Since food preferences develop during early childhood and contribute to dietary patterns that can track into adulthood, it is critical to support healthy food environments in places where children spend significant amounts of time in, such as childcare. It is important to understand what factors influence the diet quality of children cared for in family childcare homes (FCCH). Methods: This study used baseline data from a cluster-randomized trial in FCCH, Healthy Start/Comienzos Sanos. Surveys capturing providers’ socio-demographic characteristics were completed. Food and beverage consumptions were estimated using the Dietary Observation in Childcare protocol, and diet quality was calculated using the Healthy Eating Index (HEI)-2015. Comparison of mean HEI scores by provider socio-demographic variables were completed using ANOVAs, followed by multiple linear regression models for significant variables. Post-hoc ANOVA models compared mean HEI-2015 sub-components by income and ethnicity. Results: Significant differences in mean HEI-2015 scores were found for provider income level (less than $25,000, HEI: 64.8 vs. $25,001–$50,000: 62.9 vs. $75,001 or more: 56.2; p = 0.03), ethnicity (Non-Latinx: 56.6 vs. Latinx: 64.4; p = 0.002), language spoken outside of childcare (English: 58.6 vs. Spanish: 64.3, p = 0.005), and language spoken in childcare (English: 59.6 vs. Spanish: 64.4; p = 0.02). In linear regression models, a higher provider income ($75,001 or more) was negatively and significantly associated with the total HEI-2015 scores (β = −9.8, SE = 3.7; p = 0.009) vs. lower income (less than $25,000). When entering provider income and ethnicity to the same model, adjusting for Child and Adult Food Program (CACFP), only ethnicity was significant, with Latinx being positively associated with total HEI-2015 scores vs. non-Latinx (β = 6.5, SE = 2.4; p = 0.007). Statistically significant differences were found by ethnicity and language for greens/beans, total protein, and seafood and plant protein HEI-2015 component scores. Discussion: Lower income, and Latinx providers cared-for children had higher diet quality in FCCH compared to the other providers. Future studies should better understand what specific foods contribute to each of the HEI-2015 components in order to better tailor trainings and interventions.

Objective: To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention.Design: Pilot randomised controlled trial.Setting: Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials.Participants: Parents and their 2–5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups.Results: Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (−1·35, −0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (−1·52, −0·19)), using food as a reward (PE = -0·54, 95 % CI (−1·35, −0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)).Conclusion: Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

La inadecuación de micronutrientes es frecuente en los países en vías de desarrollo. En Costa Rica existe poca información acerca de la ingesta de micronutrientes y del impacto de los programas de fortificación obligatoria de alimentos. El objetivo de este estudio fue evaluar la ingesta de vitaminas y minerales y el aporte de la fortificación de alimentos a la ingesta total de micronutrientes en la población urbana costarricense. Se analizó el consumo de alimentos en una muestra de la población urbana costarricense, participantes del Estudio Latinoamericano de Nutrición y Salud (ELANS). El riesgo de ingesta inadecuada se estimó según sexo y grupo de edad, utilizando el método de punto de corte del Requerimiento Medio Estimado (EAR). Para el hierro, se utilizó el método de aproximación probabilística. Más del 85% de la muestra presentó riesgo de ingesta inadecuada para vitamina E, calcio y vitamina D. Una menor prevalencia de riesgo de ingesta inadecuada se presentó para la niacina, tiamina, folatos, hierro y selenio. La fortificación de alimentos tiene un efecto notorio en la ingesta de micronutrientes, especialmente de hierro, niacina, tiamina y folatos. La ingesta de calcio, vitamina D y vitamina E es preocupantemente inadecuada, siendo las mujeres y las personas mayores de 50 años los grupos más afectados. Resulta fundamental el establecimiento de programas y políticas públicas para asegurar el cumplimiento del requerimiento establecido para los diferentes micronutrientes. Micronutrient deficiencies are still very common in developing countries. In Costa Rica there is little information on micronutrients intake and the impact of food fortification.This study aimed to determine the contribution of food fortification to the total intake, and to estimate the risk of inadequate intake of vitamins and minerals in an urban Costa Rican population. As a part of the Latin American Nutrition and Health Study, we analyzed data from a nationally representative sample of 798 urban residents from Costa Rica (15-65 years old) whom provided two 24-h dietary recalls. The prevalence of inadequate micronutrient intake was estimated according to the EAR cut-point method. Iron was analyze using the probability approach. We observed a 100% of the sample are at risk of inadequate intake of vitamin D, and similar percentages were obtained for calcium and vitamin E, ranging from 92.9 to 100% and 85.5 to 99.2% respectively. A lower risk of inadequate intake was observed for niacin, thiamin, folate, iron and selenium. Food fortificationmakes an important contribution to folate, thiamin, iron and niacin intake. Despite the efforts that have been made to ensure adequate micronutrient intake in Costa Rica, the intake of calcium, vitamin D and vitamin E is still very low, especially among women and people over 50 are the most affected. Based on the above, it is recommended to promote a healthy diet through nutritional education as part of public health policies, in order to facilitates compliance to nutritional requirement.

Introduction: We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions. Methods: We conducted a scoping review following the Arksey and O’Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded. Results: Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions (n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions (n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake (n = 5), parental feeding practices (n = 3), and screen time (n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.

While there are several factors that contribute to the diet quality of children in childcare, one contributing factor in Family Childcare Homes (FCCHs) is the provider’s ethnicity. However, research examining the food items provided in this setting is limited; in particular, with regards to differences between FCCHs of Latino and non-Latino providers. The aim of this study was to identify and describe the food items that contribute to food group intake in preschool-aged children attending FCCHs, and to examine differences by provider ethnicity. This secondary data analysis used baseline data from Healthy Start/Comienzos Sanos: a cluster-randomized trial. Children’s dietary intake was collected using the Dietary Observation in Child Care method and entered into Nutrition Data System for Research software. Food groups were based on the Nutrition Coordinating Center classification. Contribution of food items to their respective food group was calculated as a proportion, using ratio of means and presented as a percentage. Ethnic differences were tested with ANCOVA (p < 0.05) with Bonferroni adjustments for multiple comparisons. All providers (n = 120) were female and 67.5% were Latino. Most fruit consumed by children was in the form of juice (85%), three-fourths of the grains consumed were refined (75%), and half of the sweets consumed were syrup/honey/jelly (50%). Most of the vegetables consumed were non-starchy (61%), nearly three-fourths of dairy consumed was low-fat (71%), and vegetable oils contributed the most to the fats group (89%). Food items differed by provider’s ethnicity, with children cared for by non-Latino providers consuming a higher proportion of fruit juice, animal fats and a lower proportion of legumes (p < 0.001 for all). Children with Latino providers consumed a lower proportion of non-starchy vegetables, low-fat dairy, and nuts/seeds (p < 0.001 for all). FCCH providers could offer more whole fruits and grains and a greater variety of vegetables. Differences by ethnicity suggest providers could benefit from culturally tailored recommendations.