The Efficacy of Repeated Exposure on Vegetable Intake in
Early Childhood: A Systematic Review
Objective
The evaluate existing literature to determine whether
repeated exposure (RE) can facilitate increased
consumption of a target vegetable in early childhood.
Introduction
Approximately 16.9% of children between the
ages of 2-19 years in the United States are
classified as overweight or obese. Rising
childhood obesity rates have largely been
attributed to limited intake of fruits and
vegetables (FV) and excessive intake of
processed foods high in fat, sugar, and salt
during the first few years of life. Current literature
supports adequate intake of fruits and
vegetables for chronic disease prevention,
obesity prevention, proper growth and
development, immune support, and digestive
health. According to the Centers for Disease
Control and Prevention (CDC), it is estimated
that 9 out of 10 children in the United States fail
to meet the recommended intakes for FV.
Food neophobia, or the unwillingness to try new
or unfamiliar food, arises in early childhood,
leading to problematic eating behaviors and
limited dietary variety. Repeated exposure has
been shown as a promising strategy to combat
food neophobia and promote increased intake of
a target vegetable.
Alana Sherman, MSCN Candidate
West Chester University of Pennsylvania
Methods Discussion
Search Strategy: A systematic review of literature was conducted of both randomized and non-randomized 100% of studies were conducted in a school setting
controlled trials using CINAHL, PubMed, Medline, and references extracted from eligible literature. where children were presented to food in the
presence of peers and teachers, which may have
Selection Criteria: Studies were required to meet the following inclusion criteria: 1) written in English 2) published inadvertently influenced their willingness to try and
in a peer-reviewed journal 3) conducted on children between the ages of 1-6 years 4) assessed the effect of eat the offered vegetable.
repeated exposure on vegetable intake 5) measured vegetable intake as a main outcome variable. Studies were
excluded if subjects were not in good health or had any preexisting health conditions compromising appetite or Only one study presented the target vegetable in its
dietary intake. pure and raw form. It is possible that in some studies,
the method of preparation could have altered the
Key Terms: “toddlers”, “children”, “early childhood”, “repeated exposure”, “taste exposure”, “vegetable intake”, and taste of the vegetable, increasing the likelihood of
“vegetable consumption”. acceptability among subjects.
Results
A total of 123 abstracts were identified in the initial database search. Ten full-text articles were selected for review
after meeting the identified inclusion and exclusion criteria. Two studies were crossover trials, four were non-RCTs,
and four were RCTs. Seven out of ten studies reported randomization of participants. All ten studies were located Conclusions
in a school setting. Sample size varied considerably ranging from 19 subjects to 250 subjects.
Repeated exposure, ranging from 6-15 exposures, has
been shown an effective approach to increase non-
Of the ten articles reviewed, 8 observed statistically significant increases in young children’s vegetable
bitter vegetable consumption among healthy young
consumption following RE to the selected target vegetable. Two studies did not report significant changes in intake
children between the ages of 1-6, Grade II (Fair
following RE to a target vegetable.
Evidence).
Eight studies investigated RE in comparison to associative learning techniques, including flavor-nutrient learning
(FNL)(n=1) flavor-flavor learning (FFL)(n=4) or both (n=3). Of these, 90% concluded that RE alone was effective in
promoting increased intake, irrespective of energy condition.
Future Directions
Further research is needed testing RE in the home
setting to determine whether RE would yield equally
positive results in settings outside the school.
Strengths/Limitations PRISMA Diagram
• Inconsistencies in sample demographics e.g., Future studies following subjects over long periods of
subjects from predominantly wealthy, highly time are needed to quantify the number of exposures
educated, Caucasian families needed to improve intake, as well as to specify
• Limited studies examining non-bitter tasting whether these observed increases are sustained or
vegetables decrease over time.
• Lack of follow-up to determine whether repeated
exposure can induce sustainable increases in
intake