Understanding the factors influencing fish consumption among children and adolescents: A comprehensive narrative review based on the socio-ecological model

Objective: This review aimed to examine the factors influencing fish consumption among children and adolescents globally.
Background: Fish is a rich source of protein and micronutrients, including vitamin D, iodine and selenium, which are essential for child growth and development. It is also the main dietary source of the long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA), which contribute to optimal neurodevelopment. Nonetheless, fish consumption among children and adolescents is commonly insufficient in most parts of the world.
Methods: A systematic search across five databases identified 37 relevant articles. Using the socio-ecological model, factors were categorised across individual, interpersonal, environmental and policy determinants, and were either barriers or enabling factors.
Results: Enabling factors of fish consumption at the individual level were early (aged 2-6 years) and repeated exposure of children to fish. Mild-flavoured fish and cooking methods such as frying were more appealing to children. Interpersonally, a family habit of fish consumption and parents having fish-cooking skills promoted both the varieties and quantities of fish consumed. Appropriate public health messaging, fish in school programs and nutrition were identified as policy-level enablers. Individual-level barriers included a dislike for the smell and/or texture of fish, especially among ‘picky eaters’. Interpersonally, misinformation, fear of allergies and contaminants were identified among parents. Cost and limited availability, especially in landlocked regions, were environmental barriers.
Conclusions: This review summarises how diverse and interconnected factors across the socio-ecological model shape fish consumption in children and adolescents. Improving consumption, therefore, requires a holistic public health approach that promotes early and repeated exposure to fish, delivers clear and evidence-based nutrition education for parents, and addresses structural barriers such as high cost and limited availability.