Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Protocol
2.2. Sampling
2.3. The ToyBox-Intervention
2.4. Measures
2.4.1. Food and Beverage Intake
2.4.2. Diet Quality Index (DQI)
2.4.3. Socio-Economic Status and Other Socio-Demographic Variables
2.5. Statistical Analyses
3. Results
3.1. Population Characteristics
3.2. Intervention Effects on Total Diet Quality, the Four Subcomponents, and Their Sub-Items
3.2.1. Total Sample
3.2.2. Stratified Analyses by Country
3.3. Moderation Analyses Results
4. Discussion
4.1. Future Studies
4.2. Strengths and Limitations
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Dietary Diversity |
For each food group (water, cereals, potatoes, fruit, vegetables, milk products, cheese, and meat and fish): |
sum frequency food items belonging to that food group |
If sum ≥ 1: diversity score for particular food group = 1 |
If not: diversity score for particular food group = 0 |
Total dietary diversity = Sum diversity scores of all food groups/number of food groups (8) × 100% |
Dietary Quality |
Each food item of the food frequency questionnaire has been scored ‘−1’, ‘0’, or ‘1’ depending on whether the food item of a certain food group was categorized in: |
the low-nutritious but energy-dense group (−1) |
the intermediate group (0) |
the preference group (1) |
of the Active Flemish food triangle. |
Dietary quality score for each food item = score of each food item × portion of each food item (grams/millilitres) |
Total dietary quality = sum food item dietary diversity scores/total amount of all food items (grams/millilitres per day) × 100% |
Dietary Equilibrium |
For each food group: Sum total daily intake of all food items of that food group, then: |
For adequacy |
If daily intake food group met minimum norm: adequacy food group = 1 |
If not: adequacy food group = daily intake of the food group/minimum norm of the food group. |
For moderation |
If maximum norm food group was not exceeded: moderation food group = 0 |
If maximum norm food group was exceeded: moderation food group = (maximum norm − daily intake of the food group)/maximum norm |
If daily intake of food group was twice as many or more than the recommended maximum intake: moderation = −1. |
Equilibrium specific food group = sum adequacy and moderation specific food group |
Total equilibrium score = sum equilibrium scores of all food groups/total amount of food groups (9 1) × 100% |
Meal Index = (Frequency breakfast/week + lunch/week + dinner/week)/3 × 100% |
Total DQI = Sum subcomponents/4 |
Total | Belgium | Bulgaria | Germany | Greece | Poland | Spain | |
---|---|---|---|---|---|---|---|
N | 4968 | 769 | 644 | 882 | 825 | 1021 | 827 |
Age (years) | 4.7 ± 0.4 | 4.4 ± 0.5 | 4.9 ± 0.3 | 4.5 ± 0.5 | 4.9 ± 0.3 | 4.9 ± 0.3 | 4.9 ± 0.3 |
Gender (% male) | 51.4 | 50.7 | 49.8 | 51.8 | 50.4 | 50.9 | 54.5 |
SES, % lower SES * (=% ≤14 years of education) | 38.5 | 34.1 | 40.5 | 51.4 | 52.9 | 20.7 | 34.8 |
Time × Condition β | Group | Mean Baseline | Mean Follow-Up | |
---|---|---|---|---|
Dietary Diversity | −0.34 | I | 64.6 | 63.8 |
C | 63.7 | 63.3 | ||
Diversity Bread | −0.02 | |||
Diversity Potatoes | −0.03 | |||
Diversity Fruit | 0.01 | |||
Diversity Vegetables | −0.02 | |||
Diversity Milk | −0.00 | |||
Diversity Cheese | 0.02 | |||
Diversity Meat | 0.01 | |||
Dietary Quality | 1.97 *** | I | 58.5 | 61.9 |
C | 59.1 | 60.6 | ||
Quality Water | 19.92 | |||
Quality Bread | −1.09 | |||
Quality Potatoes | −0.68 | |||
Quality Fruit | −0.46 | |||
Quality Milk | 0.88 | |||
Quality Meat | −1.11 | |||
Dietary Equilibrium | 0.82 ** | I | 66.8 | 67.7 |
C | 66.6 | 66.8 | ||
Equilibrium Water | 0.01 | |||
Equilibrium Bread | −0.00 | |||
Equilibrium Potatoes | −0.01 | |||
Equilibrium Fruit | 0.02 * | |||
Equilibrium Vegetables | 0.01 | |||
Equilibrium Milk | −0.01 | |||
Equilibrium Cheese | 0.00 | |||
Equilibrium Meat | 0.00 | |||
Equilibrium Snacks | 0.03 * | |||
Meal Index | −0.40 | I | 91.1 | 89.3 |
C | 90.0 | 88.6 | ||
Breakfast | 0.00 | |||
Lunch | −0.01 | |||
Dinner | −0.01 | |||
Total Diet Quality | 0.52 | I | 70.3 | 70.7 |
C | 69.8 | 69.8 |
Group | Belgium | Bulgaria | Germany | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean Baseline | Mean Follow-Up | Time × Condition β | Mean Baseline | Mean Follow-Up | Time × Condition β | Mean Baseline | Mean Follow-Up | Time × Condition β | ||
Dietary Diversity | I | 72.7 | 69.8 | −1.21 | 59.8 | 60.3 | 0.80 | 64.5 | 64.2 | −1.29 |
C | 72.5 | 70.8 | 60.0 | 59.7 | 65.1 | 66.0 | ||||
Dietary Quality | I | 59.5 | 63.0 | 2.14 | 63.5 | 64.2 | −0.90 | 63.3 | 66.8 | 3.72 ** |
C | 58.7 | 60.0 | 65.4 | 67.0 | 63.9 | 63.7 | ||||
Dietary Equilibrium | I | 68.3 | 69.4 | 2.36 ** | 63.0 | 65.4 | 0.75 | 69.0 | 69.7 | 0.30 |
C | 69.0 | 67.8 | 63.0 | 64.6 | 68.2 | 68.7 | ||||
Meal Index | I | 95.1 | 94.3 | −0.14 | 94.4 | 91.7 | −5.66 | 94.5 | 93.9 | 2.54 |
C | 95.6 | 94.9 | 90.9 | 93.8 | 95.7 | 92.6 | ||||
Total Diet quality | I | 73.8 | 74.0 | 0.79 | 70.2 | 70.4 | −1.25 | 72.8 | 73.6 | 1.32 |
C | 73.9 | 73.3 | 69.9 | 71.3 | 73.2 | 72.7 |
Group | Greece | Poland | Spain | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean Baseline | Mean Follow-Up | Time × Condition β | Mean Baseline | Mean Follow-Up | Time × Condition β | Mean Baseline | Mean Follow-Up | Time × Condition β | ||
Dietary Diversity | I | 62.7 | 61.5 | 1.18 | 63.6 | 63.4 | −0.88 | 64.6 | 63.8 | 0.12 |
C | 62.6 | 60.3 | 61.2 | 61.9 | 61.8 | 60.8 | ||||
Dietary Quality | I | 57.2 | 61.0 | 1.31 | 48.5 | 54.1 | 3.16 ** | 59.9 | 62.2 | 1.03 |
C | 58.8 | 61.4 | 48.9 | 51.4 | 59.8 | 61.0 | ||||
Dietary Equilibrium | I | 68.6 | 69.1 | 0.79 | 66.7 | 67.0 | 0.25 | 64.7 | 65.7 | 0.56 |
C | 69.3 | 69.0 | 65.8 | 65.9 | 64.5 | 65.0 | ||||
Meal Index | I | 78.5 | 74.7 | −0.52 | 95.9 | 95.0 | −0.91 | 87.8 | 85.9 | 1.55 |
C | 74.0 | 70.7 | 95.4 | 95.4 | 86.7 | 83.3 | ||||
Total Diet quality | I | 66.7 | 66.6 | 0.69 | 68.7 | 69.9 | 0.41 | 69.2 | 69.4 | 0.82 |
C | 66.2 | 65.3 | 67.8 | 68.7 | 68.1 | 67.5 |
Time × Condition × SES β | p | |
---|---|---|
Dietary Diversity | 0.63 | 0.343 |
Dietary Quality | 0.36 | 0.516 |
Dietary Equilibrium | −0.21 | 0.585 |
Meal Index | 1.51 | 0.173 |
Total Diet quality | 0.56 | 0.147 |
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Pinket, A.-S.; De Craemer, M.; Huybrechts, I.; De Bourdeaudhuij, I.; Deforche, B.; Cardon, G.; Androutsos, O.; Koletzko, B.; Moreno, L.A.; Socha, P.; et al. Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study. Nutrients 2017, 9, 479. https://doi.org/10.3390/nu9050479
Pinket A-S, De Craemer M, Huybrechts I, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, et al. Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study. Nutrients. 2017; 9(5):479. https://doi.org/10.3390/nu9050479
Chicago/Turabian StylePinket, An-Sofie, Marieke De Craemer, Inge Huybrechts, Ilse De Bourdeaudhuij, Benedicte Deforche, Greet Cardon, Odysseas Androutsos, Berthold Koletzko, Luis A. Moreno, Piotr Socha, and et al. 2017. "Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study" Nutrients 9, no. 5: 479. https://doi.org/10.3390/nu9050479
APA StylePinket, A.-S., De Craemer, M., Huybrechts, I., De Bourdeaudhuij, I., Deforche, B., Cardon, G., Androutsos, O., Koletzko, B., Moreno, L. A., Socha, P., Iotova, V., Manios, Y., & Van Lippevelde, W. (2017). Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study. Nutrients, 9(5), 479. https://doi.org/10.3390/nu9050479