Use of the Veggie Meter® as a tool to objectively approximate fruit and vegetable intake among youth for evaluation of preschool and school‐based interventions

Abstract

Background Reflection spectroscopy is an emerging, non‐invasive objective measure used to approximate fruit and vegetable intake. The present study aimed to use a reflection spectroscopy device (the Veggie Meter®, Longevity Link Corporation, Salt Lake City, UT, USA) to assess skin carotenoid status in preschool, middle‐ and high‐school students and to examine associations between skin carotenoids and self‐reported dietary intake. Methods In Autumn 2018, we used the Veggie Meter® to assess skin carotenoids and age‐appropriate validated dietary assessment measures to approximate fruit and vegetable (FV) intake. Preschool participants completed a previously validated pictorial liking tool using an iPad (Apple Inc., Cupertino, CA, USA). Middle‐school participants completed selected questions from the validated School Physical Activity and Nutrition (SPAN) (Michael & Susan Dell Center for Healthy Living, University of Texas, Austin, TX, USA) questionnaire regarding frequency of their FV and beverage intake on the previous day, with additional questions about physical activity. High‐school participants’ FV intake was assessed using the Fruit and Vegetable Screener (National Cancer Institute, Bethesda, MD, USA). Spearman correlation coefficients were used to determine bivariate associations between measures of dietary intake and Veggie Meter®‐assessed skin carotenoid levels. Results Mean (SD) Veggie Meter® readings were 266 (82.9), 219 (68.1) and 216 (67.2) among preschool, middle‐ and high‐school students. There was an inverse association between soda intake and Veggie Meter® readings (r = −0.22, P = 0.03) among middle‐school students; and a positive association between daily fruit intake and Veggie Meter® readings (r = 0.25, P = 0.06) among high‐school students. Conclusions The Veggie Meter® comprises a promising evaluation tool for preschool and school‐based nutrition interventions.

Measuring Skin Carotenoids Using Reflection Spectroscopy in a Low-Income School Setting

“…While dietary intake was only assessed by proxy using the Veggie Meter ® , this was by design, as the Veggie Meter ® has been previously validated against several different criteria [43], and it was critical to determine if it can be successfully implemented in lowincome schools despite the logistical challenges that accompany working in this setting. Overall, this study supports the growing body of literature that suggests that the Veggie Meter ® is an appropriate tool for measuring change in fruit and vegetable consumption by proxy in the school setting, especially in a low-income school setting [24][25][26].…”

“…With these considerations in mind, reflection spectroscopy has emerged as a relatively low-cost, non-invasive, and most-importantly, objective method of detecting changes in dietary behavior, specifically consumption of carotenoid-containing fruits and vegetables [24][25][26][27]. When consumed, carotenoids are deposited in the skin; greater consumption of fruits and vegetables is associated with higher amounts of detectable skin carotenoids [28].…”

Recommendations for the Use of the Veggie Meter® for Spectroscopy-Based Skin Carotenoid Measurements in the Research Setting

“…Before conducting skin carotenoid measurements, it is advantageous to describe the operational procedure of the Veggie Meter ® to participants to avoid apprehension due to the frequent assumption that the measurement will be painful ( 15 , 19 , 24 ). When working with toddlers, children, or adolescents, it is recommended to both verbally explain and demonstrate the process of measuring skin carotenoids using the Veggie Meter ® to ensure the participants feel comfortable during data collection procedures ( 19 ). In infants and toddlers, digit size will play a role in accuracy of measurements; therefore, before working with infants, toddlers, or children, contact the manufacturers for instructions and device modifications.…”

“…Effective methods for measuring F/V consumption, such as the rapid and noninvasive carotenoid detection method using the Veggie Meter ® , have the capacity to assess public health and nutrition education interventions; assist physicians, registered dietitians, and other health professionals with monitoring the health status of patients; and assist in research as an objective biomarker for F/V intake ( 10 , 20 , 21 , 24 , 35 , 36 ). The Veggie Meter ® has been used to measure skin carotenoids in ethnically diverse toddlers, children, and adult populations in both clinical and nonclinical settings ( 12 , 15 , 19 – 24 , 37 , 38 ). Future research efforts should focus on conducting a systematic review of the studies using the Veggie Meter ® to determine if the differences in published methods for skin carotenoid data acquisition affect the reported outcomes ( Table 4 ).…”

“…The Veggie Meter ® device is accompanied by an operating procedure ( 18 ); however, these instructions are subject to individual interpretation and, therefore, implementation may not be consistent among users. After a comprehensive review of the literature in early 2020, the novelty of the device was apparent by the limited number of publications ( 12 , 15 , 19 – 25 ). In the existing literature and supported by anecdotal evidence, inconsistencies among researchers were observed and procedural details pertaining to the Veggie Meter ® were not reported in detail.…”