The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Design
2.3. Procedure
2.4. Materials and Measures
2.4.1. Anthropometrics
2.4.2. Screening Questionnaire
2.4.3. Food Frequency Questionnaire (FFQ)
2.4.4. Parent and Child Characteristics
2.4.5. Acceptability Questionnaire
2.4.6. Follow-Up Questionnaire
2.4.7. Food Diary
2.5. Data Analysis
2.5.1. Qualitative
2.5.2. Quantitative
3. Results
3.1. Demographics
3.2. Participant Recruitment and Retention
3.3. Feasibility
3.3.1. Theme 1: In the Care of Others
3.3.2. Theme 2: Children’s Health and Behaviour
3.3.3. Theme 3: Maternal Organisation
3.4. Acceptability
3.4.1. Recording in the Food Diary
3.4.2. Week 2 Snacks
3.4.3. Week 3 Snacks
3.4.4. Sustainability of the Intervention
3.4.5. Theme 1: Recording in the Food Diary
3.4.6. Theme 2: Snack Type
3.4.7. Theme 3: Snack Preparation and Serving Method
3.4.8. Theme 4: Willingness to Continue with the Intervention
3.5. Preliminary Effects of the Intervention
3.5.1. Vegetable Intake
3.5.2. Fruit Intake
3.5.3. Energy (Mean Intake kcal/day)
3.5.4. Sugar Intake
3.5.5. Fat Intake
3.5.6. Mean Number of Snacks (LED and HED) Consumed per Day
3.5.7. Predictors of Nutritional Intake
3.6. Longer Term Effects of the Intervention on Snack Frequency (4–6 Weeks Follow-Up)
3.6.1. Theme 1: Change to Habitual Feeding Practices
3.6.2. Theme 2: Impact on Consumption
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix
1. Please circle the group you were assigned to in the study | ||||
Reduction | Replacement | |||
THINK ABOUT THE SECOND WEEK OF THE STUDY WHEN WE PROVIDED THE SNACKS FOR YOUR CHILD | ||||
2. The type of snacks provided in the snack pack for week two were appropriate for my child | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
3. My child liked the snacks in week two | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
4. The snacks offered during this week were similar to the snacks my child would normally eat | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
THINK ABOUT THE THIRD WEEK OF THE STUDY WHEN WE ASKED YOU TO REPLACE OR REDUCE YOUR CHILD’S SNACKS | ||||
5. My child’s hunger was satisfied by the snacks in week three | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
6. My child was happy with the snacks in week three | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
7. My child noticed the changes to his/her snacks | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
8. My child noticed the changes to his/her drinks | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
9. Keeping the food diary was inconvenient | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
10. Keeping the food diary was difficult | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
11. Keeping the food diary was helpful | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
12. Whilst keeping the food diary I chose different foods in order to make record keeping easier | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
13. How willing would you be to use this method to reduce your child’s portion sizes? | ||||
Very unwilling | Unwilling | Neither willing nor unwilling | Willing | Very willing |
14. How likely is this method to make permanent changes to your child’s eating habits? | ||||
Very unlikely | Unlikely | Neither likely nor unlikely | Likely | Very likely |
15. I found it easy to change my child’s snacks | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
16. I found it easy to change my child’s drinks | ||||
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
Theme | Sub Theme | Supporting Quotations |
---|---|---|
1: Reasons for non-compliance | 1.1 In the care of others | “Nursery aren’t going to follow the plan as the management aren’t happy with the snacks” (P190, Reduction, male, 22 months) |
“some days at nursery she didn’t want what she was having in her bag but I told them that she’s not meant to be isolated with it” (P77, Replacement, female, 49 months) | ||
“I felt like sometimes I didn’t want to put too much imposition on them, I felt sorry for my mother-in-law having to deal with him screaming” (P214, Replacement, male, 30 months) | ||
“My mum and dad are terrible with him, giving him chocolate and things like that and my husbands a nightmare, like he gave him a mars bar from a celebration pack yesterday morning for breakfast and I was fuming because he knows that he can’t have that” (P74, Replacement, male, 30 months) | ||
“In the morning he asked for snack and his dad gave the whole pack of jaffa cakes” (P2, Reduction, male, 39 months) | ||
1.2 Children’s health and behaviour | “He’s been ill; it has been really quite tricky because his appetite is not right. I want him to eat so I am more like have whatever you want. I was like you want crisps go get crisps” (P2, Reduction, male, 39 months) | |
“The only problems I guess was when he was ill because it was hard to, because he wasn’t eating as normal. Trying to get him to eat, because he just didn’t want to” (P202, Replacement, male, age 29 months) | ||
“She’s been crying, not happy, upset, so I’ve been giving her more tasty or unhealthy snack to be able to manage her behaviour. I gave her cookie at the doctors as she was upset” (P84, Reduction, female, 37 months) | ||
“I just gave it to him. I said this is what you’ve got we are going to V club in half an hour, you either eat it or you don’t” (P104, Replacement, male, age 50 months | ||
“I just stuck to my guns and said no you’re not having it. I mean it’s hard at the time but I stuck to my guns” (P34, Replacement, female, 48 months) | ||
1.3 Organisation | “it was okay because I just did it all at the beginning of the week, it felt a bit strange obviously getting rid of half of it, but mm it was okay. I was just more organised. I think by this stage I had cracked it” (P148, Reduction, female, 26 months) | |
“It was kind of helpful to be prompted to be organised. so I would get everything ready the night before, so sometimes I would split one thing into two bags and then I would have another days bag full all ready to go, and that was really convenient” (P205, Reduction, female, 29 months) | ||
“I was quite often forgetting to give half. With pom bears I gave her the pack forgetting that it should be half.” (P84, Reduction, female, 37 months) | ||
2: Acceptability | 2.1 Recording in the food diary | “I found it absolutely fine, it was just a case of remembering to weigh everything, but the instructions on how to do it was clear” (P199, Reduction, female, 34 months) |
“easy, it was easy peasy. I just got it into my routine. I just wrote it every time, every meal, I wrote everything straight away, I weighed it, wrote it down, served it and then weighed what was left” (P33, Reduction, female, 39 months) | ||
“it was just obviously when out and about when I didn’t have the scales it became a bit trickier because I realised I have no idea about how much things weigh at all” (P143, Replacement, male, 46 months) | ||
2.2 Snack Type | “I think that was fairly standard but then I think this week wasn’t all that dissimilar to what I would have been doing anyway” (P291, Replacement, female, 26 months) | |
“I don’t think she cared really actually as long as she likes it she’ll eat it. She wasn’t asking for anything any different”. (P160, Replacement, female, 28 months) | ||
“Pear, he wouldn’t touch pear, I tried him with the skin on, without the skin, I did all that with him”. (P74, Replacement, boy, age 30 months). | ||
2.3 Snack preparation and serving method | “it was obviously a little bit more faffy than the other one because you have to weigh it, erm, washing it and prepping it before you go out and stuff like that” (P132, Replacement, male, 45 months) | |
“Like the crisps maybe I put them in a bowl or something like that so maybe that’s why she didn’t notice as much” (P20, Reduction, female, 52 months) | ||
“I kind of tried to serve the half serving in the packet although she did question to where the other half was erm, I took half of them out and she knew then, she was like ‘I want more, there’s more’ so I gave her another one and she was okay” (P199, Reduction, female, 34 months). | ||
2.4 willingness to continue the intervention | “I will be carrying on and giving her, I’ll mix it all up and make sure I am offering more fruit and veg snacks definitely” (P77, Replacement, female, 49 months) | |
“if you said you could give him anything as long as you give him half portions that would be fine with me, but giving him just these snacks (in the schedule), I don’t think I’d be able to do it” (P190, Reduction, male, 22 months) | ||
3. Longer term effects of the intervention | 3.1 Changes to habitual feeding practices | “The study helped me think more about what he was eating and whether he needed snacks. Also it has made me focus on his main meals more to keep them more balanced and healthy” (P261, Reduction, male, 56 months) |
“The combinations of food I give as snacks has changed. I think it has introduced more variety. I now buy crackers, rather than crisps so often, and I give more vegetable snacks than before” (P104, Replacement, male, 50 months) | ||
3.2 Impact on consumption | “He is more willing to try other items, but that could be because I’ll offer different options over favourites” (P234, Replacement, male, 24 months) | |
“She is tending to finish snacks and meals more often and waste less food” (P142, Reduction, female, 39 months) | ||
“My 6year old now eats more fruit as a snack too” (P291, Replacement, female, 26 months) | ||
“His sister now eats similar snacks to him and will ask for things like peppers rather than fruit” (P104, Replacement, male, 50 months) | ||
“no, we have a food routine which we went back to” (P208, Replacement, male, 26 months) | ||
”No, she’s continued to have the same amount of snacks” (P199, Reduction, female, 34 months) |
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Weight/Portion (g) | Energy (kcal) | Energy Density (kcal/g) | Fat (g) | Carbohydrate (g) | Sugar (g) | Salt (g) | |
---|---|---|---|---|---|---|---|
Chocolate coated sponge cookie (Jaffa Cakes, McVitie’s ®) | 37 | 144 | 3.9 | 3.6 | 25.8 | 19.2 | 0.07 |
Cookies (Digestives, McVitie’s ®) | 30 | 142 | 4.7 | 6.4 | 18.6 | 5 | 0.4 |
Ritz Crackers (Mondelēz ©) | 32 | 146 | 4.6 | 5.7 | 20.5 | 2.9 | 0.7 |
Oat-bar (Goodies, Organix ®) | 30 | 121 | 4.0 | 4.5 | 17 | 7.8 | 0.01 |
Yoghurt coated raisins (Sunny Raisins, Whitworths) | 25 | 112 | 4.5 | 5.1 | 15.8 | 15.8 | 0 |
Cheese flavoured crackers ( Mini Cheddars, Jacobs ®) | 25 | 128 | 5.1 | 7.3 | 12.5 | 1.3 | 0.6 |
Salted potato chips (Pom-Bear, Intersnack ©) | 15 | 79 | 5.3 | 4.2 | 9.6 | 0.5 | 0.26 |
Bell Pepper (Red, yellow and orange) | 40 | 11 | 0.3 | 0.08 | 2.53 | 0 | 0 |
Grapes (White) | 40 | 28 | 0.7 | 0.06 | 7.24 | 6.2 | 0 |
Apple (Gala) | 40 | 20 | 0.5 | 0.25 | 5.25 | 4 | 0 |
Banana | 40 | 36 | 0.9 | 0.1 | 9 | 4.9 | 0 |
Carrot | 40 | 16 | 0.4 | 0.1 | 3.8 | 1.8 | 0 |
Cucumber | 40 | 6 | 0.2 | 0.04 | 1.45 | 0.7 | 0 |
Pear | 40 | 23 | 0.6 | 0 | 6 | 4 | 0.05 |
Tomato (cherry) | 40 | 7 | 0.2 | 0.08 | 1.57 | 1.1 | 0 |
Rice cake (Kallø) | 7 | 30 | 4.3 | 0.2 | 6.3 | 0.1 | 0.1 |
Breadstick (Tesco own brand) | 8.25 | 34.5 | 4.2 | 0.6 | 6 | 0.3 | 0.15 |
Crackerbread (Ryvita ®) | 7.5 | 27 | 3.6 | 0.15 | 5.7 | 0.15 | 0.1 |
Child | Total n = 46 | Reduction n = 22 | Replacement n = 24 |
---|---|---|---|
Gender | 52% male | 63% male | 39% male |
Age (months) | 36.6 ± 9.5 | 35.8 ± 9.9 | 37.5 ± 8.9 |
BMI Centile | 60.9 ± 26.7 | 56.0 ± 30.2 | 66.2 ± 21.8 |
Mother | |||
Age (years) | 35 ± 4 | 35 ± 3 | 35 ± 5 |
* BMI (kg/m2) | 24.7 ± 5.2 | 23.2 ± 3.5 | 26.3 ± 6.2 |
Ethnicity | White British, mixed or other 94% Chinese 4% Asian Indian 2% | White British, mixed or other 96% Chinese 4% | White British, mixed or other 92% Chinese 4% Asian Indian 4% |
Highest education | >A-level or equivalents 74% | >A-level or equivalents 88% | >A-level or equivalents 61% |
Employment Status | 63% Employed full/part time or on maternity leave | 71% Employed full/part time or on maternity leave | 57% Employed full/ part time or on maternity leave |
Residential Status | Own with or without mortgage 78% | Own with or without mortgage 88% | Own with or without mortgage 65% |
Marital Status | 100% married or cohabiting | 100% married or cohabiting | 100% married or cohabiting |
Income | £0–10,000 4% | £0–10,000 5% | £0–10,000 4% |
£10–20,000 28% | £10–20,000 32% | £10–20,000 25% | |
£20–30,000 22% | £20–30,000 23% | £20–30,000 21% | |
£30–40,000 24% | £30–40,000 23% | £30–40,000 25% | |
£40,000+ 22% | £40,000+ 18% | £40,000+ 25% |
Reduction | Replacement | Total | |||||||
---|---|---|---|---|---|---|---|---|---|
Week1 | Week2 | Week3 | Week1 | Week2 | Week3 | Week1 | Week2 | Week3 | |
Vegetable: Snacks (g) | 1.7 ± 3.9 | 1.3 ± 3.0 | 0.5 ± 1.8 | 0.2 ± 0.6 | 0.6 ± 2.3 | 21.0 ± 21.8 *# | 0.9 ± 2.8 | 0.9 ± 2.7 | 11.2 ± 18.8 *# |
Vegetable: Meals (g) | 24.8 ± 19.1 | 19.6 ± 12.0 | 20.3 ± 17.0 | 28.5 ± 29.8 | 24.3 ± 23.6 | 24.9 ± 23.0 | 26.8 ± 25.0 | 22.0 ± 18.9 | 22.7 ± 20.3 |
Vegetable: Total (g) | 26.5 ± 20.3 | 20.9 ± 12.5 | 20.8 ± 17.0 | 28.7 ± 29.8 | 24.9 ± 24.9 | 45.9 ± 35.1 *# | 27.7 ± 25.4 | 23.0 ± 19.8 | 33.9 ± 30.5 # |
Fruit: Snacks (g) | 65.6 ± 75.7 | 45.1 ± 31.4 | 65.9 ± 50.8 | 42.0 ± 31.6 | 27.6 ± 31.1 | 65.4 ± 41.6 | 53.3 ± 57.7 | 36.0 ± 32.1 *# | 65.6 ± 45.7 |
Fruit: Meals (g) | 34.4 ± 42.0 | 39.1 ± 33.3 | 37.1 ± 36.4 | 36.7 ± 28.1 | 36.7 ± 27.4 | 33.5 ± 31.3 | 35.6 ± 35.1 | 37.8 ± 30.0 | 35.2 ± 33.5 |
Fruit: Total (g) | 100.0 ± 71.8 | 84.2 ± 40.4 | 102.9 ± 63.0 | 78.7 ± 46.5 | 64.3 ± 49.7 | 99.0 ± 51.8 | 88.9 ± 60.2 | 73.8 ± 46.1 | 100.9 ± 56.8 # |
Energy (kcal) | 1052.1 ± 235.8 | 1077.8 ± 229.1 | 1063.5 ± 284.1 | 1116.3 ± 239.6 | 1058.5 ± 225.2 | 971.8 ± 188.3 *# | 1085.6 ± 37.3 | 1067.7 ± 224.7 | 1015.7 ± 240.7 |
Total Sugar (g) | 71.1 ± 21.9 | 69.9 ± 19.6 | 67.5 ± 23.7 | 79.7 ± 28.2 | 69.8 ± 19.5 | 62.6 ± 26.6 | 75.6 ± 25.5 | 69.9 ± 19.3 | 65.0 ± 25.1 * |
Free Sugar (g) | 29.2 ± 15.4 | 24.3 ± 17.0 | 20.8 ± 13.0 | 40.4 ± 26.7 | 27.2 ± 14.7 | 25.2 ± 24.6 | 35.1 ± 22.5 # | 25.8 ± 15.7 | 23.1 ± 19.8 * |
Total Fat (g) | 38.2 ± 9.1 | 42.8 ± 10.2 | 41.9 ± 15.8 | 42.0 ± 11.5 | 42.4 ± 12.6 | 34.6 ± 9.2 *# | 40.2 ± 10.5 | 42.6 ± 11.4 | 38.1 ± 13.2 # |
Mean number of snacks | 1.6 ± 0.6 | 2.1 ± 0.6 | 2.1 ± 0.6 | 2.0 ± 0.6 | 2.2 ± 0.5 | 2.1 ± 0.5 | 1.8 ± 0.6 # | 2.1 ± 0.5 | 2.1 ± 0.6 * |
Vegetables | Fresh Fruit | Total Energy | Total Fat | Total Sugar | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
b | se | β | p | b | se | β | p | b | se | β | p | b | se | β | p | b | se | β | p | |
Intervention Group | 23.91 | 6.34 | 0.39 | 0.001 | 23.81 | 12.42 | 0.22 | 0.06 | −125.83 | 58.49 | −0.26 | 0.04 | −10.44 | 3.28 | −0.40 | <0.01 | −16.09 | 6.05 | −0.31 | 0.01 |
Baseline Intake | 0.72 | 0.13 | 0.58 | <0.001 | 0.72 | 0.13 | 0.63 | <0.001 | 0.71 | 0.13 | 0.72 | <0.001 | 0.71 | 0.15 | 0.58 | <0.001 | 0.66 | 0.12 | 0.66 | <0.001 |
Child Neophobia | −1.59 | 0.62 | −0.27 | 0.01 | −7.99 | 2.21 | −0.77 | <0.01 | - | - | - | - | - | - | - | - | - | - | - | - |
Deprivation Score * | 2.06 | 0.98 | 0.21 | 0.04 | - | - | - | - | - | - | - | - | 0.88 | 0.51 | 0.22 | 0.09 | 1.95 | 0.95 | 0.24 | <0.05 |
Food Fussiness | - | - | - | - | 5.84 | 2.56 | 0.53 | 0.03 | - | - | - | - | - | - | - | - | 1.04 | 0.61 | 0.19 | 0.10 |
Modelling | - | - | - | - | −10.25 | 2.38 | −0.53 | < 0.001 | - | - | - | - | - | - | - | - | - | - | - | - |
Food Responsiveness | - | - | - | - | −3.06 | 1.70 | −0.22 | 0.08 | −18.05 | 7.85 | −0.29 | 0.03 | −0.83 | 0.41 | −0.25 | 0.05 | - | - | - | - |
Satiety Responsiveness | - | - | - | - | −4.78 | 2.38 | −0.31 | 0.05 | - | - | - | - | - | - | - | - | - | - | - | - |
* BMI Centile | - | - | - | - | −0.41 | 0.23 | −0.21 | 0.08 | - | - | - | - | - | - | - | - | - | - | - | - |
Child Age | - | - | - | - | - | - | - | - | - | - | - | - | 0.33 | 0.16 | 0.25 | < 0.05 | - | - | - | - |
Food Item | Pre-Intervention | Post Intervention | ||||
---|---|---|---|---|---|---|
Reduction | Replacement | Total | Reduction | Replacement | Total | |
Cookies | 5.68 ± 4.98 | 2.96 ± 2.03 | 4.26 ± 3.95 | 3.55 ± 2.32 | 2.92 ± 2.59 | 3.18 ± 2.47 |
Cake | 2.36 ± 2.75 | 1.49 ± 2.06 | 1.91 ± 2.43 | 1.66 ± 1.70 | 1.14 ± 1.07 | 1.36 ± 1.37 |
Pastries | 0.34 ± 0.47 | 0.28 ± 0.31 | 0.31 ± 0.39 | 0.30 ± 0.32 | 0.16 ± 0.24 | 0.22 ± 0.28 |
Sweets | 3.64 ± 3.11 | 2.52 ± 2.88 | 3.03 ± 3.00 | 3.38 ± 3.64 | 2.09 ± 1.95 | 2.63 ± 2.82 |
Potato Chips | 3.56 ± 2.69 | 2.40 ± 2.07 | 2.93 ± 2.42 | 3.13 ± 2.18 | 2.76 ± 2.97 | 2.91 ± 2.64 |
Green cooked vegetables | 6.61 ± 4.97 | 4.78 ± 3.01 | 5.66 ± 4.12 | 6.27 ± 5.13 | 5.50 ± 4.60 | 5.82 ± 4.78 |
Other Vegetables | 4.59 ± 3.30 | 4.06 ± 3.04 | 4.32 ± 3.14 | 4.66 ± 3.13 | 3.98 ± 2.24 | 4.26 ± 2.64 |
Salad | 4.69 ± 4.07 | 2.68 ± 2.24 | 3.64 ± 3.37 | 4.20 ± 3.42 | 3.86 ± 4.45 | 4.01 ± 4.00 |
Fruit | 13.14 ± 8.59 | 11.42 ± 5.32 | 12.24 ± 7.05 | 13.69 ± 6.79 | 14.73 ± 7.62 | 14.29 ± 7.21 |
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Reale, S.; Kearney, C.M.; Hetherington, M.M.; Croden, F.; Cecil, J.E.; Carstairs, S.A.; Rolls, B.J.; Caton, S.J. The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement. Nutrients 2018, 10, 1493. https://doi.org/10.3390/nu10101493
Reale S, Kearney CM, Hetherington MM, Croden F, Cecil JE, Carstairs SA, Rolls BJ, Caton SJ. The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement. Nutrients. 2018; 10(10):1493. https://doi.org/10.3390/nu10101493
Chicago/Turabian StyleReale, Sophie, Colette M. Kearney, Marion M. Hetherington, Fiona Croden, Joanne E. Cecil, Sharon A. Carstairs, Barbara J. Rolls, and Samantha J. Caton. 2018. "The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement" Nutrients 10, no. 10: 1493. https://doi.org/10.3390/nu10101493