The impact of a healthy eating intervention: A comparative, longitudinal observation of dietary intake, knowledge and behaviour in council sector nursery school children and their parents in Edinburgh.

Abstract

Good nutrition is essential for optimal growth and functional development in children. Research indicates that the preschool years are essential for encouraging children to develop a taste for healthy food. Scotland's obesity rates are amongst the highest in the world, and in areas of low socio-economic status, obesity and related conditions are considered to be most prevalent. It is also widely reported that areas of deprivation are related to poor dietary intake. In 2004, Edinburgh Community Food Initiative (ECFI) was responsible for initiatives that were based on ECFI's 'provide and promote' philosophy, combining health promotion activities with the provision of fresh fruit and vegetables to schools, child and family centres and community centres in the most disadvantaged communities of Edinburgh. Funding was acquired from the Big Lottery Fund to initiate a citywide health initiative in the nursery school setting called 'the Pip Project'. The aim of this research was to identify dietary intake at baseline in pre-school children and their parents from council sector nurseries, and to observe changes in dietary intake and behaviour over a period of 20 months, comparing dietary intake of children and their parents from areas of lower socio-economic status who received the Pip project interventions to those from areas of higher socio-economic status, who did not. Dietary intake was recorded using a 5 day diet diary at three time points; prior to nursery school attendance (August 2005), at completion of year one (June 2006), and two months prior to leaving nursery (April 2007). A questionnaire was also completed to determine knowledge and dietary behaviour at baseline (August 2005) and at the end of the research period (April 2007). Baseline intake was compared to the National Diet and Nutrition Surveys for adults and for children aged 1.5 to 4.5 years, the Payne and Belton Edinburgh preschool dietary survey, the Food Standards Agency Low Income Diet and Nutrition Survey, and the standards devised by UK Scientific Advisory Committee for Nutrition (SACN). Results at baseline were comparable to results from other national surveys. Research indicated that all adults were aware of the 5 a day message and 80 % thought that 400 g was 'just right' or 'not enough'. Adults, and particularly those from the lower SES group, had clear knowledge of what constituted one portion of fruit or vegetables and did not report any barriers to healthy eating, however at baseline fruit and vegetable intake was 260 g/d, which was significantly lower (p = < 0.05) than the recommended 400 g/d and intakes were significantly less (p = < 0.05) in the lower SES group (219.5 g/d compared with 297.5 g/d in the higher SES group). Minimal increase was seen in fruit and vegetable intake of adults from the lower SES group, who consumed significantly less (p = < 0.05) than adults from the higher SES group by the end of the 20 month research period; children from the lower SES increased their intake by 1 portion (82 g) per day but still consumed less than the children from the higher SES group by stage 3 (203 g/d compared to 253 g/d). At baseline, the diet was balanced for adults and children in terms of % energy from CHO and fat, but mean intakes of both NME sugar and saturated fat were greater than the recommended maximum intake of 11 % total food energy. Mean intake NME sugar in children was 17.9 %; intakes were greater in the higher SES group (19.5 % compared to 16.6 %). Mean intakes were also significantly greater (p = < 0.05) in the parents from the higher SES group (15.2 % compared to 11 %). Mean intakes of NME sugar in parents decreased in both groups over the 18-month duration of the study but mean intakes in children remained high throughout the research period. Saturated fat intakes increased in adults from both SES groups, but were higher in the lower SES group at all stages. There was no change in mean saturated fat intake over time in children from the higher SES group, but mean intake decreased in children from the lower SES group (from 16.2 % to 14.1 %). Mean intake of NSP increased in both parents and children, but remained below the recommended 18 g/d throughout the study. With the exception of iron, mean intakes of all micronutrients for parents were greater than the RNI in both groups. Iron intake was lower than the RNI (14.8 mg/d) at all stages. At baseline intakes were lowest in the lower SES group (9.3 mg/d compared to 11.4 mg/d); 11 participants consumed less than the LRNI (8 mg/d), eight of whom from the lower SES group (73 % of participants). Mean intakes increased in the lower SES group by 3.7 mg/d over the duration of the study but neither group reached the RNI at any stage. At baseline, children met the RNI for all micronutrients, and there were no significant differences between groups. Overall the diet of children, particularly from the lower SES group, improved over the duration of the study, although salt and NME sugar intake did not decrease over time. Further research is required to investigate the best methods to improve diet in families with young children, with particular emphasis on reducing % energy from NME sugar and saturated fat, reducing salt intake and increasing fruit, vegetable and NSP intake.