Bell Lucinda K, Gardner Claire, Tian Esther J, Cochet-Broch Maeva O, Poelman Astrid A M, Cox David N, Nicklaus Sophie, Matvienko-Sikar Karen, Daniels Lynne A, Kumar Saravana, Golley Rebecca K
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
Am J Clin Nutr. 2021 May 8;113(5):1282-1300. doi: 10.1093/ajcn/nqaa384.
Many children worldwide do not eat recommended amounts of vegetables. Disliking vegetables is a key factor associated with low intake.
This umbrella review synthesized systematic reviews to determine the effectiveness of sensory and behavioral strategies to facilitate liking of vegetables (primary outcome) in young children up to 5 y of age, as key predictors of vegetable intake (secondary outcome).
Nine databases were searched up to May 2019 (updated in September 2020). Two reviewers independently conducted study screening and selection, data extraction, and assessment of methodological quality using AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Eleven reviews (n = 1 rated strong quality, n = 4 moderate quality, n = 6 low/critically low quality) examining 85 primary studies met the review criteria: systematic reviews and meta-analyses of primary studies (any quantitative design) that examined sensory or behavioral strategies on vegetable liking or intake (outcomes reported separately for children ≤5 y). Strategy effectiveness was synthesized into 3 categories based on evidence strength: 1) promising (large and consistent body of moderate quality evidence), 2) emerging (small to moderate body of mixed consistency and quality evidence), and 3) limited (small body of limited consistency and quality evidence).
Promising evidence was identified for repeated exposure to a single or a variety of vegetables. Emerging evidence was identified for several strategies that increase familiarity with vegetable flavors (e.g., via exposure in utero and through breast milk, and a "vegetable first" approach to complementary feeding) and/or willingness to try vegetables (e.g., via parental role modeling, nonfood rewards, and vegetable-based story books).
Current evidence supports incorporation of tailored advice into guideline documents for parents and carers to repeatedly expose their children to a variety of vegetables to increase vegetable intake. Ongoing robust research on strategies to facilitate children's liking of vegetables is warranted to strengthen the evidence base underpinning advice for parents and health professionals.
全球许多儿童未摄入推荐量的蔬菜。不喜欢蔬菜是摄入量低的一个关键因素。
本伞状综述综合了系统评价，以确定感觉和行为策略对促进5岁及以下幼儿喜欢蔬菜（主要结局）的有效性，而喜欢蔬菜是蔬菜摄入量（次要结局）的关键预测因素。
检索了截至2019年5月（2020年9月更新）的9个数据库。两名评价员独立进行研究筛选和选择、数据提取，并使用AMSTAR 2（一种评估系统评价的测量工具）评估方法学质量。11篇综述（n = 1篇质量高，n = 4篇质量中等，n = 6篇质量低/极低）纳入了85项原始研究，符合综述标准：对原始研究（任何定量设计）进行的系统评价和荟萃分析，这些研究考察了感觉或行为策略对蔬菜喜好或摄入量的影响（5岁及以下儿童的结局分别报告）。根据证据强度，将策略有效性分为3类：1）有前景的（大量且一致的中等质量证据），2）新出现的（少量到中等数量的混合一致性和质量的证据），3）有限的（少量的一致性和质量有限的证据）。
确定了关于反复接触单一或多种蔬菜的有前景的证据。确定了一些新出现的证据，这些策略包括增加对蔬菜味道的熟悉度（例如，通过子宫内接触和母乳接触，以及辅食添加采用“先吃蔬菜”的方法）和/或增加尝试蔬菜的意愿（例如，通过父母的榜样作用、非食物奖励和以蔬菜为主题的故事书）。
目前的证据支持将针对性建议纳入针对父母和照顾者的指南文件中，让他们反复让孩子接触各种蔬菜以增加蔬菜摄入量。有必要对促进儿童喜欢蔬菜的策略进行持续有力的研究，以加强为父母和健康专业人员提供建议的证据基础。
