Improvement in Fruit and Vegetable Consumption Associated with More Favorable Energy Density and Nutrient and Food Group Intake, but not Kilocalories.

BACKGROUND Children generally do not consume adequate amounts of fruits and vegetables (F/V). Eating more F/V can improve energy density and overall diet quality. OBJECTIVE Our aim was to investigate whether improvements in F/V consumption were associated with improvements in energy density, total calories, and dietary components related to F/V. DESIGN We performed secondary analyses of dietary data from a successful four-group randomized controlled trial promoting F/V. Data were collected at baseline, immediately after gameplay, and 3 months post intervention. PARTICIPANTS/SETTING Preadolescent child-parent dyads (n=400) were recruited. Eligibility criteria were 4th- or 5th-grade child (approximately 9 to 11 years old) with Internet access and a parent willing to participate in the intervention. Complete dietary data were collected on 387 of the 400 child participants. The videogame was available online on a secure, password-protected website. MAIN OUTCOME MEASURES Dietary intake was assessed with three unannounced dietary recalls collected at each data-collection period via telephone by trained staff using Nutrition Data System for Research software. Energy density and F/V, nutrient, and food consumption were calculated. STATISTICAL ANALYSIS PERFORMED A 4×3 (group by time) repeated measures analysis of covariance with mixed-effect linear models was used. Covariates included child's sex, race/ethnicity, and total energy intake as well as parent's age and household education. Energy was excluded as a covariate in the energy density and energy models. RESULTS Significant changes occurred in energy density. A significant interaction (group by time) was observed (F6, 515=2.40; P<0.05) in energy density from food only, while a significant time effect was observed for energy density from all foods and beverages (F2, 388=13.75; P<0.0001). Desirable changes were also observed in F/V-related dietary components. CONCLUSIONS Increasing F/V consumption improved energy density and diet quality considerably in preadolescent children.