Reliability and Accuracy of Real-Time Visualization Techniques for Measuring School Cafeteria Tray Waste: Validating the Quarter-Waste Method

Reducing Plate Waste in Latvian Schools: Evaluating Interventions to Promote Sustainable Food Consumption Practices

Food waste (FW) threatens food security, environmental sustainability, and economic efficiency, with about one-third of global food production lost or wasted. Schools play a crucial role in addressing FW, representing lost resources and missed educational opportunities. The present research assessed three interventions to reduce plate waste (PW) in Rezekne City schools, namely (S1) a plate waste tracker, (S2) an awareness and educational campaign, and (S3) organizational changes, including larger plates, extended lunch breaks, and teacher supervision. Implemented in three schools with a fourth as a control, PW was measured at three intervals, at pre-intervention, short-term, and long-term post-intervention. The PW data analysis utilized two models (day view and class view) and a Wilcoxon signed-rank test. While the plate waste tracker initially reduced PW, sustained impact required continuous reinforcement. The awareness and educational campaign alone proved insufficient, highlighting the need for complex strategies. The organizational changes unexpectedly increased PW, underscoring FW's complexity. The research has concluded that reducing FW requires tailored and multi-faceted approaches. According to the MOA framework, the school catering model in Rezekne City lacks essential "Opportunities" for effective FW reduction, as students have limited flexibility in portion sizes and food choices, which hinders the interventions' effectiveness. Future research should explore adaptable FW-reducing interventions suited to specific school contexts.

A Food Intake Estimation System Using an Artificial Intelligence-Based Model for Estimating Leftover Hospital Liquid Food in Clinical Environments: Development and Validation Study

BACKGROUND

Medical staff often conduct assessments, such as food intake and nutrient sufficiency ratios, to accurately evaluate patients' food consumption. However, visual estimations to measure food intake are difficult to perform with numerous patients. Hence, the clinical environment requires a simple and accurate method to measure dietary intake.

OBJECTIVE

This study aims to develop a food intake estimation system through an artificial intelligence (AI) model to estimate leftover food. The accuracy of the AI's estimation was compared with that of visual estimation for liquid foods served to hospitalized patients.

METHODS

The estimations were evaluated by a dietitian who looked at the food photo (image visual estimation) and visual measurement evaluation was carried out by a nurse who looked directly at the food (direct visual estimation) based on actual measurements. In total, 300 dishes of liquid food (100 dishes of thin rice gruel, 100 of vegetable soup, 31 of fermented milk, and 18, 12, 13, and 26 of peach, grape, orange, and mixed juices, respectively) were used. The root-mean-square error (RMSE) and coefficient of determination (R2) were used as metrics to determine the accuracy of the evaluation process. Corresponding t tests and Spearman rank correlation coefficients were used to verify the accuracy of the measurements by each estimation method with the weighing method.

RESULTS

The RMSE obtained by the AI estimation approach was 8.12 for energy. This tended to be smaller and larger than that obtained by the image visual estimation approach (8.49) and direct visual estimation approach (4.34), respectively. In addition, the R2 value for the AI estimation tended to be larger and smaller than the image and direct visual estimations, respectively. There was no difference between the AI estimation (mean 71.7, SD 23.9 kcal, P=.82) and actual values with the weighing method. However, the mean nutrient intake from the image visual estimation (mean 75.5, SD 23.2 kcal, P<.001) and direct visual estimation (mean 73.1, SD 26.4 kcal, P=.007) were significantly different from the actual values. Spearman rank correlation coefficients were high for energy (ρ=0.89-0.97), protein (ρ=0.94-0.97), fat (ρ=0.91-0.94), and carbohydrate (ρ=0.89-0.97).

CONCLUSIONS

The measurement from the food intake estimation system by an AI-based model to estimate leftover liquid food intake in patients showed a high correlation with the actual values with the weighing method. Furthermore, it also showed a higher accuracy than the image visual estimation. The errors of the AI estimation method were within the acceptable range of the weighing method, which indicated that the AI-based food intake estimation system could be applied in clinical environments. However, its lower accuracy than that of direct visual estimation was still an issue.

Hidden realities: Food waste from servings in mini size packaging

This paper provides data obtained from real-life measurement of the Food Waste (FW) associated with the services offering food in mini size (9-20 g) single-use packaging representing the impact of the difficulties in emptying the food from such packages and service characteristics. We collected discarded such food packages from commercial public eateries (a time-share thermal town, student canteen, and student refectory), quantified FW, and subjected data to statistical analysis regarding the eatery places, package characteristics, and food type. The results suggest that service style, packaging, and consumer wastefulness can cause 10-47 %, 3-11 %, and 5-37 % FW, respectively, indicating hidden part of the wastage iceberg from mini size food portions with vast implication on the food and relevant packaging sustainability. Regarding the packing, the dominant cause of FW is difficulties in emptying the food, such as the shape, size, depth, width, and material of the package. Concerning the consumer wastefulness, our measurements seem to imply that the groups with relatively higher affluency creates more FW. Our results will prove to be highly beneficial in both promoting efforts to raise awareness of not only consumers but also industry players and decision makers on the sustainability for food and relevant packaging material.

Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting

BACKGROUND

Development of methods to accurately measure dietary intake in free-living situations-restaurants or otherwise-is critically needed to understand overall dietary patterns.

OBJECTIVE

This study aimed to develop and test reliability and validity of digital images (DI) for measuring children's dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC).

DESIGN

In 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children's leftovers in QSRs from parents of 4- to 12-year-old children.

PARTICIPANTS/SETTING

Parents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child's PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations.

OUTCOME MEASURES

Outcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW.

ANALYSES PERFORMED

Intraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used.

RESULTS

Interrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = -1.61 kcals, P < 0.001). Bland-Altman plots showed high DI-PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = -2.84 kcal, P = 0.20).

CONCLUSIONS

Correspondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.

Should Carbohydrate Intake Be More Liberal during Oral and Enteral Nutrition in Type 2 Diabetic Patients?

Carbohydrate (CHO) intake in oral and enteral nutrition is regularly reduced in nutritional support of older patients due to the high prevalence of diabetes (usually type 2-T2DM) in this age group. However, CHO shortage can lead to the lack of building blocks necessary for tissue regeneration and other anabolic processes. Moreover, low CHO intake decreases CHO oxidation and can increase insulin resistance. The aim of our current study was to determine the extent to which an increased intake of a rapidly digestible carbohydrate-maltodextrin-affects blood glucose levels monitored continuously for one week in patients with and without T2DM. Twenty-one patients (14 T2DM and seven without diabetes) were studied for two weeks. During the first week, patients with T2DM received standard diabetic nutrition (250 g CHO per day) and patients without diabetes received a standard diet (350 g of CHO per day). During the second week, the daily CHO intake was increased to 400 in T2DM and 500 g in nondiabetic patients by addition of 150 g maltodextrin divided into three equal doses of 50 g and given immediately after the main meal. Plasma glucose level was monitored continually with the help of a subcutaneous sensor during both weeks. The increased CHO intake led to transient postprandial increase of glucose levels in T2DM patients. This rise was more manifest during the first three days of CHO intake, and then the postprandial peak hyperglycemia was blunted. During the night's fasting period, the glucose levels were not influenced by maltodextrin. Supplementation of additional CHO did not influence the percentual range of high glucose level and decreased a risk of hypoglycaemia. No change in T2DM treatment was indicated. The results confirm our assumption that increased CHO intake as an alternative to CHO restriction in type 2 diabetic patients during oral and enteral nutritional support is safe.

Design and rationale for evaluating the impact of salad bars on elementary school students' fruit, vegetable, and energy intake: a wait list control, cluster randomized controlled trial

BACKGROUND

Most children do not consume the recommended amount of fruit and vegetable (FV) servings. Changing the school food environment can be a cost-efficient, effective approach to improving children's dietary quality. There is great popular support for school salad bars as a means to increase children's FV intake within the National School Lunch Program (NSLP), yet empirical research is limited. Further, although FV consumption can facilitate healthy weight management if these foods replace high calorie items, there is a need to enhance understanding of salad bars' influence on children's diet quality and energy intake within the NSLP. This is particularly important to investigate in schools in communities characterized by high poverty, as students they serve are particularly likely to rely on school meals.

METHODS

This report describes the design and rationale of a federally-funded investigation that uses validated methods to evaluate school salad bars. This district plans to install salad bars into 141 elementary schools over 5-years, facilitating the conduct of a waitlist control, cluster randomized controlled trial. Specifically, 12 pairs of matched schools will be randomly selected: half receiving a salad bar (Intervention) and half serving pre-portioned FVs only, standard under the NSLP (Control). Thus, groups will have different FV presentation methods; however, all schools will operate under a policy requiring students to take at least one FV serving. Schools will be matched on Title I status and percent of racial/ethnic minoritized students. Intake will be objectively assessed at lunch in each school pair, prior to (baseline), and 4-6 weeks after salad bars are installed (post), yielding ~ 14,160 lunch observations throughout the study duration. Cafeteria sales and NSLP participation data will be obtained to determine how salad bars impact revenues. Finally, implementation factors and cafeteria personnel's perspectives will be assessed, to identify barriers and facilitators to salad bars use and inform sustainability efforts. Proposed methods and current status of this investigation due to COVID-19 are described.

DISCUSSION

Results will have great potential to inform school nutrition policies and programs designed to improve dietary quality and reduce obesity.

TRIAL REGISTRATION

Retrospectively registered (10/28/22) in clinicaltrials.gov (NCT05605483).

Dietary Intake among Children Attending Childcare Centers: Impact of the New CACFP Meal Guidelines

Through the Healthy, Hunger-Free Kids Act of 2010, USDA (US Department of Agriculture) made the first major changes in the CACFP (Child and Adult Care Food Program) meal and snack menu patterns. Childcare centers that serve low-income families qualify to participate and receive reimbursement for meals and snacks served. The purpose of this study was to assess what changes in children’s dietary behaviors occurred as a result of the new CACFP meal pattern requirements. This study evaluated these changes at childcare centers operating in Houston and San Antonio, Texas, USA, areas enrolled in the CACFP, pre- (Spring 2016) and post-implementation (Fall 2016–Spring 2017) of the new meal patterns. Dietary intake was assessed via observations of children, 3–5 years old, conducted at breakfast, lunch, and snack times. Results showed improvements in adjusted means of several nutrients and food groups consumption, post-implementation of new CACFP meal guidelines compared to baseline, specifically intake of whole grains, milk, and juice. Additional studies are needed to confirm the impact of the revised CACFP meal patterns along with strategies to assist providers in meeting the new standards to increase the access to and intake of items in accordance with the CACFP meal pattern requirements in childcare settings.

Plate Waste in School Catering in Rezekne, Latvia

This research was conducted within the framework of a research project aimed at detecting patterns of plate waste and developing recommendations for improving catering in seven schools in Rezekne city (Latvia) by a combination of observation, physical weighing, semi-structured interview approaches and statistical analysis of variance (ANOVA). We identified plate waste (including wasted beverages), which remains after the lunch of schoolchildren in grades 1–7, examining a total of 7064 lunch samples. The originality of the research is due to the fact that a unified menu was designed for the field study, which ensured the same field study conditions in all the schools. The results of the research revealed that the average weight of plate waste per schoolchild reached 178 g, and the total weight of plate waste accounted for 28.75% of the total weight of food served. No significant differences in plate waste weight between various age groups and grades of schoolchildren were found, which was also confirmed by a one-way ANOVA test. An analysis of plate waste by food category showed that beverages accounted for the largest share of total plate waste (42.24%), followed by staple food (28.38%) and meat (11.77%). An analysis of plate waste shares of food served (%) by food category revealed a similar situation: the largest share of food served was made up of beverages (37.56%), followed by staple food (36.48%) and meat (28.77%). An analysis of the monetary value of food waste showed that the average cost of plate waste (excluding beverage) per schoolchild was EUR 0.236, which represented 16.6% of the national and municipal funding of EUR 1.42 per portion. Given the research results, the authors have concluded that in order to reduce the amount of plate waste generated by Rezekne city schools, school menus should be based not only on the requirements prescribed by relevant legal acts but also on cooking processes that meet the requirements of modern consumers (learners), e.g., by following trends in cooking practices in society to make the learners interested in consuming school food.

Food waste generation in a university and the handling efficiency of a university catering facility-scale automatic collection system

Purpose

This study aims to evaluate the generation of food waste in a university and the handling efficiency of an automatic waste collection system.

Design/methodology/approach

The quantity of food waste generated and collected from a university canteen was surveyed. The food waste handling efficiencies using manual collection strategy and automated food waste collection system were determined by the density of food waste. Life-cycle costing analysis was done to evaluate the economic impacts of various food waste collection methods.

Findings

As compared with the manual collection approach, the automatic system can improve the food waste handling efficiency by 30% (from 0.01 to 0.007 bin kg−1) and reduce the water use by 20% (from 0.512 to 0.406 L kg−1); however, it also consumes 4.4 times more energy (from 0.005 to 0.027 kWh kg−1). Under ideal system operation, the 10-year cost of food waste collection was significantly reduced from $3.45 kg−1 in the manual collection to $1.79 kg−1, and the payback period of the system collection was 1.9 years without discount.

Practical implications

The outcomes of this study show that an automatic food waste collection system is feasible, and it is recommended for small- and medium-sized catering facilities (e.g. canteens and food courts) to improve food waste handling efficiency. This study also provides useful reference data of automatic food waste collection systems for planning food waste management programs for catering facilities.

Originality/value

To the best of the authors’ knowledge, this is the first study to evaluate the waste handling efficiency, operational expenditure and life-cycle cost of a small-scale automatic food waste collection system.

Plate Waste Evaluation of Plant-Based Protein Entrees in National School Lunch Program

OBJECTIVE

To assess plate waste of plant-based protein entrees compared with regularly served meat-based entrees in the National School Lunch Program (NSLP).

DESIGN

Plate waste data were collected before and after introducing the plant-based entrees, using digital photography and the quarter-waste method.

PARTICIPANTS

National School Lunch Program participants in grades 6-8.

INTERVENTION

Two newly developed plant-based protein entrees were introduced into the menu cycle by replacing 2 regularly served meat-based entrees.

MAIN OUTCOME MEASURE

Student plate waste of plant-based entrees compared with entrees regularly served in the NSLP meal pattern.

ANALYSIS

A total of 4,138 meal observations were analyzed. Ordinary least-squares regressions and 2-sample unpaired t tests were used to determine significant differences in waste.

RESULTS

National School Lunch Program participants wasted plant-based entrees more than all other entrees served during lunch. Students wasted all or none of the plant-based entrees more than partial servings. There were no significant differences in waste between demographic groups for the plant-based entrees.

CONCLUSIONS AND IMPLICATIONS

Plant-based entrees served as a part of the NSLP may lead to increased plate waste than meat-based entrees. Novel food pairings and visibility of legumes may have led to increased plate waste.

Environmental and Cost Impacts of Food Waste in University Canteen from a Life Cycle Perspective

Food waste has caused double waste of resources in the food itself and the food supply chain of production, transportation, cooking, and processing, resulting in unnecessary greenhouse gas emissions and economic losses. This paper first conducted the quantification of students’ food waste and the collection of canteens operation data in the three canteens at Taiyuan University of Technology (China) in 2019 through the weighing method and interview. Then an integration of Life Cycle Assessment and Life Cycle Costing was used to quantify the impact of food waste in university canteens on the environment and costs. The study found that the total amount of food waste in the university canteens with 22,000 students was 246.75 t/a, the carbon footprint caused by food waste was 539.28 t CO2-eq, and the cost was 4,729,900 yuan. Most of the impact of canteen meals on the environment comes from the use of energy in food cooking and the consumption of animal food types. The innovative integration of life cycle cost calculations highlights the key role of the labor required for cooking. The research results answer the basic scientific questions of how much food is wasted in the university canteens, and the carbon emissions and cost ratios of these wasted food in all links of the supply chain. The research results can provide a policy-making basis and data support for reducing food waste in universities and realizing carbon emission reduction in university canteens.

Evaluation of a Novel WeChat Applet for Image-Based Dietary Assessment among Pregnant Women in China

As an important part of antenatal care for pregnant women in China, dietary assessment plays a positive role in maternal and fetal health. Shortcomings in the associated methodologies require improvement. Our purpose was to develop a novel WeChat Applet for image-based dietary assessment (WAIDA) and evaluate its relative validity among pregnant women in China. Data on 251 lunch meals of pregnant women in their second trimester were analyzed. The differences in food weight, energy, and nutrient estimates by the dietary recall or WAIDA method with the weighing method were compared using paired t-tests. Pearson correlation coefficients were used to analyze the correlation between food weight, energy, and nutrient intake obtained from the recall or WAIDA method and those obtained from the weighing method. The Bland-Altman analysis was used to examine the agreement between the recall or WAIDA method and the weighing method for energy and nutrients. Compared with the weighing method, the variation range of food weight, energy and nutrients estimated by the WAIDA method was smaller and more stable than that estimated by the recall method. Compared with the recall method, the correlations suggested a better relationship between the energy and nutrient intakes from the weighing method and those estimated by the WAIDA method (0.752-0.970 vs. 0.480-0.887), which were similar to those of food weight (0.332-0.973 vs. -0.019-0.794). The Bland-Altman analysis showed that the mean differences of the energy and nutrients estimated from the recall method were further away from zero relative to the weighing method compared to the WAIDA method and with numerically wider 95% confidence intervals. The spans between the upper and lower 95% limit of agreement (LOAs) of the energy and nutrients obtained by the WAIDA method were narrower than those obtained by the recall method, and the majority of the data points obtained by the WAIDA method lay between the LOAs, closer to the middle horizontal line. Compared with the recall method, the WAIDA method is consistent with the weighing method, close to the real value of dietary data, and expected to be suitable for dietary assessment in antenatal care.

Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption

Wellness in the Schools (WITS) is a national non-profit organization partnering with public schools to provide healthy, scratch cooked, less processed meals (called an Alternative Menu), and active recess. This study examined the effects of WITS programming on school lunch consumption, including fruit and vegetable intake, in second and third grade students in New York City public schools serving a high proportion of students from low-income households. The intervention was evaluated with a quasi-experimental, controlled design with 14 elementary schools (7 that had initiated WITS programming in fall 2015 and were designated as intervention schools, and 7 matched Control schools). School lunch consumption was assessed by anonymous observation using the System of Observational Cafeteria Assessment of Foods Eaten (SOCAFE) tool in the fall of 2015 (Time 0, early intervention) and the spring of 2016 (Time 1) and 2017 (Time 2). There were no baseline data. Data were also collected on the types of entrées served in the months of October, January, and April during the two school years of the study. Across time points, and relative to students in the Control schools, students in WITS schools ate more fruits and vegetables (units = cups): Time 0: Control 0.18 vs. WITS 0.28; Time 1: Control 0.25 vs. WITS 0.31; and Time 2: Control 0.19 vs. WITS 0.27; p < 0.001. They also had more fruits and vegetables (cups) on their trays, which included more vegetables from the salad bar. However, students in the WITS schools ate fewer entrées (grain and protein) and drank less milk than students in the Control schools. Compared to the Control schools, WITS schools offered more homestyle entrées and fewer finger foods and sandwich entrees, i.e., less processed food. Students in WITS schools who received the Alternative menu and all of the WITS programming at all data collection time points selected and consumed more fruits and vegetables. Replication studies with randomized designs and true baseline data are needed to confirm these findings and to identify avenues for strengthening the effects of the program on other school lunch components.

Promoting Food Waste Reduction at Primary Schools. A Case Study

Food waste (FW) has recently attracted the interest of different institutions and has been the focus of many studies due to its important environmental, social and economic impact. This paper aims to analyze whether a didactic intervention, consisting of informing teachers and pupils and involving pupils in reducing FW, could bring about changes in the level of knowledge and attitude towards FW and in the amount of FW generated during the mid-morning break and lunch at schools. This study was conducted at a public Primary School in Valencia (Spain). Subtle changes in the level of knowledge and attitude towards FW were detected in teachers and pupils after the intervention. Around 30% of FW reduction at lunch was observed in the intervention group but not in the other groups. A decrease of almost half of the average weight was observed during the mid-morning break in the rest of primary groups. The results apparently show that addressing the FW issue in classrooms can have a very positive effect on children’s attitudes. As it is such a cross-cutting issue; it raises awareness about a large group of Sustainable Development Goals, and encourages these young citizens to make conscious decisions and to act responsibly.

The Impact of Micronutrient Fortified Foods on Cognitive Functioning among Low-Income Children: A Pilot and Feasibility Study

Brain development continues throughout childhood and requires micronutrients for optimal maturation, but studies have typically examined only a limited number of micronutrients and there has been inconsistent use of validated cognitive measures. This study evaluated the impact of providing low-income children with a daily fortified meal (570 kcal) in the form of a bar and shake containing >75% of the FDA Daily Values for all essential vitamins and minerals, as well as macronutrients (e.g., omega-3 and omega-6 fatty acids and protein), in an afterschool care setting (instead of the usual meal provided) on cognitive functioning. Students aged 8–12 were randomly assigned to intervention (n = 19) or control (n = 16) meals. Students completed the Stroop Color Word Task, Trail Making Test, and Conner’s Continuous Performance Task (CPT) at baseline and 3 months post-intervention. Differences in cognitive scores were examined using 2 × 2 mixed model ANOVAs (Stroop and CPT) and ANCOVAs (Trail Making Test). Significant main effects of time indicated improvements in both intervention and control groups, but there were no significant main effects of group or group*time interactions. When the amount of meal consumed was examined, most results became non-significant, suggesting that overall meal consumption significantly impacted the observed results. Overall, this pilot study suggests that there may be limited additional benefits to short-term consumption of micronutrient fortified meals among low-income children in an afterschool care setting, and potential benefits observed may be directly related to the amount of food consumed.

Design and Implementation of a 5-Year School-Based Nutrition Education Intervention

OBJECTIVE

To describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students.

DESIGN

Prospective 5-year study following a pre-post intervention design.

SETTING

Four elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools.

PARTICIPANTS

Approximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period.

INTERVENTION

Healthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom.

MAIN OUTCOME MEASURES

Change in pre-post survey assessment of students' nutrition literacy, attitudes, and intent; change in teachers' self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria.

ANALYSIS

Process evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.

Smaller servings vs. information provision: Results of two interventions to reduce plate waste in two university canteens

Two interventions were systematically evaluated in two university canteens on their effectiveness to reduce visitors' plate waste. The evaluation was theory-based and focused not only at the effects on the amount of plate waste, but also at the psychological predictors underlying plate waste behaviour. In Intervention A, visitors received information about food waste over a period of three weeks. In Intervention B, in addition to information, smaller servings were offered. The actual amount of plate waste and visitors' attitudes, personal norms, beliefs, perceived behavioural control, intentions and plate waste reduction behaviour were measured before and after the interventions. Intervention B reduced the amount of plate waste by 20%, whereas no reduction was found after Intervention A. In both interventions, the provided information resulted in more positive beliefs and stronger personal norms regarding avoiding plate waste. The information also caused attitudes to have a stronger influence on plate waste reduction behaviour, whereas intention to reduce became less important for reducing plate waste. Personal norms regarding food waste were the strongest predictor of plate waste reduction behaviour, before and after the interventions. The provided information was thus insufficient to reduce plate waste, simply offering smaller servings could achieve this. Although our intervention study only included two university canteens and was conducted for a short period, our data seem to imply that a combination of both information and smaller servings reduces plate waste in the food service industry.

Using Nudges to Promote Healthy Food Choices in the School Dining Room: A Systematic Review of Previous Investigations

BACKGROUND

There is a growing interest in low-cost interventions that modify obesogenic environments and encourage positive behavior change. We conducted a systematic review of studies that used behavioral nudges to promote a healthy school cafeteria environment.

METHODS

A literature search was conducted using 5 databases; of 381 papers noted, we included 25 and assessed them using the Quality Assessment Tool for Quantitative Studies.

RESULTS

Most studies used relatively small, convenience samples and data collection methods that could not be described as robust, necessitating cautious interpretation of their results. A range of behavioral nudges were employed. Seventeen studies reported positive effects on children's selection and 11 studies reported improvements in their consumption of target foods, effected by changing the order of serving; increasing the convenience, attractiveness, and normativeness of selecting healthy options; increasing the variety available; and attractive target food labeling.

CONCLUSIONS

Overall, this review identified the requirement for well-designed and well-controlled investigations into the effects of changing the choice architecture in school cafeterias, assessing short-, medium-, and long-term changes in individual children's consumption, utilizing validated measures, and conducted across a variety of settings, including dining rooms of schools outside the United States.

Effect of classroom intervention on student food selection and plate waste: Evidence from a randomized control trial

Background

U.S. children are failing to meet the recommended daily 4 cups of fruits and vegetables. New federal guidelines were implemented for healthier school lunches for the National School Lunch Programs (NSLP). Consequently, students waste large amounts of fruits and vegetables. Several organizations advocate implementation of classroom nutrition education programs as a school nutrition policy.

Methods

We conducted a randomized control trial to evaluate the effectiveness of a classroom nutrition education on food consumption behavior of public elementary school students. Our intervention was designed to improve students’ preferences for fruits and vegetables. We collected data using digital-photography, and estimated the amount of fruits and vegetables selected and wasted using ordinary least squares.

Results

The nutrition education program had no impact on the amount of fruits and vegetables selected by the students in the treatment group. We also find no significant difference in the amount of fruits and vegetables wasted by students in the treatment and control group.

Conclusion

Nutrition education did not change students’ consumption behavior, implying the proposed policy might not be optimal. Inducing a behavioral change in elementary school students is an intricate process and might require more than classroom lessons to change their dietary habits.

Food waste at school. The environmental and cost impact of a canteen meal

The challenge of increasing food demand due to population growth urges all stakeholders to act against food losses and waste, especially in light of their environmental, cost, and social impacts. In developed countries, awareness raising, and prevention are particularly important at the consumption level, where food waste mainly occurs. In this sense, public school canteens represent a unique setting, because of their capacity of conveying food habits, while sustainably managing available resources. This research assessed the environmental and cost impact of food consumption and wastage in public school canteens through a case study in Italy. It combined life cycle assessment, environmental life cycle costing, and quarter-waste visual methods. The functional unit was defined as the average meal provided by the catering service to 3-10 years old students. Primary data on type and amounts of purchased food, transport, and utilities consumption were provided by the catering service, while food waste assessment was performed in selected representative school canteens. Secondary data on background processes were mainly sourced from databases and literature. Food waste at schools represented 20-29% of the prepared meal, depending on students' age and seasonal menu. The global warming potential (GWP) of the average meal was 1.11-1.50 kg CO₂-eq, mostly due to the food production impact. The meal preparation had the largest impact on costs. When considering embedded impacts, food waste was responsible for 14-18% of GWP and 6-11% of the costs. The sensitivity analysis showed promising environmental and cost reductions by introducing changes in the meal composition and preparation.

Measuring Food Waste and Consumption by Children Using Photography

A photography method was used to measure waste on food trays in school lunch in France, using the 5-point quarter-waste scale. While food waste has been studied extensively in US school lunches, the structure of the French lunch meal is quite different, with multiple courses, and vegetables (raw and cooked) in more than one course. Vegetables were the most wasted food category as usually seen in school lunch research, especially cooked vegetables, which were wasted at rates of 66%-83%. Raw vegetables were still wasted more than main dishes, starchy products, dairy, fruit, and desserts. Vegetables were also the most disliked food category, with the classes of vegetables falling in the same order as for waste. Waste and liking were highly correlated. Sensory characteristics of the food were cited as a main reason for liking/disliking. There is a strong connection between food liking and food consumption, and this connection should be the basis for future attempts to modify school lunch to improve consumption. The photographic method of measuring food waste at an individual level performed well.

The Adoption of the Healthy Eating Standards in Local Afterschool Programs Does Not Improve Quality of Snacks

OBJECTIVES

In 2011, the National Afterschool Association adopted the Healthy Eating and Physical Activity (HEPA) standards to address snack quality and physical activity in afterschool programs. Although research has indicated promise in the adoption of these policies by national organizations, less is known about local adoption, implementation, and effectiveness. In this study, we aimed to compare the quality of snacks served at program sites pre- and post-adoption and to determine the quality of non-program snacks compared to program snacks.

METHODS

An interrupted time series design was used to measure snack quality and consumption at 3 policy adopting sites and 2 non-policy adopting sites that served as a comparison control. Trained research staff collected snack type, brand, and amount consumed using a modified quarter-waste method. Analysis on nutrient content of snacks was completed using Nutrition Data System for Research software.

RESULTS

Adoption of the HEPA standards among policy adopting sites did not result in significantly better snack quality. Across all sites, program snacks were healthier than non-program snacks.

CONCLUSION

Pursuing additional components of the HEPA standards related to implementation may be necessary to significantly improve snack quality. Environmental supports such as limiting the amount of non-program snacks available onsite may improve snack quality.

Building Blocks for Healthy Children: Evaluation of a Child Care Center-Based Obesity Prevention Pilot Among Low-Income Children

OBJECTIVE

To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children.

DESIGN

A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted.

SETTING

A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).

PARTICIPANTS

Children aged 18-71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff).

INTERVENTION(S)

A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers.

MAIN OUTCOME MEASURE(S)

Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns.

ANALYSIS

Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers.

RESULTS

Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.

CONCLUSIONS AND IMPLICATIONS

Curriculum-driven training and implementation support improved nutritional policies and practices and staff-child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.

Impact of Breakfast in the Classroom on Participation and Food Waste

OBJECTIVE

To investigate differences in school breakfast participation and food waste in 1 school district before and after the adoption of Breakfast in the Classroom.

METHODS

Using a pretest-posttest design, participation and food waste were measured from 7 elementary schools in a rural area of southwest Virginia during the 2014-2015 school year. Participation and waste were measured on 4 days in each school (twice before and twice after Breakfast in the Classroom implementation) using the quarter-waste method.

RESULTS

Across all schools, food waste decreased from 43.0% to 38.5% with Breakfast in the Classroom, with significant decreases for entrée items, juice, and savory snack foods (P < .01). Fruit and cheese items generated the greatest amount of food waste at 58.2% and 49.0%, respectively.

CONCLUSIONS AND IMPLICATIONS

Breakfast in the Classroom may be an effective tool to decrease food waste while improving dietary intake. Future research is needed among more diverse populations.

Pilot Evaluation of Aggregate Plate Waste as a Measure of Students' School Lunch Consumption

BACKGROUND

Weighing an individual's plate waste provides reliable estimates of food intake by physically weighing individual food components to the nearest gram before and after a meal. Weighing aggregate, school-level food waste may be an inexpensive and less time-consuming alternative. However, it has not been determined whether aggregate plate waste is an accurate measure of individually weighed plate waste.

OBJECTIVE

This pilot study aimed to evaluate the accuracy of aggregate plate waste for quantifying food waste in a school cafeteria setting in comparison with individually weighed plate waste.

DESIGN

A pilot validation study in which aggregate plate waste was compared against individually weighed plate waste in a school cafeteria setting.

PARTICIPANTS/SETTING

This study took place in an urban, low-income school district in Massachusetts in the spring of 2014. Four elementary schools with identical cafeterias and meals participated in the study. Approximately 1,700 students participated in this study.

MAIN OUTCOME MEASURES

For individually weighed plate waste, the percent discarded was calculated by dividing the weight of each discarded item by the average weight of the food item served and the percent consumed was calculated as the residual. For aggregate-level measurements, waste was separated by component (entrée, vegetable, fruit, and milk), and the weight discarded was calculated based on the weight of the cumulative amount remaining and an average weight for each food item served, with the percent consumed calculated as the residual.

STATISTICAL ANALYSES PERFORMED

Intraclass correlation coefficients (ICCs) were calculated to assess the agreement between aggregate plate waste and individual-level plate waste values.

RESULTS

Agreement was excellent for entrées (ICC=0.90) and vegetables (ICC=0.78), but poor for milk (ICC=0.22) and fruits (ICC=0.23). The overall agreement for all four components combined was excellent (ICC=0.75).

CONCLUSIONS

Results suggest that aggregate plate waste may provide a reasonable estimate of individually weighed plate waste, but additional research is warranted.

Measuring lunchtime consumption in school cafeterias: a validation study of the use of digital photography

OBJECTIVE

The present study tested the validity of a digital image-capture measure of food consumption suitable for use in busy school cafeterias.

DESIGN

Lunches were photographed pre- and post-consumption, and food items were weighed pre- and post-consumption for comparison.

SETTING

A small research team recorded children's lunchtime consumption in one primary and one secondary school over seven working days.ParticipantsA primary-school sample of 121 children from North Wales and a secondary-school sample of 124 children from the West Midlands, UK, were utilised. Nineteen children were excluded because of incomplete data, leaving a final sample of 239 participants.

RESULTS

Results indicated that (i) consumption estimates based on images were accurate, yielding only small differences between the weight- and image-based judgements (median bias=0·15-1·64 g, equating to 0·45-3·42 % of consumed weight) and (ii) good levels of inter-rater agreement were achieved, ranging from moderate to near perfect (Cohen's κ=0·535-0·819). This confirmed that consumption estimates derived from digital images were accurate and could be used in lieu of objective weighed measures.

CONCLUSIONS

Our protocol minimised disruption to daily lunchtime routine, kept the attrition low, and enabled better agreement between measures and raters than was the case in the existing literature. Accurate measurements are a necessary tool for all those engaged in nutrition research, intervention evaluation, prevention and public health work. We conclude that our simple and practical method of assessment could be used with children across a range of settings, ages and lunch types.

Food Service Workers: Reliable Assessors of Food Intake in Hospitalized Patients

Early detection of malnutrition in hospitalized patients is of paramount importance. As poor food intake is a marker of malnutrition risk, a simple and accurate method to monitor intake is valuable. This quality assurance project aimed to determine if food service workers (FSW) were able to provide accurate estimates of patient intakes through visually assessing meal trays at an acute care hospital. FSW conducted visual estimates of patient trays after meals using the meal plate pictorial rating scale adapted from the My Meal Intake Tool and translated their estimates into one of 5 consumption levels (0%, 25%, 50%, 75%, or 100%). A total of 401 patient meal estimates were validated using the food weighing method. Spearman's correlations between percent calories consumed (determined by weight) and estimates by FSW were 0.624 (n = 137, P < 0.001), 0.771 (n = 134, P < 0.001), and 0.829 (n = 130, P < 0.001), for breakfast, lunch, and supper, respectively. Paired Wilcoxon tests and the Kruskal-Wallis H test showed that accuracy varied for breakfast, lunch, and supper. The overall sensitivity and specificity of FSW for detecting patient intake ≤50% was 81% and 88%, respectively. These findings identify that FSW can accurately estimate patient intake, contributing an important marker for the detection of malnutrition.

School Lunch Environmental Factors Impacting Fruit and Vegetable Consumption

OBJECTIVE

Assess impact of school lunch environmental factors on fruit and vegetable (F&V) consumption in second and third grade students.

DESIGN

Cross-sectional observations in 1 school year.

PARTICIPANTS

Students from 14 elementary schools in 4 New York City boroughs (n = 877 student-tray observations).

MAIN OUTCOME MEASURE(S)

Dependent variables were F&V consumption collected by visual observation. Independent variables included school lunch environmental factors, and individual-level and school-level demographics.

ANALYSIS

Hierarchical linear modeling was used with F&V consumption as the outcome variable, and relevant independent variables included in each model.

RESULTS

Slicing or precutting of fruits and having lunch after recess were positively associated (P < .05) with .163- and .080-cup higher fruit consumption across all students, respectively. Preplating of vegetables on lunch trays, having 2 or more vegetable options, and having lunch after recess were positively associated (P < .05) with .024-, .009-, and .007-cup higher vegetable consumption across all students, respectively.

CONCLUSIONS AND IMPLICATIONS

Although there was a small increase in intake, results of the study support that some school lunch environmental factors affect children's F&V consumption, with some factors leading to more impactful increases than others. Slicing of fruits seems most promising in leading to greater fruit consumption and should be further tested.

Impact of trayless dining intervention on food choices of university students

BACKGROUND

Students live outside of their family homes for the first time in college and are expected to make their own decisions regarding dietary choices. College food environment could be a major determinant of dietary intake and is of importance in relation to obesity. This research determines the impact of removing cafeteria trays on student's food choice.

METHOD

A quasi experimental pre-post research with control treatment was conducted in university dining halls. The participants were the dining hall patrons at a large public university in Southern US, spring 2015. The dining hall trays were removed from the intervened dining hall for five consecutive days during regular university session. Outcome measures of food choice were collected by observing tray waste before and after the tray removal in the intervened dining hall with parallel observation in the control dining hall. Difference-in-difference analysis was done to find the intervention effect.

RESULTS

A total of 3153 trays were observed (N = 1564 in control and N = 1589 in intervention dining). Removal of trays resulted in a significant decrease in the total number of lunch plates (1.76 vs 1.66 servings, p < .006), drink glasses (1.32 vs 1.02 servings, p < .0001), dishes with leftovers (0.56 vs 0.39 serving, P < .001), and lunch plates with leftovers (0.51 vs 0.35 servings, p < .005).

CONCLUSIONS

Student food choices can be affected by removing trays from dining halls, specifically favoring fewer beverages, and without sacrificing salad consumption. Studies with more precise measures of tray waste are needed to understand the direct effect on energy and nutrient consumption.

Effects of a Behavioral Economics Intervention on Food Choice and Food Consumption in Middle-School and High-School Cafeterias

Introduction

Changing food choice architecture in school cafeterias through behavioral economics may increase student selection and consumption of healthy foods. However, most research assesses the effects of short-term interventions. We evaluated a year-long choice architecture intervention implemented by school food service staff.

Methods

Food service staff from 6 secondary schools in one school district received training and support to implement behavioral economics strategies in their cafeterias to promote student selection of fruit, vegetables, and low-fat white milk. We compared student selection and consumption of these foods in the intervention schools to 5 comparison schools in the same district on the basis of visual assessment of plate waste. We applied a difference-in-differences approach to estimate intervention effect.

Results

Data for 902 students were assessed at baseline, and data for 1,407 were assessed at follow-up. In fully adjusted analyses for all students, there were significantly greater absolute increases in the proportions of intervention school students selecting any fruit, including (0.09) and excluding (0.16) juice, and students selected more fruit items including (0.21) and excluding (0.17) juice. The absolute increase in proportion of intervention students consuming fruit excluding juice (0.14) was significantly greater. However, in some analyses, fewer intervention students who selected fruits or vegetables ate them, or they ate fewer of them. There were no intervention effects for vegetables or low-fat white milk.

Conclusion

Our results indicate that behavioral economics–based choice architecture can promote student selection of healthy foods, but they raise questions about whether it increases their consumption.

Validation of a Questionnaire to Measure Fruits and Vegetables Selected and Consumed at School Lunch among Second- and Third-Grade Students

BACKGROUND

Interventions designed to encourage fruit and vegetable (F/V) consumption within schools are increasingly common. Thus, there is a need for valid, practical dietary assessment instruments to evaluate their effectiveness.

OBJECTIVE

The aim of this study was to examine the validity of a group-administered, paper-and-pencil questionnaire to assess F/V selection and consumption at school lunch relative to digital photography.

DESIGN

This was a five-phase, method-comparison study in which the questionnaire was iteratively modified between each phase.

PARTICIPANTS/SETTING

The study examined sets of questionnaires and photographs of lunch trays (n=1,213) collected on 44 days between May 2015 and June 2016 among second-grade students from three New York City schools (phases 1 to 4) and second- and third-grade students from 20 schools across eight states (phase 5).

MAIN OUTCOME MEASURES

Outcomes assessed were selection, amount eaten, preference, and intention to consume F/V.

STATISTICAL ANALYSES PERFORMED

Validity was assessed by percent agreement (categorized as "match, omission, or intrusion" for items on or off tray and "match, overestimation, or underestimation" for amount eaten), Spearman correlation coefficients, and intraclass correlation coefficients (ICC).

RESULTS

The total match rate for items on tray was substantial (phases 1 to 5: 83%, 84%, 92%, 93%, and 89%), with items more frequently intruded than omitted. For amounts eaten, the total match rates were moderate, but generally improved throughout the study (phases 1 to 5: 65%, 64%, 83%, 83%, and 76%), with overestimations more frequent than underestimations. There was good correspondence between methods in the estimates of amount eaten in a quantitative, cup equivalent amount (fruit ICC=0.61; vegetables ICC=0.64). Significant differences (α=.05) were not observed between second- and third-grade students, respectively, in the match rate for fruits (86% and 89%) or vegetable (89% and 86%) items on tray or fruit (69% and 73%) and vegetables (74% and 76%) amount eaten. Excellent correlations were observed between amount eaten and preference for fruit (r=0.91) and vegetables (r=0.93).

CONCLUSIONS

The questionnaire offers a feasible, valid instrument for assessing F/V selection and consumption among elementary students in schools participating in the National School Lunch Program. Additional research is recommended to test the instrument's sensitivity and to reproduce these findings using an alternative reference method, such as direct observations.

Factors Related to Fruit and Vegetable Consumption at Lunch Among Elementary Students: A Scoping Review

INTRODUCTION

Few children consume the recommended amount of fruits and vegetables, and schools are a valuable setting for interventions, including programs such as the National School Lunch Program, to increase consumption. Previous research explored factors in this program that influence fruit and vegetable consumption. The objective of this scoping review was to identify, describe, and categorize studies that quantitatively measured the consumption of fruits and vegetables during the school lunch meal among US elementary school students.

METHODS

We conducted a scoping review to identify, describe, and categorize studies examining factors influencing fruit and vegetable consumption during lunch among children in the United States. Eligibility criteria included studies that reported fruit and vegetable consumption at the lunch meal among children in kindergarten through grade 5. We included all types of study designs and categorized factors according to a socioecological framework.

RESULTS

We identified 49 studies that examined the influence of one or more factors on elementary students' consumption of fruits and vegetables. Factors (n = 21) were categorized according to a socioecological framework: individual (3 factors), social environment (3 factors), physical environment (9 factors), policy (2 factors), and a combined approach (4 factors). Several factors had consistent positive associations with fruit and vegetable consumption at lunch across 2 or more studies: increasing age, serving sliced fruits, serving vegetables first, allowing more time for eating, using incentives, using social marketing and/or nutrition education curricula, and using the updated nutrition standards. Only 10 studies used a randomized design.

CONCLUSION

Although we found consistent evidence for some factors, we found conflicting or limited evidence for most, which points to the need for replication in future studies. The lack of randomized designs is a challenge, because it precludes the ability to draw conclusions about cause and effect. Our review may aid in framing practical aspects of the design of future research and in identifying an approach for a systematic review.

Changes in Nutrition Policies and Dietary Intake in Child Care Homes Participating in Healthy Eating and Active Living Initiative

INTRODUCTION

From 2012 to 2014, a total of 17 family child care homes participated in a multisector, community-wide initiative to prevent obesity. Strategies included staff workshops, materials, site visits, and technical assistance regarding development and implementation of nutrition policies. The purpose of the evaluation was to examine the impact of the initiative on family child care home nutrition-related policies and practices and child dietary intake.

STUDY DESIGN

Pre- and post-intervention without control group. Measures taken at baseline and follow-up included structured observations and questionnaires regarding nutrition policies, practices, and environments; documentation of lunch foods served on 5 days; and lunch plate waste observations on 2 days. Paired t-tests were used to determine the significance of change over time.

SETTING/PARTICIPANTS

Seventeen family child care homes in a low-income diverse community in Northern California; children aged 2-5 years who attended the family child care homes.

MAIN OUTCOME MEASURES

Change in nutrition-related policies and practices, lunch foods served and consumed.

RESULTS

Data was collected at 17 sites for an average of 5.2 children aged 2-5 years per site per day at baseline and 4.6 at follow-up for a total of 333 plate waste observations. There were significant increases in staff training, parental involvement, and several of the targeted nutrition-related practices; prevalence of most other practices either improved or was maintained over time. There were significant increases in the number of sites meeting Child and Adult Care Food Program meal guidelines, variety of fruit and frequency of vegetables offered, and reductions in frequency of juice and high-fat processed meats offered. Adequate portions of all food groups were consumed at both time points with no significant change over time.

CONCLUSIONS

A simple, policy-focused intervention by a child care resource and referral agency was successful at reinforcing and improving upon nutrition-related practices at family child care homes. Children consumed adequate, but not excessive, portions of the balanced meals served to them, suggesting there is no reason to offer unhealthy options.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

Reliability and Validity of Digital Imagery Methodology for Measuring Starting Portions and Plate Waste from School Salad Bars

BACKGROUND

Scientifically sound methods for investigating dietary consumption patterns from self-serve salad bars are needed to inform school policies and programs.

OBJECTIVE

To examine the reliability and validity of digital imagery for determining starting portions and plate waste of self-serve salad bar vegetables (which have variable starting portions) compared with manual weights.

DESIGN/METHODS

In a laboratory setting, 30 mock salads with 73 vegetables were made, and consumption was simulated. Each component (initial and removed portion) was weighed; photographs of weighed reference portions and pre- and post-consumption mock salads were taken. Seven trained independent raters visually assessed images to estimate starting portions to the nearest ¼ cup and percentage consumed in 20% increments. These values were converted to grams for comparison with weighed values.

STATISTICAL ANALYSES

Intraclass correlations between weighed and digital imagery-assessed portions and plate waste were used to assess interrater reliability and validity. Pearson's correlations between weights and digital imagery assessments were also examined. Paired samples t tests were used to evaluate mean differences (in grams) between digital imagery-assessed portions and measured weights.

RESULTS

Interrater reliabilities were excellent for starting portions and plate waste with digital imagery. For accuracy, intraclass correlations were moderate, with lower accuracy for determining starting portions of leafy greens compared with other vegetables. However, accuracy of digital imagery-assessed plate waste was excellent. Digital imagery assessments were not significantly different from measured weights for estimating overall vegetable starting portions or waste; however, digital imagery assessments slightly underestimated starting portions (by 3.5 g) and waste (by 2.1 g) of leafy greens.

CONCLUSIONS

This investigation provides preliminary support for use of digital imagery in estimating starting portions and plate waste from school salad bars. Results might inform methods used in empirical investigations of dietary intake in schools with self-serve salad bars.

Factors Influencing Fluid Milk Waste in a Breakfast in the Classroom School Breakfast Program

OBJECTIVE

To determine predictors of fluid milk waste in a Breakfast in the Classroom School Breakfast Program.

DESIGN

Cross-sectional with 3 repeated measures/classroom.

SETTING

Elementary schools in a medium-sized, low-income, urban school district.

PARTICIPANTS

Twenty third- through fourth-grade classrooms across 6 schools.

MAIN OUTCOMES

Dependent variables include percentage of total and served milk wasted. Independent variables included observed daily menu offerings, program factors, and teacher and student behavior.

ANALYSIS

Descriptive statistics were used to characterize variables across classrooms and schools. Multilevel mixed-effects models were used to test associations between predictors and outcomes of interest. P ≤ .05 was considered statistically significant.

RESULTS

Total milk waste increased 12% when juice was offered and 3% for each additional carton of unserved milk. Teacher encouragement to take and/or consume breakfast was associated with a 5% and 9% increase in total and served milk waste, respectively. When students were engaged in other activities in addition to eating breakfast, total milk waste decreased 10%.

CONCLUSIONS AND IMPLICATIONS

Beverage offerings were predictive of greater total milk waste. Teacher and student behavior also appeared to influence milk consumption. Findings suggest that specific changes to School Breakfast Program implementation policies and practices could have an important role in waste mitigation.

A Plate Waste Evaluation of the Farm to School Program

OBJECTIVE

To investigate the impacts of the Farm to School (FTS) Program on the selection and consumption of fruits and vegetables.

DESIGN

Plate waste data were recorded using the visual inspection method before and after implementation of the program.

SETTING

Six elementary schools in Florida: 3 treatment and 3 control schools.

PARTICIPANTS

A total of 11,262 meal observations of National School Lunch Program (NSLP) participants in grades 1-5.

INTERVENTION

The FTS Program, specifically local procurement of NSLP offerings, began in treatment schools in November, 2015 after the researchers collected preintervention data.

MAIN OUTCOME MEASURES

The NSLP participants' selection and consumption of fruits and vegetables.

ANALYSIS

Data were analyzed using Mann-Whitney U and proportions tests and difference-in-difference regressions.

RESULTS

The NSLP participants at the treatment schools consumed, on average, 0.061 (P = .002) more servings of vegetables and 0.055 (P = .05) more servings of fruit after implementation of the FTS Program. When school-level fixed effects are included, ordinary least squares and tobit regression results indicated that NSLP participants at the treatment schools respectively consumed 0.107 (P < .001) and 0.086 (P < .001) more servings of vegetables, on average, after implementation of the FTS Program.

CONCLUSIONS AND IMPLICATIONS

Local procurement positively affected healthy eating.

The My Meal Intake Tool (M-MIT): Validity of a Patient Self- Assessment for Food and Fluid Intake at a Single Meal

OBJECTIVES

Hospital malnutrition is an under-recognized issue that leads to a variety of adverse outcomes, especially for older adults. Food/fluid intake (FFI) monitoring in hospital can be used to identify those who are improving and those who need further treatment. Current monitoring practices such as calorie counts are impractical for all patients and a patient-completed tool, if valid, could support routine FFI monitoring. The aim of this research was to determine whether the patient-completed My Meal Intake Tool (M-MIT) can accurately represent FFI at a single meal.

DESIGN

Cross-sectional, multi-site.

SETTING

Four acute care hospitals in Canada.

PARTICIPANTS

120 patients (65+ yrs, adequate cognition).

MEASUREMENTS

Participants completed M-MIT for a single meal. Food and fluid waste was visually estimated by a research dietitian at each hospital. Sensitivity (Se), specificity (Sp) and overall agreement were calculated for both food and fluid intake by comparing M-MIT and dietitian estimations to determine criterion validity of M-MIT. Patient and research dietitian comments were used to make revisions to the M-MIT.

RESULTS

Using a cut-point of ≤50% intake, Se was 76.2% and 61.9% and Sp was 74.0% and 80.5% for solid and fluids respectively (p<0.001). M-MIT identified a greater proportion of participants (37.2%) as having low FFI (≤50%) than dietitians (25.0%), as well as a greater proportion identified with low fluid intake (28.3% vs. 24.6%). Modest revisions were made to improve the tool.

CONCLUSION

This study has demonstrated initial validity of M-MIT for use in older patients with adequate cognition. Use of M-MIT could promote FFI monitoring as a routine practice to make clinical decisions about care.

Development and Validation of a Technology-Based System for Tracking and Reporting Dietary Intake at School Meals

OBJECTIVE

This report describes the development and validation of a technology-based system that integrates data on food choice, nutrition, and plate waste to generate feedback reports summarizing students' dietary intake at school meals.

METHODS

Cafeteria staff used the system to document the school lunch choices of seventh-graders (n = 37) in an urban charter school for 5 months. Plate waste was assessed by research staff using a visual estimation method that was validated against directly weighed plate waste.

RESULTS

Most food choices (97.1%) were correctly recorded through the system. Visual estimates of plate waste had excellent interrater reliability (r's ≥ .94) and agreement with direct measurements (ρ's ≥ .75). Plate waste assessment required approximately 10 s/tray. Fifty-four percent of parents received feedback reports consistently.

CONCLUSIONS AND IMPLICATIONS

The technology-based system enabled staff to monitor dietary intake accurately at school meals. The system could potentially inform lunch menu modifications aimed at reducing plate waste.

Validity and Interrater Reliability of the Visual Quarter-Waste Method for Assessing Food Waste in Middle School and High School Cafeteria Settings

BACKGROUND

Measuring food waste (ie, plate waste) in school cafeterias is an important tool to evaluate the effectiveness of school nutrition policies and interventions aimed at increasing consumption of healthier meals. Visual assessment methods are frequently applied in plate waste studies because they are more convenient than weighing. The visual quarter-waste method has become a common tool in studies of school meal waste and consumption, but previous studies of its validity and reliability have used correlation coefficients, which measure association but not necessarily agreement.

OBJECTIVE

The aims of this study were to determine, using a statistic measuring interrater agreement, whether the visual quarter-waste method is valid and reliable for assessing food waste in a school cafeteria setting when compared with the gold standard of weighed plate waste.

METHODS

To evaluate validity, researchers used the visual quarter-waste method and weighed food waste from 748 trays at four middle schools and five high schools in one school district in Washington State during May 2014. To assess interrater reliability, researcher pairs independently assessed 59 of the same trays using the visual quarter-waste method. Both validity and reliability were assessed using a weighted κ coefficient.

RESULTS

For validity, as compared with the measured weight, 45% of foods assessed using the visual quarter-waste method were in almost perfect agreement, 42% of foods were in substantial agreement, 10% were in moderate agreement, and 3% were in slight agreement. For interrater reliability between pairs of visual assessors, 46% of foods were in perfect agreement, 31% were in almost perfect agreement, 15% were in substantial agreement, and 8% were in moderate agreement.

CONCLUSIONS

These results suggest that the visual quarter-waste method is a valid and reliable tool for measuring plate waste in school cafeteria settings.

Food Waste in the National School Lunch Program 1978-2015: A Systematic Review

BACKGROUND

Food waste studies have been used for more than 40 years to assess nutrient intake, dietary quality, menu performance, food acceptability, cost, and effectiveness of nutrition education in the National School Lunch Program (NSLP).

OBJECTIVE

Describe methods used to measure food waste and respective results in the NSLP across time.

METHODS

A systematic review using PubMed, Science Direct, Informaworld, and Institute of Scientific Information Web of Knowledge was conducted using the following search terms: waste, school lunch, plate waste, food waste, kitchen, half method, quarter method, weight, and photography. Studies published through June 2015 were included. The systematic review followed preferred reporting items for systematic reviews and meta-analyses recommendations.

RESULTS

The final review included 53 articles. Food waste methodologies included in-person visual estimation (n=11), digital photography (n=11), direct weighing (n=23), and a combination of in-person visual estimation, digital photography, and/or direct weighing (n=8). A majority of studies used a pre-post intervention or cross-sectional design. Fruits and vegetables were the most researched dietary component on the lunch tray and yielded the greatest amount of waste across studies.

CONCLUSIONS

Food waste is commonly assessed in the NSLP, but the methods are diverse and reporting metrics are variable. Future research should focus on establishing more uniform metrics to measure and report on food waste in the NSLP. Consistent food waste measurement methods will allow for better comparisons between studies. Such measures may facilitate better decision making about NSLP practices, programs, and policies that influence student consumption patterns across settings and interventions.

Salad bar selection patterns of elementary school children

From the perspective of child-focused nutrition research, the analysis of the school cafeteria culture and environment is critical. Most children eat at least one meal at school per school day, thus elementary schools are a good setting for influencing the early development of healthy eating habits. The salad bar in particular has gained attention as a means of increasing fruit and vegetable consumption. The purpose of the present study was to provide insight about the types of items children choose or do not choose from the salad bar. Our aims were to document elementary school children's food selection patterns by examining photographs of 2903 cafeteria trays. Our results show students in this study took very few items - and a substantial number did not take any at all. We examined three factors, gender, grade, and item placement, in relation to food selection. Gender was the most significant factor, with girls being more likely to choose both fruits and vegetables. Students in lower grades were more likely to select vegetables and to choose more of them. Finally, item placement did not affect choice. Our findings lead us to suggest the importance of integrating information about fruits and vegetables into the school curriculum and that schools strongly consider which items to offer because our results indicate children consistently do not choose certain items and probably do not conceive of them in the context of the adult concept of a salad. Finally, because a child's choice of food is not always a simple act we suggest ethnographic research on how children perceive and use salad bars would provide important insight into the value of retaining or expanding salad bars in elementary schools.

Missing Food, Missing Data? A Critical Review of Global Food Losses and Food Waste Data

Food losses and food waste (FLW) have become a global concern in recent years and emerge as a priority in the global and national political agenda (e.g., with Target 12.3 in the new United Nations Sustainable Development Goals). A good understanding of the availability and quality of global FLW data is a prerequisite for tracking progress on reduction targets, analyzing environmental impacts, and exploring mitigation strategies for FLW. There has been a growing body of literature on FLW quantification in the past years; however, significant challenges remain, such as data inconsistency and a narrow temporal, geographical, and food supply chain coverage. In this paper, we examined 202 publications which reported FLW data for 84 countries and 52 individual years from 1933 to 2014. We found that most existing publications are conducted for a few industrialized countries (e.g., the United Kingdom and the United States), and over half of them are based only on secondary data, which signals high uncertainties in the existing global FLW database. Despite these uncertainties, existing data indicate that per-capita food waste in the household increases with an increase of per-capita GDP. We believe that more consistent, in-depth, and primary-data-based studies, especially for emerging economies, are badly needed to better inform relevant policy on FLW reduction and environmental impacts mitigation.

Patterns in Vegetable Consumption: Implications for Tailored School Meal Interventions

BACKGROUND

Vegetable consumption is a challenging behavioral target; consumption rates are below recommended levels and when interventions produce improvements, increases in vegetable consumption are typically a fraction of the change in fruit consumption. We describe vegetable consumption within Ohio school meals and examine how fruit selection, the more popular item, impacts vegetable consumption.

METHODS

Fruit and vegetable waste was collected on 11,250 trays from 17 elementary and 16 middle/high schools, using the quarter-waste visualization method.

RESULTS

One in 4 students ate at least a one-fourth of a cup of vegetables with their school lunch. Consumption was the highest (30.8%) in elementary school buildings with a majority of regular priced meals. Fruit selection was associated with vegetable consumption (p < .001). Middle/high school students who consumed a fruit were 88% more likely to consume a vegetable as oppose to waste it (95% CI: 1.45-2.42). Fruit selection was also associated with not selecting a vegetable, but the association was of a lower magnitude (odds ratio 1.32; 95% CI: 1.06-1.64). Trends were similar in elementary schools.

CONCLUSIONS

Fruit and vegetable consumption should be approached as 2 distinct behaviors with particular attention given to vegetables. Fruit items can be leveraged, though, as a means to encourage vegetable selection.

Developing a digital photography-based method for dietary analysis in self-serve dining settings

Current population-based methods for assessing dietary intake, including food frequency questionnaires, food diaries, and 24-h dietary recall, are limited in their ability to objectively measure food intake. Digital photography has been identified as a promising addition to these techniques but has rarely been assessed in self-serve settings. We utilized digital photography to examine university students' food choices and consumption in a self-serve dining hall setting. Research assistants took pre- and post-photos of students' plates during lunch and dinner to assess selection (presence), servings, and consumption of MyPlate food groups. Four coders rated the same set of approximately 180 meals for inter-rater reliability analyses; approximately 50 additional meals were coded twice by each coder to assess intra-rater agreement. Inter-rater agreement on the selection, servings, and consumption of food groups was high at 93.5%; intra-rater agreement was similarly high with an average of 95.6% agreement. Coders achieved the highest rates of agreement in assessing if a food group was present on the plate (95-99% inter-rater agreement, depending on food group) and estimating the servings of food selected (81-98% inter-rater agreement). Estimating consumption, particularly for items such as beans and cheese that were often in mixed dishes, was more challenging (77-94% inter-rater agreement). Results suggest that the digital photography method presented is feasible for large studies in real-world environments and can provide an objective measure of food selection, servings, and consumption with a high degree of agreement between coders; however, to make accurate claims about the state of dietary intake in all-you-can-eat, self-serve settings, researchers will need to account for the possibility of diners taking multiple trips through the serving line.