Veggies4myHeart digital game: an educational tool to promote vegetable consumption in preschool children - a multicentre experimental study.

Background: Vegetable consumption as part of a balanced and diversified dietary pattern is associated with a lower risk of cardiovascular disease, cancer, and all-cause mortality. Even though the scientific evidence for these benefits is strong, the consumption of vegetables remains far below recommendations, especially in early childhood. Despite existing literature, the evidence on how to increase vegetable consumption in preschool children remains limited and the development and validation of new strategies should be pursued in varied contexts. The study presented herein aimed to compare the impact of educational sessions based on the serious game Veggies4myHeart and repeated exposure to vegetables on preschool children's willingness to taste them and also their nutrition knowledge, measured at baseline and post-intervention, in Portuguese and Swiss preschool children.

Methods: The intervention was carried out in preschools with 39 Portuguese and 45 Swiss children, from 3 to 6 years old, in their preschools, between May 2019 and February 2021. Children participated in weekly 20-minute educational sessions for 5 weeks, delivered by trained nutritionists and incorporating the Veggies4myHeart digital game. Willingness to taste was assessed by offering the five raw vegetables in standard portions and recording whether each child tasted them at baseline, throughout the intervention, and post-intervention. Nutrition knowledge was assessed using three questionnaires applied before and after the intervention. Data were analysed using IBM SPSS software and statistical significance was set at p-value < 0.05.

Results: Comparing the results between the two countries post-intervention, statistically significant differences were found in the willingness to taste lettuce, carrot, and red cabbage, with Portuguese children showing more willingness to taste these vegetables than Swiss children (p < 0,05). Improvements in nutrition knowledge, from baseline to post-intervention, were observed in both countries (p < 0,001), but without statistically significant differences between countries (p = 0.114).

Conclusions: Despite differences in context and eating habits of Portuguese and Swiss children, the intervention with the Veggies4myHeart digital game increased preschoolers' willingness to taste vegetables, supporting the value of repeated exposure combined with digital tools. Improvement in nutrition knowledge further reinforces the potential of serious games as comprehensive educational strategies for promoting healthy habits in young children.