Impact of The Lunch is in the Bag Intervention on the Dietary Quality of Preschooler's Sack Lunches Measured with the HEI‐2010
Authors: Romo‐Palafox Maria Jose , Ranjit Nalini , Briley Margaret E , Sweitzer Sara J , Roberts‐Grey Cindy , Williams Courtney E Byrd , Hoelscher Deanna M 
Published: November 2023

ObjectiveTo measure the impact of Lunch is in the Bag (LIITB), a multi‐level behavioral nutrition intervention, on the dietary quality of the lunches that parents packed for their preschool children using Healthy Eating Index (HEI) 2010 total and component scores at 6‐week, 22‐week and 28‐week follow‐up periods.BackgroundThe low dietary quality of U.S. children's diets contribute to the development of childhood obesity and comorbidities. Up to 61% of U.S. children under the age of 6 receive care outside the home. The LIITB efficacy trial conducted in 30 Early Care and Education (ECE) centers in central Texas to evaluate parent‐packing and child‐eating of bag lunches provided a unique opportunity to use the HEI‐2010 to measure the intervention's impact on dietary quality of the packed lunches over time.MethodsParent‐child dyads (n=628) were recruited from 30 Early Care and Education centers in 3 cities of central Texas. Centers were randomized to control or intervention. Two food records were collected on 2 non‐consecutive days per measurement period. Dietary data were collected at baseline, after the 5‐week intervention (6 week follow‐up), after a fall out period, before the 1‐week booster (22‐week follow‐up), and post‐booster (28‐week follow‐up). Dietary records were analyzed using the Food Intake Analysis System and HEI‐2010 scores were computed using standard SAS codes. Time‐by‐treatment interactions in multi‐level modeling were computed for HEI‐2010 total and component scores to measure changes from baseline. Analyses were adjusted for child sex, age, Body Mass Index; and parental race, education and marital status.ResultsThe LIITB intervention produced an increase in the dietary quality of 4.5% (SE=1.1% p<0.0001) at 6‐week follow‐up period, 4.7% (SE=1.1%, P<0.0001) at 22‐week follow‐up period and 2.9% (SE=1.1%, P<0.01) at 28‐week follow‐up compared to baseline. The lunches packed by parents in the intervention condition had Increases in HEI‐2010 Component scores for: Total Vegetables (10.4%, SE=2.9%, P<0.001), Greens and Beans (4.3%, SE=2.2% P<0.05), Total Fruit (8.3%, SE=2.3%, P<0.05), Whole Fruit (8.3%, SE=2.6%, P<0.05), Whole Grains (8.5%, SE=3.4%, P<0.01), Refined Grains (10.1%, SE=3.1%, P<0.01). Increase in HEI‐2010 component scores were sustained through the 22‐week follow‐up period for Whole Grains and Refined Grains. Despite these improvements, the Total HEI score at the 22‐week follow‐up was 52.74 points out of (100 SE=1.4) at intervention and 49.4 points (SE = 1.4) at control ECE centers.ConclusionsMeasuring the dietary quality using the Healthy Eating Index 2010 is a useful specific tool to provide information about the impact of the intervention on food groups and nutrients. More efforts should be done to increase the dietary quality of the meals offered to preschoolers at lunch to promote lifelong healthy eating habits.Support or Funding InformationFunding for this study was made possible by the National Cancer Institute (National Cancer Institute/NIH Grant R01CA149643) and the Michael & Susan Dell Foundation through the Michael and Susan Dell Center for Healthy Living. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or the Michael and Susan Dell Foundation. The Clinical Trials Number is NCT001292434