Comparing dietary quality of provided lunches and lunchboxes in Early Childhood Education and Care Settings in England: A cross-sectional analysis

Objective: The majority of early years children (0 to-5 years) attend Early Childhood Education and Care settings (ECECs) in England. This study aims to explore the dietary quality of lunches served, consumed, and wasted in English ECECs, and compare how this differs between ECEC provided lunches and lunchboxes from home, and across deprivation levels. Design: A cross-sectional secondary data analysis of baseline dietary data from the NAPSACC UK study. Dietary quality was measured using a bespoke ECEC Dietary Score (EDS). Setting: Diet data was collected from ECECs in three areas in England. Participants: 357 children (mean age 3.5 years) from 38 ECECs. Results: 52% (n = 184) of children received ECEC provided lunches and 30% (n = 108) were from areas of high deprivation. Lunchboxes had poorer dietary quality than ECEC provided lunches (median EDS (IQR) for ECECs: 5.0 (4.0, 6.0), lunchboxes: 4.0 (3.0, 5.0). Consumed lunches were more aligned with dietary recommendations than served lunches, both had low adherence to free sugars (all lunches served = 8%, consumed = 16%). Lunchboxes from the most deprived areas contained poorer dietary quality than lunchboxes in the least deprived areas (adjusted mean difference 0.9 (95% CI 02, 1.6) p = 0.009). The largest proportion of food waste was for fruit and vegetables (median 19.6g, 25.5%). Conclusions: Dietary quality was higher in ECEC provided lunches than lunchboxes, although both contained excess energy, free sugars, saturated fat, and sodium, and were deficient in fibre. A widespread reduction in High Fat, Sugar or Salt (HFSS) foods served to early years children in ECECs is needed.