Repeated exposure of infants at complementary feeding to a vegetable puree increases acceptance as effectively as flavor-flavor learning and more effectively than flavor-nutrient learning.

Children's vegetable consumption is below the public health recommendations. This study aimed to compare learning mechanisms to increase vegetable acceptance in infants at complementary feeding, namely repeated exposure (RE), flavor-flavor learning (FFL), and flavor-nutrient learning (FNL); measure the stability of the learning effect; and examine the impact of infants' feeding history on vegetable acceptance. The study was composed of a preexposure test, an exposure period, a postexposure test, and tests at 2-wk, 3-mo, and 6-mo follow-ups. At pre- and postexposure, a basic artichoke purée and carrot purée were presented to 95 French infants (6.4 ± 0.8 mo). During the exposure period, infants were randomly split into 3 groups and were exposed 10 times to the basic (RE group; 2 kJ/g; n = 32), a sweet (FFL group; 2 kJ/g; n = 32), or an energy-dense (FNL group; 6 kJ/g; n = 31) artichoke purée 2 or 3 times/wk. To evaluate acceptance, intake (g) and liking were recorded at home by parents. Between pre- and postexposure, intake of the basic artichoke purée significantly increased in the RE (+63%) and FFL (+39%) groups but not in the FNL group; liking increased only in the RE group (+21%). After exposure, artichoke was as much consumed and as much liked as carrot only in the RE group. Learning of artichoke acceptance was stable up to 3 mo postexposure. Initial artichoke intake was significantly related to the number of vegetables offered before the study started. RE is as effective as and simpler to implement than FFL and more effective than FNL for increasing vegetable acceptance at complementary feeding.

Repetition counts: repeated exposure increases intake of a novel vegetable in UK pre-school children compared to flavour-flavour and flavour-nutrient learning.

Children are not consuming sufficient amounts of fruits and vegetables in their habitual diet. Methods derived from associative learning theories could be effective at promoting vegetable intake in pre-school children. The objective of the present study was to compare the effectiveness of different learning strategies in promoting the intake of a novel vegetable. Children aged between 9 and 38 months were recruited from UK nurseries. The children (n 72) were randomly assigned to one of three conditions (repeated exposure, flavour-flavour learning or flavour-nutrient learning). Each child was offered ten exposures to their respective version of a novel vegetable (artichoke). Pre- and post-intervention measures of artichoke purée and carrot purée (control vegetable) intake were taken. At pre-intervention, carrot intake was significantly higher than artichoke intake (P<0·05). Intake of both vegetables increased over time (P<0·001); however, when changes in intake were investigated, artichoke intake increased significantly more than carrot intake (P<0·001). Artichoke intake increased to the same extent in all three conditions, and this effect was persistent up to 5 weeks post-intervention. Five exposures were sufficient to increase intake compared to the first exposure (P<0·001). Repeated exposure to three variants of a novel vegetable was sufficient to increase intake of this vegetable, regardless of the addition of a familiar taste or energy. Repetition is therefore a critical factor for promoting novel vegetable intake in pre-school children.

Impact of energy density on liking for sweet beverages and caloric-adjustment conditioning in children.

BACKGROUND: The contribution of sweet beverages to weight gain in children is controversial; the impact of these beverages on caloric adjustment needs clarification. OBJECTIVE: We studied the influence of energy-density (ED) conditioning on the liking for sweet beverages and caloric adjustment after their consumption in children. DESIGN: We used a within-subject design. Forty-four 8-11-y-old children were exposed to the following 2 distinctly flavored, sweetened beverages: a high-energy (HE) version (150 kcal) and a no-energy (NE) version (0 kcal). During a 4-wk initial conditioning period, children were exposed either 2 or 7 times to each beverage. After a 3-wk stability period (without exposure), children were exposed 3 times to both beverages with a reversed association between the ED and flavor (4-wk reversed-conditioning period). Flavor liking and food intake during meals after the consumption of each beverage were assessed before and after each period. RESULTS: After the initial conditioning, the liking for both beverages increased (P < 0.001). After the stability period, the liking for the HE flavor was higher than for the NE flavor (P = 0.024). After the reversed conditioning, the liking for the flavor initially paired with the HE beverage tended to remain higher than for the NE flavor (P = 0.089). Initially, energy intakes during the meal did not differ after the consumption of NE or HE beverages. After the initial conditioning and up until the end of the reversed conditioning, energy intakes were lower after the HE beverage than after the NE beverage regardless of the beverage flavor (eg, after reversal; caloric compensation score: 29%). The number of exposures did not influence liking or energy intake. CONCLUSION: After the association between a flavor and ED and reversal of this association, liking may be first guided by ED and then the flavor firstly associated with ED, whereas the partial caloric compensation may consistently be guided by ED. This trial was registered at clinicaltrials.gov as NCT02070185.

Learning to eat vegetables in early life: the role of timing, age and individual eating traits.

Vegetable intake is generally low among children, who appear to be especially fussy during the pre-school years. Repeated exposure is known to enhance intake of a novel vegetable in early life but individual differences in response to familiarisation have emerged from recent studies. In order to understand the factors which predict different responses to repeated exposure, data from the same experiment conducted in three groups of children from three countries (n = 332) aged 4-38 m (18.9±9.9 m) were combined and modelled. During the intervention period each child was given between 5 and 10 exposures to a novel vegetable (artichoke puree) in one of three versions (basic, sweet or added energy). Intake of basic artichoke puree was measured both before and after the exposure period. Overall, younger children consumed more artichoke than older children. Four distinct patterns of eating behaviour during the exposure period were defined. Most children were "learners" (40%) who increased intake over time. 21% consumed more than 75% of what was offered each time and were labelled "plate-clearers". 16% were considered "non-eaters" eating less than 10 g by the 5th exposure and the remainder were classified as "others" (23%) since their pattern was highly variable. Age was a significant predictor of eating pattern, with older pre-school children more likely to be non-eaters. Plate-clearers had higher enjoyment of food and lower satiety responsiveness than non-eaters who scored highest on food fussiness. Children in the added energy condition showed the smallest change in intake over time, compared to those in the basic or sweetened artichoke condition. Clearly whilst repeated exposure familiarises children with a novel food, alternative strategies that focus on encouraging initial tastes of the target food might be needed for the fussier and older pre-school children.