Comparing strategies to improve the implementation of healthy nutrition in kindergartens: a prospective observational study

Aim: To compare different implementation strategies to improve healthy nutrition in kindergartens. Subjects and methods: Healthy 3–6-year-old children and their parents were recruited from kindergartens (n = 56) in two cities in Northwestern Germany. A prospective observational study was conducted including three study groups that followed different implementation approaches to healthy nutrition. In group A, a comprehensive nutrition concept was implemented including environmental changes, educational components and parent involvement. Study group B implemented a child nutrition-related training program for the kitchen staff of the kindergartens. Study group C did not follow a structured implementation approach. A parent-completed food frequency questionnaire assessed the children’s dietary behavior at baseline and 12 months. Change over time and comparison of study groups were analyzed using hierarchical linear regression models. Results: Of the 1368 eligible children, 478 completed the baseline assessment (35%). Three hundred seventy-four of these completed the follow-up assessment. Children from group A showed significant reductions in sweet food consumption (−2.4 portions per week, p = 0.005) and increased water consumption (+2.4 portions per week, p = 0.016) compared to baseline. No significant changes over time occurred in group B and C. A comparison of change over time between the study groups yielded no significant effects. Conclusions: This study did not provide evidence for the effectiveness of a particular implementation strategy in comparison to the other strategies. However, contrasts between the study groups were limited by the high levels of nutrition-related activities and availability of healthy foods in all groups. © 2016, Springer-Verlag Berlin Heidelberg.