Dietary interventions for mental health

This 2018 study investigated whether food advertising literacy training influences children’s food choices, with a particular focus on its effect on the manner in which children weigh the importance of taste characteristics in their food decisions. Of the 39 participants (aged 8-13 years), twenty-three children had four sessions of food advertising literacy training. During these sessions, 4 food commercial videos were shown to the audience in the lab during the first and last week, and in their houses during the second and third week. Some commercials included factual narratives that may build cognitive defenses, while others were presented with evaluative narratives. Children were encouraged to think aloud while watching these advertisements and even provided narratives. The young subjects were also asked to rate 60 food items in terms of health and taste. The aim was to test whether these taste and health attributes predict variance in the children’s food choices. The kids’ taste ratings given after completing the training was significantly lower than those documented before these commercial-viewing sessions. Thus, enhancing food advertising literacy may help reduce the effect of taste attributes in the food decision-making processes. Furthermore, viewing food adverts designed to build cognitive defenses led to an increase in critical thinking towards commercials. Food advertising literacy training may help attenuate the importance of taste in the participants’ food decisions. The 16 children in the control condition who watched 4 videos of food commercials without narratives showed no change in their food choices. Ha et al. believe that food advertising literacy training has a big role to play in the promotion of healthy eating and the prevention of childhood obesity in the future.

Since the U.S. authorities have recommended extra warnings for the taking of antidepressants, Rice et al. (2016) stress the importance of providing effective treatment for youth depression with a favourable risk-benefit ratio. This study therefore focuses on supplementation with omega-3 polyunsaturated fatty acids (PUFAs), which may have positive impacts on physical and mental health and has been shown to be a safe and effective treatment for depression. Due to the relatively small sample sizes in the past studies, this present trial recruited 400 participants (aged between 15 and 25 years old) with major depressive disorder. Subjects were randomized to either receive 1.4g of PUFAs every day or a placebo for the duration of 12 weeks. Cognitive behavioral support was also provided to both treatment and placebo groups. It was hypothesized that the younger participants will show the greatest improvements in their depressive symptoms after receiving 12 weeks of treatment with omega-3 PUFAs in addition to cognitive behavioral case management, compared with those offered placebo and cognitive behavioral aid.

Häberling et al. (2019) describes the dilemma that comes with depressive disorders in childhood and adolescence, including the poor treatment adherence and the concerns over the use of antidepressant drugs at such a young age (e.g., side effects). But depressive disorders represent the highest burden of disease in this age group. The aim of this trial was to investigate the safety and efficacy of omega-3 fatty acids in the early course of pediatric major depressive disorder (MDD). The sample consisted of 220 patients aged 8-17 years with major depressive disorder of at least moderate severity. The children and adolescents were randomized to either receive omega-3 fatty acids or placebo daily for 36 weeks. The primary outcomes measured were alterations in depression severity, and remission and recovery rates, while the participants’ omega-3 index and inflammatory parameters were measured as secondary outcomes. This trial was conducted to determine if omega-3 fatty acids play a role in the development of pediatric major depressive disorder. This study particularly focused on the clinically depressed with pre-existing omega-3 fatty acid deficiencies, elevated markers of oxidative stress, or signs of inflammation. [NPID: MDD, pediatric, omega-3, depression, trial]

Vega-López et al. (2020) presents us with the design of a study that evaluates the influence of a 10-week culturally-tailored nutrition and substance use prevention parenting program on the diet and substance use outcomes of middle school students (6th-8th grade) of Latin American origin or descent. Given the higher risk for chronic diseases among Latinx adolescents (when compared with adolescents of other ethnicities), it is believed that parenting interventions may be an effective way of promoting both healthy nutrition and substance use prevention to these adolescents. A total of 1494 parent-child dyads were recruited to take part in this randomized controlled trial comparing the use of both substance use prevention and healthy nutrition programs (FPNG Plus), substance use prevention only (FPNG), and another comparison condition focusing on academic success. Surveys on diet behaviors, substance use, and parenting practices are expected to be completed by the adolescents and parents before and after the intervention, as well as at the 16-week follow-up after program participation. In addition, 126 dyads will be randomly chosen (42 from each program) and an assessment of their home food environment will take place, they will be checked for cardiometabolic risk through measurement of their blood pressure, total cholesterol and HbA1c.

In this 2019 study, a web-based nutritional intervention named the EATS (Eating Advice to Students) was tested for its feasibility and efficacy in a sample of young university students. One hundred and twenty-four students from the University of Newcastle, Australia were randomized to either the EATS or attention control condition. The aim of the EATS intervention was to enhance certain dietary behaviors involving breakfast, fruits, vegetables, and discretionary foods. Whatnall et al. measured the efficacy of the intervention by examining changes in diet quality and consumption of fruits, vegetables, discretionary foods, and breakfast. Recruitment was completed in 5 weeks, while retention rate was 73% at the 3-month mark. The intervention participants used EATS 1.5 ± 1.0 times and scored the intervention 4.04 ± 0.74 (out of 5) for satisfaction. As for the efficacy, there was a significant reduction in intake of discretionary foods by the intervention group, compared with the control, although no difference was found in terms of diet quality, fruit, vegetable or breakfast consumption. EATS appears to be highly feasible and has the potential to improve young college students’ dietary behaviors.

Folkvord (2019) reports that children are not eating enough fruits and vegetables, and are overconsuming foods rich in fat, sugar, and salt. The purpose of this study is to check whether children’s fruit and vegetable consumption can be increased through food promotion techniques. The plan is to create vlogs based on information gathered in focus groups held with young children (aged 8-13 years old), parents, vloggers, as well as fruit and vegetable producers and marketers. These vlogs would then be tested by participants from 10 primary schools. There will be 3 different conditions, including control, viewing a vlog unboxing fruit and vegetables (preparing and tasting), and watching a vlog doing a challenge with the fruit and vegetables (e.g., contests, tricks, games). The children’s eating behaviors will be monitored at the 6- and 12-month follow-up. While some studies indicate that promoting fruits and vegetable intake influences kids’ consumption, a recent systematic review has deemed the evidence as inconclusive. Folkvord aims to enhance the existing knowledge on the effects of fruit and vegetable promotion on dietary behavior.

Schoeppe et al. (2017) point out that there has been a rise in the number of commercial apps designed to enhance children’s health-related behaviors, but few have analyzed the content and quality of these apps targeting the youth. This review did exactly this, in the context of improving diet, physical activity and sedentary behaviour in children and adolescents. Also, the researchers looked at the relationships between app quality ratings, the number of app features, and behaviour change techniques (BCTs) used. To be included in this review, the apps were required to be available on the iTunes and Google Play stores, be designed to improve diet, physical activity and/or sedentary behaviour, be available in English, and have a user rating of at least 4+ based on at least 20 ratings. The 25 apps selected scored 3.6 out of 5 on overall app quality (assessed using the Mobile App Rating Scale). The highest scores were for functionality (average 4.1), followed by aesthetics (mean = 3.8), engagement (mean = 3.6), and information quality (mean = 2.8). On average, 6 behaviour change techniques were employed by the apps, including ‘instructions’ (most frequently used), ‘general encouragement’, ‘contingent rewards’, and ‘feedback on performance’. There was a correlation found between the app quality ratings with the number of technical app features and BCTs included. To summarize, popular commercial apps aimed at positively affecting the diet, physical activity and sedentary behaviour of children and adolescents were of moderate quality. Furthermore, there were more app features and BCTs in the higher quality apps. Future apps should find out what increases users’ app engagement and should be made for specific population groups.

Hodder et al. (2019) reviewed the literature on the fruit and vegetable intake in children aged five years and under (that also used dietary or biochemical assessments to determine the outcome results). Two review authors screened the titles and abstracts of studies, while a third author was hired to resolve any disagreements. A total of 78 trials were included (providing data on 13,746 participants). When compared to no intervention, child-feeding practices were shown to have a slightly beneficial effect on child vegetable consumption, although the quality of the study was low. Moreover, multicomponent interventions increased the number of fruit and vegetable portions eaten by children by a small degree (relative to no intervention). The results from the meta-analyses conducted on trials examining parent nutrition education versus no intervention were difficult to interpret, although a positive intervention impact on child consumption of fruit and vegetables was reported. Only 6 of the trials demonstrated long-term effectiveness, one analyzed cost effectiveness, and there were 2 trials that showcased adverse effects related to the intervention. Furthermore, all but four trials received governmental or charitable funding (the 4 trials were funded by the industry). It is therefore uncertain whether parent nutrition education interventions are effective in raising the consumption levels of fruits and vegetables in children aged five years and younger.

The aim of this 2013 Brazilian study was to present the health promotion strategies used at public and private schools in the Federal District of Brazil. Interviews were held with 122 private and 173 public schools to determine their health promotion efforts. Only one private school fulfilled the criteria for at least 20 of the 24 items investigated. On the other hand, there were 2 public schools that only fulfilled the criteria for 3 items. There was a positive correlation found between the number of meetings organized with the school community to address healthy eating with the presence of healthy environments in the school. Moreover, schools that monitored the nutritional status of its students were more likely to have healthy environments. Schools that held more meetings than average to help promote health had a smaller percentage of street vendors and local stores in the school’s vicinity. Most of the schools that partnered with health professionals included the topic of healthy eating in the curriculum. The different relationships highlighted by this study demonstrate the importance of these components of health promotion. The schools in the federal district of Brazil still require more support and training for them to be "health-promoting schools".

Saxe-Custack et al. (2019) tell us about a fruit and vegetable prescription program (FVPP) that provides users with a $15 prescription to be spent on fresh produce for each child at farmers' markets and local mobile markets. This program was designed to improve access to fruits and vegetables and increase affordability for children with low-income families. The consumption of fruits and vegetables by the 108 participants was monitored following the rollout of the program. Compared to baseline, the average daily intake of whole fruits by the children was significantly higher at the 6-month follow-up visit. Around 44% of the kids were eating a quarter of a cup more than they used to daily, while 30% reported an increased intake of at least ½ cup per day. There was no marked change in the amount of total fruit (including fruit juice) consumed daily. Overall, these results suggest that a pediatric fruit and vegetable prescription program may have a substantial impact on children's dietary behaviors, especially their intake of whole fruits.

In this 2019 study, Saxe-Custack et al. describe the characteristics, dietary patterns, food access, and food security reported at baseline by 261 caregiver-child dyads. The number of vegetables, whole grains, and dairy products eaten by the child participants was well below recommendation levels. Moreover, low, or very low food security was reported by 53% of children and 49% of caregivers. However, there were no marked differences in the child consumption of fruits and vegetables between households that reported high versus low food security. As many of these children living in Flint, Michigan are still experiencing an ongoing drinking water crisis, these results bring up serious concerns about the poor dietary patterns and the food insecurity issues that these kids encounter. Previously, there was a successful fruit and vegetable prescription program that offered a $15 spending allowance on fresh produce at numerous markets for each child in Flint. It is clear that further support is required in this region of the United States.

This 2016 study tested various marketing strategies on school pupils to assess whether their vegetable selections during meals can be influenced. The boys and girls were randomly assigned to one of three condition groups. In the first condition, a vinyl banner displaying vegetable characters was placed on the bottom side of the salad bar. Hanks et al. also tried providing health education using vegetable characters as part of television segments. The third condition was a combination of the vinyl banner and the television segments. The children were then monitored on their vegetable intake over the following 6 weeks. The number of schoolchildren that took vegetables from the salad bar rose by 90% when the vinyl banner was on display, while there was a 239.2% increase in the number of vegetable-eating students when exposed to both the banner and television segments. These boys and girls responded positively to the vinyl banners. This study provides evidence that branded media can have a beneficial impact on children's vegetable selection in the school cafeteria. This marketing strategy may encourage children to adopt healthier food choices.

This 2018 study explores the 3 dimensions of eating pleasures that are learned during childhood. These include sensory dimension (pleasure from sensory sensations felt while eating), interpersonal dimension (pleasure from the social context of food consumption), and psychosocial dimension (pleasure based on what the food represents in your mind). The purpose of this review was to examine whether these three dimensions can be used to promote healthy eating among children. Marty et al. highlight the shortcomings of past strategies in influencing people’s food choices. It was once said that educating kids on which foods are “good” and “bad” would encourage healthier food choices, but this plan can actually be counterproductive. Sometimes this approach can lead to children avoiding healthy foods. According to this review, a different perspective is required to develop interventions that assist children to make healthy choices.

This 2016 trial focused on implementing an intervention called Fuel for Fun: Cooking with Kids Plus Parents and Play, which targets 4th graders and their families, and aims to facilitate positive environments for food and activities, as well as policies and behaviors at the individual, family, and school levels. The parents and kids of 8 schools in Northern Colorado were recruited for this randomized controlled trial. A total of five components were scheduled to be delivered over one school year. These components include Cooking with Kids - Colorado (an experiential classroom-based cooking and tasting curriculum); Cafeteria Connections (cafeteria-based reinforcements of classroom food experiences); SPARK active recess (an intervention designed to encourage kids to take part in moderate to vigorous activities); Fuel for Fun Family (helping parents reinforce the 3 school-based components at home); and About Eating (an online interactive program for parents). Both children and parents will then be examined on their fruit and vegetable preferences and intakes, cooking, physical activity, sedentary behaviors, and attitudes. At the schools, food wastage and physical activity during recess will be inspected. These assessments will take place at baseline, immediately after intervention, and 7-months and 12-months post-intervention. The strengths of this project are the valid child and parent self-report instruments, the use of theory- and evidence-based programs, and application of objective measures at the individual, family and school levels.

In this 2020 study, the BRA intervention was assessed on its impact on the kindergarten staff’s food-related practices and the frequency, variety and number of vegetables served in a department. This intervention was specifically targeted at public and private kindergartens in the counties of Vestfold and Buskerud, Norway. Among the 73 kindergartens that participated, the quantity of vegetables served increased by around 20g per day for each person in the intervention group at the first follow-up, compared with the control group. Moreover, the diversity in the vegetables served increased by 150% per month following the intervention. However, there was no clear indication of changes in frequency of vegetables served or in the staff's food-related practices. The researchers conclude that the BRA intervention successfully enhanced the number and variety of vegetables served within intervention kindergartens.

The aim of this 2019 review was to determine whether there is a link between actively helping with meal preparation at home with diet quality, consumption of certain foods, and diet-related perceptions among children. This literature review included 15 relevant studies, all of which obtained data through surveys and/or interviews. Increased youth involvement in meal preparation at home was associated with higher diet quality, greater intake of fruits and vegetables, increased preference for vegetables, and higher self-efficacy for cooking and choosing healthy foods.

Burrington et al. (2020) tell us that rural families are often at risk of developing diet-related diseases despite their close proximity to farms. This study introduced families to a Fruit and Vegetable Prescription Program (F&VRx), which consisted of family cooking and nutrition classes and shopping at a pilot online produce site. These families had been referred since they consisted of one or more children at risk for chronic diseases related to obesity. The objective of this project was to promote lifestyle dietary changes in rural families. Firstly, the family were given credit to spend at the online grocery store once a week for 5 months. Moreover, the families were invited to monthly nutrition/cooking lessons. After completing the program, the families reported higher consumption of fruits and vegetables by the children, as well as increased confidence, culinary skills, and food literacy. In fact, 60% of the families continued shopping online for fresh groceries on a weekly basis even 3 months after the program finished. It can be concluded that using a F&VRx, online groceries ordering, and family cooking classes can improve families’ behaviors with regards to shopping, preparing, and consuming fruits and vegetables.

This 2016 article discusses the findings of the iCook 4-H study, which was designed to educate young children (9-10 year olds) and their primary meal providers on how to cook healthy foods, improve shopping and meal habits, and increase the number of family activities. Fifty-four dyads (adult and child pairs) were recruited across 5 states. Most of the participants had attended college, while half were white, 66% were married, 82% were female, and 30% of families took part in assistance programs. Following completion of the program, significant improvements were seen in the participants’ meal planning, prioritizing of healthy meal choices, shopping with a grocery list, and reading Nutrition Facts Labels. The adult subjects also became markedly more confident in their cooking ability, wanted to cook more meals at home, and consumed less fast food. Furthermore, the feeding interaction between the adult and child was found to be better as a result. In terms of specific foods, the intakes of fruit juices, vegetable soup, and whole grains increased. To conclude, the teachings enhanced the adults’ meal planning, cooking, and purchasing skills.