Eur J Clin Nutr. 2003

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Food preferences of Spanish children and young ... Results: Bananas and apples were the fruit items preferred by Spanish children and young people across all ...
European Journal of Clinical Nutrition (2003) 57, Suppl 1, S45–S48

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ORIGINAL COMMUNICATION Food preferences of Spanish children and young people: the enKid study C Pe´rez-Rodrigo1*, L Ribas2, Ll Serra-Majem3 and J Aranceta1 1 Community Nutrition Unit, Bilbao Department of Public Health, Bilbao, Spain; 2Unit of Research in Community Nutrition, Scientific Park, University of Barcelona, Barcelona, Spain; and 3Department of Preventive Medicine and Public Health, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

Objective: To describe the profile of food preferences, likes and dislikes of Spanish children and young people and analyse its connection with prevailing food patterns. Design: Cross-sectional population survey. Setting: Population study. Data were collected at participants’ home address. Subjects: Random sample of the Spanish population aged 2–24 y (n ¼ 3534; 1629 boys and 1905 girls). Interventions: Food preferences, food consumption and practices as well as nutrition-related information were assessed by means of a multiple choice questionnaire. A food preference score was computed considering food items ranked as first, second or third choice within each food group. Data collection was carried out during May 1998–April 2000. Results: Bananas and apples were the fruit items preferred by Spanish children and young people across all age and gender groups. Within the vegetable group tomato sauce and salads, particularly lettuce and tomato salad scored highest, followed by carrots in all age and gender groups. However, 47% (95% confidence interval 46–48%) of the sample reported dislike for vegetables and an additional 5.7% (95% confidence interval 4.9–6.5%) a dislike for fruit. The proportion of individuals with low consumption of vegetables or fruit was significantly higher among those reporting a dislike either for vegetables (w2 ¼ 127.69; Po0.001); fruit (w2 ¼ 24.62; Po0.001) or for both groups (w2 ¼ 81.53; Po0.001). Conclusion: There is a significant relationship between the likes/dislikes for fruits and vegetables and usual consumption of this food group among children and young people. Strategies addressed to improve acceptance for this food group should be considered when designing interventions aimed at promoting adequate consumption of fruits and vegetables among children and young people. Sponsorship: Kellogg’s, Spain. European Journal of Clinical Nutrition (2003) 57, Suppl 1, S45–S48. doi:10.1038/sj.ejcn.1601814 Keywords: food preferences; fruits; vegetables; children; adolescents

Introduction Determinants of food habits are complex. According to theoretical models, they can be arranged at different levels of influence: individual, social environmental, physical environmental and macrosystem influences (Story et al, 2002). Preferences play an important role in defining children’s *Correspondence: C Pe´rez-Rodrigo, Community Nutrition Unit, Luis ˜ as, 18, 4th Floor, 48013 Bilbao, Spain. Brin E-mail: [email protected] Guarantor: C Pe´rez-Rodrigo. Contributors: CP-R has been the main contributor to this paper. LR has been responsible for paper organisation and data analysis. LlS-M and JA have been responsible for study design and methods.

food patterns, as they are linked to food acceptance (Birch & Fisher, 1998). Genetic factors influence food likes, dislikes and taste perception (Drewnowski & Hann, 1999; Duffy & Bartoshuk, 2000; Skinner et al, 2002). However, research shows that children develop their food preferences as they grow and are exposed to a variety of food items, textures, taste and flavours (Birch, 1999) they learn from modelling in the family, parents and siblings; what they experience at home, in the school and with their friends (Skinner et al, 1998). Environmental influences such as publicity (Byrd-Bredbenner & Grasso, 2000), school-based nutrition education programmes or school meals also play a relevant role

Food preferences of Spanish children and youth C Pe´rez-Rodrigo et al

S46 (Neumark-Sztainer et al, 1999; Skinner et al, 2002). A number of studies have described children’s acceptance of a wider variety of foods as they are repeatedly exposed to them, even from very early in utero life or via breast milk after birth (Glanz et al, 1998; Skinner et al, 2002; Tuorila, 1990). Evidence shows that children’s food preferences predict their food consumption patterns (Drewnowski & Hann, 1999). Understanding children’s food preferences and how they change over time is critical to planning effective nutrition education and dietary intervention programmes (Hoelscher et al, 2002). In this paper, the profile of food preferences, likes and dislikes of Spanish children and young people assessed in the enKid study is analysed in connection with prevailing food patterns.

dislikes question followed the same format and included the option ‘I like all of them’. A food preference score has been computed considering food items ranked as first, second or third choice within each food group. Preferences for fruit and vegetables have been compared to usual fruit and vegetable consumption in the whole sample and to information related to the benefits of fruit and vegetable consumption in children over 8 y. Data analysis was performed using SPSS v 10. w2 statistics have been computed to compare rates and proportions as well as Kendall’s Tau. P-values o0.05 have been considered for statistical significance.

Results Materials and Methods The enKid study on nutritional status and food habits of Spanish children and young people, a cross-sectional population survey, was carried out between 1998 and 2000 on a random sample of the Spanish population aged 2–24 y, (n ¼ 3534; 1629 boys and 1905 girls), selected by multistage random sampling procedures based on a population census. Sampling and response rate have been described elsewhere (Serra-Majem & Aranceta, 2000, 2001). The study protocol included socioeconomical family background (level of education of the mother and the father; occupation of mother and father). Food consumption was assessed by means of multiple 24-h recalls and a 164-item food frequency questionnaire. The mother or person responsible for feeding the children, completed with the kid the food consumption questionnaire for children under 8 y of age (Serra-Majem & Aranceta, 2002). The questionnaires were completed during a personal interview in their home address. Questions on dietary habits, consumption of supplements, physical activity on weekdays as well as leisure time, tobacco and alcohol use and basic information regarding food and nutrition were part of the study protocol too. Anthropometrical measurements were assessed on each individual. Data about nutrition-related information were collected as well. Instruments were pretested and validated. All field workers (dietitians) followed a training period prior to data collection. Field work was completed between May 1998 and April 2000. The study protocol was approved by the ethical committee of the Spanish Society of Community Nutrition. Food preferences were collected by means of six questions covering beverages, fruit, vegetables, legumes, main food groups and overall dislikes. Each question included a number of food items within the particular food group. Participants were asked to rank their first three favourite items from the list according to their preference. ‘None of them’ was included as an option for each food group. The European Journal of Clinical Nutrition

Favourite beverages for Spanish children and young people were water, cola flavoured soft drinks, milk and natural fruit juices. According to the fruit preference score, bananas and apples were the fruit items preferred by Spanish children and young people across all age and gender groups, followed by oranges, strawberries and melon. The pattern was consistent across all age and gender groups (Figure 1). Within the vegetable group, tomato sauce and salads, particularly lettuce and tomato salad scored highest, followed by carrots in all age and gender groups. However, 47% (95% confidence interval 46–48%) of the sample reported dislike for vegetables and an additional 5.7% (95% confidence interval 4.9–6.5%) a dislike for fruit. Lentils and garbanzo beans scored the highest among the legume group, both among boys and girls and all age groups. Overall food preferences showed a higher like for pasta, followed by rice and meat. Vegetables, legumes and fish deserved the higher dislike score. A higher proportion of boys reported a dislike for fish compared to girls. The proportion of individuals having usual low consumption of vegetables was significantly higher among those reporting a dislike for this food group (w2: 127.69, Po0.0001); the same trend was observed for children and youngsters reporting a dislike for fruit (w2: 24.63; Po0.0001) (Table 1). Teenagers 11–17 y were less aware of the beneficial effects of fruits and vegetables, particularly in the male subgroup (w2: 29.69; Po0.0001).

Discussion The enKid study describes food preferences related to usual consumption on a random sample of the Spanish population aged 2–24 y. The sample design and response rate (68%) makes it representative of this population group in the country. Results of this study point a high preference score for soft drinks within the beverage group. This fact may be underlying the shift in dietary habits observed in several studies.

Food preferences of Spanish children and youth C Pe´rez-Rodrigo et al

S47

Figure 1

Fruit and vegetable preference score by gender in Spanish children and young people.

Table 1 Usual consumption of fruits and vegetables and reported like/ dislike for the food group Like Food group

Frequency of consumption

Fruits

Vegetables

Dislike

n

%

n

%

Kendall’s Taub

o0.5 portions/day 0.5–1.5 portions/day >1.5 portions/day

791 1296 1093

24.88 40.76 34.36

122 155 77

34.20 43.92 21.88

0.0970.01 P=0.0000

o0.5 portions/day 0.5–1.5 portions/day >1.5 portions/day

425 892 542

22.90 47.96 29.14

642 769 264

38.28 45.92 15.80

0.1970.01

Soft drinks are replacing fruit and milk in children’s and ˜oz et al, 1997; Lytle, 2002). adolescents’ diets (Mun Pasta, rice and meat are the favourite foods for Spanish children and young people, while vegetables, legumes and fish lead dislikes. Food preferences have been regarded as predictors of food consumption in a number of studies (Birch & Fisher, 1998; Glanz et al, 1998; Drewnowski & Hann, 1999). Furthermore, research supports a potential for educating food preferences, despite genetic and family influences, thus leading to an open possibility for increased acceptance of selected food items and hence consumption (Drewnowski & Hann, 1999; Hoelscher et al, 2002). Results from the enKid study reflect a significant relationship between likes/dislikes for fruit and vegetables and usual

P=0.0000

consumption of this food group among children and young people. A recent study in Denmark showed a positive association between increased access to fruits and vegetables in schools by means of a subscription programme and an increase in intake of these food groups (Eriksen et al, 2003). The study highlights an additional effect, since consumption of fruits and vegetables increased among children subscribers and nonsubscribers to the programme. This suggests that the subscription program stimulated parents of nonsubscribers to supply their children with more fruits and vegetables. These findings enhance the potential of nutrition education strategies that include taste-testing activities, increased exposure to a variety of foods and modelling from parents, siblings and peers. European Journal of Clinical Nutrition

Food preferences of Spanish children and youth C Pe´rez-Rodrigo et al

S48 References Birch L (1999): Development of food preferences. Annu. Rev. Nutr. 19, 41–62. Birch L & Fisher J (1998): Development of eating behaviors among children and adolescents. Pediatrics 101 (suppl), 593–594. Byrd-Bredbenner C & Grasso D (2000): What is television trying to make swallow?: content analysis of the nutrition information in prime-time advertisments. J. Nutr. Educ. 32, 187–195. Drewnowski A & Hann C (1999): Food preferences and reported frequency of consumption as predictors of current diet in young women. Am. J. Clin. Nutr. 70, 28–36. Duffy VB & Bartoshuk LM (2000): Food acceptance and genetic variation in taste. J. Am. Diet. Assoc. 100, 647–655. Eriksen K, Haraldsdo¨tttir J, Pederson R & Vig Flyger H (2003): Effect of a fruit and vegetable subscription in Danish schools. Public Health Nutr. 6, 57–63. Glanz K, Basil M, Maibach E, Goldberg J & Snyder D (1998): Why Americans eat what they do: taste, nutrition, cost, convenience and weight control concerns as influences on food consumption. J. Am. Diet. Assoc. 98, 1118–1126. Hoelscher DM, Evans A, Parcel GS & Kelder SH (2002): Designing effective nutrition interventions for adolescents. J. Am. Diet. Assoc. 102 (Suppl), S52–S63. Lytle LA (2002): Nutritional issues for adolescents. J. Am. Diet. Assoc. 102 (Suppl), S8–S12. ˜oz KA, Kreb-Smith SM, Ballard-Barbash R & Cleveland LE (1997): Mun Food intakes of US children and adolescents compared with recommendations. Pediatrics 100, 323–329.

European Journal of Clinical Nutrition

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