Family meals 'help kids get their five-a-day'

'Family meals aid five-a-day: Eating together at the table boosts children's intake of fruit and vegetables,' the Daily Mail reports.

The news is from a study that aimed to explore the influence that the home environment has upon a child's fruit and vegetable intake, in particular parental attitudes to fruit and vegetables. The study included 2,383 primary school children from London who had food diaries completed for them at school and home over a single 24-hour period. The children's parents were asked additional questions exploring their dietary attitudes, such as how often they eat fruit and vegetables themselves and whether the family eats their meals together.

Overall, the researchers found several factors in the home associated with a child's fruit and vegetable intake. Children had a higher daily intake if the family always ate their meals together, if their parents ate fruit and vegetables daily, and if parents reported cutting up fruit and vegetables for their child to eat.

The findings suggest that the home environment and family eating patterns may have an influence on a child's eating patterns, and this seems highly plausible. However, this cross-sectional study assessing the intake of a single sample of London schoolchildren over a single 24-hour period cannot reliably prove this. Nevertheless, increased fruit and vegetable intake is known to be beneficial for health, so any ways that encourage this can only be a good thing.

Limitations of the study include that we don't know whether these are normal dietary patterns for the children, whether similar results would be seen with other samples (London contains a diverse population), and what combination of factors may be directly influencing the child's intake.

Where did the story come from?

The study was carried out by researchers from the University of Leeds and was funded by the National Institute for Health Research (NIHR) Public Health Research programme.

The study was published in the peer-reviewed Journal of Epidemiology and Public Health.

The media has generally reported this research accurately. The Daily Mail also includes a useful piece of additional advice from one of the study's authors, Professor Cade, who says: "There are more benefits to having a family meal together than just the family's health.

"They provide conversational time for families, incentives to plan a meal, and an ideal environment for parents to model good manners and behaviour."

What kind of research was this?

This was a cross-sectional study which aimed to examine the influence that the home food environment and parental attitudes have upon children's fruit and vegetable (F&V) intake.

The positive health benefits of a diet high in F&V are well established, and the researchers discuss how dietary habits develop in childhood and persist throughout life. Parental attitudes and beliefs about food are thought likely to influence how they and their children eat.

Conversely, having a diet with a low F&V intake is a significant risk factor for premature death from conditions such as high blood pressure, obesity and type 2 diabetes.

The study looked at a large sample of children from London to explore and identify characteristics of the home food environment that were associated with the children's F&V intake. However, this sort of study can only explore associations between factors and cannot reliably tell which factors have directly influenced the children's eating patterns.

What did the research involve?

The study included a sample of 2,383 children attending 52 primary schools in London. The children were of an average age of 8.3 years and were taking part in two separate randomised controlled trials examining a school gardening programme. The sample included an equal proportion of boys and girls, and one-quarter of the sample was of white ethnic origin.

The children's diet was assessed using a validated 24-hour food tick list called the Child and Diet Evaluation Tool (CADET). This tool lists 115 separate food and drink items grouped under the following 15 categories:

cereals
sandwich/bread/cake/biscuit
spreads/sauces/soup
cheese/egg
chicken/turkey
meat, other
fish
vegetarian
pizza/pasta/rice
desserts/puddings
sweets/crisps
vegetables and beans
potato
fruit
drinks

The CADET tool was split into a school food diary and a home food diary, which both included the same food options with alternative time options, such as morning break in the school diary and evening meal/tea in the home diary. The school diary was completed by the researchers and the home diary was completed by the parents, who ticked each food item consumed under the appropriate mealtime heading over the 24-hour period.

The home food diary included questions about the home food environment and parents' attitudes to fruit and vegetables, such as "on average, how many nights a week does your family eat at a table?" and "do you cut up fruit and vegetables for your child to eat?".

It also included questions that asked the parents to consider what they thought about the price of fruit and vegetables, how much money they had available to spend on fruit and vegetables, and whether preparation time and knowledge of different ways to prepare fruit and vegetables influenced their decision to buy fruit and vegetables for their family.

These questions were answered on sliding scales (for instance, 0 for never, 10 for always) and statistical models were then used to see how the importance of various factors in the home related to the child's F&V intake.

What were the basic results?

Overall, the CADET tool found that children consumed 293g F&V per day on average.

They found that children of families who reported "always" eating a family meal together at a table ate significantly more F&V per day (125g more) than families who reported never eating a meal together.

Children of parents who ate F&V daily themselves also ate 88g more F&V per day than children of parents who reported rarely or never consuming F&V themselves.

The researchers also found that if parents reported always cutting up F&V for their children, these children ate 44g more F&V daily than children of families who never reported cutting up their children's F&V.

How did the researchers interpret the results?

The researchers report that they have identified factors that are associated with the children's intake of F&V, such as the family consumption of F&V and whether parents cut up F&V for their children to eat. The researchers suggest that regularly eating a family meal together could increase children's F&V intake and help them achieve the recommended intake.

Conclusion

The findings suggest that the home environment and family eating patterns may have an influence on the eating patterns of the child, and this seems highly plausible. However, this cross-sectional study cannot reliably prove this. While this study has strengths – including its large sample size and reliable methods of assessing dietary intake through a validated food intake tool – there are a few important limitations:

This is a single sample of London schoolchildren taking part in trials assessing gardening. We do not know whether the children who were taking part in this trial may have particular characteristics that make them different from, for example, children selected from a completely random primary school sample. Also, the children in this London area may not be representative of the entire UK population in terms of culture and ethnicity, which may be related to family eating patterns.
Food intake was assessed over a single 24-hour period and we don't know whether these are normal dietary patterns for the children, or whether similar or different results would be seen on another day.
It could be the case that some parents and children actually reported eating more F&V than was the case in order to "impress" the researchers, to make it appear that they were living healthy lifestyles.
Some parents (36%) did not complete the additional questions and 23% did not return the home food diary. This could mean that the children who completed both diaries are not representative of the general population (they may have a greater interest healthy eating), which is known as "response bias".
While home environment and parent food attitudes are likely to influence the child's food intake, other factors are likely to be involved, such as children's preference and social factors or peer groups. A combination of these factors could be directly influencing the child's intake.

The researchers suggest that if families regularly eat fruit and vegetables with their child, it may help children to achieve recommended intakes. This may or may not be true, but increased fruit and vegetable intake is known to be beneficial for health, so any ways that encourage this can only be a good thing.