Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study

Objectives: To evaluate the long-term effects of the Schoolgruiten Project, a Dutch primary school-based intervention providing free fruit and vegetables (F&V). In addition, we assessed whether children's appreciation of the project mediated these intervention effects. Design and methods: Participating schoolchildren (mean age 9?9 years at baseline) and their parents completed parallel questionnaires at baseline, at 1-year and at 2-year follow-up, including questions on usual F&V intake of the child, potential behavioural determinants, their appreciation of the project and general demographics. Primary outcomes were usual F&V intakes as assessed by parent and child self-reported food frequency measures. Secondary outcome measures were taste preference, knowledge of daily recommendations, availability and accessibility for fruit intake. Multilevel linear regression analyses were used to assess differences at second follow-up adjusted for baseline values between control and intervention groups. Subjects: Reports were available for 346 intervention children (148 parents) and 425 control children (287 parents). Results: Both child and parent reports indicated that the intervention group had a significantly higher fruit intake at 2-year follow-up (difference, servings/d: 0?15; 95 % CI 0?004, 0?286 for child reports; 0?19; 95 % CI 0?030, 0?340 for parent reports). No significant effects on vegetable intake were observed. Significant positive intervention effects were also found for knowledge of fruit recommendations among boys. Some evidence was found for partial mediation analyses of the effects on fruit intake. Conclusion: The present study indicates that the Schoolgruiten scheme was effective in increasing children's fruit intake and that appreciation of the project partially mediated this effect.

Section: Discussionsupporting

confidence: 91%

Long-term effects of the Dutch Schoolgruiten Project – promoting fruit and vegetable consumption among primary-school children

Tak

Velde

Brug

2009

“…The components designed and used in this programme are similar to those used in other multi-component interventions which have been shown to be effective (5,10,14,17,19,22) . However, implementation rate is a vital component in the success of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…To tackle this issue, the Project Tomato intervention incorporated fun activities for parents and children to do together at home, because parents play a direct role in their child's eating behaviours and attitudes towards food (4,5) . Several systematic reviews have summarised existing research on school interventions to increase children's fruit and vegetable intake (6)(7)(8) and these reviews suggest multi-component interventions are the most successful in terms of improving fruit and vegetable consumption (9)(10)(11)(12)(13)(14)(15)(16)(17) , supporting the design methodology used to create the Project Tomato intervention. Some of the successful studies that have previously used multi-component interventions included the following elements in their interventions:…”

mentioning

confidence: 99%

Process evaluation of a cluster randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato

Mestres

Evans

Ransley

et al. 2011

Objective: The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8-9 years. Design: A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms. Setting: Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group. Subjects: A total of 311 children received the intervention. Results: Implementation of the intervention was low, 21?3 % of school items and 56?0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3-7 nights/week on average consumed 37?6 (95 % CI 9?8, 65?4) g more fruit and vegetables than children who ate with their parents 0-2 times/week. Conclusions: Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on children's fruit and vegetable intake.

“…Therefore, several school-based or family-based initiatives have been implemented in order to promote F&V intake among schoolchildren (24)(25)(26)(27)(28) . These programmes had a positive effect on actual intake levels among this target group in the countries where they were implemented.…”

mentioning

confidence: 99%

Fruit and vegetable consumption in a sample of 11-year-old children in ten European countries – the PRO GREENS cross-sectional survey

Lynch

Kristjansdottir

Velde

et al. 2014

104

Objective: To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines. Design: Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol. Setting: Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries. Subjects: A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project. Results: The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥ 400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥ 400 g/d as a cut-off, only 23·5 % (13·8-37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded). Conclusions: Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group. Keywords Fruit and vegetable consumption Children EuropeIt has been recognized for some time that fruit and vegetables (F&V) constitute an essential part of a healthy diet (1)(2)(3) . High consumption of F&V has been associated with a decreased risk of morbidity and mortality from a number of chronic diseases like CHD (4) , stroke (5) , type 2 diabetes (6) and certain cancers (7) . F&V are low in energy