The goal of the current study was to assess dietary intake in a large sample (N = 1016) of Dutch toddlers (1–3 years old), both at childcare and at home. Dietary intake during two weekdays was recorded using an observation format applied by childcare staff for intake at childcare, and partially pre-coded dietary journals filled out by parents for intake at home. Children’s intake of energy, macronutrients and energy balance-related food groups (fruit, vegetables, sweet snacks, savoury snacks) were compared with Dutch dietary guidelines. In addition, differences between the dietary intake by various subgroups (based on gender, age, childcare attendance, socio-economic status of childcare centre) were explored using multilevel regression analyses, adjusting for nesting of children within centres. Energy intake was high relative to dietary guidelines, and children consumed more or less equal amounts of energy at home and at childcare. Dietary fibre, fruit and vegetable and snack intakes were low. Intake at childcare mainly consisted of carbohydrates, while intake at home contained more proteins and fat. The findings imply various opportunities for childcare centres to improve children’s dietary intake, such as providing fruit and vegetables at snacking moments. In addition, the findings underline the importance of assessing dietary intake over a whole day, both at childcare and at home, to allow intake to be compared with dietary guidelines.

BackgroundThe need to understand barriers to the implementation of health care innovations in daily practice has been widely documented, but perceived facilitators and barriers in diabetes care by Dutch health care professionals remain unknown. The aim of this study was to investigate these factors among health care professionals (HCPs) using a qualitative research design.MethodsData were collected from 18 semi-structured interviews with HCPs from all professions relevant to diabetes care. The interviews were recorded and transcribed verbatim and the data were analyzed using NVivo 8.0.ResultsMajor facilitators were the more prominent role of the practice nurses and diabetes nurses in diabetes care, benchmarking, the Care Standard (CS) of the Netherlands Diabetes federation and multidisciplinary collaboration, although collaboration with certain professional groups (i.e. dieticians, physical therapists and pharmacists), as well as the collaboration between primary and secondary care, could still be improved. The bundled payment system for the funding of diabetes care and the role of the health insurers were perceived as major barriers within the health care system. Other important barriers were reported to be the lack of motivation among patients and the lack of awareness of lifestyle programs and prevention initiatives for diabetes patients among professionals.ConclusionsOrganizational changes in diabetes care, as a result of the increased attention given to management continuity of care, have led to an increased need for multidisciplinary collaboration within and between health care sectors (e.g. public health, primary care and secondary care). To date, daily routines for shared care are still sub-optimal and improvements in facilities, such as registration systems, should be implemented to further optimize communication and exchange of information.

Health promotion efforts should aim to stimulate breakfast consumption, particularly among vocational school students and adolescents of non-Dutch origin. Special attention should be given to breakfast quality. Future research should investigate whether better adherence to the recommendations of the NNC results in enhanced nutrient intake at breakfast.

BackgroundTo assess how much of a public health problem emotional and instrumental feeding practices are, we explored the use of these feeding practices in a sample of Dutch mothers regarding their child’s food intake between main meals.MethodsA cross-sectional questionnaire study was conducted among 359 mothers of primary school children aged 4–12 years. The questionnaires were completed online at home.ResultsOf the mothers, 29.5% reported using foods to reward, 18.1% to punish and 18.9% to comfort their child. Mothers most frequently offered energy-dense and nutrient-poor products such as candy in the context of emotional and instrumental feeding practices. The use of these practices was associated with a lower age of both mother and child and a higher educational level of the mother. Mothers living in neighborhoods with intermediate socioeconomic position used the practices less often than mothers from low and high socioeconomic position neighborhoods.ConclusionsOur results show that mothers in our sample mainly used unhealthy products in the context of instrumental and emotional feeding practices. Research into the association between these practices and children’s dietary intake is warranted, since the use of unhealthy products in the context of these practices may not necessarily lead to an increased consumption of these products. Findings regarding the frequency of use of these practices among specific subgroups can be used to carefully determine the target population for interventions and tailor the content of interventions to specific target group characteristics. Besides examining associations between personal and family characteristics and the use of emotional and instrumental feeding practices, attempts should be made to understand parents’ reasons for using them.

BackgroundKrachtvoer is a school-based healthy diet programme, developed in 2001 and revised in 2007 to meet the needs of particular segments of the target population as well as a wider target group. The main aims of the present process evaluation of the revised programme were to examine student and teacher appreciation of the programme, completeness of and adherence to its implementation, and relations between appreciation and completeness of implementation.MethodsData were collected among 22 teachers and 1117 students of 13 schools, using student evaluation forms, teacher logbooks, telephone interviews, and classroom observations.ResultsResults indicate favourable levels of teacher and student appreciation for the programme in general and the revised elements. Girls, first-year students and students with more favourable dietary intakes particularly appreciated individual programme elements. Levels of completeness of implementation were high, but several teachers did not adhere to the intended implementation period. Some moderately strong relations were found between teacher appreciation and completeness of implementation scores.ConclusionWe conclude that the revisions have resulted in a programme that was appreciated well, also by the extended target group, and was implemented with a high degree of completeness. Teacher appreciation proved potentially important for completeness of implementation. We identified several aspects requiring improvement, indicating the importance of continued programme updates and repeated evaluation.