Consumption of fruit and vegetables and associated factors among 11- to 13- year old children in Portugal

Summary Background A high intake of fruit and vegetables is important as an essential part of a healthy lifestyle. Although differences in fruit and vegetable intake have been observed between the European countries, large proportions of the population, including children and adolescents, have a low consumption compared with the recommendations. It is important to promote a high intake of fruit and vegetables in childhood as dietary habits acquired in early life may have a great impact on long-term health status. In order to increase the intake of fruit and vegetables among children, insight into important and changeable correlates of fruit and vegetable consumption is needed. The Pro Children cross-sectional survey was designed to gather information about the actual consumption and potential correlates of fruit and vegetable consumption among 11- to 13-year-old children and their parents in the participating European countries. The aim of this study was to assess the intake of fruit and vegetables among Portuguese children and their mothers. Proportion of children reporting positively to personal, social and physical environmental factors regarding fruit and vegetable consumption, together with assessment of potential correlates of daily fruit and vegetable intake were also studied. Focus was made on gender and regional differences (Norte, Centro, Lisboa e vale de Tejo, Alentejo and Algarve) in the consumption and the associated factors within Portugal. Method For this thesis data from the Pro Children cross-sectional study in Portugal was used. Portugal had the largest sample size of the nine participating countries with 2535 eligible students from 27 schools and their respective parents. A precoded self-administered questionnaire was developed to assess fruit and vegetable intake as well as possible factors associated with these consumption patterns among children, as well as among one of their parents. Fruit and vegetable intake was assessed with a 24-hour recall and food frequency questions. The potential correlates included were divided into demographic, personal, perceived social environmental and perceived physical-environmental factors, and were assessed with separate questions. Data from 2134 children and 1314 mothers were included in the analyses. Results The consumption of fruit and vegetables was low among the children, both amount (mean fruit intake = 153 grams and mean vegetables intake = 111 grams) and frequency of intake (daily fruit intake = 56.5% and daily vegetable intake = 50.1%). Both gender and regional differences were found. Girls had a more frequent consumption of both fruit and vegetables compared with boys, and Lisboa and Algarve were the two regions where children reported the lowest consumption of fruit and vegetables respectively. The proportion of children consuming 400 grams per day, as recommended by WHO, the day prior to the survey was only 21.4%. The consumption of fruit and vegetables was also low among the mothers, and only 44.0% of the mothers reported to reach the WHO recommendations. Children were in general positive towards factors regarding fruit and vegetable intake. Gender and regional differences were found, with more girls reporting positively to the personal and social environmental factors regarding fruit and vegetables compared with boys. In addition, nearly all children perceived the fruit and vegetable availability at home to be good. The personal factors, i.e. knowledge, liking and preferences, were found to be significantly associated with daily intake of fruit and vegetables, as well as two social environmental factors: modelling and demand family rule. In addition, mothers’ intake of fruit was associated with daily fruit intake among their offspring. Gender and regional differences were also found for the factors associated with daily fruit and vegetable intake. Conclusion The fruit and vegetable intake among Portuguese children as well as their mothers, although high in the European setting, is low compared with the recommendations. However children are positive toward factors regarding fruit and vegetable consumption. Gender and regional differences were found both for consumption of fruit and vegetables, and for the associated factors. It is important to increase the consumption, especially of vegetables, and personal and social environmental factors together with mother’s intake were found to be important correlates