The effect of the association between food budget and food quality on adherence to national guidelines in kindergartens, and the impact of budget limit on the food quality

Kristin Fjæra; Ratib Lekhal; Sølvi Helseth; Milada Hagen; Samira Lekhal

doi:10.29219/fnr.v68.9524

Kristin Fjæra Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; and GreeNudge and Morbid Obesity Center, Vestfold Hospital Trust, Oslo, Norway
Ratib Lekhal Department of Education; University of Oslo, Oslo, Norway
Sølvi Helseth Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
Milada Hagen Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
Samira Lekhal GreeNudge and Morbid Obesity Center, Vestfold Hospital Trust, Oslo, Norway

DOI: https://doi.org/10.29219/fnr.v68.9524

Keywords: cross-sectional, children, kindergarten, diet, food budget

Abstract

Background: In Norway, almost 97% of children attend kindergartens. Most of the daily food intake happens during the day in kindergartens, and the quality of food and meals being served is essential to promote healthy food habits. There is variation in the food that kindergartens provide, and kindergartens can ask for additional payment from parents to cover the food. There are no rules neither across kindergartens for the food offering nor how much additional payment kindergarten can request.

Objective: Our main objective is to investigate possible associations between the food budget and the quality of food offered in kindergartens. We specifically aimed to identify budget levels that were associated with better adherence to national guidelines, thereby the quality of the food provided, as recommended by the Norwegian Directorate of Health.

Design: A cross-sectional study design, based on kindergarten pedagogical leaders’ answers to a web-based questionnaire.

Settings: Private and public kindergartens across Norway are included in this present study.

Participants: A total of 324 kindergarten staff attending on behalf of kindergartens participated.

Results: The food budget thresholds over NOK 199 are associated with higher quality of served food, in adherence to national guidelines of food and meals (odds ratio 5.2, CI = [1.5, 16.5]), compared to thresholds under 199 NOK. However, increasing the monthly food budget per child to low (200–299 NOK), medium (300–399 NOK), high (400–499 NOK), or very high (>500 NOK) levels did not lead to an improvement in food quality.

Conclusion: The main results reveal that budget plays a limited role in the quality of food and meals served as long as it is above ‘very low’ (199 NOK) food budget threshold. We assume that other contextual factors can influence the quality of food and meals in a more prominent role.

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Author Biographies

Ratib Lekhal, Department of Education; University of Oslo, Oslo, Norway

Ass. professor. Department of Education; University of Oslo, Oslo; Norway

Sølvi Helseth, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway

professor. Faculty of Health Sciences, Oslo Metrolpolitan University; Oslo; Norway

Milada Hagen, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway

Professor. Faculty of Health Sciences, Oslo Metrolpolitan University; Oslo; Norway

Samira Lekhal, GreeNudge and Morbid Obesity Center, Vestfold Hospital Trust, Oslo, Norway

Medical Doctor, Phd, GreeNudge and Motbid Obesity Center, Vestfold Hospital Trust, ; Oslo; Norway

References

tr>
1.
Schwartz C, Scholtens PAMJ, Lalanne A, Weenen H, Nicklaus S. Development of healthy eating habits early in life. Review of recent evidence and selected guidelines. Appetite 2011; 57(3): 796–807. doi: 10.1016/j.appet.2011.05.316

2.
Micha R, Khatibzadeh S, Shi P, Andrews KG, Engell RE, Mozaffarian D. Global, regional and national consumption of major food groups in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys worldwide. BMJ Open 2015; 5(9): e008705. doi: 10.1136/bmjopen-2015-008705

3.
Folkehelseinstituttet. Ungkost 3. Landsomfattende kostholdsundersøkelse blant 4-åringer i Norge, 2016. Oslo; 2016. Available from: https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2016/rapportungkost-3-landsomfattende-kostholdsundersokelse-blant-4-aringer-i-norge-2016.pdf [cited 20 November 2022].

4.
OECD. Starting strong 2017: key OECD indicators on early childhood education and care; starting strong. Paris: OECD Publishing; 2017. Available from: https://www.oecd.org/education/starting-strong-2017-9789264276116-en.htm [cited 03 January 2023].

5.
Statistics Norway. Kindergartens, 2020: final numbers. Oslo: Statistics Norway; 2020.

6.
Norwegian Ministry of Education and Research. Guidelines for the kindergartens content and tasks [in Norwegian]. Oslo: Norwegian Ministry of Education and Research; 2011.

7.
The Norwegian Directorate for Education and Training. Parental fee. Oslo: Norwegian Directorate for Education and Training; 2021. Available from: https://www.udir.no/regelverk-og-tilsyn/barnehage/foreldrebetaling/ [cited 03 March 2022].

8.
Norwegian Directorate of Health. Meals, physical activity and environmental health care in kindergartens 2012. Report No.: IS-0345. Oslo: Norwegian Directorate of Health; 2012.

9.
Norwegian Directorate of Health. National guidelines for food and meals in kindergartens. Report No.: IS-2783. Oslo: Norwegian Directorate of Health; 2018.

10.
Forbrukerrådet. Barnehagemat. Næring til liv, lek og læring: Appetitt på livet. Oslo: Forbrukerrådet; 2018.

11.
Eng K, Lekhal R, Løseth M, Helseth S, Lekhal S. Mat-og måltidspraksisen i et utvalg norske barnehager- en deskriptiv studie. 2021. Available from: https://www.ntfe.no/journal/2021/4/m-525/Mat-_og_m%C3%A5ltidspraksisen_i_et_utvalg_Norske_barnehager_%E2%80%93_en_deskriptiv_studie [cited 11 February 2022].

12.
Gerritsen S, Dean B, Morton SMB, Wall CR. Do childcare menus meet nutrition guidelines? Quantity, variety and quality of food provided in New Zealand Early Childhood Education services. Aust N Z J Public Health 2017; 41(4): 345–51. doi: 10.1111/1753-6405.12667

13.
Carroll JD, Demment MM, Stiles SB, Devine CM, Dollahite JS, Sobal J, et al. Overcoming barriers to vegetable consumption by preschool children: a child care center buying club. J Hunger Environ Nutr 2011; 6(2): 153–65. doi: 10.1080/19320248.2011.576207

14.
Zaltz DA, Pate RR, O’Neill JR, Neelon B, Benjamin-Neelon SE. Barriers and facilitators to compliance with a state healthy eating policy in early care and education centers. Child Obes 2018; 14(6): 349–57. doi: 10.1089/chi.2018.0077

15.
Rao M, Afshin A, Singh G, Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 2013; 3(12): e004277. doi: 10.1136/bmjopen-2013-004277

16.
Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015; 73(10): 643–60. doi: 10.1093/nutrit/nuv027

17.
Vandevijvere S, Seck M, Pedroni C, De Ridder K, Castetbon K. Food cost and adherence to guidelines for healthy diets: evidence from Belgium. Eur J Clin Nutr 2021; 75(7): 1142–51. doi: 10.1038/s41430-020-00815-z

18.
Goudie S. Broken plate 2021: the state of the nation’s food system. Technical Report. Nuffield foundation, UK; 2021.

19.
Uldahl M, Bere E. Lavinntektsfamilier i Norge må bruke en større andel av inntekten sin for å spise i tråd med kostrådene. Norsk tidsskrift ernæring 2023; 21(1): 23–32. doi: 10.18261/ntfe.21.1.5

20.
Johnson BJ, Hendrie GA, Golley RK. Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework. Public Health Nutr 2016; 19(9): 1684–95. doi: 10.1017/S1368980015002992

21.
Field A. Discovering statistics using IBM SPSS statistics. London: Sage publication Ltd; 2013.

22.
Monsivais P, Drewnowski A. Lower-energy-density diets are associated with higher monetary costs per kilocalorie and are consumed by women of higher socioeconomic status. J Am Diet Assoc 2009; 109(5): 814–22. doi: 10.1016/j.jada.2009.02.002

23.
Seward K, Finch M, Yoong SL, Wyse R, Jones J, Grady A, et al. Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: a systematic review. Prevent Med 2017; 105: 197–205. doi: 10.1016/j.ypmed.2017.09.024

24.
Himberg-Sundet A, Kristiansen AL, Bjelland M, Moser T, Holthe A, Andersen LF, et al. Is the environment in kindergarten associated with the vegetables served and eaten? The BRA Study. Scand J Public Health 2019; 47(5): 538–47. doi: 10.1177/1403494818756702

25.
Ray C, Määttä S, Lehto R, Roos G, Roos E. Influencing factors of children’s fruit, vegetable and sugar-enriched food intake in a Finnish preschool setting–preschool personnel’s perceptions. Appetite 2016; 103: 72–9. doi: 10.1016/j.appet.2016.03.020

26.
Dahl T, Jensberg H. Diet in schools and kindergartens and the significance for health and learning – an overview. Norden; 2011, p. 534. Available from: http://norden.diva-portal.org/smash/get/diva2:700700/FULLTEXT01.pdf [cited 26 November 2022].

27.
Utdanningsdirektoratet. Statistikk barnehage. 2021. Available from: https://www.udir.no/tall-og-forskning/statistikk/statistikk-barnehage/om-barnehagen/ [cited 02 Fmarch 2023].

28.
Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, et al. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2016; 10(10): CD011779. doi: 10.1002/14651858.CD011779.pub2

29.
World Health Organization. Closing the health equity gap: policy options and opportunities for action. Geneva: World Health Organization; 2013.

30.
Norwegian Ministry of Health and Care Services. Lov om folkehelsearbeid (Folkehelseloven) [Act on Public Health Work (the Public Health Law)]. Oslo: Helse og omsorgsdepartementet, 2011 [cited 30 February 2023].

31.
Haug E, Robson-Wold C, Helland T, Jåstad A, Torsheim T, Fismen A, et al. Barn og unges helse og trivsel: Forekomst og sosial ulikhet i Norge og Norden. Bergen: Institutt for helse, miljø, og likeverd, Universitetet i Bergen; 2020.

32.
McGill R, Anwar E, Orton L, Bromley H, Lloyd-Williams F, O’Flaherty M, et al. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health 2015; 15(1): 1–15. doi: 10.1186/s12889-015-1781-7

33.
Schap T, Kuczynski K, Hiza H. Healthy eating index – beyond the score. J Acad Nutr Dietetics 2017; 117(4): 519–21. doi: 10.1016/j.jand.2017.02.002

34.
Voortman T, Kiefte-de Jong JC, Geelen A, Villamor E, Moll HA, de Jongste JC, et al. The development of a diet quality score for preschool children and its validation and determinants in the Generation R Study. J Nutr 2015; 145(2): 306–14. doi: 10.3945/jn.114.199349

35.
Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 2004; 7(7): 931–5. doi: 10.1079/PHN2004556

36.
Public Health England. National diet and nutrition survey results from years 5 and 6 combined of the rolling programme for 2012 and 2013 to 2013 and 2014. London: Public Health England; 2016.