Centre-Based Childcare in Early Childhood and Nutritional Risk in Later Childhood: A Prospective Cohort Study.

Centre-based childcare is a promising environment for promoting healthy lifestyle behaviours in early childhood. Little is known about the impact of centre-based childcare on child nutrition. The primary objective was to evaluate the association between centre-based childcare, compared to non-centre-based childcare, and nutritional risk in early childhood. Secondary objectives were to evaluate associations with dietary intake and eating behaviours, and whether the associations were modified by family income and childcare intensity. A prospective cohort study of children aged 1 to 5 years was conducted through the TARGet Kids! primary care research network in Toronto, Canada (n = 2420). Childcare attendance was measured between 1 and 4 years of age. Nutritional risk, dietary intake and eating behaviours were measured using the Nutrition Screening Tool for Every Toddler and Preschooler (NutriSTEP®) between 4 to 5 years of age. Centre-based childcare was associated with a more favourable NutriSTEP® (-0.66 units; 95%CI: -1.11, -0.21), dietary intake (-0.31 units; 95%CI: -0.57, -0.06) and eating behaviours score (-0.14 units; 95% CI: -0.29, 0.00) compared to non-centre-based childcare. Associations were stronger for children who attended centre-based childcare full time with a more favourable NutriSTEP® (-0.89 units; 95%CI: -1.39, -0.41), dietary intake (-0.44 units; 95%CI: -0.72, -0.16) and eating behaviours score (-0.20 units; 95%CI: -0.36, -0.03). Associations were stronger for children from lower income families (< $50,000CDN) who attended centre-based childcare with a more favourable NutriSTEP® (-2.39 units, 95%CI: -3.99, -0.78), dietary intake (-1.43 units; 95%CI: -2.35, -0.50), and lower odds of high nutritional risk (OR 0.44; 95%CI: 0.20, 0.97). Centre-based childcare was associated with more favourable nutritional risk scores, which were stronger for children who attended centre-based childcare full time and those who were from lower income families. Centre-based childcare may be an important early environment for supporting childhood nutrition. NCT01869530 (clinicaltrials.gov).