Eating vegetables first: the use of portion size to increase vegetable intake in preschool children

Background: Serving larger portions of low-energy-dense vegetables at a meal could have beneficial effects on children's food and energy intakes. Objective: We investigated whether increasing the portion size of vegetables served at the start of a meal leads to increased vegetable consumption and decreased meal energy intake in children. Design: In a crossover design, 3- to 5-y-old children in a daycare center were served a test lunch once a week for 4 wk (n = 51). In 3 of the meals, a first course of raw carrots varied in portion size (30, 60, or 90 g), and no first course was served in the control meal. Children consumed the first course ad libitum over 10 min and then were served a main course of pasta, broccoli, applesauce, and milk, which was also consumed ad libitum. Results: Total vegetable consumption at the meal increased as the portion size of carrots increased (P < 0.0001). Doubling the portion size of the first course increased carrot consumption by 47%, or 12 +/- 2 g (P < 0.0001). Tripling the portion size of carrots, however, did not lead to a further increase in intake (P = 0.61). Meal energy intake was not significantly affected by the amount of carrots served in the first course. The effect of portion size on intake was not significantly influenced by the children's age or body weight status. Conclusion: Increasing the portion size of a vegetable served as a first course can be an effective strategy for increasing vegetable consumption in preschool children. Am J Clin Nutr 2010; 91: 1237-43.