Why Caring Children Eat More Fruits and Vegetables

Children who engage in more helping, sharing, and caring behaviors early in life are slightly more likely to consistently eat more fruits and vegetables by late adolescence. A longitudinal analysis of 6,265 participants in the UK Millennium Cohort Study found that each +1 SD increase in prosociality scores at age 5 was associated with a +14% greater likelihood of maintaining (at both age 14 and age 17) ≥2 servings of fruit and ≥2 servings of vegetables per day (PR=1.14; 95% CI 1.02–1.27). Associations of similar magnitude were observed for prosociality scores at age 7 and 11. The study was published in the American Journal of Preventive Medicine.

Background

Teenagers rarely consistently stick to “fruits and vegetables every day,” and eating habits formed in youth then “drag” into adulthood. Therefore, it is important to look for early, modifiable factors that help maintain a healthy diet not just once, but year after year.

• Prosociality as a resource. Helping-sharing-caring behaviors in childhood are associated with stronger social connections, better mood, self-efficacy, and stress resilience. These psychological and social resources may support self-regulation and healthy food choices, especially as adolescents gain greater decision-making autonomy.

Gaps in knowledge

Previously, the relationship between prosociality and healthy habits was often studied cross-sectionally (at the same age) and without checking whether the effect persists throughout adolescence. Rarely were the following considered:

• the trajectory of prosociality in different age windows (5, 7, 11 years);
• possible reverse causality (that children who were better nourished initially might appear more “obedient”/prosocial);
• sustainable goal achievement in two directions at once (both fruits and vegetables) at two points - at 14 and 17 years old.

Why this particular cohort and methods

Millennium Cohort Study (UK) provides:

• large nationally representative sample, repeated measurements from ages 5 to 17;
• validated SDQ prosociality subscale (parent report);
• the ability to set a hard outcome: “maintained ≥2 servings of fruits and ≥2 servings of vegetables daily at both ages 14 and 17”;
• stepwise adjustment for important confounding factors (gender, demographics, emotional problems, verbal ability) and accounting for early fruit consumption (at 5 years) to reduce reverse causality;
• application of Poisson regression with calculation of prevalence ratios (PR), which are appropriate for a non-rare outcome.

Hypothesis and novelty

Authors' hypothesis: Higher prosociality in childhood predicts sustained (rather than ad hoc) adherence to fruit and vegetable recommendations in late adolescence. The novelty is the focus on long-term stability of behavior, comparison of the effects of prosociality measured at different ages, and careful consideration of potential confounders and early eating habits.

The idea is simple but practical: if “kindness and cooperation” in primary schools is not only about relationships but also about the sustainability of healthy habits, then schools and families gain an additional point of application – by developing prosociality, we potentially strengthen healthy eating in adolescence.

What did they do?

• Cohort: UK national sample, children born 2000–2002; analyses include those who reached age 17 and had dietary data at 14 and 17 years (N=6,265).
• Prosociality. Parental rating of the Strengths and Difficulties Questionnaire subtest (5 items: “polite/caring,” “shares,” “helps when someone is upset/hurt,” “kind,” “offers help”). Score 0–10, standardized across models.
• Nutrition. Self-reported by adolescents at 14 and 17 years: frequency of consumption of ≥2 servings of fruits and ≥2 servings of vegetables per day.
  • A serving of fruit is a whole fruit or ~80 g of sliced fruit (juices are excluded).
  • A serving of vegetables is ~3 heaping tablespoons of boiled vegetables, a handful of raw vegetables, or a small bowl of salad (potatoes are excluded).
• Analytics. Poisson regressions with stepwise correction:
  1. gender; 2) demographics (ethnicity, income, parental education, marital status); 3) child's emotional problems and verbal abilities; 4) early fruit consumption at 5 years (to reduce the risk of reverse causality).
• Additionally, we tested associations separately for ages 14 and 17; we repeated the analysis using prosociality at ages 7 and 11.

Key Results

• A consistent 'healthy' pattern is rare: only 11.8% maintained target levels of fruit and vegetables at both 14 and 17 years.
• Main effect: more prosociality at age 5 → higher chance of maintaining a healthy diet by age 17 (connections at age 14 are weaker and often zero).
• Comparable at 7 and 11 years: linear trends PR≈1.12 (7 years) and PR≈1.13 (11 years) at +1 SD.
• Across exposure quartiles, the “kindest” (upper quartile) had a significantly higher chance of sustained healthy consumption than the “lowest”, even after full adjustment.
• Fruits and vegetables separately: in fully adjusted models, the effects were weakened and often lost significance - it was the combined target (both fruits and vegetables) that held up better.

How can this be explained?

The authors discuss a “resource” model: prosociality strengthens social connections, increases self-efficacy, mood, and a sense of competence—all of which help teens maintain healthy habits as they become more independent in their eating habits.

Limitations (important to remember)

• Measures: Diet—one question; prosociality—parent report (outside-home behavior may be elusive). Subscale reliability is moderate (α≈0.65–0.68).
• Confounders: Parenting style and family atmosphere may not have been fully taken into account.
• Generalizability: Children born in the UK in the early 2000s; generalizability to other countries and cohorts requires testing.
• Associations, not causation. This is an observational study, RCTs are needed to infer "impact".

What does this mean in practice?

• Schools and communities. Programs that promote cooperation and caring (cooperative learning, mentoring, service-learning/volunteering) can have a combined effect: a better climate, greater prosociality, and more sustainable healthy habits. In some studies, such interventions have already been linked to improved behavioral and even cardiometabolic indicators in adolescents.
• For parents. Prizes, routines, and “visible” behavior patterns work: cooking together, “a rainbow on the plate,” available chopped vegetables/fruits at home, praise for helping others and for “contributing to the family” — these are all about the same self-regulation skills.
• For health care workers and municipalities: When developing healthy eating programs for young people, it’s worth investing not only in food information, but also in the social-emotional skills (SEL) that make that knowledge stick in real life.

What's next?

Randomized and quasi-experimental studies are needed that directly test: improved prosociality in elementary school → better retention of healthy eating in high school and beyond. More precise dietary measures (diaries/24-hour surveys) and multidimensional prosociality scales (empathy, altruism, cooperation - separately) are desirable.

Conclusion

“Good character” in childhood is not only about relationships. It seems to help maintain healthy eating habits when a teenager has more freedom. Prosociality is a promising “point of application” for schools and families if the goal is not a short-term campaign, but a long-term diet with vegetables and fruits.