Working together to increase Australian children’s liking of vegetables: A position statement by the vegetable intake strategic alliance (VISA)

Children need to be repeatedly and consistently exposed to a variety of vegetables from an early age to achieve an increase in vegetable intake. A focus on enjoyment and learning to like eating vegetables at an early age is critical to forming favourable lifelong eating habits. Coordinated work is needed to ensure vegetables are available and promoted in a range of settings, using evidence-based initiatives, to create an environment that will support children’s acceptance of vegetables. This will help to facilitate increased intake, and ultimately realise the associated health benefits. The challenges and evidence base for a new approach are described

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

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

Vegetables and other core food groups : A comparison of key flavour and texture properties

Vegetables are the food category least liked by children. This research investigated the sensory properties of vegetables vis-a-vis other core foods that comprise children's diets, to determine to what degree low acceptance of vegetables can be attributed to sensory properties. Vegetables (n = 34) were compared to fruit (n = 26), dairy (n = 28), meat/fish (n = 28) and grains (n = 38); these foods were representative of the diet of Australian children and profiled by a trained sensory panel on 10 key taste and texture attributes as part of a larger study (Lease, Hendrie, Poelman, Delahunty, & Cox, 2016). Mean intensities were analysed using ANOVA. Vegetables were more bitter in taste than the other food categories and amongst the hardest. They were the lowest, or amongst the lowest, in all other flavour properties. Other core food categories had sensory properties known to be drivers of food liking: sweet and sour for fruit, sour, salty and fatty for dairy, salty, umami and fatty for meat/fish, and salty for grains. No food category other than vegetables had a bitter taste, a known driver of dislike. This research shows that vegetables, relative to other food groups, have sensory properties that are known to predispose to low acceptance based on innate likes and dislikes or preferences acquired within the first few months of life. High hardness of vegetables implicates a slow eating rate, which is generally beneficial from a public health perspective, but may make it difficult to meet recommended vegetable intake. To increase children's acceptance and intake for vegetables, either vegetable sensory properties can be modified, or children's acceptance for vegetables can be modified through sensory learning strategies

Multiple vs Single Target Vegetable Exposure to Increase Young Children's Vegetable Intake

Objective: To evaluate the effectiveness of repeated exposure to multiple vs single target vegetables in increasing young children's vegetable intake. Methods: A pilot randomized controlled trial (children aged 4–6 years, n = 32) was conducted, which exposed children at home 15 times over 5 weeks to either 1 (single target) or 3 (multiple target) vegetables. A comparison group did not change eating habits. Vegetable intake was measured by (1) a dinner meal consumed at research facilities, (2) 3-day weighed food records, and (3) usual vegetable intake (parent report). Measures were collected at baseline and either immediately after intervention (1), at 3-month follow-up (3) or both (2). Results: There were no differences between groups at baseline in vegetable intake. Usual vegetable intake increased in the multiple target group from.6 to 1.2 servings/d and did not change in other groups (P =.02). Food record data were not significant but underpowered. Vegetable intake from dinner meals was not significantly different between groups. Conclusions and Implications: Exposure to multiple vegetables simultaneously may be more effective than a single vegetable to increase young children's intake. Larger scale research is recommended to confirm the effectiveness of offering variety in exposure and to enhance the understanding of the mechanisms involved.</p

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

Effect of Experiential Vegetable Education Program on Mediating Factors of Vegetable Consumption in Australian Primary School Students: A Cluster-Randomized Controlled Trial

Schools provide a relevant and equitable environment to influence students towards increased vegetable consumption. This study aimed to evaluate the effectiveness of a Vegetable Education Resource To Increase Children&rsquo;s Acceptance and Liking (VERTICAL) for Australian primary schools (curriculum aligned and based on a framework of food preference development and sensory experiential learning) on positively influencing factors predisposing children towards increased vegetable consumption. The secondary aim was to evaluate two levels of teacher training intensity on intervention effectiveness. A cluster-RCT amongst schools with three conditions was conducted: 1 = teaching VERTICAL preceded by online teacher training; 2 = as per 1 with additional face-to-face teacher training; 3 = Control. Pre-test, post-test and 3-month follow-up measures (knowledge, verbalization ability, vegetable acceptance, behavioural intentions, willing to taste, new vegetables consumed) were collected from students (n = 1639 from 25 schools in Sydney/Adelaide, Australia). Data were analyzed using mixed model analysis. No difference in intervention effectiveness was found between the two training methods. Compared to the Control, VERTICAL positively affected all outcome measures after intervention (p &lt; 0.01) with knowledge sustained at 3-month follow-up (p &lt; 0.001). In conclusion, VERTICAL was effective in achieving change amongst students in mediating factors known to be positively associated with vegetable consumption

Menu Audit of Vegetable-Containing Food Offering in Primary School Canteens in Sydney, Australia: A Preliminary Study

Children’s vegetable intakes are too low, and school canteens could provide an equitable environment to improve their intake. This study aimed to develop and apply a systematic method to quantify the proportion and variety of vegetable-containing items on primary school canteen menus and examine differences between schools of different socio-economic statuses, sizes and types. Online canteen menus from 112 primary schools in Sydney, Australia, were collected, and data were extracted on a total number of items and vegetable-containing items across different menu categories. Further, data on preparation type and variety were extracted. Differences in the proportion of vegetable items between socio-economic status, school size and type were tested. On average, 80.4 ± 34.0 items were listed, with 30% of items containing vegetables. Most sandwiches (60%) and hot foods (54%) contained no vegetables. The variety of raw vegetables (4.9 ± 1.8 types) was greater than for cooked vegetables (1.3 ± 1.2 types; p &lt; 0.01). Limited differences were observed by socio-economic status and school type. Small schools offered fewer vegetable-containing items than large schools. While primary school canteen menus listed a large variety of items, only one-third contained vegetables. Data from this study can be used to track changes and to develop new opportunities to increase the vegetable supply in schools

Effectiveness of a Multi-Strategy Behavioral Intervention to Increase Vegetable Sales in Primary School Canteens: A Randomized Controlled Trial

Children&rsquo;s vegetable intake remains inadequate and school canteens may provide opportunities to address this public health concern. This study aimed to determine the effectiveness of an 8-week multi-strategy behavioral intervention that included vegetable provisioning and online menu architecture on vegetable sales in primary school canteens. A randomized controlled trial was undertaken in 16 Australian primary schools (n = 4302 students). The control arm kept their regular canteen menu. The primary outcome was vegetable sales measured by assessing vegetable content (in grams) from all menu items and using canteen sales (ordered online and over-the-counter) to calculate vegetable sales (in grams/week) at baseline (3 weeks) and during intervention implementation (8 weeks). Secondary outcomes were vegetable sales in subcategories, intervention acceptability among canteen managers and vegetable waste (four schools). Linear mixed model analysis showed that from baseline to follow-up, the intervention group had significantly higher weekly vegetable sales overall compared with the control group (2707 g/week, 95% CI 1276 to 4137 g/week; p &lt; 0.001), with increased vegetable sales in the subcategories of burgers, hot foods and snacks, but not in sandwiches and pasta/rice dishes. The intervention did not lead to more vegetable waste, nor to a decrease in canteen revenue. The canteen managers found the intervention easy to implement and felt children responded favorably to three of the seven strategies. In conclusion, a multi-strategy behavioral canteen intervention increased vegetable sales amongst primary school students