Increasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review

doi:10.1016/j.jand.2016.10.014

Journal of the Academy of Nutrition and Dietetics

Volume 117, Issue 2, February 2017, Pages 240-250

https://doi.org/10.1016/j.jand.2016.10.014 Get rights and content

Abstract

Although there are numerous health benefits associated with eating fruit and vegetables (F/V), few children are consuming recommended amounts. Gardening interventions have been implemented in various settings in an effort to increase children’s F/V consumption by expanding knowledge, exposure, and preferences for a variety of F/V. The purpose of this review was to identify the effectiveness of gardening interventions that have been implemented to increase F/V consumption among children. A systematic review was conducted using four electronic databases: Web of Science, PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature. English language studies conducted in developed countries between January 2005 and October 2015 were included in this review. Included studies measured F/V consumption among children aged 2 to 15 years before and after implementation of a gardening intervention in a school, community, or afterschool setting. All study designs were included in this review. A total of 891 articles were identified through database searching and cross-referencing. After removing duplicates, 650 articles remained and were screened using inclusion and exclusion criteria. Twenty-seven full-text articles were analyzed and 14 articles were included in this review. Of the 14 articles reviewed, 10 articles found statistically significant increases in fruit or vegetable consumption among participants after implementation of a gardening intervention. However, many studies were limited by the use of convenience samples, small sample sizes, and self-reported measurements of F/V consumption. Although the evidence is mixed and fraught with limitations, most studies suggest a small but positive influence of gardening interventions on children's F/V intake. Future studies that include control groups, randomized designs, and assessments of F/V consumption over at least 1 year are needed to advance the literature on this topic.

Section snippets

Search Strategy

A systematic review of published literature on 14 studies investigating F/V consumption among children receiving gardening interventions was conducted based on protocols established for reviews through Preferred Reporting Items for Systematic Reviews and Meta-Analyses.²⁴ The databases Web of Science, PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature were searched for medical subject heading terms and terms found in titles and abstracts of applicable studies. In

Study Selection

A total of 887 abstracts were identified in the databases using medical subject headings terms and key words with an additional four articles identified from searching reference lists. Of these, 241 articles were duplicates resulting in a screening of 650 titles and abstracts. An additional 623 articles were excluded after screening for eligibility. Of the 27 remaining full-text articles reviewed, 13 were eliminated as a result of the inclusion and exclusion criteria listed above. The process

Discussion

This review of the influence of gardening interventions on F/V consumption among children included 14 studies with considerable diversity in study design, sample size, and tools used to measure F/V consumption. Ten studies found that participating in various gardening interventions was associated with significantly greater F/V consumption.27, 28, 29, 30, 31, 32, 33, 34, 35, 38 However, four other studies indicated no significant changes in F/V consumption.36, 37, 39, 40 Furthermore, minimal

Conclusions

Gardening-based interventions have been implemented around the country with an overall goal of improving health-related behaviors of children in school and community settings. Although the evidence is somewhat mixed, most available studies suggest a small but positive influence of gardening interventions on children's F/V consumption. Recommendations for future research include investigating long-term changes in F/V consumption, the influence of parental components of gardening-based

M. R. Savoie-Roskos is a professional practice assistant professor, Nutrition, Dietetics, and Food Sciences Department, Utah State University, Logan.

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Explore participant perceptions of involvement in an experiential food education program during elementary school and the scope and extent of program influence on food decisions.
Focus groups with current participants and program alumni.
Washington, DC.
Thirty-nine elementary school students and 39 program alumni ranging from middle school through university students.
Participant perceptions of program impact from childhood into adolescence and young adulthood.
Inductive thematic analysis.
Nine emergent themes were identified, spread over 3 categories of program impact: immediate, beyond the classroom, and sustained. Immediate program impact themes came from all participants and included enjoyment, hands-on learning, and fostering connection. Beyond the classroom, older elementary students and alumni expressed perceived shifts in individual and family food intake, involvement in household food practices, and desire for fresh food options at school. Themes of sustained program impact among alumni participants were an appreciation for fresh food, openness to trying new foods, and confidence to make informed food decisions.
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Dietary Psychosocial Mediators of Vegetable Intake in Schoolchildren From Low-Income and Racial and Ethnic Minority US Families: Findings From the Texas Sprouts Intervention
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Numerous school-based interventions have used cooking and gardening approaches to improve dietary intake; however, research is limited on the mediation effect of dietary psychosocial factors on the link between the intervention and increased vegetable intake, particularly in children from low-income and racial and ethnic minority US families.
Our aim was to examine the effects of the Texas Sprouts intervention on dietary psychosocial factors related to intake of vegetables, and whether these psychosocial factors mediate the link between the intervention and increased intake of vegetables in schoolchildren from low-income and racial and ethnic minority US families.
This was an analysis of data on secondary outcomes from the Texas Sprouts program, a 1-year school-based gardening, nutrition, and cooking cluster randomized controlled trial consisting of elementary schools that were randomly assigned to either the Texas Sprouts intervention or to control.
Participants were 2,414 third- through fifth-grade students from low-income and racial and ethnic minority US families from 16 schools (8 intervention and 8 control) in Austin, TX.
The intervention group received eighteen 60-minute gardening, nutrition, and cooking student lessons in an outdoor teaching garden and 9 monthly parent lessons throughout the academic year.
Child psychosocial and dietary measures were collected at baseline and post intervention via validated questionnaires.
Generalized linear mixed models assessed the intervention effects on dietary psychosocial factors. Mediation analyses examined whether these psychosocial factors mediated the link between the intervention and increased child vegetable intake.
Children in Texas Sprouts, compared with controls, showed significant increases in the mean scores of gardening attitudes, cooking self-efficacy, gardening self-efficacy, nutrition and gardening knowledge, and preferences for fruit and vegetables (all, P < .001). Each of the dietary psychosocial factors mediated the association between the Texas Sprouts intervention and child vegetable intake.
Besides targeting dietary behaviors, future school-based interventions should also focus on understanding the mechanisms through which teaching children to cook and garden influence dietary psychosocial factors as mediators of change in healthy eating behaviors.
Effects of a School-Based Gardening, Cooking, and Nutrition Cluster Randomized Controlled Trial on Unprocessed and Ultra-Processed Food Consumption
2023, Journal of Nutrition
School-based gardening and nutrition education interventions report improvements in dietary intake, notably through fruit and vegetables. However, gardening, cooking, and nutrition randomized controlled trials are limited in evaluating dietary quality, and none have examined processed food consumption to date.
The study examined the effects of Texas Sprouts (TX Sprouts), a gardening, cooking, and nutrition education intervention, compared with control on unprocessed and ultra-processed food (UPF) consumption in predominately low-income Hispanic children.
TX Sprouts was a school-based cluster randomized controlled trial that consisted of 16 elementary schools randomly assigned to either the TX Sprouts intervention (n = 8 schools) or control (delayed intervention; n = 8 schools) over 3 y (2016–2019). TX Sprouts schools received an outdoor teaching garden and 18 1-h lessons taught by trained educators throughout the school year. Dietary intake data via 2 24-h dietary recalls were collected on a random subsample (n = 468) at baseline and postintervention. All foods and beverages were categorized using the NOVA food classification system (e.g., unprocessed, processed, ultra-processed). Generalized linear mixed effects modeling tested changes in percent calories and grams of NOVA groups between the intervention and control estimates with schools as random clusters.
Of the sample, 63% participated in the free and reduced-price lunch program, and 57% were Hispanic, followed by non-Hispanic White (21%) and non-Hispanic Black (12%). The intervention, compared to the control, resulted in an increase in consumption of unprocessed foods (2.3% compared with –1.8% g; P < 0.01) and a decrease in UPF (–2.4% compared with 1.4% g; P = 0.04). In addition, Hispanic children in the intervention group had an increase in unprocessed food consumption and a decrease in UPF consumption compared to non-Hispanic children (–3.4% compared with 1.5% g; P < 0.05).
Study results suggest that school-based gardening, cooking, and nutrition education interventions can improve dietary intake, specifically increasing unprocessed food consumption and decreasing UPF consumption.
This trial was registered at clinicaltrials.gov as NCT02668744.
Insights into parents' and teachers' support for policies promoting increased plant-based eating in schools
2023, Appetite
Global environmental and public health challenges related to current food systems call for large-scale shifts towards increasingly plant-based diets, especially in Western meat-centric societies. School meal systems can play a role in these changes due to their widespread prevalence and multi-sectoral impact. However, there is a lack of evidence about how adults involved in the school meals system perceive school-based pro-environmental food policies, which limits the ability to align those policies with the needs and expectations of the school community. This study aimed to address this knowledge gap by exploring parents' (n = 104) and teachers' (n = 252) support for policies to promote increased plant-based eating in public schools in a highly meat-centric EU country (Portugal). Overall, teachers seemed to be slightly more supportive of such policies and displayed more favorable (injunctive and dynamic) norms toward plant-based eating, more negative appraisals of meals with meat (i.e., perceived healthiness, naturalness, and sustainability), and lower attachment to meat consumption. Furthermore, injunctive norms in favor of plant-based meals were linked with higher support for measures promoting plant-based meals in schools, in both samples (parents, teachers). Lower meat attachment and favorable perceived meal attributes (e.g., perceptions about plant-based and fish meals) were associated with teachers' support for measures promoting plant-based meals in schools. These findings suggest that future efforts and research with parents and teachers to enable less meat-centric and more flexitarian food practices in schools should consider social and motivation variables relevant to plant-forward transitions.
The effects of school gardens on fruit and vegetable consumption at school: A randomized controlled trial with low-income elementary schools in four U.S. states
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This randomized controlled trial examines the effects of a school garden intervention on children’s fruit and vegetable (FV) consumption at school over two years. We randomly assigned schools to the intervention group that received gardens and related curriculum (n = 24) or to the waitlist control group that received gardens and curriculum at the conclusion of the study (n = 22). Children in second, fourth, and fifth grade at baseline (n = 2767) in low-income schools (n = 46) in four U.S. States (Arkansas, Iowa, New York, and Washington) participated. The intervention comprised gardens for each classroom; a curriculum focused on nutrition, plant science, and horticulture, including activities and FV tasting sessions; resources for the school that addressed topics such as soil contamination and food safety; an implementation guide focused on issues related to planning, planting, and maintaining the garden through the year, engaging volunteers, summer gardening, building community capacity, and sustaining the gardening program. FV consumption was measured by photographing lunches before and after children ate, for 2–3 days, at baseline and at each of 3 subsequent periods of data collection during the intervention. FV consumption was calculated using Digital Food Image Analysis. Among children in the intervention, fruit consumption and low-fat vegetable consumption increased from pre-garden baseline to post-garden more than among control group children. Garden intervention fidelity (GIF) also predicted changes in dietary intake, with more robust interventions showing a stronger effect than weaker interventions. GIF-lessons was a particularly potent predictor of change in dietary intake. School gardens modestly increase children’s FV consumption at school.

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M. R. Savoie-Roskos is a professional practice assistant professor, Nutrition, Dietetics, and Food Sciences Department, Utah State University, Logan.

H. Wengreen is an associate professor, Nutrition, Dietetics, and Food Sciences Department, Utah State University, Logan.

C. Durward is an assistant professor and extension nutrition specialist, Nutrition, Dietetics, and Food Sciences Department, Utah State University, Logan.

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

: FUNDING/SUPPORT None to report.

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ResearchReviewIncreasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review

Abstract

Section snippets

Search Strategy

Study Selection

Discussion

Conclusions

Am J Clin Nutr

Am J Clin Nutr

J Am Diet Assoc

Adv Nutr

J Am Diet Assoc

J Acad Nutr Diet

J Am Diet Assoc

Appetite

J Nutr Educ Behav

J Nutr Educ Behav

J Am Diet Assoc

J Clin Epidemiol

J Am Diet Assoc

Am J Prev Med

Appetite

J Am Diet Assoc

J Nutr Educ Behav

J Adolesc Health

J Acad Nutr Diet

J Am Med Inform Assoc

J Acad Nutr Diet

J Nutr Educ Behav

Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

J Natl Cancer Inst

Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus—The European Prospective Investigation of Cancer-Norfolk prospective study

Arch Intern Med

Relationship of fruit and vegetable intake with adiposity: A systematic review

Obes Rev

Research
Review
Increasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review