Dietary Quality of Preschoolers' Sack Lunches as Measured by the Healthy Eating Index

      Abstract

      Background

      Eating habits are developed during the preschool years and track into adulthood, but few studies have quantified dietary quality of meals packed by parents for preschool children enrolled in early care and education centers.

      Objective

      Our aim was to evaluate the dietary quality of preschoolers’ sack lunches using the Healthy Eating Index (HEI) 2010 to provide parents of preschool children with guidance to increase the healthfulness of their child’s lunch.

      Design

      This study is a cross-sectional analysis of baseline dietary data from the Lunch Is in the Bag trial.

      Participants

      A total of 607 parent−child dyads from 30 early care and education centers in Central and South Texas were included.

      Main outcome measures

      Total and component scores of the HEI were computed using data obtained from direct observations of packed lunches and of children’s consumption.

      Statistical analysis

      Three-level regression models with random intercepts at the early care and education center and child level were used; all models were adjusted for child sex, age, and body mass index (calculated as kg/m2).

      Results

      Mean HEI-2010 total scores were 58 for lunches packed and 52 for lunches consumed, out of 100 possible points. Mean HEI component scores for packed and consumed lunches were lowest for greens and beans (6% and 8% of possible points), total vegetables (33% and 28%), seafood and plant proteins (33% and 29%), and whole grains (38% and 34%); and highest for empty calories (85% and 68% of possible points), total fruit (80% and 70%), whole fruit (79% and 64%), and total protein foods (76% and 69%).

      Conclusions

      Parents of preschool children pack lunches with low dietary quality that lack vegetables, plant proteins, and whole grains, as measured by the HEI. Education of parents and care providers in early care and education centers is vital to ensure that preschoolers receive high dietary-quality meals that promote their preference for and knowledge of a healthy diet.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Ogden C.L.
        • Carrol M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Te Velde S.
        • Van Nassau F.
        • Uijtdewilligen L.
        • et al.
        Energy balance-related behaviours associated with overweight and obesity in preschool children: A systematic review of prospective studies.
        Obes Rev. 2012; 13: 56-74
        • Kranz S.
        • Smiciklas-Wright H.
        • Siega-Riz A.M.
        • Mitchell D.
        Adverse effect of high added sugar consumption on dietary intake in American preschoolers.
        J Pediatr. 2005; 146: 105-111
        • Singer M.R.
        • Moore L.L.
        • Garrahie E.J.
        • Ellison R.C.
        The tracking of nutrient intake in young children: The Framingham Children's Study.
        Am J Public Health. 1995; 85: 1673-1677
        • Haire-Joshu D.
        • Elliott M.B.
        • Caito N.M.
        • et al.
        High 5 for Kids: The impact of a home visiting program on fruit and vegetable intake of parents and their preschool children.
        Prev Med. 2008; 47: 77-82
        • Dehghan M.
        • Akhtar-Danesh N.
        • Merchant A.T.
        Childhood obesity, prevalence and prevention.
        Nutr J. 2005; 2: 24
        • O'Connor T.M.
        • Yang S.J.
        • Nicklas T.A.
        Beverage intake among preschool children and its effect on weight status.
        Pediatrics. 2006; 118: e1010-e1018
        • Birch L.
        Effects of peer models' food choices and eating behaviors on preschoolers' food preferences.
        Child Dev. 1980; 51: 489-496
        • Cooke L.J.
        • Wardle J.
        • Gibson E.L.
        • Sapochnik M.
        • Sheiham A.
        • Lawson M.
        Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children.
        Public Health Nutr. 2004; 7: 295-302
        • Nicklaus S.
        • Boggio V.
        • Chabanet C.
        • Issanchou S.
        A prospective study of food variety seeking in childhood, adolescence and early adult life.
        Appetite. 2005; 44: 289-297
        • Sigman-Grant M.
        • Christiansen E.
        • Branen L.
        • Fletcher J.
        • Johnson S.L.
        About feeding children: Mealtimes in child-care centers in four western states.
        J Am Diet Assoc. 2008; 108: 340-346
        • Cooke L.
        The importance of exposure for healthy eating in childhood: A review.
        J Hum Nutr Diet. 2007; 20: 294-301
        • Skinner J.D.
        • Carruth B.R.
        • Wendy B.
        • Ziegler P.J.
        Children's food preferences: A longitudinal analysis.
        J Am Diet Assoc. 2002; 102: 1638-1647
        • Matheson D.
        • Spranger K.
        • Saxe A.
        Preschool children's perceptions of food and their food experiences.
        J Nutr Educ Behav. 2002; 34: 85-92
        • Story M.
        • Kaphingst K.M.
        • French S.
        The role of child care settings in obesity prevention.
        Future Child. 2006; 16: 143-168
        • Sweitzer S.J.
        • Briley M.E.
        • Robert-Gray C.
        Do sack lunches provided by parents meet the nutritional needs of young children who attend child care?.
        J Am Diet Assoc. 2009; 109: 141-144
        • Erinosho T.
        • Ball S.C.
        • Hanson P.P.
        • Vaughn A.E.
        • Ward D.S.
        Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005.
        J Acad Nutr Diet. 2013; 113: 1084-1089
        • Sweitzer S.J.
        • Briley M.E.
        • Roberts-Gray C.
        • Hoelscher D.M.
        • Staskel D.M.
        • Almansour F.D.
        How to help parents pack better preschool sack lunches: Advice from parents for educators.
        J Nutr Educ Behav. 2011; 43: 194-198
        • Sweitzer S.J.
        • Briley M.E.
        • Roberts-Gray C.
        • et al.
        Lunch is in the bag: Increasing fruits, vegetables, and whole grains in sack lunches of preschool-aged children.
        J Am Diet Assoc. 2010; 110: 1058-1064
      1. US Department of Agriculture. ChooseMyPlate.gov website. http://www.choosemyplate.gov/preschoolers.html. Accessed January 3, 2015.

      2. National Academies, Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes: Recommended Intakes for Individuals. 2011. http://www.nal.usda.gov/fnic/DRI/DRI_Tables/recommended_intakes_individuals.pdf. Accessed January 3, 2015.

        • Guenther P.M.
        • Kirkpatrick S.I.
        • Reedy J.
        • et al.
        The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.
        J Nutr. 2014; 144: 399-407
        • Hanson K.L.
        • Olson C.M.
        School meals participation and weekday dietary quality were associated after controlling for weekend eating among US school children aged 6 to 17 years.
        J Nutr. 2013; 143: 714-721
      3. Sweitzer SJ, Byrd-Williams C, Ranjit N, Briley ME, Roberts-Gray C, Hoelscher DM. Development of a method to observe preschoolers' packed lunches in child care centers [published online ahead of print May 12, 2015]. J Acad Nutr Diet. http://dx.doi.org/10.1016/j.jand.2015.03.012.

        • Hoelscher D.M.
        • Day R.S.
        • Lee E.S.
        • et al.
        Measuring the prevalence of overweight in Texas schoolchildren.
        Am J Public Health. 2004; 94: 1002-1008
      4. Food Intake and Analysis System (FIAS). Food Intake and Analysis System. Houston, TX: The University of Texas School of Public Health. 2010. https://sph.uth.edu/research/centers/dell/fias-food-intake-and-analysis-system/. Accessed August 22, 2014.

        • Guenther P.M.
        • Casavale K.O.
        • Reedy J.
        • et al.
        Update of the Healthy Eating Index: HEI-2010.
        J Acad Nutr Diet. 2013; 113: 569-580
        • Nicklas T.A.
        • Liu Y.
        • Stuff J.E.
        • Fisher J.O.
        • Mendoza J.A.
        • O'Neil C.E.
        Characterizing lunch meals served and consumed by pre-school children in Head Start.
        Public Health Nutr. 2013; 16: 2169-2177
        • Nicklas T.A.
        • O'Neil C.E.
        • Stuff J.E.
        • Hughes S.O.
        • Liu Y.
        Characterizing dinner meals served and consumed by low-income preschool children.
        Child Obes. 2012; 8: 561-571
      5. National Cancer Institute. Applied Research Program website. Healthy Eating Index. HEI Tools for Researchers. Last modified April 11, 2014. http://appliedresearch.cancer.gov/hei/tools.html. Accessed September 12, 2014.

      6. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. About BMI for children and teens. July 2014. http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html#normal%20weight%20ranges. Accessed January 3, 2015.

      Biography

      M. J. Romo-Palafox is a doctoral candidate, Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin.

      Biography

      S. J. Sweitzer is a lecturer and Didactic Program in Dietetics (DPD) program director, Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin.

      Biography

      M. E. Briley is a professor, Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin.

      Biography

      N. Ranjit is an assistant professor, Michael & Susan Dell Center for Healthy Living, Department of Health Promotion/Behavioral Sciences, University of Texas School of Public Health, Austin.

      Biography

      D. M. Hoelscher is director and John P. McGovern Professor in Health Promotion, Michael & Susan Dell Center for Healthy Living, Department of Health Promotion/Behavioral Sciences, University of Texas School of Public Health, Austin.

      Biography

      C. E. Byrd-Williams is a faculty associate, Michael & Susan Dell Center for Healthy Living, Department of Health Promotion/Behavioral Sciences, University of Texas School of Public Health, Austin.

      Biography

      C. Roberts-Gray is a program evaluation specialist, Galveston, TX.