Background: Although there are numerous health benefits associated with eating fruit and 4 vegetables (FV), few children are consuming recommended amounts. Gardening interventions 5 have been implemented in various settings in an effort to increase FV consumption of children 6 by expanding knowledge, exposure, and preferences for a variety of FV. 7Objective: The purpose of this review was to identify the effectiveness of gardening 8 interventions that have been implemented to increase FV consumption among children. 9Methods: A systematic review was conducted using four electronic databases: Web of Science, 10PubMed, Scopus, and CINAHL. English language studies conducted in developed countries 11 between January 2005 and October 2015 were included in this review. Included studies 12 measured FV consumption of children ages 2-15 years old before and after implementation of a 13 gardening intervention in a school, community, or after school setting. All study designs were 14 included in this review. A total of 891 articles were identified through database searching and 15 cross-referencing. After removing duplicates, 650 articles remained and were screened using 16 inclusion and exclusion criteria. Twenty-seven full text articles were analyzed and 14 articles 17 were included in this review. 18Results: Of the 14 articles reviewed, 10 articles found statistically significant increases in fruit 19 or vegetable consumption among participants after implementation of a gardening intervention. 20However, many studies were limited by the use of convenience samples, small sample sizes, and 21 self-reported measurements of FV consumption. 22
Conclusions:Although the evidence is mixed and fraught with limitations, most studies suggest 23 a small but positive impact of gardening interventions on children's FV intake. Future studies 24 GARDENING INTERVENTIONS FOR CHILDREN 2 that include control groups, randomized designs, and assessments of FV consumption over at 25 least one year are needed to advance the literature on this topic.
Mortality risk across metabolic health-by-BMI categories in NHANES-III was examined. Metabolic health was defined as: (1) homeostasis model assessment-insulin resistance (HOMA-IR) <2.5; (2) ≤2 Adult Treatment Panel (ATP) III metabolic syndrome criteria; (3) combined definition using ≤1 of the following: HOMA-IR ≥1.95 (or diabetes medications), triglycerides ≥1.7 mmol/L, HDL-C <1.04 mmol/L (males) or <1.30 mmol/L (females), LDL-C ≥2.6 mmol/L, and total cholesterol ≥5.2 mmol/L (or cholesterol-lowering medications). Hazard ratios (HR) for all-cause mortality were estimated with Cox regression models. Nonpregnant women and men were included (n = 4373, mean ± SD, age 37.1 ± 10.9 years, BMI 27.3 ± 5.8 kg/m2, 49.4% female). Only 40 of 1160 obese individuals were identified as MHO by all definitions. MHO groups had superior levels of clinical risk factors compared to unhealthy individuals but inferior levels compared to healthy lean groups. There was increased risk of all-cause mortality in metabolically unhealthy obese participants regardless of definition (HOMA-IR HR 2.07 (CI 1.3–3.4), P < 0.01; ATP-III HR 1.98 (CI 1.4–2.9), P < 0.001; combined definition HR 2.19 (CI 1.3–3.8), P < 0.01). MHO participants were not significantly different from healthy lean individuals by any definition. While MHO individuals are not at significantly increased risk of all-cause mortality, their clinical risk profile is worse than that of metabolically healthy lean individuals.
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