Effectiveness of Interventions Promoting Dietary Intake, Physical Activity, and Healthy Weight Status of Children in Family Child Care: A Systematic Review

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

Barriers and Facilitators for Healthy Eating and Physical Activity: Interviews with Family Child Care Educators and Organization Staff

Introduction: Family child care (FCC) offers a promising setting for obesity prevention, yet interventions have had varied success, potentially due to insufficient stakeholder input. This study aimed to explore barriers, facilitators, and preferences for healthy eating and physical activity interventions among Australian FCC educators and organization staff. Methodology: Semi-structured interviews were conducted with 15 FCC educators and 6 staff members, using the framework method for data analysis. Results: Findings were organized according to the socioecological model. At the public policy level, regulations were seen as prioritizing risk avoidance over health benefits. At the community level, educators cited community programs and facilities as supportive of physical activity, noting that cultural and socioeconomic factors influence healthy eating. At the organizational level, adequate space promoted physical activity, but financial limitations impacted food provision and access to physical activity equipment. Some FCC organizations did not provide support for healthy practices. At the interpersonal level, educators and staff struggled to address unsupportive parental choices. Lastly, at the individual level, nutrition knowledge and education were deemed important for promoting healthy eating, with picky eating as a common obstacle. Conclusion: To enhance healthy eating and physical activity in FCC, recommended strategies include training safety assessors, educators, and parents on risky play; adapting regulations to the FCC context; reimbursing food provision; enhancing opportunities for excursions and outdoor play spaces; improving communication between educators and parents and expanding educators' knowledge of nutrition and physical activity.

Web-Based Tool for Australian Family Day Care to Promote Healthy Lifestyles: Randomized Controlled Trial

Food and physical activity environments in family day care can be improved to better support healthy behaviors. A 6-month two-arm parallel randomized controlled trial evaluated the effectiveness of a web-based tool to promote healthier practices through quality improvement planning among Australian service providers and their educators. Service providers were randomized 1:1 into the intervention group (using the tool for a minimum of 1 month alongside regular quality improvement plan processes) and control group (regular quality improvement plan processes). The primary outcome of change in the quality of the improvement plan (in relation to the incorporation of healthy practices) was assessed using a checklist designed specifically for the study. Secondary outcomes were self-ratings of awareness and knowledge of various topics assessed using a 5-point Likert-type scale. Eight service providers and 22 educators participated (four service providers and 10 educators in the intervention group; four service providers and 12 educators in the control group). Intention-to-treat analyses found significant change in quality of the revised improvement plan for the intervention group. The intervention group showed an increase in self-rated awareness and knowledge on healthy practices and National Quality Standards, and confidence in identifying priority areas. This is the first-known web-based tool designed specifically for family day care to promote healthier practices. There are several opportunities for the tool to be embedded in practice, including delivery of the tool as part of support programs or training. This trial is registered with Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000369628.

Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools

BACKGROUND

Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators' practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking.

OBJECTIVE

The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness.

METHODS

This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature.

RESULTS

The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53%). The largest proportion of studies were conducted in the United States (11 studies, 37%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42%), physical activity (5 tools, 26%), or both nutrition and physical activity (6 tools, 32%). All tools were web based (19 tools, 100%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57%) and the United States (3 tools, 43%). The majority targeted nutrition (4 tools, 57%) and were primarily web based (6 tools, 86%), with 1 mobile app (1 tool, 14%).

CONCLUSIONS

This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change.

TRIAL REGISTRATION

Open Science Framework XTRNZ; https://osf.io/xtrnz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/52252.