The addition of a plain or herb-flavored reduced-fat dip is associated with improved preschoolers' intake of vegetables

From preschool to policy: A scoping review of recommended interventions for a systems approach to improve dietary intake in early childhood

Early childhood is a key opportunity to establish healthy eating behaviors and prevent future non-communicable diseases associated with poor diets. How to effectively intervene in the system of the many determinants influencing children's dietary intake remains unclear. This scoping review aimed to map the determinants of nutrition and eating that have been addressed in early childhood nutrition interventions and identify which of these improve dietary intake. We searched six electronic databases to identify eligible studies published from January 2000 to January 2024. We included studies of any interventions reporting dietary intake among children aged between two and five years. A total of 193 eligible studies were identified and mapped to the Determinants of Nutrition and Eating (DONE) Framework. Parent (n = 97) and child (n = 76) food knowledge and skills were most frequently addressed. Most studies addressing parent (67%) and child (66%) food knowledge and skills reported improvements in dietary intake. Government regulations such as healthy food subsidies, and food advertising and labeling interventions showed promised, with 82% of studies reporting improvements in dietary intake. However, these interventions were predominantly implemented in the United States and Chile. This review provides a comprehensive and systematic map of a range of interventions that positively influence nutritional outcomes in preschool-aged children but recommends further policy-level action globally.

Culinary Medicine

The use of food as medicine to treat illness and maintain health has ancient roots across various cultures. Despite significant scientific progress during the past 2 centuries linking diet, the microbiome, and overall health, modern challenges persist due to sociocultural factors, aggressive food marketing, and insufficient nutritional education. However, there is increasing support from health systems, insurers, nonprofits, philanthropic organizations, and government bodies to develop health policies that promote access to high-quality meals for disease prevention and management. Culinary medicine is now incorporated into undergraduate and postgraduate medical education through electives, certifications in culinary and lifestyle medicine, and continuing medical education conferences. There is substantial potential for culinary medicine to enhance patient care across diverse populations and settings, including individual consultations, group visits, schools, farms, and community gardens. Collaborative efforts among stakeholders can advance practical solutions to translate scientific knowledge into effective policy and practice. [Pediatr Ann. 2025;54(3):e83-e87.].

Nutrition Education in Primary Care: Comparing Video vs Handout Interventions

OBJECTIVE

Compare the effectiveness of instructional videos with print handouts when educating family medicine patients about the use of herbs and spices to reduce sodium, saturated fat, and added sugars during meal preparation.

DESIGN

Enrollees were randomized to either view 5 short videos or read 3 handouts. The intervention was implemented while patients waited for their provider to begin their appointment. Postintervention surveys were completed on the patient's smartphone.

SETTING

Penn State Health family medicine clinics.

PARTICIPANTS

Patients who attended in-person appointments between September 2022 and August 2023 (n = 102).

MAIN OUTCOME MEASURE(S)

The impact of video and handout intervention on participants' interest, confidence, knowledge, and intention to use herbs and spices and their perceptions of the intervention.

ANALYSIS

Descriptive statistics summarized sample characteristics; t tests compared video and handout groups.

RESULTS

The video group had higher scores for interest, confidence, and intention to use herbs and spices. Participants perceived the videos as clearer (P = 0.001) and more appropriately complex (P = 0.02) than the handout materials.

CONCLUSIONS AND IMPLICATIONS

Videos were superior to handouts in promoting interest, confidence, and intention to use herbs and spices for healthier cooking. Videos may improve patient engagement and preventive health care practices in clinical settings.

From plate to planet: culturally responsive culinary practices for health system innovation

The field of culinary medicine has gained significant attention for its potential to improve health outcomes through the integration of nutrition and medical practice. However, the cultural dimensions of this interdisciplinary field remain underexplored. Emphasizing the role of sociocultural practices, the paper highlights how culturally appreciative culinary practices can meet the sextuple aim of healthcare system innovation. By examining diverse cultural traditions and their contributions to culinary medicine, this review underscores the importance of culturally attuned approaches in promoting human health. The integration of cultural food wisdom into healthcare practices offers a pathway to more effective and personalized care, stronger patient-provider relationships, diversity/equity/inclusion/belonging, and sustainable food systems.

Child-reported vegetable neophobia is associated with risk avoidance for distaste in children aged 4-15 years

Children who are food neophobic and/or picky eaters often refuse intake of especially fruits and vegetables, thereby narrowing their dietary variety and impairing the quality of their food intake. In this preregistered study, we investigated whether picky eating and food neophobia are related to bitter taste sensitivity (PROP taster status) and risk avoidance for distaste. A total of 367 children (201 girls; M age = 8.7 years, range: 4-15 years) participated in the study. They completed the vegetable neophobia subscale of the fruit and vegetable neophobia instrument (FVNI). A caregiver completed the child food rejection scale (CFRS), a parent-report measure of food neophobia and picky eating. Children's bitter taste sensitivity was measured with a PROP (6-n-propylthiouracil) taste strip, and the children completed a modified Children's Gambling Task (Candy Gambling Game) to measure risk avoidance for distaste. In this task, children could select cards from a risky deck (chance of winning two tasty cherry-flavoured jelly beans, but also the risk of getting a distasteful soap-flavoured jelly bean) or a safe deck (chance of winning one tasty jelly bean or no jelly bean). The results show that picky eating and food neophobia (either parent- or self-reported) are not related to PROP taster status. However, children who self-reported higher levels of vegetable neophobia showed less risky choice behaviour in the Candy Gambling Game, although this relationship was not found with parent-reported food neophobia. We conclude that risk avoidance for distaste, but not taste function, is associated with children's self-reported food rejection tendencies. To broaden the food repertoire of children high in food neophobia, it might be useful to reduce the perceived risk of distaste, when introducing a novel food or meal.

Staff perspectives on the feeding practices used in holiday clubs to promote healthy eating in disadvantaged communities

An increasing number of holiday clubs provide free meals to alleviate children's hunger during the school holidays. Holiday clubs are well-placed to promote healthy eating among children from disadvantaged communities who may be at risk of experiencing food insecurity, but currently little is known about the feeding practices used by staff and whether these are conducive to maximising opportunities to promote healthy eating. Unlike previous research which has predominantly studied feeding practices in parent-child dyads and childcare settings, this qualitative study explored staff perspectives on the feeding practices they use to promote healthy eating within nine UK holiday clubs working with children from disadvantaged communities. Nine individual interviews and four focus groups were completed with 27 holiday club staff during the 2019 summer holidays. Thematic analysis revealed seven feeding practice themes, including teaching about nutrition; encouraging balance and variety; modelling; involvement; non-food rewards; restriction; and reoffering foods. The results revealed that some staff implement various positive feeding practices which align with the existing evidence-base of feeding practices in other contexts, which is a promising finding given the current lack of information and guidance from which to draw on. However, staff also sometimes reported using maladaptive feeding practices, including overt restriction and punishment. These results emphasise the need for guidance on effective ways to implement feeding practices with children in holiday clubs. Indeed, staff demonstrated their receptivity to engaging with training resources to maximise their opportunities to promote healthy eating behaviours among children.

Development and Proof-of-Concept Evaluation of a Sensory Science-Based Model for Product Development of Vegetable-Based Products for Children

Children's vegetable intake is too low, and a key barrier to the inadequate intake is low acceptance. To facilitate successful development of new vegetable-based products for children, a sensory science approach to product development has been taken. A new theoretical model is proposed, the CAMPOV model: Children's Acceptance Model for Product development of Vegetables. The model is informed by scientific literature and considers biological, psychological, and situational, and intrinsic and extrinsic product factors relevant to children's acceptance of vegetables, with a focus on modifiable factors at the product level. Simultaneously, 14 new vegetable-based product concepts for children were developed and evaluated through focus groups with 5-8-year-olds (n = 36) as a proof-of-concept evaluation of the model. Children had high interest in six of the concepts. Factors identified from the literature that positively associated with the children's interest in the concepts included bright colours, bite-sized pieces, good taste, fun eating experience, and familiarity. The CAMPOV model and proof-of-concept evaluation results can guide further sensory and consumer research to increase children's acceptance of food products containing vegetables, which will in turn provide further insights into the validity of the model. The food industry can use the model as a framework for development of new products for children with high sensory appeal.

Multi-component food-items and eating behaviour: What do we know and what do we need to know?

Multi-component food-items are single food products that comprise more than one food class, brought together usually via some form of processing. Importantly, individual components of the food-item remain discernible and sensorially distinguishable from each other (e.g., chocolate chip cookies or 'choc ice'). Despite a sizable research literature on the formulation of such products, there lacks a concomitant research literature on the effect(s) of multi-component food-items (compared to single component food-items) on eating behaviour. Considerable previous research has investigated the effect of multiple separate food items on food intake, portion size selection and palatability. However, studies rarely use test foods that capture the physical or chemical interactions between components that are characteristic of multi-component foods. Nevertheless, previous research and relevant theory allow us to generate hypotheses about how multi-component foods may affect eating behaviour; consideration of food variety and perceived sensory complexity suggest that consumption of multi-component foods are likely to increase perceived palatability of such foods, self-selected portion size and food intake. Moreover, many (but not all) multi-component foods would be considered ultra-processed, which is a driver of food intake in and of itself. One possibility is that food components brought together as part of a multi-component food-item interact to strongly drive eating behaviour. To explore this idea, researchers will need to work across disciplines to address various practical and methodological barriers including the technical preparation of test foods.

Promoting vegetable intake in preschool children: Independent and combined effects of portion size and flavor enhancement

This study investigated the independent and combined effects on preschool children's vegetable intake of serving a larger portion of vegetables and enhancing their flavor. In a crossover design, lunch was served in childcare centers once a week for four weeks to 67 children aged 3-5 y (26 boys, 41 girls). The meal consisted of two familiar vegetables (broccoli and corn) served with fish sticks, rice, ketchup, applesauce, and milk. Across the four meals, we varied the portion of vegetables (60 or 120 g total weight, served as equal weights of broccoli and corn) and served them either plain or enhanced (6.6% light butter and 0.5% salt by weight). All meals were consumed ad libitum and were weighed to determine intake. Doubling the portion of vegetables led to greater consumption of both broccoli and corn (both p < 0.0001) and increased meal vegetable intake by 68% (mean ± SEM 21 ± 3 g). Enhancing vegetables with butter and salt, however, did not influence their intake (p = 0.13), nor did flavor enhancement modify the effect of portion size on intake (p = 0.10). Intake of other meal components did not change when the vegetable portion was doubled (p = 0.57); thus, for the entire meal, the increase in vegetable consumption led to a 5% increase in energy intake (13 ± 5 kcal; p = 0.02). Ratings indicated that children had similar liking for the plain and enhanced versions of each vegetable (both p > 0.31). All versions of vegetables were well-liked, as indicated by ≥ 76% of the children rating them as "yummy" or "just okay". Serving a larger portion of vegetables at a meal was an effective strategy to promote vegetable intake in children, but when well-liked vegetables were served, adding butter and salt was not necessary to increase consumption.

Considering Nature and Nurture in the Etiology and Prevention of Picky Eating: A Narrative Review

Children are often categorized as picky eaters by parents and caregivers for their rejection of foods, such as vegetables, and for exhibiting other difficult mealtime behaviors. However, there are several factors that contribute to these mealtime behaviors, including early feeding practices (i.e., breastfeeding, introduction to solid food), repeated exposure to novel foods, and genetic taste sensitivity to certain compounds. Using the online database of PubMed, a review of the literature on the development of picky eating in children, its outcomes, and intervention strategies was conducted. This review groups the developmental contributors to picky eating into the categories of nature and nurture and explores the interaction between the two. This paper will also summarize the potential outcomes of picky eating and the various strategies that are currently recommended to mitigate picky eating in young children. However, there is a lack of longitudinal work targeting consistent picky eating behaviors that have the potential to impact long-term food preferences and dietary variety. Future intervention strategies should address the factors that influence the development of picky eating on an individual level.

Youth Willingness to Purchase Whole Grain Snack Packs from New York City Corner Stores Participating in a Healthy Retail Program

Corners stores in low-income communities are a promising setting to intervene in youth whole grain intake. One strategy that may encourage whole grain intake is if corner stores were to pair and sell whole grain snacks in combination with either a liked fruit or vegetable and an optional condiment (i.e., a whole grain snack pack). This study examined youth in terms of their (1) liking of fruits, vegetables, and whole grain snacks; (2) perceptions about which fruits and vegetables pair best with whole grain snacks; and (3) willingness to pay for a whole grain snack pack. One-time intercept surveys were conducted with 10-18-year-olds (n = 402) who visited a New York City (NYC) corner store (n = 34) participating in the City Harvest Healthy Retail Program. On average, youth were willing to spend $2.38 (SD $4.32) on a whole grain snack pack. Higher overall liking scores for vegetables and whole grain snacks were associated with willingness to spend 24.4% (95% confidence interval (CI): 11.5-38.7%) and 21.6% (95%CI: 5.2-40.6%) more on whole grain snack packs, respectively. In conclusion, youth are receptive to purchasing whole grain snack packs from NYC corner stores participating in a healthy retail program.

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.

Modelling positive consequences: Increased vegetable intakes following modelled enjoyment versus modelled intake

OBJECTIVE

Modelling has previously been demonstrated to encourage healthy eating, but the importance of modelling the behaviour versus modelling the positive consequences of the behaviour is unknown. This work investigated the impact of modelling carrot intake (the behaviour) and modelling carrot enjoyment (the positive consequences) on subsequent liking and consumption of carrots and sweetcorn.

METHODS

155 children aged 7-10 years were randomized to hear a story where fictional characters consumed a picnic with either: no mention of carrot sticks (control) (N = 45); mention of carrot sticks that all characters ate (modelling intake) (N = 60); or mention of carrot sticks that the characters like (modelling enjoyment) (N = 50). Carrot and sweetcorn liking and intake were measured before and after the story during a 5 min task.

RESULTS

Carrot liking and intake after a story were higher following the story modelling carrot enjoyment compared to the stories not modelling enjoyment (smallest β = 0.16, p = 0.05), and in those with higher pre-story carrot liking and intake (smallest β = 0.25, p < 0.01). Sweetcorn liking and intake after a story were associated with pre-story sweetcorn liking and intake (smallest β = 0.28, p < 0.01), and sweetcorn intake was lower following the story modelling carrot enjoyment compared to the stories not modelling enjoyment (β = -0.17, p = 0.04).

CONCLUSIONS

These findings demonstrate a role for modelling enjoyment to encourage vegetable liking and intake, although effects sizes were small. These findings also suggest a benefit from modelling the positive consequences of a behaviour for encouraging healthy food intake in children, while limited effects were found for modelling the behaviour itself.

Observations of Toddlers' sensory-based exploratory behaviors with a novel food

BACKGROUND

Food neophobia hinders the acceptance of healthy foods in young children, and may be overcome by repeated food exposure. Prevalent literature states that children exhibit five sensory-based exploratory behaviors (SBEBs): smelling, licking, spitting, manipulating and/or swallowing as they progress towards accepting a novel food, yet there is a paucity of research on these behaviors. This study aimed to use direct observations of SBEBs across first-time exposures to hummus to (1) determine the prevalence of five SBEBs (smelling, licking, spitting, manipulating and swallowing) in 12-35 month olds, (2) quantify the psychometric properties of the SBEB assessment; and (3) examine the association of SBEBs with parent-assessed food fussiness, and consumption of the novel food.

METHODS

Direct observations of SBEBs during a 15-20 min snack time were conducted by trained staff members for 55 hummus-naïve toddlers ages 12-35 months, across 16 exposures to a novel food (hummus). Parents completed the child eating behavior questionnaire. Hummus consumption was measured using digital plate waste method.

RESULTS

Very low base rates of spitting (0.06%), smelling (0.97%) and licking (1.95%) were observed but manipulation (26.36%) and swallowing (62.15%) were more prevalent. Observation data on two behaviors over 16 occasions gave rise to a reliability coefficient from our G study portion of our generalizability analyses of Eρ² = 0.65. SBEBs did not significantly associate with parent-assessed food fussiness, nor hummus consumption.

CONCLUSIONS

Although literature refers to the prevalence of SBEBs, we did not observe this for three proposed behaviors. We did observe manipulation, but more research is needed to determine if there are additional SBEBs not noted in the literature, and to better delineate the process that leads to acceptance/rejection of novel food.

Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years

BACKGROUND

Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important.

OBJECTIVE

To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years.

DESIGN

The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included.

RESULTS

30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked.

CONCLUSIONS

Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).

Comparing the portion size effect in women with and without extended training in portion control: A follow-up to the Portion-Control Strategies Trial

Following a 1-year randomized controlled trial that tested how weight loss was influenced by different targeted strategies for managing food portions, we evaluated whether the effect of portion size on intake in a controlled setting was attenuated in trained participants compared to untrained controls. Subjects were 3 groups of women: 39 participants with overweight and obesity from the Portion-Control Strategies Trial, 34 controls with overweight and obesity, and 29 controls with normal weight. In a crossover design, on 4 different occasions subjects were served a meal consisting of 7 foods that differed in energy density (ED). Across the meals, all foods were varied in portion size (100%, 125%, 150%, or 175% of baseline). The results showed that serving larger portions increased the weight and energy of food consumed at the meal (P < .0001), and this effect did not differ across groups. Increasing portions by 75% increased food intake by a mean (±SEM) of 111 ± 10 g (27%) and increased energy intake by 126 ± 14 kcal (25%). Across all meals, however, trained participants had lower energy intake (506 ± 15 vs. 601 ± 12 kcal, P = .006) and lower meal ED (1.09 ± 0.02 vs. 1.27 ± 0.02 kcal/g; P = .003) than controls, whose intake did not differ by weight status. The lower energy intake of trained participants was attributable to consuming meals with a greater proportion of lower-ED foods than controls. These results further demonstrate the robust nature of the portion size effect and reinforce that reducing meal ED is an effective way to moderate energy intake in the presence of large portions.

Influence of seasoning on vegetable selection, liking and intent to purchase

Low vegetable intake continues to be a health concern, and strategies to increase vegetable intake have resulted in only small increases. One strategy that has received less attention is the use of seasonings. This study's objective was to determine the impact of seasoning on vegetable selection, liking, and intent to purchase. We conducted a 3-week study in a public café on a university campus. Customers buying a main dish could select a vegetable side (seasoned [SS] or steamed [ST]) at no cost. Based on café data and power analysis (alpha 0.05, 80% power), 2 days per vegetable pair were conducted with carrot, broccoli, and green bean pairs randomized 3 days/week 1 and 3, with normal service week 2. Selection was greater for SS vs ST, n = 335 vs. 143 for all 3 vegetables combined; n = 97 vs 47 for carrots; n = 114 vs. 55 for broccoli; n = 124 vs. 41 for green beans (p < 0.001 Chi-Square). Liking responses were similar for SS vs ST and were high for all vegetables. Response distribution was not significantly different for SS vs ST vegetables when people were asked if they would purchase the vegetable that they selected. More customers chose the 'somewhat likely' and 'very likely' (n = 353) than the 'not likely' and 'definitely would not' (n = 121) purchase responses. Regression showed that people who did not often consume a vegetable with lunch while dining out were 1.59 times more likely to select the SS vegetables over the ST (p = 0.007). Given a choice, consumers were more likely to select a seasoned vegetable. With low vegetable consumption as a predictor of seasoned vegetable choice, offering seasoned vegetables may increase intake in those with poor vegetable intake in a café setting.

Investigating offering of vegetables by caregivers of preschool age children

BACKGROUND

Research into the methods which caregivers use to encourage children to eat vegetables is limited, with minimal evidence about what the barriers are to offering these foods. Vegetable consumption in children is typically low, and so gaining information on these factors is vital in order to develop further caregiver-centred interventions to increase children's vegetable consumption. This study aimed to investigate the methods caregivers use to offer vegetables to preschool aged children, as well as the factors which influence whether and how caregivers present vegetables to their children.

METHOD

Seventeen caregivers with a preschool aged child participated in focus groups to assess these questions.

RESULTS

Thematic analysis indicated that caregivers use a range of methods to offer their children vegetables, with these methods falling into three broad categories: behavioural/active methods, passive methods and food manipulations. Influences on caregiver offering which emerged from the focus groups formed four categories: information, cost, parent factors and child factors.

CONCLUSIONS

Together with large-scale quantitative data, this information can be used to shape future interventions aiming to increase children's vegetable intake as well as to tailor advice given to caregivers striving to achieve a healthful diet for their children.

Variety of fruit and vegetables is related to preschoolers' overall diet quality

Children are encouraged to eat a specific amount of fruits and vegetables to optimize health. The purpose of this study was to assess whether consumption of a variety of fruits and vegetables, respectively, was associated with a greater diet quality among preschool-aged children. Analyses were performed using a cross-sectional, nationally representative sample of US children. Dietary intakes from 24-h dietary recalls of two-five year old children (n = 2595) in 2005–2010 NHANES were examined. Diet quality was evaluated using MyPlate equivalents and the Healthy Eating Index 2010 (HEI-2010). Variety categories were determined based on children's fruit, fruit juice, and vegetable consumption on the recalled day. Differences in diet quality were examined using t-tests. Variety of fruits and vegetables was linked to higher overall diet quality. Children who consumed whole fruit had better diet quality scores for total fruit, whole fruit, whole grains, dairy, seafood, refined grains, sodium, and empty calories (P ≤ 0.018). Significantly higher HEI-2010 scores for total fruit, whole fruit, fatty acids, sodium, and empty calories, but a lower dairy HEI-2010 score, were identified in children who drank fruit juice (P ≤ 0.038). Vegetable consumption was significantly associated with higher total vegetables, greens/beans, and empty calories, but a lower sodium score (P ≤ 0.027). Children who consumed whole fruit, fruit juice and non-starchy vegetables (P ≤ 0.017), but not white potatoes, had significantly higher total HEI-2010 scores. Reinforcing fruit and 100% fruit juice consumption may indirectly support healthier diets among children. However, underlying associations between fruit and vegetable intakes and overall diet quality should be examined further.

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Children's variety of fruit and vegetable intake resulted in better diet quality.

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Children who consumed whole fruit had better diet quality scores.

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Vegetable consumption was significantly associated with higher total vegetables.

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Children who consumed 100% fruit juice had higher total HEI-2010 scores.

Girls' picky eating in childhood is associated with normal weight status from ages 5 to 15 y

BACKGROUND

Picky eating has been associated with lower weight status and limited food intake and variety in childhood. Little is known about how the persistence of picky eating in childhood is associated with changes in weight and food intake from childhood into adolescence.

OBJECTIVE

We determined whether picky eating identified in childhood was related to growth, nutrition, and parental use of pressure over a 10-y period.

DESIGN

Non-Hispanic white girls (n = 181) participated in a longitudinal study and were assessed biannually from ages 5 to 15 y. The Child Feeding Questionnaire was used to classify girls as persistent picky eaters or nonpicky eaters and to assess parental use of pressure to eat. Height and weight were measured to calculate body mass index (BMI) z scores at each occasion. Three 24-h dietary recalls obtained at each occasion were used to determine intakes of fruit and vegetables. With the use of repeated-measures analyses, differences between persistent picky eaters and nonpicky eaters in BMI z scores, dietary intake, and use of pressure were examined.

RESULTS

From ages 5 to 15 y, persistent picky eaters (n = 33; 18%) had lower BMI (tracking at the 50th percentile) than did nonpicky eaters (n = 148; tracking at the 65th percentile) (P = 0.02). Persistent picky eaters were less likely to be overweight into adolescence. Both groups consumed less than the recommended amounts of fruit and vegetables, although persistent picky eaters had lower intakes of vegetables than did nonpicky eaters at all time points (P = 0.02). Persistent picky eaters also received higher amounts of pressure (P = 0.01).

CONCLUSIONS

Findings that persistent picky eaters were within the normal weight range, were less likely to be overweight, and had similar fruit intakes to those of nonpicky eaters suggest that higher parental concerns about persistent picky eaters are unwarranted. All parents and children could benefit from evidence-based anticipatory guidance on alternatives to coercive feeding practices to increase fruit and vegetable consumption.

National Institutes of Health Update: Translating Basic Behavioral Science into New Pediatric Obesity Interventions

Pediatric obesity increases the risk of later-life obesity and chronic diseases. Basic research to better understand factors associated with excessive weight gain in early life and studies translating research findings into preventive and therapeutic strategies are essential to our ability to better prevent and treat childhood obesity. This overview describes several National Institutes of Health efforts designed to stimulate basic and translational research in childhood obesity prevention and treatment. These examples demonstrate the value of research in early phase translational pediatric obesity research and highlight some promising directions for this important area of research.

An Exploratory Analysis of Child Feeding Beliefs and Behaviors Included in Food Blogs Written by Mothers of Preschool-Aged Children

OBJECTIVE

This study analyzed child feeding beliefs and behaviors, types of recipes, and their associations in blogs focused on child feeding.

DESIGN

The authors selected 13 blogs using purposive snowball sampling, from which 158 blog posts were sampled and coded using directed qualitative content analysis.

VARIABLES MEASURED

Child feeding beliefs and behaviors and types of recipes were coded using schemes developed from existing literature.

ANALYSIS

Code frequencies were calculated. Chi-square tests for independence examined associations between child feeding and recipe codes. Bonferroni corrections were applied: P < .05/(n tests).

RESULTS

Child feeding beliefs and behaviors were coded in 78% and 49% of posts, respectively. Beliefs about children's food preferences (48% of posts) and involving children in food preparation (27% of posts) were the most frequent codes. Recipes were included in 66% of posts. Most recipes were for mixed dishes (32% of recipes), followed by sweets and desserts (19% of recipes). Vegetable recipes were more likely in posts that included behavior encouraging balance and variety (χ2 [1, n = 104] = 18.54; P < .001).

CONCLUSIONS AND IMPLICATIONS

Blog posts contained information that may influence readers' child feeding practices. Future research should explore how mothers use blogs to learn about child feeding.

Increasing vegetable intakes: rationale and systematic review of published interventions

Purpose

While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group.

Methods

Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms.

Results

Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent.

Conclusions

Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions.

Nutrient Intakes and Vegetable and White Potato Consumption by Children Aged 1 to 3 Years

In 2020, for the first time, the Dietary Guidelines for Americans will include recommendations for children from birth to age 24 mo. We examined average nutrient intakes as well as total vegetable and white potato (WP) consumption among children aged 1-3 y using day 1 dietary data from the NHANES 2009-2012 and the Food Patterns Equivalents Database 2009-2012. Appropriate survey weights were used to calculate average daily consumption of total vegetables and WPs, which included French-fried potatoes and chips, for boys and girls aged 1-3 y. We calculated mean intakes of selected nutrients of concern, including vitamin D, potassium, dietary fiber (DF), and calcium. We also examined intakes of selected nutrients by major food group. Average intakes of most nutrients, including calcium, by children aged 1-3 y exceeded Dietary Reference Intakes (DRIs). However, average intakes of potassium, DF, and vitamin D were 67%, 55%, and 49% of DRIs, respectively. Mean total vegetable intake was less than the recommendation of 1 cup/d. Boys and girls aged 1-3 y consumed an average of 0.58 cup equivalents of total vegetables on the day of the survey, which included 0.16 cups of WPs. Average vegetable consumption and mean intakes of potassium, DF, and vitamin D were far below recommendations. The consumption of all vegetables, particularly those that are excellent sources of potassium and DF, such as potatoes, should be encouraged.

Impact of the National School Lunch Program on Fruit and Vegetable Selection in Northeastern Elementary Schoolchildren, 2012-2013

Increasing children's fruit and vegetable (FV) consumption is an important goal of the U.S. Department of Agriculture's (USDA's) National School Lunch Program. Since 2012, the USDA's requirement that children select FVs at lunch as part of the reimbursable school meal has been met with concern and evidence of food waste. We compared elementary schoolchildren's FV selection, consumption, and waste before (10 school visits, 498 tray observations) and after (11 school visits, 944 tray observations) implementation of this requirement using validated dietary assessment measures. More children selected FVs in higher amounts when FVs were required compared with when they were optional (0.69 cups vs. 0.89 cups, p<0.001); however, consumption decreased slightly (0.51 cups vs. 0.45 cups, p=0.01) and waste increased (0.25 cups vs. 0.39 cups, p<0.001) when FVs were required compared with when they were optional. More exposure to FVs in schools through programmatic efforts and in the home environment may help familiarize children with FV offerings and encourage consumption.

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

BACKGROUND

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.

OBJECTIVE

We investigated the relative effectiveness of repeated exposure and flavour-flavour learning in increasing vegetable intake and acceptance in preschoolers.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

'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.

Learning to eat vegetables in early life: the role of timing, age and individual eating traits

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4–38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were “learners” (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled “plate-clearers”. 16% were considered “non-eaters” eating less than 10 g by the 5^th exposure and the remainder were classified as “others” (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children.

Transitioning to new child-care nutrition policies: nutrient content of preschool menus differs by presence of vegetarian main entrée

Children who attend child care outside the home may be at increased risk for developing obesity. In 2012, the South Carolina ABC Child Care program issued new standards for food and nutrition. The goal of our study (conducted June to December 2012) was to examine changes that occurred at a large, Columbia, SC, preschool during the implementation of the South Carolina ABC Child Care program standards using an observational design, including a survey of parents and nutrient analysis of menus. The nutrition content of menu items before (n=15 days; six of which were vegetarian) and after (n=15 days; six of which were vegetarian) implementation of the new standards was compared. In addition, parents (N=75) were surveyed to examine opinions and support for the changes. Independent samples t tests were used to compare nutrient values before and after menu changes and analysis of variance was used to compare pre- and post-change vegetarian menus and pre- and post-change nonvegetarian menus. There were no significant differences between before and after menus with the exception of a 0.3 cup/day increase in vegetables (P<0.05). Vegetarian menus after the revisions were significantly higher in fiber (13 ± 3 g) than postrevision nonvegetarian menus (11 ± 3 g; P<0.05) and lower in sodium (1,068 ± 207 mg) than postrevision nonvegetarian menus (1,656 ± 488 mg; P<0.05). Standards that received the most parental support were serving at least two vegetables (score of 8.7 on a scale of one to nine) and two fruits per day (score of 8.6) and implementing policies against staff using food as a reward or punishment (score of 8.6). The center-specific policy of only bringing healthy foods for celebrations received the lowest support (score of 5.8). Adding more vegetarian menu items has the potential to improve the nutrient content of menus while keeping energy intake, saturated fat, sodium, and cholesterol levels at a more optimum level.