School nutrition guidelines: overview of the implementation and evaluation

Application of DNA-fueled molecular machines in food safety testing

Food is consumed by humans, which is indispensable to human life. Therefore, considerable attention of the whole society has been paid to food safety. Over the last few years, dramatic social development has brought new challenges to food safety, making developing new and quick methods for on-site food safety testing an important necessity. As a result, DNA-fueled molecular machines, characterized by high efficiency, accuracy, and sensitivity in testing, have come into the spotlight, based on which sensors can be constructed to detect toxic and harmful substances in food products. This study reviewed recent research on several DNA-fueled molecular machines, including DNA tweezers, DNA walkers, and DNA origami, for rapidly detecting toxic and harmful substances. Based on the above studies, the sensitivity and timeliness of several DNA molecular machines were summarized and compared, and the development prospect of DNA fuel molecular machines in the field of food safety detection was prospected.

The Activities of the Slovenian Strategic Council for Nutrition 2023/24 to Improve the Health of the Slovenian Population and the Sustainability of Food: A Narrative Review

The health status of individuals in Slovenia across age groups is a matter of concern, as current unsustainable lifestyle choices are already leading to various chronic noncommunicable diseases (NCDs). Outdated national dietary guidelines, their inconsistent implementation, and a lack of structural changes represent obstacles to promoting healthy and sustainable nutrition. Limited access to and rising prices of healthy, sustainable foods, in addition to the high availability of low-priced, highly processed foods, increase the risk of NCDs. The lack of systematic health monitoring and early disease detection poses a challenge. Global and local environmental issues, resistance, and/or the inability to adopt healthier diets hinder individuals from changing their nutritional behaviours. In this narrative review, we provide an overview of the current situation in Slovenia as well as planned activities initiated by the Slovenian government and the Prime Minister's Strategic Council for Nutrition, aiming to make progress in supporting healthy and sustainable nutrition, limiting food waste, and increasing the availability of healthier foods for all. Improving the sustainability of the Slovenian food system can contribute to several Sustainable Development Goals (SDGs), ensuring Slovenia's commitment to internationally agreed-upon targets. This could lead Slovenia to take a role as a pilot country in testing and implementing the necessary systemic changes, which could be further applied in other countries.

Sustainable and Nutritional Recommendations for the Development of Menus by School Food Services in Spain

BACKGROUND

Recommendations for the development of school menus can promote healthier, more sustainable food systems. In Spain, these recommendations depend on regional governments (Autonomous Communities-CCAAs) that develop their own guides. The objective of this study was to explore the nutritional and sustainability recommendations for the development of menus by school food services in Spain.

METHODS

Guides were reviewed that were available on the official web pages of the councils of health and education. Twenty-four variables were studied and organized into three categories: characteristics, nutritional recommendations and sustainability. The number of recommendations included in each guide was counted. The weekly frequency of the suggested food provision for each food group was calculated, as was the average, median, standard deviation, confidence interval and interquartile index.

RESULTS

Overall, 13 guides were reviewed from different CCAAs. All of them included at least three of the nutritional recommendations, two suggested restrictions in the provision of foods with high quantities of salt and six suggested restrictions in foods with high levels of trans and saturated fats and sugars. All except one guide recommended the weekly provision of foods by food group: protein-rich foods (n = 8), cereals and root vegetables (n = 6), vegetables (n = 5.2) and fruit (n = 4.3). Of the eight criteria for sustainability studied, nine guides included one or none.

CONCLUSIONS

Guides for the provision of meals at school in Spain promote the incorporation of healthy foods; however, they rarely restrict foods with high levels of fat, salt and sugar, and the promotion of food sustainability is only just beginning. These guides should be reviewed and updated to include recommendations that promote healthy and sustainable food systems.

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.

Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review

BACKGROUND

Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools.

METHODS

The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study.

RESULTS

Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool.

CONCLUSIONS

The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.

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.

Time trends in consumption of sugar-sweetened beverages and related socioeconomic differences among adolescents in Eastern Europe: signs of a nutrition transition?

BACKGROUND

High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe.

OBJECTIVES

We assessed trends in the prevalence of adolescent daily consumption of SSBs in 14 Eastern European countries between 2002 and 2018, both overall and according to family material affluence.

METHODS

We used 2002, 2006, 2010, 2014, and 2018 data of the Health Behaviour in School-Aged Children school-based study (repeated cross-sectional). Nationally representative samples of adolescents aged 11, 13, and 15 years were included (n = 325,184; 51.2% girls). Adolescents completed a standardized questionnaire, including a question on SSB consumption frequency. We categorized adolescents into 3 socioeconomic groups based on the relative Family Affluence Scale (FAS). Adjusted prevalences of daily SSB consumption by survey year, as well as country-level time trends between 2002 and 2018, were computed using multilevel logistic models (overall and by FAS groups).

RESULTS

In 2018, the prevalence of adolescents consuming SSBs every day varied considerably between countries (range, 5.1%-28.1%). Between 2002 and 2018, the prevalence of daily SSB consumption declined in 10/14 countries (P for linear trends ≤ 0.004). The largest reductions were observed in Slovenia (OR, 0.48; 95% CI: 0.45-0.50) and the Russian Federation (OR, 0.67; 95% CI: 0.64-0.70). Daily SSB consumption was reduced at faster rates among the most affluent adolescents (who were larger consumers in 2002) than in the least affluent adolescents in 11/14 countries (P for linear trends ≤ 0.004). Thus, differences between FAS groups narrowed over time or even reversed, leading to larger proportions of daily consumers in the least affluent adolescents in 2018 in 5/14 countries (P ≤ 0.05).

CONCLUSIONS

Adolescent daily consumption of SSBs decreased between 2002 and 2018 in most Eastern European countries. Declines were larger among higher-affluence adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

Barriers and facilitators to the implementation of nutrition standards for school food: a mixed-methods systematic review protocol

Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards. Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904.

Barriers and facilitators to the implementation of nutrition standards for school food: a mixed-methods systematic review protocol

Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards.

Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework.

Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals.

Systematic review registration: PROSPERO CRD42019117904

How Are School Menus Evaluated in Different Countries? A Systematic Review

School meals should focus on quality of life issues, particularly on reducing food shortages, overweight, obesity and its consequences. As an essential tool for quality assurance, creating the menu is an activity of great complexity and requires multidisciplinary knowledge. This activity covers the observation of countless aspects of quality, highlighting nutritional, sensory, cultural, hygienic, and sanitary issues, among others. This study aims to identify and analyze instruments and methods to evaluate school menus in different countries. The authors developed specific search strategies for Scopus, Web of Science, Science Direct, Pubmed, Lilacs, ProQuest Global, and Google Scholar. The included studies’ methodological quality was assessed using the statistical analysis and meta-analysis review tool (MASTARI). A total of 16 cross-sectional studies met the inclusion criteria and were analyzed. Brazil and Spain were the countries that presented the highest number of studies (n = 5; 31.25% for each). The majority of the studies have a qualitative approach (n = 12, 75%), and only 25% (n = 4) of the studies present quantitative assessment methods to evaluate school menus. No school menu assessment tools were found to assess all aspects of menu planning. The results show a lack of a methodology or of instruments for evaluating the menus offered for school meals that can contribute to better dietary care offered to students.

Barriers and facilitators to the implementation of nutrition standards for school food: a mixed methods systematic review protocol

Background: The importance of nutrition during childhood and the high prevalence of child and adolescence obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence implementation of school food standards. Methods: This mixed methods systematic review will use qualitative, quantitative and mixed methods evidence from peer reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adaption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904

Increasing trends in childhood overweight have mostly reversed: 30 years of continuous surveillance of Slovenian youth

The aim of this study is to describe trends in overweight and obesity among Slovenian youth for the period 1989-2018. Nearly all schoolchildren in Slovenia had their height and weight measured annually, which lead to a total of 6,738,510 data-points during the 30-year period. The IOTF cut-off points and Joinpoint regression were used to examine annual percent change (APC) in overweight and obesity prevalence across 3 age groups (7-10, 11-14 and 15-18 years). Obesity approximately tripled, while overweight doubled between 1989 and late 2000s in both genders. Since then overweight has been steadily decreasing in all 3 age groups for boys and in 7-10-year-old girls. Obesity has also been declining since 2009, but only in the youngest boys and girls (APC = - 1.9, 95% CI = - 3.2 to - 0.6 and APC = - 1.6, 95% CI = - 3.0 to - 0.2, respectively). Unfavourable trends were noted only in 15-18-year-old girls, with obesity rising at an unchanged rate over the past 30 years (APC = 4.8, 95% CI = 4.5-5.1). Overweight and obesity among Slovenian youth has increased dramatically over the last 3 decades. Still, during the last decade this rise has been reversed or at least stopped. This reversal of trends was more marked in boys than in girls, and in young children compared to adolescents.

Effect of a school-based intervention in eating habits among school children: quasi experimental study, Tunisia

OBJECTIVE

The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6-12 years.

METHODS

We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion.

RESULTS

The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups. The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001).

CONCLUSION

A healthy environment should be created through effective school policies to prevent obesity.

The Association between Perceived Adequacy and Capacity for School Food Policy Implementation with Food Availability and Policy Adherence in Nova Scotia, Canada

Supporting the implementation of school food and nutrition policies is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and promote healthier eating. The purpose of this study was to explore the association between perceived adequacy of facilities or equipment and capacity of staff to support policy implementation with food availability and policy adherence in the province of Nova Scotia (NS), Canada, one of the first regions in Canada to launch a comprehensive school food and nutrition policy (SFNP). A cross-sectional online survey was conducted in 2014-2015 to provide a current-state assessment of policy implementation and adherence. Adequacy and capacity for food policy implementation was used to assess policy adherence through the availability of prohibited 'minimum' nutrition foods. An exploratory factor analysis was conducted on a selection of available foods, and 'slow'- and 'quick'-service food composition measures were dichotomized for food availability. Schools with above-average perceived adequacy and capacity for policy implementation had greater odds (OR = 3.62, CI = 1.56, 8.40) of adhering to a lunch policy, while schools that adhered to a snack and lunch policy had lower odds (OR = 0.48, CI = 0.23, 1.01 and OR = 0.18, CI = 0.08, 0.41) of serving quick-service foods. This study identified the need for appropriate adequacy of facilities or equipment and capacity of staff for policy implementation to ensure policy adherence and improve the school food environment. These findings highlight the relationship between school food and nutrition policies, suggesting that better supporting their implementation could increase the likelihood of their success.

Factors Influencing the Implementation of Nutrition Policies in Schools: A Scoping Review

BACKGROUND

Although school nutrition policies (SNPs) have been highlighted as an important intervention to support childhood nutrition, their implementation and maintenance within real-word settings is complex. There is a need to understand the factors that influence implementation by consolidating existing research and identifying commonalities and differences.

AIMS

The purpose of this review is to determine what is known about the influence of broad and local system factors on the implementation of SNPs internationally.

METHOD

This scoping review involved identifying and selecting relevant literature that related SNP implementation in primary and secondary schools. Following the search process, 2,368 articles were screened and 59 articles were synthesized and charted and emerging themes were identified.

RESULTS

Across the final studies identified, factors emerged as barriers and facilitators to the implementation of SNPs, with system implications that related to five areas to support policy action: providing macro-level support may encourage policy implementation; addressing the financial implications of healthy food access; aligning nutrition and core school priorities; developing a common purpose and responsibility among stakeholders; recognition of school and community characteristics.

DISCUSSION

While SNPs can help to support childhood nutrition, strategies to address issues related to policy implementation need to be taken to help schools overcome persistent challenges.

CONCLUSION

The results of this review provide opportunities for action across multiple system levels to ensure synergy and coordinated action toward SNP goals to foster the creation supportive nutrition environments for children.

Stakeholder perceptions of a school food policy ten years on

Objective

To assess (i) the extent to which stakeholders have accepted and implemented a Healthy Food and Drink Policy for schools a decade after its introduction and (ii) any resulting implications for canteen profitability.

Design

Online survey distributed via electronic newsletter to school principals.

Setting

Western Australian public schools.

Subjects

Principals, teachers, canteen managers, and parents and citizens committee presidents (n307).

Results

Large majorities of respondents reported that the policy has made the foods and drinks provided in schools healthier (85 %) and that the policy constitutes a good opportunity to teach children about healthy eating (90 %). Only small proportions of respondents felt it had been difficult to implement the policy in their schools (13 %) or that the policy fails to accommodate parents’ rights to choose the foods consumed by their children (16 %). Most of the policy outcomes assessed in both the initial post-implementation evaluation (2008) and the 10-year follow-up evaluation (2016) demonstrated significant improvement over time.

Conclusions

The study results indicate that comprehensive school food policies can favourably influence the foods and drinks provided on school premises and can be highly acceptable to key stakeholders, without adversely affecting profitability. The results are encouraging for policy makers in other jurisdictions considering the implementation of similar policies.