Mary Poppins was right: Adding small amounts of sugar or salt reduces the bitterness of vegetables

A critical review of consumer responsibility in promoting sustainable cocoa production

Consumer buying behavior can be defined as all the different steps that consumers follow before purchasing a good or service. Web browser research, involvement in online networking discussions, and a range of other activities might be a part of this process. Despite the negative effects of its production chain on the environment, and on the socio-economical condition of local farmers, chocolate products are among the most distributed food and beverage items in the world. In this review, the consumer responsibility for sustainable cocoa production is described. This study determines the consumer opinions and attitudes on the different operations pursued in the production chain of chocolate, from the collection of cocoa beans to their processing into different final products. For this, data on life cycle assessment from some studies was gathered to identify and investigate links between the production chain of different types of chocolate (dark, white, milk) and its impact on natural resources so that the sensitivity of consumers to purchase more sustainable products can be evaluated. This approach revealed that consumers will not only purchase chocolate because of its good quality or health benefits, but they also consider it the most sustainable product.

Consumer Liking of Turnip Cooked by Different Methods: The Influence of Sensory Profile and Consumer Bitter Taste Genotype

Brassica vegetables are bitter, predominantly because they contain bitter-tasting glucosinolates. Individuals with high bitter taste sensitivity are reported to have lower consumption of bitter vegetables. Studies reported that cooking methods can alter the sensory characteristics of vegetables, increasing acceptability. This study investigated consumer liking of turnip cooked by four methods (boiled-pureed, roasted, steamed-pureed and stir-fried) and related this to sensory characteristics. Additionally, this study examined the effect of the bitter taste genotype on taste perception and liking of the cooked turnip samples. Participants (n = 74) were recruited and the TAS2R38 genotype was measured. Liking, consumption intent, perception of bitterness and sweetness of turnip were evaluated. A sensory profile of the cooked turnip variants was also determined by a trained sensory panel. There were significant differences in the overall (p = 0.001) and taste (p = 0.002) liking between cooking methods. Turnip liking was increased when preparation led to sweeter taste profiles. The TAS2R38 genotype had a significant effect on bitter perception (p = 0.02) but did not significantly affect taste liking. In conclusion, the cooking method affected turnip liking, and the bitter perception in turnip was influenced by the TAS2R38 genotype. However, taste sensitivity did not predict turnip liking in this UK adult cohort.

Anticancer activity of broccoli, its organosulfur and polyphenolic compounds

The use of natural bioactive constituents from various food sources for anticancer purposes has become increasingly popular worldwide. Broccoli (Brassica oleracea var. italica) is on the top of the consumed vegetables by the masses. Its raw matrix contains a plethora of phytochemicals, such as glucosinolates and phenolic compounds, along with rich amounts of vitamins, and minerals. Consumption of broccoli-derived phytochemicals provides strong antioxidant effects, particularly due to its sulforaphane content, while modulating numerous molecules involved in cell cycle regulation, control of apoptosis, and tuning enzyme activity. Thus, the inclusion of broccoli in the daily diet lowers the susceptibility to developing cancers. Numerous studies have underlined the undisputable role of broccoli in the diet as a chemopreventive raw food, owing to the content in sulforaphane, an isothiocyanate produced as a result of hydrolysis of precursor glucosinolates called glucoraphanin. This review will provide evidence supporting the specific role of fresh florets and sprouts of broccoli and its key bioactive constituents in the prevention and treatment of different cancers; a number of studies carried out in the in vitro and in vivo conditions as well as clinical trials were analyzed.

The Impact of Wet Fermentation on Coffee Quality Traits and Volatile Compounds Using Digital Technologies

Fermentation is critical for developing coffee’s physicochemical properties. This study aimed to assess the differences in quality traits between fermented and unfermented coffee with four grinding sizes of coffee powder using multiple digital technologies. A total of N = 2 coffee treatments—(i) dry processing and (ii) wet fermentation—with grinding levels (250, 350, 550, and 750 µm) were analysed using near-infrared spectrometry (NIR), electronic nose (e-nose), and headspace/gas chromatography–mass spectrometry (HS-SPME-GC-MS) coupled with machine learning (ML) modelling. Most overtones detected by NIR were within the ranges of 1700–2000 nm and 2200–2396 nm, while the enhanced peak responses of fermented coffee were lower. The overall voltage of nine e-nose sensors obtained from fermented coffee (250 µm) was significantly higher. There were two ML classification models to classify processing and brewing methods using NIR (Model 1) and e-nose (Model 2) values as inputs that were highly accurate (93.9% and 91.2%, respectively). Highly precise ML regression Model 3 and Model 4 based on the same inputs for NIR (R = 0.96) and e-nose (R = 0.99) were developed, respectively, to assess 14 volatile aromatic compounds obtained by GC-MS. Fermented coffee showed higher 2-methylpyrazine (2.20 ng/mL) and furfuryl acetate (2.36 ng/mL) content, which induces a stronger fruity aroma. This proposed rapid, reliable, and low-cost method was shown to be effective in distinguishing coffee postharvest processing methods and evaluating their volatile compounds, which has the potential to be applied for coffee differentiation and quality assurance and control.

Effect of Monosodium Glutamate on Salt and Sugar Content Reduction in Cooked Foods for the Sensory Characteristics and Consumer Acceptability

Three different types of typical Korean foods were studied to investigate the effect of monosodium glutamate (MSG) on the sensory characteristics and hedonic perception of sodium- or sugar-reduced samples. The first consumer test (n = 300) was conducted to evaluate the overall liking (OL) of the samples containing four different levels of salt and sugar contents without added MSG, while the second consumer test (n = 300) was designed to examine the effects of MSG on the samples containing reduced salt and sugar contents with the lowest observed OL in the first consumer test. The results showed that the intensity of the umami taste and saltiness of the samples increased, whereas sourness and bitterness were suppressed with added MSG. The samples with the lowest salt contents were observed to be acceptable to consumers after MSG addition, indicating a 23% reduction in sodium intake. Bitterness was partially masked, while sweetness, umami taste, and saltiness were the main factors affecting the OL after MSG addition. However, no consistent results of added MSG on the sensory attributes of samples with reduced sugar contents were observed, possibly indicating that the effect of umami taste on sweetness depends on the MSG concentration used or the type of food studied. This study could be beneficial to researchers who want to know the optimal level of MSG required to reduce the sodium or sugar contents in cooked food.

From food preference development to responsive feeding - Selective studies to commemorate the life and work of Dr Leann Birch

Dr Leann Birch was a pioneer in conducting research on infant and child eating behaviour. At the beginning of her research career, Leann recognised a significant gap in the developmental psychology literature, namely that few studies had been conducted to understand infant eating and feeding behaviours. This seems an unusual omission given that food intake is essential and that developmental milestones from milk to solids, and from being fed to becoming an autonomous eater, are obvious to most caregivers. Leann paved the way for interdisciplinary research from psychology, paediatrics and public health to explore and apply this knowledge to infant and child appetite, eating behaviour, dietary patterns, food preferences, and obesity risk. Early studies in her laboratory demonstrated that children form food preferences through experience and socialisation. Experiments published in 1979 tested the role of familiarisation through repeat exposure, and the impact of instrumental and social learning on the acquisition of food preferences. In 1984, a presentation given to the British Feeding and Drinking Group (BFDG) in Brighton set out three organising principles for understanding how children acquire food preferences: genetically pre-programmed behavioural propensities; social constraints on experience with food; and social transmission resulting from direct social interaction. Building on these three organising principles, research on child eating behaviour has flourished, including the intersection between individual differences, food experience and environmental influences on children's food preferences, energy regulation, and weight outcomes. In this review, the initial groundwork set out by Leann Birch on food preference development in children is considered followed by a discussion of how this has since inspired an interdisciplinary, international and expanding field of research on children's food intake, appetite and body weight regulation.

Flavor science in the context of research on electronic cigarettes

Thousands start smoking or vaping daily, despite long-standing efforts by public health authorities to curb initiation and use of nicotine containing products. Over the last 15 years, use of electronic nicotine delivery systems has increased dramatically, with a diverse range of products on the market, including pod-based, disposable, and refillable electronic cigarettes (eCigs). Originally intended for harm reduction and smoking cessation, eCigs may encourage nicotine use among never smokers, given the vast range of appealing flavors that are available. To better understand abuse liability and to facilitate appropriate regulations, it is crucial to understand the science of flavor, and flavor perception within the context of eCig use. Here, we (a) provide a brief primer on chemosensory perception and flavor science for addiction and nicotine researchers, and (b) highlight existing some literature regarding flavor and nicotine use, with specific attention given to individual differences in perception, and interaction between different sensory modalities that contribute to flavor. Dramatic increases in use of eCigs highlights the importance of flavor science in contemporary addiction research, both with regards to public health and regulatory efforts. Other recent work summarizes findings on flavored e-liquids and eCig use, but none have focused explicitly on chemosensory processes or flavor perception as they relate to appeal and use of such products. We argue flavor science needs to be considered as perceptual and behavioral phenomena, and not merely from analytical, toxicological and pharmacological perspectives; we help address this gap here.

Application of a salt substitute in bitter taste suppression and toward better acceptance of cruciferous vegetables in diet

The addition of table salt has been reported to enable better acceptance when consuming the least preferred vegetables belonging to the Cruciferae family. Considering the adverse effect of excessive table salt intake on incidence of hypertension and cardiovascular diseases, it is essential to explore an alternative healthier option for better acceptance and to encourage consumption of these vegetables. In this study, 261 adult participants were evaluated for their preferences toward basic tastes and food as well as sensory evaluation of a meal prepared from cruciferous vegetables with the addition of two different salts, sodium chloride and salt substitute containing a blend of potassium and sodium salts. A general questionnaire was used to assess taste and food preferences, while the Cruciferous Vegetable Food Frequency Questionnaire (CVFFQ) was used for vegetable intake assessment. The Labeled Magnitude Scale (LMS), Just About Right (JAR) scale, and several hedonic scales were used to determine taster status and sensory evaluation. The results show that a low concentration of the salt substitute did not impact bitterness suppression but did result in higher preference of the cruciferous vegetable meal. Although, subjects self-reported to have salty taste preferences were more sensitive to bitter taste, they did not perceive samples as less salty and less acceptable than subjects with lower sensitivity. The results show the necessity for further examination of the effectiveness of different concentrations of the assessed salt substitute in suppressing perceived bitterness of cruciferous vegetables and regarding their overall acceptance for inclusion in diets.

Nutritional Quality of Wholegrain Cereal-Based Products Sold on the Italian Market: Data from the FLIP Study

The consumption of wholegrains (WG) is encouraged worldwide, but the lack of a common legal definition of such products leads to an unclear classification and identification on the grocery store shelf. In Italy, several products are generally sold as WG, but it cannot be determined if they are made entirely with all WG cereal(s) or if they are partially produced with WG ingredients (PWG). The aims of this study were to (a) survey the number of cereal-based food items formulated with WG, PWG, or refined (RG) present on the Italian market; and (b) analyse the nutritional quality, intended as nutrition facts, of WG products in comparison to PWG and RG. Nutritional information and declarations were retrieved from packs of 3040 products belonging to five different categories: breakfast cereals, biscuits, sweet snacks, bread, and bread substitutes. A descriptive analysis of the products and comparison of energy, macronutrients, fibre and salt among RG, PWG and WG products within each category was performed. In all categories, a major portion of the products did not contain WG ingredients. Results showed that the nutritional quality of RG, PWG, and WG products varied in relation to the product category and that WG inclusion cannot be always considered a marker of the overall nutritional quality of foods. Instead, it is necessary to evaluate the global product characteristics, and it is important to pay attention to differences between WG and PWG products that can be perceived by consumers as equivalent.

Infant and Toddler Responses to Bitter-Tasting Novel Vegetables: Findings from the Good Tastes Study

BACKGROUND

Infants are born with the biological predisposition to reject bitterness. Dark green vegetables contain essential nutrients but also bitter compounds, making them more difficult to like.

OBJECTIVE

The Good Tastes Study was designed to determine whether reducing bitterness by adding small amounts of sugar or salt would alter infant acceptance of kale purées.

METHODS

Caregivers (n = 106, 94% mothers, 82% Non-Hispanic White) and children (53% male, aged 6-24 mo) participated in a videorecorded laboratory visit during which infants were offered 4 versions of puréed kale: plain, 1.2% or 1.8% added sugar, or 0.2% added salt. Caregivers rated their children's liking for each kale version. Videos were coded for the number of tastes accepted and for children's behaviors and acceptance of each kale version. A multilevel ordered logistic model was fit for the number of accepted tastes and caregiver ratings of child liking of kale versions with age, breastfeeding history, order effects, and kale version as predictors.

RESULTS

Infants 6 to <12 mo accepted more tastes (b = 2.911, P < 0.001) and were rated by caregivers as liking the kale more than older toddlers (≥18 mo; b = 1.874, P = 0.014). The plain kale was more likely to be accepted (P < 0.001); also, the first version offered was more likely to be rejected (b = -0.586, P < 0.007). Older infants (≥18 mo) exhibited more avoidant behaviors (b = 1.279, P < 0.001), more playing (b = 2.918, P < 0.001), and more self-feeding (b = 1.786, P = 0.005) than younger infants (6 to <12 mo). Children who were reported to have been breastfed more in the last 7 d were more likely to self-feed (b = 0.246, P < 0.001) and play with food (b = 0.207, P < 0.005).

CONCLUSIONS

Our findings support that there may be a sensitive period, during the early phase of complementary feeding, to improve success of introducing a novel, bitter, more difficult-to-like food. When low levels of sugar or salt were added, no advantage of bitterness reduction was observed. This study has been registered with ClinicalTrials.gov as NCT04549233.

Differences in preferred fat level, sweetener type, and amount of added sugar in chocolate milk in a choice task relate to physical activity and orthorexia

Fluid dairy milk consumption has decreased over the last 4 decades, and this drop has accelerated with the introduction of many competing beverage alternatives, such as plant-based milks and bottled water. Conversely, flavored milk sales remain strong, but many adults avoid flavored milk because of concerns about added sugar and calories and/or excessive sweetness. Here we used two discrete choice experiments to assess interest for a dark chocolate milk drink in adults, and explored whether there might be a consumer segment who prefers a more bitter, lower sugar chocolate milk. Adults were recruited from the Mid-Atlantic region of the United States for two conjoint analysis studies. In a general population cohort (n = 735), type of sweetener was the most important attribute (24%), followed by milk fat (19%), grams of added sugar (16%), front of pack messaging (15%), package type (12%), carton size (8%), and protein content (6%). Attribute importance was relatively consistent in a second study with a younger, more physically active cohort (n = 1017). Product choices in the active cohort were related to orthorexia and physically activity scores, indicating revealed preferences in a choice task are reflective of personal lifestyle and eating behavior. In both cohorts, three consistent consumer segments were identified and characterized: the calorie conscious, the average consumer, and the natural eaters. These data can help uncover lifestyle differences between adult consumers that impact their food product choices.

Characterization of the Human Bitter Taste Receptor Response to Sesquiterpene Lactones from Edible Asteraceae Species and Suppression of Bitterness through pH Control

Vegetables are important sources of nutrients and bioactive compounds; however, their consumption is often insufficient, partly because of unpleasant taste characteristics. This study aimed to investigate the mechanisms underlying bitter taste reception and to develop methods to suppress bitterness. We focused on sesquiterpene lactones found in edible Asteraceae species. HEK293T cells that heterologously expressed human bitter taste receptors (including TAS2R46) together with a chimeric G protein were analyzed using calcium imaging, and cellular responses to four sesquiterpene lactones contained in lettuce were examined. We found that TAS2R46-expressing cells responded most strongly to bitter compounds. The EC₅₀ value of 11β,13-dihydrolactucopicrin was 2.0 ± 0.6 μM, in agreement with the previously reported bitterness threshold of the compound. Adjustment of pH from neutral to weak acidic conditions reduced the response of TAS2R46-expressing cells to sesquiterpene lactones. We demonstrate the possibility of regulating the bitterness of Asteraceae species by controlling the pH.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden.

OBJECTIVES

To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding.

AUTHORS' CONCLUSIONS

Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Factors related to sensory properties and consumer acceptance of vegetables

Many consumers perceive the bitter taste or other sensory characteristic of vegetables as unpleasant, posing a challenge to dietary recommendations aiming to increase vegetable consumption. Food experience is multisensory, with complex interactions between the senses and individual differences in sensory perception. This review focuses on the factors affecting sensory properties of vegetables and sensory perception of vegetables among adults. Topical examples of sensory quality and evaluation of vegetable samples are presented. Cultivar and growing conditions are related to the internal sensory quality of vegetables. The effects of different processing methods, such as freezing and cooking, on the sensory properties of vegetables are also reviewed. Flavor modification of vegetables with seasonings may be used to improve palatability and incorporating vegetables to meals may increase the intake of vegetables. Recently, external factors (e.g. visual and odor stimuli) have been tested in multisensory research in the context of vegetable perception and choice. These options to achieve better sensory quality, more palatable meals and pleasant eating context may be used to promote vegetable intake among adults.

Blending dark green vegetables with fruits in commercially available infant foods makes them taste like fruit

Vegetables are an important but under consumed part of a healthy diet. There is growing interest in promoting vegetable acceptance and consumption among infants to help establish life-long healthy eating patterns. A recent survey of commercial baby food products in the United States by Moding and colleagues revealed a lack of variety in the types of vegetables offered. Most notably, there were no commercially available single, dark green vegetable products. Instead, dark green vegetables were often mixed with fruits or red/orange vegetables (e.g., squash) that provide additional sweetness. In order for liking for vegetables to be learned, the flavors from the vegetables must still be perceptible within the mixture. Thus, the objective of the research reported here was to understand the sensory profiles of vegetable-containing Stage 2 infant products commercially available in the United States and how ingredient composition affects flavor profiles. We performed descriptive analysis to quantitatively profile the sensory properties of 21 commercial vegetable-containing infant foods and one prepared in our laboratory. Eleven experienced panelists participated in 14.5 h of lexicon generation and training prior to rating all 22 products (in triplicate) for 14 taste, flavor, and texture attributes. Products that contained fruit were not only sweeter than products that did not contain fruit but were also higher in fruit flavors and lower in vegetable flavors. In general, sensory profiles were driven by the first ingredient in the product. Because few products had dark green vegetables as a first ingredient, dark green vegetable flavor was not prevalent in this category. This suggests the sensory profiles of commercially available infant vegetables foods may not be adequate to facilitate increased acceptance of green vegetables.

Influences of sensory attribute intensity, emotional responses, and non-sensory factors on purchase intent toward mixed-vegetable juice products under informed tasting condition

Product-related sensory and non-sensory cues have been studied in the past to understand purchase behavior among consumers. However, there has been little research related to integrating emotional responses with such cues to achieve better prediction of consumer purchase behavior. This study aimed to determine the impacts of sensory attribute intensities (SAI), non-sensory factors (NSF), and emotions on purchase intent and consumer choice. Emotional responses were measured using a self-reported emotion questionnaire (EQ), facial expression analysis (FE), and autonomic nervous system responses (ANS). Sixty-nine adults were asked to view product labels, and look at, smell, and drink five commercially-available vegetable juice samples. For each sample, SAI, NSF, EQ, FE, ANS, and purchase intent ratings were measured. Participants were also asked to select the one they would be most likely to buy. Results showed that the five samples differed significantly with respect to SAI, NSF, and emotional responses measured by EQ and FEs. SAI (bitterness intensity) and NSF (brand liking) played an extremely important role in purchase-related behavior of vegetable juice products. Correlation analysis and a PLSR prediction model further revealed that products with higher ratings of purchase intent elicited lower levels of negative emotions and higher levels of positive emotions, as measured by EQ as well as FE. In conclusion, this study shows that NSF in combination with SAI and emotions measured using EQ and FE can modulate consumer purchase intent toward vegetable juice products under informed tasting conditions.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden.

OBJECTIVES

To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding.

AUTHORS' CONCLUSIONS

Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Putting out the fire - Efficacy of common beverages in reducing oral burn from capsaicin

Capsaicin is classically considered an irritant, due to the warming and burning sensations it elicits. Widespread consumption of chilis suggests many individuals enjoy this burn, but these sensations can be overwhelming if the burn is too intense. While substantial folklore exists on the ability of specific beverages to mitigate capsaicin burn, quantitative data to support these claims are generally lacking. Here, we systematically tested various beverages for their ability to reduce oral burn following consumption of capsaicin in tomato juice. Participants (n = 72, 42 women, 30 men) rated the burn of 30 mL of spicy tomato juice on a general Labeled Magnitude Scale (gLMS) immediately after swallowing, and again every 10 s for 2 min. On 7 of 8 trials, a test beverage (40 mL) was consumed after tomato juice was swallowed, including: skim milk, whole milk, seltzer water, Cherry Kool-Aid, non-alcoholic beer, cola, and water. Participants also answered questions regarding intake frequency and liking of spicy food. Initial burn of tomato juice alone was rated below "strong" but above "moderate" on a gLMS and continued to decay over the 2 min to a mean just above "weak". All beverages significantly reduced the burn of the tomato juice. To quantify efficacy over time, area under the curve (AUC) values were calculated, and the largest reductions in burn were observed for whole milk, skim milk, and Kool-Aid. More work is needed to determine the mechanism(s) by which these beverages reduce burn (i.e., partitioning due to fat, binding by protein, or sucrose analgesia). Present data suggest milk is the best choice to mitigate burn, regardless of fat context, suggesting the presence of protein may be more relevant than lipid content.

Using Herbs and Spices to Increase Vegetable Intake Among Rural Adolescents

OBJECTIVE

To test whether adding herbs and spices to school lunch vegetables increases selection and intake compared with lightly salted control versions among rural adolescents.

DESIGN

This study compared intake of vegetables with herbs and spices with lightly salted controls (phase I) and tested whether 5 repeated exposures would increase students' intake of herb and spice seasoned vegetables (phase II).

PARTICIPANTS AND SETTING

A total of 600-700 students at a rural middle/high school (age 11-18 years).

INTERVENTION

In phase I, herbs and spices were added to 8 vegetables and outcomes were compared with 8 control recipes. In phase II, the impact of repeated exposure to herb and spice blends served on different vegetables was assessed.

MAIN OUTCOMES

Vegetable selection rates, weighed intake, and willingness to eat again.

ANALYSIS

Two-way ANOVAs tested effects of condition (herbs and spices vs control; before vs after exposure) and age (middle vs high school) on selection and intake.

RESULTS

In phase I, students ate more control than seasoned broccoli (P = .01), cauliflower (P = .006), and green beans (P = .01), and high schoolers generally consumed more seasoned vegetables than did middle schoolers (P < .03). In phase II, repeated exposure to herbs and spices increased reported willingness to eat again for seasoned broccoli (P = .003).

CONCLUSIONS AND IMPLICATIONS

In a short-term intervention, herbs and spices did not produce robust increases in school lunch vegetable intake among rural adolescents, but limited repeat exposure may increase students' willingness to consume these flavors. Additional work is needed to identify individual and school-level characteristics that affect students' willingness to select and consume vegetables with herbs and spices.