STRATEGIES TO INCREASE VEGETABLE INTAKE AND MODERATE ENERGY INTAKE IN PRESCHOOL-AGED CHILDREN
Open Access
- Author:
- Spill, Maureen
- Graduate Program:
- Nutrition
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 07, 2011
- Committee Members:
- Barbara Jean Rolls, Dissertation Advisor/Co-Advisor
Barbara Jean Rolls, Committee Chair/Co-Chair
Leann L Birch, Committee Member
Terryl Johnson Hartman, Committee Member
Cynthia Bartok, Committee Member
Danielle Symons Downs, Committee Member - Keywords:
- energy density
portion size
children
energy intake
vegetable - Abstract:
- Despite the known benefits for consuming vegetables, vegetable consumption is far below recommendations in children and adults. In addition, rates of childhood overweight and obesity have been rising over the past 3 decades. Children’s dietary habits are likely to continue into adulthood and can affect their risk of chronic diseases such as diabetes, cardiovascular disease, and some cancers. Therefore, it is imperative to identify strategies to improve the diet habits of children particularly through increasing vegetable intake and decreasing energy intake. Serving larger portions of low-energy-dense vegetables at a meal could have beneficial effects on children’s food and energy intake. We investigated whether increasing the portion size of vegetables served at the start of a meal leads to increased vegetable consumption and decreased meal energy intake in children. Using a crossover design, 3- to 5-year-old children (n=51) in a daycare center were served a test lunch once a week for 4 weeks. In 3 of the meals, a first course of raw carrots was varied in portion size (30, 60, or 90 g), and in the control meal, no first course was served. Children consumed the first course ad libitum over 10 minutes and then were served a main course of pasta, broccoli, applesauce, and milk, also consumed ad libitum. Total vegetable consumption at the meal increased as the portion size of carrots was increased (P<0.0001). Doubling the portion size of the first course increased carrot consumption by 47%, or 12±2 g (P<0.0001). Tripling the portion size of carrots, however, did not lead to a further increase in intake (P=0.61). Meal energy intake was not significantly affected by the amount of carrots served in the first course. The effect of portion size on intake was not significantly influenced by the children’s age or body weight status. Increasing the portion size of a vegetable served as a first course can be an effective strategy to increase vegetable consumption in preschool children. Study 2 tested whether varying the portion of low-energy-dense vegetable soup served at the start of a meal affects meal energy and vegetable intakes in children. Subjects were 3- to 5-year-olds (n=72) in daycare facilities. Using a crossover design, children were served lunch once a week for four weeks. On three occasions, different portions of tomato soup (150, 225, and 300 g) were served at the start of the meal, and on one occasion no soup was served. Children had 10 minutes to consume the soup before being served the main course which consisted of pasta, broccoli, applesauce, and milk. All foods were consumed ad libitum. The primary outcomes were soup intake as well as energy and vegetable intake at the main course. A mixed linear model tested the effect of soup portion size on intake. Serving any portion of soup reduced entrée energy intake compared with serving no soup, but total meal energy intake was only reduced when 150 g of soup was served. Increasing the portion size increased soup and vegetable intake. Serving low-energy-dense, vegetable soup as a first course is an effective strategy to reduce children’s intake of a more energy-dense main entrée and increase vegetable consumption at the meal. Substantial amounts of vegetables can be incorporated into foods to reduce their energy density (kcal/g; ED) without children noticing. This strategy, which has the potential to increase vegetable intake and decrease energy intake, was tested in a crossover study with 3- to 5-year-old children. In a daycare center, 40 children were served all meals and snacks one day a week for 3 weeks. Across conditions, breakfast, lunch, and dinner entrées were reduced in ED by increasing the proportion of puréed vegetables. The conditions were 100% ED (standard), 85% ED (tripled vegetable content), and 75% ED (quadrupled vegetable content). These were served with unmanipulated side dishes, and children were instructed to eat as much as they liked. The results showed that daily vegetable intake increased significantly by 52 g (50%) in the 85% ED condition and 73 g (73%) in the 75% ED condition compared to the standard condition (both p<0.0001). Consuming more vegetables in the entrées did not affect consumption of the vegetable side dishes. Children ate a similar weight of food across conditions, thus significantly decreasing daily energy intake by 142 kcal (12%) from the 100% ED to the 75% ED condition (p<0.05). Children rated their liking of the manipulated foods similarly. Incorporating substantial amounts of puréed vegetables into foods is an effective strategy to increase vegetable intake and decrease energy intake in young children. These studies have provided evidence that increasing the portion size vegetables served to children and incorporating puréed vegetables into children’s entrées can be used to increase children’s vegetable intake. Serving vegetables at the start of the meal and within the entrées added to intake of vegetable side dishes at the meal and increased total vegetable intake. Providing soup at the start of the meal reduced energy intake of the energy-dense entrée, and may be an effective strategy to decrease energy intake in children. Incorporating puréed vegetables into entrées led to a significant reduction of children’s daily energy intake. Offering vegetables as a first course, providing large portions of well-liked vegetables, serving vegetable-enhanced entrée, and serving vegetable side dishes are all methods that parents and caregivers should incorporate into their daily meal routines to significantly increase children’s vegetable consumption. Used together these techniques are likely to have a substantial impact on the number of children meeting their recommended vegetable intake levels.