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Dietary intake and health outcomes among children attending two urban day care centers
Journal of the American Dietetic Association (1999)
  • Kay Stearns Bruening, Syracuse University
  • Judith A Gilbride
  • Marian A Passannante
  • Sandra McClowry

Objective To assess the impact of the Child and Adult Care Food Program (CACFP) on diet and 3 health outcomes—weight-for-height status, dental caries (tooth decay) score, and number of days of illness—among preschool children attending 2 urban day care centers.

Design Dietary intake and health outcome measures were assessed and compared for children attending 2 day-care centers in an urban community. Data were obtained for 14 days of dietary intake, which were analyzed for energy and 15 nutrients and 6 food groups; anthropometric measures, including weight-for-height; dental caries; and days of illness.

Subjects/setting Forty 3- to 5-year-old black children from 2 day-care centers participated. One center participates in the CACFP. At the other center, children bring all meals and snacks from home.

Statistical analyses performed Data from the 2 groups of children were compared using parametric and nonparametric t tests.

Results Children receiving CACFP meals at day care had significantly higher mean daily intakes of vitamin A (804±191 vs 595±268 retinol equivalents), riboflavin (1.45±0.32 vs 1.21±0.22 mg), and calcium (714±180 vs 503±143 mg) than the children who brought all of their meals and snacks from home. Children who received CACFP meals also consumed significantly more servings of milk (2.9±0.9 servings vs 1.5±0.7) and vegetables (1.8±0.5 vs 1.2±0.5 servings) and significantly fewer servings of fats/sweets (4.6±1.3 vs 5.4±1.1 servings) than children who brought their meals. Weight-for-height status and dental caries scores did not differ between the 2 groups. Children from the center participating in the CACFP have significantly fewer days of illness (median 6.5 vs 10.5 days) than children from the nonparticipating center.

Applications Nutritious meals provided by the CACFP can improve diets and may promote health among young, urban children. Registered dietitians can contribute to food assistance programs by intervening to enhance the quality of meals served and by examining the impact of participation on measures of diet quality and diet-related health outcomes. J Am Diet Assoc. 1999;99:1529–1535.

The Child and Adult Care Food Program (CACFP), a federal food program authorized in 1975, reimburses child-care institutions that serve nutritious food to children. Its purpose is to establish nutritious meal programs, similar to those provided by the School Breakfast Program and the School Lunch Program, to meet the needs of children in day-care centers, especially in low-income areas (1). The program has grown since its inception. According to Briley and Roberts-Gray (2), the number of meals served in child-care facilities participating in CACFP increased by more than 100% between 1982 and 1992, and this growth is expected to continue.

The effect of receiving CACFP meals has not been evaluated extensively. The pilot program for the child-care component of CACFP, conducted in 1977, evaluated 7-day food records of participants for adequacy of 9 nutrients. Although overall nutrient consumption was adequate, meals and snacks provided by day-care centers failed to provide 75% to 80% of the Recommended Dietary Allowances for iron and calcium (3). More recently, several studies based on menu evaluation in day-care centers have been conducted (4), (5) and (6). These studies showed that energy and nutrient contents of menus were below the recommended amount (7) for energy, niacin, vitamin B-6, iron, zinc, and calcium in a number of child-care centers. Two studies have evaluated children's actual intakes. Drake (8) evaluated intakes of children from meals provided at day-care centers and found that consumption of iron, zinc, magnesium, and folic acid was below the recommended standard of two thirds of the Recommended Dietary Allowance (RDA) (9). In another study, Drake (10) evaluated diets and 2 health outcomes (anthropometric measures and biochemical indexes of iron nutriture) among middle-class white children attending day care and found low intakes of iron, zinc, and folic acid. Fifteen percent of the children had biochemical evidence of iron deficiency (10). These findings illustrate that even though dietary inadequacies may not be reflected in obvious problems such as stunting or underweight, they may indeed contribute to less obvious health problems such as iron deficiency.

Dental caries (tooth decay) is a diet-related health problem, at least for some children. Twenty-five percent of US children account for 75% of dental caries (11). According to Caplan and Weintraub (11), black and other minority children, children living in rural areas, and children living solely in communities lacking fluoridated water have higher dental caries scores. Dental caries has a multifactorial etiology (12). Dietary factors related to dental caries include nutrients and residues from food remaining in the oral cavity after swallowing a food bolus, carbohydrate content of food, frequency of consumption, and sequence of ingestion. Dental hygiene practices can affect how long food residues remain on the teeth. A study by Litt et al (13) demonstrated that frequency of sleeping with a bottle, ethnicity, level of Streptococcus mutans, and previous dental caries experience significantly predicted tooth decay scores in low-income preschool children. At least one report has indicated that diet may be related to dental caries among preschool children participating in a federal food assistance program (14).

A problem for children attending day-care centers that is costly in terms of medical expenses and lost hours of work for parents is minor infectious illness. Several researchers (15) and (16) have demonstrated that children attending day-care centers experience more sick days than children cared for at home or in family settings. Other factors related to minor illness in children include the number of siblings and whether a child is living with a smoker (15) and (16). Young children are highly susceptible to infection, partly because of the immaturity of their immune systems. Limited evidence suggests a link between diet and immunity in preschool children who were not undernourished (17) and (18).

In the present study we evaluated the contribution of the CACFP to young children's diets by comparing a group of children who attended a day-care center that participated in the CACFP with a group of children who brought all meals and snacks from home to the day-care center. We examined 3 diet-related health outcomes: weight-for-height status, dental caries, and days of illness.

Publication Date
Citation Information
Kay Stearns Bruening, Judith A Gilbride, Marian A Passannante and Sandra McClowry. "Dietary intake and health outcomes among children attending two urban day care centers" Journal of the American Dietetic Association Vol. 99 Iss. 12 (1999)
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