Fourth-grade children's consumption of fruit and vegetable items available as part of school lunches is closely related to preferences

OBJECTIVE: To use data from observations and interviews to document fourth-graders' preferences for, and consumption of, fruits compared to vegetables available as part of school lunches. DESIGN: Observations and interviews were conducted for studies regarding the impact of time interval between eating and reporting on the accuracy of children's school lunch recalls. SUBJECTS/SETTINGS: Children were recruited from up to 4 schools in one district during 3 school years; 63% agreed to participate. Randomly selected children (n = 237) were each observed eating school lunch once and were interviewed (regarding items eaten and preferences for items eaten) within 11/2 hours or the next morning. MAIN OUTCOME MEASURES: Observed consumption of servings of items available as part of school lunch was recorded as none, taste, little bit, half, most, and all. Response options for preferences for items available as part of school lunch were liked not at all, a little, and a lot. STATISTICAL ANALYSES PERFORMED: Mixed-model analysis of variance. RESULTS: Preferences were higher for fruits than vegetables. As preferences increased, consumption increased (P <.0001). Consumption of fruits compared to vegetables was similar after adjusting for preferences. IMPLICATIONS: Research is needed to understand how to increase children's preferences for vegetables as a means of increasing consumption.     

Low fruit and vegetable consumption is associated with low knowledge of the details of the 5‐a‐day fruit and vegetable message in the UK: findings from two cross‐sectional questionnaire studies

Background

This project aimed to understand the details of the 5‐a‐day fruit and vegetable (FV) message (which foods are included, portion sizes, the need for variety, reasons for consumption) least known by UK consumers, and most associated with low FV consumption.

Methods

Study 1 assessed FV consumption, knowledge of the details of the message, and relationships between these, using a short questionnaire administered face‐to‐face to an opportunity sample of one large UK city. Study 2 assessed the same variables using a comprehensive postal questionnaire administered across the UK to a representative population sample.

Results

Five hundred and seven respondents completed Study 1 and 247 respondents completed Study 2. The majority of individuals in both studies were aware of the 5‐a‐day message and could recount this correctly. In both studies, however, knowledge of the details of the message was low, and lower knowledge was associated with lower FV consumption. Respondents had lowest knowledge of the details of the message related to portion sizes and the need for variety. However, FV consumption was not independently associated with knowledge of any one aspect of the message.

Conclusions

These findings suggest that, although most of the UK population sampled were aware of the 5‐a‐day FV message and could recount this correctly, details of the 5‐a‐day FV message were not well known, and that FV consumption was related to this knowledge. These findings suggest that strategies to increase FV consumption will benefit from increasing UK consumers’ knowledge of the details of the 5‐a‐day FV message.     

Using social norm nudges in supermarket shopping trolleys to increase fruit and vegetable purchases

Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing obesity and chronic diseases: however, only one in twenty Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test if shopper purchasing behaviour can be modified to purchase more F&Vs using social norm nudge messages (prompts) placed in shopping trolleys. Placards giving the message that the majority of shoppers purchased F&Vs at each shop were placed in shopping trolleys. Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting receipts to measure the quantity (kg), total and F&V spending (Australian dollars) for intervention versus control trolleys. We also conducted a short intercept survey that was administered independently from the research study day. Shoppers who selected trolleys with the social norm nudge placards (n = 109) purchased 1.25 kg more F&Vs (Intervention: mean = 5.45 kg, SD = 4.23 kg, 95% CI 4.65 kg, 6.26 kg vs. Control: mean 4.19 kg, SD = 3.75 kg, 95% CI 3.48 kg, 4.90 kg, p = 0.020, Cohen's d = 0.32) and spent an extra $9.10 more on F&Vs compared to shoppers in the control group (n = 109; Intervention: mean = $36.20, SD = $26.30, 95% CI = $31.24, $41.26 vs. Control: mean $27.10, SD = $24.00, 95% CI = $22.50, $31.67, p = 0.008, Cohen's d = 0.36). The social norm nudge placard shows promise in modifying shoppers' purchases to buy more F&Vs. Larger studies are required to elucidate and confirm these findings over the longer term.     

Overweight and average-weight children equally responsive to "Kids Choice Program" to increase fruit and vegetable consumption

Secondary analyses were conducted for children participating in the school-based Kids Choice Program [Hendy, H. M., Williams, K., & Camise, T. (2005). "Kids Choice" school lunch program increases children's fruit and vegetable acceptance. Appetite, 45, 250-263.] to examine whether fruit and vegetable consumption and preference ratings by overweight and average-weight children within the original sample were equally responsive to the program. The Kids Choice Program produced increased fruit and vegetable consumption by both overweight and average-weight children that lasted throughout the month-long program, while avoiding "over-justification" drops in later fruit and vegetable preference ratings. We believe that the Kids Choice Program shows promise for encouraging overweight children to improve nutrition and weight management behaviors while in their everyday peer environment.     

Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate

Objective To determine whether socioeconomic groups differ in their food intakes for fruit and vegetables, their consumption of fruit and vegetables dense in vitamin A, folate and vitamin C, and their nutrient intakes of vitamin C, folate and vitamin A. Methods The 1995 Australian National Nutrition Survey collected food intake data from 8883 adults aged 18–64 years using a 24‐h dietary recall. Fruit and vegetables were measured as amount (g) consumed. Intakes of nutrients were estimated from the 24‐h dietary recall data. Participants were categorized by whether or not they consumed fruit or vegetables high in vitamin A, folate and vitamin C. Gross annual household income was used to measure socioeconomic position. Results Participants from low‐income households consumed a smaller quantity of fruit and vegetables. They were also less likely to consume fruit and vegetables high in vitamin C, folate and vitamin A. Consistent with these findings, men and women from disadvantaged socioeconomic groups had lower intakes of vitamin C and folate compared with their more affluent counterparts. These differences were small to moderate in magnitude. Vitamin A intakes were not significantly related to income. Conclusion As well as promoting healthy dietary practices, nutrition‐promotion strategies should target the nutrient intakes of lower socioeconomic groups. These programmes should focus on improving the quantity and choice of fruit and vegetables consumed by people from low‐income households.     

Patterns of fruit, vegetable, and milk consumption among smoking and nonsmoking female teens

BACKGROUND: The increase in teenage smoking, and the fact that concern about body weight is given as a reason for smoking initiation by girls, suggest that food intake may be compromised in female teens who smoke. Daily consumption of a variety of foods is important due to the health-protective constituents they contain. Few studies have documented how smoking and the consumption of fruits, vegetables, and milk may be associated in female teens. METHODS: This study examined the relationship of smoking and the consumption of fruit, fruit juice, vegetables, and milk in ninth- to twelfth-grade Caucasian (n=2797), African-American (n=2196), and Hispanic (n=2052) female teens. Data from the Youth Behavior Risk Survey (1999) were analyzed with SUDAAN software, using logistic regression models. RESULTS: Smoking was significantly associated with decreased odds of consuming milk at 0.74 (95% confidence interval [CI], 0.55-0.98); fruit, 0.70 (95% CI, 0.54-0.92); fruit juice, 0.74 (95% CI, 0.56-0.98); and vegetables, 0.75 (95% CI, 0.63-0.89) among Caucasian female teens, and with decreased odds of consuming fruit juice among Hispanic female teens at 0.59 (95% CI, 0.40-0.89). For each significant food variable, a dose-response relationship was detected with significantly more females consuming each food at lower smoking levels and significantly fewer doing so at the highest level (p<0.05). By contrast, African-American female teen smokers tended to consume higher levels of the specified food/beverages than nonsmokers, but this relationship was not statistically significant. IMPLICATIONS: This study establishes a smoking/food intake interaction for the specific foods tested, in an adolescent female population. Compromising the intake of healthy foods and their protective nutrients leaves young women more vulnerable to the serious health consequences of smoking. These results underscore the need for young women to be educated on the importance of eating maximum servings of fruits and vegetables and dairy products, such as milk, particularly if they smoke or are at risk for smoking initiation. The study also underscores the need to culturally tailor programs according to differences in smoking initiation and eating/dieting behaviors.     

Combined fruit and vegetable intake is correlated with improved inflammatory and oxidant status from a cross-sectional study in a community setting

Previous studies have examined the relationship between specific nutrient and food intakes with limited markers of either inflammation or oxidant status. The objective of this study was to determine if an increase in combined self-reported fruit and vegetable (F&V) intake in a community setting was associated with improved multiple markers of inflammatory and oxidant status. A community group (N = 1000, age 18–85 years, 61% female) gave two fasted blood samples separated by 12 weeks. Blood inflammatory biomarkers included total leukocytes (WBC), plasma C-reactive protein (CRP), interleukin-6 (IL-6), IL-10, tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1, and granulocyte colony stimulating factor. Measured oxidant status markers were ferric reducing ability of plasma (FRAP), oxygen radical absorbance capacity (ORAC) and plasma F₂-isoprostanes. The relation of markers across categories of F&V intake was examined. In analyses controlling for other important dietary and lifestyle factors, IL-6 and TNF-α were significantly lower across categories of increasing F&V intakes (p < 0.008). FRAP and ORAC were significantly higher (p < 0.0001 and p = 0.047 respectively) while F₂-isoprostanes was significantly lower (p < 0.0001) across F&V categories. In a community study, several markers of both inflammation and oxidant status were associated in a putatively salutary direction by higher intake of combined F&V, supporting current guidelines suggesting increased F&V consumption for the prevention of chronic diseases.     

The role of fruit juice in the diet: an overview

Over recent years, consumers have shown an increasing interest in health and wellbeing, with many wanting food and drink products that are healthy and nutritious, yet fit in with busy lifestyles. Fruit juice is one beverage that has seen a dramatic increase in consumer purchasing since the 1970s, and is now consumed by nearly half the UK population. While the beneficial effects of consuming diets rich in fruit and vegetables are well documented, the specific health effects of consuming fruit juice are less so. Further, the role of fruit juice in conditions such as obesity has also recently come under scrutiny, due to questions over how liquid calories affect subsequent energy intake. Limitations in the literature in this area include a lack of studies looking at different types of fruit juices and their effects on health, as well as studies that differentiate fruit juice from fruit and vegetable intake. Consuming a diet rich in fruit and vegetables (to which fruit juice can count once towards the 5 A DAY target) can help to reduce an individual's risk of suffering from a variety of chronic diseases, and should therefore be encouraged.     

Seattle 5 a Day worksite program to increase fruit and vegetable consumption

BACKGROUND: 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables. The Seattle 5 a Day worksite investigators designed and evaluated an intervention, organized on stages of behavioral change, to increase worksitewide fruit and vegetable consumption. METHODS: We recruited 28 worksites with cafeterias and randomized 14 to intervention and 14 to control. The intervention addressed both changes in the work environment and individual level behavior change. In each worksite, an employee advisory board, with study interventionist assistance, implemented the program. By surveying cross-sectional samples of 125 employees per worksite, we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline. Unobtrusive site-level indicators including plate observation and cafeteria checklist were also used. RESULTS: The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites, with an intervention effect of 0.3 daily serving (P < 0.05). Other measures of fruit and vegetable consumption, including unobtrusive indicators, supported the effectiveness of the intervention. CONCLUSIONS: This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias. There was a significant differential increase in fruit and vegetable consumption in the intervention worksites. This kind of worksite intervention can achieve important health benefits on a population basis, because of its potential to reach large numbers of people.     

Using a divider nudge in supermarket shopping trolleys to increase fruit and vegetable purchases: A feasibility study using an intervention design

Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing obesity and chronic diseases: however, only one in 16 Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test the feasibility of covertly modifying shopper purchasing behaviour to purchase more F&Vs using a visual divider nudge message (prompts) covering the entire base of shopping trolleys. Placards provided a visual representation of the recommended proportion of the trolley base that should be allocated to fruits and vegetables (implied social norm). Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting receipts to measure the weight (kg), total spending and F&V specific spending (Australian dollars) for intervention versus control trolleys for one weekend day only. We also conducted a short intercept survey that was administered independently from the research study day on non-trial shoppers. Shoppers who selected trolleys with the divider nudge placards (n = 102) purchased equal weight of F&Vs (Intervention: mean = 6.25 kg, SD = 5.60 kg, 95% CI = 5.14 kg, 7.35 kg, vs. Control: mean 6.03 kg, SD = 5.17 kg, 95% CI = 5.01 kg, 7.04 kg, p = 0.768) and spent equal amounts on F&Vs compared to shoppers in the control group (n = 102) (Intervention: mean = $41.46, SD = $36.68, 95% CI = $34.25, $48.66, vs. Control: mean $39.85, SD = $33.30, 95% CI = $33.34, $46.39, p = 0.744). There was no difference in the total spending between groups (Intervention: mean = $135.99, SD = $90.10, 95% CI = $118.29, $153.68, vs. Control: mean $155.68, SD = $96.46, 95% CI = $136.73, $174.63, p = 0.133). The divider nudge placard did not lead to any difference in shoppers' purchases of F&Vs. However, this study demonstrates the feasibility of testing a cheap, simple and easy supermarket nutrition intervention. Larger studies are required to elucidate and confirm these findings over the longer term.