Consuming not enough fruit and vegetables is a considerable health burden in developed countries. Eating fruit and vegetables is associated with a reduced risk of future chronic disease. Early childhood represents a critical period for the establishment of dietary habits. Interventions to increase consumption of fruit and vegetables in early childhood may therefore be an effective strategy in reducing this disease burden.
To assess the impact of interventions designed to increase eating of fruit or vegetables or both among children aged five years and under.
We searched various electronic databases and relevant journals to find studies. We contacted authors of included trials for additional potentially relevant trials. Any randomised trial (participants have the same chance of being assigned to treatment or control) was eligible of interventions aiming to increase the intake of fruit or vegetables or both by children aged five years and under that measured intake. Two review authors independently searched for and extracted information from studies. The evidence is current to September 2017.
We include 55 trials with 11,108 people taking part. Thirty-three trials examined child-feeding interventions, 13 examined parent nutrition education interventions, eight examined multicomponent interventions and one examined a child nutrition education intervention. Child-feeding interventions (e.g. repeated exposure to vegetables) were effective in increasing children’s intake of vegetables in the short term (less than 12 months). Parent nutrition education and multicomponent interventions (e.g. combining preschool policy changes with parent education) were not effective in increasing children’s eating of fruit and vegetables. There was not enough information to assess long-term effectiveness, cost effectiveness and unintended harms. Studies reporting funding support received governmental or charitable funds, except for three studies that received industry funding.
The evidence for effective interventions to increase eating of fruit and vegetables by children aged five and under remains sparse. Child-feeding interventions appear to increase vegetable intake by children (by 4.03 g), but this conclusion is based on very low-quality evidence and is very likely to change when future research is undertaken.
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.