Downsizing: Snacking in Preschool Children
Condition: Food Habits; Food, Snack; Acceptance Processes
Study type: Interventional

Summary: 
      The aim of the study is to investigate and compare two strategies of portion control in
      toddlers aged 24 to 59 months (snack replacement and snack reduction). The investigators aim
      to compare the effect of these strategies on habitual dietary intake (total energy intake
      (kcal), sugar intake (g), intake of fruits and vegetables, and intake at a test meal provided
      in the home (total energy intake (kcal) and intake of each component of the meal, e.g. intake
      of vegetables). Outcome measures will be compared to baseline within strategies and also
      between strategies to explore which portion control strategy might be most effective.
    

Detailed description: 
      Following provision of informed consent the primary caregiver will be provided with a
      recruitment questionnaire. The questionnaire can be completed on paper or online (identical
      questionnaires). It will include the Food Frequency Questionnaire (FFQ; Hammond et al., 1993)
      to determine whether the child likes and regularly eats HED snacks. A FFQ will also be
      administered to the main caregiver in order to establish familial patterns of food intake.

      Demographic information will be collected for both caregivers and child in paper or online
      format. Measures of child eating behaviour, parental feeding practices, food neophobia and
      temperament will be taken. Anthropometric information of the child will also be collected by
      the researcher to calculate weight-for-height z scores.

      A between-subject 3-week intervention will be implemented with participants acting as their
      own controls during the baseline (week 1) and acclimation (week 2) periods before being
      randomised in to the intervention period (week 3) (figure 1). Caregivers will be instructed
      to complete a 4-day weighed food diary each week (3 weekdays and at least one weekend day).
      This will involve the caregiver recording all food and drinks consumed by their child to the
      nearest gram using the scales provided.

      During week 1 (baseline) parents will be instructed to make no alterations to the foods and
      drinks that they provide to their child. Data from this phase of the experiment will be used
      to examine the habitual diet. Data obtained in this phase will enable us to determine whether
      or not the provision of the snacks has changed the child's dietary habits.

      During week 2 (acclimation phase) participants will be provided with a range of snacks that
      are intended to replace all usual snacks. This will consist of several different snack
      options (figure 2) to provide up to three snacks per day and to allow for any siblings who
      may want an identical snack option. All participants will be provided with the same selection
      of HED snacks, which will be familiar to all children. Snack types and amounts will be based
      on data collected from the cohort prior to the beginning of the experiment when participants
      express an interest in taking part. Parents/ caregivers will be required to replace all usual
      snacks with the ones provided over the following 7 days and will be instructed to provide the
      snacks at their child's usual snack time following a snacking schedule, and to record it in
      the food diary; this will allow the snacking schedule to be matched in week three. If parents
      usually provide fruit or vegetables (in their natural form) for a snack occasion they will be
      instructed to continue to do so. HED snacks are being provided in this pilot study to ensure
      consistency across all children.

      In week 3 parents will be randomly allocated (block randomisation) to one of two portion size
      reduction interventions via simple randomisation procedure (snack reduction or snack
      replacement). Caregivers will be instructed to either reduce all snacks by 50% or replace all
      snacks with familiar and relatively liked fruits, vegetables and a starch component
      (breadstick, cracker or rice cake). In the snack reduction condition parents and caregivers
      will be provided with the same snacks as in week 2 and a snacking schedule showing the
      amounts and types of snacks that should be offered to the child (as per week 2). Once the
      downsized snack (50% portion) has been consumed, if the child indicates that they are still
      hungry, caregivers will be advised to offer any other low energy dense foods such as fruits
      and vegetables. In the replacement condition, caregivers will be instructed to remove all HED
      snacks that were provided in week 2 or otherwise and sugar sweetened beverages from the
      child's diet for one week and offer only the fruits and vegetables, starch-based food (bread
      stick, rice cake or cracker) and sugar free drinks provided. All participants in the snack
      replacement group will be provided with a snack pack consisting of fruits and vegetables
      familiar and relatively liked to all children (for example apples, grapes, pears, banana, red
      pepper, cucumber, cherry tomatoes and carrots (all served raw)). The fruit and vegetable
      types will be based on the data collected on children familiarity of fruits and vegetables
      from the cohort prior to week 1.Caregivers will be instructed to offer 40g of both a
      specified fruit and vegetable (more if the child requests) and a pre-defined starch
      component. This is based on a typical portion size for a pre-school child. A snacking
      schedule will also be provided for the fruits and vegetables.
    

Intervention name(s): Reduction or Replacement
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Portion Size; Feasibility; Acceptability; Snacking; Preschool children