Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years

Yoong, Sze Lin; Lum, Melanie; Wolfenden, Luke; Jackson, Jacklyn; Barnes, Courtney; Hall, Alix; McCrabb, Sam; Pearson, Nicole; Lane, Cassandra; Jones, Jannah; Dinour, Lauren M.; McDonnell, Thérèse; Booth, Debbie; Grady, Alice

doi:10.1002/14651858.cd013862.pub2

Cited by 13 publications

(11 citation statements)

References 251 publications

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“…Nutrition interventions to improve food provision and intake of children within childcare settings have achieved small but significant improvements (15) . Interventions targeting the nutrition environment (e.g.…”

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confidence: 99%

Nutrition environments in early childhood education: do they align with best practice?

Aristova,

Spence,

Irwin

et al. 2024

Public Health Nutr.

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Objective: To assess the comprehensiveness (scope of nutrition guidance) and strength (clarity of written language) of centre-based nutrition policies (CBNPs) within Early Childhood Education (ECE) centres. To also consider the applicability of an existing CBNP assessment tool and policy alignment with best practice food provision and feeding practices. Design: Cross-sectional online study to assess written ECE centre-based nutrition policies using the Wellness Child Care Assessment Tool (WellCCAT). Setting: Licenced ECE centres in the state of Victoria, Australia. Participants: ECE centres (operating at least 8 hours per day, 48 weeks per annum), stratified by location (rural and metropolitan), centre management type (profit and not-for profit), and socioeconomic area (low, middle, high). Results: Included individual CBNPs (n=118), predominantly from metropolitan centres (56%) and low-medium socioeconomic areas (78%). Policies had low overall WellCCAT scores, particularly strength scores which were low across all four domains (i.e., Nutrition Education, Standards, Promotion, and Communication/Evaluation). The Nutrition Standards domain had the lowest strength score. The Communication/Evaluation domain had the lowest comprehensiveness score. Content analysis indicated low scores may relate to WellCCAT applicability for the Australian context due to differences in best practice guidance. Conclusion: Despite the presence of written nutrition policies in ECE centres, many showed weak language and lacked comprehensiveness and strength. This may relate to poor implementation of best practice food provision or feeding practices. Low scores, however, may partly stem from using an assessment tool that is not country-specific. The redevelopment of country-specific tools to assess ECE centre-based nutrition policy may be warranted.

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confidence: 99%

Nutrition environments in early childhood education: do they align with best practice?

Aristova,

Spence,

Irwin

et al. 2024

Public Health Nutr.

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“…moderate, 24,65,66 which was also confirmed in a 2023 Cochrane review on healthy eating interventions in children aged 6 months to 6 years. 67 When it comes to school-aged children, the majority of the interventions have been tested in school settings, while fewer interventions in this age group have been tested in a family setting. Most of the tested interventions have focused on improved diet and increased physical activity, for example, by restructuring the sports curriculum, focusing on daily physical activity, promoting consumption of water instead of sugary drinks, or restructuring the selection of foods and drinks available at school.…”

Section: Levels Of Prevention Of Overweight and Obesitymentioning

confidence: 99%

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention

Olsen,

Østergaard,

Bjerregaard

et al. 2023

Obesity Reviews

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SummaryPrimary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.

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“…To synthesize the effects of the use of engagement strategies on the primary health risk outcome targeted by the DHI, we used the direction of the effect where available rather than statistical significance in accordance with SWiM (Synthesis Without Meta-Analysis) guidelines [58]. Similarly to previous reviews of nutrition, physical activity, and overweight and obesity interventions [52,59], we focused on a single measure of each health risk factor outcome from each study, which was selected based on a hierarchical criterion: validated measures over nonvalidated measures, global scores over individual constructs, measures that were deemed most relevant to answering the review question or were most commonly used among the included studies over other measures, and results from adjusted analyses over unadjusted analyses. Where a single measure could not be determined using the hierarchy, a web-based random number generator was used to select the measure to be included.…”

Section: Secondary Outcome Synthesismentioning

confidence: 99%

The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis

Grady,

Pearson,

Lamont

et al. 2023

J Med Internet Res

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Background Digital health interventions (DHIs) are effective in improving poor nutrition, physical inactivity, overweight and obesity. There is evidence suggesting that the impact of DHIs may be enhanced by improving user engagement. However, little is known about the overall effectiveness of strategies on engagement with DHIs. Objective This study aims to assess the overall effectiveness of strategies to improve engagement with DHIs targeting nutrition, physical activity, and overweight or obesity and explore associations between strategies and engagement outcomes. The secondary aim was to explore the impact of these strategies on health risk outcomes. Methods The MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Scopus, and Academic Source Complete databases were searched up to July 24, 2023. Eligible studies were randomized controlled trials that evaluated strategies to improve engagement with DHIs and reported on outcomes related to DHI engagement (use or user experience). Strategies were classified according to behavior change techniques (BCTs) and design features (eg, supplementary emails). Multiple-variable meta-analyses of the primary outcomes (usage and user experience) were undertaken to assess the overall effectiveness of strategies. Meta-regressions were conducted to assess associations between strategies and use and user experience outcomes. Synthesis of secondary outcomes followed the “Synthesis Without Meta-Analysis” guidelines. The methodological quality and evidence was assessed using the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation tool respectively. Results Overall, 54 studies (across 62 publications) were included. Pooled analysis found very low-certainty evidence of a small-to-moderate positive effect of the use of strategies to improve DHI use (standardized mean difference=0.33, 95% CI 0.20-0.46; P<.001) and very low-certainty evidence of a small-to-moderate positive effect on user experience (standardized mean difference=0.29, 95% CI 0.07-0.52; P=.01). A significant positive association was found between the BCTs social support (effect size [ES]=0.40, 95% CI 0.14-0.66; P<.001) and shaping knowledge (ES=0.39, 95% CI 0.03-0.74; P=.03) and DHI use. A significant positive association was found among the BCTs social support (ES=0.70, 95% CI 0.18-1.22; P=.01), repetition and substitution (ES=0.29, 95% CI 0.05-0.53; P=.03), and natural consequences (ES=0.29, 95% CI 0.05-0.53; P=.02); the design features email (ES=0.29, 95% CI 0.05-0.53; P=.02) and SMS text messages (ES=0.34, 95% CI 0.11-0.57; P=.01); and DHI user experience. For secondary outcomes, 47% (7/15) of nutrition-related, 73% (24/33) of physical activity–related, and 41% (14/34) of overweight- and obesity-related outcomes reported an improvement in health outcomes. Conclusions Although findings suggest that the use of strategies may improve engagement with DHIs targeting such health outcomes, the true effect is unknown because of the low quality of evidence. Future research exploring whether specific forms of social support, repetition and substitution, natural consequences, emails, and SMS text messages have a greater impact on DHI engagement is warranted. Trial Registration PROSPERO CRD42018077333; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77333

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Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years

Cited by 13 publications

References 251 publications

Nutrition environments in early childhood education: do they align with best practice?

Nutrition environments in early childhood education: do they align with best practice?

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention

The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis

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