Food intake may be determined by plate waste in a retirement living center

Something to Chew on; Plate-Waste at an Ontario Veteran's Centre

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study

Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.

Availability of Lower-Sodium School Lunches and the Association with Selection and Consumption among Elementary and Middle School Students

BACKGROUND

During 2010, the US Department of Agriculture updated the school meals standards, including three progressively decreasing sodium targets. The Target 1 standards went into effect in 2014, but during 2018, the US Department of Agriculture delayed the Target 2 standards until 2024 and eliminated the Target 3 standards citing concerns regarding the availability and acceptability of lower-sodium foods. In addition, there are currently no sugar standards, and it is unknown whether sugar is substituted for salt in lower-sodium school foods.

OBJECTIVE

To examine the availability, selection, and consumption of school lunches already in alignment with the Target 2 and 3 sodium levels and the association between sodium and sugar.

DESIGN

An observational cafeteria-based study conducted during fall 2018.

PARTICIPANTS AND SETTING

Students (n = 1985) in grades three through eight attending 13 elementary/kindergarten through eighth-grade schools in a large, urban school district in New England.

MAIN OUTCOME MEASURES

Availability, selection, and consumption were examined using plate waste methodology.

STATISTICAL ANALYSES PERFORMED

Mixed-model analysis of variance accounting for student demographic characteristics with schools/students as a random effect (students nested within schools) were used to examine differences in availability, selection, and consumption. Linear regression was used to examine the association between sodium and sugar in the school foods.

RESULTS

The majority of meals selected (87%) and consumed (98%) were already in alignment with the Target 2 standards. There were significant inverse associations between sodium levels and consumption; each 100-mg increase in sodium was associated with a decrease in consumption by 2% for entrées (P = 0.002) and 5% for vegetables (P = 0.01). When examining the association between sodium and sugar, each 10-mg reduction in sodium was associated with 1-g increase in sugar among entrées (P < 0.0001), whereas there was a significant positive association between sodium and sugar with vegetables and condiments.

CONCLUSIONS

This study provides some evidence that schools may already have the ability to provide lower-sodium meals that are acceptable to students, and therefore the recent rollbacks to the sodium standards may be unwarranted. Study findings suggest that the US Department of Agriculture should take under consideration policies that would limit added sugar for school meals as sugar may be substituted for salt.

An investigation of recommended serve food portions and attaining energy and protein requirements in older adults living in residential care

BACKGROUND

Ageing populations show a propensity for reduced food intake, which impacts nutritional adequacy. Nutrition guidelines for residential care homes (RCHs) are currently based on serve size of core food groups and do not consider nutrient density. The present study aimed to investigate the weight of foods served/consumed compared to recommended serve sizes and to compare energy and protein intake with individual requirements.

METHODS

This was an observational study of older adults living in four RCHs. Dietary intake was estimated through the difference between weighed reference meals and a single, double-weighed 24-h food plate waste collected from each participant. FoodWorks9^® (Xyris^® Software, Brisbane, Australia) was used to calculate energy, protein and serves of core food groups from food intake and the menu provided to recommended serve sizes. Individual intake was compared with nutrition guidelines and estimated energy and protein requirements.

RESULTS

Across 420 participants, 9.8% completed a main meal (lunch or dinner). The servings provided [248 g; interquartile range (IQR) = 206-290 g] were less than the recommended servings for a main meal (306 g = protein/starch/two vegetables), with 157 g (IQR = 109-221 g) consumed. The menu provided for minimum serves of all core food groups except for dairy. Median energy intake (n = 389) (5272 kJ day^-1 , IQR = 4229-6720 kJ) and protein intake (47.3 g day^-1 , IQR = 35.9-60.8 g) were less than estimated requirements (8181 kJ day^-1 , IQR = 7300-9338 kJ day^-1 ; 76.7 g day^-1 , IQR = 66.7-90.8 g).

CONCLUSIONS

Nutritional needs were not met in this cohort. The findings of the present study highlight the need for smaller, nutrient-dense meals and revised menu standards to ensure nutritional adequacy in this vulnerable population.

The addition of spices and herbs to vegetables in the National School Lunch Program increased vegetable intake at an urban, economically-underserved, and predominantly African-American high school

Vegetable intake is far below recommendations among African-American adolescents living in economically-underserved urban areas. While the National School Lunch Program (NSLP) helps overcome access barriers, vegetable intake remains challenging and novel interventions are required. A two-year, multi-phase, school-based intervention was conducted at an urban, economically-underserved, and predominantly African-American high school in Baltimore, Maryland to determine whether stakeholder-informed addition of spices and herbs to NSLP vegetables would increase intake. The stakeholder engagement phase included assessment of NSLP vegetable attitudes/preferences among 43 school stakeholders and subsequent student sensory testing. The second phase was conducted in the school cafeteria and consisted of eight weeks comparing student intake of typical vegetable recipes versus otherwise-identical recipes with spices and herbs. 4,570 student lunch plates were included in the vegetable intake comparison. Vegetable intake was measured by lunch tray plate waste. Willingness to try vegetables was assessed by the difference between plate waste and estimated mean vegetable served weight. Intake of typical vegetable recipes and vegetable recipes with spices and herbs was compared with student's t-test. Chi-square test was used to compare willingness to try vegetables. Total vegetable intake was 18.2% higher (8.22 grams per meal, p<0.0001) with spices and herbs than with typical recipes. There were no differences in trying vegetables with spices and herbs, although student-led advocacy was associated with increased trying vegetables with spices and herbs (78.8% with advocacy, 67.5% without advocacy, p<0.0001). The addition of spices and herbs to vegetables in the NSLP was feasible and associated with small increases in vegetable intake at an urban, economically-underserved, and predominantly African-American high school.

Acceptability and Feasibility of Best Practice School Lunches by Elementary School-Aged Children in a Serve Setting: A Randomized Crossover Trial

Background: National School Lunch Program (NSLP) standards have improved school lunch dietary quality (DQ), however, further improvements could be made. Acceptability and feasibility of higher DQ are potential barriers. Thus, the purpose is to compare acceptability and feasibility of best practice (BPSL, optimizing DQ) with typical school lunches (TSL, meeting minimum NSLP standards) served separately and concurrently. Methods: Forty elementary school-aged participants were recruited for a randomized crossover trial. Participants attended three meal conditions (MC) choosing one of two meal types—MC1) BPSL1/BPSL2, MC2) TSL1/TSL2, MC3) BPSL/TSL. Acceptability included taste test surveys, weighted plate waste assessments, and hunger scales. Feasibility included meal cost, time, and skill and equipment requirements. Results: There were no significant differences in total taste test score, average total plate waste, or change in hunger (ps > 0.017) before or after adjusting for covariates. TSL was selected significantly more often in MC3 (TSL = 83.3%, BPSL = 16.7%, p = 0.001). Meal cost (p = 0.783) and skill and equipment requirements were not significantly different between meal types. BPSL required significantly longer preparation time (TSL = 60 ± 25 min, BPSL = 267 ± 101 min, p = 0.026). Conclusions: Results indicate few differences in acceptability and feasibility between BPSL and TSL. This study could inform decision and policy-makers seeking to improve school lunch DQ and acceptance of higher DQ meals.

Sustainable Food Consumption in Nursing Homes: Less Food Waste with the Right Plate Color?

The problem of unsustainable food consumption among vulnerable residents of nursing homes who suffer from dementia is often multifaceted. From an individual perspective, people with dementia who do not finish their meals are likely to encounter serious health issues associated with malnutrition. Moreover, at the institutional level, nursing homes generate tons of nonrecoverable food waste each year, impairing not only their economic position but also the natural and social environment at large. The purpose of this study is to explore the possibility of reducing food waste in Norwegian nursing homes by appraising how large this reduction could be as one replaces traditional dining white porcelain with plates with diverse color combinations. A quasi-experimental method was adopted. The results of the pilot study were extrapolated to the annual amount of food wasted at the national level. The findings indicate that, on average, 26% of food was thrown away when served on white plates compared to only 9% when served on one of the colored plate options tested. Nationally, approximately 992.6 tons of food per year could potentially be saved with only a single change, ultimately ameliorating the unsustainable food consumption problem among residents of nursing homes.

Impact of the Updated USDA School Meal Standards, Chef-Enhanced Meals, and the Removal of Flavored Milk on School Meal Selection and Consumption

BACKGROUND

In Fall 2012, updated US Department of Agriculture school meal standards went into effect and did not result in increased food waste overall. However, consumption of school foods, especially fruits and vegetables, remains low. Therefore, strategies to improve school meal consumption are necessary.

OBJECTIVE

This study evaluated the combined impact of the updated school meal standards and chef-enhanced, healthier meals, and the removal of flavored milk on students' school food selection and consumption compared with students in control schools.

DESIGN

The Project MEALS (Modifying Eating and Lifestyles at School) study was a cafeteria-based quasi-experimental intervention conducted during the 2012 to 2013 school year.

PARTICIPANTS/SETTING

Participants were students (n=1,309) in grades 3 through 8 attending four intervention and four control schools in two low-income, urban school districts.

INTERVENTION

Chef-enhanced school meals and the removal of flavored milk combined with the updated US Department of Agriculture school meal standards.

MAIN OUTCOME MEASURES

Changes in school meal selection and consumption were examined using plate waste methodology.

STATISTICAL ANALYSES PERFORMED

Logistic regression and mixed-model analysis of variance adjusting for student demographics and schools/students as a random effect (students nested within schools) were used to examine differences in selection and consumption before (Fall 2012) and after (Spring 2013) a chef-based intervention with the updated school meal standards.

RESULTS

After the chef-based intervention was implemented, there were no significant differences in entrée, vegetable, or fruit selection. Significantly fewer students selected milk compared with students in control schools (56.8% vs 94.0%; P<0.0001) and milk consumption was significantly lower (54.8% vs 63.7%; P=0.004). However, consumption was significantly greater for vegetables (62.2% vs 38.2%; P=0.005) and fruits (75.2 vs 59.2%; P=0.04) in the intervention schools compared with control schools. There were no significant differences in entrée consumption.

CONCLUSIONS

Schools collaborating with chefs can be an effective method to improve the consumption of fruits and vegetables with the updated US Department of Agriculture school meal standards. Further research should examine the longer-term impact of the removal of flavored milk from schools to determine whether the lower selection and consumption rates persist.

Hospital food waste and environmental and economic indicators--A Portuguese case study

This study presents a comprehensive characterization of plate waste (food served but not eaten) at an acute care hospital in Portugal and elaborates on possible waste reduction measures. Even though waste prevention is a priority in Europe, large amounts of food are still being wasted every day, with hospitals giving rise to two to three times more food waste than other foodservice sectors. For this work the plate waste arising at the ward level was audited during 8 weeks, covering almost 8000 meals, using a general hospital as case study. Weighing the food served to patients and that returned after the meal allowed calculating plate waste for the average meal, as well as for individual meal items. Comparison of food waste arising showed that differences exist among wards, with some generating more waste than others. On average each patient throws away 953 g of food each day, representing 35% of the food served. This equates to 8.7 thousand tonnes of food waste being thrown away each year at hospitals across Portugal. These tonnes of food transformed into waste represent economic losses and environmental impacts, being estimated that 16.4 thousand tonnes of CO2 (equivalent) and 35.3 million euros are the annual national indicators in Portugal. This means that 0.5% of the Portuguese National Health budget gets thrown away as food waste. Given the magnitude of the food problem five measures were suggested to reduce food waste, and their potential impact and ease of implementation were discussed. Even though food waste is unavoidable the results obtained in this work highlight the potential financial and environmental savings for Portuguese hospitals, providing a basis to establish future strategies to tackle food waste.

Amount of Time to Eat Lunch Is Associated with Children's Selection and Consumption of School Meal Entrée, Fruits, Vegetables, and Milk

BACKGROUND

There are currently no national standards for school lunch period length and little is known about the association between the amount of time students have to eat and school food selection and consumption.

OBJECTIVE

Our aim was to examine plate-waste measurements from students in the control arm of the Modifying Eating and Lifestyles at School study (2011 to 2012 school year) to determine the association between amount of time to eat and school meal selection and consumption.

DESIGN

We used a prospective study design using up to six repeated measures among students during the school year.

PARTICIPANTS/SETTING

One thousand and one students in grades 3 to 8 attending six participating elementary and middle schools in an urban, low-income school district where lunch period lengths varied from 20 to 30 minutes were included.

MAIN OUTCOME MEASURES

School food selection and consumption were collected using plate-waste methodology.

STATISTICAL ANALYSES PERFORMED

Logistic regression and mixed-model analysis of variance was used to examine food selection and consumption.

RESULTS

Compared with meal-component selection when students had at least 25 minutes to eat, students were significantly less likely to select a fruit (44% vs 57%; P<0.0001) when they had <20 minutes to eat. There were no significant differences in entrée, milk, or vegetable selections. Among those who selected a meal component, students with <20 minutes to eat consumed 13% less of their entrée (P<0.0001), 10% less of their milk (P<0.0001), and 12% less of their vegetable (P<0.0001) compared with students who had at least 25 minutes to eat.

CONCLUSIONS

During the school year, a substantial number of students had insufficient time to eat, which was associated with significantly decreased entrée, milk, and vegetable consumption compared with students who had more time to eat. School policies that encourage lunches with at least 25 minutes of seated time might reduce food waste and improve dietary intake.

Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial

IMPORTANCE

Little is known about the long-term effect of a chef-enhanced menu on healthier food selection and consumption in school lunchrooms. In addition, it remains unclear if extended exposure to other strategies to promote healthier foods (eg, choice architecture) also improves food selection or consumption.

OBJECTIVE

To evaluate the short- and long-term effects of chef-enhanced meals and extended exposure to choice architecture on healthier school food selection and consumption.

DESIGN, SETTING, AND PARTICIPANTS

A school-based randomized clinical trial was conducted during the 2011-2012 school year among 14 elementary and middle schools in 2 urban, low-income school districts (intent-to-treat analysis). Included in the study were 2638 students in grades 3 through 8 attending participating schools (38.4% of eligible participants).

INTERVENTIONS

Schools were first randomized to receive a professional chef to improve school meal palatability (chef schools) or to a delayed intervention (control group). To assess the effect of choice architecture (smart café), all schools after 3 months were then randomized to the smart café intervention or to the control group.

MAIN OUTCOMES AND MEASURES

School food selection was recorded, and consumption was measured using plate waste methods.

RESULTS

After 3 months, vegetable selection increased in chef vs control schools (odds ratio [OR], 1.75; 95% CI, 1.36-2.24), but there was no effect on the selection of other components or on meal consumption. After long-term or extended exposure to the chef or smart café intervention, fruit selection increased in the chef (OR, 3.08; 95% CI, 2.23-4.25), smart café (OR, 1.45; 95% CI, 1.13-1.87), and chef plus smart café (OR, 3.10; 95% CI, 2.26-4.25) schools compared with the control schools, and consumption increased in the chef schools (OR, 0.17; 95% CI, 0.03-0.30 cups/d). Vegetable selection increased in the chef (OR, 2.54; 95% CI, 1.83-3.54), smart café (OR, 1.91; 95% CI, 1.46-2.50), and chef plus smart café schools (OR, 7.38, 95% CI, 5.26-10.35) compared with the control schools, and consumption also increased in the chef (OR, 0.16; 95% CI, 0.09-0.22 cups/d) and chef plus smart café (OR, 0.13; 95% CI, 0.05-0.19 cups/d) schools; however, the smart café intervention alone had no effect on consumption.

CONCLUSIONS AND RELEVANCE

Schools should consider both collaborating with chefs and using choice architecture to increase fruit and vegetable selection. Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that also increased consumption. This was observed only after students were repeatedly exposed to the new foods for 7 months. Therefore, schools should not abandon healthier options if they are initially met with resistance.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02309840.

Impact of the new U.S. Department of Agriculture school meal standards on food selection, consumption, and waste

BACKGROUND

The U.S Department of Agriculture (USDA) recently made substantial changes to the school meal standards. The media and public outcry have suggested that this has led to substantially more food waste.

PURPOSE

School meal selection, consumption, and waste were assessed before and after implementation of the new school meal standards.

METHODS

Plate waste data were collected in four schools in an urban, low-income school district. Logistic regression and mixed-model ANOVA were used to estimate the differences in selection and consumption of school meals before (fall 2011) and after implementation (fall 2012) of the new standards among 1030 elementary and middle school children. Analyses were conducted in 2013.

RESULTS

After the new standards were implemented, fruit selection increased by 23.0% and entrée and vegetable selection remained unchanged. Additionally, post-implementation entrée consumption increased by 15.6%, vegetable consumption increased by 16.2%, and fruit consumption remained the same. Milk selection and consumption decreased owing to an unrelated milk policy change.

CONCLUSIONS

Although food waste levels were substantial both pre- and post-implementation, the new guidelines have positively affected school meal selection and consumption. Despite the increased vegetable portion size requirement, consumption increased and led to significantly more cups of vegetables consumed. Significantly more students selected a fruit, whereas the overall percentage of fruit consumed remained the same, resulting in more students consuming fruits. Contrary to media reports, these results suggest that the new school meal standards have improved students' overall diet quality. Legislation to weaken the standards is not warranted.

Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care

BACKGROUND

Poor satisfaction with institutional food is a significant moderator of food intake in geriatrics/rehabilitation and residential aged care.

PURPOSE

To quantify the relationship between foodservice satisfaction, foodservice characteristics, demographic and contextual variables in geriatrics/rehabilitation and residential aged care.

METHODS

The Resident Foodservice Satisfaction Questionnaire was administered to 103 patients of 2 geriatrics/rehabilitation units and 210 residents of nine residential aged care facilities in Brisbane, Australia. Ordered probit regression analysis measured the association of age, gender, ethnicity and appetite, timing and amount of meal choice, menu selectivity, menu cycle, production system, meal delivery system and therapeutic diets with foodservice satisfaction.

RESULTS

Patient and resident appetite (P < 0.01), the amount and timing of meal choice (P < 0.01), self-rated health (P < 0.01), accommodation style (P < 0.05) and age (P < 0.10) significantly moderated foodservice satisfaction. High protein/high energy therapeutic diets (P < 0.01), foodservice production (P < 0.01) and delivery systems (P > 0.01) were significant moderators for those with 'fair' self-rated health.

CONCLUSIONS

Patient and resident characteristics and structural and systems-related foodservice variables were more important for influencing foodservice satisfaction than characteristics of food quality. The results suggest modifications to current menu planning and foodservice delivery methods: reducing the time-lapse between meal choice and consumption, augmenting the number of meals at which choice is offered, and revising food production and delivery systems.It is important that residents in poorer health who are a high risk of under-nutrition are provided with sufficient high protein/high energy therapeutic diets. Diets that restrict macro- and micro-nutrients should be minimized for all patients and residents.

School lunch waste among middle school students: nutrients consumed and costs

BACKGROUND

The National School Lunch Program has been guided by modest nutrient standards, and the palatability of meals, which drives consumption, receives inadequate attention. School food waste can have important nutritional and cost implications for policymakers, students, and their families.

PURPOSE

Nutrient losses and economic costs associated with school meal waste were examined. The study also assessed if school foods served were valid proxies for foods consumed by students.

METHODS

Plate waste measurements were collected from middle school students in Boston attending two Chef Initiative schools (n=1609) and two control schools (n=1440) during a 2-year pilot study (2007-2009) in which a professional chef trained cafeteria staff to make healthier school meals. The costs associated with food waste were calculated and the percentage of foods consumed was compared with a gold standard of 85% consumption. Analyses were conducted in 2010-2011.

RESULTS

Overall, students consumed less than the required/recommended levels of nutrients. An estimated $432,349 of food (26.1% of the total food budget) was discarded by middle school students annually at lunch in these Boston middle schools. For most meal components, substantially less than 85% was consumed.

CONCLUSIONS

There is substantial food waste among middle school students in Boston. Overall, students' nutrient consumption levels were below school meal standards, and foods served were not valid proxies for foods consumed. The costs associated with discarded foods are high; if translated nationally for school lunches, roughly $1,238,846,400 annually is wasted. Students might benefit if additional focus were given to the quality and palatability of school meals.

Long-term impact of a chef on school lunch consumption: findings from a 2-year pilot study in Boston middle schools

School cafeterias can play an important role in providing healthy meals. Although schools participating in the National School Lunch Program are required to meet minimum program standards, advocates recommend that innovations be sought to enhance menu dietary quality. This study evaluated the Chef Initiative, a 2-year pilot study in two Boston middle schools, designed to increase the availability and consumption of healthier school foods. Between 2007 and 2009, a professional chef trained cafeteria staff to prepare healthier school lunches (ie, more whole grains, fresh/frozen fruits and vegetables, and less sugar, salt, saturated fats, and trans fats). Meal nutrient compositions were monitored from 2007 to 2009, and a plate waste study conducted in the spring of 2009 compared food selection and consumption patterns among students at Chef Initiative schools, with students receiving standard school lunches at two matched control schools. Paired t tests and descriptive statistics were used to examine differences in menus and mixed-model analysis of variance was used to analyze differences in students' food selection and consumption between Chef Initiative and control schools. Overall, the Chef Initiative schools provided healthier lunches and the percent of foods consumed at Chef Initiative and control schools were similar (61.6% vs 57.3%; P=0.63). Of the areas targeted, there was greater whole-grain selection and vegetable consumption; 51% more students selected whole grains (P=0.02) and students consumed 0.36 more vegetable servings/day (P=0.01) at Chef Initiative schools. The potential of chefs collaborating with cafeteria staff to improve the availability, selection, and consumption of healthier meals is promising.

High consumption foods and their influence on energy and protein intake in institutionalized older adults

BACKGROUND

The elderly, and especially those attending nursing homes, are at great risk from certain nutritional deficiencies.

OBJECTIVE

The aim of this study was to determine which food groups present the highest rates of consumption among the institutionalized elderly and study the energy density of each food group and the number of calories and amount of protein in the total diet of each resident.

DESIGN

This was a multicentre observational study of a sample of the institutionalized population over the age of 65. The sample of patients was drawn from four Spanish nursing homes (Santa Coloma Gramanet, Barcelona, Madrid and Bilbao). Our final sample comprised a total of 62 individuals, of whom 22 were men and 40 women, aged between 68 and 96 years.

METHODS

Dietary data were collected using the double weight method for each main meal (breakfast, lunch, afternoon snack and dinner), including food type, the quantity of food served and the amount of plate waste for each of the main meals served during 21 days.

STATISTICAL ANALYSES

The characteristics of the study population were compared by Student's t-test and χ2 test. The results are expressed in terms of their median values and the interquartile range. To analyse the overall differences between sites, gender and food groups we used Kruskall-Wallis test combined with the Mann-Whitney U-test with Bonferroni correction for multiple comparisons.

RESULTS

The food group that was served most was milk products (376.25 g/day). A large amount of potatoes were also served (109.64 g/day) as were sweets and pastries (62.14 g/day). The daily serving of fruit (138.34 g/day) and vegetables (239.47 g/day) was equivalent to no more than that of a daily ration in each case. Milk was the food group with the highest consumption (311 g/day). Most of the energy was provided by groups with a higher energy density like as fats and sauces, sweets and pastries and bread. The mean protein consumption was 82,6 g/day (Table 5) and no significant differences were recorded in this consumption between men and women.

CONCLUSIONS

We conclude that there is a need to improve the residents' energy intake and to redistribute their energy and protein intake among the various food groups. An alternative to increasing food portions so as to improve energy intake might involve enriching certain food types.