A systematic review of practices to promote vegetable acceptance in the first three years of life.

BACKGROUND: Although most children do not meet vegetable intake recommendations no clear universal guidelines exist on the best method of introducing and promoting vegetables in infants. OBJECTIVE: To identify strategies to promote vegetable acceptance in children from the start of complementary feeding until 3 years of age. DESIGN: A comprehensive search strategy was performed using the databases Scopus and Pubmed. Articles published before March 2018 measuring vegetable intake and/or liking were included. RESULTS: 46 papers, 25 experimental (intervention) studies, and 21 observational studies were included. Intervention studies revealed that repeated exposure increased acceptance of the target vegetable, whereas exposure to variety was found to be particularly effective in increasing acceptance of a new vegetable. Starting complementary feeding with vegetables increased vegetable acceptance, whereas starting with fruits did not. Visual exposure to an unfamiliar vegetable increased the acceptance of that vegetable even without consuming it, while visual exposure to a familiar vegetable did not. A stepwise introduction of vegetables resulted in better initial acceptance of vegetables than introducing vegetables directly. Observational studies showed that vegetable consumption was associated with frequency of exposure, exposure to variety, and modelling. A majority of studies found a positive association between breastfeeding and vegetable acceptance, but only two out of seven studies found an association between age of vegetable introduction and their acceptance. CONCLUSIONS: Based on the papers reviewed, we conclude that introducing vegetables at the beginning of complementary feeding, giving a different type of vegetable every day and ensuring repeated exposure to the same vegetable following an interval of a few days are the most promising strategies to promote vegetable intake in children starting complementary feeding until they are 3 years of age.