Malnutrition is a key element that is modifiable and may lead to a variety of medical issues such as obesity, heart disease, and some cancers. Primarily, inadequate consumption of fruits and vegetables with an exaggerated amount of energy-dense, nutrient-poor items and drinks abundant in salt, added sugars, and/or saturated fat has been linked to multiple persistent health problems. The first few years of a person’s life are important for building long-term healthy habits regarding food consumption. These habits are known to persist into adulthood, and may also have a significant impact on a child’s growth, overall health, and even the overall development of the individual. For instance, one’s dietary habits starting as early as 3 years can affect markers related to cardio issues, such as being overweight, having an issue with fats or lipids in the blood, or high blood pressure, and this can remain an issue later in life. International figures show that an average of 30% of a baby or toddler’s daily calorie intake comes from foods that contain few nutrients and lots of energy. Also, more than 90% of this age group fail to have the recommended daily portions of vegetables.
It is becoming more widely accepted that early childhood education and care can provide the platform needed for growth and learning throughout a child’s lifetime. Early Childhood Education and Care (ECEC) provision includes regulated childcare entities including extended daycare programs, preschools, nurseries, kindergartens, and family daycare, all directed towards tending to children up to the age of 6, just before compulsory school registration. In countries with high incomes like Australia, Canada, the UK, Denmark, Norway, and Germany, around 80-90% of kids aged five and under go to some type of childcare, which usually lasts for up to 30 hours each week. ECEC centers offer a controlled environment, in which toddlers and young children can intake up to 66% of the recommended daily amount of food. Therefore, these settings represent a great opportunity for targeting eating patterns in infants and young children.
The Determinants of Nutrition and Eating (DONE) framework 2.0 implies that a variety of elements can have an effect on food selection. Factors that influence one’s diet consist of the availability and convenience of food, the size of portions, food values and customs, the atmosphere of the dining area, and exposure to food advertising. In the majority of nations that oversee ECEC facilities, licensing, and accreditation standards are in place to guard the well-being and good nutrition of children. These standards require ECEC centers to carry out initiatives and regulations to guarantee that children receive healthy, nourishing meals that meet their social, cultural, and educational requirements. It is also recommended that further guidelines be established connected to the nutrition policies, education, and practices of Early Childhood Education and Care personnel. The establishment of Early Childhood Education and Care (ECEC) has been recommended as a great way to influence children’s diets due to its widespread presence and capacity to provide healthy eating interventions.
Matwiejczyk and colleagues performed an umbrella review comprised of 12 systematic reviews which found that most interventions aimed at enhancing children’s eating habits usually led to meaningful modifications in certain dietary aspects like food groups and/or nutrient intakes. Additionally, it was noticed that the most influential strategies used were those involving environmental changes such as restructuring menus, altering policies, and introducing modifications to food provision along with offering technical support and training. Yet, it is necessary to bring attention to the fact that these verdicts are based on systematic review hunts that took place more than three years prior to now and may not demonstrate updated approaches and discoveries concerning the intervention due to the continuous effort in terms of policy-making and public health put forth in this sector. The purpose of this systematic review is to conduct a current search of the literature to analyze the impact of early care and education interventions aimed at promoting healthy eating habits in children’s diets.
DATA COLLECTION AND ANALYSIS
SELECTION OF STUDIES
Two teams of reviewers will independently assess the titles and summaries of all studies with the help of Covidence software. If the opinions of the reviewers cannot be reconciled by agreement, then another reviewer will be asked to comment in order to decide whether the study should be further assessed.
Full-text versions of the study will be acquired for any research that could not be excluded with certainty by just reading the title and summary. Pairs of review authors will evaluate the full-text articles to see if they meet the criteria for inclusion. If agreement cannot be reached amongst reviewers, a third party will be called upon to determine which studies should be included in the analysis. Documentation of any rationale for excluding any complete documents will be made at this time, and a complete PRISMA flow diagram will be constructed after properly detailing the selection process.
DATA EXTRACTION AND MANAGEMENT
Two reviewers that are not masked will extract data from the studies that were included. If the reviewers cannot come to an agreement on the discrepancies, a third reviewer will be consulted to make the ultimate ruling.
For included studies, we will use a piloted and adapted version of the Cochrane Public Health data extraction template to extract data on:
- Study characteristics: first author, publication year, country, study design, sample size, funding source;
- Childcare service characteristics: type (center-based (preschool or long day care) or family day care), operational aspects (public or private; full-time or part-time), location (urban or rural);
- Participant characteristics: age, gender, ethnicity;
- Intervention characteristics: name of the program, intervention description, duration, and intensity of the intervention;
- Outcome definitions and time points of outcome measurement;
- Study results relevant to our review outcomes;
- Dropout/adherence rate;
- The financial cost of the intervention;
- Unintended adverse events of the intervention;
- Conflict of interest, using the Tool for Addressing Conflicts of Interest in Trials (TACIT: http://tacit.one/).
ASSESSMENT OF RISK OF BIAS
The risk of bias for each individual study will be independently evaluated by two people, with the use of the Cochrane Collaboration’s RoB tool that is outlined in the Cochrane Handbook for Systematic Reviews of Interventions. If necessary, a separate reviewer will decide any disagreements about the risk of bias that cannot be settled by mutual agreement.
The focus of this review will be on the result of being assigned a particular intervention, regardless of if it was applied as intended or not (the intention-to-treat effect). It was determined that this was the best option for determining which health interventions should be endorsed for policy decisions.
The specific domains of bias reviewed will relate to:
- Selection bias
- Performance bias
- Detection bias
- Attrition bias
- Reporting bias
- Other bias
An extra domain of potential prejudiced tendencies arising from when the selection and enlistment of participants take place will be investigated for cluster randomized controlled trials. The evaluation of the risk of bias will be categorized as either ‘low’, ‘high’, or ‘unspecified’ and this assessment will be employed to summarize the findings of an individual study as well as the overall risk of bias for an entire study.
Eating an unhealthy diet can affect a child’s immediate and future health. ECEC settings give a big chance to implement public health measures to improve the eating habits of children, so determining successful and healthy eating initiatives in that context is essential to battle population-wide obesity. This review seeks to analyze the most recent findings on interventions promoting healthy eating in early childhood education centers and the impacts they have on children’s diets, size, and shape, factors that may lead to cardiovascular disease, as well as their effects on cognition, mental health, and overall well-being.
Combining the facts of this field is especially critical considering that discovering successful tactics in the context is still an international concern in regard to public health and resources. In addition, understanding the effect of this setting on the health and well-being of children, research evidence has increased swiftly in recent years, with a considerable number of randomized control trials being carried out. An examination of randomized controlled trials produces the strongest evidence for causation that can be used to help determine policy and investment decisions. Furthermore, this evaluation hopes to delineate any potential negative impacts, and the total/cost efficacy of ECEC-fueled nutritious eating interventions, to further reinforce the selection of interventions that are effective, secure, and economical to administer.
By disseminating this systematic review protocol it is anticipated that any redundant efforts will be minimized while making the methods and processes used more open and accessible. Specifying the results in advance lowers the chance of skewing the reported data. Any significant changes to the procedure must be documented in the PROSPERO database. The findings from the carried out systematic review and synthesis of data will be featured at pertinent national/international gatherings and will be put forth for peer-assessment magazine circulation. This systematic review is anticipated to provide public health workers and policymakers with an overview of the current evidence base involving healthy eating initiatives within the Early Childhood Education and Care context.
FACTORS INFLUENCING INTAKE
Different elements can affect the way kids eat and their feelings toward food. The attitude children have about their nutrition is affected by their family atmosphere, current cultural patterns, food inclinations, and media portrayals. TV ads can encourage children to consume high-sugar snacks, fried foods, too many calories, heavily processed ingredients, and a lot of salt. It is essential that adults who look after children guide them toward making healthy decisions.
One way to motivate children to consume nutritious foods is to make mealtimes and snack periods entertaining and enjoyable. Parents should incorporate their kids into the food planning and cooking process by allowing them to be involved in selecting items in the grocery store and helping to put together part of the meal, like assembling a salad. Parents can currently instruct their children about kitchen safety. It might be useful to divide sandwiches, meats, or pancakes into tiny or unique forms. Rather than giving children cookies, cakes, salted snacks, and ice cream, parents ought to provide nutritious desserts such as fresh fruits. Investigations indicate that youngsters who partake in family meals regularly consume healthier food items.
CHILDREN AND MALNUTRITION
Many kids suffer from malnutrition, both in developing countries and those that are advanced. Many youngsters in North America suffer from lack of nourishment or experience hunger, despite the abundance of food. The US Census Bureau characterizes households into the following groups:
- food secure
- food insecure without hunger
- food insecure with moderate hunger
- food insecure with severe hunger
A huge number of children experience an unstable food supply in their households, which in turn leads to nutrition deficiencies caused by a lack of food options and poor food quality. Approximately one-fifth of families with kids in the U.S. are facing food insecurity in some form. In half of those, only adults experience food insecurity. In the other half, nutritious meals are not always attainable for adults and children alike, meaning that food insecurity is present.
Experiencing food insecurity during childhood can be detrimental to one’s development. An insufficiency of iron, zinc, protein, and vitamin A can cause halted growth, ailment, and restricted growth. Government initiatives like the National School Lunch Program, the School Breakfast Program, and Summer Feeding Programs address the danger of starvation and malnutrition amongst school-aged kids. They support bridging the gaps and grant kids who reside in households that lack sufficient nourishment access to healthier meals.
THE NATIONAL SCHOOL LUNCH PROGRAM
Starting from pre-kindergarten, kids take in at least one of their meals in a school environment. A lot of kids are eating their morning and afternoon meals away from their homes. Therefore, schools need to provide nutritionally sound meals. There are over 31 million kids in financially disadvantaged households who receive food through the National School Lunch Program. This program, which is funded by the federal government, provides schools with either discounted or free lunches and snacks for after-school activities. School districts that take part in this program will get money from the US Department of Agriculture (USDA) for every meal they provide. School lunches must fulfill the 2015 Dietary Guidelines for Americans and supply at least a third of the Recommended Dietary Allowances for protein, vitamin A, vitamin C, iron, and calcium. Nevertheless, it is up to local government bodies to make a selection of what foods are available and how they are made.
The Healthy School Lunch Campaign endeavors to advance the sustenance given to youngsters in school and advance their physical and psychological wellness by instructing authorities, school authorities, food-service laborers, and guardians. This institution is backed by the Physicians Committee for Responsible Medicine and is promoting educational establishments to serve more low-fat, cholesterol-free items in their cafeterias and snack machines.
FOOD ALLERGIES AND FOOD INTOLERANCE
Studies conducted recently indicate that out of all the minors under 18 years of age, three million of them show some form of allergic reaction when exposed to certain kinds of food. This remains an issue for school-aged children.
Some of the most typical triggers of allergies are peanuts, dairy products, eggs, soy, wheat, and seafood. When a protein found in food stimulates the body’s defense mechanisms, an allergic reaction ensues. This reaction involves the release of antibodies, histamine, and other protections which work to fight off potential invaders. Itching of the skin, hives, abdominal discomfort, vomiting, loose stools, and feeling sick to one’s stomach could be signs. Signs of an allergic reaction to food typically appear within a few minutes to hours after consuming the substance. Kids can cease to have a sensitivity to food items such as wheat, milk, eggs, or soy over time.
THE THREAT OF LEAD TOXICITY
School-aged kids are at risk of lead poisoning. Lead can be located in water pipes in older buildings, in paints containing lead-based substances, and on occasion in the earth. Food and water that are polluted can increase the possibility of a person having high amounts of lead in their bloodstream. Children under age six are especially vulnerable. They could ingest products that have been contaminated with lead, including pieces of peeling, lead paint. Lead dust in carpets is something we come into contact with daily. The particles of dust, which is a product of paint on walls, come loose and flutter around. When young kids play or tumble on rugs treated with lead, they are at risk. Lead is permanent and can not be broken down, and once it is consumed, it is hard to combat or eliminate it from the body. The accumulation of it in the body can take place gradually and undetectably over the course of months or even years before the emergence of symptoms. Exposure to too much lead can cause harm to the brain and central nervous system, resulting in a decrease in thinking skills, making decisions, and understanding.
The remedy for lead poisoning involves relocating the youngster away from the cause and eliminating the lead from the body. Chelation therapy may be utilized for the removal of lead, which binds to the therapy and is subsequently excreted in the urine. A different treatment option, EDTA therapy, requires the injection of a medication identified as ethylenediaminetetraacetic acid to extract lead from people who have a concentration higher than 45 mcg/dL in their circulation. Fortunately, lead toxicity is highly preventable. The process includes locating any possible dangers, like lead paint and plumbing, and eliminating them to ensure that kids are not put in contact with them.