Children do not eat enough vegetables

 While the body of evidence for feeding recommendations for children continues to evolve, one constant remains: Children do not eat enough vegetables. In fact, more than 90% of young children fail to meet vegetable recommendations, and these patterns often persist into adolescence and adulthood, making it important to understand the factors involved in establishing feeding patterns in early childhood. Are children not eating their vegetables because of texture, lack of role modeling, negative sensory experience, delayed introduction, bitter taste, infrequent exposure, rejection of any new foods, or are they just plain picky and stubborn?

A panel of leading nutrition experts convened on Friday, March 27, 2015 to discuss these issues in an American Society for Nutrition (ASN) Satellite Session, "Science and Policy: Adopting a Fruitful Vegetable Encounter for Our Children," in conjunction with ASN's Annual Meeting, held as part of Experimental Biology 2015. The symposium was sponsored by the Alliance for Potato Research and Education (APRE), a not-for-profit organization dedicated to expanding and translating potato nutrition research into science-based policy and education initiatives.

Ron Kleinman, MD, Physician in Chief at Massachusetts General Hospital and co-chair of the symposium, noted that while it is well established that low vegetable consumption is a major dietary concern for infants and young children, a better understanding of current food consumption behaviors and behavior change strategies is needed to increase daily vegetable intake, particularly in light of the current evidence analysis and development of Dietary Guidelines for the birth-to-24 months age group.

"In the research that has been conducted to date, repeated exposure has been shown to have the most consistent impact on increasing vegetable acceptance in young children," says Susan Johnson, PhD, Professor of Pediatrics and Director of The Children's Eating Laboratory at University of Colorado-Denver. "It appears that many children need to try a new food 8 to 12 times in order to learn to like it, while parents often give up after 3 to 5 tries if the food is rejected. The bottom line is that in order for kids to eat vegetables, parents have to offer them consistently and persistently."

Co-chaired by Kleinman and Theresa Nicklas, DrPH, MPH, Professor of Pediatrics, USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, the symposium examined the state of the science on vegetable feeding practices and consumption patterns, including theories on environmental and cultural influences on children's food acceptance, the impact of various policies on vegetable access, the influence of early exposure on the development of taste preferences, and the economic and nutrition implications of vegetable plate waste in schools.

Presenters covered a variety of topics, including:

Dr. Kleinman presented an historical overview of transitional feeding recommendations and current vegetable consumption patterns for infants and young children. Kleinman also identified research gaps, highlighting the need to better understand what factors are driving the top vegetables consumed and barriers to consuming a wider variety of vegetables.

Ed Cooney, Executive Director at the Congressional Hunger Center, provided an overview of current policies for government feeding programs targeting low-income families, and advised that increasing participation in federal child nutrition programs can be an effective strategy in reducing both hunger and obesity.

Dr. Johnson reviewed the developmental and maternal influences on vegetable consumption of children ages 3 - 5 years, citing the use of encouragement and praise, parental modeling of vegetable consumption, child-centered feeding practices, and the use of structure and rules for mealtimes as strategies that have been shown to positively influence preschooler vegetable consumption.

Maureen Storey, PhD, President and CEO of APRE, presented a new analysis of vegetable and nutrient intake in children ages 1 -3 years, using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2012. The data show that mean nutrient intakes by children ages 1-3 years meets or exceeds recommendations except for potassium, fiber and vitamin D, and that vegetable, potato and starchy vegetable consumption is well below recommendations by the 2010 Dietary Guidelines for Americans.

Dr. Nicklas presented a new model for analyzing the implications of replacing potatoes with other vegetables, showing significant decrease in intake potassium and fiber when potatoes are replaced by other vegetables. Given that the most commonly consumed vegetable by children are potatoes, and that plate waste is higher for other vegetables, the consumption of white potatoes provides a significant source of nutrients and may be an important strategy to help children meet vegetable recommendations.

G. Harvey Anderson, PhD, Professor of Nutritional Sciences at University of Toronto, provided new data evaluating the effects of carbohydrate sources in meals on satiety and food intake in lean, healthy children, comparing rice, pasta, boiled mashed potatoes and baked or fried French fried potatoes served with 100 g (~3 oz) of lean beef. Anderson stated, "Just as we've seen in adults, glycemic index was not a reliable predictor of satiation and blood glucose response in children when carbohydrates were consumed as part of a meal. Despite the comparatively high GI of potatoes, children consumed 30% fewer calories at meals with mashed potatoes with similar post-meal glucose response, and fried French fried potatoes resulted in the lowest post-meal glucose and insulin concentrations."

Jennifer Fisher, PhD, Professor of Public Health and Interim Director, Center for Obesity Research and Education at Temple University, identified top research priorities for advancing the science in this area, including establishing a better understanding of how caregivers can improve diet quality, identifying the types of exposure that promote acceptance of vegetables from weaning into early childhood, how to effectively provide exposure in terms of type, frequency, and preparation of vegetables, and how to best respond to children's fear of trying new foods.

Collectively, the symposium presentations demonstrated that young children do not meet recommendations for vegetable and potato intake and that consumption of all types of vegetables should be encouraged. White potatoes, with or without skin and regardless of how they are cooked, provide a significant source of shortfall nutrients including potassium (760 mg in a small baked potato with skin) and fiber (3.2 g), are well-accepted by children and may be an important strategy to help children eat more vegetables.

Several of the presentations are based on papers submitted for publication in an upcoming supplement to the peer-reviewed journal, Advances in Nutrition, which will help enhance the foundational guidance for feeding vegetables to young children in the 2020 Dietary Guidelines. A full video of the symposium will be available on ASN's website in the coming weeks.