*2.4. Processing of Dietary Intake Data*

Only respondents for whom complete dietary intake data were available (for both measurement days, both at childcare and at home) were retained in the analyses. Of the 2788 children participating in the entire study, 1016 (43.7%) provided complete dietary intake data for both measurement days, both at home and at childcare. Of the 1773 children without complete data, the majority (75.0%) had complete data at childcare, but data at home was only available for 1 day or no days at all. Furthermore, 24.0% had only attended childcare on the day, so data for two complete days at childcare could not be provided, and 1.0% only provided data for intake at home, but not for childcare. The 1016 children with complete data were included in the final analyses.

The observed and reported dietary intake data of the children were entered by the dieticians in the FoodFigures Program [26] separately for each of the six eating moments (breakfast, morning snack, lunch, afternoon snack, dinner, evening snack). The amounts consumed as reported by the childcare staff and parents were recalculated by this program into weights and volumes using the procedures on measures and weights of the Dutch nutrient database [27] where necessary (e.g., using a standardized weight for a slice of bread). Amounts of half or a quarter of a portion were also recalculated by the program. As the focus of the current paper was on dietary intake, the average intake per day of the following nutrients was calculated by the program, based on the Dutch nutrient database [27]: energy (in kcal), proteins (in energy percent (en%)), carbohydrates (en%), total fat (en%), saturated fat (en%), unsaturated fat (en%) and fibre (grams (g)). In addition, intake from the following energy balance-related food groups was calculated: fruit (g), vegetables (g), sweet snacks (g; including sweets (e.g., jelly candy, liquorice, marshmallows), chocolate, cookies (e.g., butter cookies) and pastry (e.g., cake, pie)) and savoury snacks (g; including salty snacks (e.g., potato chips) and fried snacks (e.g., fried meats)).

#### *2.5. Data Analyses*

All analyses were conducted using SPSS 20.0 [28]. *p*-Values < 0.05 were considered statistically significant. Independent *t*-tests and chi-square tests were conducted to compare the background characteristics (children's age, gender, childcare attendance, and the childcare centre's SES) of the children in the final sample with those of children who had incomplete data and were thus excluded.

Descriptive statistics were used to explore the children's background characteristics and total dietary intake. In addition, children's total dietary intake was compared with the dietary guidelines for toddlers from the Netherlands Nutrition Centre (Voedingscentrum; see Table 1) [29]. The overall dietary guidelines applied in the current study were specific Dutch guidelines [29]. The dietary guidelines for toddlers from the Netherlands Nutrition Centre refer to the guidelines for a healthy food choice of the Netherlands Nutrition Centre for a balanced dietary intake for children of one year and older. These guidelines are therefore used as a benchmark source for nutrient and food group analyses. Next, children's dietary intakes at home and at childcare were analysed separately, as well as their intakes at different eating moments (breakfast, morning snack, lunch, afternoon snack, dinner and evening snack).


**Table 1.** Total dietary intake by toddlers, compared to national guidelines (*N* = 1016).

Notes: en% = energy percent, g = grams, mL = millilitres, *N* = number of children, SD = standard deviation; a Nutritional guidelines from the Netherlands Nutrition Centre ([29]). No specific guidelines are available for unsaturated fats and snacks; <sup>b</sup> 10% deviation from the guideline allowed (*i.e.*, 1080–1320 kcal). Below the guideline: 18.8%; above the guideline: 43.7%; <sup>c</sup> below the guideline: 14.9%; above the guideline: 2.0%; <sup>d</sup> *N* (%) meeting the guideline of 50 g/day; <sup>e</sup> *N* (%) meeting the guideline of 100 g/day; <sup>f</sup> Including sweets, chocolate, cookies and pastry; <sup>g</sup> Including salty snacks and fried snacks.

In addition, the intakes by subgroups of children based on gender (boys *vs*. girls), age (2, 3 or 4 years old), childcare attendance (up to 2 days *vs*. 3 or more days a week) and the childcare centre's SES (low, medium or high) were explored. Multi-level linear regression analyses were conducted to examine the associations between these background variables and the dietary intake variables, corrected for the nesting of children within childcare centres and the background variables.

#### **3. Results**

Of the 1016 children, 54.8% (*N* = 554) were male. The average age was 2 years and 1 month (SD = 10 months), with 313 1-year-olds (34.1%), 330 2-year-olds (36.0%) and 274 3-year-olds (29.9%). On average, the children went to childcare for 2.4 days per week (SD = 0.6). A total of 24.5% of the children attended childcare centres that were located in low-SES neighbourhoods, 28.2% in medium-SES neighbourhoods, and 47.3% in high-SES neighbourhoods.

Children included in the final sample attended childcare for slightly more days a week than children with incomplete dietary intake data (2.4 *vs*. 2.1, *p* < 0.001). There were no other significant differences in background characteristics (age, gender, childcare SES) between children who did or did not drop out.

#### *3.1. Dietary Intake and Guideline Compliance*

Table 1 lists the total dietary intake of the toddlers in the current study, as well as the number and percentage of children complying with the dietary guidelines of the Netherlands Nutrition Centre [29]. About one third of the children (37.5%) complied with the guidelines regarding energy intake. A smaller group (18.8%) consumed less than the recommended amount of energy, while most children (43.7%) consumed more energy than recommended.

The vast majority of the children met the guidelines with regard to macronutrients (carbohydrates, proteins and fat). However, only 17.2% of the children consumed sufficient dietary fibre. This was also reflected in the low percentages of children consuming sufficient fruit and vegetables. Snack intake (both sweet and savoury) was generally low.

#### *3.2. Dietary Intake at Childcare and at Home*

Children consumed more or less equal amounts of energy at home and at childcare. However, while their intake at childcare mainly consisted of carbohydrates, a relatively larger proportion of the intake at home consisted of proteins and fat (see Table 2). Furthermore, children consumed most of their fruit at childcare, and most of their vegetables at home. Sweet snacks were mostly eaten at childcare.

#### *3.3. Dietary Intake at Different Eating Moments*

Table 3 shows the children's dietary intake at different eating moments, as well as the intake as a proportion of total daily intake (from different meals). The percentage of children consuming food at each of the eating moments was very high (98.6%–99.8%), except for evening snacks, which were consumed by only 62.8% of the children.

The main energy sources were lunch and dinner, together accounting for over half (57.4%) of the total energy intake. The snacking moments were very high in carbohydrates, while the main meals contained relatively larger proportions of proteins and fat. The main sources of dietary fibre were the main meals. Most fruit was consumed during the morning snacking moment, while the afternoon snacking moment often involved sweet snacks (e.g., cookies, sweets, pastry). The evening snacking moment involved a relatively large proportion of saturated fat compared to the other snacking moments.


**Table 2.** Dietary intake by toddlers at childcare and at home (*N* = 1016).

Notes: en% = energy percent, g = grams, mL = millilitres; <sup>a</sup> Including sweets, chocolate, cookies and pastry; b Including salty snacks and fried snacks.
