JMIR Publications

ABSTRACT

Background:

In Western countries, children’s diets tend to be low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet.

Objective:

In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diet by shaping the food and eating environment.

Methods:

The Food4toddlers randomized controlled trial was conducted in Norway in 2017/2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (child age = mean ± SD: 10.9 ± 1.2 months). Post-intervention questionnaires were completed immediately after the intervention (follow-up 1; child age = mean ± SD: 17.8 ± 1.3 months), and six months after the intervention (follow-up 2; child age = mean ± SD: 24.2 ± 1.9 months). The intervention is guided by Social Cognitive Theory, targeting the linked relationship between the person, the behavior, and the environment. The intervention group (n = 148) got access to the Food4toddlers website for six months from baseline. The website included information on diet and how to create healthy food and eating environment, activities, recipes, and collaboration opportunities. To assess intervention effects on child diet quality and food variety from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations (GEE) and a time by group interaction term. Between-group differences in changes over time for fruits, vegetables (frequency and variety), and discretionary foods (frequency) were assessed.

Results:

At follow-up 1, a significant time by group interaction was observed for the frequency of vegetable intake (p = 0.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items/day (95% CI = 0.06, 0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed.

Conclusions:

A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1, but not at follow-up 2. No other effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention is delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Clinical Trial: https://doi.org/10.1186/ISRCTN92980420 Registered 13 September 2017.