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Social modeling of eating: A review of when and why social influence affects food intake and choice.

Background
Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease.

Objectives
To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials.

Selection criteria
We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

Data collection and analysis
Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

Main results
We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.

Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies.

Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).

Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding.

Authors' conclusions
Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.

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.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

Changing children's eating behaviour - A review of experimental research.

Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions.

https://hal.archives-ouvertes.fr/hal-01464651/document

Food rejections in children: Cognitive and social/environmental factors involved in food neophobia and picky/fussy eating behavior.

Effect of sensory education on willingness to taste novel food in children.

As part of 'EduSens', a project aiming to measure the effect of a sensory education program developed in France on the food behaviour of school children, the present paper shows the results regarding neophobia. One hundred and eighty children (8-10 years old) were involved in the study. Half of them (experimental group) were educated during school-time with the 12 sessions of taste lessons ''Les classes du gout'' by J. Puisais. The others served as a control group. Food neophobia was evaluated before and after the education period of the experimental group and once again 10 months later. An adapted food neophobia scale was used (AFNS) and the willingness to taste novel food (WTNF) was evaluated by the presentation of eight unknown foods. To improve involvement in the expressed willingness to taste new foods, the children were told that they would have to eat one of the not rejected unknown foods afterwards. Results revealed that, at the end of the education period, in the educated group, declarative food neophobia decreased significantly and participants' willingness to taste novel food seemed to increase compared to the control group. Nevertheless, these effects had disappeared 10 months later. Thus, we have shown that sensory education can influence childrens' food neophobia, but does so only temporarily. This is especially true for the WTNF test, which measures the expression of neophobia in concrete situations, whereas neophobia measured as a psychological trait by the AFNS test hardly changes. # 2008 Elsevier Ltd. All rights reserved.

F. Chesnel

Papers

Effect of sensory education on willingness to taste novel food in children.

Research report Effect of sensory education on willingness to taste novel food in children