Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.

ABSTRACT

Background Although dietary guidelines recommend that vegetables and fruits make up half the diet, it is unclear whether serving vegetables and fruits in larger portions will have sustained effects on children's intake over multiple days.

Objectives This study tested the effects on children's intake of 2 strategies for increasing the proportion of vegetables and fruits: either adding or substituting extra portions as side dishes at meals and snacks over 5 d.

Methods In a cluster-randomized crossover design with 3 periods, we provided all meals and snacks for 5 d to 53 children aged 3–5 y in classrooms in their childcare centers. In the Control condition, we served typical portions for all food groups. In the Addition condition we increased portions of low-energy-dense vegetables and fruits by 50%, and in the Substitution condition we increased portions of vegetables and fruits by 50% and also reduced portions of other foods by an equivalent weight.

Results For vegetables, the Addition strategy increased daily intake compared with Control by 24% (mean ± SEM = 12 ± 3 g/d; P = 0.0002), and the Substitution strategy increased intake compared with Control by 41% (22 ± 3 g/d; P < 0.0001). For fruits, consumption increased by similar amounts: Addition by 33% (60 ± 6 g/d) and Substitution by 38% (69 ± 8 g/d; both P < 0.0001). Both strategies increased vegetable and fruit intakes compared with Control across all 5 days (all P < 0.004), although the increase in fruit consumption with Addition declined over time (P < 0.0001). Daily energy intake compared with Control increased by 5% with Addition (57 ± 17 kcal; P = 0.001) but decreased by 6% with Substitution (−64 ± 21 kcal; P = 0.004).

Conclusions Both the Addition and Substitution strategies promoted increases in vegetable and fruit intake over 5 d in preschool children. When excess energy intake is a concern, substituting vegetables and fruits for other foods is a better option than simply serving more.

This trial was registered at http://www.clinicaltrials.gov as NCT03242863 (https://clinicaltrials.gov/ct2/show/NCT03242863), where the protocol is available.

This is a pre-copyedited, author-produced PDF of an article accepted for publication in The American Journal of Clinical Nutrition following peer review. The version of record [Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial. The American Journal of Clinical Nutrition (2021)] is available online at: https://doi.org/10.1093/ajcn/nqab321.

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Work Title Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.
Access
Open Access
Creators
  1. Liane S. Roe
  2. Christine E. Sanchez
  3. Alissa D. Smethers
  4. Kathleen L. Keller
  5. Barbara J. Rolls
Keyword
  1. Preschool children
  2. Vegetable intake
  3. Fruit intake
  4. Energy intake
  5. Portion size
  6. Dietary guidelines
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Oxford University Press (OUP)
Publication Date October 28, 2021
Publisher Identifier (DOI)
  1. 10.1093/ajcn/nqab321
Source
  1. The American Journal of Clinical Nutrition
Deposited May 23, 2022

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Work History

Version 1
published

  • Created
  • Added 2021 Kids 5-day FV Study - Accepted manuscript with figures + PROOF EDITS untracked-1.pdf
  • Added Creator Liane S Roe
  • Added Creator Christine E Sanchez
  • Added Creator Alissa D Smethers
  • Added Creator Kathleen L Keller
  • Added Creator Barbara J Rolls
  • Published
  • Updated Work Title, Description Show Changes
    Work Title
    • Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.
    • ! Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.
    Description
    • <jats:title>ABSTRACT</jats:title>
    • <jats:sec>
    • <jats:title>Background</jats:title>
    • <jats:p>Although dietary guidelines recommend that vegetables and fruits make up half the diet, it is unclear whether serving vegetables and fruits in larger portions will have sustained effects on children's intake over multiple days.</jats:p>
    • </jats:sec>
    • <jats:sec>
    • <jats:title>Objectives</jats:title>
    • <jats:p>This study tested the effects on children's intake of 2 strategies for increasing the proportion of vegetables and fruits: either adding or substituting extra portions as side dishes at meals and snacks over 5 d.</jats:p>
    • </jats:sec>
    • <jats:sec>
    • <jats:title>Methods</jats:title>
    • <jats:p>In a cluster-randomized crossover design with 3 periods, we provided all meals and snacks for 5 d to 53 children aged 3–5 y in classrooms in their childcare centers. In the Control condition, we served typical portions for all food groups. In the Addition condition we increased portions of low-energy-dense vegetables and fruits by 50%, and in the Substitution condition we increased portions of vegetables and fruits by 50% and also reduced portions of other foods by an equivalent weight.</jats:p>
    • </jats:sec>
    • <jats:sec>
    • <jats:title>Results</jats:title>
    • <jats:p>For vegetables, the Addition strategy increased daily intake compared with Control by 24% (mean ± SEM = 12 ± 3 g/d; P = 0.0002), and the Substitution strategy increased intake compared with Control by 41% (22 ± 3 g/d; P &amp;lt; 0.0001). For fruits, consumption increased by similar amounts: Addition by 33% (60 ± 6 g/d) and Substitution by 38% (69 ± 8 g/d; both P &amp;lt; 0.0001). Both strategies increased vegetable and fruit intakes compared with Control across all 5 days (all P &amp;lt; 0.004), although the increase in fruit consumption with Addition declined over time (P &amp;lt; 0.0001). Daily energy intake compared with Control increased by 5% with Addition (57 ± 17 kcal; P = 0.001) but decreased by 6% with Substitution (−64 ± 21 kcal; P = 0.004).</jats:p>
    • </jats:sec>
    • <jats:sec>
    • <jats:title>Conclusions</jats:title>
    • <jats:p>Both the Addition and Substitution strategies promoted increases in vegetable and fruit intake over 5 d in preschool children. When excess energy intake is a concern, substituting vegetables and fruits for other foods is a better option than simply serving more.</jats:p>
    • <jats:p>This trial was registered at http://www.clinicaltrials.gov as NCT03242863 (https://clinicaltrials.gov/ct2/show/NCT03242863), where the protocol is available.</jats:p>
    • </jats:sec>
    • ABSTRACT
    • Background
    • Although dietary guidelines recommend that vegetables and fruits make up half the diet, it is unclear whether serving vegetables and fruits in larger portions will have sustained effects on children's intake over multiple days.
    • Objectives
    • This study tested the effects on children's intake of 2 strategies for increasing the proportion of vegetables and fruits: either adding or substituting extra portions as side dishes at meals and snacks over 5 d.
    • Methods
    • In a cluster-randomized crossover design with 3 periods, we provided all meals and snacks for 5 d to 53 children aged 3–5 y in classrooms in their childcare centers. In the Control condition, we served typical portions for all food groups. In the Addition condition we increased portions of low-energy-dense vegetables and fruits by 50%, and in the Substitution condition we increased portions of vegetables and fruits by 50% and also reduced portions of other foods by an equivalent weight.
    • Results
    • For vegetables, the Addition strategy increased daily intake compared with Control by 24% (mean ± SEM = 12 ± 3 g/d; P = 0.0002), and the Substitution strategy increased intake compared with Control by 41% (22 ± 3 g/d; P < 0.0001). For fruits, consumption increased by similar amounts: Addition by 33% (60 ± 6 g/d) and Substitution by 38% (69 ± 8 g/d; both P < 0.0001). Both strategies increased vegetable and fruit intakes compared with Control across all 5 days (all P < 0.004), although the increase in fruit consumption with Addition declined over time (P < 0.0001). Daily energy intake compared with Control increased by 5% with Addition (57 ± 17 kcal; P = 0.001) but decreased by 6% with Substitution (−64 ± 21 kcal; P = 0.004).
    • Conclusions
    • Both the Addition and Substitution strategies promoted increases in vegetable and fruit intake over 5 d in preschool children. When excess energy intake is a concern, substituting vegetables and fruits for other foods is a better option than simply serving more.
    • This trial was registered at http://www.clinicaltrials.gov as NCT03242863 (https://clinicaltrials.gov/ct2/show/NCT03242863), where the protocol is available.
  • Updated Keyword Show Changes
    Keyword
    • Preschool children, Vegetable intake, Fruit intake, Energy intake, Portion size , Dietary guidelines
  • Renamed Creator Liane S. Roe Show Changes
    • Liane S Roe
    • Liane S. Roe
  • Renamed Creator Christine E. Sanchez Show Changes
    • Christine E Sanchez
    • Christine E. Sanchez
  • Renamed Creator Alissa D. Smethers Show Changes
    • Alissa D Smethers
    • Alissa D. Smethers
  • Renamed Creator Kathleen L. Keller Show Changes
    • Kathleen L Keller
    • Kathleen L. Keller
  • Renamed Creator Barbara J. Rolls Show Changes
    • Barbara J Rolls
    • Barbara J. Rolls
  • Updated Creator Liane S. Roe
  • Updated Work Title Show Changes
    Work Title
    • ! Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.
    • Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial.
  • Updated Creator Liane S. Roe
  • Updated