Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;26(12):3062-3075.
doi: 10.1017/S136898002300174X. Epub 2023 Aug 25.

Development of an initiatives package to increase children's vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment

Lucinda K Bell  1 , Samantha Morgillo  1 , Dorota Zarnowiecki  1   2 , Claire Gardner  1 , Shalem Leemaqz  3 , Jennifer Arguelles  4 , Astrid Am Poelman  5 , Maeva O Cochet-Broch  6 , David N Cox  7 , Rebecca K Golley  1
Affiliations

Development of an initiatives package to increase children's vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment

Lucinda K Bell et al. Public Health Nutr. 2023 Dec.

Abstract

Objective: To inform a package of initiatives to increase children's vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum.

Design: Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children's dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability.

Setting: LDC centres in metropolitan Adelaide, South Australia.

Participants: 32 centres, 276 staff and 1039 children aged 2-5 years.

Results: There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0-50 % completed the menu assessment, 3/5 would recommend).

Conclusion: A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children's vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.

Keywords: Children; Complex interventions; Long day care; Multiphase Optimisation Strategy; Vegetable intake.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of centres and children through the study according to the CONsolidated Standards of Reporting Trials (CONSORT)
See this image and copyright information in PMC

References

    1. World Health Organization (WHO) (2019) Increasing Fruit and Vegetable Consumption to Reduce the Risk of Noncommunicable Diseases. Geneva, Switzerland: World Health Organization.
    1. Maynard M, Gunnell D, Ness AR et al. (2006) What influences diet in early old age? Prospective and cross-sectional analyses of the Boyd Orr cohort. Eur J Public Health 16, 315–323. - PubMed
    1. Taylor CM, Hays NP & Emmett PM (2019) Diet at age 10 and 13 years in children identified as picky eaters at age 3 years and in children who are persistent picky eaters in a longitudinal birth cohort study. Nutrients 11, 807. - PMC - PubMed
    1. Bell LK, Gardner C, Tian EJ et al. (2021) Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews. Am J Clin Nutr 113, 1282–1300. - PubMed
    1. Smithers LG, Golley RK, Brazionis L et al. (2011) Characterizing whole diets of young children from developed countries and the association between diet and health: a systematic review. Nutr Rev 69, 449–467. - PubMed

Publication types