Interventions for Improving Young Children’s Dietary Intake through Early Childhood Settings: A Systematic Review

Early childhood settings (ECS) offer a unique opportunity to intervene to improve children’s nutrition. This paper reviews the literature on early childhood setting interventions that aim to improve children’s dietary intake. Environmental and individual determinants of children’s dietary intakes were also investigated. Prospective intervention studies targeting centres, staff, parents/caregivers or children, were reviewed. Methodological quality was assessed. Twenty six studies (14 weak, 12 moderate quality) were included. Interventions were delivered primarily via training workshops and/or written materials. Study findings favoured intervention effectiveness in 23 studies. Improvements were seen in children’s intake for 8 out of 11 studies assessing dietary intake outcomes. Small increases in fruit and vegetable consumption were observed in five studies. Most studies measuring parental or centre food provision observed post-intervention improvements across a number of food groups, including fruit, vegetables, whole grains and sweetened beverages. Significant improvements in child, parent and/or staff knowledge, attitudes or behaviours were observed consistently across studies. For those studies that included a comparison group, these improvements were observed only in the intervention group. ECS interventions can achieve changes in children’s dietary intake and associated socio- environmental- determinants, although the quality of current research limits confidence in study findings. Future intervention development needs to carefully consider the behavioural targets, modifiable determinants and utilise age-appropriate and effective behaviour change theory, in addition to inclusion of dietary intake outcomes

Understanding the role of infant and toddler nutrition on population health : epidemiological resources in Australasia

The importance of understanding the relationship between weaning and toddler nutrition, which in turn impacts on health in later life, is highlighted. Emphasis is placed on the need for epidemiological research in Australasia for population-specific information on early life diet and health.Rebecca K Golley, Lisa G Smithers, Karen Campbell, and John Lync

Discrete strategies to reduce intake of discretionary food choices: a scoping review

On a population level, dietary improvement strategies have had limited success in preventing the surge in overweight and obesity or reducing risk factors for chronic disease. While numerous multi-component studies have examined whole-of-diet strategies, and single component (i.e. discrete) dietary intervention strategies have targeted an increase in core foods (e.g. fruits, vegetables, dairy), there is a paucity of evidence on the effectiveness of dietary intervention strategies targeting a decrease in discretionary choices. The aim of this review was to identify dietary intervention strategies that are potentially relevant to reducing intake of discretionary choices in 2–65 year olds. A scoping review was carried out to map the literature on key discrete dietary intervention strategies that are potentially applicable to reducing discretionary choices, and to identify the targeted health/nutrition effects (e.g. improve nutrient intake, decrease sugar intake, and reduce body weight) of these strategies. Studies conducted in participants aged 2–65 years and published in English by July 20, 2015, were located through electronic searches including the Cochrane Library, Medline, Embase, CINAHL, and Scopus. Three thousand two hundred and eighty three studies were identified from the search, of which 44 met the selection criteria. The dietary intervention strategies included reformulation (n = 13), substitution (n = 5), restriction/elimination (n = 9), supplementation (n = 13), and nutrition education/messages (n = 4). The key findings of the review were: restricting portion size was consistently beneficial for reducing energy intake in the acute setting; reformulating foods from higher fat to lower fat could be useful to reduce saturated fat intake; substituting discretionary choices for high fibre snacks, fruit, or low/no-calorie beverages may be an effective strategy for reducing energy intake; supplementing nutrient dense foods such as nuts and wholegrain cereals supports an improved overall diet quality; and, a combination of permissive and restrictive nutrition messages may effectively modify behavior to reduce discretionary choices intake. Longer-term, well-controlled studies are required to assess the effectiveness of the identified dietary strategies as interventions to reduce discretionary choices intake

Group-based trajectories of maternal intake of sugar-sweetened beverage and offspring oral health from a prospective birth cohort study

OBJECTIVES: To investigate the trajectory of maternal intake of sugar-sweetened beverages (SSB) during the first five years of their child's life and its effect on the child's dental caries at five years-of-age. METHODS: This is an ongoing prospective population-based birth cohort study in Adelaide, Australia. Mothers completed questionnaires on their SSB intake, socioeconomic factors and health behaviors at the birth of their child and at the ages of one, two and five years. Child dental caries measured as decayed, missing, or filled tooth surfaces was collected by oral examination. Maternal SSB intake was used to estimate the trajectory of SSB intake. The trajectories then became the main exposure of the study. Dental caries at age five years were the primary outcomes. Adjusted mean- and prevalence-ratios were estimated for dental caries, controlling for confounders. RESULTS: 879 children had dental examinations at five years-of-age. Group-based trajectory modeling identified three trajectories of maternal SSB intake: 'Stable low' (40.8%), 'Moderate but increasing' (13.6%), and 'High early' trajectory (45.6%). Multivariable regression analysis found children of mothers in the 'High early' and 'Moderate but increasing' groups to have greater experience of dental caries (MR: 1.37 (95%CI 1.01-1.67), and 1.24 (95%CI 0.96-1.60) than those in the 'Stable low' trajectory, respectively. CONCLUSION: Maternal consumption of SSB during pregnancy and in the early postnatal period influenced their offspring's oral health. It is important to create a low-sugar environment from early childhood. The results suggest that health promotion activities need to be delivered to expecting women or soon after childbirth

Development of an initiatives package to increase children’s vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment

Abstract Objective: To inform a package of initiatives to increase children’s vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum. Design: Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children’s dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability. Setting: LDC centres in metropolitan Adelaide, South Australia. Participants: 32 centres, 276 staff and 1039 children aged 2–5 years. Results: There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0–50 % completed the menu assessment, 3/5 would recommend). Conclusion: A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children’s vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework

A preference based measure of complementary feeding quality: Application to the Avon Longitudinal Study of Parents and Children

This paper presents the development of the Complementary Feeding Utility Index (CFUI), a composite index aimed to measure adherence to infant feeding guidelines. Through an axiomatic characterization this paper shows the advantages in using the CFUI are the following: it avoids the use of arbitrary cut-offs, and by converting observed diet preferences into utilities, summing the score is meaningful. In addition, as the CFUI is designed to be scored continuously, it allows the transition from intake of beneficial foods (in low quantities) and intake of detrimental foods (in high quantities) to be more subtle. The paper first describes the rationale being the development of the CFUI and then elaborates on the methodology used to develop the CFUI, including the process of selecting the components. The methodology is applied to data collected from the Avon Longitudinal Study of Parents and Children to show the advantages of the CFUI over traditional diet index approaches. Unlike traditional approaches, the distribution of the CFUI does not peak towards mean value but distributes evenly towards the tails of the distribution.Murthy N. Mittinty, Rebecca K. Golley, Lisa G. Smithers, Laima Brazionis, John W. Lync

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: Protocol for a Systematic Review with Individual Participant Data Meta-Analysis of Behavioural Interventions for the Prevention of Early Childhood Obesity

INTRODUCTION: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. METHODS AND ANALYSIS: Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. ETHICS AND DISSEMINATION: Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO REGISTRATION NUMBER: CRD42020177408

Unpacking the Behavioural Components and Delivery Features of Early Childhood Obesity Prevention Interventions in the TOPCHILD Collaboration: A Systematic Review and Intervention Coding Protocol

INTRODUCTION: Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. METHODS AND ANALYSIS: Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. ETHICS AND DISSEMINATION: The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study\u27s findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. PROSPERO REGISTRATION NUMBER: CRD42020177408

Which outcome measurement instruments are used to measure core infant feeding outcomes in children up to 1 year of age? A scoping review protocol

BackgroundHow, what, and when infants are fed plays a role in the aetiology of childhood obesity. Heterogeneity in how infant feeding outcomes are measured in trials of interventions to prevent childhood obesity limits evidence syntheses and understanding of intervention effectiveness. An infant feeding core outcome set (COS) was previously developed to standardised outcome measurement and reporting. The COS represents what to measure; determining how best to measure these outcomes is the next essential step to improve intervention evaluations. The aim of this scoping review is therefore to identify what outcome measurement instruments have been used in trials, and how they have been used, to measure the core infant feeding outcomes.MethodsA scoping review will be conducted. MEDLINE, EMBASE, CINAHL, PsychINFO, the Cochrane Central Register of Controlled Trials, OpenGrey and GreyNet will be searched from inception. Papers areeligible for inclusion if they report trials involving primary data collection that measure and report at least one core infant feeding outcome in infants ≤one year of age. Following searching and screening, eligible studies will be categorised into the following four overarching categories for data extraction, synthesis and write-up: caregiver-related outcomes; diet-related outcomes; feeding environment outcomes; child weight outcomes. Data will be narratively described and presented in tabular format, with findings presented in four separate review papers delineated by the four overarching categories.DiscussionThis scoping review forms part of the Standardised measurement for Childhood Obesity Prevention (SCOPE) study (www.eiascope.com). Evidence from this scoping review on what measurement instruments are used, and how they are used, represents an essential first step in developing recommendations and guidance about how best to measure core infant feeding outcomes for childhood obesity prevention. This can improve evidence syntheses and understanding of what infant feeding interventions are most effective for childhood obesity prevention

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity.

INTRODUCTION: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. METHODS AND ANALYSIS: Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. ETHICS AND DISSEMINATION: Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO REGISTRATION NUMBER: CRD42020177408