August 2013

Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005

The first few years of life build important eating habits, and help to establish a baseline of health through childhood and into early adulthood. Day care centers may provide up to 80% of a child's food intake each day, and 55% of preschool-aged children attend day care centers (ChildStats.gov, 2011), so there are significant implications for health if optimal nutrition is not met during these critical years.

Several studies have found that many children do not eat adequate amounts of important nutrients, particularly in the child-care setting. One recent study analyzed the dietary intake of children at 40 day care centers in New York, and found that less than 50% of children reached even half of the daily recommended intake of five major food groups, and less than 20% ate half of the recommended intake for vegetables (Erinosho et. al, 2011). A second study surveying Oklahoma day cares found that only 18% of the 314 centers surveyed offered non-starchy vegetables on a daily basis, and nearly two-thirds did not offer high-fiber and whole grains more than once per week (Sisson et. al, 2012).

The purpose of this study was to determine, using the Healthy Eating Index-2005, how closely day care centers are meeting the 2005 Dietary Guidelines for Americans in their meal and snack offerings to preschool-aged children. This was the first study to utilize the HEI-2005 in this particular setting. The Healthy Eating Index-2005 (HEI-2005) measures compliance with the 2005 Dietary Guidelines for Americans and MyPyramid. The Dietary Guidelines for Americans is published every 5 years by the Department of Health and Human Services and the USDA, and provides advice about good dietary habits and the prevention of chronic disease. 

The HEI-2005 consists of 12 food and nutrient categories, including total fruit, whole fruit, total vegetables, dark green and orange vegetables and legumes, total grains, whole grains, milk, meats and beans, oils, saturated fat, sodium, and calories from SoFAS. Each component is assessed on density as a percent of total calories, and assigned a standard score by the USDA. The maximum possible score of each category meets the ideal requirements for that nutrient category.

The participants for this study include male and female preschool children, aged 3-5, enrolled in day cares throughout North Carolina that participated in The Nutrition and Physical Activity Self-Assessment for Child Care intervention (designed to promote physical activity and nutrition in day cares). Research assistants observed foods and beverages offered to children in one preschool classroom at each center. The types and amounts of food and beverages served at breakfast, morning snack, lunch, and afternoon snack were recorded for each child. The final sample consisted of 120 children, 6 each from 20 day cares randomly selected of 84 participating in the intervention program. Statistical analysis included

The Nutrition Data System for Research software was used to determine food groups, calories, and nutrients, and each HEI-2005 component was averaged over a 2-day intake to determine a score. T-tests were used to assess whether mean HEI-2005 scores and total HEI-2005 scores differed significantly from maximum recommended scores.

The results of the study show a mean HEI-2005 of 59.12, significantly lower than the optimal score of 100. While all centers met the maximum score for milk, and the majority met the maximum score for total fruit, whole fruit, and sodium, scores for all other categories were significantly lower than the maximum scores recommended. Most notably, dark green/orange vegetables and legumes had the lowest score of all categories (mean=0.20+0.43 out of 5). The mean score for calories from solid fats and added sugars  show there is room for improvement (mean=14.76+4.08 out of 20). Only four centers met the recommendations for calories from solid fat and added sugars.

In conclusion, this study found that there is room for improvement in the overall quality of foods and beverages provided by day care centers for young children, specifically increasing the amount of vegetables, whole grains, meats/beans, and oils, and decreasing the amount of saturated fats, solid fats, and added sugars. Considering the results of this study, and the study findings of other day care centers in various states, child-care nutrition is an area that should needs to addressed for improvements.

Referenced studies:

1. Erinosho T, Dixon LB, Young C, Brotman LM, Hayman LL. Nutrition practices and children's dietary intakes at 40 child 

           care centers in New York City. J Am Diet Assoc. 2011;111(9):1391-1397.

2. Sisson SB, Campbell JE, May KB, Brittain DR, Monroe LA, Guss SH, & Ladner JL. Assessment of food, nutrition, and 

          physical activity practices in Oklahoma Child-care centers. J Acad Nutr Diet. 212;112:1230-1240.