This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children’s energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015–2016 in 66 Finnish preschools in eight municipalities involving 864 children (3–6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children’s EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children’s long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children’s physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children’s EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB.

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Objective: In many studies it has been shown that breakfast is associated with normal weight in children and adolescents. Other meals, family meals and a regular meal pattern have been less studied. Therefore, the aim of the present study was to examine whether a regular meal pattern, or breakfast, lunch or dinner as separate regular meals, is associated with the BMI of children. Design: A cross-sectional study conducted within the Helsinki region during 2006. Study participants were measured and weighed by research staff. Children filled in a study questionnaire on their health behaviour, including the frequency of consuming meals. A regular meal was defined as one usually eaten on every school day. A regular meal pattern was defined as one consisting of a usual consumption of breakfast, school lunch and dinner on every school day. Covariance analysis was used as the statistical analysis method. Setting: Capital region, Finland, 2006. Subjects: A total of 604 schoolchildren (312 girls) aged 9-11 years. Results: Irregular breakfast and an irregular meal pattern were associated with higher BMI. Regularity of school lunch, dinner or family dinner was not associated with BMI. Conclusions: A regular breakfast and meal pattern was associated with lower BMI in children, although breakfast was the only single meal associated with BMI. We conclude that, although the association between breakfast and weight status in children is fairly consistent, the role of other meals is less convincing.

BackgroundEffective interventions that target socioeconomic status (SES) differences to avoid the potential widening of inequalities in health are needed. Children at preschool age is a valuable intervention target since sedentary behaviors, physical activity (PA), dietary behaviors, and sleep habits, jointly called the energy balance-related behaviors (EBRBs), are established in early childhood and tend to persist later in life. The interventions are most effective, when they focus on evidence-based factors. One potential factor associated with EBRBs and SES is children’s stress regulation, which receives special attention in this study. Based on the socioecological approach, the combinations of multiple levels (e.g. individual, environmental, societal) of analysis and diverse methodologies (e.g. surveys, observations, biological measurements) are used to assess the healthfulness of environments (e.g. social, physical, learning, policy) in preschool and family settings. The intervention aimed to diminish SES differences in EBRBs is then conducted in the preschool setting.Methods/designThe DAGIS study is divided into two phases. The first phase comprises focus group interviews and a cross-sectional survey. Parents and preschool personnel in low SES neighborhoods participated in interviews about children’s sedentary behaviors, dietary behaviors, and PA in 2014. In the cross-sectional survey beginning in autumn 2015, preschools will be recruited from a random sample of preschools in 3–5 municipalities in Southern Finland. A total of 800 children will wear an accelerometer for seven days. Children’s hair and saliva samples will be taken. Parents and preschool personnel will complete questionnaires on EBRBs, social and physical environments and SES factors. The quality of preschool environment is also observed. In the second phase, an intervention targeting to narrowing SES differences in EBRBs is conducted. The effects of the intervention will be evaluated in randomised controlled trial. The implementation of the intervention will also be evaluated.ConclusionIf effective, this unique preschool-based study will be able to narrow the SES differences in preschool children’s EBRBs. This study is anticipated to identify the most important modifiable factors in preschool and family environmental settings associated with children’s EBRBs, especially in children from low SES backgrounds.Trial registrationISRCTN57165350 (January, 8th, 2015).

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