Lunches in UK early years education and care settings: cross-sectional analysis of food processing, provision and intake

Objective: Most young children attend early childhood education and care (ECEC), but little is known about lunch provision, intake and processing. We investigated lunch quality, serving size and consumption within ECECs by provision (packed vs. ECEC provided) using the UK nutrient profile model (high fat, salt or sugar, HFSS), ultraprocessing (UPF) and non-core as food quality measures. Design: Lunches of children attending ECEC were analysed using food photography. Total kcal served/consumed and % total kcal from foods classified as HFSS, UPF or non-core were calculated. Multivariable mixed effects linear regression modelled associations of serving size with provision or quality adjusting for age, zBMI and deprivation. Setting: ECEC providers in England and Scotland. Participants: 532 children aged 2-4 from 52 ECECs. Results: Packed lunches were more prevalent in England (48%) than Scotland (3%). Packed lunch servings were larger (adjusted mean difference (aMD) 120.0kcal (95%CI 76.7 to 163.3), p<0.001) but consumed kcal were not (aMD 16.0 (-28.0, 60.0), p=0.476). HFSS, UPFs and non-core food servings were 15-24% higher in packed compared with ECEC provided lunches. Overall, serving size was associated with kcal consumed: for every 100kcal served 60kcal (56, 69) were consumed. Higher HFSS and non-core food provision resulted in increased consumption. Conclusions: Servings in packed lunches were larger and poorer quality, with both features associated with consuming more. We reinforce guidance to avoid serving HFSS food and provide small servings initially, to allow children to eat optimal energy intakes. Universal free lunches in ECECs could improve lunch quality and serving sizes.