Background: In Western countries, children’s diets are often 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’ diets by shaping their 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 (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results: At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per 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. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. 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 between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420

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中文翻译：

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以父母为中心的电子卫生保健干预措施对儿童水果，蔬菜和酌情食物摄入量的影响（Food4toddlers）：随机对照试验

背景：在西方国家，儿童饮食中水果和蔬菜的摄入通常较低，而自由饮食则较高。早年的饮食习惯往往贯穿儿童和青年甚至成年时期。因此，应在建立习惯性状的时期进行干预，例如在儿童适应家庭饮食的幼儿期。目的：在这项研究中，我们评估了Food4toddlers eHealth干预的效果，该干预旨在通过改变幼儿的饮食和饮食环境来增强幼儿的饮食。方法：2017-2018年在挪威进行了Food4toddlers随机对照试验。亲子二元组是通过社交媒体招募的。总共有298位父母在基线时完成了在线问卷调查（平均孩子年龄10.9个月，SD 1.2）。干预后立即进行干预后问卷调查（即随访1；平均儿童年龄17.8个月，标准差1.3）和干预后6个月（即随访2；平均儿童年龄24.2个月，标准差1.9）。干预以社会认知理论为指导，该理论以人，行为和环境之间的联系为目标。干预组（148 / 298，49.7％）从基线开始的6个月内可以访问Food4toddlers网站。该网站包含有关饮食以及如何创建健康饮食环境的信息，以及活动，食谱和合作机会。为了评估从基线到随访1以及从基线到随访2对儿童饮食的干预效果，我们使用广义估计方程和时间×组交互作用项。评估了水果和蔬菜的频率和种类随时间变化的组间差异以及任意食物的频率。结果：在随访1中，观察到蔬菜摄入频率的显着时间×组交互作用（P = .02）。从基线到随访1的变化，两组之间的差异为每天0.46种蔬菜（95％CI 0.06-0.86），有利于干预组。从基线到随访1或随访2的饮食变化没有其他显着的组间差异。但是，有一个明显的时间趋势表明，随年龄的增长，随意摄入的食物从基线时的每周少于1种增加到2岁时每周的大于4种（P <.001），而不论使用哪种组。结论：在随访1中观察到对蔬菜摄入频率的积极干预作用，但在随访2中未观察到。饮食中未观察到其他组间作用。为了获得长期效果，可能需要较长时间的eHealth干预措施，包括在干预措施的主要内容交付后进行提醒，以及以数字或个人形式进行调整。试用注册：国际标准随机对照试验号码（ISRCTN）92980420；https://doi.org/10.1186/ISRCTN92980420 以及以数字或个人形式进行剪裁。试用注册：国际标准随机对照试验号码（ISRCTN）92980420；https://doi.org/10.1186/ISRCTN92980420 以及以数字或个人形式进行剪裁。试用注册：国际标准随机对照试验号码（ISRCTN）92980420；https://doi.org/10.1186/ISRCTN92980420

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