Exploration of diet quality predictors in early care and education centers

Abstract Background: Over 75% of children ages 2-5 years attend Early Care and Education (ECE) centers, where they consume most of their daily caloric intake. This study sought to identify characteristics of ECE centers such as the state licensure, facility type (if centers are part of a local religious church or are not; faith-based or center-based, respectively), household income, monthly tuition, if cook taught in the classroom, daily attendance, hours children spent at the center, access to foods, menu substitutions, and who develops the menu; characteristics that predict the diet quality of menus as prepared by the center, the quality of meals served by the center, and discrepancies in diet quality between the menu and what was served.Methods: This observational study assessed associations between center characteristics and diet quality using menu collection and visual observation of food/beverages. Healthy Eating Index-2015 (HEI) scores were calculated for food/beverages listed on menus (HEI_MENU), served to children (HEI_SERVED), and differences between MENU and SERVED (HEI_M-S). Multiple linear regression identified predictors of MENU, SERVED, and M-S.Results: 53 centers were included, 68% (n=36) center-based and 32% (n=17) faith-based. Of the ECE centers analyzed, 75% held Alabama licensure and 58% participated in Child and Adult Care Feeding Program. The HEI scores of ECE menus were associated with facility type, such that center-based ECEs had higher HEI scores compared to faith-based centers (p=0.04). Center-based ECEs showed a menu HEI mean score of 62.4 ± 11.0 and served HEI score of 56.3 ± 12.2. No additional center characteristics were associated with measures of dietary quality. Conclusions: Facility type was identified as a preliminary predictor of menu diet quality. In Alabama, center-based ECEs are required to be licensed and meet the Food Nutrition Services (FNS) meal pattern guidelines. For faith-based ECEs, licensure is optional, so they face fewer regulations to meet the FNS meal pattern guidelines. Additional research should explore licensure as a potential mediator between facility type and HEI_MENU diet quality.