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Background: Although dietary guidelines recommend that vegetables and fruits make up half the diet, it is unclear whether serving vegetables and fruits in larger portions will have sustained effects on children's intake over multiple days., Objectives: This study tested the effects on children's intake of 2 strategies for increasing the proportion of vegetables and fruits: either adding or substituting extra portions as side dishes at meals and snacks over 5 d., Methods: In a cluster-randomized crossover design with 3 periods, we provided all meals and snacks for 5 d to 53 children aged 3-5 y in classrooms in their childcare centers. In the Control condition, we served typical portions for all food groups. In the Addition condition we increased portions of low-energy-dense vegetables and fruits by 50%, and in the Substitution condition we increased portions of vegetables and fruits by 50% and also reduced portions of other foods by an equivalent weight., Results: For vegetables, the Addition strategy increased daily intake compared with Control by 24% (mean ± SEM = 12 ± 3 g/d; P = 0.0002), and the Substitution strategy increased intake compared with Control by 41% (22 ± 3 g/d; P < 0.0001). For fruits, consumption increased by similar amounts: Addition by 33% (60 ± 6 g/d) and Substitution by 38% (69 ± 8 g/d; both P < 0.0001). Both strategies increased vegetable and fruit intakes compared with Control across all 5 days (all P < 0.004), although the increase in fruit consumption with Addition declined over time (P < 0.0001). Daily energy intake compared with Control increased by 5% with Addition (57 ± 17 kcal; P = 0.001) but decreased by 6% with Substitution (-64 ± 21 kcal; P = 0.004)., Conclusions: Both the Addition and Substitution strategies promoted increases in vegetable and fruit intake over 5 d in preschool children. When excess energy intake is a concern, substituting vegetables and fruits for other foods is a better option than simply serving more.This trial was registered at http://www.clinicaltrials.gov as NCT03242863 (https://clinicaltrials.gov/ct2/show/NCT03242863), where the protocol is available., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

This study investigated the independent and combined effects on preschool children's vegetable intake of serving a larger portion of vegetables and enhancing their flavor. In a crossover design, lunch was served in childcare centers once a week for four weeks to 67 children aged 3-5 y (26 boys, 41 girls). The meal consisted of two familiar vegetables (broccoli and corn) served with fish sticks, rice, ketchup, applesauce, and milk. Across the four meals, we varied the portion of vegetables (60 or 120 g total weight, served as equal weights of broccoli and corn) and served them either plain or enhanced (6.6% light butter and 0.5% salt by weight). All meals were consumed ad libitum and were weighed to determine intake. Doubling the portion of vegetables led to greater consumption of both broccoli and corn (both p < 0.0001) and increased meal vegetable intake by 68% (mean ± SEM 21 ± 3 g). Enhancing vegetables with butter and salt, however, did not influence their intake (p = 0.13), nor did flavor enhancement modify the effect of portion size on intake (p = 0.10). Intake of other meal components did not change when the vegetable portion was doubled (p = 0.57); thus, for the entire meal, the increase in vegetable consumption led to a 5% increase in energy intake (13 ± 5 kcal; p = 0.02). Ratings indicated that children had similar liking for the plain and enhanced versions of each vegetable (both p > 0.31). All versions of vegetables were well-liked, as indicated by ≥ 76% of the children rating them as "yummy" or "just okay". Serving a larger portion of vegetables at a meal was an effective strategy to promote vegetable intake in children, but when well-liked vegetables were served, adding butter and salt was not necessary to increase consumption., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To test whether adding herbs and spices to school lunch vegetables increases selection and intake compared with lightly salted control versions among rural adolescents., Design: This study compared intake of vegetables with herbs and spices with lightly salted controls (phase I) and tested whether 5 repeated exposures would increase students' intake of herb and spice seasoned vegetables (phase II)., Participants and Setting: A total of 600-700 students at a rural middle/high school (age 11-18 years)., Intervention: In phase I, herbs and spices were added to 8 vegetables and outcomes were compared with 8 control recipes. In phase II, the impact of repeated exposure to herb and spice blends served on different vegetables was assessed., Main Outcomes: Vegetable selection rates, weighed intake, and willingness to eat again., Analysis: Two-way ANOVAs tested effects of condition (herbs and spices vs control; before vs after exposure) and age (middle vs high school) on selection and intake., Results: In phase I, students ate more control than seasoned broccoli (P = .01), cauliflower (P = .006), and green beans (P = .01), and high schoolers generally consumed more seasoned vegetables than did middle schoolers (P < .03). In phase II, repeated exposure to herbs and spices increased reported willingness to eat again for seasoned broccoli (P = .003)., Conclusions and Implications: In a short-term intervention, herbs and spices did not produce robust increases in school lunch vegetable intake among rural adolescents, but limited repeat exposure may increase students' willingness to consume these flavors. Additional work is needed to identify individual and school-level characteristics that affect students' willingness to select and consume vegetables with herbs and spices., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Large portions of energy dense foods promote overconsumption but offering small portions might lead to compensatory intake of other foods. Offering a variety of vegetables could help promote vegetable intake and offset the effect of reducing the portion size (PS) of a high energy dense (HED) food. Therefore, we tested the effect on intake of reducing the PS of a HED unit lunch item while varying the variety of the accompanying low energy dense (LED) vegetables. In a within-subjects design, 43 3⁻5-year-old pre-schoolers were served a lunch meal in their nursery on 8 occasions. Children were served a standard (100%) or downsized (60%) portion of a HED sandwich with a side of LED vegetables offered as a single (carrot, cherry tomato, cucumber) or variety (all 3 types) item. Reducing the PS of a HED sandwich reduced sandwich (g) ( p < 0.001) and total meal intake (kcal) consumption ( p = 0.001) without an increased intake of other foods in the meal (LED vegetables ( p = 0.169); dessert ( p = 0.835)). Offering a variety of vegetables, compared with a single vegetable, increased vegetable intake (g) ( p = 0.003) across PS conditions. Downsizing and variety were effective strategies individually for altering pre-schoolers' intakes of HED and LED meal items, however, using variety to offset HED downsizing was not supported in the present study.

Background: Behavioral economics and psychology have been applied to altering food choice, but most studies have not measured food intake under free-living conditions., Objectives: To test the effects of a strategy that pairs positive stimuli (ie, stickers and cartoon packaging) with vegetables and presents them as the default snack., Design: A randomized controlled trial was conducted with children who reported consumption of fewer than two servings of vegetables daily. Children (aged 3 to 5 years) in both control (n=12) and treatment (n=12) groups received a week's supply of plainly packaged (ie, generic) vegetables, presented by parents as a free choice with an alternative snack (granola bar), during baseline (Week 1) and follow-up (Week 4). During Weeks 2 and 3, the control group continued to receive generic packages of vegetables presented as a free choice, but the treatment group received vegetables packaged in containers with favorite cartoon characters and stickers inside, presented by parents as the default choice. Children in the treatment group were allowed to opt out of the vegetables and request the granola bar after an imposed 5-minute wait., Statistical Analysis: General Linear Model repeated measures analysis of variance was conducted to compare vegetable and granola bar intake between control and treatment groups across the 4-week study. Both within- and between-subjects models were tested., Results: A time×treatment interaction on vegetable intake was significant. The treatment group increased vegetable intake from baseline to Week 2 relative to control (P<0.01), but the effects were not sustained at Week 4 when the treatment was removed. Granola bar intake decreased in the treatment group at Week 2 (P≤0.001) and Week 3 (P≤0.005) relative to baseline., Conclusions: Parents were able to administer feeding practices derived from behavioral economics and psychology in the home to increase children's vegetable intake and decrease intake of a high-energy-density snack. Additional studies are needed to test the long-term sustainability of these practices., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Reductions in food energy density can decrease energy intake, but it is not known if the effects depend on the way that energy density is reduced. We investigated whether three methods of reducing energy density (decreasing fat, increasing fruit and vegetables, and adding water) differed in their effects on energy intake across the day. In a crossover design, 59 adults ate breakfast, lunch, and dinner in the laboratory once a week for 4 weeks. Across conditions, the entrées were either standard in energy density or were reduced in energy density by 20% using one of the three methods. Each meal included a manipulated entrée along with unmanipulated side dishes, and all foods were consumed ad libitum. Reducing the energy density of entrées significantly decreased daily energy intake compared to standard entrées (mean intake 2667 ± 77 kcal/day; 11,166 ± 322 kJ/day). The mean decrease was 396 ± 44 kcal/day (1658 ± 184 kJ/day) when fat was reduced, 308 ± 41 kcal/day (1290 ± 172 kJ/day) when fruit and vegetables were increased, and 230 ± 35 kcal/day (963 ± 147 kJ/day) when water was added. Daily energy intake was lower when fat was decreased compared to the other methods. These findings indicate that a variety of diet compositions can be recommended to reduce overall dietary energy density in order to moderate energy intake., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Effective strategies are needed to increase vegetable intake in accordance with health recommendations. Previous research has shown that increasing the variety of foods leads to increased consumption, yet this strategy has not been investigated for promoting vegetable intake. This crossover study, conducted in 2008 and 2009, tested whether filling half the plate with a variety of vegetables influences vegetable consumption and meal energy intake. Once a week for 4 weeks, a meal of pasta and cooked vegetables was consumed ad libitum by 66 adults (34 women, 32 men). The meals were varied in the type of vegetables offered: at three meals 600 g of a single vegetable was served (broccoli, carrots, or snap peas) and at one meal 200 g of each of the three vegetables was served side by side. Data were analyzed using a mixed linear model with repeated measures. In this study, serving a variety of vegetables increased vegetable intake at the meal (P<0.0001). Subjects ate more vegetables when served the variety than when served any single type; the mean increase was 48±6 g, or more than one-half serving. This increase remained significant when intake of the variety of vegetables was compared with the preferred vegetable of each participant (mean 25±8 g; P=0.002). Vegetable intake was not significantly related to energy intake at the meal. The results of this study demonstrate that increasing the variety of low-energy-dense vegetables served at a meal can be used as a strategy to increase vegetable intake., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Serving larger portions of energy-dense foods has been shown to promote children's energy intake at meals. Whether larger portions increase children's intake of both fruits and vegetables (F&V) is less clear. A 2×2 within-subjects design systematically varied portion sizes of fruit (75 vs 150 g) and vegetable (75 vs 150 g) side dishes served at dinner. Children's F&V liking was measured using a validated tasting method. Thirty children aged 4 to 6 years were tested in a laboratory setting at 5:00 pm on weekdays from November 2008 through March 2009. Mixed linear models were used to determine effects of fruit portion size, vegetable portion size, and their interaction on food and energy intakes. Data are presented as model-based means±standard error unless otherwise indicated. When portions were doubled, children increased their vegetable intake by 37% (12±4 g; P<0.01) and their fruit intake by 70% (41±6 g; P<0.01). Vegetable portion size effects were not influenced by offering more fruit and vice versa. Portion size effects were limited to children who liked that particular food. Total meal energy intake did not vary by portion size condition. These results indicate that serving larger F&V portions at meals can be used to promote young children's intake of both foods without influencing total meal energy intake. Effects were not seen in children who disliked F&V, suggesting a need to combine increased F&V portions with strategies to increase their acceptance.

The objective was to determine the relationship between dietary energy density (ED; kcal/g) and measured weight status in children. The present study used data from a nationally representative sample of 2442 children between 2 and 8 y old who participated in the 2001-2004 NHANES. Survey measures included 24-h dietary recall data, measurement of MyPyramid servings of various food groups, and anthropometry. The relationship among dietary ED, body weight status as calculated using the 2000 CDC growth charts, and food intake was evaluated using quartiles of ED. Additionally, other dietary characteristics associated with ED among children are described. Specific survey procedures were used in the analysis to account for sample weights, unequal selection probability, and the clustered design of the NHANES sample. In this sample, dietary ED was positively associated with body weight status in U.S. children aged 2-8 y. Obese children had a higher dietary ED than lean children (2.08 ± 0.03 vs. 1.93 ± 0.05; P = 0.02). Diets high in ED were also found to be associated with greater intakes of energy and added sugars, more energy from fat; and significantly lower intake of fruits and vegetables. Interventions that lower dietary ED by means of increasing fruit and vegetable intake and decreasing fat consumption may be an effective strategy for reducing childhood obesity.

Background: Strategies are needed to increase children's intake of a variety of vegetables, including vegetables that are not well liked., Objective: We investigated whether incorporating puréed vegetables into entrées to reduce the energy density (ED; in kcal/g) affected vegetable and energy intake over 1 d in preschool children., Design: In this crossover study, 3- to 5-y-old children (n = 40) were served all meals and snacks 1 d/wk for 3 wk. Across conditions, entrées at breakfast, lunch, dinner, and evening snack were reduced in ED by increasing the proportion of puréed vegetables. The conditions were 100% ED (standard), 85% ED (tripled vegetable content), and 75% ED (quadrupled vegetable content). Entrées were served with unmanipulated side dishes and snacks, and children were instructed to eat as much as they liked., Results: The daily vegetable intake increased significantly by 52 g (50%) in the 85% ED condition and by 73 g (73%) in the 75% ED condition compared with that in the standard condition (both P < 0.0001). The consumption of more vegetables in entrées did not affect the consumption of the vegetable side dishes. Children ate similar weights of food across conditions; thus, the daily energy intake decreased by 142 kcal (12%) from the 100% to 75% ED conditions (P < 0.05). Children rated their liking of manipulated foods similarly across ED amounts., Conclusion: The incorporation of substantial amounts of puréed vegetables to reduce the ED of foods is an effective strategy to increase the daily vegetable intake and decrease the energy intake in young children. This trial was registered at clinicaltrials.gov as NCT01252433.

This study tested whether varying the portion of low-energy-dense vegetable soup served at the start of a meal affects meal energy and vegetable intakes in children. Subjects were 3- to 5-year-olds (31 boys and 41 girls) in daycare facilities. Using a crossover design, children were served lunch once a week for four weeks. On three occasions, different portions of tomato soup (150, 225, and 300 g) were served at the start of the meal, and on one occasion no soup was served. Children had 10 min to consume the soup before being served the main course. All foods were consumed ad libitum. The primary outcomes were soup intake as well as energy and vegetable intake at the main course. A mixed linear model tested the effect of soup portion size on intake. Serving any portion of soup reduced entrée energy intake compared with serving no soup, but total meal energy intake was only reduced when 150 g of soup was served. Increasing the portion size increased soup and vegetable intake. Serving low-energy-dense, vegetable soup as a first course is an effective strategy to reduce children's intake of a more energy-dense main entrée and increase vegetable consumption at the meal., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: The overconsumption of energy-dense foods leads to excessive energy intakes. The substitution of low-energy-dense vegetables for foods higher in energy density can help decrease energy intakes but may be difficult to implement if individuals dislike the taste of vegetables., Objective: We investigated whether incorporating puréed vegetables to decrease the energy density of entrées at multiple meals reduced daily energy intakes and increased daily vegetable intakes., Design: In this crossover study, 20 men and 21 women ate ad libitum breakfast, lunch, and dinner in the laboratory once a week for 3 wk. Across conditions, entrées at meals varied in energy density from standard versions (100% condition) to reduced versions (85% and 75% conditions) by the covert incorporation of 3 or 4.5 times the amount of puréed vegetables. Entrées were accompanied by unmanipulated side dishes. Participants rated their hunger and fullness before and after meals., Results: Subjects consumed a consistent weight of foods across conditions of energy density; thus, the daily energy intake significantly decreased by 202 ± 60 kcal in the 85% condition (P < 0.001) and by 357 ± 47 kcal in the 75% condition (P < 0.0001). Daily vegetable consumption significantly increased from 270 ± 17 g of vegetables in the 100% condition to 487 ± 25 g of vegetables in the 75% condition (P < 0.0001). Despite the decreased energy intake, ratings of hunger and fullness did not significantly differ across conditions. Entrées were rated as similar in palatability across conditions., Conclusions: Large amounts of puréed vegetables can be incorporated into various foods to decrease the energy density. This strategy can lead to substantial reductions in energy intakes and increases in vegetable intakes. This trial was registered at clinicaltrials.gov as NCT01165086.

Background: Serving larger portions of low-energy-dense vegetables at a meal could have beneficial effects on children's food and energy intakes., Objective: We investigated whether increasing the portion size of vegetables served at the start of a meal leads to increased vegetable consumption and decreased meal energy intake in children., Design: In a crossover design, 3- to 5-y-old children in a daycare center were served a test lunch once a week for 4 wk (n = 51). In 3 of the meals, a first course of raw carrots varied in portion size (30, 60, or 90 g), and no first course was served in the control meal. Children consumed the first course ad libitum over 10 min and then were served a main course of pasta, broccoli, applesauce, and milk, which was also consumed ad libitum., Results: Total vegetable consumption at the meal increased as the portion size of carrots increased (P < 0.0001). Doubling the portion size of the first course increased carrot consumption by 47%, or 12 +/- 2 g (P < 0.0001). Tripling the portion size of carrots, however, did not lead to a further increase in intake (P = 0.61). Meal energy intake was not significantly affected by the amount of carrots served in the first course. The effect of portion size on intake was not significantly influenced by the children's age or body weight status., Conclusion: Increasing the portion size of a vegetable served as a first course can be an effective strategy for increasing vegetable consumption in preschool children.

Background: An increase in the proportion of vegetables at meals could help achieve recommended vegetable intakes and facilitate weight management., Objective: We investigated the effects on food and energy intakes of varying the portion size and energy density of a vegetable that was added to a meal or substituted for other foods., Design: In 2 experiments with crossover designs, men and women were served a meal of a vegetable, grain, and meat. Across the meals, the vegetable was served in 3 portion sizes (180, 270, or 360 g) and 2 energy densities (0.8 or 0.4 kcal/g) by altering the type and amount of added fat. In the addition study (n = 49), as the vegetable portion was increased, amounts of the grain and meat were unchanged, whereas in the substitution study (n = 48), amounts of the grain and meat decreased equally., Results: An increase in the vegetable portion size resulted in greater vegetable consumption in both studies (mean +/- SE: 60 +/- 5 g; P < 0.0001). The addition of more of the vegetable did not significantly affect meal energy intake, whereas substitution of the vegetable for the grain and meat decreased meal energy intake (40 +/- 10 kcal; P < 0.0001). A reduction in vegetable energy density decreased meal energy intake independent of portion size (55 +/- 9 kcal; P < 0.0001). By combining substitution with a reduction in energy density, meal energy intake decreased by 14 +/- 3%., Conclusions: Serving more vegetables, either by adding more or substituting them for other foods, is an effective strategy to increase vegetable intake at a meal. However, to moderate meal energy intake, vegetables should be low in energy density; furthermore, the substitution of vegetables for more energy-dense foods is more effective than simply adding extra vegetables.

Increasing the portion size of energy-dense entrées has been shown to increase children's energy intake during a meal. It remains to be investigated whether serving larger portions to children can be used to promote intake of more healthful foods, such as fruits and vegetables (F&V). The aim of the present study was to examine the effects of increasing the portion size of F&V side dishes on children's intake. Forty-three children (22 boys, 21 girls), aged 5-6 years, were served dinner once a week for 2 weeks. Each dinner consisted of pasta with tomato sauce, three F&V side dishes (broccoli, carrots, and applesauce), and milk. The portion size of the F&V was doubled between experimental conditions whereas the size of the pasta remained constant. Doubling the portion size of the side dishes resulted in a 43% increase in children's intake of the fruit side dish (P = 0.001), but did not affect children's intake of the two vegetable side dishes (P > 0.60). Further, when the portion size of F&V side dishes was doubled, children ate significantly less of the pasta (P = 0.04). The difference in meal energy intake between portion size conditions (19.5 +/- 16.3 kcal) was not significant (P = 0.24). Although more studies are needed to understand whether increases in portion size can influence vegetable intake, children did eat more in response to a large quantity of a preferred low energy-dense fruit side dish at meals. Thus variations in portion size can be used strategically to help children achieve the recommended intake of fruits.

The energy density (ED; kcal/g) of an entrée influences children's energy intake (EI), but the effect of simultaneously changing both ED and portion size of an entrée on preschool children's EI is unknown. In this within-subject crossover study, 3- to 5-year-old children (30 boys, 31 girls) in a daycare facility were served a test lunch once/week for 4 weeks. The amount and type of vegetables and cheeses incorporated into the sauce of a pasta entrée were manipulated to create two versions that varied in ED by 25% (1.6 or 1.2 kcal/g). Across the weeks, each version of the entrée was served to the children in each of two portion sizes (400 or 300 g). Lunch, consumed ad libitum, also included carrots, applesauce, and milk. Decreasing ED of the entrée by 25% significantly (P<0.0001) reduced children's EI of the entrée by 25% (63.1+/-8.3 kcal) and EI at lunch by 17% (60.7+/-8.9 kcal). Increasing the proportion of vegetables in the pasta entrée increased children's vegetable intake at lunch by half of a serving of vegetables (P<0.01). Decreasing portion size of the entrée by 25% did not significantly affect children's total food intake or EI at lunch. Therefore, reducing the ED of a lunch entrée resulted in a reduction in children's EI from the entrée and from the meal in both portion size conditions. Decreasing ED by incorporating more vegetables into recipes is an effective way of reducing children's EI while increasing their vegetable intake.

Background: Consuming foods low in energy density (kcal/g) decreases energy intake over several days, but the effectiveness of this strategy for weight loss has not been tested., Objective: The effects on weight loss of 2 strategies for reducing the energy density of the diet were compared over 1 y., Design: Obese women (n = 97) were randomly assigned to groups counseled either to reduce their fat intake (RF group) or to reduce their fat intake and increase their intake of water-rich foods, particularly fruit and vegetables (RF+FV group). No goals for energy or fat intake were assigned; the subjects were instructed to eat ad libitum amounts of food while following the principles of their diet., Results: After 1 y, study completers (n = 71) in both groups had significant decreases in body weight (P < 0.0001). Subjects in the RF+FV group, however, had a significantly different pattern of weight loss (P = 0.002) than did subjects in the RF group. After 1 y, the RF+FV group lost 7.9 +/- 0.9 kg and the RF group lost 6.4 +/- 0.9 kg. Analysis of all randomly assigned subjects also showed a different pattern of weight loss between groups (P = 0.021). Diet records indicated that both groups had similar reductions in fat intake. The RF+FV group, however, had a lower dietary energy density than did the RF group (P = 0.019) as the result of consuming a greater weight of food (P = 0.025), especially fruit and vegetables (P = 0.037). The RF+FV group also reported less hunger (P = 0.003)., Conclusion: Reducing dietary energy density, particularly by combining increased fruit and vegetable intakes with decreased fat intake, is an effective strategy for managing body weight while controlling hunger.

Objective: We tested the effect on meal intake of varying the energy density and portion size of a compulsory first-course salad., Design: The study used a randomized crossover design., Subjects/setting: Forty-two women from the State College, PA, university community ate lunch in the laboratory once per week for 7 weeks., Intervention: Lunch comprised one of six first-course salads, or no salad in the control condition, followed by a main course of pasta. Subjects were required to consume the entire salad, but ate as much pasta as they wanted. The salads varied in energy density (0.33, 0.67, or 1.33 kcal/g) and portion size (150 or 300 g). The energy density of the salad was reduced by changing the amount and type of dressing and cheese., Main Outcome Measures: Energy intake and ratings of hunger, satiety, and food characteristics were measured., Statistical Analyses Performed: Outcomes were analyzed using a linear mixed model with repeated measures., Results: Compared with having no first course, consuming the low-energy-dense salads reduced meal energy intake (by 7% for the small portion and 12% for the large), and consuming the high-energy-dense salads increased intake (by 8% for the small portion and 17% for the large). When two salads with the same number of calories were compared, meal intake was decreased when the large portion of the lower-energy-dense salad was consumed., Conclusions: Eating a low-energy-dense first course enhances satiety and reduces meal energy intake. Consuming a large portion of a low-energy-dense food at the start of a meal may be an effective strategy for weight management.

Clinical evidence shows that combining advice to increase fruit and vegetable consumption with caloric restriction is an effective strategy for weight management. The purpose of this review is to evaluate epidemiologic evidence to determine whether it supports an association between fruit and/or vegetable consumption and body weight. Few studies have been designed to specifically address this issue, and those that are available vary in methodology and offer inconsistent results. We make recommendations on how to strengthen future studies so that the influence of fruit and vegetable consumption on body weight in free-living individuals is better understood.

Given the recent surge in obesity, effective dietary strategies for weight management are required. Because fruits and vegetables are high in water and fiber, incorporating them in the diet can reduce energy density, promote satiety, and decrease energy intake. Although few interventions have specifically addressed fruit and vegetable consumption, evidence suggests that coupling advice to increase intake of these foods with advice to decrease energy intake is a particularly effective strategy for weight management. This approach may facilitate weight loss because it emphasizes positive messages rather than negative, restrictive messages.

Background: When children choose amounts of food to eat, it is unclear what influences the portions they select and whether their selections are related to the amounts they consume.Objectives: Using a computer survey, we investigated the effect of food liking on portion selection in middle childhood and examined how children's selections were related to measured intake at meals in which portions of all foods were varied across 4 test days.Methods: Fifty-one children aged 7-10 y completed a computer survey of 20 common foods with a range of energy density. For each food, the survey presented sliding scales with 5 images varying in portion size and children indicated their liking and the amount they would eat at a specified meal or snack. On 4 test days in a randomized crossover design, children were served a meal of 6 foods from the survey with portions of 100%, 133%, 167%, or 200% of baseline amounts. Data were analyzed using random coefficients models.Results: Across the 20 foods used in the survey, portion selection ratings were predicted by food liking ratings (P < 0.0001). After accounting for liking, portion selection ratings did not vary by food energy density (P = 0.50). At the meals, intake of all 6 foods increased when larger portions were served (P = 0.002). Furthermore, the selected portion of a food on the survey was positively related both to intake of that food at the 100%-portion meal (P = 0.014) and to increased intake as larger portions were served (P < 0.0001).Conclusions: Children aged 7-10 y were able to use a computer survey to choose food portions that predicted their measured intake in response to increased portions. The relation of liking to selection and intake indicates that to promote children's consumption of larger portions of low-energy-dense foods such as fruits and vegetables, these foods must be well liked by the children. This trial was registered at clinicaltrials.gov as NCT02759523. [ABSTRACT FROM AUTHOR]

Background: Although serving a greater variety of food increases intake, this effect has not been well studied as a strategy to encourage consumption of vegetables and fruit in preschool children. Objective: This study examined whether providing a variety of familiar vegetables or fruit to preschool children as a snack would lead to increased selection and intake. Design: In a crossover design, 61 children (aged 3-5 y) ate a snack in their childcare facility on 8 afternoons. At 4 snack times, the children were offered vegetables: either a single type (cucumber, sweet pepper, or tomato) or a variety of all 3 types. At 4 other snack times, the children were offered fruit (apple, peach, pineapple, or all 3 types). Uniform-sized pieces were served family style, and children selected and ate as much as they desired. Results: Offering a variety of vegetables or fruit increased the likelihood of selection (P < 0.0001); children chose some pieces in 94% of snacks with variety and in 70% of snacks without variety. Serving a variety also increased consumption of both vegetables and fruit (P < 0.0002); the mean (±SEM) increase was 31 ± 5 g, about one-sixth the recommended daily amount. Independent of the variety effect, children were less likely to select vegetables than fruit (P < 0.0001), and the mean intake was substantially less for vegetables than for fruit (22 ± 1 compared with 84 ± 3 g). Conclusions: Providing a variety of vegetables and fruit as a snack led to increased consumption of both food types in a childcare facility. Serving a variety of vegetables or fruit as a snack could help preschool children meet recommended intakes. This trial was registered at clinicaltrials.gov as NCT01557218. [ABSTRACT FROM AUTHOR]

The energy density (ED) of an entree influences children's energy intake (EI), but the effect of simultaneously changing both ED and portion size of an entrée on preschool children's E1 is unknown. This within-subjects crossover design study tested whether ED and portion size of an entrée combine to affect EI in 3- to 5-year-old children. One day/week for 4 weeks, 61 children (mean BMI percentile 62.0 ± 3.3) were served an ad libitum test lunch in a child care setting. A baked pasta entrée was formulated in two versions that varied in ED due to fat and vegetable manipulations: HED entrée had 1.6 kcal/g and LED entrée had 1.2 kcal/g, a 25% reduction. There were 4 pasta conditions: 300 g of HED, 400 g of HED, 300 g of LED, and 400 g of LED. Other lunch foods (carrots, applesauce, and milk) did not vary. Children did not prefer one entrée over the other. ED, but not portion size, of the entrée significantly (p<0.0001) affected children's El. When served the LED entree, children consumed 25% less energy from the entree and 17% less energy from the total meal. Children consumed more vegetables from the LED entrée lunch (29 g vs. 17 g; p<0.0001). The role of portion size in young children's EI needs further investigation. The results demonstrate that children's EI is influenced by the ED of an entree and their vegetable intake can be increased by adding vegetables to entrées. [ABSTRACT FROM AUTHOR]

Abstract: In a previous study, consuming a fixed amount of low-energy-dense salad as a first course reduced meal energy intake. We investigated whether this effect depended on serving salad before rather than with the main course, or on compulsory rather than ad libitum consumption. On five occasions, 46 women consumed ad libitum a main course of pasta, accompanied four times by low-energy-dense salad (300g; 100kcal [418kJ]). At two meals the salad was served 20min before the pasta (once compulsory; once ad libitum), and at two meals the salad was served with the pasta (once compulsory; once ad libitum). Results showed that adding a fixed amount of salad to the meal reduced energy intake by 11% (57±19kcal [238±79kJ]). Ad libitum salad consumption was less than compulsory consumption and did not significantly affect energy intake. Across all participants, the timing of serving the salad did not significantly influence energy intake, but the effect of timing depended on participant scores for flexible dietary restraint. Consuming low-energy-dense salad before rather than with the main course increased vegetable consumption by 23%. To moderate energy intake, maximizing the amount of salad eaten may be more important than the timing of consumption. [Copyright &y& Elsevier]

Purpose Vegetable consumption in youth is below recommendations and strategies to increase intake at school are needed. We investigated barriers to vegetable intake at a rural public high school and evaluated whether new vegetable recipes using herbs and spices would increase liking and preference for vegetables served to adolescents at this school. Methods Before recipe development, herb and spice familiarity and barriers to vegetable intake were assessed through surveys with a sample of students, parents, and cafeteria staff at the high school. Recipes for vegetables were then developed using spice blends (including dill, coriander, cumin, etc.) uniquely formulated for each vegetable. To evaluate recipe acceptance, we assessed liking (100 mm visual analog scales) and preference (forced choice) among students ( N’s  = 96–110; aged 14–18 years) for 8 plain (oil and salt) and 8 seasoned vegetables. Liking ratings between plain and seasoned vegetables were compared with paired T- tests. Preferences were compared by chi-square tests. Results Students reported higher liking for several seasoned recipes compared to plain: broccoli ( P  = 0.02), vegetable dip ( P  < 0.0001), black beans and corn ( P  < 0.001), and cauliflower ( P  = 0.01). Students preferred the seasoned recipe to the plain for corn and peas ( P  = 0.002), broccoli ( P  = 0.02), dip ( P  < 0.0001), black beans and corn ( P  < 0.001), cauliflower ( P  < 0.0001), and green beans ( P  = 0.02). Conclusions Common herbs and spices improved liking and preference for several school lunch vegetables compared to plain varieties among rural high school students. Future research will test the impact of offering these vegetables in the school lunch program on student vegetable intake. [ABSTRACT FROM AUTHOR]