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Assessing Foods Offered to Children at Child-Care Centers Using the Healthy Eating Index-2005

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Abstract

The Healthy Eating Index-2005 (HEI-2005) has been applied primarily to assess the quality of individual-level diets but has recently been applied to environmental-level data as well. Currently, no studies have applied the HEI-2005 to foods offered in child-care settings. This cross-sectional study used the HEI-2005 to assess the quality of foods and beverages offered to preschool children (3 to 5 years old) in child-care centers. Two days of dietary observations were conducted and 120 children (six children per center) were observed at 20 child-care centers in North Carolina between July 2005 and January 2006. Data were analyzed between July 2011 and January 2012 using t tests. Mean total HEI-2005 score (59.12) was significantly (P<0.01) lower than the optimal score of 100, indicating the need to improve the quality of foods offered to children. All centers met the maximum score for milk. A majority also met the maximum scores for total fruit (17 of 20 centers), whole fruit (15 of 20 centers), and sodium (19 of 20 centers). Mean scores for total vegetable (mean=2.26±1.09), dark green/orange vegetables and legumes (mean=0.20±0.43), total grain (mean=1.09±1.25), whole grain (mean=1.29±1.65), oils (mean=0.44±0.25), and meat/beans (mean=0.44±0.25) were significantly lower than the maximum scores recommended (P<0.01). Mean scores for saturated fat (mean=3.32±3.41; P<0.01) and calories from solid fats and added sugars (mean=14.76±4.08; P<0.01) suggest the need to decrease the provision of foods high in these components. These findings indicate the need to improve the quality of foods offered to children at the centers to ensure that the foods provided contribute to children's daily nutrition requirements.

Section snippets

Sample

Data for this cross-sectional study were collected between July 2005 and January 2006, before a statewide evaluation of the Nutrition and Physical Activity Self-Assessment for Child Care intervention.24, 25 The Nutrition and Physical Activity Self-Assessment for Child Care intervention was designed to improve the nutrition and physical activity environment in child-care centers, and was evaluated in 84 licensed child-care centers across North Carolina. A subset of 20 centers was randomly

Results

Table 2 describes HEI-2005 component scores and total HEI-2005 scores for foods and beverages provided to children at all 20 child-care centers. Mean total HEI-2005 score was significantly lower than the optimal recommended score (59.12 vs optimal score of 100; P<0.01), with total HEI-2005 scores ranging from 47.30 to 76 across all 20 centers. Mean scores for total fruit (mean=4.69±0.81 vs optimal score of 5; P=0.11) and whole fruit (mean=4.70±0.74 vs optimal score of 5; P=0.08) were not

Discussion

Many children in the United States share a substantial portion of their daily lives between the child-care center and home,2, 3 and their ability to meet their daily nutrition requirements is largely dependent on the quality and quantity of foods and beverages provided in child-care centers. This is the first study to use the HEI-2005 to assess the quality of foods and beverages provided to preschool children in child-care centers. Findings indicate the need to improve the overall quality of

Conclusions

This is the first study to use the HEI-2005 to assess the quality of foods and beverages provided to preschool children in child-care centers. Although based on a small convenience sample from a single state, findings of the study indicate the need for improvements in the overall quality of foods and beverages provided to preschool children in child-care centers. Specifically, child-care centers need to provide more vegetables, including dark green and orange vegetables and legumes, total grain

Acknowledgements

The authors thank Diane Mitchell, Coordinator of the Diet Assessment Center at Pennsylvania State University, for providing guidance in calculating Healthy Eating Index 2005 scores using output from the Nutrition Data System for Research software, and Christina McWilliams and Stephanie Mazzucca of the Centers for Health Promotion and Disease Prevention, University of North Carolina, for their insightful feedback.

T. O. Erinosho is a research assistant professor, Department of Nutrition and Center for Health Promotion and Disease Prevention, the University of North Carolina at Chapel Hill.

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    T. O. Erinosho is a research assistant professor, Department of Nutrition and Center for Health Promotion and Disease Prevention, the University of North Carolina at Chapel Hill.

    D. Stanton Ward is a professor, Department of Nutrition and Center for Health Promotion and Disease Prevention, the University of North Carolina at Chapel Hill.

    P. P. Hanson is a research assistant, Center for Health Promotion and Disease Prevention, the University of North Carolina at Chapel Hill.

    A. E. Vaughn is a research associate, Center for Health Promotion and Disease Prevention, the University of North Carolina at Chapel Hill.

    S. C. Ball is a nutrition consultant in private practice, Chicago, IL.

    To take the Continuing Professional Education quiz for this article, log in to www.eatright.org, click the “myAcademy” link under your name at the top of the homepage, select “Journal Quiz” from the menu on your myAcademy page, click “Journal Article Quiz” on the next page, and then click the “Additional Journal CPE Articles” button to view a list of available quizzes, from which you may select the quiz for this article.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT This study was conducted at the University of North Carolina at Chapel Hill's Center for Health Promotion, which is supported by Cooperative Agreement No. U48-DP001944 from the Centers for Disease Control and Prevention. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This work was also supported by the Nutrition Obesity Research Center at the University of North Carolina at Chapel Hill (NIH DK056350).

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