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V is for Vegetable: Applying Learning theory to increase liking and intake of vegetables

Final Report Summary - VIVA (V is for Vegetable: Applying Learning theory to increase liking and intake of vegetables.)

The VIVA project (V is for Vegetable: Applying learning theory to increase liking and intake of vegetables) was a 4 year industry and academia partnerships and pathways (IAPP) award to exchange knowledge and to develop both qualitative and quantitative studies to improve preference and consumption of vegetables in children. In particular, the qualitative studies explored best practice among mothers in two EU countries for introducing vegetables at weaning and the quantitative studies examined whether experience of unfamiliar vegetables at weaning or during pre-school would increase acceptance of these vegetables and would also generalise to other vegetables. The rationale for these studies emerged in part from large scale studies indicating that young children eat fewer vegetables than is recommended (NDNS, 2011). Diets which are high in plant sources confer protection against several diseases including cardiovascular disease, diabetes, cancer and obesity (Boeing et al 2012). In order to achieve these health benefits, intake of vegetables must be frequent and habitual. However, food choice is largely determined by preference and a major barrier to vegetable intakes in children includes a strong dislike for the taste of vegetables. This could be due to lack of familiarity with some vegetables, their low energy density, or the bitter taste of some green, leafy vegetables or unusual texture of some vegetables. It could be a combination of all of these elements. It is important to understand the best ways to encourage vegetable consumption in the early years of life. In particular, food habits including preferences are formed in childhood and track into later life. Thus the early years are a crucial time to encourage vegetable intake so that these foods are preferred and selected at the beginning of food preference development.The specific objectives of the project were: to explore best practice in the use of vegetables during weaning; to compare weaning recommendations from Europe, WHO and the US ; to develop and trial interventions at the weaning and preschool stage to increase liking and intake of vegetables; and to disseminate findings widely. In the first year of the project, an audit of official recommendations for the introduction of vegetables in the weaning diet was completed (WP1); then an expert workshop to discuss these feeding guidelines and state of the art research and practice in infant feeding was held at the University of Aberdeen (WP2); a qualitative research study was performed in the UK involving mothers of infants to develop questions about general weaning behaviours, specific practices of vegetable exposure, and mothers' experience of recommendations and advice from health professionals, family and friends (WP3). Findings from the audit, the qualitative study and selected presentations from the expert workshop have been published together in a peer-reviewed special section of the journal Appetite (volume 57, December 2011); findings from the first qualitative study shaped the qualitative study of French mothers (WP3) and these results have been submitted to Appetite for publication. A randomised control trial was developed to test the efficacy of a step-by-step intervention for introducing vegetables in the weaning period (WP4) and a pilot intervention using a vegetable smoothie was developed for preschool children (WP5). Communications materials have now been developed for healthcare practitioners both in leaflet format and in a community practitioner journal. Both are publically available on the VIVA congress website (WP6). A major international congress (http://vivacongress2013.co.uk) was organised at the end of the project to disseminate these findings and to facilitate knowledge exchange across EU and US stakeholders including early years and healthcare practitioners (WP7). The project coordinator and partners have developed close links to the HabEat project and 3 joint workshops were organised during and after the project (http://www.habeat.eu). Overall, the VIVA project has produced scientific outputs, new product ideas and dissemination through scientific and stakeholder meetings, linkage to the HabEat project and communications materials to promote best practice in promoting vegetable liking and intake in the early years across Europe.

Dissemination activities for Period 1 focussed on the outputs of an expert workshop held in Aberdeen and in preparing the outputs from this expert meeting for submission to the journal Appetite.
This meeting of experts in the field of infant and child feeding produced 9 oral presentations; from these we invited authors to submit to the Special Section on Infant Feeding which was then published in Period 2 (December 2011).

In all, 6 papers within the special section were developed directly from the expert workshop and 2 additional articles provided an Overview and Concluding Articles.

Dissemination activities for Period 2 focussed on organising and delivering on the VIVA International congress which was held in March 2013.

In all, the VIVA project has delivered outputs via a) peer reviewed academic papers; b) conference proceedings; c) healthcare professional resources including a community practitioner article and HCP leaflet; d) policy guidance development; e) community outreach via stakeholder meetings for healthcare anhd childcare professionals; f) website open to the general public.

Scientists, health care professionals, policy makers, representatives of industry and stakeholder groups participated in the VIVA International congress and delegates came from Europe, Asia and the USA. Several of the experts who attended the first VIVA expert workshop in Aberdeen (WP2) were also invited to present their research on weaning with vegetables and infant feeding. Results from the IAPP exchange were disseminated through posters, oral communications and specialist seminars.

The congress focused on weaning (i.e. the introduction of complementary feeding/introduction of foods to infants) and the pre-school period, addressing important questions such as:
- How to introduce vegetables in the diet of an infant to promote liking and intake?
- What parental feeding styles contribute to vegetable acceptance?
- How infants and toddlers learn about food?
- What we can do to be more effective in promoting healthy eating habits and to prevent obesity?

The congress was held at the Gateway Building at the University of St Andrews on Thursday 21st March 2013 and Friday 22nd March 2013 during the University’s 600 year anniversary. The event was opened by the Principal of the University of St Andrews, Professor Louise Richardson.

Approximately 230 delegates were invited. 133 responded to the invitation and 98 attended the congress. Most delegates were drawn from the scientific community, but nursery nurses, parents and other local stakeholders accepted the invitation to attend and to participate in the congress.
Most of the delegates who attended were drawn from the UK. However, delegates from Eastern Europe, Turkey and Asia also attended and participated in the congress.