Food4toddlers. Fostering healthy dietary habits through targeting toddlers' food and eating environment : The Food4toddlers study

Aims and objectives: 1) to develop, implement, and evaluate an eHealth intervention, aiming to promote healthy dietary habits in toddlers by targeting parents’ awareness of their child’s food and eating environments, and 2) to examine associations between parental food choice motives, parental feeding practices, and children’s fruit and vegetable intake. Results: The study’s rationale and development were described in a protocol paper, along with a presentation of the baseline characteristics of the included participants. In total, 404 parents signed up for participation, and 298 answered baseline questionnaires and were randomized into either the control (n=150) or intervention (n=148) group. Most of the parents were highly educated mothers. From baseline to the first follow-up there was a significant time by group interaction for the frequency of vegetable intake (p = 0.02), showing a higher change in intake in the intervention group compared with the control group (paper III). A borderline significant between-group difference in the variety of vegetable intake in favor of the intervention group was seen from baseline to both follow-ups. No significant differences were observed for other food groups. The process evaluation of the study (paper IV) revealed that 86.5% of the participants in the intervention group visited the website. Most parents found the website appropriate to the child’s age as well as self-explanatory (86–95%) and appreciated the layout and interface (55–63%). The recipes were valued as the most appreciated element included in the website. Highly educated participants (> 4 years of university/college) reported that they used end learned more from the website than participants with ≤ 4 years of education. Regarding the second aim (paper II), the results showed that higher parental scores on health motives were associated with a higher child intake of vegetables (τ = 0.394 (SE = 0.098), p < 0.001). No associations with fruit or vegetables were found for other parental food choice motives. Some associations between food choice motives and child vegetable or fruit intakes were mediated by the feeding practices assessed, though solely for health and sensory appeal motives. Effect sizes of the observed associations were generally small. Conclusions: Our findings support the use of eHealth interventions for supporting parents in their children's dietary upbringing. Through making the parents aware of dietary determinants and encouraging them to create a healthy food and eating environment, child diet was slightly improved, i.e., higher vegetable intake in the intervention group was observed. The intervention was well received by the parents, although especially by highly educated parents. Still, we did not manage to engage 13% of the participants, who did not enter the website at all. Health motives were associated with child vegetable intake, and healthpromoting feeding practices had some mediation effect. Our findings contribute to a better understanding of the relations affecting toddler’s eating habits. However, more research is needed to examine the prospective and experimental evidence of interventions to enhance toddlers’ diet and to clarify interactions between elements in the child’s food and eating environment that affect the diet.publishedVersio

Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers) : Randomized Controlled Trial

Background: In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet. Objective: In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment. Methods: The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results: At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions: A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form.publishedVersio