Centre-Based Childcare in Early Childhood and Nutritional Risk in Later Childhood: A Prospective Cohort Study

Michaela D Kucab¹, Charles D G Keown-Stoneman², Catherine S Birken³, Michal Perlman⁴, Janet Parsons⁵, Danielle D'Annunzio⁶, Sharon Thadani⁷, Chris A D Allen⁸, Jonathon L Maguire⁹; TARGet Kids! Collaboration

Affiliations

¹ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada.
² Applied Health Research Centre, Unity Health Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada.
³ Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.
⁵ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada; Department of Occupational Science & Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
⁶ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada.
⁸ Applied Health Research Centre, Unity Health Toronto, Toronto, Ontario, Canada.
⁹ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: jonathon.maguire@utoronto.ca.

PMID: 41022151
DOI: 10.1016/j.tjnut.2025.09.028

Centre-Based Childcare in Early Childhood and Nutritional Risk in Later Childhood: A Prospective Cohort Study

Michaela D Kucab et al. J Nutr. 2025.

. 2025 Sep 27:S0022-3166(25)00573-5.

doi: 10.1016/j.tjnut.2025.09.028. Online ahead of print.

Authors

Affiliations

¹ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada.
² Applied Health Research Centre, Unity Health Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada.
³ Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.
⁵ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada; Department of Occupational Science & Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
⁶ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada.
⁸ Applied Health Research Centre, Unity Health Toronto, Toronto, Ontario, Canada.
⁹ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto Ontario Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: jonathon.maguire@utoronto.ca.

PMID: 41022151
DOI: 10.1016/j.tjnut.2025.09.028

Abstract

Background: Centre-based childcare is a promising environment for promoting healthy lifestyle behaviours in early childhood. Little is known about the impact of centre-based childcare on child nutrition.

Objectives: The primary objective was to evaluate the association between centre-based childcare, compared to non-centre-based childcare, and nutritional risk in early childhood. Secondary objectives were to evaluate associations with dietary intake and eating behaviours, and whether the associations were modified by family income and childcare intensity.

Methods: A prospective cohort study of children aged 1 to 5 years was conducted through the TARGet Kids! primary care research network in Toronto, Canada (n = 2420). Childcare attendance was measured between 1 and 4 years of age. Nutritional risk, dietary intake and eating behaviours were measured using the Nutrition Screening Tool for Every Toddler and Preschooler (NutriSTEP®) between 4 to 5 years of age.

Results: Centre-based childcare was associated with a more favourable NutriSTEP® (-0.66 units; 95%CI: -1.11, -0.21), dietary intake (-0.31 units; 95%CI: -0.57, -0.06) and eating behaviours score (-0.14 units; 95% CI: -0.29, 0.00) compared to non-centre-based childcare. Associations were stronger for children who attended centre-based childcare full time with a more favourable NutriSTEP® (-0.89 units; 95%CI: -1.39, -0.41), dietary intake (-0.44 units; 95%CI: -0.72, -0.16) and eating behaviours score (-0.20 units; 95%CI: -0.36, -0.03). Associations were stronger for children from lower income families (< $50,000CDN) who attended centre-based childcare with a more favourable NutriSTEP® (-2.39 units, 95%CI: -3.99, -0.78), dietary intake (-1.43 units; 95%CI: -2.35, -0.50), and lower odds of high nutritional risk (OR 0.44; 95%CI: 0.20, 0.97).

Conclusions: Centre-based childcare was associated with more favourable nutritional risk scores, which were stronger for children who attended centre-based childcare full time and those who were from lower income families. Centre-based childcare may be an important early environment for supporting childhood nutrition.

Clinical trial registry number: NCT01869530 (clinicaltrials.gov).

Keywords: childcare; dietary intake; early childhood; eating behaviour; nutrition; pediatrics; prospective.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jonathon Maguire reports financial support was provided by Canadian Institutes of Health Research. J.M. has received research funding from the Canadian Institutes of Health Research, Physician Services Inc, Ontario SPOR Support Unit, as well as an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011-2012) and Ddrops provided nonfinancial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011-2015). C.B. has received research funding from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Physician Services Inc, The Leong Centre at the University of Toronto, Centre for Addictions and Mental Health, Ontario Child Health Support Unit (OCHSU) Impact Child Health Award, and a Walmart Community Grant through the SickKids Foundation for a study on food insecurity in the inpatient hospital setting. The other authors have no conflicts of interest relevant to this article to disclose. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Centre-Based Childcare in Early Childhood and Nutritional Risk in Later Childhood: A Prospective Cohort Study

Affiliations

Centre-Based Childcare in Early Childhood and Nutritional Risk in Later Childhood: A Prospective Cohort Study

Authors

Affiliations

Abstract

Conflict of interest statement

Associated data

LinkOut - more resources

Full Text Sources

Medical