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Interventions for increasing fruit and vegetable consumption in children
aged five years and under.
Cochrane Database Syst Rev. 2018 05 17;5:CD008552
Authors: Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton-McHarg T,
Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong
SL, Wolfenden L
Abstract
BACKGROUND: Insufficient consumption of fruits and vegetables in childhood
increases the risk of future non-communicable diseases, including
cardiovascular disease. Interventions to increase consumption of fruit and
vegetables, such as those focused on specific child-feeding strategies and
parent nutrition education interventions in early childhood may therefore
be an effective strategy in reducing this disease burden.
OBJECTIVES: To assess the effectiveness, cost effectiveness and associated
adverse events of interventions designed to increase the consumption of
fruit, vegetables or both amongst children aged five years and under.
SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and two clinical
trials registries to identify eligible trials on 25 January 2018. We
searched Proquest Dissertations and Theses in November 2017. We reviewed
reference lists of included trials and handsearched three international
nutrition journals. We contacted authors of included studies to identify
further potentially relevant trials.
SELECTION CRITERIA: We included randomised controlled trials, including
cluster-randomised controlled trials and cross-over trials, of any
intervention primarily targeting consumption of fruit, vegetables or both
among children aged five years and under, and incorporating a dietary or
biochemical assessment of fruit or vegetable consumption. Two review
authors independently screened titles and abstracts of identified papers; a
third review author resolved disagreements.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted
data and assessed the risks of bias of included studies; a third review
author resolved disagreements. Due to unexplained heterogeneity, we used
random-effects models in meta-analyses for the primary review outcomes
where we identified sufficient trials. We calculated standardised mean
differences (SMDs) to account for the heterogeneity of fruit and vegetable
consumption measures. We conducted assessments of risks of bias and
evaluated the quality of evidence (GRADE approach) using Cochrane
procedures.
MAIN RESULTS: We included 63 trials with 178 trial arms and 11,698
participants. Thirty-nine trials examined the impact of child-feeding
practices (e.g. repeated food exposure) in increasing child vegetable
intake. Fourteen trials examined the impact of parent nutrition education
in increasing child fruit and vegetable intake. Nine studies examined the
impact of multicomponent interventions (e.g. parent nutrition education and
preschool policy changes) in increasing child fruit and vegetable intake.
One study examined the effect of a nutrition education intervention
delivered to children in increasing child fruit and vegetable intake.We
judged 14 of the 63 included trials as free from high risks of bias across
all domains; performance, detection and attrition bias were the most common
domains judged at high risk of bias for the remaining studies.There is very
low quality evidence that child-feeding practices versus no intervention
may have a small positive effect on child vegetable consumption equivalent
to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33,
95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent
interventions versus no intervention may have a very small effect on child
consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66;
participants = 2009; studies = 5; low-quality evidence), equivalent to an
increase of 0.37 cups of fruit and vegetables per day. It is uncertain
whether there are any short-term differences in child consumption of fruit
and vegetables in meta-analyses of trials examining parent nutrition
education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28;
participants = 3078; studies = 11; very low-quality evidence).Insufficient
data were available to assess long-term effectiveness, cost effectiveness
and unintended adverse consequences of interventions. Studies reported
receiving governmental or charitable funds, except for four studies
reporting industry funding.
AUTHORS' CONCLUSIONS: Despite identifying 63 eligible trials of various
intervention approaches, the evidence for how to increase children's fruit
and vegetable consumption remains limited. There was very low- and
low-quality evidence respectively that child-feeding practice and
multicomponent interventions may lead to very small increases in fruit and
vegetable consumption in children aged five years and younger. It is
uncertain whether parent nutrition education interventions are effective in
increasing fruit and vegetable consumption in children aged five years and
younger. Given that the quality of the evidence is very low or low, future
research will likely change estimates and conclusions. Long-term follow-up
is required and future research should adopt more rigorous methods to
advance the field.This is a living systematic review. Living systematic
reviews offer a new approach to review updating, in which the review is
continually updated, incorporating relevant new evidence as it becomes
available. Please refer to the Cochrane Database of Systematic Reviews for
the current status of this review.
PMID: 29770960
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Dette abstract er hentet via PubMed fra National Library of Medicine, USA
<https://www.ncbi.nlm.nih.gov/home/about/policies>.
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