Interventions for increasing fruit and vegetable consumption in children aged five years and under

Background Insufficient consumption of fruits and vegetables in childhood increases the risk of future non‐communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child‐feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden. Objectives To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. Search methods We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials. Selection criteria We included randomised controlled trials (RCTs), including cluster‐randomised controlled trials (C‐RCTs) and cross‐over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no‐intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and s of identified papers; a third review author resolved disagreements. Data collection and analysis Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random‐effects models in meta‐analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures. Main results We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child‐feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable