Healthy food, drinks and choking guidance in New Zealand : do early learning service menus align? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics

Abstract

Background: Food intake from birth to six years is especially important as early life is a period for healthy flavour learning, rapid growth, and establishing long-term eating patterns. Early learning services (ELS) provide an influential environment outside of the home where young children consume a considerable amount of their daily nutritional requirements. Understanding the foods and drinks available within ELS is crucial to address health issues young children may face during their formative years, such as an increased risk of choking, overweight and obesity, and subsequent development of non-communicable diseases such as cardiovascular diseases and diabetes mellitus. Aim: To assess the alignment of food and drinks served to NZ children in ELS with the Ministry of Health (MoH) Healthy Food and Drink (HFD) and Reducing Food Related Choking (choking) guidance. Methods: Menus (271) collected remotely from 148 ELS from November 2020-March 2021 were analysed for their nutritional quality (percentage of ‘green’, ‘amber’, and ‘red’ menu items) using a scoring system based on the MoH guidance. Results: Overall, 2.6% of menus met the MoH HFD guidance, and alignment was greater for menus for over two-year-olds (over-2s) than under two-year-olds (under-2s; p<0.01). One-fifth (18.5%) of menus met the MoH choking guidance. Services with a Healthy Heart Award (HHA) provided more green items to over-2s (p=0.039) and under-2s (p=0.01), and fewer red items to over-2s (p=0.04). Providing more green menu items was inversely correlated with providing less high-choking-risk foods (p<0.01, r=-0.347 over-2s; p<0.01, r=-0.504 under-2s). Menu scores did not vary by service location (p=0.317 over-2s; p=0.108 under-2s), neighbourhood socioeconomic deprivation (p=0.118 over-2s; p=0.770 under-2s), type (services operating independently versus those part of an education group chain; p=0.451 over-2s; p=0.520 under-2s), or menu length (full menu providing a minimum of one meal and two snacks daily, or partial menu providing less; p=0.445 over-2s, p=0.796 under-2s). Conclusions: Alignment with MoH nutritional guidance is low, particularly in ELS caring for very young children (under-2s). Service characteristics, except for HHA status, are a poor predictor of the nutritional quality of menus at ELS. There is a widespread need to further support ELS with the implementation of nutrition guidelines.