The effect of system-level intervention in early childhood education and care on children's dietary intake and environmental impact of the diet

Clinical Snapshot

Key Findings

• P Value: Bonferroni-corrected p < 0.001 for food consumption changes and climate impact; p = 0.003 for biodiversity impact

• Effect Size: Cohen's d (or equivalent) ranging from 0.9 to 2.69 for food group consumption changes — large to very large magnitude

• Primary Outcome: Significant increases in legume/legume product and local fish consumption; significant decreases in red meat, sausages, and other meat product consumption during the 10-month intervention period. No significant change in overall nutrient intake. Significant reductions in climate and biodiversity impacts of food provided at daycare.

• Nnt Or Sensitivity: NNT not applicable for continuous dietary outcomes. No hazard ratio or odds ratio reported. Effect sizes (0.9–2.69) are the primary measure of treatment effect magnitude.

• Confidence Interval: Not reported in abstract or available metadata

Clinical Application

The co-creation model engaging food service staff, educators, and municipal administrators is a strength for real-world implementation. Menu modification within existing institutional food service frameworks is operationally feasible without requiring individual-level clinical intervention. However, scaling requires municipal or government-level policy commitment and food procurement flexibility. Australian ECEC settings are regulated under the National Quality Framework and the Education and Care Services National Law. Dietary standards for long day care are guided by the Australian Dietary Guidelines (NHMRC, 2013) and the Get Up & Grow resources. The intervention's plant-based menu shift aligns with the 2023 Australian Dietary Guidelines update direction and sustainability goals articulated in the National Preventive Health Strategy. PBS and TGA are not directly relevant to this dietary intervention. RACGP's preventive health agenda supports early childhood nutrition as a priority. Key barriers to Australian translation include variable food service capacity across ECEC providers, cultural diversity of enrolled children, and the predominantly private/not-for-profit ECEC sector structure, which differs from the Finnish municipal model. The Australian Government's Healthy Food Partnership and state-based healthy canteen policies provide potential implementation pathways. Preschool-aged children (approximately 1–6 years) attending centre-based early childhood education and care (ECEC) settings in high-income countries with institutional food service capacity

Abstract

PURPOSE: Food systems have a large impact on human health and environmental sustainability. Early childhood education and care is an ideal setting for systemic change. We performed a cluster-randomised trial aiming at climate-friendly and healthy sustainable diet at 23 daycare centres in four Finnish municipalities in 2022 and evaluated system-level intervention effects on food consumption and nutrient intake, and climate and biodiversity impacts of the diet. METHODS: The intervention was initially designed by the research group and refined through co-creation workshops with food service and daycare professionals, and municipal decision makers. The 10-month intervention comprised a modified menu towards more plant-based food supply, and food education. Children's (n = 111) diet was assessed at baseline, mid-term, and/or at the end of the intervention by food frequency questionnaires. The climate and biodiversity impacts per megajoule were assessed using previously specified coefficients for the foods. Multilevel linear mixed models were used in the analysis. RESULTS: During the intervention, children's consumption of legumes and legume products and fish from nearby areas increased, while that of red meat, sausages, and other meat products decreased (Bonferroni-corrected p < 0.001). The changes in food consumption were substantial, with effect sizes ranging from 0.9 to 2.69. Nutrient intake was not affected by the intervention. Intervention decreased climate and biodiversity impacts of food provided at daycare (Bonferroni-corrected p < 0.001, p = 0.003, respectively). CONCLUSION: This study demonstrated that well-planned systemic change in meal provision and food education at daycare resulted in healthier and more climate-friendly diets among children.

References

1. 1.Åkerlund, M., Kyttä, V., Meinilä, J., Pietilä, A., Korhonen, T. E., Vepsäläinen, H., Korkalo, L., Kinnunen, S., Niinistö, S., Raulio, S., Forma, L., Erkkola, M., Saarinen, M., & Virtanen, S. M. (2026). The effect of system-level intervention in early childhood education and care on children's dietary intake and environmental impact of the diet. European Journal of Nutrition. https://doi.org/10.1108/BFJ-09-2024-0981