DEVELOPMENT OF A CHILDREN’S COOKBOOK WITH HEALTHY

AFTER-SCHOOL RECIPES AND NUTRITION

EDUCATION INFORMATION

A PROJECT REPORT

Presented to the Department of Family and Consumer Sciences

California State University, Long Beach

In Partial Fulfillment

of the Requirements for the Degree

Master of Science in Nutritional Science

Committee Members:

Peter G. Kreysa, Ph.D. (Chair)

Wendy Devine, MPH
Michelle Loy, MPH

College Designee:

Wendy Reiboldt, Ph.D.

By Barbora Jirickova

B.S., 2015, Northeastern State University

May 2018




ProQuest Number: 10785113




All rights reserved

INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.

In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.






ProQuest 10785113

Published by ProQuest LLC (2018 ). Copyright of the Dissertation is held by the Author.


All rights reserved.
This work is protected against unauthorized copying under Title 17, United States Code
Microform Edition © ProQuest LLC.


ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346
 ABSTRACT

DEVELOPMENT OF A CHILDREN’S COOKBOOK WITH HEALTHY

AFTER-SCHOOL RECIPES AND NUTRITION

EDUCATION INFORMATION

By

Barbora Jirickova

May 2018

Little attention is given to child health literacy even though early nutrition has long-term

effects on health. The purpose of this project was to create a visually engaging book for children

that will educate them on nutrition, provide a relatable story, and offer nutritious recipes for

afternoon snacks or light meals. This book is divided into daily chapters accompanied by an

illustration, a recipe and a nutrition education page.

Research suggests that children are capable of becoming health advocates in their

families and thus it is important to start improving their health literacy at a young age. The book

was designed to emphasize gentle, nonjudgmental approach on nutrition education and to avoid

black-white thinking about food. The book also serves as a resource for parents. An expert panel

provided feedback to strenghten the content of the book. Future projects may use similar concept

with different target audience and areas of focus.

ii
 TABLE OF CONTENTS

ABSTRACT………………………………………………………………………………...…….ii

LIST OF TABLES………………………………………………………………………………..iv

1. INTRODUCTION AND STATEMENT OF THE PROBLEM...…………….………......1

2. REVIEW OF LITERATURE………………………………………………………....…..9

3. METHODOLOGY……………………………………………………............................23

4. RESULTS……………………………………………………………………………......30

5. DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS……………………..35

APPENDICES………………………………………………..……………………….…………41

A. RECOMMENDED DAILY INTAKES………………………………………………….42

B. CHILDREN’S BOOK………………………………………………………...…………44

REFERENCES…………………………………………………………………………....….….72

iii
 LIST OF TABLES

1. Weekly Vegetable Subgroup Recommended Consumption for Children…………….…..43

2. Recommended Daily Fruit Intake for Children…………………………….............……..43

3. Recommended Daily Dairy Intake for Children…………………….………………...…..43

4. Recommended Daily Protein Intake for Children……………………………………..….43

5. Scenario of the Book with Concepts and Sources…………………………………….…..26

iv
 CHAPTER 1

INTRODUCTION AND STATEMENT OF THE PROBLEM

Introduction

Children’s food choices are influenced by a multitude of factors, including parents, peers,

teachers, media, and many others. While nutrition education for young children has been

designated by White House Conference on Food and Nutrition as a high priority in 1969,

cookbooks remain an underappreciated source of nutrition education in the United States.

Since the 1970s, there have been guidelines on how to achieve a balanced diet by setting

vitamin-mineral and fat-sugar-salt standards. Agencies like the American Heart Association

promoted cookbooks for children. Vegetarian cookbooks first appeared during the time between

the 1970s and 2000 as well as creative food themes, cultural foods, and cookbooks emphasizing

healthy, wholesome recipes. Despite that, many recipes found in children’s cookbooks are high

in calories and they often omit vegetables (Hertzler, 2005).

Given the fact that children are in the stage of body growth, they need additional energy

and substrate intakes to support this growth. In fact, the biological relevance of supply and

utilization of nutrients is much higher in children than in any other life period. Early nutrition has

long-term effects on risk of developing obesity, diabetes, and cardiovascular disease later in life,

according to epidemiological studies. Thus, optimizing feeding strategies during this period can

positively influence long-term health, life expectancy, and cognitive abilities as well. Children’s

needs are distinct from those of adults; they need specific formulations for body and brain

development, specifically energy, amino acids, iron, zinc, calcium, and long-chain

polyunsaturated fatty acids (Koletzko, 2008).

1
 Data presented in the study by Carroll, Navaneelan, Bryan, and Ogden (2015) show that

there has been no change in prevalence of obesity among children in the United States over the

last decade despite all the efforts to lower the number of overweight and obese children. In

addition, the United States has the third highest healthcare expenditure in the world; therefore, it

would benefit from practices and education materials that would lead to improvements in

childhood health literacy and reduce those costs over time as those children grow up to become

healthier adults than they would be without these interventions (Hess & Slavin, 2014).

Despite the momentum that health literacy promotion is experiencing nowadays, very

little attention is given to children’s health literacy. Similarly, the academic consensus on which

abilities children should possess to be able to make sound health decisions is lacking. Some

experts agree that everyday contexts have potential to positively or negatively affect one’s well-

being and health. This means that children should be included in decision-making and be given

the opportunities to engage in health literacy actions. Children are able to absorb information

fast, they learn quickly and hence childhood may very likely be the period when health

information is being transformed into action and the other way around (Bröder et al., 2017).

One way to reduce the risk of development of obesity and other chronic diseases that

have been supported by numerous research studies is to increase fruit and vegetable intake.

Those food groups not only reduce the risk of developing the previously mentioned diseases,

they also help to satisfy hunger, provide macronutrients and micronutrients, fiber, water, and

polyphenols (compounds with capacities ranging from antioxidant, anti-inflammatory,

antiproliferative, antineoplastic, fat cell development inhibition, and others; Mejia-Meza et al.,

2010). Fruit and vegetable intake varies between different countries and different cultures. In

France for example, fruit is often served as a dessert and vegetables are usually part of most

2
courses during dinner, whereas in the United States children are usually exposed to less variety

of fruits. They may also choose something else over vegetables during dinner since all food

courses are served at once. For example, they will choose a dinner roll over black beans as a side

dish (Kremer-Sadlik et al., 2015). Children in Romania, similarly to children in other western

countries, prefer to eat pasta, sweets, and meat products. They reported liking fruit as well albeit

they prefer fruits high in sugar, such as bananas, grapes, and pears, specifically. Vegetables

ranked last in their favorite food types and only a minimum percentage of children consider them

necessary for a healthy diet (Roman, 2014). On the contrary, to Romanian children, children in

the United Kingdom are familiar with the strongly reinforced importance of eating five portions

of fruits and vegetables per day. Moreover, many of these children were aware of differences

between healthy and unhealthy foods, natural and artificial foods, and knew that sugar is bad for

their teeth and waistline. Some British children report that they rely on their parent’s opinion

when choosing what to eat which shows the importance of child-parent link (Fairbrother, Curtis,

& Goyder, 2016).

Statement of the Problem

Since the United States has the third highest healthcare expenditures in the world,

encouraging health-promoting practices in children could help the government to reduce these

costs over time (Hess & Slavin, 2014). Overall, children in the United States do not consume

sufficient nutrients. They are especially lacking in fiber, vitamin D, calcium, and potassium.

These nutrients are of low intake across the population so based on those statistics both children

and their parents would benefit from incorporating meals containing higher amounts of these

nutrients in their diet. Consuming too little of vitamin D, calcium, and potassium can later in life

lead to osteoporosis, hyperparathyroidism, and hypertension (Hess & Slavin, 2014). On the other

3
hand, young children often consume excess energy and refined carbohydrates, which can lead to

higher susceptibility to developing obesity and cardiovascular disease later in their lives.

Moreover, focusing on proper nutrition at an early age can have positive or negative results as

children will be growing up to becoming adults. Poor dietary habits can lead to a lifetime pattern

of poor eating habits.

Dietary Guidelines for Americans (U.S. Department of Health and Human Services &

U.S. Department of Agriculture, 2015) includes a list of foods that are recommended to be

consumed more frequently. These are fruits and vegetables, whole grains, low-fat milk and milk

products, seafood and other sources of lean protein, and monounsaturated and polyunsaturated

oils. The guidelines also recommend limiting the consumption of sodium, saturated fats, trans

fat, cholesterol, added sugar, and refined grains.

This project focused on developing a book for children that contains healthy recipes for

each day of 1 week as well as child-appropriate nutrition education messages. The book features

two main characters, a little girl and a little boy who are friends and together, every day after

school, learn about cooking and eating healthy food while being with their family and preparing

for a sports event.

Purpose Statement

The purpose of this directed project was to create a children’s book that includes

nutrition education information along with healthy recipes that children can help prepare as an

after-school snack or light meal. This book teaches children about the importance of balance and

healthier eating, especially when being involved in sports, as well as it improves health literacy

in children. In addition, this book serves as a nutrition resource for parents. The intended

4
audience for this project and thus readers of the book are healthy children of ages 5 to 11, both

boys and girls.

Project Objectives

The specific objectives of this directed project were to:

1. Review current literature to identify appropriate approach for creating the book and use

the research literature to identify essential topics to include.

2. Review existing children nutrition books and identify the topics that have and have not

yet been previously covered.

3. Develop characters, write a story that children can identify with, and create illustrations.

4. Gather the recipes to include in the book and research the educational information to

include with each chapter.

5. Create a review panel and evaluate the success of the book in regards to children’s

interest, learning outcomes, and the quality of the provided material.

Definitions of Terms

Adequate intakes (AI): Those are established when evidence is insufficient to develop an

RDA and is set at a level assumed to ensure nutritional adequacy (Institute of Medicine, 2000).

Body mass index (BMI): Body mass index (BMI) is a number calculated from a person's

weight and height using the formula: weight(kg)/height(m)2. Values of BMI are separated into

categories including normal (18.5-24.9), overweight (25-29.9) and obesity 30 and above (Centers

for Disease Control and Prevention [CDC], 2014).

Childhood obesity: Defined as BMI at or above the 95th percentile for children aged 6 to

12 years (CDC, 2014).

5
 Chronic disease: Chronic disease is defined by the CDC (2014, para.2) as “conditions

that last a year or more and require ongoing medical attention and/or limit activities of daily

living.”

Cognition: Is a complex set of multiple higher mental functions that are promoted by the

brain, including thinking, learning, memory, attention, and perception.

Cookbook: “Cookbook” (2000) is defined as a “cookery book” by the Oxford English

Dictionary, while “cookery” (2000) is defined as “the art of practice of preparing food.” The

online version of Encyclopedia Britannica provides the following definition of “cookbook”

(2015): “collection of recipes, instructions, and information about the preparation and serving of

food” (The Editors of Encyclopaedia, 2015).

Dietary reference intakes (DRIs): A set of guidelines for the daily intake of macro and

micronutrients (such as vitamins, proteins, and fats) and other food components (such as fiber)

that include recommended daily allowances, adequate daily intake values for nutrients having

undetermined recommended daily allowances, and tolerable upper level values of daily intake

(U.S. Department of Agriculture, 2011).

Glycemic index (GI): The glycemic index is defined as a method of categorizing

carbohydrate-containing foods based on the body’s glucose response after their ingestion,

digestion, and absorption (Dunford & Doyle, 2012).

Health literacy: A variable construct that can be acquired in a life-long learning process

and that starts in early childhood (Bröder et al., 2017).

Macronutrient: Chemical substances (proteins, carbohydrates, and fats) that are required

in relatively large quantities in human nutrition (Macronutrient, 2015).

6
 Micronutrient: An organic compound, specifically vitamin or mineral that is essential in

minuscule amounts for the growth and health of humans and animals (Micronutrient, 2015).

Neophobia: Reluctance to eat new, unknown foods, usually in children and usually

associated with a reduced liking of vegetables (Allirot, Da Quinta, Chokupermal, & Urdaneta,

2016).

Nutrition education: Defined as any combination of educational strategies, accompanied

by environmental supports, that are designed to facilitate voluntary adoption of food choices and

other food and nutrition-related behaviors conducive to health and well-being. These may be

delivered through multiple venues and involve activities at the individual, institutional,

community, and policy levels (Contento, 2010, p. 14).

Overweight and obesity: Overweight and obesity describe categories of weight that are

greater than what is considered healthy for a given height. For adults 20 years and older, the

ranges are determined by using weight and height to calculate a number called the BMI. An adult

who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or

higher is considered obese (CDC, 2014).

Recommended dietary allowances (RDA): Average daily level of intake sufficient to meet

the nutrient requirements of nearly all (97% to 98%) healthy people (National Institutes of

Health [NIH], n.d.).

Limitations

The book did not account for individual, unique needs of each child. As a general tool,

the book serves all apparently healthy children 5 to 11 years old and thus some recipes may not

be suitable for children with allergies, food intolerances, suffering from certain clinical

conditions and/or chronic disease, and so on, as those children should talk about their specific

7
needs during a one-on-one sitting with a registered dietitian. Even though this book provides

suggestions for healthy nutritious recipes, the book is not intended to be used as a weight loss

tool.

Assumptions

There are five assumptions for this directed project. First, it is assumed that the review of

current literature provided accurate information about the nutritional needs of children and

children’s eating habits and preferences that helped in the creation of this book. Second, it is

assumed that children will have an adult supervisor to help with preparation of the recipes. It is

also assumed that children and their supervisors have access to a kitchen equipped with basic

kitchen tools and appliances and that the supervisors are familiar with basic cooking skills and

safety. Fourth, it is assumed that children are willing to try new food items and have the desire to

help with food preparation. Finally, it is assumed that the review panel provides a complete

critique of the recipes and the content of the book and provides valuable and reliable feedback.

8
 CHAPTER 2

REVIEW OF LITERATURE

Introduction

The purpose of this directed project was to create a new, unique children’s book that

includes nutrition education information along with healthy recipes that children can help their

parents or other family members prepare as an after-school snack or light meal. This book aims

to teach children about the importance of nutrition, balance and moderation, especially when

being involved in sports. The book also improves health literacy in children. In addition, this

book serves as a nutrition resource for parents. The intended audience for this project and thus

readers of the book are healthy children of ages 5 to 11, both boys and girls.

Several topics were identified and sorted into six categories that are reviewed in this

chapter. Those cover first, the literature overview of the health literacy in childhood, second, the

nutritional needs of children ages 5 to 11, including the needs for active children, third the

overview of children’s health status, the fourth category covers eating habits and food

preferences among children, fifth category overviews several children’s books dealing with

eating, nutrition, and cooking that have been published so far, and the last, sixth category,

overviews sports nutrition. All those areas were necessary to be reviewed as children’s nutrition

education books are tricky to be written successfully, in a way that children stay engaged and

entertained by the book yet learn at the same time.

Overview of Health Literacy in Children

Health literacy is a term that covers how people process and understand basic health

information, how they interact with health messages, and how they use the information to

promote good health (Fairbrother et al., 2016). Compared to the momentum that health literacy is

9
experiencing nowadays, the attention that is given to children’s health literacy is still very small

(Bröder et al., 2017). Based on Bröder et al.’s (2017) idea that childhood may be the critical life

period when health information is going to be transformed into action and vice versa, children

should be a core target group for health literacy research and intervention. During childhood,

fundamental cognitive, physical, and emotional development processes take place and health-

related skills and behaviors develop. Moreover, acquiring health literacy is a life-long process

that has to be started in early childhood so that healthy behaviors can be promoted and future

health risks ameliorated (Bröder et al., 2017).

One problem is that knowledge and academic consensus are lacking when it comes to

abilities a child should possess to be able to make sound health decisions (Bröder et al., 2017).

Several gaps in research of differences between children and adult population have been

identified: developmental changes, dependency on resources and skills, epidemiological

differences, and vulnerability to social-demographic determinants of health (Bröder et al., 2017).

According to the same authors, childhood health literacy is a multidimensional, complex

construct, trying to understand the unique needs and unique characteristics of children. In

addition, many everyday aspects have the ability to potentially affect the well-being and promote

one’s health. Since good health literacy enables personal empowerment, engaging in

opportunities to practice this skill should be encouraged (Bröder et al., 2017).

Future research should find out to which extent families actually allow children to take an

active role in health literacy and to participate in health literacy practices (Bröder et al., 2017).

A framework established by James and Prout called “Social Studies of Childhood” sees

children as “competent social actors, who have informed views on social world” (as cited in

Fairbrother et al., 2016, p. 477). James and Prout also claim that children are active and

10
reflective and not just passive recipients of socialization as viewed in the past (as cited in

Fairbrother et al., 2016). Moreover, according to Mayall, children do health-related activities at

school or at home, they are becoming “healthcare actors” (as cited in Fairbrother et al, 2016, p.

477).

A study by Fairbrother et al. (2016) interviewing children found that some children

understand the concept of natural and artificial food and are able to distinguish between

“healthy” and “unhealthy.” The same study found that many children were worried about sugar,

even naturally occurring sugar, since they have been told multiple times that sugar causes tooth

decay. This leads to an interesting finding that this contradicting information confuses children,

eating fruits yet limiting sugar, in this case.

In Romania, in a qualitative study conducted by Roman (2014), 87% of children who

participated thought that “to eat healthily” means to eat cooked food, to have family meals, and

to avoid fast food and cold cuts.

Children’s Nutritional Needs

Based on the recommendation given by the Dietary Guidelines for Americans 2015-2020

(U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2015) the

estimated calorie needs for children 5 to 11 years old are as follows: boys who lead sedentary

lifestyle need between 1,200 and 1,800 calories, boys who are moderately active need between

1,400 and 2,000 calories, and boys who are active need between 1,600 and 2,200 calories per

day. Girls who are mostly sedentary need between 1,200 and 1,600 calories, girls who are

moderately active need between 1,400 and 1,800 calories, and active girls need between 1,600

and 2,000 calories per day (U.S. Department of Health and Human Services & the U.S.

11
Department of Agriculture, 2015). Recommended amounts of vegetables, fruits, and dairy for

each sex and each age group are listed in Appendix A.

As Koletzko (2008) states in his study, early childhood is a critical period in which the

supply and utilization of nutrients has a greater biological relevance than in any other period of

life since children need additional energy and substrate for body growth. The same author, based

on epidemiological studies, also emphasizes that nutrition during this time of life has long-term

effects on development chronic diseases later in life. Optimum feeding strategies can thus

positively affect long-term health as well as life expectancy. Moreover, early nutrition has been

proven to have effects on cognitive abilities and cognitive development since brain function

relies on energy supply as well as the intake and metabolism of amino acids, long-chain

polyunsaturated fatty acids, and micronutrients including zinc and iron. Children are in a period

of growth. They are not simply small adults and thus they need formulations that are specific to

their age (Koletzko, 2008).

According to Hess and Slavin (2014), children in the United States do not consume

sufficient nutrients in their diet. Overall, they are lacking fiber, vitamin D, calcium, and

potassium. On the other hand, average children consume excess added sugars, refined

carbohydrates, and energy.

Based on the recommendations provided by Choosemyplate.gov (U.S. Department of

Agriculture, Center for Nutrition Policy & Promotion, 2018a), children should consume a variety

of vegetables, and enough fruit and dairy. Table 1 shows recommended weekly amount of each

vegetable group for children ages 4 to 8 and for boys and girls ages 9 to 13 (U.S. Department of

Agriculture, Center for Nutrition Policy & Promotion, 2018c). Table 2 shows the recommended

daily consumption of fruit for the same age groups (U.S. Department of Agriculture, Center for

12
Nutrition Policy & Promotion, 2018b) and Table 3 does the same for recommended amount of

dairy per day (U.S. Department of Agriculture, Center for Nutrition Policy & Promotion, 2017).

Overall, it is recommended by Choosemyplate.gov to consume a variety of vegetables, to

consume enough fruit, especially whole fruit, to choose healthy grains while making at least half

of them whole grain, to choose a variety of lean protein, to consume low fat or fat free dairy, and

to include oils, predominantly plant oils. On the other hand, the website recommends to limit

added sugars by making them less than 10% of daily calorie intake, to limit saturated and trans

fats by making them less than 10% daily consumed calories, to limit sodium intake and to

incorporate small changes like adding more vegetables to favorite recipes, cooking more at

home, and to incorporate physical activity to achieve healthy eating pattern.

Many studies have demonstrated that dietary patterns along with fruit and vegetable

consumption are critical for prevention of heart disease, cancer, diabetes, and obesity, and are

essential for overall health. Thus, school curricula in the past several decades attempted to teach

children of the importance of fruit and vegetable consumption and even though there have been

short-term benefits, none of those attempts seemed to lead to significantly higher consumption of

those in children (Kremer et al., 2015).

The minimum protein requirements are affected by multiple different factors, such as

genotype, metabolic demand, factors that affect phenotype, lifestyle, environmental influences,

and states of active growth. Currently protein requirements for children are lower than previous

estimates. Higher quality protein is preferable for its essential amino acid content and thus

required in lower quantities. In European children, protein intake is associated with growth-

stimulation by affecting insulin-like growth factor (Uauy et al., 2015).

13
 Dietary fibers, particularly soluble fibers, such as β-glucans, are important part of a

healthy diet. Those can be found in barley and oats, for example, and are proven to lower low-

density lipoprotein (LDL) cholesterol levels, which can significantly reduce the risk of chronic

diseases. Moreover, oats also have prebiotic benefits because the fiber in them serves as a

substrate to beneficial bacteria in the colon (Shahidi, 2012).

Better cognition can be achieved by consuming foods rich in certain nutrients such as

lutein, a dietary carotenoid that can be found in avocados (Johnson et al., 2015) and omega-3

fatty acids, which are also important for heart health protection and for eye health. Allport (2006)

suggests to ensure increased omega-3 consumption by eating plenty of fruits and vegetables,

especially green vegetables, to consume oils with a balanced content of omega-3s and omega-6s,

to eat a variety of fish, to eat omega-3 enriched eggs, to avoid hydrogenated oils since they

contain trans fats, to choose free range chicken and beef, to cut down on saturated fats, and to

maintain a healthy weight.

There are certain foods that can be used to treat mild diseases, like the common cold. One

such food is garlic, which is proven to have antimicrobial and antiviral properties. A randomized

controlled trial revealed that there were less common cold cases (24) in garlic supplement group

compared to placebo group (65; Lissiman, Bhasale & Cohen, 2010). Harris, Cottrell, Plummer,

and Lloyd (2001) add that garlic has been used for thousands of years by many ancient cultures

and valued for its properties that also include being antifungal and antiprotozoal.

Overview of Children Health Status and Statistics

In the United States, overweight and obesity is still of major concern among the

population since it is a risk factor for a number of fatal and chronic diseases including type 2

diabetes, hypertension, coronary heart disease, dyslipidemia, osteoarthritis, and cancer (Mejia-

14
Meza et al., 2010). According to the CDC, obesity among children remains too high. In 2011 –

2014, 17% children and adolescents (2 to 19 years old) were obese. On average, 1 in 6 children

and adolescents in the United States is obese, according to CDC, while only 5.6% of children

were obese in the late 1970s (Carroll et al., 2015). Obese children pose a serious health concern

since they can develop diseases like type 2 diabetes or coronary heart disease at a young age and

there is a high chance that overweight children will grow to become overweight adults (Mejia-

Meza et al., 2010). Similarly, childhood practices have been linked to adult health outcomes by

epidemiological research (Fairbrother et al., 2016).

Monitoring trends in childhood obesity is important in order to assess interventions that

have a goal to reduce the burdens of obesity. Over the past decade, there has been no change in

prevalence of obesity among children in the United States and Canada (Carroll et al., 2015).

A number of studies has demonstrated that the risk of obesity may be lowered by

increasing the intake of fruits and vegetables. Those not only satisfy hunger but also contain high

levels of polyphenols that are of antioxidant, anti-inflammatory, antiproliferative, and anti-

neoplastic properties as well as are capable of inhibiting fat cell development and intracellular fat

deposition (Mejia-Meza et al., 2010).

In order to improve child health, recognition of children as active health literacy

practitioners is necessary. One useful and very important tool to promote child health is health

education. Children are “sponges, waiting to be filled with information” (Fairbrother et al., 2016,

p. 482). Consequently, children can become “health promoting actors” in their family and start

improving nutritional habits in the whole family (Fairbrother et at., 2016, p. 482).

Generally, school lunches are high in calories from solid fats and added sugars while only

providing the child with 10% of target nutrients. Most American children consume snacks. They

15
prefer desserts and sugar-sweetened drinks, which are choices high in sugar and energy and low

in nutrients, as well (Hess & Slavin, 2014). Replacing current snack foods with other options

would thus promote child health and diet quality. Nutrients of concern, according to Hess and

Slavin (2014), are calcium and vitamin D, and thus yogurt made with vitamin D fortified milk

would be a great option, as well as fruits and vegetables would be. Since low-fat yogurts are

often loaded with added sugar and other ingredients, recent studies suggest that full-fat dairy

products may actually offer health benefits while decreasing the need for added sugars (Hess &

Slavin, 2014).

Eating Habits, Food Preferences and Beliefs

Overall, people in the United States decrease their consumption of food prepared from

the sources they have at home and reduce their time spent cooking (Smith, Ng, & Popkin, 2013).

Some women even express lack of food preparation skills and that putting food together requires

time and energy. They, however, find it useful when instructions for food preparation are written

directly on the food packaging to make the cooking process easier (Engler-Stringer, 2010). On

average, participants of the study conducted by Laska, Hearst, Lust, Lytle, and Story (2014)

prepared meals at home less than once per day even though they were aware that preparing food

at home is related to healthier dietary patterns. Specifically, cooking more than six times per

week is associated with higher fruit and vegetable consumption (Wolfson & Bleich, 2015).

In a qualitative study conducted by Fairbrother et al. (2016) in the United Kingdom,

children typically associated healthy eating with eating fruits and vegetables. Food-related health

information was communicated to children through multiple different sources including school,

family, media and advertising, social marketing campaigns, and health professionals. In the

United Kingdom specifically, there is a campaign with a slogan “Live life the healthy way,

16
always eat your 5 a day,” referring to a number of portions of fruits and vegetables. According to

the findings of this study, children enjoy chanting this slogan while simultaneously being

strongly reinforced to eat their vegetables and fruits as well. Some children, however, complain

that this information gets repetitive and reductive. Fairbrother et al. have also found that

information that is conveyed to them orally and/or visually resonates with them more than

written information does.

Children often filter health information using their personal experience, for example, they

will not stop eating chocolate when they see they will not gain weight immediately after that or

will start avoiding foods that made them feel sick to the stomach in the past. Other children value

discussions with their parents who help them break down and personify the apparently universal

health information. Despite efforts to teach children to limit their sugar consumption, children

believe that sugar is a source of energy (Fairbrother et al., 2016).

Some children, boys especially, know about the role of food as a fuel for exercise and are

able to have an enthusiastic conversation on this topic. Those who are members of any sports

team are especially motivated to be healthy and eat healthy, especially the night before a match

or a game (Fairbrother et al., 2016).

Based on the analysis of answers obtained from questionnaires and focus group

discussion conducted by Roman (2014) in Romania, children 10 to 12 years old ate on average

two servings of fruit daily and two to three servings of vegetables daily. However, vegetables

were indicated as their least favorite type of food to eat. Fruit ranked a little higher in popularity,

while bananas, grapes, and pears were said to be children’s favorite compared to apples,

grapefruit, lemons, and oranges that were indicated by some children as their least favorite fruit.

Overall, children in this study preferred to eat pasta, sweets, and meat and meat products. This

17
was quite an alarming discovery since the top two preferred foods are high glycemic foods. It

was also discovered by Roman that children who always eat with their families ate an additional

1.5 cups of fruit and vegetables each day.

In contrast to British children, only 13% of Romanian children believe that fruit and

vegetables are a necessary part of a healthy diet (Roman, 2014). Moreover, children in Roman’s

study saw advantages that sweets have over fruit, namely: good taste, they give the feeling of

fullness, they are not so perishable, and they have an expiration date marked on the package.

Children were also drawn to sweets because they saw commercials on television.

Allirot, Da Quinta, Chokupermal, and Urdaneta (2016) focus on neophobia and offer

several strategies to reduce it. These strategies include promoting exposure to novel foods in

order to increase children’s familiarity with the food; making an effort to create positive

experiences with novel foods; and involving children in sensory education as well as in cooking

activities, since cooking can both increase familiarity and create positive experiences with novel

food. Moreover, the authors suggest that involving children in home cooking is associated with

higher fruit and vegetable consumption and better diet quality overall. Thus, children’s food

preferences, attitudes, and behaviors can be positively influenced and manipulated by

implementing cooking programs. Results of Allirots et al.’s (2016) study show that participating

children were more likely to choose a vegetable-containing snack over a conventional snack if

they were involved in preparing the snack. In addition, they were also more willing to taste new

foods after they were done snacking. Finally, they also reported higher liking of vegetable-

containing food items than those who did not help to prepare it.

The consumption of fruits and vegetables varies from culture to culture, from country to

country. Kremer-Sadlik et al. (2015) compared and contrasted fruit and vegetable consumption

18
in American families in Los Angeles to French families in Paris. The researchers have noted that

parents and family play an important part in the success of interventions that attempt to heighten

the consumption of fruit and vegetables in children yet very few programs actually include

parents in them. The researchers found that French children are exposed to a greater variety of

fruits (14 compared to 4 in American households) and that French dinner always ended with

fruit, unlike American dinner. Dinner in France was served in courses, which reduced

competition for vegetables with other foods, and thus French children were more likely to overall

consume more vegetables as well.

Nutrition Education and Review of Existing Nutrition Books for Children

Most experts agree that nutrition education consists of three essential components: the

motivational phase, the action phase, and the environmental component (Roman, 2014). To

enhance healthier eating habits, it might be beneficial to implement education of comprehensive

cooking skills, to teach how to navigate the grocery store, budgeting, meal planning, safe

storage, as well as quick and easy cooking techniques (Wolfson & Bleich, 2015). Increased

cooking class attendance was associated with increased intake of fruit and vegetables (Reicks et

al., 2014). Interventions involving home food preparation and/or cooking may result in favorable

dietary outcomes, food choices, and other health-related outcomes (Reicks, Trofholz, Stang, &

Laska, 2014). Most people associate healthy feeding with reinforcing natural products that will

ensure the sufficient intake of nutrients as well as balanced calorie intake. A commonly accepted

fact is also that cultivating children’s taste for foods containing nutrients that are necessary for

normal bodily functions, especially vegetables and fruit, is highly desirable.

Worldwide, cookbooks for children are becoming a fast-growing trend. While sales of

traditional cookbooks are dropping, sales of children’s cookbooks doubled from 2012 to 2013

19
(18% to 36%; Ketelaars, 2013). There are numerous nutrition books and cookbooks for children

on the market. For example, Disney Book Group has published many cookbooks, including The

Disney Princess Cookbook, which provides 50 easy, child-appropriate recipes for breakfast,

lunch, and dinner. Despite being a number one bestseller on Amazon in its category, this book

does not emphasize healthfulness of the recipes.

Eating the Alphabet: Fruits & Vegetables from A to Z by Lois Ehlert was published in

1989, but is still one of the top sellers in the children’s book category. Even though this book

does not contain any other text than the names of the pictured fruit and vegetables, it is still a

great tool to familiarize toddlers and young children with a variety of colorful produce.

In general, most children’s cookbooks do not focus on healthy recipes. However, several

books exist that encourage children to consider what they are eating and guide them to prepare

healthier recipes while having fun making them. One example is the Kid’s Fun and Healthy

Cookbook by Nicola Graimes published in 2007. This book not only provides systematic recipes,

but guides through techniques as well, is enjoyable to both children and adults, emphasizes fresh,

whole foods, and provides discussion about food groups and their role in the balanced diet.

Another would be American Grown by Michelle Obama who offers simple, wholesome recipes

and displays the importance of using fresh, whole, local ingredients, especially vegetables.

Sports Nutrition

Dietary recommendations for active individuals differ slightly from the recommendations

for non-active individuals. Generally, an athlete’s diet should be well-designed and meet energy

requirements to support physiological adaptation to training. Timing of nutrients intake plays a

role as well and food should be divided into four to six meals per day. Improper nutrient intake

may lead to muscle and strength loss, to greater susceptibility to illness, and increased prevalence

20
of overtraining. People involved in general fitness (30 to 40 minutes per day, three times per

week) generally only need to follow general nutrient and energy recommendations since their

physical activity is not too great. However, those who participate in moderate (2 to 3 hours per

day, five to six times per week) and intense (3 to 6 hours per day, five to six times per week)

exercise will need to up their intake to 2,500 to 8,000 kcal (50 to 100 kg athlete). For some

athletes it may be difficult to consume enough calories thus nutrient-dense food is recommended.

Similarly, athletes engaged in moderate and high intensity exercise will need higher

macronutrient intake (Kreyder et al, 2010).

There is limited data available on how meal frequency affects the body composition,

hunger, and performance of active individuals and athletes. According to the article by La

Bounty et al. (2011), meal frequency in a hypocaloric diet had no impact on body composition in

a sedentary population, but could have impact on body composition in athletic populations.

According to the limited research, increased meal frequency can suppress lean body mass losses

during hypocaloric dieting, it can increase lean body mass and support anaerobic power, and can

significantly increase fat loss in athletic populations. The study however did not focus on

children so these findings may not be relevant to them and further research is needed to

determine optimal meal frequency for children who participate in sports.

A cross-sectional descriptive study conducted by Tomlin, Clarke, Day, McKay, and

Naylor (2013) found that children who were actively involved in sports had lower BMIs

compared to children who were not involved in sports despite generally consuming higher

calorie diets. Children involved in organized sport also consumed more fruit and vegetables and

they ate healthier diets overall.

21
 Summary

In conclusion, review of the literature highlights that targeting children with health

education in order to improve their health literacy could be an important and effective way to

lower the number of overweight and obese children and to prevent their development into obese

adults. Children’s unique characteristics should be incorporated into any efforts to improve

children health literacy. Once children adopt healthy practices and beliefs, they can become

health-promoting actors and advocate for a healthier lifestyle in their family. Children are able to

understand the concept of healthy nutrition and are able to make decisions for themselves. Many

children associate healthy food with vegetables and fruit even though they prefer to eat sweet

instead. One method to make children eat more vegetables and to decrease neophobia is to

involve them in the cooking process. Currently, there are numerous cookbooks and nutrition

books for children on the market but only a fraction of these lead children to eat healthy

compared to the majority of books that feature mostly general, not exactly healthy recipes for

cooked and baked dishes. Children participating in sports tend to be more active, eat healthier

diets and consume more fruit and vegetables. This literature review helped with understanding

children’s eating habits, preferences, nutrition needs, and health literacy as well as reviewed

previous nutrition books and cookbooks to develop a book that is suitable for children and

enjoyable for their parents.

22
 CHAPTER 3

METHODOLOGY

Introduction

The purpose of this directed project was to create an educational, yet entertaining

children’s book that includes healthy recipes that children can help prepare as an after-school

snack or light meal. This book is meant to teach children about the importance of balance,

moderation, and healthier eating, especially when being involved in sports. The book’s purpose

is also to improve health literacy in children. In addition, this book serves as a nutrition resource

for their parents. The targeted readers of the book are healthy children of ages 5 to 11, both boys

and girls.

Current dietary guidelines, recommendations, and current literature were all used to

develop this book. Recipes were selected based on easy difficulty level, balanced macronutrient

content, the likelihood of children acceptance and willingness to prepare the specific food, and

higher micronutrient content with a focus on nutrients of concern for children. It has been

discovered that children in the United States generally lack fiber, vitamin D, calcium, and

potassium (Hess & Slavin, 2014). This chapter will present: (a) prospective participants, (b)

evaluation instrument, (c) procedures, and (d) book outline.

Participants

The target audience for this book are children ages 5 to 11 and their parents. Children

have been identified by Bröder et al. (2017) as the core target group for health literacy

interventions, since targeting children can help promote healthy behaviors and lessen health risks

in adulthood. Children are advised to consume their nutrients in food rather than in a form of a

supplement (Hess & Slavin, 2014). Once children are educated and willing to make healthier

23
choices, they could become health advocates to influence their whole family (Fairbrother et al.,

2016).

Procedure

The book was developed in three phases. The first phase consisted of the review of

current literature, nutrition recommendations, and existing nutrition books and cookbooks for

children. This step allowed for identification of nutrients of concern and dietary patterns among

children and enabled the researcher to learn from previous similar work and integrate these

findings into the book. Current cookbooks do not always guide children to consider their health

when preparing food. In fact, most books contain recipes for foods like cupcakes, hamburgers,

and cookies, which are foods that are popular yet high in calories, sugar, and saturated fat, even

though all these foods have potential to be prepared in a healthier way that is still tasty and

satisfying.

Step two was writing the text of the book. This step had to include identification of

recipes to include, identification and research and writing of the nutrition education sections, as

well as writing the text that tells the story. The book features seven recipes as the story covers

the length of 7 days. Every day, the characters meet after school and go visit one of their friends

or family members with whom they prepare a light meal and learn something new about

nutrition and health. In the end, the boy has a soccer game that he has been preparing for the

whole week and the girl is supporting him while preparing for her own dance classes and helping

him by introducing him to the world of healthy eating, focusing specifically on colorful fruit and

vegetables.

All books for children should be graphically interesting to engage children better and to

keep their attention. Step three hence was creating illustrations for the book that enhance the

24
story. Those feature the three main characters: a boy, a girl, and a dog. The dog plays the role of

a fun character that children can laugh at which improves their liking of the book and makes

them want to try to cook the recipes themselves, with the help of an adult.

Evaluation Instrument

Evaluation was completed to assess the success of creating a children’s book that

motivates children to eat more fruit and vegetables and to get involved in cooking and food

preparation. For this directed project, an expert review was used as an evaluation instrument. The

expert panel consisted of the researcher’s thesis committee members. The panel was given a 2-

week timeframe to review the children’s book and provide feedback. The expert panel consisted

of Peter G. Kreysa, Ph.D.; Wendy Devine, MPH, RD; Michelle Loy, MPH, MS, RDN, and

Virginia Gray, Ph.D., RD, the graduate coordinator for the Nutritional Science major at

California State University, Long Beach.

Book Outline

Chapters in the book Toothsome Time with Felix and Sophia are listed below and Table 5

contains chapter summaries and sources of information.

1. Little Friends

2. Sunday in the Country

3. Homework on Monday

4. Biking on Tuesday

5. Grilling on Wednesday

6. Sick Thursday

7. Parfait Friday

8. Saturday Baking

25
 9. Soccer Game
TABLE 5. Scenario of the Book with Concepts and Sources
Day Concept
Sunday The two friends and their dog are
visiting the girl’s grandmother today.
She teaches them to bake a healthy
oat bread and together they learn how
beneficial oats could be for children
and adults alike.
Monday Monday brings homework for school.
The two friends decide to study and
do homework together and visit the
boy’s house, where his mother lets
them help her to make sandwiches
full of healthy ingredients that will
help their brains to function better.
26
Evidence from current literature
Shahidi (2012) – oats are beneficial due
to its soluble fiber content and prebiotic
properties. β-glucans, water-soluble
fibers, can lower LDL cholesterol.
Meydani (2009) – due to their high β-
glucan content, oats are healthy for the
heart. They contain unique
polyphenols, avenanthramides. Those
have strong antioxidant properties, are
also anti-inflammatory, and
antiproliferative. They protects against
coronary heart disease and colon
cancer.
Johnson et al. (2015) – lutein (a
carotenoid) in avocados helps to
maintain cognitive health. (cognition
includes attention, memory, thinking,
learning, and perception (Wallace,
2018)
Allport (2006) – omega-3 fatty acids
are beneficial for heart and brain tissue.
They are integral part of cell
membranes.
Scott, Rasmussen, Chen, & Johnson
(2017) – lutein accumulates in the
macula. It acts as a blue light filter. The
macular pigment optical density is
related to cognitive function. Lutein
can also be found in leafy green
vegetables, broccoli, and eggs.
Wallace (2018) – choline, an essential,
vitamin-like nutrient contained in eggs,
has both structural and regulatory roles
in the body.
TABLE 5. Continued
Day Concept
Tuesday Tuesday is a nice day outside so our
friends decide to go for a bike ride
after school with the girl’s uncle.
They, however, spend too much time
outside and come home late so that
the aunt is unhappy about that. The
uncle guides the children to make a
vegetable plate arranged to look like
a clock to make it up to the aunt and
to make everyone feel better yet
remember to keep an eye on time
next time.
Wednesday On Wednesday afternoon, after the
girls dance rehearsal, the children and
the dog gather with the girl’s family
in their backyard, where they help the
girl’s father to prepare cheeseburgers
on a stick.
27
Evidence from current literature
Choosemyplate.gov (2018) – children
should consume variety of vegetables,
including dark green vegetables.
Dias (2012) – vegetables are source of
vitamins, minerals, dietary fiber, and
phytochemicals. For their antioxidant
content, they reduce the risk of chronic
disease and protect against free-radical
damage. They are strongly associated
with overall good health, vision, and
improvement of gastrointestinal health.
Uauy et al., (2015) – Feeding children
high quality protein promotes proper
growth, prevents stunting.
Benton (2017) – Human body breaks
carbohydrates down to simple sugars,
which are absorbed into the
bloodstream, before they are absorbed
into the cells. This process is slower for
whole grain foods compared to non-
whole grain foods, meaning that whole
grain products provide energy over a
longer period of time.
Gavin (2014) – protein from foods we
consume is broken down in the
digestive tract into amino acids. Those
are used to build, maintain, and replace
muscle and other tissue in the body, as
well as to make specialized molecules
like hemoglobin.
Gavin (2018) – fats are important for
proper growth of children’s’ body. It is
useful for absorption of fat-soluble
vitamins. It helps to feel full after the
meal. It is important to choose the right
kind of fat and the right amount.
TABLE 5. Continued
Day Concept
Thursday Thursday is an unusually cold day.
The boy does not feel good and is
sniffling and cold. The girl helps him
to get home and get to bed. She
prepares a warm soup for him with
the help of his older sister so that he
can feel better and his immunity can
improve.
Friday Friday is a sunny day again, almost
too hot. The girl decides to make sure
that the boy is healthy for his
Saturday match and asks her friend to
help her prepare fruit and yogurt
parfaits that are full of vitamins and
minerals.
28
Evidence from current literature
Lissiman et al. (2010) and Harris et al.,
(2001)– due to its antimicrobial and
antiviral properties, garlic may be
capable of relieving the symptoms of
common cold due to its allicin content.
Josling (2001) – participants of a
double blind, placebo-controlled study
were found to be less likely to get a flu
when they were taking an allicin
supplement, compared to the placebo
group. The duration of sickness was
shorter in the treatment group
compared to the placebo group.
Arreola et al. (2015) – garlic
components directly stimulate immune
cells. For centuries, garlic has been
used as a natural remedy. Its benefits
have been proved by many animal
studies, however, human studies are not
conclusive yet and further research is
needed.
Beattie, Crozier, & Duthie (2005) –
higher fruit consumption leads to lower
incidence of heart disease and several
cancers. Berries are especially rich in
phytochemicals, which are antioxidants
and anti-inflammatory compounds.
Mejia-Meza et al. (2010) – higher
consumption of fruit can lower the risk
of obesity and other chronic diseases.
TABLE 5. Continued

Day Concept Evidence from current literature

Saturday Boy’s big match is happening today. Tomlin et al. (2013) – Children
He is ready and healthy, feeling good. involved in coordinated sports are more
The girl makes him some healthy active, have lower BMI, eat more fruits
muffins, with the help of her mother, and vegetable, and have healthier diets
to provide him with good energy for than those children who are not
sport. involved in sports.
Both friends also go through an
internal change throughout the week.
The boy realizes that eating healthy
food does not have to mean
unpleasant taste and admits that he
felt great during his match after a
whole week of providing his body
with healthy, fresh, and colorful food.
The girl realizes that she was acting a
little selfish and bossy but she
actually enjoyed taking care of her
friend when he was sick and will now
change to be more friendly and
tolerant.

29
 CHAPTER 4

RESULTS

Introduction

This directed project had the following purpose: to create a book for children that

includes nutrition education information and healthy recipes that children readers can help

prepare as an after-school snack or light meal. This book improves health literacy in children. It

teaches them about the importance of balance and healthier eating, especially when being

involved in sports. In addition, this book serves as a nutrition resource for their parents. The

target audience for this project are healthy children of ages 5 to 11, both boys and girls. This

chapter will discuss the following: (a) meeting the objectives of the project, and (b) the

evaluation.

Meeting the Objectives

Several objectives were stated and followed in order to guide the development of this

book:

1. Review current literature to identify appropriate approach for creating the book and use

the research literature to identify essential topics to include.

2. Review existing children nutrition books and identify the topics that have and have not

yet been previously covered.

3. Identify a concise and visually stimulating format with which to present the story,

recipes, and theoretical knowledge.

4. Gather the recipes to include in the book and research the educational information to

include with each chapter.

30
 5. Create a review panel and evaluate the success of the book in regards to children’s

interest, learning outcomes, and the quality of the provided material.

Project objectives were met by addressing each topic in a respective chapter. The first

step towards completion involved a review of current research related to this topic, which was

conducted using the CSULB Library online reserves and the Internet. Overall, fewer resources

study children than adults. Even though promoting health literacy is gaining momentum, very

little attention is given to health literacy of children. That is not ideal considering that early

nutrition has long-term effects on health later in life. Thus, poor nutrition during early stages of

life can increase the risk of developing obesity, diabetes, and cardiovascular disease later in life.

Cookbooks remain an untapped source of nutrition education, because most children cookbooks

do not focus on health. Children learn quickly and childhood may be the period of time when

information is being transformed into action and vice versa. One in three children and

adolescents in the United States are overweight or obese and improving health literacy of

children may help lower this statistic and the risk of these children of developing chronic disease

later in life.

The approach for creating the book was to motivate children in a subtle, engaging, fun,

and colorful way to want to be involved in food preparation and to become interested in nutrition

at a young age. The book is made to improve health literacy in children. To ensure that the

content will be beneficial and understandable to this target audience, all physiological and

nutritional material in the book was presented in a short and simple manner. Literature has

pointed out that children in the United States eat less vegetables and fruit than children overseas

(France, Romania) do; thus fruit and vegetable consumption was identified as an important topic

to include in the book. Recipes for the book were researched, chosen and modified based on

31
nutritional value, short preparation time or easiness of preparation, availability of ingredients and

eating preferences of children. Effort was also made to choose recipes with low amounts of

added sugar, low or no refined carbohydrates, and high fiber content.

The book includes resources that may promote fruit and vegetables intake as well as

consumption of whole grains, lean meat, healthy fats, and other nutrient dense food. Those foods

are presented in form of recipes and nutrition education paragraphs that focus on specific foods,

nutrients, or a food groups to expose children to nutrition knowledge at a young age. The book’s

story takes place over the course of 7 days. Thus, each day is accompanied by one recipe and one

nutrition education informational section.

Evaluation

This project was evaluated by an expert panel consisting of this thesis’s committee

members, Peter G. Kreysa, Ph.D.; Wendy Devine, MPH, RD; Michelle Loy, MPH, MS, RDN;

and Virginia Gray, Ph.D., RD, the graduate coordinator for the Nutritional Science major at

California State University, Long Beach.

The purpose of the expert panel was to assist with developing the content of children’s

book, provide feedback, evaluate the progress, and to assess whether previously stated goals for

this project were met by creating the project itself.

The following paragraphs will focus on feedback that was received from the expert panel

during the development of the children’s book. The experts liked the illustrations and described

them as great, colorful, and engaging. The story was also positively evaluated. There was a call

for a creative, catchy, and kid friendly title for the book. One of the experts suggested a little flair

to be added to the main girl character, a flaw for example. Experts also pointed out the

importance of not teaching children to be judgmental of others based on their thinking about

32
food. Moreover, the experts advised against using black-and-white thinking about nutrition.

Instead, they gave encouragement to promote balance and moderation in the story and to

integrate nutrition education that is gentle in its delivery. The experts also emphasized focusing

on impacts of foods that children can relate to. To encourage children to want to cook and try

new recipes, experts suggested to write what happens in the story when the children eat the

prepared healthier food and whether or not they like it. Experts wanted to see more nutrition

information included in the book. The concepts and terminology, however, may be too difficult

for younger children to understand and thus the experts suggested reworking some of the

nutrition education paragraphs. On the other hand, the experts appreciated some of the easy-to-

understand concepts like “eat the rainbow,” or “feel better soup.” They also liked the concept of

the recipes matching the chapters of the story.

The experts also provided suggestions related to the recipes and the educational section

of the book. They encouraged further researching the effects of garlic on relieving the common

cold. They suggested emphasizing the use of granola without added sugars. When protein was

discussed, the experts suggested emphasizing its benefits on growth, strength, and muscle rather

than claiming it can help with “energy.” They also suggested that the book discuss carbohydrates

and fats as well, and to provide examples of foods that contain each of these macronutrients. The

type of sugar used in the muffin recipe was suggested to be changed to a kind that is easily

accessible to families since some types of sweetener, like maple syrup and coconut sugar, tend to

be more expensive. Similarly, the experts suggested recommending frozen fruit and vegetables

along with fresh ones since they provide similar nutritional value and are often more affordable,

especially when the specific produce is not in season.

33
 Summary

The results of this project suggested that the goals of this project were met. Development

of this book was supported by literature review conducted based on current research articles and

nutrition recommendations. Apart from extensive research, the completion of this project

included gathering and adjusting the recipes, writing nutrition education sections in a way to be

understandable to the target population, character development and story planning, creating the

illustrations, obtaining expert feedback and integrating it back into the book to strengthen its

content. It took much effort to make the book visually appealing, fun, engaging, and informative

at the same time. Seven mini chapters were written, each including a background story,

illustration, a recipe, and an educational nutrition information.

34
 CHAPTER 5

DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS

Introduction

The purpose of this directed project was to conduct a research in order to create a

children’s book that provides nutrition education information along with healthy recipes that

children can help prepare as an after-school snack or light meal. This new book teaches children

about the importance of healthier eating, balance, and moderation, especially when being

involved in sports. This way, it improves health literacy in children. In addition, this book serves

as a nutrition resource for parents of those children. The intended audience for this project and

thus the targeted readers of the book are healthy children of ages 5 to 11, both boys and girls.

Interpretation of Findings

The literature review was divided into six main topic areas. Those were: (1) the literature

overview of the health literacy in childhood; (2) the nutritional needs of children ages 5 to 11,

including the needs for active children; (3) the overview of children health status; (4) eating

habits and food preferences among children (5) overview of children books dealing with eating,

nutrition, and cooking that have been published so far; and (6) overviewed sports nutrition.

The literature revealed that health literacy is gaining a momentum nowadays, however,

only little attention is given to children’s health literacy, even though children are very likely to

transform health information into action. Fundamental development processes take place during

childhood. This development then affects health-related skills and behaviors. The problem is that

there is a lack of academic consensus on what abilities a child should possess to be able to make

its own sound health decisions (Bröder et al., 2017). According to James and Prout (2015),

children are not just passive recipients of health information, but are instead active and reflective.

35
A qualitative study by Fairbrother et al. (2016) found that children are aware that they should be

limiting their sugar consumption and increase their fruit and vegetable consumption instead.

They have gained this knowledge through school and government campaigns, mostly. Some

children, however, seemed annoyed to be preached this information in the same manner

repeatedly and would appreciate a different type of learning strategy, something that they would

actually enjoy and perceive as fun, not education. Information that was conveyed to them

visually rather than just in a written form resonated better with children. One problem that

Fairbrother et al. ran into was that some children view sugar as a source of energy and thus

demand it. Similarly, children tend to filter information using their own experience. They hear

that chocolate for example makes their teeth go bad but if their teeth remain unchanged after they

ate chocolate they will keep eating chocolate in the future, believing that it does not actually

affect their teeth. When it comes to sports, many children, boys especially, are aware that food

serves as a fuel for them. This often helps them to make healthier food choices (Fairbrother et al.,

2016).

Nutrient and adequate calorie intake during childhood is especially important since body

growth is taking place. Moreover, nutrition during this time will likely affect long-term health,

development of chronic diseases, and life expectancy (Koletzko, 2008). In the United States,

children generally do not consume enough nutrients. Fiber, vitamin D, calcium, and potassium

are the most common ones that they are lacking. On the other hand, children often overconsume

added sugars, refined carbohydrates, and calories (Hess & Slavin, 2014). Thus, a diet that is

made mostly of whole foods, limits added sugars and processed foods, and emphasizes fruits and

vegetables, since those are high in fiber, calcium, and potassium, would have positive impact on

36
children’s health and disease prevention. Physical activity or time spent outside should be

recommended as well to get a daily dose of vitamin D.

Fiber consumption is crucial for lowering the LDL cholesterol levels, which in return

helps to lower the risk of chronic disease development. This is especially important since

overweight and obesity are still major concerns in the United States. More than often, these

conditions lead to cardiovascular disease, type 2 diabetes, and other chronic health

complications. According to the CDC, 1 in 6 children in the United States is obese, and there is

high chance that obese children will grow up to become obese adults. Hence, targeting children

with health and nutrition information would be beneficial in obesity management and prevention.

People in the United States have reduced their time spent cooking (Smith et al., 2013).

This is not desirable since cooking more than 6 times per week was associated with higher fruit

and vegetable consumption (Wolfson et al., 2015). Another thing that sometimes prevents

children from eating fruits and vegetables is neophobia. To reduce this fear of trying new things,

Allirot et al. (2016) suggest to keep exposing children to novelty food, involve them in sensory

education and evaluation, and to create positive experiences with novel food. This includes

involving children in cooking. Children preferences were shown to be positively influenced by

letting them help with preparing the food. Implementing cooking skills education may thus

enhance healthier eating habits in children.

Cookbooks for children are a trend that is fast growing. There are numerous cookbooks

for children on the market, however, most of these books provide recipes that are not nutrient

dense nor are they healthy. Considering this, there is a need for creation of more children

cookbooks that will offer appealing recipes that are nutrient dense and follow the current

recommendations for healthy eating.

37
 Based on the feedback obtained from the expert panel, several changes were made to

improve the content of the children’s book. An effort was made to remove parts that may have

led to thinking judgmentally about which food is good and which food is bad. Minimizing black-

and-white thinking about nutrition was another area of improvement since thinking about food as

only being “healthy” or only being “unhealthy” leaves little room for flexibility. Flexibility is

especially important in children, as well as delivering the nutrition information gently and

without spreading much fear. Black-and-white thinking about food may promote less healthful

relationships with food. To make the information accessible to young children, nutrition

education paragraphs were revised to minimize the amount of difficult terminology. The effort

was made to promote healthy body image and size rather than mentoring children about obesity

and the risk of developing chronic illness, and discussing body weight and size. To support this,

the section about sport and physical activity was reworked to emphasize the concept of desire to

become stronger, faster, and achieve better well-being overall. The impact of foods that children

are able to relate to was added as well. Since the main boy character is an athlete, the main girl

character told him that certain foods could help him to perform well in sports.

Challenges

Challenges of developing this project included working with a relatively low number of

peer-reviewed sources focusing on children nutrition. Writing the book for an audience of

children 5 to 11 was another challenge, since the text has to be short and precise yet tell all that

needs to be expressed. The text needed to work together with the illustrations to create a whole

experience for the reader in order to keep them engaged and entertained as well as provide the

underlining education on healthy food, recipes, and habits. Another challenge was to choose

recipes that are appealing to young readers and are functional at the same time. Illustrations were

38
very challenging due to requiring extensive amount of time for planning, execution, and

completion. Along with those, artistic and graphic design skills were challenged when creating

this book.

Implications

The findings from the literature review suggest that starting nutrition education as early

as in childhood may positively enhance health literacy. Higher health literacy may consequently

positively affect fruit and vegetable consumption, improve neophobia, and encourage children to

get involved in food preparation and cooking. Being involved in the preparation of their food

will help children to start appreciating the importance of proper nutrition and help them see the

positive effects it can have on their body, energy level, performance, and most importantly,

health. This book was developed for children and their parents to educate them about healthy

food; to suggest and provide easy, healthy, tasty recipes; to promote family time and

engagement; and to appreciate friendship. This book may inspire future development of similar

books for children that will be educational yet fun to read.

The book was designed to be visually appealing to the target audience. It focuses on

giving the opportunity to create positive experiences by bringing family together and for children

to be involved in preparing their own after-school snacks and light meals. The book should

inspire readers to make small, long-term changes in their diet and lifestyle by incorporating more

whole food and home-cooked food.

Recommendations

Since this book is directed towards healthy individuals, future research and similar

projects may be needed to address populations suffering from a disease or a health condition. To

build up on this project, more books with the same characters and similar concept could be

39
created. Those books would each focus on a different topic or area of nutrition. For example, a

breakfast book, lunch box book, vegetarian book, gluten-free book, lactose-free book, or books

featuring ethnic food such as Mexican or Asian cuisine could all be created in the future. To get

more feedback, parents and children who have read the book could be contacted to ask for their

personal opinion on the content of the book. This would provide data that could be used to

develop a better understanding of the needs and desires of the target population and their parents.

Summary

The objectives were satisfied by the end of this project. Literature review was conducted

to gather current available research on children’s nutrition and nutrition education. The literature

revealed that there is a need to start educating children about nutrition at a young age. There

were several challenges when completing this project including finding research that studies

children, creating the illustrations, and writing the content of the book in way that would be

understandable to children readers. Phrases that would encourage black-and-white thinking about

nutrition were modified to promote balance and gentle delivery of nutrition education. Emphasis

was also given on not teaching children to be judgmental of others and their nutritional choices.

The book encourages children to try new foods and recipes and to value friends and family while

also educating them about nutrition. Projects in the future may use the same concept to create

books for children with dietary restrictions, preferences, and/or for different ethnicities.

40
APPENDICES

41
 APPENDIX A

RECOMMENDED DAILY INTAKES

42
TABLE 1. Weekly Vegetable Subgroup Recommended Consumption for Children

Red + Beans +
Group Dark green Starchy Other
Orange Peas
Children 4 –
1c 3c ½c 3½c 2½c
8
Girls 9 – 13 1½c 4c 1c 4c 3½c
Boys 9 – 13 1½c 5½c 1½c 5c 4c
Source: U.S. Department of Agriculture Center for Nutrition Policy & Promotion (2017).

TABLE 2. Recommended Daily Fruit Intake for Children

Group Fruit amount

Children 4 – 8 1 c to 1 ½ c
Girls 9 – 13 1½c
Boys 9 – 13 1½c
Source: U.S. Department of Agriculture Center for Nutrition Policy & Promotion (2017).

TABLE 3. Recommended Daily Dairy Intake for Children

Group Dairy amount

Children 4 – 8 2½c
Boys & Girls 9 – 13 3c
Source: U.S. Department of Agriculture Center for Nutrition Policy & Promotion (2017).

TABLE 4. Recommended Daily Protein Intake for Children

Group Protein amount

Children 4 – 8 4 ounce equivalents
Boys & Girls 9 – 13 5 ounce equivalent
Source: U.S. Department of Agriculture Center for Nutrition Policy & Promotion (2017).

43
 APPENDIX B

CHILDREN’S BOOK

44
 Toothsome Time with Felix and Sophia

By Barbora Jirickova

Main characters:

Girl – Sophia
Boy – Felix
Dog –Kaipo, the French bulldog

45
The story (text for children five to 11 years old):

46
47
 Little Friends
Felix and Sophia live across the street from each other. Sophia loves ballet and one day she
wants to become a beautiful dancer. Felix really enjoys soccer and playing with his dog Kaipo.
Kaipo is always ready to have some fun.
Every day after school, Sophia and Felix get together. They get along very well, until it
comes to food... Felix loves all things fried. And pizza. And donuts. He scrunches his nose every
time Sophia starts talking about what she is going to cook that day. None of it sounds appetizing
to Felix. Sophia is very interested in staying healthy. She frowns. She wishes her friend Felix
could enjoy with her the fresh, colorful foods she loves!
“This food will not help you perform well in soccer!” she argues.

48
 Sunday in the Country
On Sunday, Sophia invites Felix to come along to visit her grandma.
“Look Kaipo, do you enjoy being in the country?” she smiles and pets the French bulldog.
The kitchen smells wonderful! Grandma is baking an oatmeal cake.
“There is no way that this cake is good for you!” says Felix. “It smells so yummy. I will try
it, but if it’s not good, I will only eat this homemade jam that we put in the middle.”
Soon after, all of them are enjoying the cake.
“How do you like cake made with oats, Felix?” asks Sophia.
“You must be playing some tricks on me!” Felix did not believe that this cake could
be delicious and be healthier, full of vitamins, at the same time.

49
 Homework on Monday
Felix and Sophia received a lot of homework. Felix’s mom watches them struggle with
reading and writing.
“Let me make you a snack!” she offers.
“I love nutritious food!” says Sophia. “Can you make something that will nourish our brains
so we are ready for all this homework?”
“Stop being annoying!” Felix gets even more frustrated.
Sophia sticks her tongue out at him. She does not want to confess that she actually loves
treats, too!
His mom smiles and starts preparing sandwiches with egg and avocado.
Felix is hesitant to see all the green stuff in his sandwich but bites into it anyway. His eyes
suddenly go wide. “Mom, since when do green things taste good?” he asks, completely
surprised.
A smile of victory appears on Sophia’s face. She knew that he would like these brain.

50
 Biking on Tuesday
On Tuesday, the two friends visit Sophia’s uncle. It is a beautiful day outside! Perfect for a
bike ride. They are having such a good time, that they forget what time it is and come back late.
Oh no! Sophia’s aunt is not happy at all.
“Do you even know what the clock looks like?” she frowns.
“We do, and we will even show you!” says Sophia’s uncle.
He guides Sophia and Felix and together they create something wonderful: a plate full of
colorful vegetables and cooked egg that looks like a clock!
Sophia nudges her friend. “Isn’t this fun? We get to eat them now!”
“Green stuff may have been good yesterday, but there is no way I’m putting this purple thing
in my mouth!” he crosses his arms on his chest. But Sophia starts chewing on a piece of beetroot
and Felix gets curious. He picks up a piece and once again, he is in disbelief. He enjoys eating
this dark purple crunchy vegetable!

51
 Grilling on Wednesday
Sophia has a ballet class. Felix is practicing soccer for his upcoming match. He looks so tired
when he comes to visit Sophia at their backyard.
“Felix, did you know that some food can help you run faster? And kick the ball harder
without you getting tired easily?” Sophia asks.
“What does food have to do with sports?” Felix shrugs his shoulders.
“Everything!” Sophia replies. “Food is like building blocks for your body. Carbs like fruits,
veggies, and whole grains give you energy. Fats like olive oil and avocado give you energy as
well. And protein like meat, beans, eggs, and dairy make you strong.”
Sophia’s dad has started the grill. With Sophia’s instructions, Felix helps them to prepare
cheeseburger with veggies on a stick. He is in disbelief when he tries them later and finds out
how good they are! And yet again, Sophia claims these are better for your health than regular
cheeseburgers would be! Unbelievable…

52
 Sick Thursday
Felix’s big game is getting closer. But such tragedy! He came from school feeling sick! Even
Kaipo is sad.
“Don’t worry little brother,” says Felix’s big sister. She smiles and shows Sophia a head of
garlic. “Will you help me make a feel better soup, Sophia?” she asks.
Sophia takes a look at her friend and then nods her head. She is a little unsure though. Will
she be able to take care of him? She is only used to taking care of herself!
Felix is also skeptical. How can a soup get him well for his game? He feels sad.
Once the soup is ready, Sophia helps Felix to sit up and feeds him warm liquid and
vegetables. With every spoonful, Felix can feel his body relaxing more and more. He feels
better! He smiles at Sophia.
“If you eat garlic and veggies repeatedly, little brother, you will get sick less often,” his sister
informs him.

53
 Parfait Friday
Felix has to admit, that the garlic soup really made him feel better! Sophia and her friend
want to prove to him that food can do even more. They want to make a snack that will be healthy
for their bodies and yummy for their tummies.
Felix does not understand. “What is a granola parfait? A French joke?”
“A simple formula for a big result,” Sophie winks before she reaches up. She is surprised.
Again, she is taking care of someone and it makes her feel good! What is happening to her?
Fruit, yogurt, and granola is her favorite snack. She likes the name, too. Parfait. She watches
Felix’s reaction when he takes a first spoon. He swallows, with pleasure in his eyes. Before you
know it, Felix’s glass is empty. He liked it that much!

54
 Saturday Baking
On Saturday morning, Sophia is staying home with her mom, watching Kaipo. Felix is at the
soccer field, practicing before his game. Mom is mixing ingredients in a big bowl. They are
making muffins. It will be a surprise refreshment for Felix and his team.
“Sophia, can you hand me the zucchini?” mom asks, looking over her shoulder.
“Mom, Kaipo stole it!” Sophia screams.
Kaipo bites into the green vegetable and drops it with disapproval. How can you put this in a
muffin? He must be thinking. “We will pair the zucchini with applesauce, chocolate, and other
ingredients,” says mom. “You will see how moist and enjoyable there muffins will be.”

55
 Soccer Game
Later that day, Sophia and her friends go cheer for Felix and his team. He was happy to see
her before the game started. He enjoyed a muffin, not even knowing that it contained vegetables!
“Let’s go Felix!” Sophia is so nervous that she starts biting her nails. “Come on!” Fans cheer
as Felix approaches the net. He is focused. Getting ready to kick the ball…
“Goooooaaaaaal!” fans are screaming in excitement as Felix overcomes the goalkeeper and
scores. They won the game! Felix cannot believe it. He is so happy! So relieved.
Sophia comes running at him and gives him a big hug. “See, you did it!” she says.
“Thanks to all the yummy foods I was eating with your help, Sophia!” Felix responds.
Sophia blushes. “I enjoyed it. And I am sorry that I was annoying.”
“And I believe now that healthy food can make you feel amazing! And help you do better in
sports,” Felix smiles in happiness. Let’s find more healthy treats, he thinks to himself.

56
The nutrition information and the recipes:

57
 Sunday: Oats are a cereal grain that has many benefits for you. It is a whole

grain so it is going to keep your heart strong and healthy. It contains many vitamins

and minerals, like B vitamins, iron, and magnesium. It also contains a lot of fiber

that will help your digestive system and your heart. Eating food made from oats will

also protect the body’s cells from harm because oats contain compounds called

antioxidants. Do not be afraid to eat oats every day!

58
 Oats, raisin, walnut bread
Ingredients:
• 1 c milk
• 2 c rolled oats
• 1/3 c packed brown sugar
• 1 mashed ripe banana
• 2 eggs
• 1 c flour
• 1 ½ tsp baking powder
• 2 tsp vanilla extract
• ½ c shredded apple
• ¼ c raisins
• ¼ c walnuts
• 1 jar fruit preserve
Method:
1) Combine milk and oats and let soak for two
hours
2) In a separate bowl, mix together the flour,
baking powder, and sugar.
3) Add eggs, mashed banana, and vanilla to
soaked oats and mix well. Add apple, raisins,
and walnuts.
4) Add the dry ingredients and mix together, be
careful not to overmix.
5) Pour the batter in a greased cake pan.
6) Cook in 350°F oven until the top is golden
brown and toothpick inserted comes out clean.
7) Let cool. Cut the cake lengthwise in half, spread
the bottom part with fruit preserve and cover
with the top part.
59
 Monday: Your brain needs good nourishment too! A little marvel called

choline found in egg yolks will help your brain work better. It will help you focus,

think, and learn. Avocados are another friends of yours that will help you learn and

think better. They contain a special coloring that helps you be more focused. Eat

some omega-3 fats too to nourish your brain and think better. Walnuts are especially

rich source of those important fats! Omega-3 fats also keep your heart healthy.

60
 Brain-boost sandwiches

Ingredients for pesto: Method:

• 1 c of spinach, packed 1) Place everything in a food processor and

• 2 ½ tbsp olive oil blend until smooth
• Juice from ½ lemon (careful, no 2) If you end up with leftover pesto, store it in
seeds) an airtight glass jar.
• ½ c walnuts
• ¼ tsp sea salt
• ½ tsp onion powder
Ingredients for sandwiches: Method:

• 1 avocado 1) Heat olive oil in a pan and cook the eggs

• 8 slices of whole-grain or sprouted over easy. Sprinkle them with salt and
bread, bun, roll or ciabatta pepper.
• 4 eggs 2) Toast your bread.
• 1 tsp olive oil 3) Spread one bread with pesto. Spread the
• Spinach or lettuce second bread with avocado slices and mash
• Salt and pepper them slightly with a fork.
4) Sprinkle avocado with salt and pepper and
lay an egg over it.
5) Lay lettuce over the egg and cover with the
pesto smeared bread.

61
 Tuesday: Did you know that there are 402 vegetable kinds grown on our planet?

That is so many to try! Why does everyone keep telling you to eat vegetables? Because

they just are the best thing you can eat! They can be fun too. They are full of vitamins and

minerals that help you grow. They have fiber, a very important thing. We cannot digest it

but it works like a brush to clean your intestines to keep them healthy. Veggies also protect

you against sickness. They help you see. They satisfy hunger. You will not believe how

wonderful you will feel once you discover the power of tackling and eating your vegetables

62
 Colorful edible clock

Ingredients: Method:

For the vinaigrette: 1) Spread the baby greens on a big serving plate
• Juice of ½ lemon 2) Slice the cucumber, tomatoes and eggs to get
• 1 small clove of garlic, crushed circles.
• 1 tsp Dijon mustard 3) Arrange the vegetables on top of the lettuce.
• 2 tbsp olive oil 4) Whisk the dressing ingredients together in a
• 1 tbsp honey small bowl and pour over the vegetables.
• ¼ tsp salt 5) Arrange the 12 best egg slices on top of the
For the plate: vegetables to resemble a clock (each slice
represents one hour).
• Mixed baby greens
6) Thinly slice the beetroot. Cut the slices into
• Hard boiled eggs
thin sticks. Use the beetroot sticks to make
• Cucumber
roman numbers on top of each egg slice and
• tomatoes to make the clocks arms.
• beetroot

63
 Wednesday: Have you ever wondered what your food is made out of? It is made

out of tiny elements called carbs, fats, and protein.

Carbs are in veggies, fruit, bread, rice, pasta, potatoes, and cereal. Children need to

eat a lot of carbs. They give you energy for your everyday activities, like sports and doing

homework. They also give you energy to grow.

Fats are another good source of energy for the human body. You can find them in

peanut butter, nuts, seeds, olive oil, avocado, tuna and salmon. They help you feel full and

satisfied. They keep your skin and hair healthy. And they also help you stay warm.

Proteins are in chicken, beef, fish, eggs, tofu, beans, and lentils. They help you

grow because they help build muscles and bones. They help you fight off germs. They also

help your body carry around oxygen.

64
 Cheeseburger on a stick

Ingredients: Method:

For meatballs: 1. Sautee onion in butter till

• 1 lb lean ground beef
• ½ c cooked black beans
• ¼ onion, diced
• 2 cloves of garlic, minced
• 1 tsp butter
• ½ c oat flour (ground up oats) 3.
• 1 egg
• ¼ c milk
• 1/8 c parmesan cheese
• ½ tsp salt
• ¼ tsp black pepper
• 1 tsp oregano
For the assembly:
• Cheese, cherry or grape
tomatoes, pickles, lettuce, whole
wheat or sprouted bread, mustard
translucent. Add garlic and
cook for one more minute.
2. In a bowl, mix together
egg, beans, milk, parmesan,
oat flour, and oregano.
Add ground meat and stir
well.
4. Form mixture into balls
and cook them on an
aluminum pan on a grill or
in the oven until golden
brown.
5. Prepare the rest of the ingredients by cutting them to
bite size pieces.
6. Assemble the kabobs by sliding the ingredients onto
the skewers in any order you like!

65
 Thursday: Throughout history, garlic has not only been used in the kitchen, but in

medicine as well. We know that all the biggest old civilizations, including the Egyptians,

Babylonians, Greeks, Romans, and the Chinese were using it. Garlic has the power to help

your body fight germs. Eating garlic often will make your immunity stronger and you will be

less likely to get a flu.

66
 The feel good soup

Ingredients: Method:

• 4 cloves Garlic 1) Peel the carrots, potato, onion and garlic.

• ½ Onion 2) Cut the potato and carrots into small cubes. Slice the
• 2 Carrots mushrooms.
• 1 big Potato 3) In a pot, add bone broth and bring to a boil. Add small onion,
• 1 c brown potato, carrots, and mushrooms and simmer until the
mushrooms vegetables are tender.
• 5 c Bone broth 4) In a small saucepan, heat the butter until melted and add flour,
whisking vigorously. Cook for a minute until a light gold
• 1 tbsp. Butter
paste forms. This paste is called a roux.
• 1 ½ tbsp Flour
5) Pour some of the broth from soup over your roux while
• Salt and pepper
whisking. When there are no lumps, pour the mixture back in
• Fresh parsley your soup.
6) Cook the soup on low until it thickens, about 15 minutes.
Season with salt, pepper and chopped parsley and serve hot!

67
 Friday: Fruit comes in many colors and shapes. Fruit is full of vitamins and minerals

and other tiny components that work together to keep your body strong, healthy, and full

of energy. They help your body to fight off any germs and other invaders. To use all the

wonderful benefits of fruit, choose to eat it fresh or frozen fruit on most occasions. Have

fun! Experiment, try new kinds and new ways to eat them. Eat all the colors. Eat the

rainbow!

68
 Fruity granola parfait

Ingredients: Method:

• 1 c Granola without added sugar
• 2 c Plain Greek yogurt
• 1 tbsp Honey
• ½ tsp Cinnamon
• 4 c Fruit (blueberries, raspberries,
strawberries, banana, pineapple,
nectarines, grapes, pear, etc.)
1) Cut the big fruit into small pieces.
2) Stir cinnamon and honey into the yogurt
3) Layer yogurt in the bottom of your glasses,
followed by a layer of granola and a layer
of fruit.
4) Repeat until you reach the top of your
glass. You can garnish with a mint leaf and
enjoy!

69
 Saturday: Food can do so much more than make you full and satisfied! Eating

colorful fruits and veggies, tasty whole grains, crunchy nuts and your favorite proteins

along with some treats from time to time is the best way to have lots of energy, to grow

strong, and to be healthy now and in the future. To feel awesome, you also have to be

physically active. Sports, exercise, and fun activities like jumping rope, swimming, running

around with friends, walking your dog, and playing outdoor games need to be part of your

life every day. Give it a try and you will see that you will enjoy it and have so much fun!

Overall, you will be healthier, stronger, faster, and happier when you get to be active every

day. You will feel like a superhero!

70
 Sport-power chocolate zucchini muffins
Ingredients:
• 1 c whole wheat flour
• ½ c unsweetened cocoa
powder
• 1 ½ tsp baking powder
• ½ tsp baking soda
• ¼ tsp salt
• 2 large eggs
• ½ c plain Greek yogurt
• 1/3 c honey
• ¼ c brown sugar
• 1/3 c unsweetened applesauce
• 1 tsp vanilla extract
• 1 c grated zucchini
• ½ c chocolate chips
Method:
1) Preheat oven to 350°F. Line a muffin tin with paper
liners or grease with a cooking spray.
2) In a large bowl, combine the flour, cocoa, baking
powder, baking soda, salt, and chocolate chips.
3) In a second bowl, beat the eggs, add yogurt, honey,
sugar, applesauce, and vanilla. Squeeze some of the
water out of grated zucchini and measure 1 cup. Add
the wet ingredients into the dry ingredients and mix
gently, be careful not to overmix. Fold in the
zucchini.
4) Divide the batter equally between the 12 muffin cups
and bake for 17 – 19 minutes, or until the muffin tops
are firm to the touch and a toothpick inserted in the
center comes out clean.
71
REFERENCES

72
 REFERENCES

Alleva, J. M., Sheeran, P., Webb, T. L., Martijn, C., & Miles, E. (2015). A meta-analytic review
of stand-alone interventions to improve body image. Plos One, 10(9). doi:10.1371/
journal.pone.0139177

Allirot, X., Da Quinta, N., Chokupermal, K., & Urdaneta, E. (2016). Involving children in
cooking activities: A potential strategy for directing food choices toward novel foods
containing vegetables. Appetite, 103, 275-285.

Allport, S. (2006). The queen of fats: Why omega-3s were removed from the Western diet and
what we can do to replace them (California Studies in Food and Culture: 15). Berkeley:
University of California Press.

Arreola, R., Quintero-Fabián, S., López-Roa, R., Flores-Gutiérrez, E., Reyes-Grajeda, J.,
Carrera-Quintanar, L., & Ortuño-Sahagún, D. (2015). Immunomodulation and anti-
inflammatory effects of garlic compounds. Journal of Immunology Research, 13, 1-13.

Beattie, J., Crozier, A., & Duthie, G. (2005). Potential health benefits of berries. Current
Nutrition & Food Science, 1(1), 71-86.

Benton, J. M. (2017, April). Learning about carbohydrates. Retrieved from http://kidshealth.

org/en/kids/carb.html

Broder, J., Okan, O., Bauer, U., Bruland, D., Schlupp, S., Bollweg, T., . . . Pinheiro, P. (2017).
Health literacy in childhood and youth: A systematic review of definitions and
models. BMC Public Health, 17(1). doi: 10.1186/x12889-017-4267-y

Carroll, M., Navaneelan, T., Bryan, S., & Ogden, C. (2015). Prevalence of obesity among
children and adolescents in the United States and Canada (NCHS data brief no. 211).
Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, National Center for Health Statistics.

Centers for Disease Control and Prevention. (2014). Obesity and overweight. Retrieved from
http://www.cdc.gov/nchs/fastats/overwt.htm

Cha, E., Akazawa, M. K., Kim, K. H., Dawkins, C. R., Lerner, H. M., Umpierrez, G., & Dunbar,
S. B. (2015). Lifestyle habits and obesity progression in overweight and obese American
young adults: Lessons for promoting cardiometabolic health. Nursing & Health Sciences,
17(4), 467-475. doi:10.1111/nhs.12218

Contento, I. (2010). Nutrition education: linking research, theory, and practice (2nd ed.).
Sudbury, MA: Jones & Bartlett Learning.

Cookbook. (2000). In Oxford English Dictionary. Oxford, England: Oxford University Press.

73
Cookery. (2000). In Oxford English Dictionary. Oxford, England: Oxford University Press.

Dias, J. (2012). Nutritional quality and health benefits of vegetables: A review. Food and
Nutrition Sciences, 3 (10), 1354-1374.

Dunford, M., & Doyle, J. (2012). Nutrition for sport and exercise (2nd ed.). Belmont, CA:
Wadsworth, Cengage Learning.

The Editors of Encyclopaedia Britannica. “Cookbook.” Encyclopædia Britannica, Encyclopædia

Britannica, Inc., 27 Feb. 2015, www.britannica.com/topic/cookbook

Engler-Stringer, R. (2010). The domestic foodscapes of young low-income women in Montreal:

Cooking practices in the context of an increasingly processed food supply. Health
Education & Behavior, 37(2), 211-226. doi:10.1177/1090198109339453

Fairbrother, H., Curtis, P. & Goyder, E. (2016). Making health information meaningful:
Children's health literacy practices. SSM - Population Health, 2, 476-484.

Harris, J., Cottrell, S., Plummer, S., & Lloyd, D. (2001). Antimicrobial properties of Allium
sativum (garlic). Applied Microbiology and Biotechnology, 57(3), 282-6.

Hertzler, A. (2005). Nutrition trends during 150 years of children's cookbooks. Nutrition
Reviews, 63(10), 347-351.

Hess, J., & Slavin, J. (2014). Snacking for a cause: Nutritional insufficiencies and excesses of
U.S. children, a critical review of food consumption patterns and macronutrient and
micronutrient intake of U.S. children. Nutrients, 6(11), 4750-4759.

Gavin, M. L., (2014, October). Learning about proteins. Retrieved from http://kidshealth.org/
en/kids/protein.html?ref=search&WT.ac=msh-k-dtop-en-search-clk

Gavin, M. L., (2018, February). Learning about fats. Retrieved from http://kidshealth.org/en
/kids/fat.html?ref=search&WT.ac=msh-k-dtop-en-search-clk

Institute of Medicine. (2000). Dietary reference intakes: A report of the Subcommittees on

Interpretation and Uses of Dietary Reference Intakes and the Standing Committee on the
Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of
Medicine: Applications in dietary assessment. Washington, DC: National Academy
Press.

Johnson, E., Vishwanathan, R., Mohn, E., Haddock, J., Rasmussen, H., & Scott, T. (2015).
Avocado consumption increases neural lutein and improves cognitive function. FASEB
Journal, 29. doi: 10.1179/147683008X301450

Josling, P. (2001). Preventing the common cold with a garlic supplement: A double-blind,
placebo-controlled survey. Advances in Therapy, 18(4), 189-193.

74
Ketelaars, R. A. (2013). Norwegian cookbooks for children: Why write them and why read them?
Historical document analysis of children's cookbooks published in Norway from 1846
until the present. (Master's thesis). University of Stavanger, Stavanger, Norway.
Retrieved from https://brage.bibsys.no/xmlui/handle/11250/185189

Koletzko, B. (2008). Basic concepts in nutrition: Nutritional needs of children and adolescents.
E-SPEN, the European E-Journal of Clinical Nutrition and Metabolism, 3(4), E179-
E184.

Kreider, R., Wilborn, C., Taylor, L., Campbell, B., Almada, A., Collins, R., & Antonio, J.
(2010). ISSN exercise & sport nutrition review: Research & recommendations. Journal of
the International Society of Sports Nutrition, 7(1). doi:10.1186/1550-2783-7-7

Kremer-Sadlik, T., Morgenstern, A., Peters, C., Beaupoil, P., Caët, S., Debras, C., & Le Mené,
M. (2015). Eating fruits and vegetables. An ethnographic study of American and French
family dinners. Appetite, 89, 84-92.

La Bounty, P., Campbell, B., Wilson, J., Galvan, E., Berardi, J., Kleiner, S., & Antonio, J.
(2011). International Society of Sports Nutrition position stand: Meal frequency. Journal
of the International Society of Sports Nutrition, 8. doi:10.1186/1550-2783-8-4

Larson, N., Neumark-Sztainer, D., Laska, M. N., & Story, M. (2011). Young adults and eating
away from home: Associations with dietary intake patterns and weight status differ by
choice of restaurant. Journal of the American Dietetic Association,111(11), 1696-1703.
doi:10.1016/j.jada.2011.08.007

Laska, M. N., Hearst, M. O., Lust, K., Lytle, L. A., & Story, M. (2014). How we eat what we eat:
Identifying meal routines and practices most strongly associated with healthy and
unhealthy dietary factors among young adults. Public Health Nutrition,18(12), 2135-
2145. doi:10.1017/s1368980014002717

Laska, M. N., Larson, N. I., Neumark-Sztainer, D., & Story, M. (2012). Does involvement in
food preparation track from adolescence to young adulthood and is it associated with
better dietary quality? Findings from a 10-year longitudinal study. Public Health
Nutrition,15(07), 1150-1158. doi:10.1017/s1368980011003004

Lissiman, E., Bhasale, A. L., & Cohen, M. (2010). Garlic for the common cold. The Journal of
Perioperative Practice, 20(1). doi: 10.1002/14651858.CD006206.pub2

Macronutrient. (2015). Retrieved from the Merriam-Webster website: http://www.merriam

webster.com/medlineplus/macronutrient

Mejia‐Meza, E., Yáñez, J., Remsberg, C., Takemoto, J., Davies, N., Rasco, B., & Clary, C.
(2010). Effect of dehydration on raspberries: Polyphenol and anthocyanin retention,
antioxidant capacity, and antiadipogenic activity. Journal of Food Science, 75(1), H5-
H12.

75
Meydani, M. (2009). Potential health benefits of avenanthramides of oats. Nutrition Reviews,
67(12), 731-735.

Micronutrient. (2015). Retrieved from the Merriam-Webster website: http://www.merriam

webster .com/medlineplus/micronutrient

Miller, N. (2017). Nutrition education series for female club soccer players 14 to 18 years of
age, (Master's thesis). Retrieved from ProQuest Dissertations and Theses database.
(10254192)

National Institutes of Health (NIH). (n.d.). Nutrient recommendations: Dietary reference intakes
(DRI). Retrieved June 30, 2018, from https://ods.od.nih.gov/Health_Information/
Dietary_Reference_Intakes.aspx

Pelletier, J. E., & Laska, M. N. (2013). Campus food and beverage purchases are associated with
indicators of diet quality in college students living off campus. American Journal of
Health Promotion, 28(2), 80-87. doi:10.4278/ajhp.120705-quan-326

Reicks, M., Trofholz, A. C., Stang, J. S., & Laska, M. N. (2014). Impact of cooking and home
food preparation interventions among adults: Outcomes and implications for future
programs. Journal of Nutrition Education and Behavior, 46(4), 259-276. doi:10.1016
/j.jneb.2014.02.001

Roman, I. (2014). The psychology of nutritional behaviour and children's nutrition education.
Procedia - Social and Behavioral Sciences, 149, 819-824.

Scott, T., Rasmussen, H., Chen, O., & Johnson, E. (2017). Avocado consumption increases
macular pigment density in older adults: A randomized, controlled trial. Nutrients, 9(9).
doi:10.3390/nu9090919

Shahidi, F. (2012). Cereals and pulses – An overview. In Functional food science and technology
series (pp. 1-5). Oxford, United Kingdom: Wiley‐Blackwell.

Smith, L. P., Ng, S. W., & Popkin, B. M. (2013). Trends in US home food preparation and
consumption: Analysis of national nutrition surveys and time use studies from 1965–1966
to 2007–2008. Nutrition Journal,12(1). doi:10.1186/1475-2891-12-45

Soto Ruiz, N., Marín Fernández, B., & Aguinaga Ontoso, I. (2015). Analysis of body image
perception of university students in Navarra. Nutrición Hospitalaria, 31, 2269-2275

Strong, K. A., Parks, S. L., Anderson, E., Winett, R., & Davy, B. M. (2008). Weight gain
prevention: Identifying theory-based targets for health behavior change in young
adults. Journal of the American Dietetic Association, 108(10). doi:10.1016/j.jada.
2008.07.007

76
Tomlin, D., Clarke, S., Day, M., McKay, H., & Naylor, P. (2013). Sports drink consumption and
diet of children involved in organized sport. Journal of the International Society of Sports
Nutrition, 10. doi:10.1186/1550-2783-10-38

Uauy, R., Kurpad, A., Tano-Debrah, K., Otoo, G., Aaron, G., Toride, Y., & Ghosh, S. (2015).
Role of protein and amino acids in infant and young child nutrition: Protein and amino
acid needs and relationship with child growth. Journal of Nutritional Science and
Vitaminology, 61, (Suppl), S192-4.

U. S. Department of Agriculture. (2011). Dietary reference intakes (DRIs): Recommended

dietary allowances and adequate intake elements. Retrieved from http://www.nal.
usda.gov/fnic/DRI/DRI_Tables/RDA_AI_vitamins_elements.pdf

U.S. Department of Agriculture, Center for Nutrition Policy & Promotion. (2017, November 03).
All about the dairy group. Retrieved from https://www.choosemyplate. gov/dairy

U.S. Department of Agriculture, Center for Nutrition Policy & Promotion (2018a, January 03).
10 tips. Retrieved from https://www.choosemyplate.gov/10-tips-choose-myplate

U.S. Department of Agriculture, Center for Nutrition Policy & Promotion. (2018b, January 04).
All about the fruit group. Retrieved from https://www.choosemyplate. gov/fruit

U.S. Department of Agriculture, Center for Nutrition Policy & Promotion. (2018c, January 04).
All about the vegetable group. Retrieved from https://www.choosemyplate.gov/
vegetables

U.S. Department of Health and Human Services & U.S. Department of Agriculture. (2015).
(2015). Dietary guidelines for Americans 2015-2020. Washington, DC: U.S. Department
of Health and Human Services.

Wallace, T. (2018). A comprehensive review of eggs, choline, and lutein on cognition across the
life-span. Journal of the American College of Nutrition, 37, 1-17.

Wolfson, J. A., & Bleich, S. N. (2015). Fruit and vegetable consumption and food values:
National patterns in the United States by Supplemental Nutrition Assistance Program
eligibility and cooking frequency. Preventive Medicine, 76, 1-7. doi:10.1016/j.ypmed.
2015.03.019

Zick, C. D., Stevens, R. B., & Bryant, W. K. (2011). Time use choices and healthy body weight:
A multivariate analysis of data from the American Time Use Survey. International
Journal of Behavioral Nutrition and Physical Activity, 8(1), 84. doi:10.1186/1479-5868-
8-84

77