Evidence Mapping: Healthy Eating and Physical Activity Practice Elements in Early Childhood Education and Care

Background: A large number of guideline recommendations have been developed by local-, state- and national-level health organisations available to promote the healthy eating and physical activity of children attending early childhood education and care (ECEC) settings. However, the evidence supporting these recommendations is often not well-described. An examination of the current evidence is needed to support decision-makers to understand and prioritise practices for implementation.Aim: To describe a novel systematic evidence-mapping process which: i) examines the evidence-base underpinning ECEC-based healthy eating and physical activity practice elements; and ii) classifies practice elements according to the World Health Organization (WHO) Standards for Healthy Eating, Physical Activity, Sedentary Behaviour and Sleep in Early Childhood and Care Settings to examine alignment with current global guidelines. Methods: We undertook a two-stage, five-step systematic process. Stage 1 involved identifying the existing ECEC-based guideline recommendations and randomised controlled trial evidence which evaluated child diet and physical activity outcomes. Stage 2 involved conducting a secondary data analysis and synthesis of the evidence underpinning practice elements by: extracting practice elements of RCTs and mapping these to existing guideline recommendations, where possible, or included these as additional practices; using vote-counting approaches and a framework to assess the evidence underpinning each practice element; and, classifying practice elements according to the WHO Standards for Healthy Eating, Physical Activity, Sedentary Behaviour and Sleep in Early Childhood and Care Settings. Results: We found 16 healthy eating (e.g. Educators discuss the food served with children) and 19 physical activity (e.g. Educators embed physical activity into educational activities) practice elements were assessed as likely beneficial. Most of these mapped to WHO Standard 2: Creating supportive environments. Seven practice elements were assessed as possibly beneficial, two as possibly not beneficial and none as not beneficial. There was insufficient evidence to assess 39 practice elements. Conclusions: This study provides insights into the evidence underpinning practice elements included in ECEC-based healthy eating and physical activity guidelines, identifies evidence-based practice elements not included in existing guidelines and highlights opportunities where evidence can be strengthened.