title: Differences in fruit and vegetable intake and their determinants among 11-year-old schoolchildren between 2003 and 2009.
abstract: BACKGROUND
  Fruit and vegetable (FV) intake in children in the Netherlands is much lower than recommended. Recurrent appraisal of intake levels is important for detecting changes in intake over time and to inform future interventions and policies. The aim of the present study was to investigate differences in fruit and vegetable intake, and whether these could be explained by differences in potential determinants of FV intake in 11-year-old Dutch schoolchildren, by comparing two school samples assessed in 2003 and 2009.
  
  
  METHODS
  For 1105 children of the Pro Children study in 2003 and 577 children of the Pro Greens study in 2009 complete data on intake and behavioural determinants were available. The self-administered questionnaire included questions on children's ethnicity, usual fruit and vegetable intake, mother's educational level, and important potential determinants of fruit and vegetable intake.Multiple regression analysis was applied to test for differences in intake and determinants between study samples. Mediation analyses were used to investigate whether the potential mediators explained the differences in intake between the two samples.
  
  
  RESULTS
  In 2009, more children complied with the World Health Organization recommendation of 400 g fruit and vegetables per day (17.0%) than in 2003 (11.8%, p = 0.004). Fruit consumption was significantly higher in the sample of 2009 than in the sample of 2003 (difference = 23.8 (95%CI: 8.1; 39.5) grams/day). This difference was mainly explained by a difference in the parental demand regarding their child's intake (23.6%), followed by the child's knowledge of the fruit recommendation (14.2%) and parental facilitation of consumption (18.5%). Vegetable intake was lower in the 2009 sample than in the 2003 sample (12.3 (95%CI -21.0; -3.6). This difference could not be explained by the assessed mediators.
  
  
  CONCLUSIONS
  The findings indicate that fruit intake among 11-year-olds improved somewhat between 2003 and 2009. Vegetable intake, however, appears to have declined somewhat between 2003 and 2009. Since a better knowledge of the recommendation, parental demand and facilitation explained most of the observed fruit consumption difference, future interventions may specifically address these potential mediators. Further, the provision of vegetables in the school setting should be considered in order to increase children's vegetable intake.
authors.affiliation: The EMGO+ Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fischer
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.forename: Nannah I
authors.initials: NI
authors.lastname: Tak
authors.forename: Agneta
authors.initials: A
authors.lastname: Yngve
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: te Velde
mesh_terms: D002648:Child; D002664:Child Nutritional Physiological Phenomena; D004032:Diet / Q000639:trends*; D005260:Female; D005518:Food Preferences; D005638:Fruit; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009426:Netherlands; D018673:Nutrition Policy; D010290:Parents; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires; D014675:Vegetables; D014944:World Health Organization