Multi-Level Interventions To Improve Vegetable Consumption in Children

Consumption of vegetables falls short of the 2010 Dietary Guideline recommendations for health promotion and disease prevention. Federal nutrition programs have increased access to vegetables, such as more servings of vegetables in the National School Lunch Program. However, a 2012 systematic review and meta-analyses of school-based efforts (Evens et al) showed limited improvement to children’s vegetable intake with well-intentioned single level (access only) or multi-level (education+access) interventions. The media shows teens protesting new school menus and increasing amounts of foods discarded uneaten. Although younger children are more responsive to interventions, our evaluation studies show only some preschoolers increase vegetable consumption across a multi-component intervention.  We concur with others (Hoffman et al, 2011) that improvements in vegetable intake are not sustained long-term because vegetable preference is not established. Can vegetable sensations be improved to support acquisition of preference and increase vegetable consumption? Bitterness hinders vegetable preference, particularly when coupled with pronounced olfactory flavors. Perception of oral sensations from vegetables varies individually with taste receptor genetics and exposures such as to chronic otitis media. We will present findings on modifying tastes of disliked green vegetables by adding bitter blockers in a laboratory study of adults and community pilot studies with preschoolers. Although bitter blockers work peripherally (sodium salts) and centrally (sweetness), adding small amounts of sweetener proved most effective to shift vegetable disliking to liking in a lab setting, particularly when sweetness and vegetable bitterness were perceptually balanced. Simple survey report of vegetable disliking identified adults most responsive to bitter blocking. In the community, 2 of 3 preschoolers preferred vegetables lightly misted with small amounts of sweetener to plain vegetables. Serving lightly sweetened vegetables weekly across 4 weeks was associated with increases in vegetable intake compared with little change for preschoolers served plain vegetables. Improved vegetable sensations will promote willingness to taste and encourage conditioning a vegetable preference, even if the sweetness is removed (Capaldi & Privitera, 2008).  Improving vegetable tastes and flavors with early life exposures to promote vegetable preference should be combined with nutrition education and increased access to vegetables to achieve dietary recommendations for vegetable consumption.