Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews

Abstract

Background Many children worldwide do not eat recommended amounts of vegetables. Disliking vegetables is a key factor associated with low intake. Objective This umbrella review synthesized systematic reviews to determine the effectiveness of sensory and behavioral strategies to facilitate liking of vegetables (primary outcome) in young children up to 5 y of age, as key predictors of vegetable intake (secondary outcome). Methods Nine databases were searched up to May 2019 (updated in September 2020). Two reviewers independently conducted study screening and selection, data extraction, and assessment of methodological quality using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Eleven reviews (n = 1 rated strong quality, n = 4 moderate quality, n = 6 low/critically low quality) examining 85 primary studies met the review criteria: systematic reviews and meta-analyses of primary studies (any quantitative design) that examined sensory or behavioral strategies on vegetable liking or intake (outcomes reported separately for children ≤5 y). Strategy effectiveness was synthesized into 3 categories based on evidence strength: 1) promising (large and consistent body of moderate quality evidence), 2) emerging (small to moderate body of mixed consistency and quality evidence), and 3) limited (small body of limited consistency and quality evidence). Results Promising evidence was identified for repeated exposure to a single or a variety of vegetables. Emerging evidence was identified for several strategies that increase familiarity with vegetable flavors (e.g., via exposure in utero and through breast milk, and a “vegetable first” approach to complementary feeding) and/or willingness to try vegetables (e.g., via parental role modeling, nonfood rewards, and vegetable-based story books). Conclusions Current evidence supports incorporation of tailored advice into guideline documents for parents and carers to repeatedly expose their children to a variety of vegetables to increase vegetable intake. Ongoing robust research on strategies to facilitate children's liking of vegetables is warranted to strengthen the evidence base underpinning advice for parents and health professionals.

Development and Proof-of-Concept Evaluation of a Sensory Science-Based Model for Product Development of Vegetable-Based Products for Children

“…Most of our food preferences are learned [ 9 , 20 ]. A recently published umbrella review (which is a systematic review of systematic reviews) based on 11 systematic reviews, which together covered 85 primary studies, has found solid evidence that familiarisation through repeated exposure to a single, and to a variety of, vegetables increases vegetable acceptance and intake in children under five years old [ 58 ]. Several reviews have shown that repeated exposure is also effective in increasing vegetable acceptance and intake in primary school children [ 59 , 60 ].…”

Application of the multiphase optimisation strategy to develop, optimise and evaluate the effectiveness of a multicomponent initiative package to increase 2-to-5-year-old children’s vegetable intake in long day care centres: a study protocol

“…The initiatives will use a paradigm that focuses on building acceptance and familiarity with vegetables, as a sustainable approached to increasing vegetable intake. 44 This study will use a full factorial design during the optimisation phase to identify which components individually and in combination, produce the best initiative package subject to constraints. Using this approach will overcome limitations of studies testing either single intervention components or multicomponent interventions, that are unable to identify which component(s) or combination of components are most effective.…”

Menu Audit of Vegetable-Containing Food Offering in Primary School Canteens in Sydney, Australia: A Preliminary Study

“…As vegetables are the most disliked food group [23], they can easily be overlooked by canteen managers in favour of other food categories to meet canteen guidelines, in particular as policy guidelines typically focus on limiting unhealthy food options. However, vegetable liking is a learned behaviour [24], and therefore normalising vegetable consumption in food environments other than at home is important both for increasing acceptance and consumption. A first step would be an inventory of the current state of play.…”