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Rongen FC, Coosje Dijkstra S, Hupkens TH, Vingerhoeds MH, Seidell JC, van Kleef E. A qualitative study exploring the perceptions of children, parents and school staff towards the development and implementation of school lunch provision within primary schools in the Netherlands. BMC Public Health 2023; 23:2367. [PMID: 38030987 PMCID: PMC10687776 DOI: 10.1186/s12889-023-17265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There is no tradition of serving school lunches in primary schools in the Netherlands. Most children tend to bring their own packed lunch, however these are often nutritionally suboptimal. While school lunch provision can aid healthy eating behavior amongst children, its introduction would constitute a profound change for children, parents and school staff. Therefore, this qualitative study aims to explore children's, parents and school staffs' perceptions of both the current lunch situation and the implementation of school lunch provision within primary schools in the Netherlands. METHODS In this qualitative study we conducted nine interviews with school principals, 98 interviews with children, and held six focus groups with teachers and six with parents at primary schools in two Dutch cities. The data was analysed via iterative coding. RESULTS The results showed that most children and parents are satisfied with the current lunch situation, although existing school food policies are not always put in place. Most teachers felt that children had insufficient time to consume their lunch in the current situation. The children were generally positive about the idea of a school lunch, and stressed that it was important to have the ability to choose. While both parents and school staff saw school lunch provision as an opportunity to educate families about healthy food options, they also expressed concern about who would be responsible, as well as the financial and organizational implications of its introduction. CONCLUSIONS Perceptions of children, parents and school staff about a school provided lunch are mixed. A complex intervention such as a new school lunch program is difficult to envisage for all parties involved and more research is needed regarding the effects, organization, logistics and the costs of school lunch provision in the Netherlands.
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Affiliation(s)
- Frédérique C Rongen
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, de Boelelaan 1085, Amsterdam, Netherlands
| | - S Coosje Dijkstra
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, de Boelelaan 1085, Amsterdam, Netherlands.
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - Tobie H Hupkens
- Food Health & Consumer Research, Wageningen Food & Biobased Research, P.O. Box 17, Wageningen, 6700AA, Netherlands
| | - Monique H Vingerhoeds
- Food Health & Consumer Research, Wageningen Food & Biobased Research, P.O. Box 17, Wageningen, 6700AA, Netherlands
| | - Jacob C Seidell
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, de Boelelaan 1085, Amsterdam, Netherlands
| | - Ellen van Kleef
- Marketing and Consumer Behaviour Group, Wageningen University, Hollandseweg 1, Wageningen, 6706 KN, Netherlands
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Vitale M, Crossland S, Shinwell J, Stretesky PB, Defeyter MA, Brownlee IA. The Nutritional Quality of Food Provision at UK Government-Funded Holiday Clubs: A Cross-Sectional Analysis of Energy and Nutrient Content. Nutrients 2023; 15:1937. [PMID: 37111156 PMCID: PMC10144653 DOI: 10.3390/nu15081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
A large proportion of children are at risk of food insecurity during school holidays in the UK. The government-funded Holiday Activities and Food (HAF) programme provides free holiday clubs offering at least one healthy meal/day to eligible children and adolescents. This study aims at evaluating the nutritional quality of food provision at HAF holiday clubs, particularly hot/cold and vegetarian/non-vegetarian meals. Menu variants (n = 2759) from 49 HAF holiday clubs were assessed for adherence to School Food Standards (SFS) and their notional compositional quality, which was scored utilising a novel nutrient-based meal quality index. The median adherence to SFS across all available menus was 70% (IQR 59-79%). Overall, hot variants scored statistically higher menu quality scores than cold variants for both 5-11y (92.3 (80.7-102.7) vs. 80.4 (69.3-90.6)) and 11-18y (73.5 (62.5-85.8) vs. 58.9 (50.0-70.7)) criteria. Cold and hot menu variants tended to score differentially for quality sub-components. These findings highlight areas for potential future improvement in HAF holiday club provision with a tendency for food provision to appear less ideal for attendees for those aged 11-18. Ensuring that children from low-income households have access to a healthy diet is crucial to reduce UK health inequalities.
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Affiliation(s)
- Martina Vitale
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.V.); (S.C.)
| | - Shannon Crossland
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.V.); (S.C.)
| | - Jackie Shinwell
- Healthy Living Lab, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (J.S.); (M.A.D.)
| | - Paul B. Stretesky
- Department of Social Sciences, Northumbria University, Newcastle upon Tyne NE7 7YT, UK;
| | - Margaret Anne Defeyter
- Healthy Living Lab, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (J.S.); (M.A.D.)
| | - Iain Andrew Brownlee
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.V.); (S.C.)
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Rongen FC, van Kleef E, Vingerhoeds MH, Seidell JC, Dijkstra SC. Content of lunchboxes of Dutch primary school children and their perceptions of alternative healthy school lunch concepts. Public Health Nutr 2022; 26:1-9. [PMID: 36268771 PMCID: PMC9989704 DOI: 10.1017/s1368980022002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/17/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the content of lunchboxes of primary school children and to examine children's support and preferences for alternative healthy school lunch concepts. DESIGN A cross-sectional study among Dutch children from seven primary schools. The content of the lunchboxes was assessed by photographs. Support and preferences for alternative lunch concepts were examined via a self-reported questionnaire. Linear regression analyses were used to investigate the associations between children's support and preferences and sex, educational group and migration background. SETTING The Netherlands. PARTICIPANTS Primary school children. RESULTS A total of 660 children were included (average 9·9 years old). Most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts 'Sandwiches prepared by the children themselves' and a 'hot lunch buffet' had the highest mean support, while the concept 'a healthy lunch brought from home' was the most preferred concept. Small significant differences were observed depending on sex, educational group and migration background. CONCLUSION Lunchboxes of Dutch children contained sandwiches and a drink but rarely fruit and vegetables. Among different alternatives, children reported the highest support for the preparation of their own sandwiches in class or a hot lunch buffet. Future studies should investigate if these alternative lunch concepts improve the dietary intake of children.
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Affiliation(s)
- Frédérique C Rongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, Amsterdam1081 HV, the Netherlands
| | - Ellen van Kleef
- Marketing and Consumer Behaviour Group, Wageningen University, Wageningen, the Netherlands
| | - Monique H Vingerhoeds
- Food, Health & Consumer Research group, Wageningen Food & Biobased Research, Wageningen, the Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, Amsterdam1081 HV, the Netherlands
| | - Sanne Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, Amsterdam1081 HV, the Netherlands
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van Kleef E, Dijkstra SC, Seidell J, Vingerhoeds MH, Polet IA, Zeinstra GG. Which factors promote and prohibit successful implementation and normalization of a healthy school lunch program at primary schools in the Netherlands? JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:47. [PMID: 36243766 PMCID: PMC9569068 DOI: 10.1186/s41043-022-00328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A school provided healthy lunch might help to improve the nutritional quality of children's lunches. However, in the Netherlands, school lunch programs are not common. The aim of this study was to identify factors that promote or inhibit the implementation of a school lunch program at primary schools, from the viewpoint of school professionals. METHODS A cross-sectional online survey was conducted among 204 primary school professionals. The normalization process theory and its four constructs (i.e. coherence, cognitive participation, collective action, reflective monitoring) were used to develop questions and interpret findings. Descriptive statistics were used for 14 multiple choice questions (yes, no, don't know) and thematic content analysis for qualitative responses. RESULTS Participants had a shared understanding about how a lunch program differed from current practices. Most participants had the same view on the rationale for implementation (coherence), such as equality among children. Sixty percent expected that a healthy school lunch will contribute to healthier eating by the children. Participants showed different degrees of cognitive participation (46% indicated that healthy school lunch is good idea). Commitment depended on their belief whether providing a healthy lunch was part of their responsibility as school and 30% expected a large effect on their daily work (collective action). When appraising school lunch implementation (reflective monitoring), participants' concerns focused on feasibility and adaptability of a program in their own school. CONCLUSIONS The introduction of a school lunch program will require substantial effort, although there is considerable support and understanding about potential benefits. The findings point to a number of preconditions for large-scale introduction, including the need for support-both financially and organizationally-bottom-up involvement of teachers, children and parents and freedom to adapt the program.
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Affiliation(s)
- Ellen van Kleef
- Marketing and Consumer Behaviour Group, Wageningen University, Hollandseweg 1, 6706 KN Wageningen, The Netherlands
| | - S. Coosje Dijkstra
- Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, The Netherlands
| | - Jaap Seidell
- Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, The Netherlands
| | - Monique H. Vingerhoeds
- Food, Health and Consumer Research, Wageningen Food and Biobased Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
| | - Ilse A. Polet
- Food, Health and Consumer Research, Wageningen Food and Biobased Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
| | - Gertrude G. Zeinstra
- Food, Health and Consumer Research, Wageningen Food and Biobased Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
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5
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Haney E, Parnham JC, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J, White M, Millett C, Vamos EP. Dietary quality of school meals and packed lunches: a national study of primary and secondary schoolchildren in the UK. Public Health Nutr 2022; 26:1-12. [PMID: 35641314 DOI: 10.1017/s1368980022001355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE School lunches represent a key opportunity to improve diets and health of schoolchildren. No recent nationally representative studies have examined the nutritional differences between school meals and packed lunches in the UK. This study aimed to characterise and compare the nutritional quality of school meals and packed lunches among primary and secondary school-age children. DESIGN A pooled cross-sectional analysis of the UK's National Diet and Nutrition Survey (2008-2017). SETTING United Kingdom. PARTICIPANTS 3001 children (aged 4-16 years) who completed a 3/4-d food diary which recorded meal type (school meal/packed lunch). Multivariable logistic regression models assessed associations of meeting food and nutrient recommendations by meal type. Analyses were stratified by academic key stages (KS). RESULTS KS-1 (4-7 years) and 2 (8-11 years) children consuming school meals were more likely to meet minimum recommendations for vegetables, protein-rich foods and fibre, and not exceed maximum recommendations for salt, savoury and sweet snacks compared with pupils consuming packed lunches. However, in KS-3 (12-14 years) and 4 (14-16 years), these effects were reduced. As children aged, the median weight of fruits, vegetables, protein-rich foods and dairy products consumed typically decreased for both school meals and packed lunches, and generally an increasing proportion of school meals contained sweet and savoury snacks. CONCLUSION These findings suggest school meals are nutritionally superior to packed lunches but are not yet optimal. Quality declined at higher KS. Actions to improve lunches of primary and secondary schoolchildren across the UK are needed, with attention to KS-3 and 4 in secondary schools.
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Affiliation(s)
- Erin Haney
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
| | - Stephanie von Hinke
- School of Economics, University of Bristol, Bristol, UK
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon-Tyne, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
- Public Health Research Centre & Comprehensive Health Research Center (CHRC), National School of Public Health, Lisbon, Portugal
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, LondonW6 8RP, UK
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Warren E, Williams L, Knai C. The "Cinderella sector": The challenges of promoting food and nutrition for young children in early years' settings in England. Ecol Food Nutr 2022; 61:576-594. [PMID: 35579381 DOI: 10.1080/03670244.2022.2073353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The quality of food that children eat in early childhood has profound impacts on their future wellbeing. In England, many children eat the majority of meals in early years' settings including nurseries and childminders. We conducted 16 interviews with 18 stakeholders exploring food provision, the use of voluntary nutrition guidelines, and the effects of government support on the early years' sector. Key themes emerging from our thematic analysis included feeling insufficiently consulted, undervalued, support being unequally distributed, needing to fill multiple support roles for families, disagreement about the role and effect of voluntary nutrition standards, and being chronically underfunded.
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Affiliation(s)
- Emily Warren
- , Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London
| | - Lorraine Williams
- , Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London
| | - Cécile Knai
- , Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London
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Goldthorpe J, Vaughan M, Keyworth C, Epton T, Calam R, Armitage C. What are the environmental factors that affect implementation of the Manchester Healthy Schools programme? A qualitative exploration of staff perspectives. BMJ Open 2022; 12:e048683. [PMID: 35487719 PMCID: PMC9058701 DOI: 10.1136/bmjopen-2021-048683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Primary/elementary schools are crucial settings for early weight management interventions but effects on children's weight are small. This may be because the environments in which these schools are situated support unhealthy behaviours that lead to weight gain (obesogenic environments). Staff working in schools have a unique insight into the environmental factors that might affect their efforts to support child health and weight management interventions. The aim of this study is to explore the views of staff in relation to the perceived effects of the environmental context in which they deliver a child health promotion intervention. METHODS Staff from five schools involved in delivering the Manchester Healthy Schools programme were interviewed (N=19). These interviews were transcribed verbatim and analysed thematically. RESULTS Three themes were produced: opportunities to be healthy; importance of funding, resources and governance; and resources available to households and neighbourhoods. CONCLUSION The views of school staff were consistent with themes identified in other relevant literature. Although there were serendipitous opportunities to capitalise on local resources, such as using nearby land and leisure facilities for outdoor physical activities, many barriers relating to local environmental and resource features were reported. Joined up, multi-agency solutions such as place-based approaches might be able to offer schools some resource-based support; however, more research is needed to establish the best way to achieve the best outcomes for children.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Matthew Vaughan
- Division of Health Sciences, School of Health Sciences,The University of Manchester, Manchester, UK
| | - Chris Keyworth
- School of Psychology, The University of Leeds, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Health Sciences, School of Health Sciences,The University of Manchester, Manchester, UK
| | - Chris Armitage
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
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Parnham JC, Chang K, Millett C, Laverty AA, von Hinke S, Pearson-Stuttard J, de Vocht F, White M, Vamos EP. The Impact of the Universal Infant Free School Meal Policy on Dietary Quality in English and Scottish Primary School Children: Evaluation of a Natural Experiment. Nutrients 2022; 14:1602. [PMID: 35458164 PMCID: PMC9029848 DOI: 10.3390/nu14081602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023] Open
Abstract
The Universal Infant Free School Meal (UIFSM) policy was introduced in September 2014 in England and January 2015 in Scotland and offered all infant schoolchildren (ages 4-7 years) a free school lunch, regardless of income. Yet, impacts of UIFSM on dietary intakes or social inequalities are not known. A difference-in-differences study using the National Diet and Nutrition Survey assessed pooled pre-UIFSM (2010-2014) and post-UIFSM (2014-2017) dietary data. English or Scottish infant schoolchildren (4-7 years; n = 458) were the intervention group, with junior schoolchildren (8-11 years; n = 401) as controls. We found that implementation of UIFSM led to an increase in infant schoolchildren having a school meal. Impacts on key food groups such as fruit and vegetables or sweetened beverages were not seen. However, there was evidence that the UIFSM policy lowered consumption of foods associated with packed lunches, such as crisps, and some nutrients, such as total fat and sodium. Policy impacts differed by income group, with larger effect sizes in low-income children. In conclusion, evaluation of UIFSM demonstrated some improvements in dietary quality but the findings suggest school meal quality needs to be improved to fully realise the benefits of UIFSM.
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Affiliation(s)
- Jennie C. Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
| | - Stephanie von Hinke
- Erasmus School of Economics, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands;
- School of Economics, University of Bristol, Priory Road Complex, Bristol BS8 1TU, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2AZ, UK;
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon-Tyne NE27 0QJ, UK
- Health Analytics, Lane Clark & Peacock LLP, London W1U 1DQ, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK;
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK;
| | - Eszter P. Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; (K.C.); (C.M.); (A.A.L.); (E.P.V.)
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Poličnik R, Rostohar K, Škrjanc B, Seljak BK, Blaznik U, Farkaš J. Energy and Nutritional Composition of School Lunches in Slovenia: The Results of a Chemical Analysis in the Framework of the National School Meals Survey. Nutrients 2021; 13:nu13124287. [PMID: 34959835 PMCID: PMC8703510 DOI: 10.3390/nu13124287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Slovenia similar to some European countries has a long tradition of the organized system of school meals. The present survey aimed to compare school lunch composition in Slovene primary schools (n = 40) with the national dietary guidelines; Methods: The survey took place from January to September 2020. Sampling of a 5-day school lunch (n = 200) for adolescents aged 10 to 13 years, were performed in schools. Chemical analysis was provided by an accredited national laboratory. RESULTS The median energy value of school lunches was 2059 kJ (24% of the recommended daily energy intake). The school lunches contained 24.8 g of proteins, 52.9 g of carbohydrates and 16.7 g of dietary fats. Saturated fatty acids represent 4.7 g, polyunsaturated fatty acids 4.7 g, monounsaturated fatty acids 5.8 g, and industrial trans fats 0.2 g/100 g of a meal (1.2 g/meal). Dietary fibre represented 7.8 g, free sugars for 14.7 g and salt for 3.9 g; Conclusions: The survey showed lower values for energy, carbohydrates and total fats in school lunches as recommended, and exceeded values of salt, saturated and polyunsaturated fatty acids.
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Affiliation(s)
- Rok Poličnik
- National Institute of Public Health, Trubarjeva 2, SI 1000 Ljubljana, Slovenia; (K.R.); (U.B.); (J.F.)
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI 1000 Ljubljana, Slovenia
- Correspondence:
| | - Katja Rostohar
- National Institute of Public Health, Trubarjeva 2, SI 1000 Ljubljana, Slovenia; (K.R.); (U.B.); (J.F.)
| | - Barbara Škrjanc
- National Laboratory of Health, Environment and Food, Grablovičeva 44, SI 1000 Ljubljana, Slovenia;
| | - Barbara Koroušić Seljak
- Computer System Department, Jožef Stefan Institute, Jamova cesta 39, SI 1000 Ljubljana, Slovenia;
| | - Urška Blaznik
- National Institute of Public Health, Trubarjeva 2, SI 1000 Ljubljana, Slovenia; (K.R.); (U.B.); (J.F.)
| | - Jerneja Farkaš
- National Institute of Public Health, Trubarjeva 2, SI 1000 Ljubljana, Slovenia; (K.R.); (U.B.); (J.F.)
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakičan, SI 9000 Murska Sobota, Slovenia
- Medical Faculty, University of Ljubljana, Vrazov trg 2, SI 1000 Ljubljana, Slovenia
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Engler-Stringer R, Black J, Muhajarine N, Martin W, Gilliland J, McVittie J, Kirk S, Wittman H, Mousavi A, Elliott S, Tu S, Hills B, Androsoff G, Field D, Macdonald B, Belt C, Vatanparast H. The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study. JMIR Res Protoc 2021; 10:e30899. [PMID: 34546171 PMCID: PMC8493466 DOI: 10.2196/30899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones. Objective The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices. Methods This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project. Results This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention. Conclusions The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent. International Registered Report Identifier (IRRID) DERR1-10.2196/30899
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Affiliation(s)
- Rachel Engler-Stringer
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jennifer Black
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Wanda Martin
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Janet McVittie
- Department of Educational Foundations, College of Education, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara Kirk
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Hannah Wittman
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
| | - Amin Mousavi
- Department of Educational Psychology and Special Education, College of Education, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sinikka Elliott
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Sylvana Tu
- Saskatchewan Population Health Evaluation and Research Unit, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brent Hills
- Saskatoon Public Schools Division, Saskatoon, SK, Canada
| | | | - Debbie Field
- Coalition for Healthy School Food, Food Secure Canada, Montreal, QC, Canada
| | - Brit Macdonald
- Little Green Thumbs Program, Agriculture in the Classroom, Saskatoon, SK, Canada
| | - Chelsea Belt
- Health Promotion Department, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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11
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Illøkken KE, Johannessen B, Barker ME, Hardy-Johnson P, Øverby NC, Vik FN. Free school meals as an opportunity to target social equality, healthy eating, and school functioning: experiences from students and teachers in Norway. Food Nutr Res 2021; 65:7702. [PMID: 34349612 PMCID: PMC8287658 DOI: 10.29219/fnr.v65.7702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 01/18/2023] Open
Abstract
Background There are no national arrangements for free school meals provision in Norway despite this being an important opportunity to improve children’s and adolescents’ nutritional status and ultimately their physical and cognitive development. During a one academic year (2014–2015), a group of Norwegian sixth graders were served a free healthy school meal in a project called ‘The School Meal Project’. Objective To explore students’ and teachers’ experiences of receiving free school meals after the free school meal in 2015 and 5 years later. Design In-depth, semi-structured interviews with separate groups in 2015 and in 2020 were conducted face to face or via telephone or digital platforms. The findings are based on 13 students (aged 12–16) and 5 teacher interviews. Findings Thematic analysis identified four main themes that describe the perceived benefits of receiving free school meals: 1) the meal as a social event where students made new friends and learned new skills; 2) as an aid to forming healthy eating habits; and as an opportunity to 3) improve school functioning and 4) increase social equality among students. Discussion Our analysis suggests that the free school meal may influence healthy behaviors not only at the individual level but also at the social-, physical-, and macro-levels. Methodological limitations, including self-selection bias, should be considered when interpreting our findings. Conclusion This study provides unique insights into the social benefits for students of receiving free school meals. Our findings illustrate the potential of free school meals: eating healthy foods, sharing a meal together, and interaction between students and teachers at mealtime, to promote health, learning, and equality. In order to maximize these benefits through national implementation of free school meals, more understanding is needed of possible facilitators and barriers related to the provision and uptake of free school meals.
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Affiliation(s)
- Kristine E Illøkken
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Berit Johannessen
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
| | - Mary E Barker
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway.,Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton Foundation Trust, Southampton, UK
| | - Polly Hardy-Johnson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Frøydis Nordgård Vik
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
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12
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Implementation of Universal Infant Free School Meals: a pilot study in NE England exploring the impact on Key Stage 1 pupil's dietary intake. Public Health Nutr 2021; 24:3167-3175. [PMID: 33261703 PMCID: PMC9884742 DOI: 10.1017/s1368980020004875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To consider the principal effect of an interaction between year (pre- and post-Universal Infant Free School Meals (UIFSM)) and school on pupil's dietary intakes. DESIGN A repeated cross-sectional survey using dietary data from 2008 to 2009 (pre-) and 2017 to 2018 (post-UIFSM). SETTING Two primary schools, NE England. PARTICIPANTS Pupils aged 4-7 years (2008-2009 n 121; 2017-2018 n 87). RESULTS At lunchtime, there was a statistically significant decrease in pupils non-milk extrinsic sugars intake (%E NMEs) pre- to post-UIFSM (mean change -4·6 %; 95 % CI -6·3, -2·9); this was reflected in total diet (-3·8 %; -5·2, -2·7 %). A year and school interaction was found for mean Ca intakes: post-UIFSM pupils in School 2 had a similar mean intake as pre; in School 1 intakes had increased (difference of difference: -120 mg; 95 % CI -179, -62); no reflection in total diet. Post-UIFSM mean portions of yogurt decreased in School 2 and remained similar in School 1 (-0·25; -0·46, -0·04); this was similar for 'cake/pudding' and fruit. CONCLUSIONS Within the limitations, these findings highlight positives and limitations following UIFSM implementation and demonstrate the role of school-level food practices on pupil's choices. To facilitate maximum potential of UIFSM, national levers, such as discussions on updating school food standards, including sugars, could consider removing the daily 'pudding' option and advocate 'fruit only' options 1 d/week, as some schools do currently. Small school-level changes could maximise positive health impacts by decreasing NMEs intake. A more robust evaluation is imperative to consider dietary impacts, equitability and wider effects on schools and families.
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13
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Bunten A, Porter L, Burgess-Allen J, Howell-Jones R, Jackson J, Ward D, Staples V, Staples P, Rowthorn H, Saei A, van Schaik P, Tydeman E, Blair P, Hugueniot O, Gold N, Chadborn T. Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial. Appetite 2020; 157:104987. [PMID: 33039508 DOI: 10.1016/j.appet.2020.104987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 01/11/2023]
Abstract
Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.
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Affiliation(s)
- Amanda Bunten
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Lucy Porter
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
| | | | - Rebecca Howell-Jones
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | | | - Derek Ward
- Medical School, University of Lincoln, Brayford Way, Brayford Pool, Lincoln, LN6 7TS, UK; Public Health Division, Adult Care and Community Wellbeing, Lincolnshire County Council, County Offices, Newland, Lincoln, LN1 1YL, UK
| | - Vicki Staples
- University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Paul Staples
- University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Harriet Rowthorn
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK; Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK
| | - Ayoub Saei
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Paul van Schaik
- School of Social Sciences and Law, Teesside University, Campus Heart, Southfield Rd, Middlesbrough, TS1 3BX, UK
| | - Elizabeth Tydeman
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Penny Blair
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Orla Hugueniot
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Natalie Gold
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Tim Chadborn
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
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14
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Parnham JC, Laverty AA, Majeed A, Vamos EP. Half of children entitled to free school meals did not have access to the scheme during COVID-19 lockdown in the UK. Public Health 2020; 187:161-164. [PMID: 32980783 PMCID: PMC7447260 DOI: 10.1016/j.puhe.2020.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. STUDY DESIGN The study design was cross-sectional analyses of questionnaire data collected in April 2020. METHODS Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. RESULTS Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. CONCLUSIONS In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.
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Affiliation(s)
- J C Parnham
- Public Health Policy Evaluation Unit, Imperial College London, UK.
| | - A A Laverty
- Public Health Policy Evaluation Unit, Imperial College London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, UK
| | - E P Vamos
- Public Health Policy Evaluation Unit, Imperial College London, UK
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15
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Goldthorpe J, Epton T, Keyworth C, Calam R, Brooks J, Armitage C. What do children, parents and staff think about a healthy lifestyles intervention delivered in primary schools? a qualitative study. BMJ Open 2020; 10:e038625. [PMID: 32819951 PMCID: PMC7440822 DOI: 10.1136/bmjopen-2020-038625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Primary schools are crucial settings for early weight management interventions but effects on children's weight are small and evidence shows that deficiencies in intervention implementation may be responsible. Very little is known about the roles of multiple stakeholders in the process of implementation. We used a multiple-stakeholder qualitative research approach to explore the implementation of an intervention developed to improve the diet and increase the levels of physical activity for children living in some of the most deprived areas of England. DESIGN For this qualitative study, interviews and focus groups were carried out using semi-structured topic guides. Data were analysed thematically. SETTING Seven primary schools (pupils aged 4 to 11) in Manchester, England. PARTICIPANTS We conducted 14 focus groups with children aged 5 to 10 years and interviews with 19 staff members and 17 parents. INTERVENTION Manchester Healthy Schools (MHS) is a multicomponent intervention, developed to improve diet and physical activity in schools with the aim of reducing and preventing childhood obesity. RESULTS Three themes were developed from the data: common understandings of health and health behaviours; congruence and consistency of messages; negotiations of responsibility. CONCLUSION All participant groups had a common conceptualisation of health as having physical and psychological components and that action could be taken in childhood to change behaviours that protect long-term health. When parents and staff felt a shared sense of responsibility for children's health and levels of congruence between home and school norms around diet and physical activity were high, parents and children were more likely to accept the policies implemented as part of MHS. Effective two-way communication between home and school is therefore vital for successful implementation of this intervention.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Tracy Epton
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Chris Armitage
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Everitt T, Engler-Stringer R, Martin W, Vatanparast H. Comparing Diet Quality of School Meals versus Food Brought from Home. CAN J DIET PRACT RES 2020; 81:179-185. [PMID: 32495636 DOI: 10.3148/cjdpr-2020-013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Consuming nutritious food is essential to learning. The purpose of this research was to determine the diet quality of elementary school lunches, both those in meal programs and those bringing food from home, in urban and rural locations in Saskatchewan.Methods: Using a School Food Checklist and digital photography we compared food group servings and diet quality in 3 school types: urban schools with a meal program and urban and rural schools without a meal program. The total sample was 773 students.Results: Only 55% of students brought the minimum number of servings for grain products and meat and alternatives, with fewer bringing the minimum for vegetables and fruit (25.6%-34.9%), whole grains (24.1%), and milk and alternatives (14.1%). Students bringing food from home had significantly more calories in their lunches from minimally nutritious foods. Students in meal programs had the highest diet quality scores using the Healthy Eating Index adapted for school hours.Conclusions: The diet quality of elementary students' lunches needs improvement, although students in meal programs have healthier diets. Interventions targeting what children eat at school should focus on increasing the number of students meeting recommendations for healthy foods while decreasing minimally nutritious foods brought to school.
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Affiliation(s)
- Tracy Everitt
- Department of Human Nutrition, St. Francis Xavier University, Antigonish, NS
| | - Rachel Engler-Stringer
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Wanda Martin
- College of Nursing, University of Saskatchewan, Saskatoon, SK
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The importance of school lunches to the overall dietary intake of children in Sweden: a nationally representative study. Public Health Nutr 2020; 23:1705-1715. [PMID: 32312356 PMCID: PMC7267782 DOI: 10.1017/s1368980020000099] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: School lunches have potential to foster healthy diets in all children, but data on their importance are relatively scarce. The current study aimed to describe the dietary intake from school lunches by sex and school grade, and to assess how the daily intake, school lunch intake and the daily intake provided by lunch differ by sex and parental education. Design: Cross-sectional. All foods and drinks consumed for 1–3 weekdays were self-reported. Energy, absolute and energy-adjusted intakes of nutrients and food groups were calculated per weekday and per school lunch. Mixed-effects linear models assessed sociodemographic differences in dietary intakes. Nutrient and energy density at lunch and during the rest of the day were compared. Setting: Seventy-nine Swedish primary schools. Participants: Pupils in grades 5 and 8 (N 2002), nationally representative. Results: Lunch provided around half of daily vegetable intake and two-thirds of daily fish intake. Nutrient density was higher and energy density lower at lunch compared with the rest of the day (P < 0·001). Boys had greater energy-adjusted intakes of red/processed meat and lower intakes of vegetables and dietary fibre compared with girls (P < 0·001), overall and at lunch. Daily energy-adjusted intakes of most nutrients/food groups were lower for pupils of lower-educated parents compared with pupils of parents with higher education, but at lunch, only Fe and fibre intakes were significantly lower in this group. Conclusions: School lunches are making a positive contribution to the diets of Swedish children and may mitigate well-established sex differences and social inequalities in dietary intake.
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18
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Noor S, Dehghan M, Lear SA, Swaminathan S, Ibrahim Q, Rangarajan S, Punthakee Z. Relationship between diet and acculturation among South Asian children living in Canada. Appetite 2020; 147:104524. [PMID: 31756412 DOI: 10.1016/j.appet.2019.104524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 10/18/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Diet and South Asian ethnicity are both associated with early onset of cardiovascular risk factors. Among youth of South Asian origin, little is known about the role of culture in determining healthy dietary patterns. We aimed to assess dietary patterns and their relationships with acculturation to Western and traditional lifestyles among South Asian youth in Canada. METHODS The Research in Cardiovascular Health - Lifestyles, Environments and Genetic Attributes in Children and Youth (RICH LEGACY) study targeted South Asian children and adolescents aged 7-8 and 14-15 years in two Canadian cities. In this cross-sectional study, acculturation questionnaires and food frequency questionnaires were administered to assess the correlations between Western and traditional culture scores, immigration status (generation and length of residency) in Canada and intake frequency of various foods. RESULTS Among 759 youth, those who ate fruits and vegetables more often consumed dairy and whole grains more often (all r = 0.17-0.22, all p < 0.001), while those who ate fast food more often consumed meat, sweets and sugared drinks more often (all r 0.24-0.38, all p < 0.001). Traditional culture scores were weakly positively correlated with whole grain intake frequency (r = 0.12, p = 0.001), and negatively with meat intake frequency (r = -0.14, p < 0.001). Western culture scores positively correlated with high intake frequency of meat (r = 0.23, p < 0.001), fast food (r = 0.14, p < 0.001) and sweets (r = 0.14, p < 0.001). DISCUSSION Children who are more acculturated with Western lifestyle consumed foods associated with increased metabolic risk. However, whether this eating pattern translates into increased risk of obesity and cardiovascular diseases needs to be further explored.
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Affiliation(s)
- Salmi Noor
- McMaster University, Hamilton, ON, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | | | - Quazi Ibrahim
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Zubin Punthakee
- McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
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Evans CEL, Melia KE, Rippin HL, Hancock N, Cade J. A repeated cross-sectional survey assessing changes in diet and nutrient quality of English primary school children's packed lunches between 2006 and 2016. BMJ Open 2020; 10:e029688. [PMID: 31932386 PMCID: PMC7045752 DOI: 10.1136/bmjopen-2019-029688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Mandatory school meal standards were introduced in 2006 in England; however, no legislation exists for packed lunches. This study analyses provision of foods and nutrients in packed lunches in 2016 to highlight differences in diet and nutrient quality since 2006. DESIGN Two cross-sectional surveys of children's packed lunches were conducted in 2006 and 2016. Data were analysed using multilevel regression models taking into account the clustering of children within primary schools. SETTING Data were collected from 1148 children who attended 76 schools across England in 2006 and from 323 children attending 18 schools across England in 2016. PARTICIPANTS Children were included if they regularly ate a packed lunch prepared at home (approximately half of children take a packed lunch to school) and were aged 8-9 years (in year 4), for both surveys. OUTCOME MEASURES Data collected in both years included provision of weight and type of food, nutrients and proportion of lunches meeting individual and combined school meal standards. RESULTS Frequency of provision and portion size of some food types changed substantially between surveys. Frequency of provision of confectionery in lunches reduced by 9.9% (95% CI -20.0 to 0.2%), sweetened drinks reduced by 14.4% (95% CI -24.8 to -4.0%), and cakes and biscuits not containing chocolate increased by 9.6% (95% CI 3.0 to 16.3%). Vegetable provision in lunches remained low. Substantial changes were seen in the percentage of lunches meeting some nutrient standards: non-milk extrinsic sugars (19%, 95% CI 10 to 29%), vitamin A (-8%, 95% CI -12 to -4%), vitamin C (-35%, 95% CI -42 to -28%) and zinc (-8%, 95% CI -14 to -1%). CONCLUSIONS Packed lunches remain low quality with few meeting standards set for school meals. Provision of sugars has reduced due to reductions in provision and portion size of sugary drinks and packaged sweet foods; however, provision of some nutrients has worsened.
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Affiliation(s)
| | | | - Holly L Rippin
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Neil Hancock
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
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20
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Effect of implementing school meals compared with packed lunches on quality of dietary intake among children aged 7-13 years. J Nutr Sci 2019; 8:e3. [PMID: 30746124 PMCID: PMC6360196 DOI: 10.1017/jns.2018.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/26/2018] [Accepted: 12/06/2018] [Indexed: 11/21/2022] Open
Abstract
Strategies are needed to improve the dietary habits of children. The aim of the present study was to evaluate the effect of implementing a school food programme on the dietary quality of lunches consumed by school children aged 7–13 years compared with packed lunches brought from home. A secondary objective was to investigate if a possible effect would differ between the younger children and the older. A quasi-experimental study design with four intervention schools and four matched control schools was conducted. In total, 984 school children participated. Data on packed lunches were collected at baseline. At the 1st follow-up the children in the intervention schools were offered free school meals and at the 2nd follow-up children paid for their school meals. The control group had packed lunches at all measurements. A digital photographic method combined with a Meal Index of dietary Quality (Meal IQ) was used for dietary assessment. Multilevel modelling was employed for data analyses. The quality of dietary intake was improved when free school meals were offered (P = 0·004); if the school meals were paid for the use was limited and no difference in change in dietary quality was found (P = 0·343). The school food programme had no difference in effect according to age (P = 0·083). In conclusion, offering a free school meal had a positive effect on dietary quality of the lunches consumed by school children aged 7–13 years. No effect was measured when the school meals were not provided for free. The dietary effect did not depend on age.
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21
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High-risk environments for eating foods surplus to requirements: a multilevel analysis of adolescents' non-core food intake in the National Diet and Nutrition Survey (NDNS). Public Health Nutr 2018; 22:74-84. [PMID: 30404666 DOI: 10.1017/s1368980018002860] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Interventions to reduce adolescents' non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown. DESIGN Cross-sectional. SETTING Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008-2012 were analysed. NDNS food items were classified as 'non-core' based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between 'where' (home, school, etc.) and 'with whom' (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).ParticipantsAdolescents (n 884) aged 11-18 years. RESULTS Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at 'Eateries' (2·51; 2·14, 2·95) and 88 % higher at 'School' (1·88; 1·65, 2·13) compared with 'Home'. EO with 'Friends' (1·16; CI 1·03, 1·31) and 'Family & friends' (1·21; 1·07, 1·37) contained 16-21 % more non-core food compared with eating 'Alone'. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake. CONCLUSIONS Regardless of individual characteristics, adolescents' non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.
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22
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Hawthorne DL, Neilson LJ, Macaskill LA, Luk JMH, Horner EJ, Parks CA, Salvadori MI, Seabrook JA, Dworatzek PDN. Parental Reports of Lunch-Packing Behaviours Lack Accuracy: Reported Barriers and Facilitators to Packing School Lunches. CAN J DIET PRACT RES 2018; 79:99-105. [PMID: 29893145 DOI: 10.3148/cjdpr-2018-011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Parents influence the foods their children consume and often provide proxy reports of this intake. One way parents exert this influence is by providing home-packed lunches. This study compared parental reports of foods packed in children's lunches with what was actually packed and identified parental barriers and facilitators to packing lunches. METHODS Grade 3 and 4 student-parent dyads (n = 321) in 19 elementary schools in Ontario participated. Parental reports and actual packed lunch contents were collected via self-administered surveys and direct observation, respectively. Parental barriers and facilitators were obtained through open and closed survey questions. RESULTS Median portions packed were significantly higher for sugar-sweetened beverages and snacks and significantly lower for fruits, fruit juice, vegetables, milk/alternatives, and meat/alternatives than parents reported. Packing a healthy lunch was "important/very important/of the utmost importance" for 95.9% of respondents, and 97.5% perceived their nutrition knowledge as "adequate/good/very good". Barriers to packing a lunch included: child's food preferences, time, finances, allergy policies, and food safety. Nutrition resources, observing other children's lunches, child's input, and planning ahead were identified as facilitators. CONCLUSIONS Strategies to improve packed lunches should move beyond parental nutrition knowledge and importance of lunch packing to address parental barriers and facilitators.
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Affiliation(s)
- Dana L Hawthorne
- a Leeds, Grenville and Lanark District Health Unit, Brockville, ON
| | | | - Lesley A Macaskill
- c School of Food and Nutritional Sciences, Brescia University College, London, ON
| | | | | | | | - Marina I Salvadori
- g Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Jamie A Seabrook
- c School of Food and Nutritional Sciences, Brescia University College, London, ON.,h Departments of Paediatrics, and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON.,i Children's Health Research Institute, London, ON.,j Lawson Health Research Institute, London, ON.,k Human Environments Analysis Laboratory, London, ON
| | - Paula D N Dworatzek
- c School of Food and Nutritional Sciences, Brescia University College, London, ON.,l Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, ON
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Ziauddeen N, Page P, Penney TL, Nicholson S, Kirk SFL, Almiron-Roig E. Eating at food outlets and leisure places and "on the go" is associated with less-healthy food choices than eating at home and in school in children: cross-sectional data from the UK National Diet and Nutrition Survey Rolling Program (2008-2014). Am J Clin Nutr 2018; 107:992-1003. [PMID: 29741556 PMCID: PMC5985724 DOI: 10.1093/ajcn/nqy057] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/06/2018] [Indexed: 12/25/2022] Open
Abstract
Background Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity. Objective The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey. Design Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5-18 y from the UK National Diet and Nutrition Survey Rolling Program (2008-2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and "on the go." Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking. Results The main eating location across all age groups was at home (69-79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and "on the go" combined increased with age, from 5% (1.5-3 y) to 7% (11-18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4-10 y who ate school-sourced foods. Conclusions Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat "on the go," may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.
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Affiliation(s)
- Nida Ziauddeen
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Polly Page
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Tarra L Penney
- UKCRC Center for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Sonja Nicholson
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Sara FL Kirk
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eva Almiron-Roig
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
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Oostindjer M, Aschemann-Witzel J, Wang Q, Skuland SE, Egelandsdal B, Amdam GV, Schjøll A, Pachucki MC, Rozin P, Stein J, Lengard Almli V, Van Kleef E. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´s diet and food consumption? A cross-national comparative perspective. Crit Rev Food Sci Nutr 2018; 57:3942-3958. [PMID: 27712088 DOI: 10.1080/10408398.2016.1197180] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is little agreement among governments, institutions, scientists and food activists as to how to best tackle the challenging issues of health and sustainability in the food sector. This essay discusses the potential of school meals as a platform to promote healthy and sustainable food behavior. School meal programs are of particular interest for improving public diet because they reach children at a population scale across socio-economic classes and for over a decade of their lives, and because food habits of children are more malleable than those of adults. Current research on the history and health implications of school meal programs is reviewed in a cross-national comparative framework, and arguments explored that speak for the need of a new developmental phase of school meals as an integrative learning platform for healthy and sustainable food behavior. Nutritional, social, practical, educational, economical, political, and cultural perspectives and challenges linked to the implementation of healthy and sustainable school meals are discussed. Finally, the need for long-term interventions and evaluations is highlighted and new research directions are proposed.
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Affiliation(s)
- Marije Oostindjer
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway
| | - Jessica Aschemann-Witzel
- b MAPP Centre - Research on Value Creation in the Food Sector , Aarhus University , Aarhus C , Denmark
| | - Qing Wang
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway
| | - Silje Elisabeth Skuland
- c Consumption Research Norway , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Bjørg Egelandsdal
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway
| | - Gro V Amdam
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway.,d School of Life Science , Arizona State University , Tempe , Arizona , USA
| | - Alexander Schjøll
- c Consumption Research Norway , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Mark C Pachucki
- e Department of Sociology, Computational Social Science Institute , University of Massachusetts Amherst , Amherst , Massachusetts , USA
| | - Paul Rozin
- f Department of Psychology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Jarrett Stein
- g Netter Center for Community Partnerships , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | | | - Ellen Van Kleef
- i Marketing and Consumer Behavior Group , Wageningen University , Hollandseweg , The Netherlands
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Tugault-Lafleur CN, Black JL, Barr SI. Lunch-time food source is associated with school hour and school day diet quality among Canadian children. J Hum Nutr Diet 2017; 31:96-107. [PMID: 28758252 DOI: 10.1111/jhn.12500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is limited research on the dietary behaviours of Canadian children at school, including where students obtain food from during school hours or whether lunch-time food source influences diet quality. METHODS Nationally representative cross-sectional data from 24-h dietary recalls were analysed from the 2004 Canadian Community Health Survey (n = 4589). Dietary outcomes included school hour and school day dietary intakes and School Healthy Eating Index (S-HEI) scores. Survey-weighted covariate-adjusted linear regression models examined differences in dietary outcomes across lunch-time food source groups. RESULTS The majority of children (72.8%) reported bringing lunch from home, whereas fewer students obtained lunch from off-campus locations (11.6%), schools (9.6%) or skipped lunch (5.9%). Compared to off-campus lunches, home-packed lunches were significantly higher in fibre, vitamins A, D and C, thiamin, magnesium, iron, grains, vegetables and fruit, but lower in total calories, fat and calories from minimally nutritious foods. Average school hour diet quality required improvement for all age groups, although S-HEI scores did not differ significantly by lunch-time food source among 6-8-year-old children. However, for children age 9-17 years, bringing a home-packed lunch was associated with significantly higher S-HEI scores compared to students obtaining lunch from off-campus locations. After adjusting for age and sex, lunch-time food source was also significantly associated with whole day dietary quality. CONCLUSIONS Although the nutritional quality of off-campus lunches was lower than home-packed lunches, the quality of foods was suboptimal, regardless of food source. Strategies are needed to enhance access to nutritious foods on campus and improve the nutritional quality of packed lunches, which supply the majority of lunch-time foods consumed by Canadian children.
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Affiliation(s)
- C N Tugault-Lafleur
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - J L Black
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - S I Barr
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
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Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents. Nutrients 2017; 9:nu9060608. [PMID: 28613261 PMCID: PMC5490587 DOI: 10.3390/nu9060608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/09/2017] [Accepted: 06/09/2017] [Indexed: 11/16/2022] Open
Abstract
Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14-18 years old in the 2011-2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods.
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Goodchild GA, Faulks J, Swift JA, Mhesuria J, Jethwa P, Pearce J. Factors associated with universal infant free school meal take up and refusal in a multicultural urban community. J Hum Nutr Diet 2017; 30:417-428. [DOI: 10.1111/jhn.12442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. A. Goodchild
- Division of Nutritional Sciences; School of Biosciences; University of Nottingham; Loughborough UK
| | - J. Faulks
- City Catering; Leicester City Council; Leicester UK
| | - J. A. Swift
- Division of Nutritional Sciences; School of Biosciences; University of Nottingham; Loughborough UK
| | - J. Mhesuria
- City Catering; Leicester City Council; Leicester UK
| | - P. Jethwa
- Division of Nutritional Sciences; School of Biosciences; University of Nottingham; Loughborough UK
| | - J. Pearce
- Division of Nutritional Sciences; School of Biosciences; University of Nottingham; Loughborough UK
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Emmett PM, Jones LR. Diet, growth, and obesity development throughout childhood in the Avon Longitudinal Study of Parents and Children. Nutr Rev 2015; 73 Suppl 3:175-206. [PMID: 26395342 PMCID: PMC4586450 DOI: 10.1093/nutrit/nuv054] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7-11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood.
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Affiliation(s)
- Pauline M Emmett
- P.M. Emmett is with the Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.L.R. Jones is with the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
| | - Louise R Jones
- P.M. Emmett is with the Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.L.R. Jones is with the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Evans CEL, Albar SA, Vargas-Garcia EJ, Xu F. School-Based Interventions to Reduce Obesity Risk in Children in High- and Middle-Income Countries. ADVANCES IN FOOD AND NUTRITION RESEARCH 2015; 76:29-77. [PMID: 26602571 DOI: 10.1016/bs.afnr.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
School-based interventions are relatively new and were first introduced in the United States in the 1990s. Early programs were mainly education based with many of the findings now embedded in school policy in the form of a healthy eating curriculum. More recent school programs have taken education outside the classroom and attempted to engage parents as well as teachers. Environmental changes such as improving the quality of foods available at lunchtime and at other times during the school day are now common. Reviews of evaluations of school-based programs have demonstrated that they are effective and successfully improve dietary quality such as increasing fruit and vegetable intake and decreasing sweet and savory snacks and sweetened drinks; not just in school but over the whole day and particularly in younger school children. School-based interventions are also effective at reducing obesity if components to increase physical activity and reduce sedentary behaviors are also targeted but not if only dietary behaviors are tackled. Most of the high-quality evaluation studies using randomized controlled trials have been carried out in high-income countries as they are costly to run. However, middle-income countries have benefitted from the information available from these evaluation studies and many are now starting to fund and evaluate school-based programs themselves, resulting in unique problems such as concomitant under- and overnutrition being addressed. Action for the future demands more focus on populations most at risk of poor dietary quality and obesity in order to reduce inequalities in health and on adolescents who have not benefited as much as younger children from school-based interventions. This will involve innovative solutions within schools as well as targeting the food environment outside schools such as reducing the density of fast-food outlets and marketing of sweet and savory snacks and drinks.
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Affiliation(s)
- Charlotte E L Evans
- Lecturer in Public Health Nutrition, Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK.
| | - Salwa Ali Albar
- School of Food Science and Nutrition, King Abdul-Aziz University, PO Box 42807, 21551 Jeddah, Saudi Arabia; Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Elisa J Vargas-Garcia
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention 2, Zizhulin, Nanjing 210003, China
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A qualitative study exploring pupil and school staff perceptions of school meal provision in England. Br J Nutr 2015; 114:1504-14. [DOI: 10.1017/s0007114515002834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractDespite recent attempts to improve the quality of school meals in England through the introduction of school meal standards, uptake remains low. Since the introduction of the universal infant free school meal (UIFSM) scheme in September 2014 all pupils in Reception, Year 1 and Year 2 in English state-funded primary schools are eligible to receive a free lunch. This study aimed to explore the perceptions of pupils, catering managers and head teachers concerning school meal provision in eight primary schools in North England and provides a unique insight into each school’s preparation for implementation of UIFSM. A total of thirty-two focus groups were conducted with sixty-four pupils aged 7–8 years (Year 3) and sixty-four pupils aged 9–10 years (Year 5) in June–July 2014, to explore perceptions of school meals. Interviews were carried out with six catering managers and five head teachers concerning catering and the impending implementation of UIFSM. Increasing acceptance of school meals could lead to improved uptake. Pupils desired increased choice and menu variety, including greater variety of vegetables and fruit. Caterers can influence the quantity and types of foods offered to pupils, and there are opportunities for them to promote healthy eating behaviours in the dining room. The important roles of school meal providers, caterers, pupils and parents need to be recognised to improve delivery and acceptability of school meals and ultimately school meal uptake. There were practical challenges to implementation of UIFSM, with some concerns expressed over its feasibility. Head teachers were mainly positive about the potential beneficial impacts of the scheme.
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Abstract
AbstractObjectiveNutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type.DesignA cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches.SettingFifty-four primary schools across England.SubjectsChildren (n 2709) aged 6–8 years.ResultsChildren having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day.ConclusionsCompared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake.
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Spence S, Delve J, Stamp E, Matthews JNS, White M, Adamson AJ. Did school food and nutrient-based standards in England impact on 11-12Y olds nutrient intake at lunchtime and in total diet? Repeat cross-sectional study. PLoS One 2014; 9:e112648. [PMID: 25409298 PMCID: PMC4237353 DOI: 10.1371/journal.pone.0112648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/10/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction In September 2009, middle and secondary schools in England were required to comply with food and nutrient-based standards for school food. We examined the impact of this policy change on children’s lunchtime and total dietary intake. Methods We undertook repeat cross-sectional surveys in six Northumberland middle schools in 1999–2000 and 2009–10. Dietary data were collected from 11–12 y olds (n = 298 in 1999–2000; n = 215 in 2009–10). Children completed two consecutive 3-day food diaries, each followed by an interview. Linear mixed effect models examined the effect of year, lunch type and level of socio-economic deprivation on children’s mean total dietary intake. Results We found both before and after the introduction of the food and nutrient-based standards children consuming a school lunch, had a lower per cent energy from saturated fat (−0.5%; p = 0.02), and a lower intake of sodium (−143 mg; p = 0.02), and calcium (−81 mg; p = 0.001) in their total diet, compared with children consuming a home-packed lunch. We found no evidence that lunch type was associated with mean energy, or absolute amounts of NSP, vitamin C and iron intake. There was marginal evidence of an association between lunch type and per cent energy NMES (p = 0.06). In 1999–2000, children consuming a school lunch had a higher per cent energy from fat in their total diet compared with children consuming a home-packed lunch (2.8%), whereas by 2009–10, they had slightly less (−0.2%) (year by lunch type interaction p<0.001; change in mean differences −3%). Conclusions We found limited evidence of an impact of the school food and nutrient-based standards on total diet among 11–12 year olds. Such policies may need to be supported by additional measures, including guidance on individual food choice, and the development of wider supportive environments in school and beyond the school gates.
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Affiliation(s)
- Suzanne Spence
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, England
| | - Jennifer Delve
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, England
| | - Elaine Stamp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, England
| | - John N. S. Matthews
- School of Mathematics and Statistics, Newcastle University, Newcastle upon Tyne, England
| | - Martin White
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, England
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, England
| | - Ashley J. Adamson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, England
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, England
- * E-mail:
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What's in children's backpacks: foods brought from home. J Acad Nutr Diet 2014; 114:1424-31. [PMID: 25037557 DOI: 10.1016/j.jand.2014.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 05/09/2014] [Indexed: 11/21/2022]
Abstract
Forty-one percent of elementary schoolchildren bring lunch to school on any given day. Forty-five percent bring snacks. Surprisingly, little is known about the foods and beverages they bring. This cross-sectional analysis of baseline data from the GREEN (Growing Right: Eco-friendly Eating and Nutrition) Project Lunch Box Study sought to characterize foods and beverages brought from home to school by elementary schoolchildren and compare the quality of packed lunches with National School Lunch Program standards and packed snacks with Child and Adult Care Food Program requirements. Lunches and snacks from 626 elementary schoolchildren were assessed and evaluated using digital photography and a supplemental food checklist. Food and beverage types most likely to be provided for lunch were sandwiches (59%), snack foods (42%), fruit (34%), desserts (28%), water (28%), and sugar-sweetened beverages (24%). Twenty-seven percent of lunches met at least three of five National School Lunch Program standards. At snack, snack foods (62%), desserts (35%), and sugar-sweetened beverages (35%) were more common than fruits (30%), dairy foods (10%), and vegetables (3%). Only 4% of snacks met two of four Child and Adult Care Food Program standards. Future research is needed to understand the multiple determinants of food-packing behavior, including constraints faced by families. School wellness policies should consider initiatives that work collaboratively with parents to improve the quality of foods brought from home.
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Caparosa SL, Shordon M, Santos AT, Pomichowski ME, Dzewaltowski DA, Coleman KJ. Fundraising, celebrations and classroom rewards are substantial sources of unhealthy foods and beverages on public school campuses. Public Health Nutr 2014; 17:1205-13. [PMID: 23764087 PMCID: PMC10282267 DOI: 10.1017/s1368980013001493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses. DESIGN A cross-sectional observational study was conducted using a specially designed objective nutrition observation system. SETTING One low-income school district in southern California with six elementary and two middle schools. SUBJECTS Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings. RESULTS Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test-retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week. CONCLUSIONS There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention.
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Affiliation(s)
- Susan L Caparosa
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
| | - Maggie Shordon
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
| | - Asherlev T Santos
- Graduate School of Public Health Joint Doctoral Program, San Diego State University and University of California at San Diego, San Diego, CA, USA
| | - Magdalena E Pomichowski
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
| | | | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101, USA
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Walton J, Hannon EM, Flynn A. Nutritional quality of the school-day diet in Irish children (5-12 years). J Hum Nutr Diet 2014; 28 Suppl 1:73-82. [PMID: 24479448 DOI: 10.1111/jhn.12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The European Commission has identified schools as a priority setting for health promotion, including nutrition education and intervention. The present study examined the school-day diet of Irish primary-school children with the aim of identifying opportunities for dietary improvement. METHODS Data from The National Children's Food Survey (2003-2004) were used to establish a dataset of school-days. Dietary intake data were collected from 594 children (5-12 years) using a 7-day weighed food-record. The nutritional quality of the diet was examined for the total school-day and for food eaten 'before school', 'at school' and 'after school'. RESULTS Examination of dietary intake on school-days has highlighted nutritional imbalances for intakes of fat, saturated fat, added sugars, sodium and dietary fibre (DF). Mean energy (E) intake for the overall school-day was 7.1 MJ, with 16% of energy provided from food eaten 'before school', 33%E from food eaten 'at school' and 53% of energy from food eaten 'after school'. Relative to the overall school-day, food eaten 'before school' was lower in saturated fat and sodium, and higher in DF and many micronutrients. Food eaten 'at school' was relatively high in added sugars and sodium; lower in DF and micronutrients; and similar in saturated fat compared to the overall school-day. Food eaten 'after school' was relatively high in DF and vitamin A; similar in saturated fat, magnesium and sodium; and lower in added sugars and other micronutrients compared to the overall school-day. CONCLUSIONS To improve the overall nutritional quality of the school-day diet, food eaten at school should be targeted.
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Affiliation(s)
- J Walton
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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He C, Mikkelsen BE. The association between organic school food policy and school food environment: results from an observational study in Danish schools. Perspect Public Health 2014; 134:110-6. [PMID: 24458368 DOI: 10.1177/1757913913517976] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments. METHODS The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The 'organic' schools were compared to 'non-organic' schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools. RESULTS Data indicates that 20 'organic' schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school (p = .032), recommending children to eat healthily (p = .004). CONCLUSIONS The study suggests that organic food policies in schools may have potential to support a healthier school food environment.
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Affiliation(s)
- Chen He
- Research group for Meal Science & Public Health Nutrition, Department of Development and Planning, Aalborg University Copenhagen. A.C. Meyers Vænge 15, 2450 Copenhagen, Denmark
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Fung C, McIsaac JLD, Kuhle S, Kirk SF, Veugelers PJ. The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children. Prev Med 2013; 57:934-40. [PMID: 23891787 PMCID: PMC3842499 DOI: 10.1016/j.ypmed.2013.07.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 06/07/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study is to assess population-level trends in children's dietary intake and weight status before and after the implementation of a provincial school nutrition policy in the province of Nova Scotia, Canada. METHOD Self-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population-level study with grade 5 students in 2003 (n=5215) and 2011 (5508), prior to and following implementation of the policy. We applied random effects regression methods to assess the effect of the policy on dietary and health outcomes. RESULTS In 2011, students reported consuming more milk products, while there was no difference in mean consumption of vegetables and fruits in adjusted models. Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption. Despite significant temporal decreases in dietary energy intake and increases in diet quality, prevalence rates of overweight and obesity continued to increase. CONCLUSION This population-level intervention research suggests a positive influence of school nutrition policies on diet quality, energy intake and healthy beverage consumption, and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity.
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Affiliation(s)
- Christina Fung
- University of Alberta, School of Public Health, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta T6G 2T4, Canada
| | - Jessie-Lee D. McIsaac
- University of Alberta, School of Public Health, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta T6G 2T4, Canada
- Dalhousie University, School of Health and Human Performance, 1318 Robie Street, PO BOX 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Stefan Kuhle
- IWK Health Centre, Perinatal Epidemiology Research Unit, Halifax, Nova Scotia, Canada
| | - Sara F.L. Kirk
- Dalhousie University, School of Health and Human Performance, 1318 Robie Street, PO BOX 15000, Halifax, Nova Scotia B3H 4R2, Canada
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK
| | - Paul J. Veugelers
- University of Alberta, School of Public Health, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta T6G 2T4, Canada
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Müller K, Libuda L, Diethelm K, Huybrechts I, Moreno LA, Manios Y, Mistura L, Dallongeville J, Kafatos A, González-Gross M, Cuenca-García M, Sjöström M, Hallström L, Widhalm K, Kersting M. Lunch at school, at home or elsewhere. Where do adolescents usually get it and what do they eat? Results of the HELENA Study. Appetite 2013; 71:332-9. [PMID: 24055659 DOI: 10.1016/j.appet.2013.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 11/27/2022]
Abstract
Considering the lack of uniformity regarding school meals in Europe, information on adolescents' school lunch patterns is of public health importance. Thus, the aim of this analysis was to describe and evaluate lunchtime energy and food intake of European adolescents at different lunch locations. Data on nutritional and health-related parameters were derived from the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). A sub-sample of 891 adolescents (47% male) with plausible data on total and lunchtime energy intake (2 × 24 h recall) as well as usual lunch location was considered. Food intake was compared to lunch of the Optimized Mixed Diet (OMD) for children and adolescents. Although energy intake was nearly in line with the recommendations, food intake was suboptimal compared to the OMD regardless of usual lunch location. Adolescents had more potatoes and less sweets at school, and more drinks (water, coffee and tea) and vegetables at home when each compared with the other locations. Food intake of adolescents getting their lunch elsewhere was characterized by the smallest amounts of potatoes and the highest amounts of sweets. Although lunch patterns may differ among countries, schools in Europe do not seem to reveal all their potential to offer access to a healthy lunch for adolescents yet.
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Affiliation(s)
- Katrin Müller
- Research Institute of Child Nutrition (FKE), Dortmund, Germany; University of Applied Sciences (DHfPG), Institute for Prevention and Public Health, Hermann Neuberger Sportschule 3, D-66123 Saarbrücken, Germany(2).
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School lunches v. packed lunches: a comparison of secondary schools in England following the introduction of compulsory school food standards. Public Health Nutr 2013; 16:1037-42. [PMID: 23578700 DOI: 10.1017/s1368980013000852] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare food choices and nutrient intakes of pupils taking a school lunch or a packed lunch in eighty secondary schools in England, following the introduction of the food-based and nutrient-based standards for school food. DESIGN Cross-sectional data collected between October 2010 and April 2011. Pupils' lunchtime food choices were recorded over five consecutive days. SETTING Secondary schools, England. SUBJECTS A random selection of 5925 pupils having school lunches and 1805 pupils having a packed lunch in a nationally representative sample of eighty secondary schools in England. RESULTS The differences in the specific types of food and drink consumed by the two groups of pupils are typical of differences between a hot and cold meal. On average, school lunches as eaten contained significantly more energy, carbohydrate, protein, fibre, vitamin A, folate, Fe and Zn than packed lunches, and 8 % less Na. CONCLUSIONS Although neither school lunches nor packed lunches provided the balance of nutrients required to meet the nutrient-based standards (based on about one-third of daily energy and nutrient requirements), school lunches generally had a healthier nutrient profile, with lower Na and percentage of energy from fat, and higher fibre and micronutrient content. These differences were greater than those reported prior to the introduction of compulsory standards for school lunches. In order to ensure more pupils have a healthy lunch, schools could introduce and enforce a packed lunch policy or make school meals the only option at lunchtime.
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A cluster-randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato. Public Health Nutr 2012; 16:1073-81. [PMID: 23237386 DOI: 10.1017/s1368980012005290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to determine whether a multi-component school-based intervention can maintain children's fruit and vegetable intake post eligibility for free school fruit and vegetables. DESIGN A random sample of fifty-four English primary schools was randomised to receive the 10-month intervention Project Tomato, a multi-component theory-based intervention, or the control. Each group consisted of twenty-seven schools. SETTING Children's intake of fruit and vegetables is below recommendations. The English School Fruit and Vegetable Scheme has a short-term impact on intake while children are eligible for the scheme. SUBJECTS Dietary measurements were collected from 658 Year 2 pupils aged 7-8 years at baseline and at follow-up 20 months later. RESULTS Following an intention to treat analysis, the intervention as delivered compared with the control had no impact on the intake of fruit and vegetables (2 g/d, 95 % CI -23, 26 g/d) or on the number of portions of fruit (0.0 portions, 95 % CI - 0.3, 0.3) or vegetables (0.0 portions, 95 % CI - 0.2, 0.3) consumed daily by children. Intake of fruit and vegetables at school and home dropped by ≈ 100 g/d and 50 g/d, respectively, between baseline and follow-up in both the intervention and control groups. CONCLUSIONS Implementation of the intervention was low, with associated lack of impact on fruit and vegetable consumption in children. Alternatives to the delivery of an intervention by teachers and parents are needed to improve the dietary intake of primary-school children.
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Taylor JP, Hernandez KJ, Caiger JM, Giberson D, MacLellan D, Sweeney-Nixon M, Veugelers P. Nutritional quality of children's school lunches: differences according to food source. Public Health Nutr 2012; 15:2259-64. [PMID: 22463765 PMCID: PMC10271288 DOI: 10.1017/s1368980012000699] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 01/23/2012] [Accepted: 02/01/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school). DESIGN Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed. SETTING Elementary schools in Prince Edward Island, Canada. SUBJECTS Grade 5 and 6 students (n 1980). RESULTS Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school. CONCLUSIONS The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.
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Affiliation(s)
- Jennifer P Taylor
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE, Canada.
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Abstract
OBJECTIVE To estimate the costs per relevant unit (pupils and meals) associated with improvements to school food and the potential economic and health gains that may result. DESIGN Calculation of costs per relevant unit (pupils and meals) based on (i) Department for Education expenditure to support improvements in school food, 2005–2011 and (ii) measures of the changes in the number of pupils taking school lunch and the number of meals served over the same time period; plus examples of the use of linked data to predict longer-term economic and health outcomes of healthier eating at school. SETTING England. SUBJECTS Local authorities, government departments and non-departmental public bodies. RESULTS Analysis of investment over a 6-year period indicates that costs of setting up and maintaining a change organization such as the School Food Trust were low in relation to short-term benefits in nutrition and behaviour. Models that predict long-terms gains to the exchequer and to quality-adjusted life years need further elaboration. CONCLUSIONS Modest levels of government investment in the delivery and promotion of healthier school food is likely to yield both short-term and long-term benefits in relation to nutrition, learning, economics and health.
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Lunchtime food and nutrient intakes of secondary-school pupils; a comparison of school lunches and packed lunches following the introduction of mandatory food-based standards for school lunch. Public Health Nutr 2012; 16:1126-31. [DOI: 10.1017/s1368980012003928] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo compare the key differences between school lunches and packed lunches as eaten in eleven secondary schools in England, 21 months after the food-based standards for school lunch became mandatory, but before the introduction of nutrient-based standards.DesignData on 358 school lunches and 139 packed lunches were collected in May and June 2008 from pupils attending secondary schools in Sheffield, Manchester, Leicester City and Essex. Fieldwork was conducted over five consecutive school days at each school. Fieldworkers randomly selected five pupils taking a school lunch and five pupils bringing a packed lunch each day. All food and drink items chosen by pupils were weighed and recorded. Leftovers were also weighed.SettingEleven state-maintained, co-educational secondary schools from four local authorities in England.SubjectsFour hundred and ninety-seven pupils aged 11–16 years.ResultsPupils taking school lunches, on average, had significantly higher intakes of energy, protein, carbohydrate, NSP, vitamin C, folate, Fe and Zn than pupils bringing a packed lunch to school. Mean intakes of protein, fat and vitamin C from both types of lunch met the nutrient-based standards and school lunches also met standards for carbohydrate, NSP and energy.ConclusionsNutrient intakes from school lunches were more favourable than those from packed lunches, but typically failed to meet nutrient-based standards for school food. A combination of continued improvements to school food, educating pupils to make healthier choices and policies to encourage pupils to eat at school or bring healthier packed lunches is needed.
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Hur I, Burgess-Champoux T, Reicks M. Higher Quality Intake From School Lunch Meals Compared With Bagged Lunches. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1941406411399124] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies show that nutritional quality of lunches brought from home is poor when compared with school lunches. Most of these studies were conducted in the United Kingdom, while studies of this type are limited in the United States. Therefore, this study compared lunch food, nutrient, and energy intake by lunch type (school lunch vs bagged lunch) in 2 schools in a Midwest metropolitan area of the United States. Food intake data were collected from 129 children with meal observation procedures. Energy, food, and nutrient intakes were estimated using Nutrition Data System for Research software and compared with t tests by lunch type. Children eating school lunches had higher intakes of protein; vitamins A, D, and K; and calcium and lower intakes of energy, fat, carbohydrate, vitamin E, and sugar compared with children eating bagged lunches. The ratios of mean protein and calcium consumption to minimum required values tended to be greater for children eating school lunches compared with those eating bag lunches. Children eating bag lunches had lower vegetable intake and higher whole grain and fruit intakes and higher meal energy density compared with children eating school lunch. Findings support parent nutrition education to improve the nutritional quality of bagged lunches.
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Affiliation(s)
- Inyoung Hur
- Korea Centers for Disease Control & Prevention, Chungcheongbuk-do, South Korea
| | - Teri Burgess-Champoux
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota,
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