"Preparing vegetable-enhanced entrees is a technique that should be used with other strategies, such as providing vegetables as snacks and side dishes."
Hiding vegetables in kids' foods can increase vegetable intake...
Preschool children consumed nearly twice as many vegetables and 11 percent fewer calories over the course of a day when researchers Penn State added pureed vegetables to the children's favorite foods.
"Childhood obesity rates are on the rise, and at the same time children are not eating the recommended amount of vegetables," said Barbara Rolls, holder of the Helen A. Guthrie Chair in Nutritional Sciences. "Vegetables have been shown to help lower calorie intake. The problem is getting kids to eat enough vegetables."
In their study, the researchers served vegetable-enhanced entrees to 39 children between the ages of 3 and 6 on three separate days. They tested three familiar foods - zucchini bread for breakfast, pasta with a tomato-based sauce for lunch and chicken noodle casserole for dinner. The team modified the standard recipes for these foods by adding a variety of pureed vegetables to reduce the calories in the entrees by 15 percent and 25 percent.
"We incorporated several vegetables into the dishes, including broccoli, cauliflower, zucchini, tomatoes and squash," said Maureen Spill, a post-doctoral fellow in nutritional sciences and the study's lead author. "We were pleased to find that the children found the vegetable-enhanced versions to be equally acceptable to the standard recipes."
According to Spill, the children ate the same weight of food regardless of the vegetable content of the entrees. And when they ate the vegetable-enhanced entrees as opposed to the standard-recipe entrees, their daily vegetable intake nearly doubled while their calorie intake decreased by 11 percent. The team's findings are online today in the American Journal of Clinical Nutrition.
Rolls and Penn State colleagues Alexandria Blatt, a recent Ph.D. recipient and Liane Roe, a researcher, both in nutritional sciences, found similar results when they served vegetable-enhanced entrees to adults. That work appeared in the April 2011 issue of the American Journal of Clinical Nutrition.
"Regarding children, some people argue that hiding vegetables in foods is deceptive and that doing so suggests that whole vegetables are not acceptable," said Rolls. "But I don't agree. Parents modify recipes all the time. For example, it is well-accepted that applesauce can be used to replace oil in cake batter."
Spill noted that serving vegetables both within entrees and as side dishes is a great way to increase daily vegetable intake even more. "Preparing vegetable-enhanced entrees is a technique that should be used with other strategies, such as providing vegetables as snacks and side dishes. Together these strategies can substantially increase children's vegetable intake while also teaching them to like vegetables."
The National Institute of Diabetes and Digestive and Kidney Diseases funded this research. Other authors on the paper include Leann Birch, Distinguished Professor of human development and family studies, and Liane Roe, researcher in nutritional sciences.
Excerpt from a recent study by Elsevier Health Sciences (Nov, 2014) Titled: Theory or not? Best study designs for increasing vegetable intake in children
In a systematic, in-depth review focused on the use of behavior theory in interventions aimed to increase fruit and vegetable intake among children, researchers found theory-based interventions to be beneficial for vegetable intake only. The authors determined the effects of theory use to be limited overall.
"Higher levels of fruit and vegetable intake protect against hypertension, heart disease, stroke, and other chronic diseases and may be a strategy for obesity prevention among children and adults, but fruit and vegetable interventions have been minimally effective," concluded lead author Cassandra Diep, PhD, US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine.. Her team wanted to determine if using or not using a behavior theory contributed to effectiveness. However, they found "little or mixed support for enhanced dietary change with use of theory, multiple theories, or a formal planning process in dietary change interventions." This result may be surprising to many researchers, professional organizations, and funding agencies that stress the inclusion of behavior theory in nutrition programs.
The researchers focused their work on the hypothesis that interventions clearly based on theory were more effective in changing fruit and vegetable intake among children than interventions with no behavioral theoretical foundation. To do so, the authors searched for peer-reviewed studies on fruit and vegetable interventions among children and adolescents that met five exclusionary criteria. In total, 29 articles were included, all of which appeared in journals between 1989 and 2013, with the majority published in or after 2000. Most of the studies occurred in the United States.
A total of 33 interventions were found among the 29 articles, eight with no theoretical foundation, 15 using one theory, and the remaining 10 using two theories. Social Cognitive Theory was the most common, as it was used in 17 interventions; Theory of Planned Behavior was used in six interventions. In the statistical analysis, interventions had a small but significantly greater impact on vegetable consumption than control conditions and a moderate effect on fruit and vegetable consumption combined. After controlling for study quality, theory use remained a significant predictor for vegetable intake only.
Given these findings, the researchers recommend that future studies examine the causality and strength of relationships between theoretical variables and dietary change behaviors. Additional research could also focus on what is needed to identify practical or experience-based procedures that may be useful to incorporate into interventions.
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