School meals in French secondary state schools: Do national recommendations lead to healthier nutrition on offer?

Robust implementation of school food policy is needed to improve nutritional outcomes of children in European and Western Pacific countries: A systematic review

OBJECTIVE

The present systematic review explored compliance status with school food policies in Europe and the Western Pacific regions, challenges and facilitators of policy compliance, and its impact on children's diets and nutrient intakes.

RESEARCH METHODS

An electronic search for full-text research articles published between January 2009 and July 2023 was conducted in Science Direct and PubMed scientific databases.

RESULTS

A total of 659 titles and abstracts were screened, and final data was extracted from 34 included studies. Results showed low compliance with the school food policy in Europe and the Western Pacific regions. The European schools chad better compliance than the Western Pacific, and supportive interventions improved policy adherence. Impact assessment studies reported that the implementation of the school food policy increased fruit and vegetable consumption, thus increasing nutrient intakes (vitamin A, vitamin D, iron, calcium, folate, and dietary fibers). However, its impact on the availability and consumption of foods high in fat, sugar, and salt (HFSS) was less conclusive. The effects of the policy on the school food environment indicated no significant improvement.

CONCLUSION

Results highlighted the need for additional support and surveillance at the school level to ensure adequate policy compliance.

Sugar-sweetened beverages intake and the risk of obesity in children: An updated systematic review and dose-response meta-analysis

BACKGROUND

The prevalence of childhood obesity has increased worldwide and has reached alarming proportions. Contradictive results from studies and reviews have fuelled an endless debate on the role of SSBs in the development of childhood obesity.

OBJECTIVE

This study aimed to assess the impact of sugar-sweetened beverages (SSBs) intake on body mass index (BMI), body fat percentage (BFP), and waist circumference (WC) among children.

METHODS

Databases including PubMed/MEDLINE, Scopus, Cochrane Library, EMBASE, and Web of Science were searched up to August 2021. Observational studies reporting the relation between SSBs intake and BMI, BFP, and WC were included. STATA version 15 was used to analyse the data.

RESULTS

In this meta-analysis, 33 studies with 121 282 subjects were included. Excessive SSBs intake was associated with 0.75 kg/m² increase in BMI in children and adolescents (WMD: 0.75; CI 0.35-1.15; p < 0.001). In addition, high SSBs intake was significantly associated with higher WC (WMD: 2.35 cm; 95% CI, 1.34, 3.37; p = 0.016) and BFP (WMD: 2.81; CI 2.21-3.41; p < 0.001). No departure from linearity was detected in dose-response meta-analysis between SSBs consumption and changes in BMI, WC, and BFP.

CONCLUSION

High SSBs consumption was associated with increased BMI, WC, and BFP among children and adolescents. Further large prospective long-term interventions are recommended to confirm the observed relationships.

Energy and Nutritional Composition of School Lunches in Slovenia: The Results of a Chemical Analysis in the Framework of the National School Meals Survey

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.

Ultra-processed food consumption by Brazilian adolescents in cafeterias and school meals

This cross-sectional study utilized the National School Health Survey 2015 database to assess the association between school cafeterias; the meals offered by the Brazilian School Food Program (PNAE); and the consumption of industrialized/ultra-processed salty foods, sweets, and soft drinks among Brazilian adolescents. A sample of 102,072 adolescents, aged 11-19 years, who were enrolled in the 9th grade completed the survey. The evaluated outcome was the consumption of industrialized/ultra-processed salty foods, sweets, and soft drinks. A Poisson regression model-based multivariate analysis was performed. The effect measure was the prevalence ratio (PR) with its respective 95% confidence intervals (CIs). The results indicated that Brazilian adolescents who attended schools without meals offered through the PNAE had a higher probability of regularly (≥5 times/week) consuming ultra-processed salty foods [PR = 1.06, CI = 1.01-1.11] and soft drinks [PR = 1.08, CI = 1.03-1.14] compared to those who attended schools that offered PNAE meals. Moreover, the presence of a school cafeteria was associated with a higher probability to consume industrialized/ultra-processed salty foods [PR = 1.05, CI = 1.02-1.08], sweets [PR = 1.09, CI = 1.07-1.11], and soft drinks [PR = 1.10, CI = 1.07-1.13]. School meals appear to be associated with the consumption of ultra-processed foods by Brazilian adolescents, indicating areas for health promotion programs.

School-level changes in factors related to oral health inequalities after national recommendation on sweet selling

Aims: In 2007, Finnish authorities gave a national recommendation that schools should not sell sweet products. This study aimed to determine the effects of the national recommendation on school-level intermediary determinants (factors related to oral health inequalities) and if the changes were different according to school-level socio-economic position (SEP). Methods: This ecological and longitudinal study combined school-level data from two independent studies from Finnish upper comprehensive schools (N = 970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). The baseline data (SHPS from 2006-2007 and SSSS from 2007) and the post-intervention data (SHPS and SSSS from 2008-2009) were combined into a longitudinal school-level data set (n = 360 and response rate = 37%). The intermediary determinants were: attitudes and access to intoxicants, school health services, school environment, home environment, schools' health-promoting actions (including sweet product selling) and pupils' eating habits. Three equal-sized school-level SEP group - slow, middle and high - were formed. The changes in the intermediary determinants were analysed using Wilcoxon Signed Ranks test. Differences between school SEP groups were analysed the using Kruskal-Wallis test. Longitudinal linear mixed modelling was used to determine the contribution of intermediary determinants to the changes in pupils' eating habits. Results: The national recommendation was effective in decreasing sweet product selling at schools and the effect was equal in each school-level SEP group. Intermediary determinants contributed differently to eating habits in the three SEP groups. Conclusions: A national recommendation seems to be an effective tool in making the school environment healthier without increasing inequalities.

Nutritional Quality of School Meals in France: Impact of Guidelines and the Role of Protein Dishes

In France, school meals must comply with 15 frequency criteria (FC) expressed as nutritional requirements (e.g., “starters containing more than 15% fat served no more than four times out of 20”) in a series of 20 consecutive meals. The objective was to assess, for the first time, the nutritional impact of complying with French school food FC. Based on 40 series of meals actually served in primary schools (“observed series”), several scenarios (1600 series per scenario) of compliance or non-compliance with FC were simulated, and nutritional quality was assessed via the mean adequacy ratio (MAR/2000 kcal). In the observed series, only 9.7 FC on average (range 4–14) were fulfilled. In the simulated series: (i) MAR was positively associated with FC compliance level, with the highest MAR obtained with complete compliance; (ii) MAR decreased when meat or fish-based dishes were replaced by dishes without meat or fish; and (iii) removing the protein dish without replacement led to the lowest MAR. This study demonstrates that French school food guidelines ensure good nutritional quality of food services. It also shows that generalizing the service of meals without meat or fish would deteriorate overall nutritional quality, highlighting the need to define the composition of vegetarian dishes and their frequency of service to children.

Breaking Habits: The Effect of the French Vending Machine Ban on School Snacking and Sugar Intakes

This paper estimates the effect of the 2005 vending machine ban in French secondary schools on nutrient intakes and on the frequency of morning snacking at school. Using data before and after the ban, and exploiting the discontinuity associated with the age-dependent exposure to the ban, we specify a difference-in-differences regression discontinuity design. Since the relationship between age-at-interview and school level is not precise, we introduce fuzziness in the model. We find that the ban has generated a 10-gram reduction in sugar intakes from morning snacks at school, and a significant reduction in the frequency of these morning snacks. However, we find no evidence that the intervention affects total daily intakes, and our results are suggestive of compensation effects.

Healthy fats for healthy nutrition. An educational approach in the workplace to regulate food choices and improve prevention of non-communicable diseases

INTRODUCTION

An educational activity, aimed at highlighting the benefits of Mediterranean Diet, compared to less healthy eating patterns, can encourage the adoption and maintenance of a mindful approach to food choice. This is especially important when a progressive shift towards a non-Mediterranean dietary pattern can be observed, even in Mediterranean countries.

AIM

To test a protocol aimed at increasing knowledge and motivation to embrace healthy eating habits and, engendering conscientious food choices, improve the prevention of non-communicable diseases.

METHODS

Employees were involved in educational activities focusing on a healthy Mediterranean diet and on the role played by extra-virgin olive oil, one of its key components. Food questionnaires were completed both before and after the educational and information activities, in order to assess changes in personal knowledge of and attitudes towards fat consumption.

RESULTS

Answers on dietary guidelines and fat properties were more accurate after the seminars. The results showed increased understanding of the properties of extra-virgin olive oil versus seed oil and a stronger tendency towards healthy food choices.

CONCLUSIONS

Implementing preventive information and training strategies and tools in the workplace, can motivate a more mindful approach to food choice with the long-term goal of contribute to reducing non-communicable diseases.

Effect of national recommendation on sweet selling as an intervention for a healthier school environment

Aims: In 2007, the Finnish National Board of Education (FNBE) and the National Institute for Health and Welfare (THL) gave a national recommendation that Finnish upper comprehensive schools should not sell sweet products. The aim was to find out how the national recommendation changed the schools’ selling of sweet products. Methods: This longitudinal survey was conducted in Finnish upper comprehensive school classes 7–9 (13–15-year-old pupils) in 2007 and 2010. All the schools ( N=970) were invited to answer the questionnaire and 237 schools answered in both years (response rate 24%). The questionnaires contained questions concerning the selling of sweet and healthy products and school policy on sweet selling guidelines. Of the nine items in the questionnaire, three weighted sum scores were formed for oral health promotion: Exposure, enabling and policy (higher score indicating better actions). These sum scores were also trichotomized. Statistical significances of the changes were analyzed using nonparametric Wilcoxon’s test, McNemar’s test, and McNemar-Bowker’s test. Results: Schools had decreased exposure of pupils to sweet products ( p<0.001), more often provided oral health protecting items ( p=0.047) and had improved their oral health-promoting policy ( p<0.001). The selling of some sweet products, candies and soft drinks had decreased ( p<0.001) whereas the selling of other sweet products had not changed ( p=0.665). Schools tended to improve their exposure and policy status ( p<0.001). Conclusion: It is possible to improve school environments by means of a national recommendation. Other actions are needed both inside and outside schools in order to decrease the total consumption of sweet products among adolescents.

Food Policy Approaches to Obesity Prevention: An International Perspective

This paper provides a comprehensive overview of the recent obesity prevention-related food policies initiated in countries worldwide. We searched and reviewed relevant research papers and government documents, focusing on those related to dietary guidelines, food labeling, regulation of food marketing, and policies affecting food prices. We also commented on the effects and challenges of some of the related policy options. There are large variations regarding what, when, and how policies have been implemented across countries. Clearly, developed countries are leading the effort, and developing countries are starting to develop some related policies. The encouraging message is that many countries have been adopting policies that might help prevent obesity and that the support for more related initiatives is strong and continues to grow. Communicating information about these practices will help researchers, public health professionals, and policy makers around the world to take action to fight the growing epidemic of obesity and other nutrition-related diseases.

Dietary standards for school catering in France: serving moderate quantities to improve dietary quality without increasing the food-related cost of meals

OBJECTIVE

To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France.

DESIGN

A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals.

MAIN OUTCOME MEASURE

Food-related cost of meals.

ANALYSIS

Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively.

RESULTS

The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes.

CONCLUSIONS AND IMPLICATIONS

Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals.

Lunch at school, at home or elsewhere. Where do adolescents usually get it and what do they eat? Results of the HELENA Study

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.