Fruits, vegetables and whole grains are important sources of nutrients for healthy growth and development of young children. Recent evidence suggests that sack lunches packed by parents for children to consume at childcare centers do not regularly meet the goal of one serving of fruit, vegetables and whole grains. Lunch is in the Bag is a childcare center-based nutrition education program targeted to parents of preschool-age children to increase the number of servings of fruits, vegetables and whole grains in sack lunches sent from home that was pilot tested in fall of 2008. In a quasi-experimental design, six childcare centers were paired by size before being randomly assigned to intervention (n=3) and comparison (n=3) groups. The parents of caregivers with primary responsibility for preparing the sack lunches of the three to five year old children attending the centers were enrolled as parent-child dyads. The intervention included parent handouts, classroom activities, educational stations and teacher training. The contents of the lunch sacks for both the intervention group and comparison group were recorded for three non-consecutive days before and immediately after the intervention period to measure the number of servings of fruits, vegetables and whole grains. A total of 132 parent-child dyads completed the study, 81 in the intervention group and 51 in the comparison group. Direct observation of children’s lunches from the intervention group showed an increase in predicted mean number of servings of vegetables, from 0.41 to 0.65 (P < 0.001) and whole grains, from 0.54 to 1.06 (P < 0.001). No significant difference was observed in the mean number of servings of fruit. Lunch is in the Bag which is designed to fit in the childcare environment and targets parents of three to five year old children is a feasible intervention for improving the nutritional quality of sack lunches.

BackgroundLunches that parents pack for their young children to eat at school or the Early Care and Education (ECE) center fall short of recommended standards. Lunch is in the Bag is a multi-level behavioral nutrition intervention to increase parents’ packing of fruit, vegetables, and whole grains in their children’s lunches. Designed for implementation in ECE centers, the five-week long intervention is followed three months later with a one-week booster.MethodsEfficacy of Lunch is in the Bag was tested in cluster randomized trial. Participants were 633 families from 30 ECE centers (15 intervention, 15 control) across Austin, San Antonio, and Houston, Texas, USA. Primary outcomes were servings of fruit, vegetables, and whole grains observed in the children’s parent-packed bag lunches. Servings of refined grains, meats/beans/eggs/nuts, dairy, chips, and sweets also were observed. Data were collected at baseline, post-intervention (6-week follow-up), pre-booster (22-weeks follow-up), and post-booster (28-week follow-up). Time-by-treatment interactions were analyzed separately for each of the food groups using multi-level models to compare changes from baseline. Analyses were adjusted for relevant demographic variables and clustering within centers and parents.ResultsThe intervention effected increases from baseline to 6-week follow-up in vegetables (0.17 servings, SE = 0.04, P < 0.001) and whole grains (0.30 servings, SE = 0.13, P = 0.018). The increase in whole grains was maintained through the 28-week follow-up (0.34 servings, SE = 0.13, P = 0.009). Fruit averaged more than 1.40 servings with no differences between groups or across time. The intervention prevented increase in sweets (-0.43 servings, SE = 0.11, P < .001, at the 22-week follow-up). Parents persisted, however, in packing small amounts of vegetables (averages of 0.41 to 0.52 servings) and large amounts of sweets and chips (averages of 1.75 to 1.99 servings).ConclusionsThe need for and positive effects of the Lunch is in the Bag intervention at ECE centers where parents send bag lunch for their preschool-aged children was confirmed. An important direction for future research is discovery of more options for leveraging the partnership of ECE centers and families to help young children learn to eat and enjoy vegetables and other healthy foods in preference to less healthy choices such as chips and sweets.Trial registrationThe Clinical Trials Number is NCT01292434.

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Background Eating habits are developed during the preschool years and track into adulthood, but few studies have quantified dietary quality of meals packed by parents for preschool children enrolled in early care and education centers. Objective Our aim was to evaluate the dietary quality of preschoolers’ sack lunches using the Healthy Eating Index (HEI) 2010 to provide parents of preschool children with guidance to increase the healthfulness of their child’s lunch. Design This study is a cross-sectional analysis of baseline dietary data from the Lunch Is in the Bag trial. Participants A total of 607 parent–child dyads from 30 early care and education centers in Central and South Texas were included. Main outcome measures Total and component scores of the HEI were computed using data obtained from direct observations of packed lunches and of children’s consumption. Statistical analysis Three-level regression models with random intercepts at the early care and education center and child level were used; all models were adjusted for child sex, age, and body mass index (calculated as kg/m2). Results Mean HEI-2010 total scores were 58 for lunches packed and 52 for lunches consumed, out of 100 possible points. Mean HEI component scores for packed and consumed lunches were lowest for greens and beans (6% and 8% of possible points), total vegetables (33% and 28%), seafood and plant proteins (33% and 29%), and whole grains (38% and 34%); and highest for empty calories (85% and 68% of possible points), total fruit (80% and 70%), whole fruit (79% and 64%), and total protein foods (76% and 69%). Conclusions Parents of preschool children pack lunches with low dietary quality that lack vegetables, plant proteins, and whole grains, as measured by the HEI. Education of parents and care providers in early care and education centers is vital to ensure that preschoolers receive high dietary-quality meals that promote their preference for and knowledge of a healthy diet.

Background Packing fruit, vegetables, and whole grains in preschool children’s sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. Purpose Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. Methods Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N=81) and comparison (N=51) parent-child dyads were evaluated in multilevel modeling. Results The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. Discussion Tailored options were identified for further strategies to increase vegetables and whole grains in parent-packed sack lunches. Translation to Health Education Practice Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.