According to the directions and solutions for policy, research, and action that were elaborated for the sustainable diets and biodiversity by Food and Agriculture Organization of the United Nations (FAO), the necessary element for sustainable nutrition is increasing fruit and vegetable intake [1
]. This is not only due to the lowest environmental impact of fruit and vegetable production, as indicated for the environmental pyramid of food production [2
]—even though some negative effects are also mentioned [3
], but above all because sustainable diets contribute to a healthy life [1
To date, there has been no global dietary recommendation for children and adolescents; however, the World Health Organization (WHO) indicates primary issues for individuals and populations, including the increasing the intake of fruits and vegetables [4
]. Moreover, for the intake of fruits and vegetables, the joint report of the FAO and WHO [5
] indicated increasing food intake as an extremely important aim for the global population, which is very challenging because the interventions and programs assessed by the FAO/WHO have contributed to a daily increase of intake of only 0.14–0.9 servings of fruit and vegetable for children and up to 1.2 in adults to date. Furthermore, the intake of fruits and vegetables is commonly inadequate. According to the Eurostat data for 2014 [6
], only one in seven European Union inhabitants met the recommendation of five servings of fruits and vegetables per day. Similar data were indicated by the Centers for Disease Control and Prevention (CDC) of the United States of America for 2015 [7
], in which only one in 10 inhabitants of the United States met the abovementioned recommendations.
Thus, the current situation of inadequate fruit and vegetable intake is alarming because, according to estimations of Lim et al. [8
], inadequate consumption contributed in 2010 alone to a worldwide burden of 6.7 million deaths. Moreover, the diseases that are linked with inadequate fruit and vegetable intake (coronary heart disease, stroke, and certain types of cancer) [9
], are currently more often observed both for adults and in the pediatric population, while dietary habits and related excessive body mass are among the most important risk factors [10
]. Therefore, it must be emphasized that childhood is a period in which dietary prevention is particularly important. Moreover, the WHO [9
] emphasizes that childhood dietary patterns of fruit and vegetable intake are later transferred to adulthood [13
]; therefore, it is particularly vital to create beneficial patterns from the very early beginning because they will be decisive for the future.
However, as indicated by WHO [9
] in this period of life, there are important factors that determine the fruit and vegetable intake, which are not observed for adults and may reduce their intake. These include the food consumption patterns of parents, as well as the availability of fruits and vegetables and accessibility at home [15
]. Furthermore, although children learn their eating behaviors from peers and others in kindergarten and school, the parents are the ones who are the most important influencing individuals because their dietary patterns are confirmed to be strongly associated with the dietary patterns of their progeny [18
]. This was confirmed in our own previous analysis for the fruit and vegetable intake in Polish and Romanian national samples [19
]. Taking this into account, the aim of the presented study was to analyze the mother-related determinants of children at-home fruit and vegetable dietary patterns in a Polish national sample of children aged 3–10 years.
The crucial observation from the national Polish study conducted for a representative sample of mothers of children aged 3–10 is associated with the role of assessed factors such as the mother-related determinants of children at-home fruit and vegetable dietary patterns. Among the assessed factors, age, educational background, place of residence, occupational status, and total net income in household influenced the fruit and vegetable consumption, their general dietary patterns, and their preferences as assessed by mothers.
In the conducted study, only the marital status of mothers did not determine the at-home dietary patterns associated with fruit and vegetable intake. It may be associated with the common observation that single mothers [21
], even with the limited financial resources [22
], are trying to provide their children with an adequate diet, and that their own diet is characterized by a lower quality than those of their children. Moreover, even if they are not able to provide the adequate meal, they provide the possibility of obtaining it, as in the other Polish study that presented a lower frequency of having school lunch prepared at home for the children of single mothers, than for others, but at the same time providing their children resources to buy it at school [23
]. However, a lack of nutritional knowledge may be a problem, as it is an important determinant [24
], which was also evident from the example of pregnant single mothers who tend to have a lower nutritional value of their diet but also smoke cigarettes compared with the reference group of other pregnant women [25
]. Also, the recent study by Boccia et al. [26
] indicated that for consumers, their perception and awareness may be crucial while making purchase decisions.
The children of younger mothers more often consumed fruits, while for the children of older mothers, vegetables may have been associated with the natural age-related profile of food choices [27
]. Fruit and vegetable preferences may change after adolescence, which is a point at which lower self-efficacy, peer modelling, and family dinner frequency are observed [28
]. The situation that is observed in Poland is in agreement with the other studies indicating that vegetable consumption is most likely for the children of the oldest mothers [29
], while a younger age of mother is a risk factor for the child having an improperly balanced diet [30
The observed associations allow indicating that the specific target groups of children may be characterized by particularly unfavorable nutritional behaviors that are associated with the lowest fruit and vegetable intake, consuming these items only in the processed form, and not as a part of a properly balanced meal. Indicating such target groups in a specific population is essential to introduce any actions in order to conduct the properly planned nutritional education [31
], which should be developed for specific population groups [32
Based on the conducted study, the following target groups are in Poland: children of mothers with a low level of education, from villages, with no professional job, and with a low income, which may be summarized as children from families that have a lower socioeconomic status. It is well-known that socioeconomic status is a significant determinant of health [33
] and of the eating behaviors of children in the family [34
]. Moreover, fruit and vegetable intake is particularly reduced in families with lower socioeconomic status because the financial resources are spent on other products [35
], including those that are not necessary, such as alcoholic beverages [36
]. Such a situation is typical and observed independently from any individual country, which was stated in a study of Nordic countries, as socioeconomic inequalities in fruit and vegetable consumption were observed in all countries with no cross-country differences and no changes over time [37
However, in our own conducted study, for those specific groups of children of mothers with a low level of education, from villages, with no job, and with low income, an additional aspect was declared by mothers, i.e., their children having an especially high preference for fruits and/or vegetables. Such a situation was unexpected, as mothers indicated an especially high preference for their children; however, at the same time, they indicated worse dietary patterns for the fruit and vegetable intake of their children compared with other sub-groups. Such a situation may result from multiple reasons; among the main ones, there may be indicated: mothers overestimating the fruit and vegetable preference of their children and mothers not offering children a sufficient amount of fruits and vegetables because of low financial resources, despite indicating a high preference for such products.
The overestimation by mothers of the fruit and vegetable preference of their children may be associated with the common overestimation of the fruit and vegetable intake of children by their parents, which is associated with the general overestimation of the quality of the diet of children by their parents [38
]. It is especially common in the case of children with a higher body mass [39
], probably because parents want to present themselves in a better way, and they perceive fruit and vegetable consumption as a promoted dietary habit [40
]. Moreover, especially women overestimate their children’s intake of fruits and vegetables [41
], which may have contributed to the observed overestimation of preference. Furthermore, the observed situation may have been associated with so-called pseudo-maintenance (the false belief that the intake is adequate), which for fruit and vegetable consumption was so far indicated as associated with certain socioeconomic factors such as educational background or food and nutrition security [42
]. Moreover, it must be emphasized that maternal educational background was indicated in another Polish study as an important determinant of overweight adolescents [43
]. Therefore, it may be concluded that mothers from a lower socioeconomic status families overestimate the fruit and vegetable preference of their children because of a lack of knowledge, a lack of interest in their real preference, and a need for family to be perceived in a better way.
The other explanation for the presented situation may be associated with the real (not overestimated) high preference for fruits and vegetables by children, which may result from the needs that are not met because of low financial resources and relatively high prices of fruits and vegetables, which are important determinants [44
]. As was previously indicated, the fruit and vegetable intake in families of lower socioeconomic status is reduced [35
]. Moreover, reduced intake may cause the feeling of deprivation and so-called hedonic hunger, which is defined as a need to consume driven by pleasure and creating psychological effects [45
], which is known to be associated with prolonged food deprivation [46
]. In general, food preference depends, among others, on the symbolic value that the food product has for a consumer; if the product is perceived as valuable or rare, the consumer may even perceive a more favorable taste as they consume it [47
]. For adults, one well-known case is that of upscale wines, which may be perceived as tasting better only because of their price and not the real feeling of taste [48
]. A similar association may be assumed for children from lower socioeconomic status families, which may perceive rarely consumed products as tastier compared to perception of other children. However, it must be emphasized that in such cases, the poverty and high prices of food products, which are commonly indicated as factors limiting the fruit and vegetable intake increase [49
], are the real barriers that require a general intervention to ensure that such products are provided to families with low financial resources, e.g., by offering healthy products at lower prices [50
Considering the role of fruits and vegetables, particularly for children who should create beneficial patterns that will be transferred to adulthood, actions planned to increase the intake of these products are necessary, not only to obtain a sustainable diet following, but also due to the health-related consequences for society. It should be also indicated that in another Polish study, the fruit and vegetable dietary patterns were associated with generally positive attitudes toward health [51
], and thus may be treated as an indicator of broader problems. Furthermore, financial support for the fruit and vegetable consumption of children from lower socioeconomic status families is needed, as the financial barrier may reduce the effectiveness of education. However, the mother-related determinants of fruit and vegetable consumption should be still analyzed and considered for nutritional education as a factor that may affect the intake.