title: Nutrition practices of nurseries in England. Comparison with national guidelines.
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.
authors.affiliation: 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; Department of Community and Family Medicine, Duke University Medical Center, 2200 W Main St, DUMC 104006, Durham, North Carolina 27705, USA; Duke Global Health Institute, Duke University, 310 Trent Hall, Durham, North Carolina 27710, USA. Electronic address: sara.benjamin@duke.edu.
authors.forename: Sara E Benjamin
authors.initials: SE
authors.lastname: Neelon
authors.affiliation: 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.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burgoine
authors.affiliation: 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; Centre for Policy Research, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, England.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Hesketh
authors.affiliation: 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.
authors.forename: Pablo
authors.initials: P
authors.lastname: Monsivais
mesh_terms: D002656:Child Day Care Centers / Q000592:standards*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet / Q000592:standards*; D002523:Edible Grain; D002149:Energy Intake; D007887:Fabaceae; D005522:Food Services / Q000592:standards*; D058870:Food, Organic; D006801:Humans; D007223:Infant; D009724:Nurseries, Infant / Q000592:standards*; D018673:Nutrition Policy; D009749:Nutrition Surveys; D009752:Nutritional Status; D006113:United Kingdom
keywords: Child care; Early years; England; Nurseries; Nutrition