Fruits, as indispensable components of a healthy diet, offer numerous benefits throughout life, including gastrointestinal health protection, weight management, reduced risk of cardiovascular and metabolic diseases, defense against colorectal and lung cancers, enhanced psychological well-being, and increased bone mineral density in children and adults (1, 2). Global Burden of Disease Study 2019 suggested that dietary risk factors, especially high intake of sodium and low intake of whole grains and fruits were leading dietary risks for deaths and disability-adjusted life-years (DALYs) from non-communicable diseases (NCDs) worldwide (3). Globally, fruit consumption is far below the recommended levels (4–7). The Global School-Based Student Health Survey (GSHS) in 2019 reported that 10–30% of school-age students in approximately half of the countries did not consume any fruit per day (6). In China, less than 10% of children aged 2–19 consumed adequate fruit, with typical dietary intake being about one-third to one-sixth of recommended levels (7). Understanding the individual and environmental factors limiting fruit consumption, particularly in children, is crucial, as eating habits established in youth often persist into adulthood (8).

Actually, children’s food choices are complex outcomes influenced by individual characteristics (genetic, early-life, biological, demographic), cognition, emotion, and environmental factors ranging from the most proximal family influences to distal policy impacts (8–12). Food literacy, a key skill for understanding and making informed food decisions, is especially important at the individual level (13, 14). For instance, the Seoul Food Survey 2021 showed that the group with the highest quartile of food literacy scores was 1.83 times more likely to consume adequate servings of fruits compared to the lowest quartile group (15). However, Cochrane’s meta-analysis of 15 trials indicates the uncertainty of parent or child nutrition education interventions in effectively increasing fruit and vegetable consumption in children under five (16).

In terms of environmental factors, the family unit plays a crucial role in shaping children’s eating habits. Parents and caregivers are instrumental in planning and preparing family meals and act as role models, influencing their children’s eating behaviors through education and feeding practices (17–19). Systematic reviews have highlighted strong correlations between food availability, parental modeling, and children’s fruit consumption (18, 20). Feeding patterns adopted by caregivers, especially those that are encouraging and well-regulated, have been associated with higher fruit intake in children. Conversely, instrumental and/or emotional feeding patterns often correlate with inadequate fruit consumption (21–23). Grandparents typically tend to be more permissive or indulgent, whereas parents are more likely to use gentle persuasion or rewards (21). However, some studies have challenged these findings, suggesting that family interventions have a lesser impact on children’s fruit consumption (12). Additionally, the Cochrane meta-analysis indicates that there is insufficient evidence to firmly conclude that caregiver involvement significantly improves children’s dietary habits (22).

Overall, fruit consumption is influenced by multiple factors that interact with each other, meaning they cannot be considered in isolation. Previous studies focusing on determining factors of children’s fruit consumption often examined individual elements, potentially leading to an incomplete understanding of the true impact of each factor. Additionally, only a few studies have specifically focused on the Chinese population. Cultural differences in parent–child relationships may affect these findings, thus limiting their applicability beyond the studied demographic. Furthermore, there is a lack of consistency in measuring both individual and environmental factors. As fruit consumption patterns can differ from those of vegetables, it is important to study them independently. This study aims to explore the effects of both individual and family environmental factors on fruit consumption among primary and secondary students in Beijing, China, to provide scientific evidences to promote fruit consumption.

A cross-sectional investigation of students in grade 3–12 in Beijing, China, revealed less than two thirds of them consumed fruit daily. This frequency of fruit consumption was found to be associated with various individual and family factors. Children with higher levels of food and nutrition literacy and a healthier family food environment were more likely to consume fruit regularly. It was worth noting that boys, who were in higher grades, had caregivers with lower levels of education and lower household incomes, should be targeted for interventions to promote their fruit intake.

Eating fruit offers significant health benefits for children and adolescents, yet global intake levels are generally low (35, 36). The China Nutrition and Health Survey (CNHS) from 2010 to 2012 showed that only 40.8% of children aged 6–17 consumed fruit daily, and 67.5% did not meet the recommended intake of 150 g (37). Fruit consumption was notably higher in urban than rural areas, with 57.2–59.0% of children in metropolitan cities eating fruit daily (37), aligning with this study’s finding of 62.5% daily consumption among children in Beijing. The Health Behaviour in School-aged Children survey (HBSC), conducted every 4 years since 1986 under the WHO Regional Office for Europe, also informed this study’s fruit consumption assessment method (26). Considering the recall errors of children and adolescents, the Food Frequency Questionnaire (FFQ) was administrated for the food intakes during the past week, despite the potential bias associated with this time frame. The HBSC data indicated a general increase in daily fruit consumption among adolescents from 2002 to 2018 in Western European countries. Overall, daily consumption remained low at 36.4%, but was higher among girls (39.9% vs. 32.7% among boys), younger adolescents (42.1% in 11-year-olds vs. 35.4% in 13-year-olds and 31.3% in 15-year-olds), and in the high Family Affluence Scale (FAS) group (42.6% vs. 36.1% in the medium and 31.7% in the low FAS groups) (35). This study observed a similar trend in children’s fruit consumption, with lower rates among boys, older children, and those from lower socio-economic backgrounds. The UK National Diet and Nutrition Survey suggested a decline in fruit intake starting from the age of 7 years, reaching the lowest level during adolescence; by 17 years, boys consumed approximately 0.93 fewer fruit portions than at the age of 2 years (38). In this study, senior high school students had the lowest frequency of fruit consumption compared to primary students (48.6% vs. 71.2%, OR = 0.384). As children age, the decreased family influence on eating behaviors and the increased autonomy in food selection may account for the decrease in fruit consumption (39). However, interestingly, vegetable consumption remains relatively stable throughout childhood and adolescence, despite the decline in fruit intake (37). This stark contrast between fruit and vegetable consumption may stem from the fact that vegetables are often served as part of the main meal, making them less prone to being skipped or avoided compared to fruit. Current evidence does not strongly indicate a resurgence in fruit consumption during early adulthood. Otherwise, the girls and lower graders often had higher food and nutrition literacy (13), which was positively correlated with fruit consumption. Therefore, initiatives aimed at promoting increased fruit intake should carefully consider these observed trends related to age, gender, and socio-economic disparities.

Improving dietary habits requires individuals to possess food-related skills and abilities and a comprehension of the social context. A systematic review showed that food literacy may play a crucial role in shaping adolescent’s dietary intake (14). This study employed a recognized and validated assessment instrument of food and nutrition literacy to explore its correlation with children’s fruit consumption. The results revealed that 11.7% of the children were nutritionally literate, which was strongly correlated with daily fruit consumption (OR = 2.438, 95%CI: 2.072–2.868); as the frequency of fruit consumption increased, the food and nutrition literacy score increased significantly (p < 0.05). Other studies arrived at similar conclusions, demonstrating that better cooking and food skills were associated with healthier eating behaviors and greater fruit consumption for boys and girls (15, 40). These findings underscore the importance of enhancing food and nutrition literacy among children, and public health interventions should focus on improving food and nutrition-related knowledge and skills to enhance child’s fruit consumption. Nevertheless, studies have shown that nutrition education can improve food and nutrition literacy but has no significant impact on fruit and other foods consumption (16, 41). In reality, food consumption is influenced by individual and environmental factors, which can be better understood through a socio-ecological model (42).

The family is the most immediate environment influencing a child’s food intake, encompassing home food accessibility, family meals, role modeling, and feeding patterns. This study employed a validated instrument to systematically assess the family food environment’s impact on children’s fruit consumption. The results indicated a significant positive association between children’s daily fruit consumption and their family food environment (OR = 1.507, 95%CI: 1.363–1.667). Children from families with easy access to healthy foods, encouragement-based feeding patterns, healthy food rules, positive meal practices, and caregivers with higher food literacy were more likely to consume fruit (p < 0.05). Similar findings have been observed in other studies, where adolescents from families not receiving supplemental food assistance, and those whose parents/caregivers reported higher fruit consumption, availability, encouragement, and set rules for fruit consumption, tended to eat more fruits (17–22, 43). Parental modeling and active guidance have been identified as strong predictors of healthy food consumption. In contrast, pressure to eat and restrictive feeding practices may undermine children’s autonomous motivation and self-regulation in eating (23, 43–45). In China, parents often pressure children to eat more to ensure adequate nutrient intake, driven by their psychological needs, leading to anxiety if children consume less than expected (46). Behavioral theory suggests that criticism or punishment during meals can instill a negative attitude towards eating in children, potentially leading to eating disorders. However, another study offers a contrasting view, indicating that children with authoritative and permissive fathers, as well as girls with authoritative mothers at ages 4–5, are more likely to consume fruits in later years (47).

One limitation of this study is the chosen methodology for assessing food consumption, particularly in relation to its suitability for younger participants and its potential time frame bias. As younger children often struggle to accurately recall their dietary intake, alternative assessment methods [such as including parents as proxy respondents (48)] should be considered, particularly for younger participants, to ensure the accuracy and validity of dietary data in research studies. Existing studies often have limitations, primarily due to their cross-sectional design, which restricts the ability to generalize the results. Additionally, the methods of assessing environmental factors and food consumption pose further challenges. While this study comprehensively examined individual and environmental factors influencing fruit consumption, it did not take into account aspects of the food system, such as sensory and physical properties, variety, visibility, taste, satiety value, preparation methods, and time costs. Moreover, other socio-ecological environmental factors, including schools, peers, neighborhoods, and broader macro-environmental influences, were not considered. Therefore, based on follow-up cohort design, a complex study, including individual (physiological and psychological factors, knowledge, belief and skill, and early-life food exposure) and socio-ecological food environmental factors (physical and social factors of family, peers, school, neighborhoods, food marketing, policy and international trade) would be undertaken to explore their comprehensive effects on child’s dietary patterns. Then implementation research could be done to promote the uptake of interventions that have been proven effective into routine practices.

Nearly two-thirds of children in Beijing, China, consume fruit daily, although this frequency is lower among boys and older students. A positive correlation was observed between both individual food and nutrition literacy and family food environment with children’s fruit consumption. It was noteworthy that interventions aimed at increasing fruit intake should focus on boys who were in higher grades, had caregivers with lower educational levels, and had lower family incomes.

Future interventions should prioritize nutrition education in schools, especially in higher grades of middle schools, to promote students’ knowledge acquirement, beliefs generation and food consumption behavior change. Although the present study did not involve the school food environment, school feeding and a healthy school environment establishment are equally important for children’s food consumption behaviors (12). Another effective strategy is to motivate parents to foster a supportive family environment. This can be achieved through positive role modeling and parental feeding practices, ensuring fruit availability, and establishing rules to guide child’s eating behaviors. It should be emphasized that caregiver’s food and nutrition literacy could be acquired by parent-teacher meetings, and positive interaction between family and school is extremely important for children’s behavior and health. Of course, media publicity including food advertisement is also important social environment (8–12).

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by Institutional Review Board of the Beijing Center for Disease Prevention and Control. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants' legal guardians/next of kin.

XW: Data curation, Writing – original draft. YY: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Writing – review & editing. HH: Investigation, Writing – original draft. XY: Investigation, Writing – original draft. DG: Investigation, Resources, Writing – original draft. WZ: Conceptualization, Data curation, Methodology, Supervision, Writing – original draft, Writing – review & editing.