RESEARCH

Research and Professional Briefs

A Novel Approach for Increasing Fruit

Consumption in Children
Anastasia Perikkou, MSc; Anna Gavrieli, PhD; Maria-Matina Kougioufa; Maria Tzirkali, MSc; Mary Yannakoulia, PhD
ARTICLE INFORMATION

ABSTRACT

Article history:

Despite the well-documented health benets of fruits and vegetables and the public
health campaigns promoting their consumption, childrens intake is below the recommended levels. A randomized controlled trial for evaluating the effectiveness of a
school-based intervention for increasing childrens fruit intake, with the teacher being
the exposure model, was designed. Two hundred eighteen elementary school students
(aged 9 years) in Cyprus were randomly assigned into two 1-year intervention groups,
the Educational Material group (EDUC) (n59) and the Exposure group (EXPO) (n67),
or a control group (n58). Childrens dietary intake was assessed through 2-day dietary
records before the intervention began (October 2008), at the end of the intervention
(June 2009), and at 1-year follow-up (June 2010). Students in the EDUC group received a
weekly educational program for increasing awareness and improving skills regarding
fruit preparation/consumption and students in the EXPO group were exposed to the
consumption of a fruit on a daily basis by their teacher. The control group members
received no intervention. Repeated measures analysis of variance was used to evaluate
the group effect and the timegroup interaction. Higher fruit intake was reported by
the children in the EXPO and the EDUC groups compared with the control group at the
end of the intervention: a statistically signicant group effect was found (P<0.001). At
1-year follow-up, results remained signicant only for the children in the EXPO group
(P<0.001). Exposure to fruit consumption by schoolteachers may be a more effective
way for improving fruit intake of children compared with traditional educational
approaches.

Accepted 15 May 2013

Available online 16 July 2013

Keywords:
Nutrition intervention
School
Teacher
Copyright 2013 by the Academy of Nutrition
and Dietetics.
2212-2672/$36.00
doi:10.1016/j.jand.2013.05.024

J Acad Nutr Diet. 2013;113:1188-1193.

ESPITE THE WELL-DOCUMENTED HEALTH BENEts of fruits and vegetables,1,2 low intakes of fruits
and vegetablesbelow the recommendationsare
reported for children in most Western countries.3-7
A number of factors may inuence childrens and adolescents choice for fruits and vegetables, including early tasting
exposure, availability, parenting style, and modeling.8 Targeting youth for improving their fruit and vegetable consumption is important because eating behaviors are established
during childhood and track into adulthood.9 Several interventions have been undertaken, many using the school
setting.10-13 Recent meta-analyses and systematic reviews
indicate that school multicomponent and/or computerbased interventions can increase fruit and/or vegetable consumption among children.14-16
Schools provide a unique environment for tailoring childrens food choices; no other institution has such a continuous and intensive contact with children.17 Students are more
likely to make healthful eating choices when they receive
consistent messages in an encouraging school environment.18
Within schools, teachers may inuence their students eating
behaviors in a number of ways. They transfer knowledge on
health behaviors, act as authority gures, and serve as role
models through their own food practices.19 However, in the
majority of the interventions so far, their modeling role has
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not been adequately used or addressed. It was speculated

that a novel intervention approach involving teachers eating
fruits in view of students would be an effective method for
increasing fruit intake and healthy eating in children. A
similar, parent-led intervention found that daily exposure to
the taste of a previously disliked vegetable increased childrens liking and consumption of that vegetable relative
to information and control conditions.20 Teachers have the
opportunity to modify childrens eating habits by increasing
at least their exposure to healthy eating for a whole school
year, or even many school years. Therefore, we conducted a
randomized controlled trial for evaluating the effectiveness of
a school-based intervention for increasing childrens fruit
intake, using teachers as the exposure vehicleor modelfor
fruit consumption, compared with a more traditional
education-based intervention and to nonintervention. Fruit
was chosen as a culturally acceptable, convenient, and
pleasant snack to be eaten during school hours, especially
school breaks.

METHODS
Study Population
The target population was children attending third grade
(aged 9 years) and living in the area of Limassol, Cyprus.
2013 by the Academy of Nutrition and Dietetics.

RESEARCH
Six out of 64 schools in Limassol were randomly selected.
Three hundred twenty children, belonging to 15 third-grade
classes, were invited to join the study. Classes were
randomly assigned (using a random-number table) into one
of three groups: ve classes (102 students) in the educational
material group (EDUC), ve classes (109 students) in the
exposure group (EXPO), and ve classes (109 students) in the
control group (Figure 1). To avoid cross-contamination within
schools, EXPO children were from classes of the same schools.
The same happened for EDUC and control children. Of them,
218 agreed to participate (68.1% response rate). However,
complete data were collected from 184 children (54.1% girls)
and this population sample was included in the analysis:
EDUC, n59; EXPO, n67; control, n58.

Before enrollment, registered third graders of participating

schools were orally informed about the study; they understood that study participation was voluntary and were
assured about the data condentiality. A consent form was
sent to parents/guardians of children, as well as a formal
information letter (describing a school program on fruit
intake without referring to specic intervention groups);
they were also given the option to call the researchers and
ask for clarications. Parents/guardians of interested students
signed the informed consent form, whereas participating
children provided their verbal assent. The study protocol
received ethical approval by the Cyprus Ministry of Education. No nancial incentives were provided to the participants or to their parents.

Figure 1. Distribution of elementary-school students (aged 9 years) in Limassol, Cyprus (N218), into educational material (EDUC)
(n59), exposure (EXPO) (n67), or control (n58) groups in a trial to evaluate the effectiveness of a school-based intervention for
increasing childrens fruit intake, with the teacher being the exposure model.
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Description of the Intervention Groups
EDUC. This intervention included a classroom-based
educational curriculum targeting boys and girls in the third
grade. The curriculum was designed to provide general information about a healthy lifestyle as well as to build skills for
choosing healthful foods from the snack service location and/
or bringing fruits and healthy sandwiches from home as a
school snack. It consisted of 29 lessons of 15 minutes each, to
be delivered by classroom teachers once a week during the
whole school year. Teachers attended one intensive, 2-hour
preintervention professional development session and one
during the middle of the intervention. They also received all
necessary material for the curriculum implementation and
a manual with activities; they were trained to implement
the activities as part of their usual classroom curricula. The
curriculum was based on Social Cognitive Theory21 along
with traditional nutrition education and active learning and
tasting.

EXPO. These children received no educational curriculum;

children in this group were exposed to the consumption of a
fruit or a healthy snack by their teacher. Teachers, acting as
role models, were asked to bring a fruit to school at least
three times a week. Alternatively, if fruit was not available,
they were given the option of a healthy snack (dened as a
homemade, small-sized, tomato-cheese sandwich). They
were instructed to place the fruit or the healthy snack on
their desk during the class and consume it during the school
break in public. They were also asked to record their school
snack all school days. A member of the research team was
routinely reviewing these records for checking adherence to
guidelines. All teachers showed good adherence, reporting on
most days of the week having eaten fruit during school hours.
Students in the control group received no intervention;
that is, no particular exposure to foods by their teachers and
no particular educational curriculum.

Data Collection
Sociodemographic and anthropometric characteristics were
collected at baseline. Dietary intake information was
collected immediately before and after intervention, as well
as 1 year following the end of the intervention (1-year
follow-up).

Demographic Information
Parents or guardians of the participating children were asked
to ll in a questionnaire on sociodemographic characteristics,
namely marital status, annual average household income,
age, nationality, years of schooling and occupation of each
parent, number of people permanently living at home, and
family living space. With regard to marital status, parents
were asked to classify themselves as unmarried, married,
divorced, or widowed. Occupation was evaluated using a
4-point scale from mainly manual to mainly intellectual
work. For simplicity, the education level achieved by the
parents was classied as follows: 9 years and >9 years of
school education.

Anthropometry
Trained personnel physically measured all participating students height and weight (without shoes, in light clothing).
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Body weight was measured on a digital scale (Seca) to the

nearest 0.1 kg and standing height was measured to the
nearest 0.5 cm using a wall-mounted stadiometer. Body mass
index (BMI) values were calculated and BMI percentiles from
the reference growth curves for Cypriot children were used
for participants classication as normal weight, overweight
(>85th percentile), or obese (>95th percentile).22

Dietary Assessment
Dietary intake of the participants was assessed using 2-day
food records. Parents of children were asked to record the
type and amount of total daily food and beverage consumed
for 2 consecutive weekdays during the same week, using
standard household and other measures (tea cups and table/
teaspoons; the size of an audio tape, a computer mouse, or a
matchbox).23 They recorded what their children ate at home
and what the children reported to have eaten at school.
Parents did not receive specic training for the completion of
the food records; they were only provided written general
guidelines. Trained personnel reviewed all food records. In
case of problematic dietary data, parents were called to verify
entries and correct data. Food records were used for the
evaluation of food group consumption in servings per day.
Food groups assessed were those that have been associated
with childrens overweight status,24,25 namely fruits, vegetables, sugar-sweetened beverages, fruit drinks, dairy foods,
and foods rich in ber (ie, whole-grain cereals). The serving
sizes are those suggested in the Dietary Guidelines for Adults
in Greece.26 Experienced researchers measured the number
of servings of the selected food groups in childrens food
records, as in a previous study.27

Statistical Analyses
Continuous variables are presented as meansstandard deviations and categorical variables as frequencies. Associations
between categorical variables were tested by use of c2 test.
Comparisons between normally distributed continuous variables and groups of the participants were performed by the
use of analysis of variance, after testing for equality of variances and normality of the dependent outcome. The repeated
measures analysis of variance evaluated the group effect and
the timegroup interaction in fruit intake before, after
intervention, and at 1-year follow-up. Childrens BMI and
maternal or paternal education were used as covariates. All
reported P values were based on two-tailed tests at a signicance level of 5%. Statistical package for Social Sciences
software, version 13.0 (2003, SPSS Inc), was used for all the
statistical calculations.

RESULTS AND DISCUSSION

According to the reference growth curves for Cypriot children, 11.8% of our sample were >85th percentile and 2.8%
were >95th percentile. All children who participated in the
study were Cypriot. There was no statistically signicant
difference between the three groups in parental age, education, and all other demographic characteristics (see the
Table). However, at baseline, BMI of EXPO children was
signicantly higher compared with EDUC and control children (P0.001 and P0.002, respectively). In relation to dietary intake, EDUC children also reported signicantly lower
fruit consumption compared with the control group children
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Table. Baseline characteristics of Cypriot children and their parents in the exposure (EXPO), education (EDUC), and control
groups, October 2008 (N184), in a trial to evaluate the effectiveness of a school-based intervention for increasing childrens
fruit intake, with the teacher being the exposure model

Characteristic

EXPO
(n[67)

EDUC
(n[59)

Control
(n[58)

Sex (% female)

53.2

55.9

53.5

33.38.2ab

Weight (kg)
Height (m)

1.350.07

Body mass index (% >85th percentile)

24.4

30.07.0
1.350.07
9.4

29.46.5
1.330.06
8.7

P value
0.94
0.003
0.22
0.01

Age of father (y)

40.85.5

39.35.4

39.74.2

0.22

Age of mother (y)

37.34.8

35.84.8

39.93.8

0.15

Education of the father (% nished secondary school)

71.0

69.8

56.5

0.16

Education of the mother (% nished secondary school)

63.9

68.7

53.0

0.16

Parental years of schooling (y)

11.64.9

14.02.9

14.33.1

0.12

Parental marital status (% married)

100.0

100.0

94.7

0.41

Occupation of the parents (% mainly intellectual)

75.0

68.8

81.3

0.77

Family living space (m2)

185.848.1

219.874.0

165.859.5

0.07

4.51.0

5.01.0

4.71.0

0.48

0.9 1.0c

1.3 1.1

0.10

0.70.6

0.70.6

0.02

No. of people permanently living at home

1.2 1.3

Childrens fruit consumption (servings/d)

Childrens vegetable consumption (servings/d)

0.50.6

de

Childrens dairy food consumption (servings/d)

1.50.8

1.60.8

1.70.6

0.52

Childrens whole-grain cereal consumption (servings/d)

0.20.7

0.20.7

0.10.5

0.65

Childrens sweetened carbonated beverage consumption (servings/d)

0.20.3d

0.20.4f

0.040.2

0.02

0.20.4

0.20.4

0.03

Childrens fruit drink consumption (servings/d)

0.10.2

Signicant difference between EXPO and control group at P<0.01.

Signicant difference between EXPO and EDUC at P<0.01.
c
Signicant difference between EDUC and control group at P<0.05.
d
Signicant difference between EXPO and control group at P<0.05.
e
Signicant difference between EXPO and EDUC at P<0.05.
f
Signicant difference between EDUC and control group at P<0.01.
a

(P0.05) (Table). Both groups reported eating habits similar

to those reported previously for Cypriot children.28
Repeated measures analysis of variance revealed a statistically signicant group effect (P<0.001) and a grouptime
interaction (P<0.001) in fruit intake. Specically, EXPO and
EDUC children consumed signicantly more fruits compared
with control group children (P<0.001 in both cases) at the
end of the intervention. At 1-year follow-up, results remained
signicant for the children in the EXPO group (P<0.001) and
were no longer signicant for the children in the EDUC group
(P<0.08), compared with the control group. A signicantly
higher fruit intake was also reported for children in the EXPO
group compared with those in the EDUC group (P<0.001)
(Figure 2). Results did not change after adjustment for childrens BMI and maternal or paternal education.
The ndings of our study support that a new, economical
approachnamely exposure to the habit of consuming one
fruit every day by a prominent individual (the schoolteacher)may be as effective as traditional educational
approaches and, most importantly, may have more lasting
effect. Interest in the availability and consumption of fruits and
vegetable has increased during the past decade. Fruit- and
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vegetable-related behaviors were the focal point of several

public health efforts,29-31 and there are a number of very
promising school-based programs.10,32,33 Along with the
challenge of efcacy, however, comes the challenge of feasibility. School is a convenient setting for promoting healthy
eating through policies, curricula, and shared physical
environments; however, although some schools are able to
adopt health promotion programs that require signicant
curricular restructuring, others are not. Changing and implementing new education curricula requires adequate school
time, effort, and money.34 An alternative way of reaching the
goal of improving diet quality of school-aged children with
long-lasting effects is presented herein, and the results provide evidence for the feasibility of implementing a simple
nutrition intervention program for improving fruit intake in
elementary school students. Results from the EXPO group
highlight the role of teachers in shaping childrens eating
habits. EXPO children consumed more fruits even 1 year after
the end of the intervention, in contrast to what was observed
in EDUC children, suggesting that teachers as role models,
by promoting healthy lifestyle behaviors, may be more
effective in changing childrens eating habits than when they
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Figure 2. Average fruit intake over 2 days by children (N184)

in Limassol, Cyprus, before (October 2008) after intervention
(June 2009) and at 1-year follow-up (June 2010) by exposure
(EXPO), education (EDUC), and control groups. Values are
meansstandard error of the mean. Means at a time without a
common letter differ, P<0.001.
adopt their traditional role of transferring educational
knowledge.
The intervention, apart from strengths, also has some
methodologic limitations. Food information used in the
analysis may be subject to some misreporting. The 2-day food
records were used for the evaluation of the dietary intake.
Recording food intake for several days is considered the gold
standard for assessing childrens diets, specically fruit and
vegetable intake.35 Most of the studies have used 3-day food
records (2 weekdays and 1 weekend day). The food record
during weekend was omitted, keeping only schooldays,
reducing the burden for the study participants. Similarly
many epidemiologic studies have used food/eating information from 1 or 2 days to evaluate childrens dietary intake.36,37
Parents were asked to provide the dietary information for
their children. They may not know exactly what their children ate outside the home, but observation of childrens food
intake by the researchers would be a more expensive and
laborious method. Furthermore, our results were obtained
from a single school district, potentially limiting generalizability. However, there was no a priori reason for the ndings
to be in any way site-specic.

3.

Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N,

Crawford D. Childrens fruit and vegetable intake: Associations
with the neighbourhood food environment. Prev Med. 2008;46(4):
331-335.

4.

Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM. Most Americans

eat much less than recommended amounts of fruits and vegetables.
J Am Diet Assoc. 2006;106(9):1371-1379.

5.

Yngve A, Wolf A, Poortvliet E, et al. Fruit and vegetable intake in

a sample of 11-year-old children in 9 European countries: The
Pro Children Cross-sectional Survey. Ann Nutr Metab. 2005;49(4):
236-245.

6.

Upton D, Upton P, Taylor C. Fruit and vegetable intake of primary

school children: A study of school meals. J Hum Nutr Diet.
2012;25(6):557-562.

7.

Pabayo R, Spence JC, Casey L, Storey K. Food consumption patterns in

preschool children. Can J Diet Pract Res. 2012;73(2):66-71.

8.

Pearson N, Biddle SJ, Gorely T. Family correlates of fruit and vegetable consumption in children and adolescents: A systematic review.
Public Health Nutr. 2009;12(2):267-283.

9.

Lytle LA, Seifert S, Greenstein J, McGovern P. How do childrens

eating patterns and food choices change over time? Results from a
cohort study. Am J Health Promot. 2000;14(4):222-228.

10.

Perry CL, Bishop DB, Taylor G, et al. Changing fruit and vegetable
consumption among children: The 5-a-Day Power Plus program in
St Paul, Minnesota. Am J Public Health. 1998;88(4):603-609.

11.

Reynolds KD, Franklin FA, Binkley D, et al. Increasing the fruit and
vegetable consumption of fourth-graders: Results from the high
5 project. Prev Med. 2000;30(4):309-319.

12.

Morgan PJ, Warren JM, Lubans DR, Saunders KL, Quick GI, Collins CE.
The impact of nutrition education with and without a school garden
on knowledge, vegetable intake and preferences and quality of
school life among primary-school students. Public Health Nutr.
2010;13(11):1931-1940.

13.

Nicklas TA, Johnson CC, Myers L, Farris RP, Cunningham A. Outcomes

of a high school program to increase fruit and vegetable consumption: Gimme 5A fresh nutrition concept for students. J Sch Health.
1998;68(6):248-253.

14.

Delgado-Noguera M, Tort S, Martinez-Zapata MJ, Bonll X.

Primary school interventions to promote fruit and vegetable consumption: A systematic review and meta-analysis. Prev Med. 2011;
53(1-2):3-9.

15.

Evans CE, Christian MS, Cleghorn CL, Greenwood DC, Cade JE.
Systematic review and meta-analysis of school-based interventions
to improve daily fruit and vegetable intake in children aged 5 to 12 y.
Am J Clin Nutr. 2012;96(4):889-901.

16.

Van Cauwenberghe E, Maes L, Spittaels H, et al. Effectiveness of

school-based interventions in Europe to promote healthy nutrition
in children and adolescents: Systematic review of published and
grey literature. Br J Nutr. 2010;103(6):781-797.

17.

Story M, Kaphingst KM, French S. The role of schools in obesity

prevention. Future Child. 2006;16(1):109-142.

18.

Perez-Rodrigo C, Aranceta J. Nutrition education in schools:

Experiences and challenges. Eur J Clin Nutr. 2003;57(suppl 1):
S82-S85.

19.

Kubik MY, Lytle LA, Hannan PJ, Story M, Perry CL. Food-related beliefs, eating behavior, and classroom food practices of middle school
teachers. J Sch Health. 2002;72(8):339-345.

20.

Wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham A, Lawson M.

Increasing childrens acceptance of vegetables; a randomized trial of
parent-led exposure. Appetite. 2003;40(2):155-162.

21.

Bandura A. Health promotion by social cognitive means. Health Educ

Behav. 2004;31(2):143-164.

22.

Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Tafouna P,

Kafatos A. Reference growth curves for Cypriot children 6 to 17 years
of age. Obes Res. 2001;9(12):754-762.

23.

Burrows TL, Martin RJ, Collins CE. A systematic review of the validity
of dietary assessment methods in children when compared with the
method of doubly labeled water. J Am Diet Assoc. 2010;110(10):
1501-1510.

24.

Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics. 2007;120(suppl 4):
S164-S192.

CONCLUSIONS
Our study supports that a novel, teacher-led, school-based
intervention, implemented over 1 academic year can induce
changes in fruit intake that may last for at least 1 year beyond
the intervention. The role of teachers, not only in providing
knowledge but also in promoting behaviors, is highlighted.
Further research is needed to evaluate the effect of such an
intervention in biological indexes; it would be also interesting to evaluate this program along with a similar, parentled program taking place outside school.

References
1.

Stables GJ, Subar AF, Patterson BH, et al. Changes in vegetable and
fruit consumption and awareness among US adults: Results of the
1991 and 1997 5 A Day for Better Health Program surveys. J Am Diet
Assoc. 2002;102(6):809-817.

2.

Krebs-Smith SM, Cook A, Subar AF, Cleveland L, Friday J, Kahle LL.

Fruit and vegetable intakes of children and adolescents in the United
States. Arch Pediatr Adolesc Med. 1996;150(1):81-86.

1192

JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

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RESEARCH
25.

Spear BA, Barlow SE, Ervin C, et al. Recommendations for treatment

of child and adolescent overweight and obesity. Pediatrics.
2007;120(suppl 4):S254-S288.

33.

Baranowski T, Davis M, Resnicow K, et al. Gimme 5 fruit, juice, and

vegetables for fun and health: Outcome evaluation. Health Educ
Behav. 2000;27(1):96-111.

26.

Trichopoulou A, Lagiou P. Dietary guidelines for adults in Greece.

Arch Hellen Med. 1999;16(5):516-524.

34.

Kolbe LJ. Education reform and the goals of modern school health
programs. State Educ Stand. 2002;3(4):4-11.

27.

Kaisari P, Yannakoulia M, Panagiotakos DB. Eating frequency and

overweight and obesity in children and adolescents: A meta-analysis.
Pediatrics. 2013;131(5):958-967.

35.

28.

Lazarou C, Kalavana T. Urbanization inuences dietary habits of

Cypriot children: The CYKIDS study. Int J Public Health. 2009;54(2):
69-77.

Peterson KE, Hebert JR, Hurley TG, et al. Accuracy and precision of
two short screeners to assess change in fruit and vegetable consumption among diverse populations participating in health promotion intervention trials. J Nutr. 2008;138(1 suppl):218S-225S.

36.

29.

Jaenke RL, Collins CE, Morgan PJ, Lubans DR, Saunders KL,
Warren JM. The impact of a school garden and cooking program on
boys and girls fruit and vegetable preferences, taste rating, and
intake. Health Educ Behav. 2012;39(2):131-141.

Kirkpatrick SI, Dodd KW, Reedy J, Krebs-Smith SM. Income and race/
ethnicity are associated with adherence to food-based dietary
guidance among US adults and children. J Acad Nutr Diet.
2012;112(5):624-635. e626.

37.

Bornhorst C, Huybrechts I, Ahrens W, et al. Prevalence and

determinants of misreporting among European children in proxyreported 24 h dietary recalls. Br J Nutr; 2012:1-9.

30.

Bihan H, Mejean C, Castetbon K, et al. Impact of fruit and vegetable

vouchers and dietary advice on fruit and vegetable intake in a lowincome population. Eur J Clin Nutr. 2012;66(3):369-375.

31.

Pivonka E, Seymour J, McKenna J, Baxter SD, Williams S. Development of the behaviorally focused Fruits & VeggiesMore Matters public health initiative. J Am Diet Assoc. 2011;111(10):15701577.

32.

Gortmaker SL, Cheung LW, Peterson KE, et al. Impact of a schoolbased interdisciplinary intervention on diet and physical activity
among urban primary school children: Eat well and keep moving.
Arch Pediatr Adolesc Med. 1999;153(9):975-983.

AUTHOR INFORMATION
A. Perikkou is a PhD student, M.-M. Kougioufa is a dietetics student, and M. Yannakoulia is an assistant professor of Nutrition and Eating Behavior,
all with the Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. A. Gavrieli is a collaborator of the Hellenic Health
Foundation, Athens, Greece; at the time of the study, she was a PhD student, Department of Nutrition and Dietetics, Harokopio University,
Athens, Greece. M. Tzirkali is a registered dietitian, Athens, Greece; at the time of the study, she collaborated with the Department of Nutrition
and Dietetics, Harokopio University, Athens, Greece.
Address correspondence to: Mary Yannakoulia, PhD, 70, El Venizelou St, 176 71, Athens, Greece. E-mail: myianna@hua.gr

STATEMENT OF POTENTIAL CONFLICT OF INTEREST

No potential conict of interest was reported by the authors.

FUNDING/SUPPORT
This study was partially supported by the Department of Nutrition and Dietetics Graduate Program, Harokopio University, Athens, Greece.

ACKNOWLEDGEMENTS
The authors thank the parents and the teachers of the children who participated for their important contribution to the study.

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