July 2014

Nutrition-Education Program Improves Preschoolers’ At-Home Diet: A Group Randomized Trial

As childhood obesity continues to be a popular topic in our news, many changes and interventions are taking place to try and improve the diet and lifestyle habits of children in the United States. There is ample evidence that preschool-aged children are falling short of meeting the 2010 Dietary Guidelines for Americans for foods such as fruits, vegetables, and low-fat or fat-free dairy products. While some of the eating habits of these children are determined in their home environment, what they eat is also influenced by child-care centers and programs. 60% of US children attend child-care centers regularly, and this provides these centers with a unique opportunity to intervene and educate these children on what constitutes a healthy diet. However, interventions that have taken place in the past have been unsuccessful due to the lack of parent involvement and ability to influence at-home eating habits. Multiple studies stress the importance of involving parents in the education process to improve their child’s eating habits, and yet this can be difficult to do. This study aimed to determine if a nutrition-education program that was administered by an RD to children and their parents in low-income child-care settings could increase children’s consumption of fruits and vegetables and low-fat or fat-free milk.

This study evaluated the impact of the program implemented by using a pretest/posttest design that sampled child-care centers in New York. Twenty-four centers participated, and were either located inside of New York City, or somewhere else in the state. The centers were also stratified based on involvement in Head Start, region, and size. Twelve centers were assigned to an intervention condition, and the other 12 were assigned to a control condition. The intervention centers received a 6-lesson program that was presented within a 6 to 10 week period by a registered dietitian, and the control centers did not. The lessons composed of information on trying new foods, eating a variety of vegetables and fruits, incorporating more dairy into the diet, eating healthier snacks, and engaging in physical activity, to name a few. Each topic included a lesson plan and activities to be used with both the preschoolers and their parents separately. The classes for children were approximately 30 minutes long, while the parent sessions ranged from 30 to 60 minutes. The lessons were available in both English and Spanish versions. At the end of each lesson, parents were given take-home materials and activities for them to complete with their children at a later time.

At the conclusion of the study, the results were analyzed to determine if the children had increased their consumption of fruits, vegetables, and low-fat or fat-free dairy products. On average, each child that participated in the program attended 5.04 classes (of the 6 total), while only 12% of the eligible parents attended any classes, and the majority of these parents attended 3 or more classes. Even with low parent involvement, however, there were significant changes in the children’s eating habits at the end of the study. The children in the intervention group were 39% more likely to drink low-fat or fat-free dairy products and had an average increase of 0.12 cups of vegetables in their diet. Fruit consumption in these children also increased, but not by enough to provide significant results.  

This study concludes that implementing an intervention to low-income child-care centers lead by registered dietitians can be successful in improving the diets of these children. Some limitations of this study were that the average age of children in the intervention and control groups differed significantly and that the pretests and posttests were based on parental responses, which may be inaccurate. If this study were to be repeated, the parental component should be evaluated to increase their involvement in the program. The biggest reason parents did not participate was cited to be because their schedules did not align with the class times. Offering more flexible class times – in both the morning and afternoon – may improve this parental participation.

Williams PA, Cates SC, Blitstein JL, Hersey J, Gabor V, Ball M, Kosa K, Wilson H, Olson S, Singh A. Nutrition-education program improves preschoolers’ at-home diet: a group randomized trial. Journal of the Academy of Nutrition and Dietetics 2014; 114:1001-1008.

Supplemental Article:

Alaimo K, Olson CM, Frongillo EA Jr. Low family income and food insufficiency in relation to overweight in US children. Arch Pediatr Adolesc Med 2001; 155:1161-1167.