Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework.
To systematically review the literature and map published studies on 4-8-year-olds' intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO).



Articles were identified through database searches (PubMed, PyscINFO®, Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences).



Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1).



Children aged 4-8 years, or parents/other caregivers.



Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective.



The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children's excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.
1Division of Health Sciences,Sansom Institute for Health Research,University of South Australia,North Terrace,GPO Box 2471,Adelaide,SA 5001,Australia.
Brittany J
BJ
Johnson
2Commonwealth Scientific Industrial Research Organisation Food and Nutrition Flagship,Adelaide,South Australia,Australia.
Gilly A
GA
Hendrie
1Division of Health Sciences,Sansom Institute for Health Research,University of South Australia,North Terrace,GPO Box 2471,Adelaide,SA 5001,Australia.
Rebecca K
RK
Golley
D001315:Australia; D001530:Belgium; D001628:Beverages; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002755:Choice Behavior; D004032:Diet; D005247:Feeding Behavior; D005858:Germany; D006293:Health Promotion; D006801:Humans; D009426:Netherlands; D014421:Turkey; D006113:United Kingdom; D014481:United States
Added sugar; Children; Diet quality; Discretionary choices; Ecological; Energy-dense nutrient-poor; Environments; Review; Solid fats; Sugar-sweetened beverages