Mike: Hello, I’m Mike Clarke podcast editor for the Cochrane Library. Helping people develop good eating habits early in life could have long term implications for their health and wellbeing. In this podcast, Mia Parkinson, Cochrane Communications Officer, talks with Rebecca Hodder from the University of Newcastle in Callaghan, Australia, lead author of the Cochrane review of programs to increase eating of fruit and vegetables among children aged 5 years and under, the latest version of which was published in September 2024.

Mia: Welcome to this Cochrane podcast, to help us understand what works and doesn’t work for encouraging young children to eat fruit and vegetables. It’s a comprehensive review of 53 studies by Rebecca and her team. Welcome Rebecca!

Rebecca: Hello Mia. Thank you for having me.

Mia: We know that early childhood is a key time for building healthy eating habits, and those habits are likely to persist into adulthood. There are a variety of ways to try to help with this, so, can you tell us about the different types of programs that your review looked at?

Rebecca: Certainly. We grouped the healthy eating programs into six categories. These were child-feeding practices (like repeatedly offering children vegetables), multicomponent programs (which combine several strategies e.g. program that aimed to change preschool policy and child nutrition education), parent nutrition education, child nutrition education, child-focused mindfulness or providing families with fruits and vegetables.

Mia: That sounds wide-ranging. What are the key findings on how these programs affect children’s fruit and vegetable intake?

Rebecca: Firstly, for children 5 years old or younger, we found that child-feeding practice programs and multicomponent programs probably lead to small increases in their intake of fruit and vegetables in the short term (less than 12 months); while parent nutrition education programs may lead to little to no increase. And, because of the small number of studies focusing on child nutrition education and other programs, such as child mindfulness, it’s uncertain whether those programs are effective in increasing child fruit and vegetable intake.

Mia: That's some encouraging news! Alongside the benefits, did you find out anything about potential negative outcomes or the cost of delivering these programs?

Rebecca: Overall, across the 53 included studies, only three looked at negative outcomes and cost. These found no negative outcomes associated with these programs were reported and the cost of delivering the program was equivalent to about $325 US dollars per family in one study and $1500 US dollars per childcare centre in another.

Mia: It’s good to hear that the positive impacts do not seem to be accompanied by significant drawbacks. So, can you summarize the key takeaways from this review for our listeners?

Rebecca: In summary, the review highlights that some programs targeting the fruit and vegetable consumption of children aged 5 years and under can have a positive impact. We found that certain strategies to boost their fruit and vegetable intake have a small but positive effect, about 16 grams a day. Although these small effects may not seem like much, they can make a big difference when applied on a larger scale at a population level. This means that our review provides important information to guide policymakers and practitioners in developing effective strategies for young children. However, more research is needed to increase the certainty of the evidence and it’s especially important future research assesses and reports unintended negative outcomes of the strategies and provides details on their costs.

Mia: So, what’s next for this review?

Rebecca: I’m glad you asked! We have maintained this review as a living systematic review since 2017, and this is actually its sixth update. We’re calling it a living systematic review because we conduct regular searches for new evidence. In our case we do this monthly, and we aim to re-publish the review each time the new evidence would change our conclusions or our certainty in the evidence. In this way, we are able to continually incorporate new evidence as it generated and provide users of the review with the most up to date evidence on this topic.

Mia: Thanks Rebecca and thanks for sharing these valuable insights with us today. To finish, if listeners want to learn more about the updated evidence, how can they get hold of the review?

Rebecca: Thanks, Mia. The review is available online at Cochrane Library dot com. A search for “children and vegetables” will show a link to it.