Macronutrient and micronutrient intakes of children in Oklahoma child-care centres, USA.

A nutrition paradox exists such that children can be overweight or obese and still be deficient in vital nutrients needed for growth and development due to the overconsumption of poor-quality food(1). For example, child Fe deficiency is linked to both cognitive and behavioural delays as well as obesity(2), and is an example of the ‘double burden’ of malnutrition from a vital micronutrient in coexistence with obesity(3,4). In the USA, obesity prevalence for children aged 2–5 years more than doubled between 1976 (5 %) and 2012 (14 %)(5), and declined to 8 % in 2014(6). The prevalence of obesity (14 %) in low-income children in Oklahoma(7) is higher than the national average (8 %)(5,6). Fifty-six per cent of children of pre-school age (3–5 years) in the USA attend full- or part-time child care and children with full-time working mothers spend an average of 38 h/week in non-parent care(8). Pre-school children are at a critical stage for appropriate growth, cognitive development and establishment of healthy food preferences(9). However, dietary reports by caregivers reveal that the intake of US pre-school children fell short of the Dietary Guidelines for Americans for total (saturated and unsaturated) fat and vitamin E by 47 % and 37 %, respectively(10). Since child-care centres (CCC) serve as a primary social environment to the majority of children in the USA, they play a significant role in influencing eating behaviours in this nation’s young children. Oklahoma state regulations and policies require that CCC menus provide nutritionally adequate meals fulfilling at least one-half to two-thirds of macronutrient and micronutrient RDA for children in full-day child care(11). Few studies have both analysed and compared the nutrient content of CCC menus with Dietary Reference Intakes (DRI)(12–14). DRI are determined by the Food and Nutrition Board of the Institute of Medicine as a cohesive estimation of nutrient intakes for Americans and include the Recommended Daily Allowance, Adequate Intake, Tolerable Upper Intake Level and Estimated Average Requirement(15). Most studies that have evaluated CCC menus based on the Food Guide Pyramid established by the US Department of Agriculture were published a decade or more ago(16,17). A recent study reported that the lunch menu for children attending CCC did not meet the DRI for carbohydrate, dietary fibre, Fe, vitamin D and vitamin E(14). Evaluation of CCC menus provides valuable insight into what is reportedly served to children over a larger area and more feasible than in-person visits. However, it does not provide information on food preparation methods or what was actually consumed, demonstrating the need for observational studies to expand upon CCC meals. An observational study in North Carolina found that children consumed only 13 %, 17 % and 21 % of whole grains, vegetables and fruits, respectively, in reference to the MyPyramid daily requirements(18). A similar study in New York City reported that only 17 % of 3–4-year-old children met at least half of the MyPyramid requirements for vegetables and 58 % did not consume enough fruits(19); consistent with a 1997 survey by the US Department of Agriculture that found 16 % of older children failed to meet any food group requirements for vegetables, grains, meats, beans or milk(17). The above studies, in addition to the limited nutritional observations and CCC menu deficiencies in this state, support the need for observation of CCC lunches and dietary intake in Oklahoma CCC. The purpose of the present study was to assess the energy, macronutrients (carbohydrate, protein and total fat) and micronutrients (Ca, Fe, Mg, Zn, vitamins A and E and folate) served to and consumed by children of pre-school age (3–5 years) in Oklahoma CCC during lunch and compare them with the RDA established in the DRI. Examining the macronutrient and micronutrient consumption among pre-school children attending CCC, especially in a geographic region of high overweight and obesity risk, is of significance to evaluate healthy eating practices. Discovering the nutrient intakes of children in Oklahoma CCC will assist in providing information on possible areas to improve CCC nutrition standards and, consequently, how health and early-care education professionals can influence those dietary changes.