Nutrition In Pre-School Children (NIPre) Study: the role of portion size, plant-based foods and commercially manufactured foods and drinks

Research question We will answer questions posed by the recent Scientific Advisory Committee on Nutrition (SACN) report: What are age-appropriate food and drink portion sizes in relation to growth and dental health?

What are the short-term effects (12 months) on growth and dental health of commercial foods for children; vegetarian/vegan/dairy-free dietary patterns?

What is the impact on growth and dental health of macro- and micro-nutrient intakes; fruit juices/free sugars; formula milks for 12m+; sweeteners?

Background In the UK, little contemporary data exists on diet in young children but worrying trends in preschool overweight and dental health are reported.

Current young child diets do not meet dietary recommendations and evidence-driven age-appropriate portion size recommendations are missing.

Further research into the impact of plant-based diets, the use of commercial foods, and toddler milks is also recommended by SACN. Aims and Objectives To provide new evidence on diet in children aged 1-5y, linked to optimum growth and dental health. Quantifying age-appropriate portion sizes for different foods and drinks.

Collect data on child dietary intake, portion sizes. Collect data on parent and child attributes, including child anthropometrics and dental health.

Evaluate food and nutrient intake in relation to i) growth over 12 months, ii) child and parent characteristics, including ethnic diversity, deprivation and iii) dental health. Make recommendations for nutrition and age-appropriate portions.

Methods We will recruit 2100 parents of young children (1-5years) through the Born and Bred in (BaBi) Network birth cohorts in Leeds, Doncaster, and East London.

Recruitment will include at least 400 in each year bracket, 20% non-white, 20% from deprived locations, and 300 (15%) vegetarian/vegan/non-dairy diet. Plans are in place to ensure recruitment targets are met. Protocols, consent forms, and questionnaires will be co-designed with our Parent Advisory Group.

Baseline data will be collected using i) online survey, ii) face-to-face growth measures of height, weight, length, head circumference iii) 3 x 24h measures of diet spanning 6 months. Follow-up data collected after 12 months will repeat baseline measures and include a dental assessment.

Cross-sectional and longitudinal analysis will explore how growth and dental health are influenced by nutrient intakes, diet pattern, and food portion sizes.

Age/gender appropriate portion sizes for key food groups will be characterised with linear mixed-effects modelling for specific foods/food groups in relation to the child s position on the growth chart centiles. Timelines Month 3 Study start (ethics, questionnaires etc.) completed. Month 5 Pilot test.

Months 6-12 baseline data collection. Month 18 all baseline diet information collected. Months 19- 24 follow-up data collected. Month 36 analysis and write up complete.

Anticipated Impact and Dissemination Knowledge of associations between food and nutrient intakes and growth/dental health and knowledge of suboptimal intakes in vegan/vegetarian/dairy-free or vulnerable groups will enable evidence-based guidelines on age-appropriate portion sizes and optimal diet composition.

Guideline promotion to key stakeholders and visual feedback to participants will support intake of age-appropriate portions and healthier diets. Ultimately resulting in healthier children, with better dental health. Guidelines will also highlight social inequalities, indicating specific actions to redress imbalances.