Public Health Nutrition

HOT TOPIC – Food environment

Characterizing lunch meals served and consumed by pre-school children in Head Start

Theresa A Nicklasa1 c1, Yan Liua1, Janice E Stuffa1, Jennifer O Fishera2, Jason A Mendozaa1 and Carol E O'Neila3

a1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA

a2 Department of Public Health, Temple University, Philadelphia, PA, USA

a3 Louisiana State University Agricultural Center, Baton Rouge, LA, USA


Objective To examine the variability of food portions served and consumed by African-American and Hispanic-American pre-school children attending Head Start.

Design Cross-sectional.

Setting Food consumption by pre-schoolers (n 796) enrolled in sixteen Head Start centres in Houston, Texas (51 % boys, 42 % African-American, mean age 4 years) were assessed during 3 d of lunch meals using digital photography. Descriptive statistics and multilevel regression models, adjusting for classroom and school clustering effects, were determined.

Subjects Head Start pre-schoolers aged 3–5 years.

Results Mean amount served was 2428 kJ (580 kcal) and 572 g. Mean intake was 1421 kJ (339 kcal) and 331 g: 20 % protein, 46 % carbohydrate and 34 % fat. Plate waste was 43 % (range: 38 % (fruit) to 61 % (vegetables)). Mean CV of food served was 29 %: 33 % for entrées, 44 % for vegetables, 60 % for fruit and 76 % for starches. Mean CV of food consumed was 46 %: 58 % for entrées, 86 % for fruit, 96 % for vegetables and 111 % for starches. Total gram amount of food served was positively correlated with consumption (r = 0·43, P < 0·001).

Conclusions Plate waste and variation in amounts served and consumed were substantial; amounts served were associated with amounts consumed. Large portion sizes may contribute to paediatric obesity by promoting excessive intake at meals. Understanding factors influencing portion sizes provides insight about specific intervention strategies that can be used in obesity prevention programmes.

(Received July 24 2012)

(Revised March 19 2013)

(Accepted April 11 2013)

(Online publication May 24 2013)


  • Lunch meals;
  • Meal consumption;
  • Pre-school children;
  • Head Start


c1 Corresponding author: Email