the intake of intervention-targeted vegetables with inconclusive effect on total vegetable intake due to large loss to follow-up. No effect on the level of food neophobia was detected.

Impact of a \u201cvegetables first\u201d approach to complementary feeding on later intake and liking of vegetables in infants: a study protocol for a randomised controlled trial

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.

The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial.

A high fruit and vegetable (F&V) diet reduces asthma exacerbations in adults; this has not been examined in children to date. To investigate the effect of a 6-month, high F&V diet on the time to first asthma exacerbation in children with asthma, in a parallel-group, randomized, controlled trial. Children (aged 3-11years) with asthma, history of exacerbations and usual low F&V intake (≤3 serves/day) were randomized to the intervention (high F&V diet) or control group (usual diet) for 6months. The primary outcome was time to first exacerbation requiring medical intervention. Secondary outcomes included exacerbation rate, lung function, plasma TNF-α, CRP, and IL-6, faecal microbiota and peripheral blood mononuclear cell (PBMC) histone deacetylase (HDAC) activity and G-protein coupled receptor (GPR) 41/43 and HDAC (1-11) expression. 67 children were randomized between September 2015 and July 2018. F&V intake (difference in change (∆): 3.5serves/day, 95% CI: [2.6, 4.4] p<0.001) and plasma total carotenoids (∆: 0.44µg/ml [0.19, 0.70] p=0.001) increased after 6months (intervention vs control). Time to first exacerbation (HR: 0.81, 95% CI: [0.38, 1.69], p=0.569; control vs. intervention) and exacerbation rate (IRR: 0.84, [0.47, 1.49], p=0.553; control vs. intervention) were similar between groups. In per-protocol analysis, airway reactance z-scores increased in the intervention versus control group (X5 ∆: 0.76 [0.04, 1.48] p=0.038, X20 ∆: 0.93 [0.23, 1.64] p=0.009) and changes in faecal microbiota were observed though there was no difference between groups in systemic inflammation or molecular mechanisms. In the control group, CRP and HDAC enzyme activity increased, while GPR41 expression decreased. No adverse events attributable to the interventions were observed. A high F&V diet did not affect asthma exacerbations over the 6-month intervention, though warrants further investigation as a strategy for improving lung function and protecting against systemic inflammation in children with asthma.

Relationships Among the Physical and Social Home Food Environments, Dietary Intake, and Diet Quality in Mothers and Children

BackgroundBoth the physical and social home food environment (HFE) are believed to influence dietary intake and diet quality, but few studies have examined both aspects together. ObjectiveThe purpose of this study was to examine the relationships among the physical and social HFE, dietary intake, and diet quality in mothers and children. DesignThis was a cross-sectional substudy of a larger study. Participants/settingThe study included 24 mothers (aged ≥30 years) with a biological child aged 6 to 12 years living in the Newark, DE, area between June and November 2018. Main outcome measuresThe outcome measures of interest included the physical HFE (ie, home food availability); aspects of the social HFE (ie, parenting styles, family meal frequency, and policies); maternal and child intake of fruits, vegetables, sugar-sweetened beverages, and snacks; and diet quality using the 2015 Healthy Eating Index total score. Statistical analysisPearson correlations were used to examine the relationship between physical HFE and dietary intake as well as social HFE and dietary intake in both mothers and children. The relationships were further examined through exploratory regression analyses. ResultsIn mothers, fruit availability in the physical HFE was correlated with fruit intake (r = 0.50; P = 0.02). Fruit and vegetable availability in the physical HFE were correlated with 2015 Healthy Eating Index total score in both the mother and child. Family meals participation was correlated with dietary intake (vegetable intake in children, r = 0.44; P = 0.04; and snack intake in mothers, r = –0.74; P < .001). Exploratory regression analysis showed vegetables in the HFE was associated with vegetable intake and 2015 Healthy Eating Index total score in mothers, and fruits and vegetables in the HFE were associated with child 2015 Healthy Eating Index total score. Family meals participation was negatively associated with maternal snack intake and child sugar-sweetened beverages intake. Authoritative parenting was negatively associated with child snack intake and permissive parenting was negatively associated with mother’s fruit intake. ConclusionsBoth the physical and social HFE are associated with maternal and child dietary intake, but only the physical HFE was associated with dietary quality. Although preliminary, these data indicate the importance of future studies that include measures to assess both the physical and social HFE to better elucidate the influences of the HFE on dietary intake.