Determinants of fruit and vegetable consumption among six to twelve-year-old children and effective school-based interventions to increase consumption
This paper presents a review of the determinants of fruit and vegetable consumption among six to twelve year old children, as well as key components for school nutrition interventions aiming at the promotion of fruit and vegetable intake.
What factors determine fruit and vegetable consumption in children?
Evidence from the literature reviewed points to availability, accessibility and taste preferences for fruit and vegetables as the most important determinants in children aged six to twelve years old(1-6).With regard to taste preferences, humans have certain innate predispositions, such as a preference for sweet and salty, an aversion for bitter and sour tastes, and possibly a tendency to readily learn to prefer tastes of energy-dense foods and to reject new, unfamiliar foods(7, 8). On the other hand, most of these predispositions appear to be alterable via repeated exposure to food (approximately 10 exposures), in a positive social context(7, 9). Additionally, the use of reward may also affect taste preferences. Indeed, foods given as rewards generally result in increased preference for those foods, while coercing a child to eat a less preferred food in order to obtain a reward can result in a further decreased liking for the food for which a reward is offered.
Other determinants may also be relevant for the consumption of fruit and vegetables for this age group. Parental behaviour (consumption/modeling) and child feeding practices are among these(4, 7, 10). With regard to the latter, research indicates that highly controlling parenting may have a counter-productive influence on their children’s diets, especially their fruit and vegetable intakes(7). On the other hand, a clear division of feeding responsibilities appears desirable: the adult is responsible for providing appropriate food for the child in a positive environment, and the child is responsible for deciding how much of the food item is eaten(4). Specific knowledge of the five-a-day intake recommendation, as well as food preparation, recognition and asking skills (i.e. abilities to ask parents to buy or prepare a favourite fruit or vegetable) are other relevant correlates of fruit and vegetable consumption(11).
Interventions to increase fruit and vegetable consumption of children
With regard to school-based interventions, the evidence indicates that a combination of classroom curriculum, parent home component and a school food service component, appears to be most effective(12-19).
Key determinants that should be targeted in a classroom curriculum are asking and preparation skills, as well as specific knowledge of recommended fruit and vegetable intakes. In addition, interventions should be theory-based, target specific behaviours with goal setting and monitoring of changes, include motivational strategies (selfassessments and feedback, discussion on media and social influences), and devote adequate time to nutrition education(20). Furthermore, hiring staff specifically trained for the program, as opposed to the usual classroom teachers, appears to contribute significantly to the intervention success(16, 17). Alternative solutions to the hiring and training of outside staff might be the use of interactive multimedia (combining individually tailored messages and entertainment), wherein the content and dose of the intervention is controlled by a computer expert system(14).
The parent-home component should aim to increase availability and accessibility of fruit and vegetables in the home, repeat exposure to fruits and vegetables in positive contexts, with reinforcements, and provide fruit and vegetable preparation skills. Parents should be aware of how taste preferences are developed and the potential positive or negative effects of rewards, the importance of parental consumption/modeling and child feeding practices as well as how to best divide feeding responsibility between adults and children. To date, it appears that the most effective method to involve parents is by having materials sent home to them, preferably in the form of “family homework”(12-14, 16, 21). A school food service component should especially improve the availability and accessibility of fruits and vegetables (including increased variety, improved taste and portion-size), and repeated exposure to fruits and vegetables in positive contexts, with reinforcements.
Another type of promising school-based interventions are fruit and vegetable provision or subscription programs(10, 26-28).
Interventions should improve the availability and accessibility of fruit and vegetables to children, and should aim to improve their taste preferences for them. Such interventions should be of a multicomponent nature, school-based and may include multi-media channels.
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