Children Vegetable Intake Research Articles

‘Just a pinch of salt’. An experimental comparison of the effect of repeated exposure and flavor-flavor learning with salt or spice on vegetable acceptance in toddlers

Children's vegetable intake is below the recommended amounts. No studies to date have tested the relevance of using salt or spices to increase children's vegetable acceptance. Our objective was to compare the effect of repeated exposure (RE) and of flavor-flavor learning (FFL) on toddlers' acceptance of a non-familiar vegetable. Two unconditioned stimuli were used: salt and a salt-associated spice. Toddlers attending six nurseries were assigned to 3 groups in a between subject design. Groups were exposed 8 times to a basic salsify puree (0.2% salt w/w; RE group; n = 47), a salty salsify puree (0.5% salt w/w; FFL-Salt group; n = 54) or a spiced salsify puree (0.2% salt and 0.02% nutmeg w/w; FFL-Nutmeg group; n = 50). Acceptance (intake and liking) of the target vegetable (basic salsify puree) and of a control vegetable (carrot puree) was evaluated at pre-exposure, at each exposure of the learning period, at post-exposure, and at 1, 3 and 6 months after exposure. In all groups, intake of the target vegetable increased from pre- to post-exposure. This increase was significantly higher in the RE group (64 ± 11 g) than in the FFL-Salt group (23 ± 11 g) and marginally higher than in the FFL-Nutmeg group (36 ± 11 g). No difference between groups was observed on the increase in liking of the target vegetable from pre- to post-exposure. The increase of the target vegetable intake was still observed after 6 months for all groups. Thus, repeated exposure appears to be the simplest choice to increase vegetable intake on the short and long term in toddlers.

Does the Royal Horticultural Society Campaign for School Gardening increase intake of fruit and vegetables in children? Results from two randomised controlled trials

BackgroundChildren’s fruit and vegetable intake in the UK is low. Changing intake is challenging. Gardening in schools might be a vehicle for facilitating fruit and vegetable intake.ObjectivesTo undertake the first clustered randomised controlled trials (RCTs) of a gardening intervention. To evaluate the impact of a school gardening programme, the Royal Horticultural Society (RHS) Campaign for School Gardening, on children’s fruit and vegetable intake.MethodsPrimary school children aged 8–11 years from eight London boroughs were included in one of two related RCTs. Trial 1 consisted of 23 schools, randomised to receive either a RHS-led or teacher-led intervention. Trial 2 consisted of 31 schools, randomised to either the teacher-led intervention or a comparison group. A 24-hour food diary [the Child And Diet Evaluation Tool (CADET)] collected baseline and follow-up dietary intake. Questionnaires measured children’s knowledge and attitudes towards fruit and vegetables and assessed intervention implementation. Data were collected by fieldworkers who were blind to the original allocation of the school. The primary outcome was change in fruit and vegetable intake analysed using a random effects model, based on intention to treat.ResultsTotal sample size at baseline for both trials (2529 children) was lower than the original aim of 2900 children. The final sample size was 1557, with 641 children completing trial 1 (RHS-led,n = 312; teacher-led,n = 329) and 916 children completing trial 2 (teacher-led,n = 488; control,n = 428). The response rate at follow-up for the two combined was 62%.Baseline analysis of children’s fruit and vegetable intake showed that eating a family meal together, cutting up fruit and vegetables, and parental modelling of fruit and vegetable intakes were all associated with higher intakes of fruit and vegetables in children.The primary trial outcome, combined fruit and vegetable intake, showed that in trial 1 the teacher-led group had a mean change in intake of 8 g [95% confidence interval (CI) –19 to 36 g], compared with a mean of –32 g (95% CI –60 to –3 g) in the RHS-led group. However, this difference was not significant (intervention effect –43 g, 95% CI –88 to 1 g;p = 0.06). In trial 2, the teacher-led group consumed 15 g (95% CI –36 to 148 g) more fruit and vegetables than the comparison group; this difference was not significant. No change was found in children’s knowledge and attitudes. However, if schools improved their RHS gardening score by three levels, children had a higher intake of 81 g of fruit and vegetables (95% CI 0 to 163 g;p = 0.05) compared with schools with no change in gardening score.ConclusionResults from these trials provide little evidence that school gardening alone can improve children’s fruit and vegetable intake. In both trials, gardening levels increased across all groups from baseline to follow-up, with no statistically significant difference between groups in terms of improvement in gardening level. This lack of differentiation between groups is likely to have influenced the primary outcome. However, when the gardening intervention was implemented at the highest intensities there was a suggestion that it could improve children’s fruit and vegetable intake by a portion. Analysis of the baseline data showed that family support for fruit and vegetable intakes was associated with higher intakes of fruit and vegetables in children. This study highlights the need for more sophisticated and accurate tools to evaluate diet in children. Future intervention designs should include a greater level of parental involvement in school interventions, along with related components such as cooking, to substantially improve children’s fruit and vegetable intake. In addition, the home environment has been demonstrated to be an important focus for intervention.Trial registrationCurrent Controlled Trials ISRCTN11396528.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 2, No. 4. See the NIHR Journals Library website for further project information.

Will Students Eat More Fruits and Vegetables if School Policies Include Longer Lunch Periods or Letting Children Play First?

ObjectiveSchool policies that increase fruit and vegetable intake in children are needed. The study aim was to evaluate the relationship of duration of lunch and order of play and eating during the lunch period with fruit and vegetables (FV) intake. A secondary aim was to examine if differences existed in these relationships by student gender, ethnicity, language spoken at home, and school lunch source.Study Design, Setting, Participants, and InterventionA diary-assisted 24-hour recall was collected during the 2011-12 school year from 3,463 4th-5th graders attending 44 elementary schools in California.Outcome, Measures and AnalysisSchool lunch characteristics including order of eating and playing time, total length of the lunch period, duration of the lunch line, and start and end times of lunch were attained from school staff and observation. The associations of play before eating and duration of lunch with FV intake were estimated using GEE.ResultsFV intake did not significantly differ by lunch period length. Overall, lunch FV intake was not significantly higher for students who had a play before versus after eating lunch schedule. Variables in the model showed significant interaction with play before eating, requiring separate effect estimates by gender, ethnicity, language spoken at home, and lunch source. When a significant effect was predicted, play before eating had a positive impact among students who brought lunch from home.Conclusions and ImplicationsPlaying before eating may help some elementary students to increase FV intake although this and other environmental policies to improve school lunch need further rigorous evaluation to understand their full impact.FundingSupplemental Nutrition Assistance Program - EducationAdditional FundingThe Orfalea Foundation ObjectiveSchool policies that increase fruit and vegetable intake in children are needed. The study aim was to evaluate the relationship of duration of lunch and order of play and eating during the lunch period with fruit and vegetables (FV) intake. A secondary aim was to examine if differences existed in these relationships by student gender, ethnicity, language spoken at home, and school lunch source. School policies that increase fruit and vegetable intake in children are needed. The study aim was to evaluate the relationship of duration of lunch and order of play and eating during the lunch period with fruit and vegetables (FV) intake. A secondary aim was to examine if differences existed in these relationships by student gender, ethnicity, language spoken at home, and school lunch source. Study Design, Setting, Participants, and InterventionA diary-assisted 24-hour recall was collected during the 2011-12 school year from 3,463 4th-5th graders attending 44 elementary schools in California. A diary-assisted 24-hour recall was collected during the 2011-12 school year from 3,463 4th-5th graders attending 44 elementary schools in California. Outcome, Measures and AnalysisSchool lunch characteristics including order of eating and playing time, total length of the lunch period, duration of the lunch line, and start and end times of lunch were attained from school staff and observation. The associations of play before eating and duration of lunch with FV intake were estimated using GEE. School lunch characteristics including order of eating and playing time, total length of the lunch period, duration of the lunch line, and start and end times of lunch were attained from school staff and observation. The associations of play before eating and duration of lunch with FV intake were estimated using GEE. ResultsFV intake did not significantly differ by lunch period length. Overall, lunch FV intake was not significantly higher for students who had a play before versus after eating lunch schedule. Variables in the model showed significant interaction with play before eating, requiring separate effect estimates by gender, ethnicity, language spoken at home, and lunch source. When a significant effect was predicted, play before eating had a positive impact among students who brought lunch from home. FV intake did not significantly differ by lunch period length. Overall, lunch FV intake was not significantly higher for students who had a play before versus after eating lunch schedule. Variables in the model showed significant interaction with play before eating, requiring separate effect estimates by gender, ethnicity, language spoken at home, and lunch source. When a significant effect was predicted, play before eating had a positive impact among students who brought lunch from home. Conclusions and ImplicationsPlaying before eating may help some elementary students to increase FV intake although this and other environmental policies to improve school lunch need further rigorous evaluation to understand their full impact. Playing before eating may help some elementary students to increase FV intake although this and other environmental policies to improve school lunch need further rigorous evaluation to understand their full impact.

An Observational Analysis of Dinner Meals to Identify Factors That Influence Vegetable Intake in Children

An Observational Analysis of Dinner Meals to Identify Factors That Influence Vegetable Intake in Children

Effects of starting weaning exclusively with vegetables on vegetable intake at the age of 12 and 23 months

Background: The low vegetable intake in children may be attributed to their low preference for vegetables. During the first year of life, first taste preferences are formed, which may track over time. In a previous study to increase infants' vegetable intake and liking, we found that at the start of weaning, infants had a higher vegetable intake in the lab after repeated exposure to vegetable purées than to fruit purées. The current study is a follow-up of these infants at the age of 12 and 23 months, and examined whether the group that started weaning with vegetables continued eating more vegetables than the group that started weaning with fruits. Methods: At 12 (n = 86) and 23 (n = 81) months of age the children's daily vegetable consumption was reported by their parents using a 3-day food diary. The intake of green beans and apple purée was measured in the laboratory. Results: Reported daily intake of vegetables at 12 months of age was 38 % higher (P = 0.02) in the vegetable group (75 ± 43 g) than in the fruit group (54 ± 29 g), but was similar for both groups at 23 months of age (49 ± 43, 57 ± 35 g, respectively; NS). Both at 12 and 23 months of age, apple and green beans intake in the lab did not differ significantly between the groups. Conclusion: These findings suggest that weaning exclusively with vegetables results in a higher daily vegetable consumption until at least 12 months of age. More research is needed to investigate how to maintain this effect.

Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior.

Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices. The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion. Parents of 307 pre-school children (3-5 years old). Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized β=0·349, P<0·0001) and desire (standardized β=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized β=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized β=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized β=-0·133, P=0·009), autonomy (standardized β=-0·118, P=0.014), attitude about negative effects of vegetables (standardized β=-0·118, P=0·015) and descriptive norms (standardized β=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices. The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.

Skin Carotenoids: A Biomarker of Fruit and Vegetable Intake in Children

BackgroundStudies of adult subjects have found a strong correlation between serum carotenoids and skin carotenoids measured by resonance Raman spectroscopy (RRS). No published studies have examined correlations between skin and serum carotenoids among children. ObjectivesWe aimed to validate skin RRS methodology against serum carotenoid measurements by high-performance liquid chromatography and to determine whether RRS can be used as a valid biomarker of fruit and vegetable (F/V) intake among children. DesignIn our cross-sectional study, participants were 45 healthy children aged 5 to 17 years who provided three blood samples used to assess serum carotenoid concentrations and three RRS skin measurements of the palm within a 4-week period. Dietary intake of F/V was assessed three times within 4 weeks using a 27-item food frequency questionnaire (FFQ) and an automated multiple-pass 24-hour daily recall. Estimates of intake from three FFQs, completed at least 7 days apart, were averaged. Estimates of intake from 24-hour daily recalls were collected on 2 weekdays and 1 weekend day and averaged. ResultsLevels of skin and serum carotenoids were highly correlated (R2=0.62; P<0.001). A linear regression model, controlling for child's weight and scanner unit, predicted that for every unit increase of total F/V from FFQ and total F/V as assessed by 24-hour daily recall, RRS intensity was predicted to increase by 3,798 (P=0.001) and 3,504 (P=0.001), respectively. Similar results were observed for reported high-carotenoid vegetable intake. Total carotenoid and beta carotene levels from 24-hour daily recalls correlated to total serum carotenoids levels (P<0.01 and P<0.05, respectively). Total carotenoid, alpha carotene, and beta carotene levels from the 24-hour daily recalls correlated to RRS (P<0.01). ConclusionsSkin carotenoids measured by RRS were strongly correlated with serum carotenoid levels and were positively associated with estimates of intake from FFQ and an automated multiple-pass 24-hour daily recall among children aged 5 to 17 years. Skin carotenoids may be used as valid biomarker of F/V intake among children.

Maternal feeding self-efficacy and fruit and vegetable intakes in infants. Results from the SAIDI study

Adequate consumption of fruits and vegetables (FV) is a characteristic of a healthy diet but remains a challenge in nutrition interventions. This cross-sectional study explored the multi-directional relationships between maternal feeding self-efficacy, parenting confidence, child feeding behaviour, exposure to new food and FV intake in a cohort of 277 infants. Mothers with healthy infants weighing ≥2500 g and ≥37 weeks gestation were recruited post-natally from 11 South Australian hospitals. Socio-demographic data were collected at recruitment. At 6 months postnatal, infants were weighed and measured, and mothers completed a questionnaire exploring their perceptions of child feeding behaviour and child exposure to new foods. The questionnaire also included the Short Temperament Scale for Infants, Kessler 10 to measure maternal psychological distress and 5 items measuring maternal feeding self-efficacy. The number of occasions and variety of FV (number of subgroups within food groups) consumed by infants were estimated from a 24-hour dietary recall and 2 days food record. Structural equation modelling was performed using Mplus version 6.11. Median (IQR) variety scores were 2 (1–3) for fruit and 3 (2–5) for vegetable intake. The most popular FV consumed were apple (n = 108, 45.0%) and pumpkin (n = 143, 56.3%). None of the variables studied predicted the variety of child fruit intake. Parenting confidence, exposure to new foods and child feeding behaviour were indirectly related to child vegetable intake through maternal feeding self-efficacy while total number of children negatively predicted child vegetable variety (p < 0.05). This highlights the need for addressing antecedents of maternal feeding self-efficacy and the family eating environment as key strategies towards development of healthy eating in children.

Efficacy of repeated exposure and flavour–flavour learning as mechanisms to increase preschooler's vegetable intake and acceptance

Dutch children's diets, like the diets of many children in Europe and the US are not balanced, do not contain enough vegetables and have been associated with a high prevalence of childhood obesity. Promoting children's vegetable intake is challenging. We investigated the relative effectiveness of repeated exposure and flavour-flavour learning in increasing vegetable intake and acceptance in preschoolers. During an intervention period of 7 weeks, 39 toddlers (aged 1.5 to 4 years) consumed red beet and parsnip crisps at day-care centres in Wageningen, the Netherlands. Half of the group received red beet crisps with a dip of tomato ketchup (Conditioned [C]) and parsnip with a neutral white sauce (Unconditioned, [UC]), whereas for the other half the order was reversed (red beet [UC], parsnip [C]). Preference and ad libitum consumption of vegetable crisps were measured once before and three times after the intervention over the course of a 6-month follow-up period to assess longer-term effects. Intake increased significantly after the intervention for both vegetables (on average with 8 g; an increase of approximately 300%), and this effect was persistent even 6 months afterwards. The increase was irrespective of crisps being offered with C or UC dip sauce. These results suggest a robust and persistent effect of repeated exposure but no effect of flavour-flavour learning. Offering pure vegetable tastes repeatedly is sufficient to increase intake.

Association between home availability and vegetable consumption in youth: a review.

To systematically review literature examining the association between vegetable home availability and vegetable intake in youth. Articles were identified through December 2012 using a search of PubMed, PsychINFO and OVID/Medline databases, using the following keywords in varying combinations: home, environment, availability, vegetable, intake, consumption, children. Quantitative studies examining home vegetable availability and vegetable intake in children and adolescents were included. Fifteen studies were included that met inclusion criteria. Studies were conducted in the USA (n 8), Australia (n 1), Greece (n 1), Iceland (n 1), Denmark (n 1), the UK (n 1), the Netherlands (n 1) and a combination of nine European countries (n 1). Various populations of children and adolescents were examined. Seven of the studies (47 %) found a positive association between vegetable availability and intake, with the others reporting null findings. There were no clear patterns of association by study design, age of subjects included, comprehensiveness of measures, or inclusion of covariates in analyses. Child report of home availability was associated with child vegetable intake (n 6, all found a positive association), while parent report of home availability was only minimally associated (n 9, one found a positive association; P=0.001 from post hoc Fisher's exact test comparing parent v. child report). Parent perception of availability may be closer to truth, given the parental role in food shopping and preparation. Therefore, to impact child vegetable intake, absolute availability may not be as important as child perception of vegetables in the home. Child perception of availability may be altered by level of familiarity with vegetables.

Will students eat more fruits and vegetables if school policies include longer lunch periods or letting students play first? (632.4)

Aim: Simple school policies that increase fruit and vegetable intake in children are needed. The study aim was to evaluate the relationship of duration of lunch and order of play and eating during the lunch period with fruit and vegetables (FV) intake. A secondary aim was to examine if differences existed in these relationships by student gender, ethnicity, language spoken at home, and school lunch source.Methods: A diary‐assisted 24‐hour recall was collected during the 2011‐12 school year from 3,463 4th‐5th graders attending 44 elementary schools in California. School lunch characteristics were attained from school staff and observation. The associations of play before eating and duration of lunch with FV intake were estimated using generalized estimation equations.Results: FV intake did not significantly differ by lunch period length. Overall, lunch FV intake was not significantly higher for students who had a play before versus after eating lunch schedule. Variables in the model showed significant interaction with play before eating, requiring separate effect estimates by gender, ethnicity, language spoken at home, and lunch source. When a significant effect was predicted, play before eating had a positive impact among students who brought lunch from home.Conclusions: Play before eating may help some elementary students to increase FV intake. Although these policies and other environmental school policies need further rigorous evaluation.Grant Funding Source: Supported by the Orfalea Foundation

Feeding strategies derived from behavioral economics can increase vegetable intake in children as part of a home‐based intervention (808.23)

We tested the effect of using behavioral economic strategies to increase children's vegetable intake in the home. These strategies included pairing cartoons with vegetables to increase appeal and presenting vegetables as the optimal default. Children (n=24; 3‐5 years‐old) in both control and treatment groups received weekly supplies of plain packaged vegetables, presented as a free choice with an alternative snack (granola bar), during baseline (wk 1) and follow‐up (wk 4). During wks 2‐3, the control group continued to receive plain packages, but the treatment group received vegetables packaged with their favorite cartoons with sticker incentives, presented as the default choice at snacks/meals. Children were allowed to opt for the granola bar after an imposed wait time. Weekly nutrition lessons were delivered to both groups. Repeated measures ANOVA revealed a time* treatment interaction on vegetable intake; during wks 2‐3, the treatment group doubled vegetable intake from baseline, while the control showed no change (p&lt;0.01). Increased vegetable intake during wks 2‐3 was associated with decreased granola bar intake (p蠄0.01). Behavioral economics has the potential to inform parental feeding practices and improve children’s food choices.

Feasibility and effectiveness of in‐home behavioral economic strategies to increase vegetable intake among low‐income children (808.18)

Poor dietary behaviors put children at risk for obesity. The purpose of this intervention is to determine which behavioral economic strategies increase vegetable consumption among low‐income children (9‐12 years) in the Minneapolis/St. Paul metropolitan area. Caregivers (n=44) are randomly assigned 6 (of 10) in‐home behavioral economic strategies; one new strategy/week to be completed at 3 dinner meals for a total of 6 weeks. An example strategy is to make vegetables more available and visible than other foods during dinner. Intervention and control group (n=20) caregivers record child vegetable intake at 3 dinner meals and report intakes weekly to a trained researcher via telephone or in person. Researchers also inquire about barriers (e.g. lack of availability) and facilitators (e.g. time) for implementing strategies. Child vegetable liking, vegetable home inventory data, and three 24‐dietary recalls are also collected at baseline and immediately after the intervention. Most children reported liking more than 5 vegetable types; often the same vegetables available in the home and prepared by caregivers at dinner meals. Mean vegetable intake is being compared for each strategy across intervention and control groups to determine the effectiveness of each. The 6 most effective will be incorporated into the Cooking Matters for Families nutrition education program to increase vegetable intake among children.Grant Funding Source: Supported by NIFA 2014‐00403

Applying learning theory to improve liking and intake of vegetables in children.

Establishing liking and intake of vegetables early in life facilitates later healthy eating and may reduce risk of obesity. Short-term liking for the taste of vegetables can be improved in children through flavour consequence learning (FCL), whereby degree of liking for specific vegetables is associated with degree of post-ingestive consequence. To investigate FCL on vegetable preference and liking, 33 pre-schoolers were recruited from, and tested in, nurseries in St Andrews and Leeds. Rank preference and liking (intake) of vegetables (carrot, pepper, celery) and smoothie drink (SD) were assessed pre and post intervention. Children received 8–10 exposures (intervention) to their moderately preferred (target) vegetable via a SD (100 g). Eating behaviour profile was measured. The novel vegetable SD was accepted over 8–10 consecutive occasions. Inter-individual variation in consumption was present: SD intake negatively correlated with food fussiness. Exposure to a moderately preferred vegetable SD did not increase target vegetable intake. Evaluative conditioning did not generalise to other vegetables; intake of vegetables remained stable. The most effective means to increase pure vegetable intake is not through FCL. Data on acceptance of the vegetable SD suggest that repeated exposure may be sufficient to increase acceptance of vegetables in some children. Food fussiness is a barrier to acceptance of new tastes, and may compromise healthy eating and later health outcomes.

Pairing Vegetables with a Liked Food and Visually Appealing Presentation: Promising Strategies for Increasing Vegetable Consumption among Preschoolers

Vegetable consumption among preschool children is below recommended levels. New evidence-based approaches to increase preschoolers' vegetable intake, particularly in the child care setting, are needed. This study tests the effectiveness of two community-based randomized interventions to increase vegetable consumption and willingness to try vegetables: (1) the pairing of a vegetable with a familiar, well-liked food and (2) enhancing the visual appeal of a vegetable. Fifty-seven preschoolers enrolled in a Child and Adult Care Food Program-participating child care center participated in the study; complete lunch and snack data were collected from 43 and 42 children, respectively. A within-subjects, randomized design was used, with order of condition counterbalanced. For lunch, steamed broccoli was served either on the side of or on top of cheese pizza. For a snack, raw cucumber was served either as semicircles with chive and an olive garnish or arranged in a visually appealing manner (in the shape of a caterpillar). Paired t-tests were used to determine differences in consumption of meal components, and McNemar's test was performed to compare willingness to taste. Neither visual appeal enhancement nor pairing with a liked food increased vegetable consumption. Pairing increased willingness to try the vegetable from 79% to 95% of children (p=0.07). Greater vegetable intake occurred at snack than at lunch. Further research should explore the strategy of pairing vegetables with liked foods. Greater consumption at snack underscores snack time as a critical opportunity for increasing preschool children's vegetable intake.

The effects of weaning with either fruits or vegetables at the age of 4–6 months on vegetable and fruit acceptance at 12 and 23 months

The low vegetable intake in children is probably due to the notion that vegetables are disliked. Because most taste preferences are formed during the first year of life, we started an intervention among weaning infants ( n = 101) to increase the liking for vegetables. We expected that starting weaning with exclusively vegetable purees, would increase the infants’ preferences for vegetables. At 4–6 months of age, one group was weaned with only vegetables, the other group with only fruit for 18 consecutive days. On day 19, the vegetable group received their first fruit (apple) and the fruit group their first vegetable (green beans). At 12 ( n = 86) and 23 ( n = 81) months of age the children’s consumption was measured in our laboratory and reported by their parents using a 3-day food diary for home intake. After the 19-day intervention, green beans intake was significantly higher in the vegetable group than in the fruit group. At 12 and 23 months of age apple and green beans intake did not differ significantly between the groups in the lab. However, home intake of vegetables at 12 months of age was significantly higher in the vegetable group than in the fruit group, but not at 23 months of age. These findings suggest that starting weaning with vegetables results in a higher vegetable consumption to at least 12 months of age.

Repeated exposure more effective than flavour flavour learning as mechanism to increase vegetable consumption in pre-school children

Children’s habitual diets contain too much high-energy-dense food like lipids and carbohydrates, but little low-energy foods like vegetables. Promoting vegetable intake in children serves better nutritional standards and energy balance. However, since most children dislike vegetables, increasing their intake is a challenge. We investigated the relative effectiveness of repeated exposure (RE) and Flavour-Flavour-Learning (FFL) in increasing vegetable intake and acceptance in pre-schoolers (n = 39). During an intervention period of seven weeks, toddlers consumed vegetable crisps (freeze-dried red beet and parsnip) twice per week. Half of the group received red beet crisps with a dip of tomato-ketchup (C+), and parsnip with a neutral white-sauce (C−), whereas for the other half the order was reversed (red beet C−, parsnip C+). Outcome measures were preference and ad libitum consumption of both crisp flavours (without dip-sauces), measured before, shortly after the intervention, and two and six months following conditioning to assess longer-term effects. Intake increased significantly after the intervention for both vegetables (on average with 8g; an increase of approx. 300%), and this effect was persistent even six months afterwards. The increase was irrespective of crisps being offered with C+ or C− dip sauce. No changes in initial preference for either red beet or parsnip were found. This suggests a robust and persistent effect of RE but no effect of FFL. In conclusion, simply offering pure vegetable tastes repeatedly is sufficient to increase intake over time, rather than adding flavour to the food.

Increasing pre-school children’s liking for a novel vegetable. A comparison of flavour flavour learning and repeated exposure

Most UK children do not consume the recommended amounts of fruits and vegetables, with intake of vegetables particularly low. Many children dislike vegetables and so strategies have been used to improve liking for vegetables in children to promote intake. The current study examined the effectiveness of flavour flavour learning and repeated exposure to increase intake of vegetables in pre-school children. Children aged 12–60 months ( N = 33) were recruited through nurseries and given 8 exposures to a root vegetable puree with added apple puree (FFL) and another root vegetable puree with nothing added (RE) on separate days over 5 weeks. A third root vegetable puree acted as a control. Intake of unadulterated forms of all three purees was measured on separate days pre and post intervention. Intake was also measured after each exposure. Preliminary analysis of data ( N = 22) demonstrates a significant trend of increased intake of vegetable purees post intervention in all three conditions ( p = .001) with no significant effect of condition on magnitude of change. No effect of condition was found on intake across exposures while results suggest a significant effect of number of exposures. A significant time x age group interaction revealed greater intake of vegetable puree by younger (12–24 m) children overall post-intervention. Results suggest that flavour flavour learning confers no added benefit to simple repeated exposure in increasing vegetable intake in pre-school children and that effects can generalize to other similar foods. Simple strategies to improve liking by adding apple sauce seem unnecessary, and familiarity through repeated exposure is sufficient to increase acceptance.

Predicting Use of Ineffective Responsive, Structure and Control Vegetable Parenting Practices with the Model of Goal Directed Behavior.

This study reports the modeling of three categories of ineffective vegetable parenting practices (IVPP) separately (responsive, structure, and control vegetable parenting practices). An internet survey was employed for a cross sectional assessment of parenting practices and cognitive-emotional variables. Parents (n=307) of preschool children (3-5 years old) were recruited through announcements and postings. Models were analyzed with block regression and backward deletion procedures using a composite IVPP scale as the dependent variable. The independent variables included validated scales from a Model of Goal Directed Vegetable Parenting Practices (MGDVPP), including: intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioral control, and anticipated emotions. The available scales accounted for 26.5%, 16.7% and 44.6% of the variance in the IVPP responsive, structure and control subscales, respectively. Different sets of diverse variables predicted the three IVPP constructs. Intentions, Habits and Perceived Behavioral Control were strong predictors for each of the IVPP constructs, but the subscales were specific to each IVPP construct. Parent emotional responses, an infrequently investigated variable, was an important predictor of ineffective responsive vegetable parenting practices and ineffective structure vegetable parenting practices, but not ineffective control vegetable parenting practices. An Attitude subscale and a Norms subscale predicted ineffective responsive vegetable parenting practices alone. This was the first report of psychometrically tested scales to predict use of IVPP subscales. Further research is needed to verify these findings in larger longitudinal cohorts. Interventions to increase child vegetable intake may have to reduce IVPP.

Home Food Environment, Dietary Intake, and Weight among Overweight and Obese Children in Southern Appalachia

This study examined the relation of multiple aspects of the home food environment to dietary intake and body weight among overweight and obese children in southern Appalachia. The study used baseline data from a cluster-randomized controlled trial, Parent-Led Activity and Nutrition for Healthy Living, evaluating a parent-mediated approach to treating child overweight and obesity in the primary care setting in southern Appalachia. Sixty-seven children ages 5 to 11 years were recruited from four primary care clinics. Multiple linear regression was used to estimate the relation between multiple aspects of the home food environment to dietary intake (fruit and vegetable intake, fat and sweets intake), and standardized body mass index (zBMI), adjusted for baseline family characteristics (education, smoking status during the past month, BMI) and child characteristics (sex, age, Medicaid/TennCare). Findings showed greater parental restriction and pressure in feeding were associated with greater fruit and vegetable intake in children (β = 0.33, β = 0.30, respectively; both P < 0.05). The availability of chips and sweets in a child's home and parental inappropriate modeling of eating were associated with an increased risk for consumption of fats and sweets by children (β = 0.47, β = 0.54, respectively; both P < 0.01). Parental monitoring of the child's eating was associated with a reduced risk for fat and sweets intake (β = -0.24; P < 0.01). Finally, parental responsibility for feeding the child was associated with lower zBMI (β = -0.20; P < 0.05). The home food environment, including food availability and parenting behaviors, was associated with overweight and obese children's dietary intake and weight. This study adds to evidence suggesting that programs aimed at improving overweight and obese children's eating patterns may target both aspects of the physical home environment and parental behaviors surrounding eating.