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Nutrient intakes of young children: implications for long-day child-care nutrition recommendations. (Short Communication).



Abstract

Objective: To develop nutrition recommendations for food provided during long-day child-care hours, expressed in terms of a percentage of recommended dietary intakes (RDIs) for nutrients.

Design: Secondary analyses of nutrient nutrient /nu·tri·ent/ (noo´tre-int)
1. nourishing; providing nutrition.

2. a food or other substance that provides energy or building material for the survival and growth of a living organism.
 intake data from the Australian Bureau of Statistics' 1995 National Nutrition Survey. Total daily intakes and intakes from lunch and daytime snacks (i.e. long-day child-care hours) were examined.

Subjects: Children aged two to five years (n = 793).

Setting: Males and females from all Australian states Noun 1. Australian state - one of the several states constituting Australia
province, state - the territory occupied by one of the constituent administrative districts of a nation; "his state is in the deep south"
 and territories.

Main outcome measures: The proportion of the mean total daily nutrient intake consumed during long-day child-care hours in quantitative amounts and in percentage RDI RDI - Receiver Data Interface .

Results: The mean daily intakes of energy, vitamin A vitamin A
 also called retinol

Fat-soluble alcohol, most abundant in fatty fish and especially in fish-liver oils. It is not found in plants, but many vegetables and fruits contain beta-carotene (see
, thiamin thiamin
 or vitamin B1

Organic compound, part of the vitamin B complex, necessary in carbohydrate metabolism. It carries out these functions in its active form, as a component of the coenzyme thiamin pyrophosphate.
, niacin niacin: see coenzyme; vitamin.
niacin
 or nicotinic acid or vitamin B3

Water-soluble vitamin of the vitamin B complex, essential to growth and health in animals, including humans.
, zinc, iron and calcium were all above 100% RDI. On average, young children derived 40 to 51% of total 24-hour nutrient intake and approximately 43 to 107% of RDI for the nutrients examined from lunch and snacks. Iron was the only nutrient with a mean intake less than 50% of the RDI for lunch and day-time snacks. However, the total mean daily intake exceeded the RDI.

Conclusion or application: The recommendation that 'at least 50% of the RDI for nutrients be provided to children during long-day child-care' is consistent with children's current eating patterns. Further research, legislation, policy development, resources and training will be required to implement this recommendation. (Nutr Diet 2002;59:187-90)

Key words: child-care, nutrient intake, nutrition recommendations

Introduction

In Australia, 28% of children attend long-day child-care and 18% attend family day care, with more than 177 000 children using long-day child-care centres in 1996 (1). Long-day child-care is defined as formal child-care that is provided in a centre for a minimum of eight hours per day, five days per week (2).

The food eaten by children during long-day child-care makes an important contribution to their overall nutritional intake at a time that is critical for physical and mental development.

Formal child-care providers require specific guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks.
 for the provision of food for children in their care. Such recommendations can be justified if they are based on both the daily nutrient requirements of children and on the proportion of food eaten while in child-care. Care needs to be taken not to overestimate o·ver·es·ti·mate  
tr.v. o·ver·es·ti·mat·ed, o·ver·es·ti·mat·ing, o·ver·es·ti·mates
1. To estimate too highly.

2. To esteem too greatly.
 these requirements as this may result in increased cost and wastage wastage

a loss of product or productivity; in terms of animal production includes losses due to deaths of animals, lowered production from survivors, including reproduction, and lost opportunity income.

wastage Fetal wastage, see there
.

In some Australian states, the child-care legislation which relates to nutrition contains broad statements only. In Queensland, for example, centres are required to provide 'adequate and nutritious nutritious /nu·tri·tious/ (noo-trish´us) affording nourishment.

nu·tri·tious
adj.
Providing nourishment; nourishing.



nutritious

affording nourishment.
 food' for children in their care (3). However, this is not supported with guidelines on the amounts and types of food required.

Previous recommendations relating to relating to relate prepconcernant

relating to relate prepbezüglich +gen, mit Bezug auf +acc 
 the provision of food for children in long-day child-care include: at least 50% of the Recommended Dietary Intake (RDI) for nutrients (New South Wales New South Wales, state (1991 pop. 5,164,549), 309,443 sq mi (801,457 sq km), SE Australia. It is bounded on the E by the Pacific Ocean. Sydney is the capital. The other principal urban centers are Newcastle, Wagga Wagga, Lismore, Wollongong, and Broken Hill.  (4) and Victoria (5)); 50 to 67% of the RDI for all nutrients (Western Australia Western Australia, state (1991 pop. 1,409,965), 975,920 sq mi (2,527,633 sq km), Australia, comprising the entire western part of the continent. It is bounded on the N, W, and S by the Indian Ocean. Perth is the capital.  (6)); 67% of daily food requirements (South Australia South Australia, state (1991 pop. 1,236,623), 380,070 sq mi (984,381 sq km), S central Australia. It is bounded on the S by the Indian Ocean. Kangaroo Island and many smaller islands off the south coast are included in the state.  (7)); and at least 50 to 67% of nutritional requirements nutritional requirements,
n the food and liquids necessary for normal physiologic function.
 (American Dietetic Association The American Dietetic Association (ADA) is the United States' largest organization of food and nutrition professionals, with nearly 65,000 members. Approximately 75 % of ADA's members are registered dietitians and about 4 % are dietetic technicians, registered.  (8)).

There is no evidence to show that children who attend long-day child-care centres are at greater nutritional risk than children who are cared for at home (9). However, studies of children in child-care centres have revealed that their intakes at lunch and the two snack times do not meet 50% of RDI for some nutrients. In Australia, energy, iron, calcium and zinc are the most common nutrients consumed at levels less than 50% of RDI during long-day child-care (7,10-13). Landers et al. (14), in their study of the nutrient intake of children both in and outside of formal child-care hours, found intakes of iron, calcium and energy over the entire day did not meet recommended amounts.

US studies of nutrient intakes during long-day childcare have reported intakes of energy (15-18), iron (15-20), calcium (15,20), zinc (17,18,20), thiamin (15,20), niacin (15,18), vitamin A (17), magnesium magnesium (măgnē`zēəm, –zhəm), metallic chemical element; symbol Mg; at. no. 12; at. wt. 24.305; m.p. about 648.8°C;; b.p. about 1,090°C;; sp. gr. 1.738 at 20°C;; valence +2.  (17) and folic acid folic acid: see coenzyme; vitamin.
folic acid
 or folate

Organic compound essential to animal growth and health and needed by bacteria as a growth factor.
 (17,21) to be low.

The aim of this study was to provide an evidence-base for recommendations addressing the nutritional contribution of meals provided during long-day child-care. Secondary analyses of the 1995 National Nutrition Survey were undertaken to determine total nutrient intake and its distribution throughout the day in two- to five-year-old children. Results were compared with the RDIs--the target for daily nutrient intake (22).

Method

Data were obtained from the Australian Bureau of Statistics' 1995 National Nutrition Survey Confidentialised Unit Record File for children aged two to five years (n = 793) (23). This household survey, run in conjunction with the National Health Survey (24), collected information on food and beverage F&B is a common abbreviation in the United States and Commonwealth countries, including Hong Kong. F&B is typically the widely accepted abbreviation for "Food and Beverage," which is the sector/industry that specializes in the conceptualization, the making of, and delivery of foods.  consumption on the day prior to the interview, using a 24-hour recall. The dietary information for children aged two to four years was provided by a parent, guardian or close relative, preferably pref·er·a·ble  
adj.
More desirable or worthy than another; preferred: Coffee is preferable to tea, I think.



pref
 the person responsible for preparing the participant's meals (24). Children aged five years and over were asked to provide their own food intake data with the assistance of an adult household member (24). The dietary intake questions covered breakfast, snacks, lunch, dinner and supper (24). Full details about the survey, including sample design and selection, are published elsewhere (25).

Data for children aged between two and five years were selected for secondary analyses to reflect the most common ages of children attending long-day child-care services. The nutrients most commonly reported as being below desired levels in the diets of children attending formal child-care were selected for consideration, these being vitamin A, thiamin, niacin, zinc, iron and calcium (7,10-13,15-18,20,14). As the RDI for some nutrients are age-dependent, data for children aged two to three years and those aged four to five years were analysed separately. The RDI for iron for both age groups is a range (6 to 8 mg), so the middle value, 7 mg, was used as the RDI.

Three outcome measures were considered:

* the mean intake of energy, vitamin A, thiamin, niacin, zinc, iron and calcium over the 24-hour period;

* the contribution of lunch and day-time snacks to total mean intake of these nutrients;

* the contribution of lunch and day-time snacks to nutrient intake expressed as a percentage of RDI.

To estimate food consumed by young children during hours comparable to the long-day child-care period lunch and day-time snacks (i.e. foods or beverages eaten between meals) were selected for analysis. Nutrient values for other meal types such as brunch were not included due to very small numbers of children consuming these meals.

Mean daily intakes for nutrients as a percentage of RDI, as well as intakes for lunch and day-time snacks were calculated as the average of all individual's intake as a percentage of RDI; that is the

Sum (individual intake/RDI x 100)/number of individuals

The 95% confidence intervals confidence interval,
n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%.
 (CI) were calculated.

Data presented in this study have been weighted to the Australian population by age, sex and metropolitan residence (25). All data were analysed using SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System.  8.2 (SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig.  Inc, Gary, NC, SAS OnlineDoc[R], version 8, 1999).

Results

As shown in Figures 1 and 2, the mean 24-hour intakes of the nutrients of interest for children aged two to five years were above 100% of the RDI, while the RDI for energy was exceeded for two- to three-year-olds (118%) and approximated RDI for four- to five-year-olds (98%).

Lunch and snacks provided between 43% to 107% of the RDI for these nutrients, with iron being the only nutrient with a mean intake less than 50% of the RDI. However, iron intakes at other meals resulted in a total mean intake over a 24-hour period that exceeded the RDI.

Table I shows the mean total nutrient intakes and intakes from lunch and snacks as a percentage of the mean 24-hour intake. Lunch and snacks contributed between 40% and 51% of 24-hour intake for the nutrients of interest.

Discussion

Children derived approximately 40 to 51% of their daily total nutrient intake and in excess of 50% of the RDI from lunch and snacks for all nutrients of interest except for iron (43% for two- to three-year-olds, 49% for four- to five-year-olds). The RDI were met for all the nutrients, over the 24-hour period. This evidence supports the provision of at least 50% of the RDI for vitamin A, niacin, thiamin, iron, zinc, calcium and energy from lunch and day-time snacks as a practical recommendation for usual long-day child-care hours.

The New South Wales 'Caring for Children' project showed that even after an intervention in long-day childcare centres, many centres failed to provide 50% of the RDI for nutrients in one meal and two snacks (12). Two other key Australian studies have also shown that meeting 50% of the RDI for some nutrients is often not achieved in eight hours of child-care (10,14). The contribution of meals other than lunch and snacks provided between 60 to 140% of RDI. Thus the recommendation for 50% of RDI to be provided during long-day child-care provides some safety margin for the 'at-risk' nutrients of interest.

The sample for the 1995 National Nutrition Survey included children within and outside formal care settings. The results are therefore not necessarily representative of children who attend child-care centres and can only be used as a guide. Long-day child-care itself may influence eating patterns, both within hours of care or outside these hours. Factors such as early morning time constraints In law, time constraints are placed on certain actions and filings in the interest of speedy justice, and additionally to prevent the evasion of the ends of justice by waiting until a matter is moot.  and late afternoon fatigue may affect food intake at breakfast and at night and this requires more research. To assist with further research some additional data should be collected in future national surveys. The 1995 National Nutrition Survey provides data on where food was obtained and includes a category for 'childcare centre, family day care' but food brought from home and consumed at child care cannot be identified (25). Data on the number of hours children spent in care on the day of the 24-hour record and where meals were eaten, would allow study of the effects of long-day child-care on the intake of meals outsid e care hours and of the nutrient intake of children who bring food from home to child care.

Conclusion

This research indicates that the recommendation that 'at least 50% of the RDI for nutrients be provided to children while in long-day child-care for eight hours' is appropriate. It is consistent with children's current eating patterns. Further research on the effect of long-day child-care on food intake both within and outside hours of care is required to confirm this finding, In order to implement the above recommendation, consistent food-based recommendations must be developed, promoted and supported through policy initiatives, state licensing and/or national accreditation standards and resources and training for child-care centre staff and parents. The collection of more detailed data by future National Nutrition Surveys would assist in providing a clearer picture of food intake by children attending long-day child-care centres.
Figure 1

Total intake and intake from lunch and snacks (a) as a percentage of
Recommended Dietary Intake (RDI) (22), for children aged two to three
years from the National Nutrition Survey (23) (n = 383)

           Average intake from  Average total intake
Nutrient    lunch and snacks       24-hour period

Energy             61                   118
Iron               43 (b)               111 (b)
Calcium            57                   119
Zinc               65                   143
Niacin             98                   233
Thiamin           106                   345
Vitamin A         107                   235

Vertical bars indicate the 95% confidence interval for the mean percent
of RDI for each nutrient.

Figures above bars are mean percentage of RDI.

(a) Snacks include all food and beverage snacks, excluding supper.

(b) The RDI for iron is 6 to 8 mg. The middle of this range was used for
comparisons (7 mg).

Note: Table made from bar graph
Figure 2

Total intake and intake from lunch and snacks (a) as a percentage to
Recommended Dietary Intake (RDI) (22), for children aged four to five
years from the National Nutrition Survey (23) (n = 410)

           Average intake from  Average total intake
Nutrient    lunch and snacks       24-hour period

Energy             50                    98
Iron               48 (b)               127 (b)
Calcium            50                   111
Zinc               50                   120
Niacin             89                   218
Thiamin            90                   200
Vitamin A          79                   202

Vertical bars indicate the 95% confidence interval for the mean percent
of RDI for each nutrient.

Figures above bars are mean percentage of RDI.

(a) Snacks include all food and beverage snacks, excluding supper.

(b) The RDI for iron is 6 to 8 mg. The middle of this range was used for
comparisons (7 mg).

Note: Table made from bar graph
Table 1

Nutrient intake data for children aged two to five year from the
National Nutrition Survey 1995 (22, 23) (d)

Intake data           Age group    Energy      Iron (b)    Calcium

Mean intake over 24   2-3 years    6350 kJ      7.8 mg      834mg
hours                 (n = 383)  (6144-6555)  (7.5-8.1)   (790-877)
                      4-5 years    7053 kJ      8.9 mg      777 mg
                      (n = 410)  (6851-7256)  (8.5-9.2)   (738-817)
Percentage of total   2-3 years  51 (50-53)   40 (39-42)  46 (44-48)
mean intake           (n = 383)
contributed by lunch  4-5 years  51 (50-53)   40 (39-42)  44 (42-46)
and snacks            (n = 410)

Intake data              Zinc      Niacin (c)   Thiamin    Vitamin A (d)

Mean intake over 24    6.7 mg       23.3 mg      1.2 mg       707 ug
hours                 (6.4-7.6)   (22.4-24.2)  (1.2-1.3)     (657-756)
                        7.2 mg      26.2 mg      1.4 mg       707 ug
                      (6.9-8.2)   (25.2-27.2)  (1.3-1.5)     (665-750)
Percentage of total   44 (42-45)   43 (41-44)  43 (41-45)   44 (42-47)
mean intake
contributed by lunch  42 (40-44)   41 (40-43)  44 (42-45)   42 (40-44)
and snacks

(a) 95% Confidence Intervals in breackets

(b) Middle of the RDI range for iron used (7 mg)

(c) Niacin values are niacin equivalents

(d) Vitamin A values are retinol equivalents


Acknowledgments

The authors wish to thank Dr Carla Patterson and Julie Appleton from the Centre for Public Health Research, Queensland University of Technology.

References

(1.) Australian Bureau of Statistics The Australian Bureau of Statistics (ABS) is the Australian government agency that collects and publishes statistical information about Australia and its people. Population and Housing
The agency undertakes the Australian Census of Population and Housing.
. Childcare Australia March 1996. Canberra: Australian Government Publishing Service; 1997.

(2.) Pollard pollard

fine protein-rich feed supplement for farm animals; a byproduct from the milling of wheat for flour. Called also shorts.
 C, Lewis J, Miller M. Food Service in long day care centres--an opportunity for public health intervention health intervention Health care An activity undertaken to prevent, improve, or stabilize a medical condition . Aust N Z J Public Health 1999;23:606-l0.

(3.) Queensland Child Care (Child Care Centres) Regulations. Brisbane: Queensland Government Printer; 1991.

(4.) NSW NSW New South Wales

Noun 1. NSW - the agency that provides units to conduct unconventional and counter-guerilla warfare
Naval Special Warfare
 Centre Based and Mobile Child Care Services Regulation (No 2). Sydney: NSW Department of Community Services; 1996.

(5.) Collins A, Foster J, Dodimead L. Nutritional guidelines and food selection for child minding centres. Melbourne: Royal Melbourne Royal Melbourne, a high class neighborhood in Chicago's North Shore, is both a residential community and Greg Norman designed golf course. The neighborhood houses some of Chicago's elite professionals, including world-renowned lawyers, doctors, and athletes.  Institute of Technology, Communication Services Unit; 1989.

(6.) Douglas F, Lewis J. Start Right--Eat Right Users Guide: Cent$ible Food Service Project. Perth: Curtin University of Technology and the Health Department of Western Australia; 1999.

(7.) Rakowski J, Gallard V, Sweeney A. Making childhood a healthy experience: Nutrition guidelines for childcare centres. Adelaide: South Australian Health Commission; 1996.

(8.) Position of the American Dietetic Association. Nutrition standards for child-care programs. J Am Diet Assoc 1999;8:981-8.

(9.) Soanes R, Miller M, Begley A. Nutrient intakes of two- and three-year-old children: a comparison between those attending and not attending long day care. Aust J Nutr Diet 2001;58:114-20.

(10.) Gelissen IC, Wall PM, Lilburne A-M A-M Alternating Maximization (algorithm) , Truswell AS. Dietary intake of Australian preschool children at long day care centres. Aust J Nutr Diet 1992;49:51-4.

(11.) Williams L. Report on the 'Caring For Children' Project, Stages 1 & 2. Gosford: Nutrition Department, Central Coast Area Health Service; 1993.

(12.) See Mathews DW, Mathews R. Evaluation Report: 'Caring for Children' Project, Stage 3. Gosford: Nutrition Department, Central Coast Area Health Service; 1993.

(13.) Australian Nutrition Foundation (Qld Division) Inc. Final Report: Caring for Children--Hygiene Project. Brisbane: Department of Human Services and Health; 1994.

(14.) Landers MCG mcg microgram.

mcg
abbr.
microgram



mcg

microgram.

mcg Microgram, see there; the preferred written abbreviation is µg
, Warden WARDEN. A guardian; a keeper. This is the name given to various officers: as, the warden of the prison; the wardens of the port of Philadelphia; church wardens.  RA, Hunt KA, Boulton TJC TJC Tyler Junior College (Texas)
TJC The Joint Commission (Oakbrook Terrace, IL)
TJC Temasek Junior College (Singapore)
TJC The Jockey Club
TJC True Jesus Church
. Nutrition in long day care centres: are the guidelines realistic? Aust J Nutr Diet 1994;51:186-90.

(15.) Briley ME, Buller AC, Roberts CR, Sparkman A. What is on the menu at the child care centre? J Am Diet Assoc 1989;89:771-4.

(16.) Domer JA. Nutrition in a private day care centre. J Am Diet Assoc 1983;82:290-3.

(17.) Drake drake

1. male duck.

2. loliumtemulentum.
 MA. Menu evaluation, nutrient intake of young children, and nutrition knowledge of menu planners in child care centres in Missouri. J Nutr Educ 1992;24:145-8.

(18.) Briley M, Jastrow S Jastrow may refer to one of the following:
  • Jastrowie, a town in Poland.
  • Marcus Jastrow, a Jewish scholar.
  • Robert Jastrow, an American astronomer.
, Vickers J, Roberts-Gray C. Dietary intake at child care centres and away: Are parents and care providers working as partners or at cross-purposes? J Am Diet Assoc 1999;99:950-4.

(19.) Briley M, Coyle E, Roberts-Gray C, Sparkman A. Nutrition knowledge and attitudes and menu planning skills of family day-home providers. J Am Diet Assoc 1989;89:694-5.

(20.) Oakley CB, Bomba AK, Knight KB, Byrd SH. Evaluation of menus planned in Mississippi child-care centres participating in the Child and Adult Care Food Program The Child and Adult Care Food Program (CACFP) is a type of United States Federal assistance provided by the U.S. Department of Agriculture (USDA) to States in order to provide a daily subsidized food service for an estimated 2. . J Am Diet Assoc 1995;95:765-8.

(21) Drake MA. Anthropometry anthropometry (ănthrəpŏm`ətrē), technique of measuring the human body in terms of dimensions, proportions, and ratios such as those provided by the cephalic index. , biochemical bi·o·chem·is·try  
n.
1. The study of the chemical substances and vital processes occurring in living organisms; biological chemistry; physiological chemistry.

2.
 iron indexes, and energy and nutrient intake of preschool children: comparison of intake and day care centre and at home. J Am Diet Assoc 1991;91:1587-8.

(22.) National Health and Medical Research Council The National Health and Medical Research Council (NHMRC) is Australia's peak funding body for medical research, with a budget of nearly A$500M a year . The Council was established to develop and maintain health standards and is responsible for implementing the . Recommended Dietary Intakes for Use in Australia. Canberra: Australian Government Publishing Service; 1991.

(23.) Australian Bureau of Statistics. Information Paper: National Nutrition Survey Confidentialised Unit Record File. ABS (Automatic Backup System) See backup program.  Cat No. 4807.0; Canberra: Australian Government Publishing Service; 1998.

(24.) Australian Bureau of Statistics. 1995 National Health Survey Users' Guide. ABS Cat No. 4801.0. Canberra: Australian Government Publishing Service; 1998.

(25.) Australian Bureau of Statistics and the Commonwealth Department of Health and Family Services. National Nutrition Survey User's Guide 1995. Canberra: Australian Government Publishing Service; 1998.

This paper was written as part of the 'Better Food Better Care' project, funded by Public Health Services health services Managed care The benefits covered under a health contract , Queensland Health.

QEII Hospital Health Service District, Queensland

B. Radcliffe, B AgrSc (Hons), GradDipNutrDiet, Community Nutritionist nu·tri·tion·ist
n.
One who is trained or is an expert in the field of nutrition.


nutritionist Dietitian, see there
 

Public Health Services, Queensland Health

C. Cameron, BSc, GradDipNutrDiet, Project Dietitian dietitian /di·e·ti·tian/ (di?e-tish´in) one skilled in the use of diet in health and disease.

di·e·ti·tian or di·e·ti·cian
n.
A person specializing in dietetics.
 

Health Information Centre, Queensland Health

P. Baade, PhD, Senior Biostatistican

Correspondence: B. Radcliffe, Mt Gravatt Community Health Services, QEII Hospital, Private Bag 2, Acacia Ridge, Queensland Acacia Ridge is a suburb of Brisbane, Queensland, Australia. Acacia Ridge is 15 km south of the central business district.

Primarily residential, Acacia Ridge is home to some light industry and a technology park.
 4110. Email: barbara_radcliffe@health.qld.gov.au
COPYRIGHT 2002 Dietitians Association of Australia
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Baade, Peter D.
Publication:Nutrition & Dietetics: The Journal of the Dietitians Association of Australia
Geographic Code:8AUST
Date:Sep 1, 2002
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