Dietary quality of preschoolers' sack lunches
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The objective of this study was to analyze the dietary quality of preschoolers' content and intake of sack lunches from the Lunch is in the Bag (LIITB) Efficacy Trial. The main hypothesis was that the nutrient composition of the lunches packed by parents and the portion consumed by their preschool children were not adequate and that the dietary quality of the lunches was associated with beverage choice. For this cross-sectional study, dietary data were obtained from 30 Early Care and Education (ECE) centers in Central Texas. Foods and beverages present in lunches that parents (n=607) from the LIITB Efficacy Trial packed for their preschool child were recorded on two non-consecutive days. The average meal included 6.5 individual food items and a mean of 602.5 kcals. The macronutrient energy distribution was adequate; however, lunches contained high amounts of sugars (29% of energy) and saturated fat (11% of energy). Preschoolers consistently consumed between 61% and 79% of the food packed by their parents (p<0.01). Parents included less than the recommended amounts of dietary fiber, calcium, vitamin A, and potassium. Mean HEI total scores of lunches packed (58/100) differed from scores of lunches consumed (52/100) (p<0.01). Meals scored low for the greens and beans, total vegetables, seafood and plant proteins and whole grain HEI components. Most parents packed a beverage as part of their preschoolers' lunch; sugar sweetened beverages being the most popular choice. Beverage choice was significantly associated with the presence of vegetables, refined grains and chips in preschoolers' lunches as well as the dietary quality (p<0.05). The nutrient content of preschoolers' sack lunches were inadequate and a cause for concern. The HEI-2010 was a useful tool to measure the dietary quality of children's meals and provided statistical advantages over nutrient analysis. Specific food choices such as beverages were associated with the dietary quality the meals, beverage choice could be a viable intervention target. These findings suggest that parents of preschool children need more guidance in order to provide better foods and beverages to promote the development of healthy food preferences and eating habits.