Dietary Quality of Preschoolers' Sack Lunches as Measured by the Healthy Eating Index

Abstract

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.

Dietary intake and physical activity levels of children attending Australian childcare services

“…Given dietary guidelines recommend that such foods are limited, and if chosen, are only eaten sometimes and in small amounts, it is concerning that children consumed such a high amount of discretionary foods while in care. Such findings are consistent with those of previous international studies that have investigated the dietary quality of foods brought from home in a lunchbox (although not necessarily consumed) . One study conducted in the United States, found that more than 80% of the sample did not provide or consume the recommended amount of vegetables, 70% did not pack or consume enough wholegrains, seafood and plant proteins, and 60–70% exceeded recommendations for refined grains, sodium and saturated fats .…”

“…Such findings are consistent with those of previous international studies that have investigated the dietary quality of foods brought from home in a lunchbox (although not necessarily consumed) . One study conducted in the United States, found that more than 80% of the sample did not provide or consume the recommended amount of vegetables, 70% did not pack or consume enough wholegrains, seafood and plant proteins, and 60–70% exceeded recommendations for refined grains, sodium and saturated fats . An additional study that undertook audits of Australian children's lunchboxes also found that 60% of lunchboxes contained more than one serve of ‘extra’ or discretionary foods, with an average of 1.8 serves per lunchbox .…”

“…This study provides valuable data regarding the current dietary intake and physical activity levels of children attending Australian childcare services, and is one of a small number describing actual child dietary intake in care from foods brought from home . Overall the study found considerable opportunity for improvement in child dietary intake and physical activity, especially in the consumption of vegetables (particularly in children attending services located in urban areas) and meat and meat alternatives.…”

Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia

“…In one study of preschool packed lunches in the UK, 42% included crisps, 24% confectionary, and most provided a sugar-sweetened drink [ 38 ]. In the USA, preschool packed lunches are high in salt, and low in minerals, vegetables, fruit, and dietary fibre [ 45 , 46 ].…”

Position of the Academy of Nutrition and Dietetics: Benchmarks for Nutrition in Child Care

“…In a recent study of 30 child-care centers in Texas, researchers found that packed lunches lacked vegetables, plant-based proteins, and whole grains. 21 The Lunch is in the Bag intervention was designed to help improve the nutritional quality of foods provided by parents through sack lunches. After the 5-week intervention and a 1-week booster training, parents increased the number of whole grains and decreased the number of sweet foods in sack lunches provided to children.…”