Availability of food and beverage items on school canteen menus and association with items purchased by children of primary-school age

Examining the New Zealand school food environment: what needs to change?

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

How healthy and affordable are foods and beverages sold in school canteens? A cross-sectional study comparing menus from Victorian primary schools

OBJECTIVE

Government policy guidance in Victoria, Australia, encourages schools to provide affordable, healthy foods in canteens. This study analysed the healthiness and price of items available in canteens in Victorian primary schools and associations with school characteristics.

DESIGN

Dietitians classified menu items (main, snack and beverage) using the red, amber and green traffic light system defined in the Victorian government's School Canteens and Other School Food Services Policy. This system also included a black category for confectionary and high sugar content soft drinks which should not be supplied. Descriptive statistics and regressions were used to analyse differences in the healthiness and price of main meals, snacks and beverages offered, according to school remoteness, sector (government and Catholic/independent) size, and socio-economic position.

SETTING

State of Victoria, Australia.

PARTICIPANTS

A convenience sample of canteen menus drawn from three previous obesity prevention studies in forty-eight primary schools between 2016 and 2019.

RESULTS

On average, school canteen menus were 21 % 'green' (most healthy - everyday), 53 % 'amber' (select carefully), 25 % 'red' (occasional) and 2 % 'black' (banned) items, demonstrating low adherence with government guidelines. 'Black' items were more common in schools in regional population centres. 'Red' main meal items were cheaper than 'green'% (mean difference -$0·48 (95 % CI -0·85, -0·10)) and 'amber' -$0·91 (-1·27, -0·57)) main meal items. In about 50 % of schools, the mean price of 'red' main meal, beverages and snack items were cheaper than 'green' items, or no 'green' alternative items were offered.

CONCLUSION

In this sample of Victorian canteen menus, there was no evidence of associations of healthiness and pricing by school characteristics except for regional centres having the highest proportion of 'black' (banned) items compared with all other remoteness categories examined. There was low adherence with state canteen menu guidelines. Many schools offered a high proportion of 'red' food options and 'black' (banned) options, particularly in regional centres. Unhealthier options were cheaper than healthy options. More needs to be done to bring Victorian primary school canteen menus in line with guidelines.

Availability and consumption of ultra-processed foods in schools in the municipality of São Paulo, Brazil: results of the SP-Proso

Ultra-processed foods are markers of unhealthy eating patterns, and their consumption is high among adolescents. Characteristics of the school eating environment associate with student eating practices. This study aims to investigate the association between the presence of school canteens and the availability of ultra-processed foods in school canteens with the consumption of these foods, inside the school, among adolescents of the 9th grade (14 years) of the public and private schools of the city of São Paulo, Brazil. We conducted a cross-sectional study with SP-Proso data, in a sample of 2,680 adolescents. We elaborated multilevel linear regression models to evaluate associations between the exposures: presence of school canteens and availability of ultra-processed foods with outcomes of consumption frequency of ultra-processed foods in the school. We found an association between the presence of school canteens and the higher frequency of consumption of sausages (0.46; 95%CI: 0.24; 0.68), package snacks (0.50; 95%CI: 0.19; 0.80), goodies (0.82; 95%CI: 0.55; 1.09), and sugary drinks (0.34; 95%CI: 0.06; 0.62), as well as a score of consumption frequency of ultra-processed foods (2.37; 95%CI: 1.25; 3.48). The availability of package snacks, goodies, and sugary drinks in school canteens increased the frequency of consumption of these foods. We observed a dose-response effect between the diversity of ultra-processed foods in canteens and the frequency of consumption of these foods. A school food environment with greater availability of ultra-processed products is associated with their higher consumption in school, indicating the need to regulate the sale of food within these institutions.

Healthy and Safe School Cafeteria Program: a randomized controlled study

ABSTRACT Objective To assess the effect of an educational intervention program focused on health risk conditions, based on an assessment of the hygiene and quality of food sold in school cafeterias. Methods This is a controlled, parallel, randomized, two-arm, community study. Public and private schools with cafeterias were invited to participate. This study was conducted in 27 school cafeterias in northern and northwestern Rio Grande do Sul, a state in southern Brazil. Representatives of the school communities in the intervention group received an educational program consisting of 160-hour distance training. The most relevant outcomes were the assessment of the hygienic conditions and composition of the menus sold in school cafeterias. All outcomes were analyzed as intention-to-treat and per-protocol. For the analysis of continuous data with normal distribution, an analysis of covariance and the Generalized Linear Model were used. The level of statistical significance considered was p<0.05 for a 95% CI. Results No statistically significant difference was observed between the intervention group and the control group in the studied outcomes. There was a reduction of 76.2 points in the score for hygienic handling conditions (95% CI: -205 to 357; p=0.581). Regarding menu composition, the difference between groups was 0.48% (95% CI: -2.69 to 3.64; p=0.760) for ultra-processed foods, 0.23% (95% CI: -1.13 to 1.60; p=0.740) for processed foods, and 1.02% (95% CI: -2.59 to 4.64; p=0.581) for fresh foods. Conclusion There is not enough evidence to conclude that the intervention had a positive impact on any of the outcomes studied.

Effects of nutritional intervention strategies in the primary prevention of overweight and obesity in school settings: systematic review and network meta-analysis

Objective

To examine the effects of different nutritional intervention strategies in the school setting on anthropometric and quality of diet outcomes by comparing and ranking outcomes in a network meta-analysis.

Design

Systematic review and network meta-analysis.

Data sources

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Education Resources Information Centre (ERIC), PsycInfo, CAB Abstracts, Campbell Library, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) BiblioMap, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice (JBI EBP) database, Practice-based Evidence in Nutrition (PEN) database, ClinicalTrials.gov, Current Controlled Trials, and World Health Organization International Clinical Trials Registry Platform.

Eligibility criteria for selecting studies

A systematic literature search was performed from inception to 2 May 2022. Cluster randomised controlled trials meeting these study criteria were included: generally healthy school students aged 4-18 years; intervention with ≥1 nutritional components in a school setting; and studies that assessed anthropometric measures (eg, body mass index, body fat) or measures related to the quality of diet (eg, intake of fruit and vegetables), or both. Random effects pairwise meta-analyses and network meta-analyses were performed with a frequentist approach. P scores, a frequentist analogue to surface under the cumulative ranking curve, ranging from 0 to 1 (indicating worst and best ranked interventions, respectively) were calculated. Risk of bias was assessed with Cochrane's RoB 2 tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to rate the certainty of evidence.

Results

51 cluster randomised controlled trials involving 75 954 participants and seven intervention nodes were included. Inconsistency could not be assessed (except for intake of fruit and vegetables) because the network meta-analyses were based mainly on star shaped networks with no direct evidence for specific pairs of nutritional interventions. Overall, little or no evidence was found to support a difference in body mass index, body weight, body fat, or waist circumference and moderate improvements in intake of fruit and vegetables with nutritional interventions in a school setting. Low to moderate certainty of evidence further suggested that multicomponent nutritional interventions likely reduced the prevalence (odds ratio 0.66, 95% confidence interval 0.55 to 0.80) and incidence (0.67, 0.47 to 0.96) of overweight compared with a control group. Based on low certainty of evidence, nutrition education and multicomponent interventions may be more effective than a control group (ie, usual practice) for increasing intake of fruit and vegetables. Multicomponent nutritional interventions were ranked the most effective for reducing body mass index (P score 0.76) and intake of fat (0.82). Nutrition education was ranked as best for body mass index z score (0.99), intake of fruit and vegetables (0.82), intake of fruit (0.92), and intake of vegetables (0.88).

Conclusions

The findings suggest that nutritional interventions in school settings may improve anthropometric and quality of diet measures, potentially contributing to the prevention of overweight and obesity in childhood and adolescence. The findings should be interpreted with caution because the certainty of evidence was often rated as low. The results of the network meta-analysis could be used by policy makers in developing and implementing effective, evidence based nutritional intervention strategies in the school setting.

Systematic review registration

PROSPERO CRD42020220451.

The effectiveness of canteen manager audit and feedback reports and online menu-labels in encouraging healthier food choices within students' online lunch orders: A pilot cluster randomised controlled trial in primary school canteens in New South Wales, Australia

Online school canteen lunch ordering systems may offer a unique opportunity to support the implementation of school canteen nutrition polices, while delivering behavioural interventions directly to consumers to influence healthy student purchasing. This cluster randomised controlled trial aimed to test the effectiveness of a menu audit and feedback strategy alone, and in combination with online menu labels in encouraging healthier purchasing from an online school canteen ordering system. Five intervention schools received a menu audit and feedback strategy, plus online menu labels; and five control schools received a delayed menu audit and feedback strategy. Data from 19,799 student lunch orders, containing over 40,000 items were included in the evaluation. Outcomes were assessed at baseline (pre-intervention), follow-up 1 (menu audit and feedback vs control), and follow-up 2 (menu audit and feedback plus online menu labels vs menu audit and feedback alone). From baseline to follow-up 1, the menu audit and feedback strategy alone had no significant effect on the proportion of healthy ('Everyday') and less healthy ('Occasional' or 'Should not be sold') items purchased. From baseline to follow-up 2, schools that received menu audit and feedback plus online menu labels had significantly higher odds of students purchasing 'Everyday' items (OR: 1.19; p = 0.019), and significantly lower odds of students purchasing 'Occasional' (OR: 0.86; p = 0.048) and 'Should not be sold' (OR: 0.52; p < 0.001) items. Menu audit and feedback with the addition of online menu labels was effective in increasing the proportion of healthy items purchased relative to menu audit and feedback in isolation. There may be a greater role for online menu labelling as part of a suite of strategies to improve public health nutrition in schools.

Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial

Background

School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online.

Objective

This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline.

Methods

This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up.

Results

In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue.

Conclusions

This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075

The role of the school food environment in improving the healthiness of school canteens and the readiness to reopen post COVID-19 pandemic: A study conducted in Indonesia

BACKGROUND

Indonesian school children spend one-third of their time in school, where they are exposed to a variety of foods at school canteens. However, the healthiness of school canteens is not yet well understood. This study was conducted to characterize the healthiness and quality of management of school canteens, and measure readiness of school canteens to reopen following COVID-19 closures.

DESIGN AND METHODS

Mixed-methods were used to conduct a cross-sectional study. Data were collected from schools located in the Bantul District of Indonesia. Primary schools (n=152) were randomly selected, with a final sample size of 147. Data were collected using Google Forms, delivered via WhatsApp or email. School canteens were classified as healthy if they had a Healthy Canteen Score (HCS) >= 10, or unhealthy if they had a HCS < 10.

RESULTS

Less than half (43.5%) of school canteens were deemed to be healthy. School canteens were more likely to be healthy if the canteen manager had a formal decision letter (OR=15.2; 95% CI=3.7-62.5); used print material messaging (OR= 3.2 to 4.6 times); or received inspection by external officers periodically (OR=2.8; 95% CI= 1.04-7.5). Readiness to reopen was 4.5 (OR=4.5; 95%CI: 1.1-17.9) times higher among schools that had their own canteen, and 4 (OR=3.9; 95% CI =1.1-13.8) times higher among schools located in rural areas, adjusting for the remaining variables.

CONCLUSIONS

School canteen healthiness can be improved by implementing national food policy and healthy school canteen standards accompanied by the existence of good management practices within schools, particularly following the COVID-19 pandemic.

School Canteens in Selected Areas in Indonesia: A Situation Analysis

BACKGROUND

The school canteen has a massive impact on the dietary intake and nutritional status of school-age children and adolescents. This study aimed at assessing the current situation of school canteens in selected areas in Indonesia and relevant knowledge, attitudes, and behaviors of school-going children and adolescents.

METHODS

A qualitative study was implemented in a purposive sample of 18 schools in Klaten and West Lombok districts with 2 comparison schools in Jakarta and Klaten. Focus group discussions and in-depth interviews were conducted with a wide range of stakeholders to collect information on nutrition knowledge, food preferences, related policies and governance, and opinions toward school canteens. Data were analyzed using thematic synthesis and narrative analysis.

RESULTS

Specific government guidelines on healthy foods and beverages to be sold in canteens are not yet in place. Many canteens had inadequate infrastructure and were managed informally, with limited rules, monitoring, and supervision. Although healthy options including vegetables and fruits were available in most canteens, unhealthy foods and beverages were abundant and cheap. Lack of awareness of the importance of nutrition of school-age children and adolescents was pervasive among all stakeholders. Personal preference and availability were main drivers of the students' food choices.

CONCLUSIONS

Concerted multisectoral and multistakeholders' efforts are warranted to improve the quality of school canteens in Indonesia by developing a comprehensive relevant guideline, improving the capacity of related stakeholders and service providers, enhancing the implementation and monitoring, and generating demand for healthy canteens.

A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness-Implementation Hybrid Cluster Randomized Controlled Trial

Background

There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted.

Objective

This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school.

Methods

A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness.

Results

A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes.

Conclusions

The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs.

Trial Registration

Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true

International Registered Report Identifier (IRRID)

RR2-10.1186/s12889-019-7725-x

How changes in menu quality associate with subsequent expenditure on (un)healthy foods and beverages in school cafeterias: A three-year longitudinal study

Evidence of the association between the school food environment and children's and adolescents' diet is mostly cross-sectional, usually based on self-reported behavior, and often conducted in high-income countries. Also, relatively little is known about how variations in menu quality associate with the subsequent expenditure on food and beverages of the same- (vs. cross-) nutritional value. Based on a three-year longitudinal dataset comprised of 4,268,457 purchases made by 20,333 children and adolescents from 54 private schools in Brazil, we unobtrusively assess how changes in (un)healthy product availability associate with students' subsequent purchase behavior. Our results reveal that, on average, only 11.6% of the products offered in the school cafeterias were of high nutritional value (HNV). Critically, expenditure on HNV products increased following both the addition of one HNV product (β = 0.18; 95% CI = 0.128, 0.240) and, to a lesser extent, the subtraction of one low nutritional value (LNV) product from the menu (β = -0.03; 95% CI = -0.042, -0.016). Cross-nutritional value effects were stronger for beverages. The inclusion of one HNV beverage was associated not only with a subsequent increase in expenditure on HNV beverages (β = 0.19; 95% CI = 0.115, 0.264), but also with a decrease in expenditure on LNV beverages (β = -0.18; 95% CI = -0.352, -0.010).Although only a small percentage of foods and beverages consumed in private school cafeterias in Brazil are of high nutritional value, improvements to menu quality have the potential to increase the consumption of healthier products and decrease the consumption of unhealthy ones.

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis

Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

The Association between Australian Childcare Centre Healthy Eating Practices and Children's Healthy Eating Behaviours: A Cross-Sectional Study within Lunchbox Centres

The association between healthy eating practices and child dietary intake in childcare centres where parents pack foods from home has received little attention. This study aimed to: (1) Describe the nutritional content of foods and beverages consumed by children in care; and (2) Assess the association between centre healthy eating practices and child intake of fruit and vegetable servings, added sugar(grams), saturated fat(grams) and sodium(milligrams) in care. A cross-sectional study amongst 448 children attending 22 childcare centres in New South Wales, Australia, was conducted. Child dietary intake was measured via weighed lunchbox measurements, photographs and researcher observation, and centre healthy eating practices were assessed via researcher observation of centre nutrition environments. Children attending lunchbox centres consumed, on average 0.80 servings (standard deviation 0.69) of fruit and 0.27 servings (standard deviation 0.51) of vegetables in care. The availability of foods within children’s lunchboxes was associated with intake of such foods (p < 0.01). Centre provision of intentional healthy eating learning experiences (estimate −0.56; p = 0.01) and the use of feeding practices that support children’s healthy eating (estimate −2.02; p = 0.04) were significantly associated with reduced child intake of saturated fat. Interventions to improve child nutrition in centres should focus on a range of healthy eating practices, including the availability of foods packed within lunchboxes.

Envisioning the Future of European Food Systems: Approaches and Research Priorities After COVID-19

The COVID-19 pandemic unveiled the fragility of food sovereignty in cities and confirmed the close connection urban dwellers have with food. Although the pandemic was not responsible for a systemic failure, it suggested how citizens would accept and indeed support a transition toward more localized food production systems. As this attitudinal shift is aligned with the sustainability literature, this work aims to explore the tools and actions needed for a policy framework transformation that recognizes the multiple benefits of food systems, while considering local needs and circumstances. This perspective paper reviews the trends in production and consumption, and systematizes several impacts emerged across European food systems in response to the first wave of pandemic emergency, with the final aim of identifying challenges and future strategies for research and innovation toward the creation of resilient and sustainable city/region food systems. The proposal does not support a return to traditional small-scale economies that might not cope with the growing global population. It instead stands to reconstruct and upscale such connections using a “think globally act locally” mind-set, engaging local communities, and making existing and future citizen-led food system initiatives more sustainable. The work outlines a set of recommended actions for policy-makers: support innovative and localized food production, training and use of information and communication technology for food production and distribution; promote cross-pollination among city/region food systems; empower schools as agents of change in food provision and education about food systems; and support the development of assessment methodologies and the application of policy tools to ensure that the different sustainability dimensions of the food chain are considered.

Are Nutrition Standards for Beverages in Schools Associated with Healthier Beverage Intakes among Adolescents in the US?

Under the U.S. Department of Agriculture's Smart Snacks in School standards, beverages sold in schools are restricted to water, flavored or unflavored non-fat milk or unflavored low-fat milk (and milk alternatives), and 100% fruit and vegetable juices; and, at the high school level, diet (≤10 kcal), low-calorie (≤60 kcal), and caffeinated beverages may also be sold. Using data from the School Nutrition and Meal Cost Study, this study examined whether secondary school student beverage consumption was associated with school-level à la carte and vending machine beverage availability, controlling for district, school, and student characteristics. On average, most beverages sold in middle schools (84.54%) and high schools (74.11%) were Smart Snacks compliant; while 24.06 percent of middle school students and 14.64 percent of high school students reported consuming non-compliant beverages, including non-compliant milk, fruit drinks, and sports or energy drinks. School beverage availability was not related to consumption among middle school students; however, high school students were less likely to consume non-compliant beverages when enrolled in schools that sold a higher proportion of compliant beverages (Range: OR = 0.97-0.98, 95% CI = 0.95, 1.00). Findings from this study build upon prior research illustrating the role that schools can play in influencing student dietary intake.

[An analysis of policy interventions regarding school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina]

The aim of this article is to analyze school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina from 2013 to 2018. A descriptive, cross-sectional study was conducted that included a sample of 10 schools in 2013 and 10 different schools in 2018. A survey of school lunch programs and 24-hour nutrition reminders was carried out with 341 children. The nutritional value of school lunch programs decreased over the study period, particularly among schools in contexts of greater social vulnerability. Significant reductions in average calcium and energy intake were also observed. Indicators of chronic malnutrition, overweight, and excess calcium and vitamin A and C intakes worsened among children attending school lunch programs. Regarding the association between school lunch program attendance and low height for age/risk of low height for age, the odds ratio was not statistically significant. We argue for the necessity of promoting policies that seek urgent improvements in child nutritional indicators from a rights-based perspective.

Investigating differences between traditional (paper bag) ordering and online ordering from primary school canteens: a cross-sectional study comparing menu, usage and lunch order characteristics

OBJECTIVE

To assess differences between traditional paper bag ordering and online ordering from primary school canteens in terms of menu, usage and lunch order characteristics.

DESIGN

A cross-sectional study.

SETTING

New South Wales (NSW) primary schools that offered both paper bag and online canteen ordering.

PARTICIPANTS

Students (aged 5-12 years) with a lunch order on the day of the observation.

RESULTS

Across the six school canteens, 59-90 % of all available items were listed on both the online and paper menus, with no significant differences in the nutritional quality ('Everyday'/'Occasional') or nutritional content (kJ/saturated fat/sugar/sodium) of menu items. In total, 387 student lunch orders were placed, containing 776 menu items. Most orders (68 %) were placed online. There were no significant differences between order modality in the quantity of items ordered or the cost of orders, or the nutritional quality of orders based on the classification system of the NSW Healthy School Canteen Strategy ('Everyday'/'Occasional'). However, nutritional analysis revealed that paper bag orders contained 222 fewer kJ than online orders (P = 0·001), 0·65 g less saturated fat (P = 0·04) and 4·7 g less sugar (P < 0·001).

CONCLUSIONS

Online canteens are commonly used to order canteen lunches for primary school children. This is the first study to investigate differences between traditional paper bag ordering and online ordering in this setting. Given the rapid increase in the use of online ordering systems in schools and other food settings and their potential to deliver public health nutrition interventions, additional research is warranted to further investigate differences in ordering modalities.

Nutritional assessment of the school menus offered in Spain's Mediterranean area

OBJECTIVES

The aim of this study was to perform a nutritional assessment of the menus served in school canteens and to verify their effects on the nutrition of schoolchildren.

METHODS

We selected three collective catering companies that offered ~53 500 menus/d in 369 schools in Spain's Mediterranean area (Valencian Community). The study included four public schools with different management models as well as different supply patterns. Considering the weight of the servings, the caloric contribution of the menus was estimated.

RESULTS

Great diversity was seen both in the same school throughout the week and between the four schools (School 1: 298-946 kcal; School 2: 465-1185 kcal; School 3: 395-656 kcal; and School 4: 374-966 kcal). The energy intake from carbohydrates complied with the recommendations in three of the four schools, the energy provided from proteins was adequate in all of the schools, and the energy from lipids was higher than the recommended values in Schools 1 and 2, lower in School 3, and compliant in School 4. The most abundant fatty acids in the menus were oleic, linoleic, and palmitic acids. The sodium content in the rated menus was 229 ± 72 mg/100 g. The highest salt content came from menus that included a precooked dish, processed meat, or both.

CONCLUSION

It is necessary to review school menus and adjust the size of the servings to the age of the children. Correct nutritional education is essential for both kitchen staff and school canteen monitors.

A cross-sectional study of the nutritional quality of student canteen purchases from New South Wales primary-school canteens

Objective:

To assess the nutritional quality of student canteen purchases at recess and lunch, including: (i) the mean energy (kilojoules), saturated fat (grams), total sugar (grams) and Na (milligrams) and percentage of energy from saturated fat and total sugar; and (ii) the proportion and types of foods purchased that are healthier (green) and less healthy (amber/red) according to a state school canteen policy.

Design:

A cross-sectional study of student canteen food and beverage recess and lunch purchases.

Setting:

Twenty-six randomly selected government primary schools that were non-compliant with a state school canteen policy from a region of New South Wales, Australia, were approached to participate.

Participants:

Students (aged 5–12 years) of participating schools.

Results:

Eighteen schools (69 %) consented to participate. On average students’ recess purchases contained 571·2 kJ energy, 1·6 g saturated fat, 11·6 g total sugar and 132·4 mg Na with 10·0 % of energy from saturated fat and 37·8 % of energy from total sugar. Students’ lunch purchases contained 685·4 kJ energy, 1·8 g saturated fat, 12·7 g total sugar and 151·4 mg Na with 9·5 % of energy from saturated fat and 31·8 % of energy from total sugar. Less healthy items represented 72 and 76 % of all items purchased at recess and lunch, respectively, with ‘savoury snacks’ and ‘sugar-sweetened ice blocks and slushies’ being the most common recess and lunch purchases, respectively.

Conclusions:

There is considerable scope to improve the nutritional quality of student purchases from primary-school canteens, with a high percentage of energy from total sugar. Future research is required to identify effective strategies to enhance compliance with canteen policies and support the purchase of healthier foods from school canteens.

Characteristics of Canteens at Elementary Schools, Upper Secondary Schools and Workplaces that Comply with Food Service Guidelines and Have a Greater Focus on Food Waste

Policy actions to improve the nutritional environment include the provision of official food service guidelines. This study aimed to examine compliance with food service guidelines for hot meals as well as self-evaluated focus on food waste reduction across settings, i.e., elementary schools, upper secondary schools and workplaces, and different canteen characteristics. The same five criteria for hot meals were applied for all settings with regard to serving of fruit and vegetables, fish, wholegrain product and high fat meat and dairy products. A self-administered questionnaire survey was conducted as a cross-sectional study among 680 Danish canteens. Canteens having a high degree of organic food procurement were more likely to comply with the five criteria for hot meals combined (OR 2.00 (Cl 1.13,3.53)). Also, the use of organic food together with having a meal policy was associated with reported focus on food waste reduction (OR 1.91 (CI 1.12,3.25) and 1.84 (Cl 1.31,2.59), respectively). Compliance with individual criteria varied across settings with elementary schools being more likely to comply with criteria on, e.g., maximum serving of non-wholegrain products, whereas workplaces were more likely to comply with criteria on, e.g., minimum fruit and vegetable content and serving of fish. In addition, specific characteristics, e.g., serving system, were found to predict compliance with some of the criteria. These findings highlight the need to address differences in canteen characteristics when planning implementation support for both guideline and food waste reduction initiatives.

Hungry for more: key stakeholders' support for more stringent school food policies

OBJECTIVE

School food policies are an important component of comprehensive strategies to address child obesity and improve children's health. Evaluations have demonstrated that these policies can be initially well accepted and appropriately implemented, however little is known about how acceptance levels may change over time. The present study aimed to re-evaluate a school food policy 10 years after its introduction to assess key stakeholders' support for various policy extensions that would strengthen the scope of the policy.

DESIGN

Online surveys administered 1 year after policy introduction (n 607, 2008) and 10 years after policy introduction (n 307, 2016).

SETTING

Western Australia.ParticipantsSchool principals, teachers, canteen managers and presidents of parents &amp; citizens associations from Western Australian Government primary schools.

RESULTS

At both time points, and especially at time 2 (10 years post policy implementation), high levels of support were reported for the policy and possible policy extensions. Support was strongest for an additional requirement to integrate the canteen menu with the classroom health curriculum.

CONCLUSIONS

The results suggest that once a policy has become embedded into school practices, stakeholders may be receptive to modifications that strengthen the policy to enhance its potential effects on children's diets.