{
  "abstract": "Background Most young children in the UK attend early childhood education and care (ECEC). Scotland has provision of universal free meals in ECEC and national food standards that all ECEC must adhere to, in contrast to England where meals are typically parent funded with no government mandated standards for ECEC provided meals, and children frequently consume packed lunches. 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.Methods The Remote Food Photography Method was used to analyse lunch intakes of 532 children aged 2-4 year attending 52 ECECs in England or Scotland. Total kcal served, consumed and % total kcal (served and consumed) from foods classified as HFSS, UPF or non-core were calculated. Associations between food provision and kcal served, kcal consumed and different food quality measures were modelled using multivariable mixed effects linear regression adjusting for age, zBMI and deprivation.Results Almost half of children in England consumed packed lunches (48%) compared to only 3% in Scotland. Packed lunch servings were larger (adjusted mean difference (aMD) 120.0kcal (95%CI 76.7 to 163.3)) but consumed kcal were not (aMD 16.0kcal (-28.0, 60.0)). Packed lunches contained more HFSS, UPFs and non-core food compared to ECEC provided lunches (15-24% higher). Larger servings were associated with more kcal consumed, with 60kcal (56, 69) consumed for every 100kcal served. Higher HFSS and non-core food provision also resulted in increased kcal consumption.Conclusion Packed lunches were larger and of poorer quality, with both features associated with higher consumption. We reinforce guidance to reduce HFSS food and encourage provision of smaller servings initially, to reduce overconsumption in children. Lunch quality and serving size could be improved with universal free lunches in ECECs in England.",
  "authors": [
    {
      "affiliations": [
        "Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Rachel Maishman"
    },
    {
      "affiliations": [
        "School for Policy Studies, University of Bristol, Bristol, UK"
      ],
      "name": "Zoi Toumpakari"
    },
    {
      "affiliations": [
        "Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Amy Turner"
    },
    {
      "affiliations": [
        "Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Marie Murphy"
    },
    {
      "affiliations": [
        "Pennington Biomedical Research Centre, Baton Rouge, USA"
      ],
      "name": "Corby K Martin"
    },
    {
      "affiliations": [
        "Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Miranda Pallan"
    },
    {
      "affiliations": [
        "Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Kimberly Hannam"
    },
    {
      "affiliations": [
        "Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Sharon A Simpson"
    },
    {
      "affiliations": [
        "MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK"
      ],
      "name": "Laura Johnson"
    },
    {
      "affiliations": [
        "Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Ruth Kipping"
    }
  ],
  "title": "P01-1 Lunches in UK early years education and care settings: cross-sectional analysis of food processing, provision and intake",
  "uid": "f1f0e42b-f094-5d6c-acf2-a6c80e721ae0"
}