Correlates of children's dietary intake in childcare settings: A systematic review

Context: Children consume up to two-thirds of their daily dietary requirements in full-time childcare, making the setting a critical vector for preventing childhood obesity. Objective: To summarize the ecological correlates of children's dietary intake in childcare settings that were identified and categorized using the Six-Cs developmental ecological model of contributors to overweight and obesity in childhood. Data Sources: A literature search was conducted in 4 electronic databases. Study Selection: English-language, peer-reviewed publications that investigated at least 1 correlate of children's (ages 2-6 years) dietary intake in childcare settings and measured children's actual consumption of foods and beverages from food groups were included. Data Extraction: Correlates were categorized into child, clan, community, and country groups. Results: A total of 55 studies, which examined 29 correlates, were reviewed. Correlates identified included child's age, sex, characteristics of food provision (namely, food composition, foods and beverages served, portion sizes), repeated exposure, nutrition education, book reading, peer influence, meal service type, and childcare teachers' responsive feeding practices. Policies and participation in Head Start and the Child and Adult Care Food Program could not be determined as correlates of children's dietary intake, owing to a lack of evidence. Conclusion: This review produced a list of correlates to consider in designing interventions to improve children's dietary intake in childcare settings. The correlates could contribute to development of lifelong healthy eating habits, thereby preventing childhood obesity.