The Association between Australian Childcare Centre Healthy Eating Practices and Children's Healthy Eating Behaviours: A Cross-Sectional Study within Lunchbox Centres.

Courtney Barnes,Sze Lin Yoong,Alice Grady,Jayde Kerr,Nicole Pearson,Taya Wedesweiler,Luke Wolfenden,Nicole Nathan

doi:10.3390/nu13041139

Abstract

The association between healthy eating practices and child dietary intake in childcare centres where parents pack foods from home has received little attention. This study aimed to: (1) Describe the nutritional content of foods and beverages consumed by children in care; and (2) Assess the association between centre healthy eating practices and child intake of fruit and vegetable servings, added sugar(grams), saturated fat(grams) and sodium(milligrams) in care. A cross-sectional study amongst 448 children attending 22 childcare centres in New South Wales, Australia, was conducted. Child dietary intake was measured via weighed lunchbox measurements, photographs and researcher observation, and centre healthy eating practices were assessed via researcher observation of centre nutrition environments. Children attending lunchbox centres consumed, on average 0.80 servings (standard deviation 0.69) of fruit and 0.27 servings (standard deviation 0.51) of vegetables in care. The availability of foods within children’s lunchboxes was associated with intake of such foods (p < 0.01). Centre provision of intentional healthy eating learning experiences (estimate −0.56; p = 0.01) and the use of feeding practices that support children’s healthy eating (estimate −2.02; p = 0.04) were significantly associated with reduced child intake of saturated fat. Interventions to improve child nutrition in centres should focus on a range of healthy eating practices, including the availability of foods packed within lunchboxes.

Highlights

Poor dietary behaviours, including low intake of fruit and vegetables, and a high intake of energy-dense discretionary foods, are the leading modifiable risk factors for the development of obesity and non-communicable diseases [1]
Early childhood education and care (ECEC) centres within the study region currently participating in a cluster randomised controlled trial (RCT) to improve child dietary intake in care served as the sampling frame for the study, with baseline data from the trial presented within this paper [20]
The average child consent rate to participate in lunchbox measurements was 75%, with lunchbox measurement data collected for 448 children (89.2% of consenting children due to absenteeism on data collection days)

Summary

Introduction

Poor dietary behaviours, including low intake of fruit and vegetables, and a high intake of energy-dense discretionary foods (i.e., foods high in added sugar, sodium and saturated fat), are the leading modifiable risk factors for the development of obesity and non-communicable diseases [1]. Within childcare centres that provide meals and snacks to children on site (i.e., menubased centres), food availability and a number of additional characteristics of centre nutrition environments have been found to be associated with improved child dietary intake in care [8,9,10,11]. A recent review consolidating evidence from systematic reviews to examine the potential effectiveness of childcare centre practices concluded that healthy food availability was associated with improved child dietary intake in care [11]. A 2019 study with 58 preschool managers and 585 children in Finland found that having comprehensive written food policies which include educator feeding practices and the provision of food in care was associated with higher child intake of vegetables [10]. Given the association between centre nutrition environments and child dietary intake, best-practice guidelines recommend centres implement evidencebased healthy eating practices targeting the characteristics of centre nutrition environments known to be supportive of children’s healthy eating behaviours [12,13]

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Conclusion