Sweet and sour sips: No effect of repeated exposure to sweet or sour-tasting sugary drinks on children's sweetness preference and liking.

Health agencies advocate reducing children's sweetness exposure to lower sweetness preference or liking to ultimately lower sugar intake. However, the relationship between sweetness exposure, preference, and liking remains unclear. This work investigated the influence of exposure to a sucrose-containing sweet or sour-tasting drink on sweetness preference and liking for sweet and sour products in 4-7-year-old children (n = 65). The children were randomized into three groups with one daily exposure to either the sweet drink, sour drink, or water (control group) for 14 days. Sweetness preference was assessed at baseline (t1), day 15 (t2), and two months after the intervention (t3), using a forced-choice, paired comparison test with five beverages varying in sweetness intensity. Hedonic liking for the intervention drinks, a sweet and sour yogurt, and a sweet and sour candy was evaluated using a 5-point pictorial scale. Linear mixed models revealed a significant increase in sweetness preference from t1 to t3 (F(2) = 7.46, p < 0.001). However, ANCOVA analysis indicated that this effect was not caused by the intervention. Based on linear mixed models, we observed that children's hedonic liking for sweet and sour products remained stable from t1 to t3 and was not influenced by the intervention. These findings suggest that 14 exposures to a sucrose-containing sweet or sour-tasting drink did not affect sweetness preference or liking in 4-7-year-old children.

Implementation of four strategies in Dutch day-care centres to stimulate young children's fruit and vegetable consumption.

The day-care setting is an ideal place to encourage children's fruit and vegetable (=F&V) eating. Whereas many studies have focused on the effectiveness to increase F&V consumption, little is known about how to successfully implement effective strategies in daily practice. This study aimed to investigate how day-care professionals evaluated the implementation of a self-chosen strategy to support children's F&V eating. Thirteen day-care locations chose one out of five promising strategies and implemented this strategy for 10-12 weeks. Before (N = 98) and after the study (N = 49), day-care professionals completed a questionnaire to assess their implementation experiences, the impact on children's F&V eating as well as their future intention to use the strategy (on a 5-point scale). Parents (N = 152) completed a short questionnaire at the end of the study to capture their experiences and potential transfer effects to the home situation. Results showed that acceptability, appropriateness, feasibility and sustainability of the strategies were generally satisfactory (scores ≥3.5 on a 5-point scale), but the strategy of cooking scored less favourable on appropriateness and sustained implementation. Children's willingness to taste F&V varieties (3.4 ± 0.7 vs. 2.8 ± 0.8; p < 0.001) and eating pleasure for vegetables (3.4 ± 0.6 vs. 3.1 ± 0.8; p = 0.01) increased, whereas children's F&V consumption did not change (p > 0.14). Parents valued the day-cares' efforts to encourage children's F&V consumption and a small group (∼20%) experienced positive effects at home. This study shows that implementing a self-chosen F&V strategy at the day-care is acceptable, appropriate and feasible for day-care professionals and has potential to positively impact children's F&V eating behaviour. Future research should investigate the effects of long-term implementation on children's eating behaviour and examine how structural implementation can be further supported.

Satiating Capacity of Plant-Based Meat in Realistic Meal Contexts at Home.

Plant-based meat substitutes replacing animal meat can potentially support the transition towards more sustainable diets. To enable the required transition, consumer acceptance of plant-based meat is essential. An important aspect of this is the feeling of satiety or being full after eating. This study determined the satiating capacity of both plant-based meat and animal meat in 60 adults under real-life in-home conditions. Participants consumed four fixed ready-to eat meals for lunch at home once per week. Two types of Indian curry with 'chicken' were investigated as well as two types of pasta Bolognese with 'minced meat'. The two 'chicken' dishes and the two 'minced meat' dishes had the same recipe except for a gram-for-gram swap (125 g each) of either animal meat (chicken breast and minced meat) or plant-based (soy) meat. Results showed no difference in the satiating power of an animal meat dish and a plant-based meat dish when these were eaten as part of a full lunch meal at home. In addition, the meals did not result in energy nor macronutrient compensation during the rest of the day after consuming the meals. This occurred despite the caloric differences of the meals as a result of the real-life conditions (i.e., a lower energy content of the pasta with plant-based meat compared to the other meals). We conclude that meals with plant-based meat can be as satiating as meals with animal meat.

Which factors promote and prohibit successful implementation and normalization of a healthy school lunch program at primary schools in the Netherlands?

BACKGROUND: A school provided healthy lunch might help to improve the nutritional quality of children's lunches. However, in the Netherlands, school lunch programs are not common. The aim of this study was to identify factors that promote or inhibit the implementation of a school lunch program at primary schools, from the viewpoint of school professionals. METHODS: A cross-sectional online survey was conducted among 204 primary school professionals. The normalization process theory and its four constructs (i.e. coherence, cognitive participation, collective action, reflective monitoring) were used to develop questions and interpret findings. Descriptive statistics were used for 14 multiple choice questions (yes, no, don't know) and thematic content analysis for qualitative responses. RESULTS: Participants had a shared understanding about how a lunch program differed from current practices. Most participants had the same view on the rationale for implementation (coherence), such as equality among children. Sixty percent expected that a healthy school lunch will contribute to healthier eating by the children. Participants showed different degrees of cognitive participation (46% indicated that healthy school lunch is good idea). Commitment depended on their belief whether providing a healthy lunch was part of their responsibility as school and 30% expected a large effect on their daily work (collective action). When appraising school lunch implementation (reflective monitoring), participants' concerns focused on feasibility and adaptability of a program in their own school. CONCLUSIONS: The introduction of a school lunch program will require substantial effort, although there is considerable support and understanding about potential benefits. The findings point to a number of preconditions for large-scale introduction, including the need for support-both financially and organizationally-bottom-up involvement of teachers, children and parents and freedom to adapt the program.

The sweet tooth of infancy: Is sweetness exposure related to sweetness liking in infants up to 12 months of age?

Infants become increasingly exposed to sweet-tasting foods in their first year of life. However, it is still unclear whether repeated exposure to sweet taste is linked to infants' sweetness liking during this period. Making use of data from the OPALINE cohort, this study aimed to examine the link between sweetness exposure and sweetness liking during two important periods in early infant feeding: at the start of complementary feeding (3-6 months) and the transition to the family table (10-12 months). Infants' sweetness exposure was assessed using 7-d food records which were completed by mothers every month (n 312), reporting daily consumption rates of formula/breast milk or complementary food and the type of formula milk and/or complementary foods for each feeding occasion. Infants' sweetness liking was studied in the laboratory at 3, 6 and 12 months of age by assessing their response to a lactose-water solution and the amount drunk of this solution compared with plain water. Linear regressions and structural equation model assessed associations between exposure to and liking for sweetness at 6 and 12 months. Neither at 6 (n 182) nor at 12 months (n 197) was sweetness exposure associated with sweetness liking. While sweetness liking at 3 months was unrelated to liking at 6 months, the latter predicted sweetness liking at 12 months. These findings demonstrate no association between sweetness exposure at 3 to 12 months and liking at 6 and 12 months despite a sharp increase in sweetness exposure in that period. However, sweetness liking at 6 and 12 months was positively associated.

An Observational Study to Evaluate the Association between Intestinal Permeability, Leaky Gut Related Markers, and Metabolic Health in Healthy Adults.

We explored whether metabolic health is linked to intestinal permeability, using a multi-sugar (MS) permeability test, and whether intestinal permeability is correlated with the leaky gut-related markers (LGM) zonulin, LBP, and sCD14. Metabolically healthy (n = 15) and unhealthy subjects (n = 15) were recruited based on waist circumference, fasting glucose, and high-density lipoprotein cholesterol levels. Participants underwent an MS permeability test that assessed site-specific permeabilities of the gastroduodenum and small and large intestines. The test was performed with/without an acetylsalicylic acid challenge to measure and correlate the gut permeability, LGM, and metabolic health. At baseline, metabolic health showed no correlation with gut permeability. Significant correlations were found between the metabolic health parameters and LGM. In the acetylsalicylic acid challenged MS permeability test, low-density lipoprotein cholesterol was correlated with the sucralose/erythritol ratio, reflecting the whole intestinal permeability. Correlations between most metabolic health parameters and LGM during the acetylsalicylic acid challenge were less pronounced than at baseline. In both MS permeability tests, no significant correlations were found between LGM (plasma and serum) and gut permeability. Thus, correlations between LGM and metabolic health might not be linked with paracellular gut permeability. Transcellular translocation and/or lipoprotein-related transportation is a more likely mechanism underlying the association between LGM and metabolic health.

Strategies to increase primary school children's fruit and vegetable intake during 10AM snack time.

In this observational study, children's fruit and vegetable (F&V) consumption during the 10AM school break was assessed for two promising strategies: a 5-day-a-week F&V policy and free provision of F&V presented in an attractive fruit bowl. Schools without a school food policy served as reference group. A secondary aim was to explore the feasibility of the two strategies. A total of 569 children aged 6-9 years participated. Children's F&V consumption at school was assessed on two different week days via observations and weighing snack portions. Parents completed an online-questionnaire on their perceptions and experiences with the two strategies. Main outcomes were the proportion of children and frequency of eating F&V, and children's F&V portion sizes. Data were analysed via ANOVA and Chi-Square (p < 0.05). Average F&V consumption differed significantly between the three situations (p < 0.001): 250 g in the fruit bowl situation, 130 g in the 5-day-policy situation and 60 g in the no-policy situation. The proportion of children eating F&V was high for the 5-day-policy (97-98%) and fruit bowl situation (87-97%), whereas this was substantially lower (50-60%; p < 0.001) in the no-policy situation. The majority of parents considered both strategies as feasible. A 5-day-a-week F&V policy seems an effective, feasible and structural strategy to support children's fruit and vegetable consumption at school. The fruit bowl strategy with an additional eating moment may enhance children's intake even further, although additional requirements are needed for structural implementation at school.

Intake of Fibre-Associated Foods and Texture Preferences in Relation to Weight Status Among 9-12 Years Old Children in 6 European Countries.

Plant foods, rich in fibre, can offer textures that children find difficult to orally manipulate, resulting in low preferences but are important for a healthy diet and prevention of overweight in children. Our aim was to investigate preferences for food texture, intake of fibre-associated foods and the relation to BMI. Three hundred thirty European children (9-12 years, 54% female) indicated their texture preferences using the Child-Food-Texture-Preference- Questionnaire (CFTPQ), and their parents responded on fibre-associated food consumption and anthropometric information. BMI was significantly lower for children with higher intake of wholegrain alternatives of common foods; in addition to being significantly influenced by country and the wearing of a dental brace. Overall BMI-for-age-percentiles (BMI_pct) were negatively associated with the consumption of wholegrain cereals, white pasta and wholemeal products and positively associated with the intake of legumes and white biscuits. In males, BMI_pct were negatively associated with wholegrain products and dried fruits, and in females, positively with legume consumption. A few country-related associations were found for BMI_pct and wholegrain biscuits, seeds and nuts and refined products. No overall correlation was found between BMI_pct and the texture preference of soft/hard foods by CFTPQ, except in Austria. We conclude that this study revealed evidence of a connection between fibre-associated foods and children's BMI at a cross-cultural level and that sex is an important determinant of fibre-associated food intake and the development of overweight in childhood.

Yuck, This Biscuit Looks Lumpy! Neophobic Levels and Cultural Differences Drive Children's Check-All-That-Apply (CATA) Descriptions and Preferences for High-Fibre Biscuits.

Food neophobia influences food choice in school-aged children. However, little is known about how children with different degrees of food neophobia perceive food and to what extent different sensory attributes drive their liking. This paper explores liking and sensory perception of fibre-rich biscuits in school-aged children (n = 509, age 9-12 years) with different degrees of food neophobia and from five different European countries (Finland, Italy, Spain, Sweden and United Kingdom). Children tasted and rated their liking of eight commercial biscuits and performed a Check-All-That-Apply task to describe the samples and further completed a Food Neophobia Scale. Children with a higher degree of neophobia displayed a lower liking for all tasted biscuits (p < 0.001). Cross-cultural differences in liking also appeared (p < 0.001). A negative correlation was found between degree of neophobia and the number of CATA-terms used to describe the samples (r = -0.116, p = 0.009). Penalty analysis showed that degree of food neophobia also affected drivers of biscuit liking, where particularly appearance terms were drivers of disliking for neophobic children. Cross-cultural differences in drivers of liking and disliking were particularly salient for texture attributes. Further research should explore if optimizing appearance attributes could be a way to increase liking of fibre-rich foods in neophobic children.

Postprandial amino acid, glucose and insulin responses among healthy adults after a single intake of Lemna minor in comparison with green peas: a randomised trial.

A high protein content combined with its enormous growth capacity make duckweed an interesting alternative protein source, but information about postprandial responses in humans is lacking. The present study aimed to assess the postprandial serum amino acid profile of Lemna minor in healthy adults in comparison with green peas. A secondary objective was to obtain insights regarding human safety. A total of twelve healthy volunteers participated in a randomised, cross-over trial. Subjects received two protein sources in randomised order with a 1-week washout period. After an overnight fast, subjects consumed L. minor or peas (equivalent to 20 g of protein). After a baseline sample, blood samples were taken 15, 30, 45, 60, 75, 90, 120, 150 and 180 min after consumption to assess amino acid, glucose and insulin levels. Heart rate, blood pressure and aural temperature were measured before and after consumption, and subjects reported on gastrointestinal discomfort for four subsequent days. Compared with green peas, significantly lower blood concentrations of amino acids from L. minor were observed, indicating lower digestibility. L. minor consumption resulted in lower plasma glucose and insulin levels compared with peas, probably due to different glucose content. There were no significant differences concerning the assessed health parameters or the number of gastrointestinal complaints, indicating that a single bolus of L. minor - grown under controlled conditions - did not induce acute adverse effects in humans. Further studies need to investigate effects of repeated L. minor intake and whether proteins purified from L. minor can be digested more easily.

Changing the behaviour of children living in Dutch disadvantaged neighbourhoods to improve breakfast quality: Comparing the efficacy of three school-based strategies.

Children's breakfast habits are suboptimal. A novel school-based education programme was developed and tested with the aim of improving children's attitude, knowledge and breakfast quality. A pre- and post-test design was used with four conditions: group-based education, role modelling, tailored feedback with goal setting, and a combination of these three delivery modes. Two hundred eighty children from disadvantaged communities (9.3 ±â€¯0.8 years) participated in three lessons at school over a two-month period. Children's attitude, knowledge and breakfast behaviour were evaluated by a pre- and post-questionnaire completed by the children. A follow-up measure was executed at 24 weeks. The data were analysed by repeated measures ANOVA. At baseline, 90% of the children ate breakfast on the measurement day; 60-76% of the children ate breakfast daily. Between pre- and post-test, a significant time effect was found for children's attitude, self-efficacy, knowledge and behaviour (all p < 0.05). Children in the feedback condition improved most favourably: correct classification of breakfast products increased by 10 products (out of 44) and breakfast quality score improved by 25 points (on a 100-point scale). The feedback condition also resulted in positive changes in the home setting. The follow-up test showed a decline in children's knowledge and their breakfast quality across conditions. To conclude, this study showed that a three-lesson school programme based on individual feedback and goal setting is most effective for changing knowledge on breakfasting and self-reported breakfast quality among children aged 8-10 years living in disadvantaged neighbourhoods. To maintain effectiveness, longer-term programmes embedded in the school curriculum are needed to enhance breakfast quality. Future research should explore the optimal duration and intensity of such programmes and should incorporate the topic of suitable portion sizes.

Breast-feeding duration and child eating characteristics in relation to later vegetable intake in 2-6-year-old children in ten studies throughout Europe.

OBJECTIVE: Breast-feeding is thought to facilitate young children's acceptance of new foods, including vegetables, but the evidence for this relationship appears inconsistent across studies. Increasing children's vegetable intake remains challenging; therefore the present study aimed to investigate whether breast-feeding duration predicts vegetable intake in 2-6-year-old children. DESIGN: Actual vegetable intake was measured in studies across three European countries. General linear model analyses with breast-feeding duration, sex and age of the child and maternal education as variables were used to predict children's vegetable intake per country. Additionally, the relationships between child eating behaviour characteristics (asked through the Child Eating Behaviour Questionnaire) and vegetable intake were investigated via Pearson correlations. SETTING: Daycare centres, schools and home settings in Denmark, Greece and the Netherlands. SUBJECTS: Children aged 2-6 years (n 750). RESULTS: Breast-feeding duration was positively associated with children's vegetable intake at 2-6 years old in Denmark (P<0·01) and the Netherlands (P<0·05), but not in Greece (P=0·17). Age of the child, maternal education and sex of the child did not predict vegetable intake in our sample. All countries showed an inverse relationship between food neophobia and children's vegetable intake and a positive relationship between vegetable liking and intake. CONCLUSIONS: The present study found that breast-feeding duration is a predictor of later vegetable intake, but that current child eating behaviour characteristics, such as vegetable liking, food neophobia and enjoyment of food, also influence vegetable intake. Besides encouragement of breast-feeding duration, strategies that support vegetable liking and food enjoyment and decrease food neophobia are needed to support young children's vegetable intake.

Is repeated exposure the holy grail for increasing children's vegetable intake? Lessons learned from a Dutch childcare intervention using various vegetable preparations.

Children's failure to eat enough vegetables highlights the need for effective interventions encouraging this behaviour. The aim of this study was to investigate the effect of repeated exposure to three a priori unfamiliar vegetables, each prepared in two ways, on children's vegetable acceptance in a childcare setting. Two hundred fifty children (mean age 25 months; 57% boys) participated in a pre-test and a post-test, where they were offered pumpkin, courgette, and white radish. The intervention group (N = 125) participated in a 5-month exposure period, where they were exposed repeatedly (∼12x) to the vegetables: pumpkin blanched and as a cracker spread; courgette blanched and as soup; white radish raw and as a cracker spread. The control group (N = 125) maintained their normal routine. Mixed model analyses were used to analyse intake data and Chi-square analyses for willingness to taste. At pre-test, children ate about 20 g of pumpkin and courgette, whereas white radish intake was approximately 10 g. There was a significant positive effect of the intervention for pumpkin (+15 g; p < 0.001) and white radish (+16 g; p = 0.01). Results for willingness to taste were in the same direction. There was no repeated exposure effect for courgette (p = 0.54); this may have been due to its less distinct taste profile or familiarity with boiled courgette. From our findings, we conclude that repeated exposure to multiple unfamiliar vegetable tastes within the daily routine of a childcare setting is effective in improving children's willingness to taste and intake of some of these vegetables. However, repeated exposure may not be sufficient for more familiar or blander tasting vegetables. This implies that one size does not fit all and that additional strategies are needed to increase children's intake of these vegetables.

In vivo and in vitro palatability testing of a new paediatric formulation of valaciclovir.

AIMS: The palatability of a new paediatric formulation of valaciclovir was assessed in children and their parents: non-inferiority of the new paediatric formulation (test formulation) compared to the reference formulation was investigated. METHODS: In vivo palatability testing was performed in a randomized, two-period, multicentre, cross-over study. Children and their parents scored the liking of the new paediatric valaciclovir formulation and the reference formulation on a 100 mm visual analogue scale (VAS). To support formulation development and palatability testing, electronic tongue measurements were applied. RESULTS: The electronic tongue measurement indicated taste-masking capabilities for three different formulations in the developmental phase. A glycerol-based formulation was further tested and compared to the reference formulation prepared out of crushed and suspended tablets. The mean difference (95% CI) in VAS scores between both formulations, as indicated by the children (n = 20), was 2.4 (-8.5, 13) mm, in favour of the new paediatric valaciclovir formulation. The mean (95% CI) difference in VAS scores indicated by the parents (n = 20) was -0.9 (-12, 9.8) mm. CONCLUSION: The palatability of the new paediatric valaciclovir formulation was considered non-inferior to the reference formulation prepared out of crushed tablets. We were able to optimize the study design and number of children to be included in the palatability testing by using electronic tongue measurements.

Effectiveness of Taste Lessons with and without additional experiential learning activities on children's willingness to taste vegetables.

This study assessed the effectiveness of the Dutch school programme Taste Lessons with and without additional experiential learning activities on children's willingness to taste unfamiliar vegetables. Thirty-three primary schools (877 children in grades 6-7 with a mean age of 10.3 years) participated in Taste Lessons Vegetable Menu (TLVM, lessons and extra activities), Taste Lessons (TL, lessons), or a control group. A baseline and follow-up measurement was used to assess for each child: number of four familiar and four unfamiliar vegetables tasted, quantity tasted, choice of vegetable of which to eat more, and number of vegetables willing to taste again later. Furthermore, children filled out a questionnaire on daily vegetable intake and food neophobia. Multilevel and Cox regression analyses were conducted to compare changes in the outcome measures between the three study groups. No significant intervention effects were found on willingness to taste unfamiliar vegetables. Neither were effects found on familiar vegetables, except for number of familiar vegetables tasted (p < 0.05). Furthermore, no significant intervention effects were found on daily vegetable consumption and food neophobia. These results indicate that more intensive school-based nutrition education activities are needed to increase children's willingness to taste unfamiliar vegetables and increase their vegetable intake.

Parental child-feeding strategies in relation to Dutch children's fruit and vegetable intake.

OBJECTIVE: To identify parental child-feeding strategies that may increase children's fruit or vegetable intake, since the relationship between these strategies and children's intake has never been investigated for fruit and vegetables as two separate food groups. DESIGN: A survey study, where parents provided information about their practices in relation to feeding their children and about their own and their children's fruit and vegetable intake. Children completed a preference questionnaire about fruit and vegetables. To find underlying parental child-feeding strategies, factor analysis was applied to parents' practices in relation to fruit and vegetables separately. Regression analysis was used to predict the effect of these strategies on children's fruit and vegetable intake. The impact of the strategies was further analysed by estimating children's intake based on the frequency of use of specific strategies. SETTING: The study was conducted at three primary schools in The Netherlands. SUBJECTS: A total of 259 children between 4 and 12 years old and their parents (n 242). RESULTS: Parents used different strategies for fruit as compared with vegetables. The vegetable-eating context was more negative than the fruit-eating context. Parental intake and presenting the children with choice were positive predictors of children's intake of both fruit and vegetables. The intake difference based on frequency of use of the strategy 'Choice' was 40 g/d for vegetables and 72 g/d for fruit (P < 0.001). CONCLUSIONS: Future interventions should focus on presenting children with choice during fruit- and vegetable-eating situations, since this is a powerful strategy to stimulate children's fruit and vegetable intake.

Offering choice and its effect on Dutch children's liking and consumption of vegetables: a randomized controlled trial.

BACKGROUND: Children's vegetable consumption is below recommended amounts. According to self-determination theory, stimulating children's feelings of autonomy by offering a choice of vegetables may be a valuable strategy to increase their vegetable liking and consumption. The effect of choice-offering on children's vegetable liking and consumption has, to our knowledge, not yet been studied. OBJECTIVE: The objective was to investigate whether having a choice between 2 vegetables enhances children's vegetable liking and consumption. DESIGN: Three hundred three children (age: 4-6 y) were randomly assigned to receive 1 of 3 dinner conditions in a restaurant setting. Two similarly liked vegetables were presented, after which the child had no choice, a premeal choice, or an at-meal choice. Subsequently, the dinner was consumed with one parent present. Comparisons between the 3 conditions regarding children's meal experience, vegetable liking, and vegetable consumption were made by using analysis of variance and Kruskal-Wallis tests. RESULTS: Children's vegetable consumption did not differ (P = 0.54) between the conditions as follows: 56 + or - 45 g in the no-choice condition, 51 + or - 46 g in the premeal-choice condition, and 49 + or - 47 g in the at-meal-choice condition. In the no-choice condition, high-reactant children (who are more sensitive to psychological, persuasive pressure) consumed fewer vegetables (45 + or - 42 g) than did low-reactant children (73 + or - 43 g; P = 0.04). Vegetable liking was similar in all 3 conditions (P = 0.43). Children appreciated being able to choose in the premeal-choice condition. CONCLUSIONS: A premeal choice between 2 vegetables was appreciated by the children but did not increase their vegetable liking and consumption. The no-choice condition decreased vegetable consumption in high-reactant children. Future research should investigate the effects of choice-offering in the long term and in more familiar eating settings. This trial was registered at controlled-trials.com as ISRCTN03035138.

Children's hard-wired aversion to pure vegetable tastes. A 'failed' flavour-nutrient learning study.

Conditioning is an important mechanism for establishing food preferences. Although the basic principles for conditioning are well-known, less is known about the conditions under which this type of learning takes place. This paper aims to add to the knowledge of the essential conditions for flavour-nutrient learning with vegetable flavours. We describe a study which aimed to investigate whether flavour-nutrient learning is effective in increasing 7-8-year-old children's preference for vegetables. Their preference for, and consumption of, two different vegetable drinks was measured before and after a 14-day-conditioning period, using a within-subject design. Flavour-nutrient learning could not occur, due to insufficient consumption during the conditioning period: 2.4 g (S.D.=5.6) for the high energy (HE) drink and 3.0 g (S.D.=9.3) for the low energy (LE) drink. The high taste intensity may have caused the insufficient consumption. We hypothesize that the pure taste of vegetables in itself is not acceptable. Mixing vegetables with other foods may lead to gradual acceptance of vegetables through flavour-flavour and flavour-nutrient learning. Future flavour-nutrient learning studies with children should use less intense vegetable flavours.

Cognitive development and children's perceptions of fruit and vegetables; a qualitative study.

BACKGROUND: Most children do not meet the recommended guidelines for fruit and vegetable intake. Since preference is an important predictor of intake, more knowledge is needed about children's preferences and about how these preferences develop. As most research about preferences has ignored cognitive development, this study was designed to explore the relation between children's perceptions and preferences for fruit and vegetables and their cognitive development. METHODS: The study population consisted of eight 4-5-year-old children, eight 7-8-year-old children and twelve 11-12-year-old children, recruited via a primary school in Wageningen, The Netherlands. Qualitative in-depth information was obtained by duo-interviews and focus group discussions. A structured guide with questions and game tasks was applied to address different domains in a consistent way. RESULTS: The developmental progress at the abstraction level was seen in children's reasoning across all domains. Children's preferences expanded and increased in complexity as they moved to a higher age bracket. The most important determinants for liking and disliking shifted from appearance and texture attributes in 4-5-year-olds towards taste attributes in 11-12-year-olds. Children's knowledge of basic tastes increased. Their understanding of health improved as they grew older. The emergence of social norms and perspectives of others as the children grew older was also seen in relation to fruit and vegetables. Child-reported parental strategies to stimulate healthy eating appeared to vary with age in line with cognitive development. CONCLUSION: Cognitive development is paralleled by changes in the importance given to the attributes that determine whether a child likes or dislikes fruits and vegetables; children's understanding of and reasoning about health; and parental use of strategies. These developmental differences should be incorporated in programs designed to increase long-term fruit and vegetable intake in children.