NEW YORK (Reuters Health) - Norwegian children attending schools where free fruit was on offer ate less junk food and drank less soda than before the fruit was available, according to a new study that also found kids from disadvantaged households seemed to benefit the most.
Although fruit promotion programs are thought to succeed in getting kids to eat more fruit, it's been unclear whether children were just adding those snacks on top of what they were already eating.
"Previous work has shown fruit consumption goes up when they offer the program, but this study adds that consumption of junk food goes down," said Punam Ohri-Vachaspati, a professor at Arizona State University School of Nutrition and Health Promotion, who was not involved in the study.
The U.S. Department of Agriculture encourages children and adults to eat more fresh fruit as part of a healthy diet, and some schools participate in the agency's Fruit and Vegetable Program, which provides free fruit and vegetables to students.
In Norway, schools can also sign up for a free fruit program, in which children who enroll are given a piece of fruit daily, or for a subscription program, in which parents pay a fee to have fruit given to their kids at school.
Nina Cecilie Øverby, the study's lead author and a professor at the University of Agder in Kristiansand, said that she and her colleagues have found both types of school program are associated with an increase in how much fruit kids eat.
But to find out whether the fruit is replacing other foods, they surveyed about 1,300 6th and 7th graders at 27 schools in two Norwegian counties - first in 2001 and again in 2008.
In 2001, before any of the schools initiated a fruit promotion, the kids reported that they ate an average of 6.6 unhealthy snacks per week.
These included soda, candy and potato chips.
By 2008, five schools had a free fruit program, 10 schools participated in a fruit subscription plan and 12 schools had no official fruit program.
At that point, children at all of the schools reported they were eating less junk food - an average of 4.4 times per week.
Øverby noted that this overall reduction reflects nation-wide initiatives to reduce sugar-sweetened foods and drinks.
"In addition, there was much publicity about the potential negative health effects of added sugar in this time period," she told Reuters Health in an email.
Still, kids at schools with a fruit program showed even larger declines in the amount of junk food they ate than those at the schools with no official program.
Children who attended the free-fruit schools, for instance, ate 2.8 fewer junk food snacks each week in 2008 than their counterparts in 2001.
In comparison, kids at schools without a program ate 1.5 fewer junk food snacks in 2008 than in 2001, the researchers report in The American Journal of Clinical Nutrition.
When researchers looked at the children's family backgrounds, they found that those whose parents had no higher education generally consumed more junk food than more advantaged peers, but also showed the biggest drop in consumption.
In 2001, kids from disadvantaged households had unhealthy snacks an average of 7.3 times a week; in 2008 that figure had dropped to 4 times a week in schools with free fruit and 4.9 times where a fruit subscription program was available.
"A reason why schools with fruit programs see the largest decrease of unhealthy snacks compared to non-fruit program schools could be that when fruit and vegetables are available for the pupils, their need for energy is satisfied, and there is not the same need to consume unhealthy snacks," said Øverby's co-author, Elling Bere, also a professor at the University of Agder.
Bere added that fruit - with its high levels of water and fiber - is satiating, and can help to reduce kids' hunger for unhealthy snacks.
The study did not show whether kids at schools with a fruit program ate fewer calories overall or if the reduction in junk food made any difference to their health.
Bere said his team is conducting more research into whether these changes have any impact on children's risk for obesity.
Helping kids learn to make healthy diet choices at an early age is likely to have lasting impacts on their decisions into adulthood, Ohri-Vachaspati said.
SOURCE: tinyurl.com/95n9dz8 The American Journal of Clinical Nutrition, online October 3, 2012.