Fruit and Vegetable Intake in Preschoolers
- Conditions
- Children, OnlyNutrition, Healthy
- Interventions
- Behavioral: Nutrition education curriculum
- Registration Number
- NCT05730530
- Lead Sponsor
- University of Virginia
- Brief Summary
The goal of this randomized controlled trial is to examine fruit and vegetable consumption in preschoolers following a nutrition education curriculum. The main questions it aims to answer is:
1. Is this intervention consisting of nutrition education and taste-test activities able to improve fruit and vegetable consumption in preschoolers during their usual lunch meal?
2. Is the improvement of fruit and vegetable consumption sustained for at least 6 weeks after completion of the intervention?
Participants in the intervention classroom will partake in 3 nutrition education sessions per week during the 6-week-long curriculum. Researchers will compare this to changes in fruit and vegetable intake of the children in the control classroom, who will undergo identical measurements, but will not participate in the curriculum.
- Detailed Description
Fruit and vegetable consumption in preschoolers in the United States is very low, with the majority of children not meeting the national recommendations. However, there is a lack of data indicating effective strategies to increase preschooler's fruit and vegetable intake and whether socio-demographic and eating behavior-related child characteristics (child eating behavior and relationship with food) may predict fruit and vegetable consumption in preschoolers as well as their response to the intervention. This information is important for researchers because it may allow for more effective development of future interventions that consider these potential external influences. There is also a lack of evidence-based interventions that are based on theoretical behavior change frameworks and the associated behavior change techniques. Furthermore, studies lack a long enough follow-up to measure whether any possibly observed behavior change (more fruits and vegetables consumed) in the preschoolers is maintained following the cessation of the intervention.
While fruit and vegetable consumption is associated with lower blood pressure in adults, little is known about this relationship in children. This will be examined in our study to determine if there is an association between blood pressure and fruit and vegetable intake at baseline and whether this association changes following the intervention.
To control for differences in energy needs, it is important to control for children's BMI-for-age percentile, which is calculated using their age, height, and weight. This is necessary because children who have higher BMI percentiles typically require more total energy consumption, which may influence fruit and vegetable consumption. Additionally, previous studies have observed that children with greater BMI percentile are less likely to eat adequate amounts of fruits and vegetables. However, this has not been measured in an interventional manner, and therefore it is unknown whether these associations are omnipotent, and whether they remain following a fruit and vegetable intervention. Therefore, our study will examine these relationships in a small sample of preschoolers to either support or contradict these previous observations.
In addition to measuring fruit and vegetable intake, it is also important to measure physical activity levels as a control variable for total energy requirements, as changes in physical activity levels may confound changes in dietary intake, including intake of fruits and vegetables. This is especially true of interventions that span different seasons (ie. winter and spring), as these may also influence physical activity levels and, subsequently, energy requirements. Secondarily, previous research has established an association between fruit and vegetable intake and both physical activity levels and screen time in children and adults. However, no studies have explored this relationship in preschool-aged children. Additionally, the evidence of the relationship between these two variables is limited to cross-sectional data; it is unknown whether an increase in one would influence the other. We plan to examine this in a small sample of preschoolers in an interventional setting.
Therefore, the purpose of this research is to determine whether such an intervention is able to increase and maintain fruit and vegetable intake during lunch in a sample of preschoolers, controlling for age, BMI percentile, and activity level. Additional aims are 1) to explore the relationship between fruit and vegetable intake and blood pressure, 2) examine the relationship between FV intake and physical activity levels in this sample of preschoolers, and 3) examine how BMI-percentile and socio-demographic and child- and parent-related eating-related characteristics are associated with fruit and vegetable intake. We plan to publish our findings in a scientific journal to contribute to the advancement of knowledge regarding interventions to improve fruit and vegetable intake in preschoolers, as information is evidently needed in this topic.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 19
- Typically-developing children with no food allergies and not taking medication
- Food Allergies
- Taking medications
- Developmental delays
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Nutrition education curriculum Classroom assigned to receive the 6-week long nutrition education curriculum
- Primary Outcome Measures
Name Time Method Fruit and vegetable intake post-intervention Change in fruit and vegetable intake from baseline (week 0) to post-intervention (week 7) Fruits and vegetables consumed during a typical lunch meal, measured using plate-waste weighing method, which involves subtracting the grams of food leftover from the grams of food served to estimate the grams of food consumed. All weighing of the foods will be done in the Diet and Nutrition Lab before and after going to the childcare center. This will be measured on three consecutive days during each of the measurement weeks below.
Fruit and vegetable intake at follow-up Change in fruit and vegetable intake from baseline (week 0) to follow-up (week 14) Fruits and vegetables consumed during a typical lunch meal, measured using plate-waste weighing method, which involves subtracting the grams of food leftover from the grams of food served to estimate the grams of food consumed. All weighing of the foods will be done in the Diet and Nutrition Lab before and after going to the childcare center. This will be measured on three consecutive days during each of the measurement weeks below.
Skin carotenoid levels post-intervention Change in fruit and vegetable intake from baseline (week 0) to post-intervention (week 7) Children's fruit and vegetable intake will be confirmed using a measure of skin carotenoid levels. This will be measured using a VeggieMeter device, which utilizes non-invasive reflection spectroscopy to estimate the amount of dietary carotenoids deposited into the skin. Children will be asked to wash their hands and then place their right pointer finger on a small lens for approximately 15 seconds. This will be measured immediately following the 3 measured lunch meals at the 3 time points.
Skin carotenoid levels at follow-up Change in fruit and vegetable intake from baseline (week 0) to follow-up (week 14) Children's fruit and vegetable intake will be confirmed using a measure of skin carotenoid levels. This will be measured using a VeggieMeter device, which utilizes non-invasive reflection spectroscopy to estimate the amount of dietary carotenoids deposited into the skin. Children will be asked to wash their hands and then place their right pointer finger on a small lens for approximately 15 seconds. This will be measured immediately following the 3 measured lunch meals at the 3 time points.
- Secondary Outcome Measures
Name Time Method Systolic and diastolic blood pressure, baseline Baseline (week 0) Systolic and diastolic blood pressure will be measured in duplicate using an automatic monitor fitted with a child-sized cuff. These blood pressure measures will also be converted to sex-, height-, and age-based blood pressure percentiles using an online calculator developed by Baylor College of Medicine. This will be measured on three consecutive days during each of the measurement weeks below.
Systolic and diastolic blood pressure, post-intervention post-intervention (week 7) Systolic and diastolic blood pressure will be measured in duplicate using an automatic monitor fitted with a child-sized cuff. These blood pressure measures will also be converted to sex-, height-, and age-based blood pressure percentiles using an online calculator developed by Baylor College of Medicine. This will be measured on three consecutive days during each of the measurement weeks below.
Fruit and vegetable liking, baseline to post-intervention Change in fruit and vegetable liking from baseline (week 0) to post-intervention (week 7) Food liking will be measured during the observed lunch meals using age-appropriate Likert scales that ask children about whether they "like", "neither", or "dislike" the specified food's appearance, smell, taste, and texture, and their overall liking of the food.
Anthropometrics Baseline (week 0) Each child's height and weight will be measured. This will be used to calculate their BMI-for-age percentile score based on the CDC growth charts.
Systolic and diastolic blood pressure, follow-up follow-up (week 14) Systolic and diastolic blood pressure will be measured in duplicate using an automatic monitor fitted with a child-sized cuff. These blood pressure measures will also be converted to sex-, height-, and age-based blood pressure percentiles using an online calculator developed by Baylor College of Medicine. This will be measured on three consecutive days during each of the measurement weeks below.
Physical activity levels, baseline Baseline (week 0) Physical activity levels will be measured using Actigraph GT3X accelerometers secured with a colorful belt to each child's hip. This data will consist of time spent in the various levels of physical activity (sedentary, light, moderate, and vigorous) and will be measured in 3-day-periods at the time points below. Additionally, parents will be asked to keep a log of when their child is wearing the Actigraph device while at home including the time they take the device off before bed, time they put it on in the morning, and when it is removed for bathing.
Physical activity levels, post-intervention Post-intervention (week 7) Physical activity levels will be measured using Actigraph GT3X accelerometers secured with a colorful belt to each child's hip. This data will consist of time spent in the various levels of physical activity (sedentary, light, moderate, and vigorous) and will be measured in 3-day-periods at the time points below. Additionally, parents will be asked to keep a log of when their child is wearing the Actigraph device while at home including the time they take the device off before bed, time they put it on in the morning, and when it is removed for bathing.
Fruit and vegetable liking, baseline to follow-up Change in fruit and vegetable liking from baseline (week 0) to follow-up (week 14) Food liking will be measured during the observed lunch meals using age-appropriate Likert scales that ask children about whether they "like", "neither", or "dislike" the specified food's appearance, smell, taste, and texture, and their overall liking of the food.
Willingness to try fruit and vegetable Once weekly during the taste-test activity of the nutrition education curriculum (6 weeks total; weeks 1-6) Willingness to try foods will be measured during the taste-test activity using the Taste Test Tool that involves asking the children a series of questions including: "Have you ever seen this food before?", "Have you ever tried this food before?", "Did you try this food today?", "Would you try this food again at school?", "Would you try this food again at home?"and "Would you ask for this food at home?" Children will be asked to answer "yes", "no", or "not sure". This will only be measured in the children whose classroom has been allocated to the intervention group (nutrition education curriculum)
Satiety, baseline Baseline (week 0) Satiety will be measured immediately before and after the ad libitum lunch meals where food intake is measured. First, an age-appropriate story will be read to the children to familiarize them with the meanings of "hungry" and "full" and children will be asked to answer questions about the characters' feelings of hunger/fullness based on what they reported eating to ascertain comprehension. Then, satiety will be measured using an age-appropriate 4-point scale developed for preschool children. The children are first asked whether they are hungry or full, and then subsequently asked the intensity of the feeling using "very" or "a little", ie "a little hungry/full" or "very hungry/full".
Satiety, follow-up follow-up (week 14) Satiety will be measured immediately before and after the ad libitum lunch meals where food intake is measured. First, an age-appropriate story will be read to the children to familiarize them with the meanings of "hungry" and "full" and children will be asked to answer questions about the characters' feelings of hunger/fullness based on what they reported eating to ascertain comprehension. Then, satiety will be measured using an age-appropriate 4-point scale developed for preschool children. The children are first asked whether they are hungry or full, and then subsequently asked the intensity of the feeling using "very" or "a little", ie "a little hungry/full" or "very hungry/full".
Satiety, post-intervention post-intervention (week 7) Satiety will be measured immediately before and after the ad libitum lunch meals where food intake is measured. First, an age-appropriate story will be read to the children to familiarize them with the meanings of "hungry" and "full" and children will be asked to answer questions about the characters' feelings of hunger/fullness based on what they reported eating to ascertain comprehension. Then, satiety will be measured using an age-appropriate 4-point scale developed for preschool children. The children are first asked whether they are hungry or full, and then subsequently asked the intensity of the feeling using "very" or "a little", ie "a little hungry/full" or "very hungry/full".
Food intake during snack, baseline Baseline (week 0) Snack intake (during morning and afternoon snack) will be measured during the same days as the lunch intake measurements, but will use different methods. For snack intake measurements, trained researchers will use visual observation to estimate the children's snack intake that will be recorded using common household measurements (cups, tablespoons, etc). Researchers will each be assigned 4 children to record. They will be asked not to engage with the children. This will be used in their estimate of total energy requirements.
Food intake during snack, post-intervention Post-intervention (week 7) Snack intake (during morning and afternoon snack) will be measured during the same days as the lunch intake measurements, but will use different methods. For snack intake measurements, trained researchers will use visual observation to estimate the children's snack intake that will be recorded using common household measurements (cups, tablespoons, etc). Researchers will each be assigned 4 children to record. They will be asked not to engage with the children. This will be used in their estimate of total energy requirements.
Food intake at home, baseline Baseline (week 0) Parents will be asked to report their child's usual diet using two researcher-conducted, parent-assisted 24-hour dietary recall method. This will occur on the same days that lunch intake and skin carotenoids will be recorded. This will be collected using Nutrition Data System for Research (NDSR) program that has an integrated script for prompting of dietary intake. There are additional supplementary questions following the dietary recall that ask parents to report the amount of time the child spent in sedentary activity and amount of screen time the child engaged in the previous day, both in minutes.
Food intake at home, post-intervention Post-intervention (week 7) Parents will be asked to report their child's usual diet using two researcher-conducted, parent-assisted 24-hour dietary recall method. This will occur on the same days that lunch intake and skin carotenoids will be recorded. This will be collected using Nutrition Data System for Research (NDSR) program that has an integrated script for prompting of dietary intake. There are additional supplementary questions following the dietary recall that ask parents to report the amount of time the child spent in sedentary activity and amount of screen time the child engaged in the previous day, both in minutes.
Trial Locations
- Locations (1)
Westminster Child Care Center
🇺🇸Charlottesville, Virginia, United States