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Updated: Feb 23, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Attainment of '5-2-1-0' obesity recommendations in preschool-aged children
Amrik Singh Khalsa1, Roohi Kharofa1, Nicholas J Ollberding2
1Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7035, Cincinnati, OH 45229, United States.
Insights
Preschoolers in child care rarely meet the
Area of Science:
- Pediatric obesity prevention
- Childhood nutrition and physical activity
- Public health and child care settings
Background:
- Obesity prevention guidelines, known as '5-2-1-0', recommend ≥5 fruit/vegetable servings, ≤2h screen time, 1h physical activity, and 0 sugar-sweetened beverages daily.
- Child care settings are crucial environments for establishing healthy habits in preschool-aged children.
- Understanding adherence to these guidelines and its impact on weight status is vital for targeted interventions.
Purpose of the Study:
- To assess the extent to which preschool-aged children in child care meet the '5-2-1-0' guidelines.
- To identify predictors of adherence to these recommendations.
- To examine the association between guideline attainment and body mass index (BMI) z-scores.
Main Methods:
- Analysis of 24-hour dietary, physical activity, and screen time data from 398 preschool children (aged 4.3±0.7 years) in 30 child-care centers.
- Data collection included direct measurement by research staff and parent-reported information.
- Mixed-effects models and generalized estimating equations were used to analyze associations between '5-2-1-0' components, demographics, and BMI z-scores.
Main Results:
- Only 1 child met all '5-2-1-0' recommendations; adherence was low across all components, especially physical activity (<1%).
- Seventeen percent met fruit/vegetable intake, 50% met sugar-sweetened beverage limits, and 81% met screen time limits.
- Increased screen time was associated with higher BMI z-scores (0.11 increase per hour). No consistent demographic predictors were found.
Conclusions:
- Preschool-aged children in child care settings demonstrate low adherence to established obesity prevention guidelines.
- Significant opportunities exist to improve fruit/vegetable intake and physical activity levels.
- Higher screen time is linked to increased BMI z-scores, highlighting the need for targeted interventions within child care.
Abstract:
Obesity prevention guidelines recommend children eat ≥ 5 servings of fruits and vegetables, view ≤ 2 h of screen time, participate in 1 h of physical activity, and consume 0 sugar-sweetened beverages daily, commonly known as '5-2-1-0'. We sought to determine: the extent to which preschool-aged children attending child care meet these guidelines, predictors of attainment, and associations of attainment with weight status. We analyzed in 2016, 24-hour dietary, physical activity, and screen time data collected in 2009-10 from 398 preschool-aged children in 30 child-care centers in Cincinnati, OH. Dietary intake, screen time and body-mass index (BMI) were obtained by research staff during child care and from parents when at home. Accelerometers measured physical activity. Mixed-effects models and generalized estimating equations were used to determine associations between '5-2-1-0' recommendations, demographic variables, and BMI z-scores. Average child age was 4.3 ± 0.7 years; 26% had a BMI ≥ 85th percentile. Seventeen percent of children with complete dietary data (n = 307) consumed ≥ 5 servings of fruits and vegetables and 50% consumed 0 sugar-sweetened beverages. < 1% with complete physical activity data (n = 386) met the activity recommendation; 81% of children (n = 379) had ≤ 2 h of screen time. Only 1 child met all of the '5-2-1-0' recommendations. There were no consistent demographic predictors of attaining individual recommendations. An additional hour of screen time was associated with a 0.11 (SD 0.06) increase in BMI z-score. Our data suggests there is ample room to increase fruit and vegetable intake and physical activity in preschool-aged children.
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