Results from an experimental trial at a Head Start center to evaluate two meal service approaches to increase fruit and vegetable intake of preschool aged children

Abstract

BackgroundStrategies to increase fruit and vegetable consumption of preschool aged children are needed.ObjectivesEvaluate the independent effects of the following meal service strategies on intake of fruits and vegetables of preschool children: 1.) Serving fruits and vegetables in advance of other menu items as part of traditional family style meal service; and 2.) Serving meals portioned and plated by providers.MethodsFifty-three preschool aged children completed a randomized crossover experiment conducted at a Head Start center in Minneapolis, MN. Over a six week trial period each of the experimental meal service strategies (serving fruits and vegetable first and serving meals portioned by providers) was implemented during lunch service for two one-week periods. Two one-week control periods (traditional family style meal service with all menu items served at once) were also included over the six week trial period. Childrens lunch intake was observed as a measure of food and nutrient intake during each experimental condition.ResultsFruit intake was significantly higher (p<0.01) when fruits and vegetables were served in advance of other meal items (0.40 servings/meal) compared to the traditional family style meal service control condition when they were served in tandem with other menu items (0.32 servings/meal). Intakes of some nutrients found in fruits (vitamin A and folate) were concomitantly higher. In contrast, fruit and vegetable intakes were significantly lower and energy intake significantly higher during the provider portioned compared with control condition.ConclusionsServing fruits in advance of other meal items may be a low cost easy to implement strategy for increasing fruit intake in young children. However, serving vegetables first does not appear to increase vegetable intake. Results provide support for current recommendations for traditional family style meal service in preschool settings.

Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2–5 years

“…When 44 intervention arms within studies were used as the unit of analysis, a slightly higher effect size was observed g = 0.42, CI: 0.33-0.51, Z = 8.79, p < 0.001. The sensitivity analyses performed by excluding three studies (Bell et al, 2015;Harnack et al, 2012;Spill et al, 2010) …”

“…For studies with more than one intervention group, the intervention arm (condition) was used as the unit of analysis. Sensitivity analysis was performed by excluding three studies, one which reported median data (Bell, Hendrie, Hartley, & Golley, 2015), another with various experimental conditions but none were defined as standard or control condition (Spill, Birch, Roe, & Rolls, 2010) and a third study by Harnack et al (2012) who found non-significant effects for one of their intervention arm but did not report the precise p value (p value of > 0.05 was entered as 0.06). Subgroup analysis was conducted based on study methodology (study design, location, study setting and quality assessment ratings) and intervention factors (intervention strategies, type of vegetable, outcome measurements, delivered by and the intervention recipient).…”

Current Trends in Childhood Obesity Research

“…Harnack et al [52] found that preschool children who served themselves, compared with children who received portioned meals from childcare providers, ate significantly more servings of fruits and vegetables, fewer servings of meat, and lower percent energy intake from fat. In another study, adolescent participants using a special plate designed by their peers selected less food overall and more fruits than those using a standard plate, and participants with higher BMIs selected a greater amount of healthful food when using the special plate [53].…”

Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children

“…23 Additional recommendations include eating with children, 24,25 talking about healthy foods, 24 enthusiastic modelling, 26,27 multiple food exposures, 3,28 appropriate portion sizes, 3,29 and serving nutrient-dense food first. 30,31 However, children attending childcare are often served and consume foods high in fat, 34,36 salt, 36 sugar, 36 and excessive protein. 31,40 Furthermore, childcare attendees do not eat enough grains or vegetables, 34–37 especially dark, nutrient-rich vegetables.…”

“…13,15–19,21,22,25–28,30,31,33,44,45 Little is known about obesogenic practices in centers serving American Indian children, who are vulnerable to health inequalities. 10,46–48 Understanding and improving factors related to the development of obesity by young minority children may improve health disparities.…”