Effect of a Parent-Focused eHealth Intervention on Children’s Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial

Abstract

Background In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet. Objective In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment. Methods The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420

Scoping review showed that obesity prevention in Nordic countries had limited effects on children from birth to 7 years of age

“…The subjects ate more vegetables and had healthier eating routines, with less sugary drinks and less added sugar. [39][40][41][42]45,56,57 These are all interesting results, since diet seems to have had a closer correlation with a child's BMI than other factors, such as physical activity. 58 However, there were no lasting effects at any of the long-term follow-up points, apart from in the subgroups analyses.…”

Preferences for lemon consumption by Mexicans and its relationship with consumer needs, emotions, and attitudes

“…(2010) ( n = 422); Phan & Chambers (2018) ( n = 100); Manstan & McSweeney (2020) ( n = 329); Røed et al . (2021) ( n = 298); Lamonaca et al . (2022) ( n = 672).…”

Discretionary foods and drinks in Norwegian children and adolescents’ diet: data from the national dietary survey Ungkost 3

“…In the present study, we included cakes, buns, waffles, muffins, biscuits and other pastries, potato crisps, chips and similar snacks, ice cream, including sorbet, sweet desserts, all sugar-sweetened drinks including soft drinks, fruit drinks, sports drinks and energy drinks, sugar confectionaries, including chocolate, sugar candy or sweets, sweet spreads and sweet snack bars in the definition of discretionary foods. This definition was based partly on previous work by Medin et al in the same study population (19) and recent studies in another Norwegian (20) , a Danish (21) and seven European populations (22) .…”