Rikke Krølner

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies

BackgroundIn order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents.MethodsPapers were identified from Medline and PsycINFO by using all combinations of the search terms: fruit(s) or vegetable(s) and children or adolescents. Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6–18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes.ResultsNinety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-economic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake.ConclusionThe determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account.This paper is published as part of the special Pro Children series in the International Journal of Behavioral Nutrition and Physical Activity. Please see [http://www.ijbnp.org/content/3/1/26] for the relevant editorial.

Fruit and vegetable intake in a sample of 11-year-old children in 9 European countries: The pro children cross-sectional survey

Background/Aims: An adequate fruit and vegetable intake provides essential nutrients and nutritive compounds and is considered an important part of a healthy lifestyle. No simple instrument has been available for the assessment of fruit and vegetable intake as well as its determinants in school-aged children applicable in different European countries. Within the Pro Children Project, such an instrument has been developed. This paper describes the cross-sectional survey in 11-year-olds in 9 countries. Methods: The cross-sectional survey used nationally, and in 2 countries regionally, representative samples of schools and classes. The questionnaires, including a precoded 24-hour recall component and a food frequency part, were completed in the classroom. Data were treated using common syntax files for portion sizes and for merging of vegetable types into four subgroups. Results: The results show that the fruit and vegetable intake in amounts and choice were highly diverse in the 9 participating countries. Vegetable intake was in general lower than fruit intake, boys consumed less fruit and vegetables than girls did. The highest total intake according to the 24-hour recall was found in Austria and Portugal, the lowest in Spain and Iceland. Conclusion: The fruit and vegetable intake in 11-year-old children was in all countries far from reaching population goals and food-based dietary guidelines on national and international levels.

Fruit and Vegetable Intake of Mothers of 11-Year-Old Children in Nine European Countries: The Pro Children Cross-Sectional Survey

Objective: To describe and compare fruit and vegetable intakes of mothers of 11-year-old children across Europe. Methods: Cross-sectional surveys were carried out in 9 European countries in October/November 2003. Self-administered questionnaires assessing fruit and vegetable consumption were used for data collection. The current paper presents dietary intake data obtained by a precoded 24-hour recall and a food frequency questionnaire. Results: The consumption levels of fruit and vegetables (without fruit juice) were in line with World Health Organization recommendations of ≧400 g/day for only 27% of all participating mothers. Based on both instruments, the Pro Children results showed comparatively high average fruit intake levels in Portugal, Denmark and Sweden (211, 203 and 194 g/day) and the lowest intake in Iceland (97 g/day). High vegetable intake levels were found in Portugal and Belgium (169 and 150 g/day), the lowest in Spain (88 g/day). A south-north gradient could not be observed in the Pro Children study. Conclusion: Fruit and vegetable intakes are low in mothers of 11-year-olds across Europe. Especially vegetable consumption can be regarded as marginal in most of the studied European countries. A high percentage of mothers indicated to eat fruit and vegetables less than once a day. The results have shown that national and international interventions are necessary to promote fruit and especially vegetable consumption in the European population of mothers.

Does school environment affect 11-year-olds' fruit and vegetable intake in Denmark?

It is often found that adolescents eat too little fruit and vegetables. We examined the importance of school for 11-year-olds daily intake measured by food frequency- and 24-h recall questionnaires in Danish data from the European 2003 Pro Children Survey. Multilevel logistic regression analyses included matched student-parent-school questionnaire data (N=1410) from a random sample of 59 schools and were conducted for fruit and vegetables separately: 1) without explanatory variables, to decompose the between-school and within-school variance; 2) with individual level covariates (socioeconomic position, parental intake, etc.) to examine if the between-school variance was attributable to different student compositions of schools; and 3) with individual- and school-level covariates (school availability of fruit/vegetables and unhealthy food) to examine the effect of context. Additional analyses stratified by gender and home availability of fruit/vegetables examined if school food availability influenced subgroups differently. Between-school variations were quantified by intra class correlations and median odds ratios. We found that 40% of the students ate > or = 200 g fruit/day and 25% ate > or = 130 g vegetables/day. Most of the total variance in students intake occurred at the individual level (93-98%). There were larger between-school variations in vegetable intake than in fruit intake. Fruit and vegetable consumption clustered within schools to a larger degree for boys than girls. The between-school variance did not differ by home availability. Boys and students from high availability homes consumed more fruit and/or vegetables if enrolled in schools with access to fruit/vegetables and unhealthy food or contrarily with no food available versus schools with only fruit/vegetables available. The small school-level effects on 11-year-olds fruit and vegetable intake imply that family level interventions may be more important and that the success of school interventions will rely on the degree of parental involvement.

Medicine use among 11- and 13-year-olds: agreement between parents' reports and children's self-reports

Background: The validity of childrens self-reports on medicine use has not been reported. Objective: To determine the agreement between parents and childrens reports of medicine use for 5 common complaints and to analyze predictors for disagreement. Methods: We used the child–parent validation survey from the research project Health Behaviour in School-Aged Children. Three hundred ninety-three 11- and 13-year-old Danish children and their parents responded to identical questionnaires. The main outcome measures were self-reported medicine use during the previous month for headache, stomachache, difficulties in falling asleep, nervousness, and asthma. Results: The percent agreement was lowest with medicine use for headache (64.6%), but was very high for the other 4 complaints (85.3–91.8%). The simple κ coefficients were moderate to good for medicine use for headaches, stomachache, and asthma (0.31–0.58) but poor for difficulties in falling asleep and nervousness. Children who had the specific complaint during the previous month were more likely than their parents to report more frequent medicine use. Conclusions: We have some confidence in young adolescents self-reports of medicine use, as the results of this study are in keeping with other studies on the validity of childrens reports of health-related behaviors. Furthermore, the findings suggest that such data can be used in epidemiologic studies that aim to categorize children into groups with and without medicine use.

Young adolescents' use of medicine for headache: sources of supply, availability and accessibility at home.

Use of medicines for headache is common among young adolescents but little is known about their sources of supply and access to medicines. The purpose was to describe sources of supply, availability and accessibility at home and to examine if supply, availability and accessibility were associated with medicine use.

Secular trends in fruit intake among Danish schoolchildren, 1988 to 2006: Changing habits or methodological artefacts?

BackgroundIntermittent monitoring of fruit and vegetable intake at the population level is essential for the evaluation and planning of national dietary interventions. Yet, only a limited number of studies on time trends in fruit and vegetable intake among children and adolescents have been published internationally. In Denmark, national comprehensive campaigns to enhance fruit and vegetable consumption were initiated in 2001. This paper describes secular trends in fruit intake among Danish adolescents by six comparable school surveys from 1988 to 2006. The paper demonstrates and discusses the consequences of measurement changes introduced in long-term trend analyses.MethodsWe used Danish data from the international Health Behaviour in School-aged Children (HBSC) study collected in 1988, 1991, 1994, 1998, 2002 and 2006. Analyses were conducted on comparable questionnaire-based data from students aged 11, 13 and 15 total (n = 23,871) from a random sample of schools. Data on fruit intake were measured by a food frequency questionnaire. Due to changes in number of response categories beween surveys, different cut-points were analysed.ResultsThe prevalence of students eating fruit at least once daily ranged from 78.3% among 13-year-old girls in 1988 to 17.3% among 15-year-old boys in 2002. Based on the six data collections, analyses of trends showed a significant decrease in prevalence of students eating fruit at least once daily from 1988 to 2002 (all p-values < 0.0001). In all age and gender groups, a significant increase in intake occurred between 2002 and 2006 (all p-values < 0.0065). Analyses of alternative cut-points revealed similar results.ConclusionFruit consumption among Danish schoolchildren decreased from 1988 to 2002 with an increase since 2002. We suggest that the increase may be attributable to a nation-wide initiative conducted in Denmark since 2001 to increase the intake of fruit and vegetables in the population. Still, the results imply that a substantial proportion of Danish schoolchildren do not meet the nationally recommended daily intake of fruit. Our analyses indicate that the observed trends are not solely caused by methodological biases related to changes in measurements.