Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina

Can Kindergarten Meals Improve the Daily Intake of Vegetables, Whole Grains, and Nuts among Preschool Children? A Randomized Controlled Evaluation

Surveys have indicated that preschool children do not consume adequate amounts of vegetables, fruits, whole grains, and nuts. This cross-sectional intervention study aimed to investigate whether a meticulously crafted meal plan for children of kindergarten age (5-6 years) could effectively enhance their daily intake of nutritious foods. Ninety-four healthy children from six kindergartens were enrolled in the study and were randomly assigned to a prototype group (PG) and a control group (CG). The PG kindergartens (n = 4) received a prototype 5-day meal plan that included regulated portions of vegetables, fruits, whole grains, and nuts adhering to dietary guidelines. Conversely, the CG kindergartens (n = 2) adhered to their standard meal plan. Participants maintained their usual eating habits outside of kindergarten and during weekends. Using the dietary assessment tool Open Platform for Clinical Nutrition (OPEN), combined with a 7-day dietary record of food consumed inside and outside the kindergarten, the average daily intake of specific food groups was assessed and compared with the Dietary Guidelines for Children. A total of 57 participants completed the study, 40 from the PG and 17 from the CG. Among the PG participants, the average daily intake of vegetables, whole grains, and nuts compared with the guideline recommendations was significantly higher than in the CG. Notably, only meals consumed within the kindergarten setting significantly improved the overall intake, with the outside intake having no significant effect. This study underscores the vital role of a well-designed and precisely executed meal plan in kindergartens in improving children's intake of healthy foods. The findings could help drive positive changes in child nutrition within educational environments.

Young Children's Dietary Quality in Family Child Care and in Their Own Home

BACKGROUND

Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care.

OBJECTIVE

The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home.

DESIGN

This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina.

PARTICIPANTS/SETTING

Participants were 123 children in 52 family child-care homes between 2018 and 2019.

MAIN OUTCOME MEASURE

The main outcome was total and component Healthy Eating Index 2015 scores.

STATISTICAL ANALYSIS

The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling.

RESULTS

Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (β = -5.18 ± 1.47; 95% CI -8.05 to -2.30; P = 0.003).

CONCLUSIONS

Children had healthier dietary intake in family child-care homes vs their respective homes.

Systematic Review of Reflection Spectroscopy-Based Skin Carotenoid Assessment in Children

Assessing children's skin carotenoid score (SCS) using reflection spectroscopy (RS) is a non-invasive, widely used method to approximate fruit and vegetable consumption (FVC). The aims for the current review were to (1) identify distributions of SCS across demographic groups, (2) identify potential non-dietary correlates for RS-based SCS, (3) summarize the validity and reliability of RS-based SCS assessment, and (4) conduct meta-analyses of studies examining the correlation between RS-based SCS with FVC. A literature search in eight databases in June 2021 resulted in 4880 citations and peer-reviewed publications written in English that investigated children's (2-10 years old) SCS using RS. We included 11 studies (intervention = 3, observational = 8). Potential covariates included weight status, ethnicity, seasonal variation, age, sex, and income. Studies reported criterion validity with children's FVC but not with plasma carotenoid. Additionally, no studies reported the reliability of RS-based SCS in children. Among the 726 children included in the meta-analysis, the correlation between RS-based SCS and FVC was r = 0.2 (p < 0.0001). RS-based SCS is a valid method to quantify skin carotenoids for children's FVC estimation with the potential for evaluating nutrition policies and interventions. However, future research should use standardized protocol for using RS and establish how RS-based SCS can translate to the amount of daily FVC in children.

Metabolic Syndrome Is Associated with Low Diet Quality Assessed by the Healthy Eating Index-2015 (HEI-2015) and Low Concentrations of High-Density Lipoprotein Cholesterol

Presenting diet quality of patients with metabolic syndrome (MetS), using a holistic approach is more useful than investigating dietary individual components, but there is still a small amount of research in this area. The aim of this study assessed the diet quality, as measured by the HEI-2015, of MetS patients compared to healthy individuals. The study and control group consisted of 215 patients with MetS and 320 people without MetS, respectively. A nutritional analysis using a semi-quantitative food frequency questionnaire was used to evaluate the nutritional habits in the study and control group. Total HEI-2015 scores were significantly lower in MetS subjects than in those in the control group (65.04 ± 9.71 vs. 66.75 ± 8.88) and the quality of women’s diets was better than the quality of men’s diet (66.83 ± 8.99 vs. 64.75 ± 9.57). We also observed that low HDL-c concentration increased the risk of MetS in the general population the most. Across the population, there was a weak positive correlation between HDL-c concentrations and total HEI-2015 scores and a weak negative correlation between mean waist circumference values and total HEI-2015 scores. HDL-c concentrations may be a key factor in the prevention of MetS and appropriate therapeutic management to increase HDL-c levels may be of key importance in patients diagnosed with MetS.

Dietary Intake among Children Attending Childcare Centers: Impact of the New CACFP Meal Guidelines

Through the Healthy, Hunger-Free Kids Act of 2010, USDA (US Department of Agriculture) made the first major changes in the CACFP (Child and Adult Care Food Program) meal and snack menu patterns. Childcare centers that serve low-income families qualify to participate and receive reimbursement for meals and snacks served. The purpose of this study was to assess what changes in children’s dietary behaviors occurred as a result of the new CACFP meal pattern requirements. This study evaluated these changes at childcare centers operating in Houston and San Antonio, Texas, USA, areas enrolled in the CACFP, pre- (Spring 2016) and post-implementation (Fall 2016–Spring 2017) of the new meal patterns. Dietary intake was assessed via observations of children, 3–5 years old, conducted at breakfast, lunch, and snack times. Results showed improvements in adjusted means of several nutrients and food groups consumption, post-implementation of new CACFP meal guidelines compared to baseline, specifically intake of whole grains, milk, and juice. Additional studies are needed to confirm the impact of the revised CACFP meal patterns along with strategies to assist providers in meeting the new standards to increase the access to and intake of items in accordance with the CACFP meal pattern requirements in childcare settings.

Home food access and children's heart healthy dietary intake at home and child care

Background: About 12 million children under 5 years of age attend early care and education centers (ECEs). Child intake at home can be impacted by food insecurity, which is higher among low income, rural, and racially diverse families. Aim: Determine whether greater access to fruits, vegetables, and snacks at home was associated with heart-healthy diet score at home and at ECEs in preschool-age children, and to determine whether there is a difference in heart-healthy diet score between home and ECEs. Methods: Cross-sectional study involving children (3-to-5-year-old, n  =  88) who attended 16 licensed ECEs across Oklahoma. Caregivers completed the Healthy Home Survey and 3-Dinner Dietary recall to report children's home food access and home dinner dietary intake, respectively. Researchers recorded children's ECE lunch consumption using the Dietary Observation for Child Care. Heart-healthy diet score was derived from composite scores for six variables: consumption of fish, fruits, vegetables, sodium, fiber, and sugary drinks. Results: Home access to total fruits and vegetables (16.2  ±  6.3) outnumbered snacks (5.5  ±  3.0). No difference in composite heart-healthy diet score between ECEs (1.50  ±  0.8) and home (1.27  ±  0.9, P  =  0.0851). Children within neither environment met recommendations for most variables (vegetables [18-24%], fruit [6-10%], fish [5-10%], fiber [1%], sodium [22-39%]). No relationship between home food access variables and the heart-healthy diet scores at home or ECEs. Conclusion: Dietary intake of children at home and ECEs does not meet heart-healthy diet score recommendations. Interventions should support preschool aged children from families that are located rurally, low-income, racial minorities, and whose primary caregivers work outside the home.

Associations between advertisement-supported media exposure and dietary quality among preschool-age children

Foods of low nutritional quality are heavily marketed to children, and exposure to food ads shapes children's preferences and intake towards advertised foods. Whether food ad exposure independently relates to an overall lower diet quality among children remains unclear. We examined the association between ad-supported media use, a proxy for food ad exposure, and diet quality using the baseline data (2014-2015) from 535 3-5-year-olds in a community-based cohort study. Parents reported their child's dietary intake over 3 days via a diary, and diet quality was assessed with the Healthy Eating Index (HEI-2015) where higher scores reflect greater adherence to USDA dietary guidelines. Children's media exposure was measured through online parent surveys. Mean HEI score was 54.5 (SD = 9.4). In models adjusted for sociodemographic characteristics and metrics of parent diet quality, children's HEI scores were 0.5 points lower (adjusted beta = -0.5 [95% CI: 0.8, -0.1]; P < 0.01) for each 1-h increment in weekly viewing of ad-supported children's TV networks. Children's use of media that may have food ads (e.g., apps, online games) also related to a lower diet quality yet to a lesser extent (adjusted beta -0.2 [-0.2, -0.1]; P < 0.01). In contrast, children's ad-free media use was not associated with diet quality (P = 0.21). Findings support the premise that exposure to food advertisements via media may result in a lower quality diet among children independently of other risk factors.

Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days

BACKGROUND

Early-child-care (ECE) programs may substantially influence child diet quality.

OBJECTIVE

The Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days.

DESIGN

Meal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs.

PARTICIPANTS/SETTING

One thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017.

MAIN OUTCOME MEASURES

Daily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations.

STATISTICAL ANALYSES PERFORMED

Regression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days.

RESULTS

Mean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats.

CONCLUSIONS

Although there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.

Self-Paced Online Training on Healthy Beverage Policy for Child Care Providers

OBJECTIVE

Determine if online training for child care providers increases knowledge and awareness of and adherence to California's Healthy Beverages in Child Care Act (AB2084) policy.

DESIGN

Cluster, randomized controlled trial with 2 intervention groups and 1 control group.

SETTING

Licensed child care centers and family child care homes.

PARTICIPANTS

Child care providers in 3 California regions.

INTERVENTION

Thirty-minute, self-paced online training in English or Spanish, with or without 6-months of ongoing technical assistance.

MAIN OUTCOMES MEASURED

Providers' self-reported knowledge and awareness of and adherence to AB2084 at baseline, after 1 and 6 months.

ANALYSIS

Generalized estimating equations and generalized linear models, adjusted for the percentage of children on child care subsidies and region.

RESULTS

Outcomes were similar between groups receiving and not receiving technical assistance. Providers receiving training (both intervention groups combined) experienced larger increases in knowledge (P = 0.002 and P = 0.003) and awareness (P = 0.004 and P = 0.001) of AB2084 compared with the control group after 1 and 6 months. All groups reported pre-post increases in adherence to AB2084.

CONCLUSIONS AND IMPLICATIONS

A brief online training supports increased knowledge and awareness of healthy beverage policy among child care providers. The training is available online and is free for California child care providers.

Healthy Eating Policy Improves Children's Diet Quality in Early Care and Education in South Carolina

Policies to promote healthy foods in early care and education (ECE) in the United States exist, but few have been prospectively evaluated. In South Carolina, a statewide program serving low-income children in ECE enacted new policies promoting healthy foods. We conducted an evaluation to measure changes in dietary intake among children in ECE exposed and not exposed to the new policy. Using direct observation, we assessed dietary intake in 112 children from 34 ECE centers in South Carolina and 90 children from 30 ECE centers in North Carolina (a state with no policy). We calculated Healthy Eating Index-2015 (HEI) scores to measure diet quality consumed before and after the policy was enacted. We fit mixed-effects linear models to estimate differences in HEI scores by state from baseline to post-policy, adjusting for child race, number of children enrolled, director education, center years in operation, participation in the Child and Adult Care Food Program (CACFP), and center profit status. The policy increased HEI scores for whole fruits, total fruits, and lean proteins, but decreased scores for dairy. Thus, the policy was associated with some enhancements in dietary intake, but additional support may help improve other components of diet.