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      Nutrition practices of nurseries in England. Comparison with national guidelines

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          Highlights

          • Recent national guidelines call for improved nutrition in child care in England.

          • Many nurseries were not meeting national guidelines for foods and beverages served.

          • Comparisons were made between nurseries in deprived areas and high resource areas.

          • Nurseries in more deprived areas reported serving more healthy and unhealthy foods.

          • Just over half of providers sought nutrition guidance from national reports.

          Abstract

          Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p = 0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p = 0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England.

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          Most cited references23

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          The Role of Sampling Weights When Modeling Survey Data

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            The quality and monetary value of diets consumed by adults in the United States.

            Food prices are an established determinant of food choice and may affect diet quality. Research on diet cost and diet quality in representative populations has been hindered by lack of data. We sought to explore the distribution of diet cost and diet quality among strata of the US population and to examine the association between the 2 variables. In this cross-sectional study, monetary costs of diets consumed by participants in the 2001-2002 NHANES were estimated with the use of a national food price database. Healthy Eating Index (HEI)-2005 values were estimated with the use of the population ratio method for the calculation of average scores. Mean daily diet costs, energy-adjusted diet costs, and HEI-2005 scores were estimated for subpopulations of interest. Associations between energy-adjusted diet cost, HEI-2005 scores, and HEI-2005 component scores were evaluated. Higher energy-adjusted diet costs were significantly associated with being older and non-Hispanic white, having a higher income and education, and living in a food-secure household. Higher diet costs were also associated with higher HEI-2005 scores for both men and women. Women in the highest quintile of diet costs had a mean HEI-2005 score of 69.6 compared with 52.5 for women in the lowest-cost quintile. Higher diet cost was strongly associated with consuming more servings of fruit and vegetables and fewer calories from solid fat, alcoholic beverages, and added sugars. Given the observed association between diet cost and diet quality, helping consumers select affordable yet nutritious diets ought to be a priority for researchers and health professionals.
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              The cost of US foods as related to their nutritive value.

              Comparisons of the cost of different foods relative to their energy and nutritive value were conducted in the 1800s by the US Department of Agriculture (USDA). The objective was to reestablish the relations between food cost, energy, and nutrients by using contemporary nutrient composition and food prices data from the USDA. The USDA Food and Nutrient Database for Dietary Studies 1.0 (FNDDS 1.0) and the Center for Nutrition Policy and Promotion food prices database were used for analysis. For 1387 foods, key variables were as follows: energy density (kcal/g), serving size (g), unit price ($/100 g), serving price ($/serving), and energy cost ($/kcal). A regression model tested associations between nutrients and unit price ($/100 g). Comparisons between food groups were tested by using one-factor analyses of variance. Relations between energy density and price within food groups were tested by using Spearman's correlations. Grains and fats food groups supplied the lowest-cost dietary energy. The energy cost for vegetables was higher than that for any other food group except for fruit. Serving sizes increased with water content and varied inversely with energy density of foods. The highest prices per serving were for meats, poultry, and fish, and the lowest prices per serving were for the fats category. Although carbohydrates, sugar, and fat were associated with lower price per 100 g, protein, fiber, vitamins, and minerals were associated with higher price per 100 g, after adjustment for energy. Grains and sugars food groups were cheaper than vegetables and fruit per calorie and were cheaper than fruit per serving. These price differentials may help to explain why low-cost, energy-dense foods that are nutrient poor are associated with lower education and incomes.
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                Author and article information

                Contributors
                Journal
                Appetite
                Appetite
                Appetite
                Academic Press
                0195-6663
                1095-8304
                01 February 2015
                01 February 2015
                : 85
                : 22-29
                Affiliations
                [a ]UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
                [b ]Department of Community and Family Medicine, Duke University Medical Center, 2200 W Main St, DUMC 104006, Durham, North Carolina 27705, USA
                [c ]Duke Global Health Institute, Duke University, 310 Trent Hall, Durham, North Carolina 27710, USA
                [d ]Centre for Policy Research, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, England
                Author notes
                [* ]Corresponding author. sara.benjamin@ 123456duke.edu
                Article
                S0195-6663(14)00514-5
                10.1016/j.appet.2014.11.002
                4286113
                25450898
                b284e4ba-ee4a-4109-b5df-0d524904aca5
                © 2014 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                : 29 December 2013
                : 24 September 2014
                : 2 November 2014
                Categories
                Research Report

                child care,early years,england,nurseries,nutrition
                child care, early years, england, nurseries, nutrition

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