Dietary patterns reflecting core and non-core food intake are identifiable in Australian toddlers. These findings support the need to intervene early with parents to promote healthy eating in children and can inform future investigations on the effects of early diet on long-term health.

Objective: Early childhood settings are promising avenues to intervene to improve children's nutrition. Previous research has shown that a nutrition award scheme, Start Right -Eat Right (SRER), improves long day care centre policies, menus and eating environments. Whether this translates into improvements in children's dietary intake is unknown. The present study aimed to determine whether SRER improves children's food and nutrient intakes. Design: Pre-post cohort study. Setting: Twenty long day care centres in metropolitan Adelaide, South Australia, Australia. Subjects: Children aged 2-4 years (n 236 at baseline, n 232 at follow-up). Methods: Dietary intake (morning tea, lunch, afternoon tea) was assessed pre-and post-SRER implementation using the plate wastage method. Centre nutrition policies, menus and environments were evaluated as measures of intervention fidelity. Comparisons between baseline and follow-up were made using t tests. Results: At follow-up, 80 % of centres were fully compliant with the SRER award criteria, indicating high scheme implementation and adoption. Intake increased for all core food groups (range: 0·2-0·4 servings/d, P < 0·001) except for vegetable intake. Energy intake increased and improvements in intakes of eleven out of the nineteen nutrients evaluated were observed. Conclusions: SRER is effective in improving children's food and nutrient intakes at a critical time point when dietary habits and preferences are established and can inform future public health nutrition interventions in this setting. KeywordsChild care Child Nutrition Food intake EvaluationYoung children increasingly spend a significant proportion of their day in early childhood settings. These settings frequently provide meals and snacks to children while they are in care and offer promising avenues for improving children's nutrition (1,2) . For example, long day care centres (LDCC) operate daily for a minimum of 8 h and often provide more than half of children's daily food intake (3) . Therefore it is important that the foods offered to children while in care provide the energy and nutrients they require for optimal growth and development. In South Australia (SA), Start Right -Eat Right (SRER) is a nutrition award scheme that has been rolled out by government state-wide since 2004. SRER aims to increase LDCC capacity to provide safe, healthy food choices and a positive eating environment for children (4) . Participation in SRER involves nutrition training for centre directors and cooks plus support for staff to improve the LDCC menus, policies and eating environment in line with the nutrition award criteria. The SRER award recognises centres that have: (i) a menu that provides at least 50 % of children's daily nutrition requirements; (ii) all staff trained in food hygiene; and (iii) a supportive eating environment for children. An auditing process ensures that once trained and awarded, the SRER criteria are maintained (4,5) .Previous research has shown the positive impact of SRER on the menus, policies and...

Interventions are required to reduce children’s consumption of discretionary foods and drinks. To intervene we need to identify appropriate discretionary choice targets. This study aimed to determine the main discretionary choice contributors to energy and key nutrient intakes in children aged 2–18 years. Secondary analyses were performed with population weighted, single 24 h dietary recall data from the 2011–2012 National Nutrition and Physical Activity Survey. Cakes, muffins, and slices; sweet biscuits; potato crisps and similar snacks; and, processed meats and sugar-sweetened drinks were relatively commonly consumed and were within the top three to five contributors to per capita energy, saturated fat, sodium, and/or added sugars. Per consumer intake identified cereal-based takeaway foods; cakes, muffins and slices; meat pies and other savoury pastries; and, processed meats as top contributors to energy, saturated fat, and sodium across most age groups. Subgroups of sugar-sweetened drinks and cakes, muffins and slices were consistently key contributors to added sugars intake. This study identified optimal targets for interventions to reduce discretionary choices intake, likely to have the biggest impact on moderating energy intake while also reducing intakes of saturated fat, sodium and/or added sugars.

The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.

Identifying toddlers at dietary risk is crucial for determining who requires intervention to improve dietary patterns and reduce health consequences. The objectives of the present study were to develop a simple tool that assesses toddlers' dietary risk and investigate its reliability and validity. The nineteen-item Toddler Dietary Questionnaire (TDQ) is informed by dietary patterns observed in Australian children aged 14 (n 552) and 24 (n 493) months and the Australian dietary guidelines. It assesses the intake of 'core' food groups (e.g. fruit, vegetables and dairy products) and 'non-core' food groups (e.g. high-fat, high-sugar and/or high-salt foods and sweetened beverages) over the previous 7 d, which is then scored against a dietary risk criterion (0-100; higher score ¼ higher risk). Parents of toddlers aged 12-36 months (Socio-Economic Index for Areas decile range 5 -9) were asked to complete the TDQ for their child (n 111) on two occasions, 3·2 (SD 1·8) weeks apart, to assess test-retest reliability. They were also asked to complete a validated FFQ from which the risk score was calculated and compared with the TDQ-derived risk score (relative validity). Mean scores were highly correlated and not significantly different for reliability (intra-class correlation ¼ 0·90, TDQ1 30·2 (SD 8·6) v. TDQ2 30·9 (SD 8·9); P¼ 0·14) and validity (r 0·83, average TDQ ((TDQ1 þ TDQ2)/2) 30·5 (SD 8·4) v. FFQ 31·4 (SD 8·1); P¼ 0·05). All the participants were classified into the same (reliability 75 %; validity 79 %) or adjacent (reliability 25 %; validity 21 %) risk category (low (0-24), moderate (25 -49), high (50 -74) and very high (75 -100)). Overall, the TDQ is a valid and reliable screening tool for identifying at-risk toddlers in relatively advantaged samples.Key words: Toddlers: Dietary risk: Questionnaires: Validity: Reliability 'Dietary risk' is a term used to describe 'any inappropriate dietary pattern' that may impair health (1) . Toddlers are vulnerable to dietary risk as they begin to exert their independence in food choices and demonstrate fussy eating behaviours (2,3) . As dietary risk habits may persist over time (4,5) and influence short-term and long-term health (6,7) , early risk identification is important.The current dietary intakes of toddlers are inadequate, suggesting that many are at dietary risk. In general, intakes of nutrient-rich foods are below the national dietary guideline recommendations and consumption of energydense, nutrient-poor foods is common. For example, the 2008/09 UK National Diet and Nutrition Survey revealed that about 50 % of 1·5-to 3-year-olds consumed energy-dense, nutrient-poor items such as meat products, fried potato products, confectionery and sweetened beverages over the 4 d food diary period (8) . Nutrient-rich foods such as fish, raw vegetables and eggs were consumed by less than half the sample (8) . Similarly, a recent Australian study demonstrated that 11 -15 % of 12-to 36-month-olds consumed no fruit or vegetables, respectively, less than one-quarter consumed ...

Objective:Globally, grandparents are the main informal childcare providers with one-quarter of children aged ≤5 years regularly cared for by grandparents in Australia, the UK and USA. Research is conflicting; many studies claim grandparents provide excessive amounts of discretionary foods (e.g. high in fat/sugar/sodium) while others suggest grandparents can positively influence children’s diet behaviours. The present study aimed to explore the meaning and role of food treats among grandparents who provide regular informal care of young grandchildren.Design:Qualitative methodology utilising a grounded theory approach. Data were collected using semi-structured interviews and focus groups, then thematically analysed.Setting:Participants were recruited through libraries, churches and playgroups in South Australia.Participants:Grandparents (n 12) caring for grandchild/ren aged 1–5 years for 10 h/week or more.Results:Three themes emerged: (i) the functional role of treats (e.g. to reward good behaviour); (ii) grandparent role, responsibility and identity (e.g. the belief that grandparent and parent roles differ); and (iii) the rules regarding food treats (e.g. negotiating differences between own and parental rules). Grandparents favoured core-food over discretionary-food treats. They considered the risks (e.g. dental caries) and rewards (e.g. pleasure) of food treats and balanced their wishes with those of their grandchildren and parents.Conclusions:Food treats play an important role in the grandparent–grandchild relationship and are used judiciously by grandparents to differentiate their identity and relationship from parents and other family members. This research offers an alternative narrative to the dominant discourse regarding grandparents spoiling grandchildren with excessive amounts of discretionary foods.

Studies assessing dietary intake and its relationship to metabolic phenotype are emerging, but limited. The aims of the study are to identify dietary patterns in Australian adults, and to determine whether these dietary patterns are associated with metabolic phenotype and obesity. Cross-sectional data from the Australian Bureau of Statistics 2011 Australian Health Survey was analysed. Subjects included adults aged 45 years and over (n = 2415). Metabolic phenotype was determined according to criteria used to define metabolic syndrome (0–2 abnormalities vs. 3–7 abnormalities), and additionally categorized for obesity (body mass index (BMI) ≥30 kg/m2 vs. BMI <30 kg/m2). Dietary patterns were derived using factor analysis. Multivariable models were used to assess the relationship between dietary patterns and metabolic phenotype, with adjustment for age, sex, smoking status, socio-economic indexes for areas, physical activity and daily energy intake. Twenty percent of the population was metabolically unhealthy and obese. In the fully adjusted model, for every one standard deviation increase in the Healthy dietary pattern, the odds of having a more metabolically healthy profile increased by 16% (odds ratio (OR) 1.16; 95% confidence interval (CI): 1.04, 1.29). Poor metabolic profile and obesity are prevalent in Australian adults and a healthier dietary pattern plays a role in a metabolic and BMI phenotypes. Nutritional strategies addressing metabolic syndrome criteria and targeting obesity are recommended in order to improve metabolic phenotype and potential disease burden.

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