Development and implementation of voluntary food and drink guidelines for early years settings in England

Energy and nutrient content of school lunches provided for children attending school-based nurseries: a cross-sectional study

OBJECTIVE

To nutritionally analyse lunches provided for 3-4-year-old children attending school nurseries. Energy and nutrient content are compared with nutrient frameworks underpinning voluntary guidelines for early years settings (EYS) and mandatory standards for infant schools (4-7-year-olds).

DESIGN

A cross-sectional study, recording all main meals, vegetarian meals, jacket potato options, sandwich options and all desserts and accompaniments provided over 5 consecutive days in each school. Two portions of each meal were collected each day and weighed. Recipe and portion weight data were entered into nutrient analysis software.

SETTING

School nurseries where lunch was provided by the school.

SUBJECTS

Nine schools, providing a total of 161 meals.

RESULTS

Lunches contained more energy (1881 kJ/450 kcal), fat (15·5 g), free sugars (10·5 g) and Na (424 mg) than suggested by the nutrient framework for EYS. Carbohydrate (60·6 g), protein (16·8 g), fibre (6·7 g), Fe (2·4 mg), Zn (2·0 mg), Ca (202 mg), vitamin A (304 µg) and vitamin C (19 mg) also exceeded minimum recommendations. Compared with a revised nutrient framework for infant schools, energy was within range, whilst saturated fat, free sugars and Na were above maximum recommendations for this age group, and Zn was below. Sandwich meals were lower in vitamin C (P < 0·001-P = 0·05) and Fe (P = 0·012-P = 0·017) and higher in Na (P < 0·001-P = 0·003) and Ca (P < 0·001-P = 0·05).

CONCLUSION

Lunches provided for children attending school nurseries are more in line with the framework for 4-7-year-olds. Free sugars, saturated fat and Na are areas of concern consistent with previous studies. Protein is three times more than recommended. Large portions of cakes and biscuits contribute to excess energy provision.

School lunch portion sizes provided for children attending early years settings within primary schools: A cross-sectional study

BACKGROUND

In England, many children attend an early years' setting (EYS) that is part of a primary school. Where a school lunch is available, this is often the same for both EYS and school children. This study explored how school lunch portion sizes served for 3-4-year-old EYS children compared with portion size guidance for EYS and schools, given that recommendations are different for EYS and school-aged children.

METHODS

Twelve schools were recruited in four local authorities, each of which provided a school lunch to children attending EYS (aged 3-4 years) and reception classes (aged 4-5 years) from the same menu. Two portions of each menu item were weighed, each day, for five consecutive days. Mean, median, standard deviation and correlation coefficient were calculated for each food item.

RESULTS

Most caterers reported serving the same-sized portions to both 3-4-year-olds and 5-7-year-olds. Food items falling outside of the typical range for EYS were more commonly above the range (10 food items) than below it (6 food items). Notably, portions of cakes and biscuits were larger than recommended. Portion weights falling outside of the recommended range for 4-10-year-olds were usually too small (12 of 14 items). Some foods provided by the schools in the study did not have typical portion sizes for EYS as they were not 'good choices of foods to serve'.

CONCLUSIONS

These results suggest caterers may not be following guidelines appropriate for all the children they are catering for.

Child-care self-assessment to improve physical activity, oral health and nutrition for 2- to 4-year-olds: a feasibility cluster RCT

Background

The Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention has shown evidence of effectiveness in the USA but not been adapted or assessed for effectiveness in the UK.

Objectives

To evaluate the feasibility and acceptability of implementing NAP SACC in the UK.

Design

Adaptation and development of NAP SACC and feasibility cluster randomised controlled trial (RCT) including process and economic evaluations. Substudies assessed mediator questionnaire test–retest reliability and feasibility of food photography methods.

Setting

Nurseries, staff and parents in North Somerset, Cardiff, Gloucestershire and Bristol.

Participants

Development – 15 early years/public health staff and health visitors, 12 nursery managers and 31 parents. RCT – 12 nurseries and 31 staff, four partners and 168 children/parents. Mediator substudy – 82 parents and 69 nursery staff. Food photography substudy – four nurseries, 18 staff and 51 children.

Intervention

NAP SACC UK partners supported nurseries to review policies and practices and set goals to improve nutrition, oral health and physical activity (PA) over 5 months. Two workshops were delivered to nursery staff by local experts. A home component [website, short message service (SMS) and e-mails] supported parents. The control arm continued with usual practice.

Main outcome measures

Feasibility and acceptability of the intervention and methods according to prespecified criteria.

Data sources

Qualitative data to adapt the intervention. Measurements with children, parents and staff at baseline and post intervention (8–10 months after baseline). Interviews with nursery managers, staff, parents and NAP SACC UK partners; observations of training, workshops and meetings. Nursery environment observation, nursery Review and Reflect score, and resource log. Child height and weight, accelerometer-determined PA and sedentary time, screen time and dietary outcomes using the Child and Diet Evaluation Tool. Staff and parent questionnaires of knowledge, motivation and self-efficacy. Child quality of life and nursery, family and health-care costs. Food photography of everything consumed by individual children and staff questionnaire to assess acceptability.

Results

Thirty-two per cent (12/38) of nurseries and 35.3% (168/476) of children were recruited; no nurseries withdrew. The intervention was delivered in five out of six nurseries, with high levels of fidelity and acceptability. Partners found it feasible but had concerns about workload. The child loss to follow-up rate was 14.2%. There was suggestion of promise in intervention compared with control nurseries post intervention for snacks, screen time, proportion overweight or obese and accelerometer-measured total PA and moderate to vigorous PA. Many parental and nursery knowledge and motivation mediators improved. The average cost of delivering the intervention was £1184 per nursery excluding partner training, and the average cost per child was £27. Fourteen per cent of parents used the home component and the mediator questionnaire had good internal consistency and test–retest reliability. Photography of food was acceptable and feasible.

Limitations

Following nursery leavers was difficult. Accelerometer data, diet data and environmental assessment would have been more reliable with 2 days of data.

Conclusions

The NAP SACC UK intervention and methods were found to be feasible and acceptable to participants, except for the home component. There was sufficient suggestion of promise to justify a definitive trial.

Future work

A multicentre cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of NAP SACC UK has been funded by NIHR and will start in July 2019 (PHR NIHR 127551).

Trial registration

Current Controlled Trials ISRCTN16287377.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 13. See the NIHR Journals Library website for further project information. Funding was also provided by the North Somerset and Gloucestershire Councils, Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) (MR/KO232331/1), and the Elizabeth Blackwell Institute.

Association of diet in nurseries and physical activity with zBMI in 2-4-year olds in England: a cross-sectional study

BACKGROUND

Childhood obesity tracks into adulthood with detrimental effects on health. We aimed to examine the relationships of diet in childcare settings and daily physical activity (PA) of preschoolers with body mass index z-score (z-BMI).

METHODS

We conducted a cross-sectional study of 150 children aged 2-4-years participating in the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) UK study to examine the associations of their diet in childcare settings and daily PA with z-BMI. Dietary intake was observed and recorded by fieldworkers using a validated tick-list food questionnaire and diet quality was assessed based on adherence to Children's Food Trust (CFT) guidelines. PA was measured using accelerometers. We derived z-BMI scores using the UK 1990 and International Obesity Taskforce growth reference charts. Multilevel regression models were used to estimate associations between diet and PA with z-BMI separately, adjusted for age, gender, ethnicity, parental education level and clustering.

RESULTS

Among children who consumed one main meal or snack at childcare, 34.4% and 74.3% met the standards on fruits and vegetables and high sugar or fat snacks, respectively. Adherence to CFT guidelines was not associated with zBMI. Only 11.4% of children met recommended UK guidelines of three hours per day of physical activity. Minutes spent in light PA (β = 0.08, 95% CI = 0.01, 0.15) and active time (β = 0.07, 95% CI = 0.01, 0.12) were positively associated with UK 1990 zBMI scores.

CONCLUSIONS

The low proportion of children meeting the standards on fruits and vegetables and high sugar or fat snacks and recommended physical activity levels highlight the need for more work to support nurseries and parents to improve preschool children's diet and activity. In our exploratory analyses, we found children with higher zBMI were more physically active which could be attributed to fat-free mass or chance finding and so requires replication in a larger study.

TRIAL REGISTRATION

ISRCTN16287377 . Registered 12 June 2014.