The quality of school lunch consumed reflects overall eating patterns in 11-16-year-old schoolchildren in Finland

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006-2020 in Catalonia

BACKGROUND

The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME's recommendations in the meals provided by school cafeterias in Catalonia during the period 2006-2020.

METHODS

Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System's "Consensus document on nutrition in schools" and the Public Health Agency of Catalonia's current guide "Healthy eating at school". Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category.

RESULTS

Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p =  < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216).

CONCLUSIONS

The positive evolution in compliance with PReME's recommendations provides evidence of the programme's effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Implementation of food education in school environments improves pupils' eating patterns and social participation in school dining

OBJECTIVE

Schools can be an effective arena for food education. The Tasty School is a tailored teacher-driven food education model that provides tools for implementing food education in primary schools. This study aimed to investigate the effects of the Tasty School model on pupils' eating patterns and experiences. We also aimed to assess the implementation strength of the Tasty School.

DESIGN

A quasi-experimental study was conducted during one school year 2019-2020 in fifteen intervention and ten control schools. The intervention schools implemented the Tasty School food education model. The pupils completed web-based baseline and follow-up questionnaires in class during a school day. The principals were interviewed after the intervention. The data were analysed using a mixed-effects model for repeated measures, accounting for the implementation strength and selected standardisation effects.

SETTING

A total of twenty-five general Finnish primary schools.

PARTICIPANTS

1480 pupils from grades 3-6 (age 8-12 years) from five municipalities in Finland.

RESULTS

Percentages of pupils eating a balanced school meal increased in schools where food education was actively implemented (P = 0·027). In addition, pupils' experience of social participation in school dining strengthened in schools where the Tasty School model was implemented (5-point scale mean from 2·41 to 2·61; P = 0·017).

CONCLUSIONS

Healthy eating patterns can be promoted by the active implementation of food education in primary schools. The Tasty School model offers a promising tool for developing healthy eating patterns and increasing social participation among pupils not only in Finland, but also potentially in other countries as well.

Free school meals as an opportunity to target social equality, healthy eating, and school functioning: experiences from students and teachers in Norway

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.

The importance of school lunches to the overall dietary intake of children in Sweden: a nationally representative study

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.

Free school meals as an approach to reduce health inequalities among 10-12- year-old Norwegian children

Background

Children spend a considerable amount of time at school and consume at least one meal/day. This study aimed to investigate if a free, healthy school meal every day for one school year was associated with children’s intake of healthy foods at school, weight status and moderating effects of socio-economic status.

Methods

A non-randomized study design with an intervention and a control group was used to measure change in children’s dietary habits at lunchtime. In total, 164 children participated; 55 in the intervention group and 109 in the control group (baseline). Intervention-children were served a free, healthy school meal every school day for one year. Participating children completed a food frequency questionnaire at baseline, at five months follow-up and after one year. Children’s anthropometrics were measured at all three timepoints. Intervention effects on children’s Healthy food score, BMI z-scores, and waist circumference were examined by conducting a Repeated Measures Multivariate ANOVA. Moderating effects of children’s gender and parental socio-economic status were investigated for each outcome.

Results

A significant intervention effect on children’s outcomes (multivariate) between baseline and after one year (F = 2.409, p < 0.001), and between follow-up 1 at five months and after one year (F = 8.209, p < 0.001) compared to the control group was found. The Univariate analyses showed a greater increase in the Healthy food score of the intervention group between baseline and follow-up 1 (F = 4.184, p = 0.043) and follow-up 2 (F = 10.941, p = 0.001) compared to the control group. The intervention-children had a significant increase in BMI z-scores between baseline and follow-up 2 (F = 10.007, p = 0,002) and between follow-up 1 and 2 (F = 22.245, p < 0.001) compared to a decrease in the control-children. The intervention-children with lower socio-economic status had a significantly higher increase in Healthy food score between baseline and follow-up 2 than the control-children with lower socio-economic status (difference of 2.8 versus 0.94), but not among children with higher socio-economic status.

Conclusions

Serving a free school meal for one year increased children’s intake of healthy foods, especially among children with lower socio-economic status. This study may contribute to promoting healthy eating and suggests a way forward to reduce health inequalities among school children.

Trial registration

ISRCTN61703361. Date of registration: December 3rd, 2018. Retrospectively registered.

Possible effects of a free, healthy school meal on overall meal frequency among 10-12-year-olds in Norway: the School Meal Project

Objective

To evaluate possible effects of intake of a free, healthy school meal on overall meal frequency among 10–12-year-olds in Norway. This was evaluated using a quasi-experimental school-based intervention study assessing children’s meal frequency retrospectively using a questionnaire in two elementary schools in the southern part of Norway in 2014/15. Multiple logistic regression analyses with breakfast, lunch, dinner, supper as dependent variables were used.

Results

A total of 164 children at baseline; 55 children in the intervention group and 109 children in the control group were included. The serving of a free school meal every day for 1 year did not improve the overall meal frequency in the intervention group compared to the control group. However, children in the intervention group had a lower odds of eating breakfast during weekends compared to the control group in crude analyses [odds ratio (OR) = 0.28 (95% confidence interval (CI) 0.09–0.84)] and in adjusted analyses [adjusted for baseline values, gender and socio-economic status) (OR = 0.15 (95% CI 0.03–0.72)]. Studies including larger study samples and therefore more statistical power are needed to further investigate possible effects of school meals on meal frequency.

Trial registration ISRCTN61703361, Date of registration: December 3rd, 2018, Retrospectively registered

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

OBJECTIVE

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

DESIGN

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

SETTING

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

RESULTS

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

CONCLUSIONS

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

Identifying eating habits in Finnish children: a cross-sectional study

Background

We aimed to identify different eating habits among Finnish children and to evaluate their association with meal patterns, breakfast consumption, and socio-demographic characteristics in a large, nationwide cohort of children.

Methods

We evaluated 10,569 children aged 9–14 years into the Finnish Health in Teens cohort in a cross-sectional design. The hierarchical K-means method was used to identify groups of children with different eating habits, based on five factors obtained through factor analysis of 10 food items. Multiple correspondence analysis was used to show associations between groups with different eating habits and meal patterns, breakfast patterns, gender, age, and language spoken at home.

Results

Analyses identified three groups: unhealthy eaters (12.3%), fruit and vegetable avoiders (43.3%), and healthy eaters (44.1%). Most children had regular meal and breakfast patterns. The proportion of boys was higher among unhealthy eaters. Unhealthy eaters also showed irregular meal and breakfast patterns, and had parents with low education level. There was a higher proportion of girls among healthy eaters. Healthy eaters also showed regular meal and breakfast patterns, and had parents with high education level.

Conclusions

Although the number of unhealthy eaters was small, special attention should be still paid to these, mostly male children, as they have poor eating habits and they lack regular eating routine. Skipping breakfast was more common among older children and girls, although girls had healthier eating habits overall. Our results can contribute to public health efforts to improve eating behaviours, especially among children with poor eating habits and those skipping healthy food items.

Comparison of school day eating behaviours of 8-11 year old children from Adelaide, South Australia, and London, England: Child eating behaviours in South Australia and England

Objective

School food intake makes a considerable contribution to children's overall diet, especially fruit and vegetable intake. Comparing differing school food provision systems can provide novel insights for intervention and improved nutrition policy. This study compared school day food in children from Australia and England.

Design

Children completed food frequency questionnaires reporting school day food intake, breakfast intake and family evening meals. Differences in food consumed over the school day between Australian and English children were evaluated. Multinomial logistic regressions compared fruit and vegetable intake, family dinner frequency and breakfast in Australian and English children adjusting for confounders: age, sex, ethnicity and parent education.

Setting

27 Primary schools in Adelaide, Australia and 32 in London, England.

Subjects

N = 772 children aged 8–11 years from the Australian REACH study (n = 347) and UK RHS School Gardening Trial in England (n = 425).

Results

Considerably more English children reported consuming vegetables at school than Australian children (recess/lunchtime Australian children 3.4%/6.1%; English children recess/lunctime 3.6/51.1%). However, Australian children were more likely to consume vegetables daily (OR = 4.1; 1.3, 12.5), and have family evening meals everyday [OR = 4.01; 1.88, 8.55], and were less likely to consume breakfast (OR = 0.26; 0.08, 0.79) than English children.

Conclusions

Findings indicate that provision of a school lunch meal, compared to a packed lunch from home, may be more supportive of children's vegetable intake. However, without a supportive home environment that encourages vegetable intake, children will not be able to consume sufficient amounts of vegetables.

Theory-informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross-sectional study

BACKGROUND

The eating patterns of school-aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar-sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

METHODS

The curriculum was developed in collaboration with school teachers using self-determination theory as a theoretical standpoint. The Health at Every Size concept and sensory-based food education were utilised in the curriculum. Self-reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012-2013 with 194 pupils aged 10-13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

RESULTS

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar-sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

CONCLUSIONS

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia

School meals make significant contributions to healthy dietary behaviour, at a time when eating habits and food preferences are being formed. We provide an overview of the approaches to the provision, regulation, and improvement of preschool and primary school meals in the UK, Sweden, and Australia, three countries which vary in their degree of centralisation and regulation of school meals. Sweden has a centralised approach; all children receive free meals, and a pedagogical approach to meals is encouraged. Legislation demands that meals are nutritious. The UK system is varied and decentralised. Meals in most primary schools are regulated by food-based standards, but preschool-specific meal standards only exist in Scotland. The UK uses food groups (starchy foods, fruit and vegetables, proteins and dairy) in a healthy plate approach. Australian States and Territories all employ guidelines for school canteen food, predominantly using a "traffic light" approach outlining recommended and discouraged foods; however, most children bring food from home and are not covered by this guidance. The preschool standards state that food provided should be nutritious. We find that action is often lacking in the preschool years, and suggest that consistent policies, strong incentives for compliance, systematic monitoring, and an acknowledgement of the broader school eating environment (including home provided food) would be beneficial.

Intervention study on school meal habits in Norwegian 10-12-year-old children

AIM

The aim of this study was to investigate whether a free school meal every day was associated with children's intake of healthy food during school.

METHODS

A non-randomized study design with an intervention and a control group was used to measure change in children's meal habits at lunchtime. In total, 164 children participated; 55 in the intervention group and 109 in the control group. Children in the intervention group were served a free, healthy school meal every school day. Participating children completed a questionnaire at baseline and at 6 months' follow up. Possible associations were evaluated with a healthy food score, which was calculated based on a food frequency questionnaire on lunch habits at school. Chi-square and Independent Samples t-test were used to analyse the data.

RESULTS

At baseline, there was no significant difference in the healthy food score between the intervention and the control group ( p = 0.08). Children in the intervention group increased their healthy food score significantly compared with children in the control group after 6 months ( p ⩽ 0.01). Change in the healthy food score was mainly due to an increase in the intake of fruit ( p ⩽ 0.01), vegetables ( p ⩽ 0.01) and fish spread ( p = 0.02); all in favour of the intervention group.

CONCLUSIONS

A serving of a free school meal every day for 6 months increased children's intake of healthy food at lunchtime compared with the control group. Further studies are needed to establish possible long-term effects.

Nordic children’s conceptualizations of healthy eating in relation to school lunch

Purpose

Pupils’ perspective should be better taken into account when developing nutrition education at school. The purpose of this paper is to explore Nordic children’s perspectives on the healthiness of meals in the context of school lunches.

Design/methodology/approach

In total, 78 focus group discussions were conducted with 10-11-year-old girls and boys (n=457) from schools in Finland, Iceland, Norway and Sweden, which were participating in the Nordic school meal project ProMeal during the school year 2013-2014. A flexible discussion guide and stimulus material in the form of 14 photographs displaying different school lunch contexts were used. The discussions were analyzed using thematic analysis.

Findings

These Nordic children seem to share the adult-set aim of healthy eating in the school context as a socio-cultural norm. Although healthy eating was constructed as a rational, normative and acceptable way to eat at school, unhealthy eating was emphasized as negotiably acceptable when eaten occasionally and under certain circumstances (e.g. at special occasions). Unhealthy eating also comprised emotionally laden descriptions such as enjoyment and disgust.

Practical implications

Children’s conceptualizations of healthy eating are connected to nutritional, socio-cultural, emotional and normative dimensions, which should be reflected also when developing nutrition education in school.

Originality/value

The need for research exploring children’s experiences of, and understandings about, school lunch motivated this unique multicenter study with a large number of participating children. In the focus groups a child-oriented, photo-elicitation method was used.

Is questionnaire-based sitting time inaccurate and can it be improved? A cross-sectional investigation using accelerometer-based sitting time

OBJECTIVES

To investigate the differences between a questionnaire-based and accelerometer-based sitting time, and develop a model for improving the accuracy of questionnaire-based sitting time for predicting accelerometer-based sitting time.

METHODS

183 workers in a cross-sectional study reported sitting time per day using a single question during the measurement period, and wore 2 Actigraph GT3X+ accelerometers on the thigh and trunk for 1-4 working days to determine their actual sitting time per day using the validated Acti4 software. Least squares regression models were fitted with questionnaire-based siting time and other self-reported predictors to predict accelerometer-based sitting time.

RESULTS

Questionnaire-based and accelerometer-based average sitting times were ≈272 and ≈476 min/day, respectively. A low Pearson correlation (r=0.32), high mean bias (204.1 min) and wide limits of agreement (549.8 to -139.7 min) between questionnaire-based and accelerometer-based sitting time were found. The prediction model based on questionnaire-based sitting explained 10% of the variance in accelerometer-based sitting time. Inclusion of 9 self-reported predictors in the model increased the explained variance to 41%, with 10% optimism using a resampling bootstrap validation. Based on a split validation analysis, the developed prediction model on ≈75% of the workers (n=132) reduced the mean and the SD of the difference between questionnaire-based and accelerometer-based sitting time by 64% and 42%, respectively, in the remaining 25% of the workers.

CONCLUSIONS

This study indicates that questionnaire-based sitting time has low validity and that a prediction model can be one solution to materially improve the precision of questionnaire-based sitting time.

A Systematic Review of Methods to Assess Children's Diets in the School Context

To evaluate the impact of school-based nutrition interventions, accurate and reliable methods are needed to assess what children eat at school. The primary objective of this study was to systematically review methodological evidence on the relative accuracy and reliability of dietary assessment methods used in the school context. The secondary objective was to assess the frequency of methods and analytical approaches used in studies reporting in-school dietary outcomes. Three health databases were searched for full-text English-language studies. Twenty-two methodological studies were reviewed. For school meal recalls, the majority of studies (n = 8 of 12) reported poor accuracy when accuracy was measured by using frequencies of misreported foods. However, when energy report rates were used as a measure of accuracy, studies suggested that children were able to accurately report energy intake as a group. Results regarding the accuracy of food-frequency questionnaires (FFQs) and food records (FRs) were promising but limited to a single study each. Meal observations offered consistently good interrater reliability across all studies reviewed (n = 11). Studies reporting in-school dietary outcomes (n = 47) used a broad range of methods, but the most frequently used methods included weighed FRs (n = 12), school meal recalls (n = 10), meal observations by trained raters (n = 8), and estimated FRs (n = 7). The range of dietary components was greater among studies relying on school meal recalls and FRs than among studies using FFQs. Overall, few studies have measured the accuracy of dietary assessment methods in the school context. Understanding the methodological characteristics associated with dietary instruments is vital for improving the quality of the evidence used to inform and evaluate the impact of school-based nutrition policies and programs.

Energy and nutrient intakes of Swedish children in relation to consumption of and habits associated with school lunch

AIMS

School lunches are provided free in Sweden, although some children choose not to eat school lunch. The aim of this study was to analyse Swedish children's total energy and nutrient intakes on weekdays by the frequency of school lunch consumption and to analyse energy and nutrient intakes from school lunches by sex. Factors associated with children's school lunch habits were also studied.

METHODS

Children in grades 2 and 5 ( n=1905) completed a food diary (school lunch data available for 1840 children) and the mean energy and nutrient intakes per day and per school lunch were calculated. The children also completed questions on the frequency of school lunch consumption and school lunch habits. Logistic regression was used to assess factors associated with school lunch habits.

RESULTS

Children who reported eating school lunch every day had significantly higher energy and absolute nutrient intakes than children reporting eating school lunch less than five times a week, but not standardized for energy. Boys had significantly higher energy and absolute nutrient intakes from school lunches than girls, but not standardized for energy. Younger children and children who liked school lunches had higher odds of eating school lunch every day. Children in grade 5, those with a foreign background and those disliking school lunches had higher odds of omitting the main lunch component.

CONCLUSIONS

Regular school lunch consumption was associated with a higher total intake for most nutrients, but not a better nutrient density. School lunch habits were associated with age, ethnic background and liking school lunches.

Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention

Among early adolescents (10-14 years), poor diet quality along with physical inactivity can contribute to an increased risk of obesity and associated biomarkers for chronic disease. Approximately one-third of United States (USA) children in this age group are overweight or obese. Therefore, attention to factors affecting dietary intake as one of the primary contributors to obesity is important. Early adolescents consume foods and beverages during eating occasions that occur with and without parental supervision. Parents may influence eating behaviors of early adolescents during eating occasions when they are present or during independent eating occasions by engaging in practices that affect availability of foods and beverages, and through perceived normative beliefs and expectations for intake. Therefore, the purpose of this article was to describe the influence of parenting practices on eating behaviors in general and when specifically applied to independent eating occasions of early adolescents. This information may be helpful to inform parenting interventions targeting obesity prevention among early adolescents focusing on independent eating occasions.

Examining the relationship between vegetable intake of mothers and that of their children: a cross-sectional study of 10- to 12-year-old schoolchildren in Japan

OBJECTIVE

The present study aimed to investigate the correlation between mothers' and children's vegetable intake and whether children are conscious about their vegetable intake.

DESIGN

Cross-sectional study. Self-administered questionnaires for mothers and children, consisting of items regarding diet history, were distributed to children via homeroom teachers. We created dummy exposure variables for each quartile of mothers' vegetable intake. Multiple regression analysis was performed with children's vegetable intake as the outcome variable.

SETTING

Two public elementary schools in a residential district of Tokyo, Japan.

SUBJECTS

Study participants were upper-grade children (aged 10-12 years) and their mothers (332 pairs of mothers and children).

RESULTS

The mean vegetable intake in mothers and children was 310 (sd 145) g/d and 276 (sd 105) g/d, respectively. A positive linear relationship was found between mothers' and children's vegetable intake even after adjustment for considerable covariates (P<0·001). When stratified by children's consciousness, the positive linear relationship was more pronounced in children who were conscious of eating all their vegetables (P<0·001 for interaction with children's consciousness).

CONCLUSIONS

Mothers' vegetable intake was significantly correlated with children's vegetable intake. However, this correlation was stronger in children who were conscious of eating all their vegetables. Our findings suggest that enhancing mother's vegetable intake and health consciousness of children are indispensable prerequisites for increasing vegetable intake among children.

Do attitudes, intentions and actions of school food coordinators regarding public organic food procurement policy improve the eating environment at school? Results from the iPOPY study

OBJECTIVE

The present study investigates whether public organic food procurement policies have the potential to induce changes in the school food service environment.

DESIGN

A comparative cross-national survey was conducted in public primary and/or secondary schools in Finland, Germany and Italy. The school food coordinators completed a web-based questionnaire on their attitudes, intentions and actions towards organic school food provision.

SETTING

In Germany, 122 out of 2050 schools in the state of Hesse responded. In Finland, 250 out of 998 schools across the country responded. In Italy, 215 out of 940 schools from eight provinces responded.

SUBJECTS

School food coordinators in the sample of schools in the three countries.

RESULTS

The German and Finnish school food coordinators separately most agreed with the promotion of healthy eating habits (P < 0·001) and organic food (P < 0·001) by schools. The Finnish schools were most likely to adopt a food and nutrition policy (P < 0·001), a health-promoting school policy according to WHO principles (P < 0·001), to have a playground (P < 0·001), to involve physical activity themes in teaching (P = 0·012) and to have a canteen (P < 0·001). The Italian schools were most likely to involve the food and nutrition policy in pedagogical activities (P = 0·004), to serve nutritional school meals (P < 0·001) and to recommend children to eat healthily (P < 0·001). In the three countries, the non-organic schools were less likely to adopt a food and nutrition policy (P < 0·001), a WHO health-promoting policy (P < 0·001) and have a canteen (P = 0·017) than the organic schools.

CONCLUSIONS

The study suggests that there is a gap in the effects of public organic food procurement policy on building a healthier school food environment.

Role of free school lunch in the associations between family-environmental factors and children's fruit and vegetable intake in four European countries

OBJECTIVE

To determine whether an association exists between different clusters of fruit- and vegetable-specific family-environmental factors and children's daily fruit and vegetable intake, and whether these associations differ between countries with different school lunch policies.

DESIGN

Cross-sectional data from four European countries participating in the Pro Greens project in 2009. These countries have different school food policies: two serve free school lunches and two do not. Self-administered data were used. Food frequency questions served to assess fruit and vegetable intakes. The study assessed sixteen children-perceived family-environmental factors, which were clustered based on principal component analysis into five sum variables: fruit and vegetable encouragement; vegetable modelling, family routine and demand; fruit modelling; fruit and vegetable snacking practices; and fruit and vegetable allowing.

SETTING

Schools in Finland, Germany, Sweden and the Netherlands.

SUBJECTS

Schoolchildren aged 11 years (n 3317).

RESULTS

Multilevel logistic regression analyses revealed positive associations between nearly all clustered family-environmental factors and daily fruit and vegetable intake. The study tested a moderation effect between family-environmental factors and school lunch policy. In five out of twenty models significant interactions occurred. In the stratified analyses, most of the associations between family-environmental factors and raw and cooked vegetable intake were stronger in Germany and the Netherlands, neither of which provided free school lunches.

CONCLUSIONS

Children reporting more fruit- and vegetable-promoting family-environmental factors had a more frequent intake of fruits and vegetables; the associations were stronger for vegetable intakes in countries providing no free school lunches, suggesting that parental involvement is crucial when schools offer no vegetables.