A longitudinal intervention to improve young children's liking and consumption of new foods: findings from the Colorado LEAP study

Abstract

Background: Many interventions have been conducted to improve young children's liking and consumption of new foods however their impacts on children's consumption have been limited. Consistent evidence supports the use of repeated exposure to improve liking for new foods however longitudinal effects lasting greater than 6 months often have not been demonstrated. Here we report the eating-related findings of the Colorado Longitudinal Eating And Physical Activity (LEAP) Study, a multi-component intervention, delivered primarily in the school setting, which aimed to improve children's liking and consumption of a target food via repeated exposure and positive experiential learning.

Methods: Four sites in rural Colorado, each housing Head Start preschool programs, matched on state vital statistics for childhood obesity rates, (2 intervention and 2 control sites) took part in a quasi-experimental study design which included 4 time points (baseline, post-intervention, one-year [Y1] and two- year [Y2] follow ups). A total of 250 children and families were enrolled (n = 143 intervention and n = 107 control; 41% Hispanic and 69% low-income). A 12-week intervention, Food Friends - Fun With New Foods®, delivered by trained preschool teachers and which focuses on positive and repeated experiences with new foods, and a 5-month (1 unit/month) social marketing "booster program" was delivered in kindergarten (one-year follow up) and 1st grade (two-year follow up). Main outcome measures included change in children's liking for new foods, analyzed by ordinal regression using generalized estimating equations, and change in weighed consumption of new foods over time, analyzed using a hierarchical mixed effects model.

Results: The intervention was delivered with good fidelity (87%). Both intervention and control groups demonstrated an increase in liking for the target food over time (p = 0.0001). The pattern of consumption of the target food was different, over time, for intervention and control groups (p < 0.005). In particular the change in intake between baseline and post-intervention was significantly greater in the intervention compared to the control group (p < 0.0001) though this pattern of change did not hold between baseline and Y2 follow up (p = 0.1144). Children in the intervention group who liked the target food consumed nearly double their baseline consumption at post-intervention (p < 0.0001;) and maintained this increase at Y2 follow up (p < 0.0001).

Conclusions: The Food Friends intervention, which utilized positive, repeated experiences with new foods, and was delivered with good fidelity by trained preschool teachers, found that larger improvements were observed in children's eating behaviors than would be expected with developmentally-based changes in eating behaviors.

Trial registration number: This trial is registered at ClinicalTrials.gov : NCT01937481. Date registered: 09/09/2013; Retrospectively registered. Date first participant registered: 09/15/2010.

Keywords: Eating behavior; Intervention; Longitudinal; Neophobia; Nutrition education; Preschooler; Vegetable intake.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Table of lesson content for the Fun with New Foods Program

Fig. 2

Consort diagram. Recruitment, enrollment and retention of participants by group and by site

Fig. 3

Proportion of children’s liking ratings of the target food (jicama) by the time point and by group (intervention and control). Per GEE analysis, there was a significant difference in liking ratings between study groups at baseline (p = 0.0002) and a significant overall change in liking ratings over time (p = 0.0002), however per interaction analysis the changes over time did not differ between study group (p = 0.1980). Statistically significant differences between follow up times and baseline are indicated by * (p < 0.05) or † (p < 0.001). Y1 = year-one follow up; Y2 = year-two follow up

Fig. 4

Change in consumption (g) for jicama (Fig. A in brown) and edamame (Fig. B in green), adjusted for sex, ethnicity, BMI, and parent income. Bars represent standard errors obtained using linear contrast statements from a hierarchical linear mixed model. To note statistically significant differences between follow up times and baseline, a * (p < 0.001) or † (p < 0.0001) is used. # indicates a significant difference in the change from baseline to post-intervention between intervention and control groups (p < 0.05). Y1 = year-one follow up; Y2 = year-two follow up

Fig. 5

Change in jicama consumption for children rating food as ‘yummy’ (top), ‘just OK’ (middle), and ‘yucky’ (bottom), adjusted for gender, ethnicity, BMI, and parent income. Bars represent standard errors obtained using linear contrast statements from a hierarchical linear mixed model. The liking ratings reflect those specified by children at each time point. To note statistically significant differences between follow up times and baseline, a * (p < 0.05) or † (p < 0.0001) is used. Y1 = year-one follow up; Y2 = year-two follow up

Fig. 6

A 2-stage model of influences on the development of children’s vegetable preferences and consumption. Stage 1 reflects influences on children’s willingness to try vegetables. Stage 2 considers inputs on children’s vegetable consumption. SES = Socioeconomic Status. Original figure from: Johnson SL. Developmental and Environmental Influences on Young Children’s Vegetable Preferences and Consumption. Advances in Nutrition. 2016;7:220S–31S. Permission to reproduce has been requested