Food and nutrient intakes of primary school children: a comparison of school meals and packed lunches

To Assess the Cariogenicity of the Lunch Box Content of Schoolgoing Children of Karad: A Cross-sectional Study

Aim

The present study was conducted to identify the main foods and beverages consumed at primary school and also to explore the information regarding cariogenic food consumption patterns of children in the school.

Materials and methods

A cross-sectional descriptive study was conducted among 150 schoolgoing children of age 6-9 years of an English medium school in Karad. Respondents were asked about the type of daily food consumption at breakfast, lunch, and dinner using a 24-hour diet chart, and the lunch box of children was viewed at the time of lunch break to assess for carbohydrate-rich diet.

Results

Majority of the students (58.6%) were boys, from class IV (25.4%) and class III (25.4%), and were between 20 and 25 kg (48%) and 116 and 130 cm (42%). It was observed that the most frequently consumed food in the lunch box was chapati/paratha and vegetables (45%) followed by poha/upma (28%) and biscuits (22%). Almost half of the students (46%) were in the category of "watch-out zone," that is, >15 sugar exposure.

Conclusion

Most of the food consumed in school was homemade and was less cariogenic. Beverages were less consumed by the students in the school time.

Clinical significance

Since dental caries is a chronic infectious disease affecting more than two-thirds of all children and the incidence of caries is directly related to "form" or "physical consistency" of the sugar-containing foods, the content of lunch box should be considered a priority for health promotion efforts among children.

How to cite this article

Gugawad S, Patil SV, Devendrappa SN. To Assess the Cariogenicity of the Lunch Box Content of Schoolgoing Children of Karad: A Cross-sectional Study. Int J Clin Pediatr Dent 2024;17(2):121-124.

Packed School Lunch Food Consumption: A Childhood Plate Waste Nutrient Analysis

Packed school lunch consumption remains a sparsely studied aspect of childhood nutrition. Most American research focuses on in-school meals provided through the National School Lunch Program (NSLP). The wide variety of available in-home packed lunches are usually nutritionally inferior compared to the highly regulated in-school meals. The purpose of this study was to examine the consumption of home-packed lunches in a sample of elementary-grade children. Through weighing packed school lunches in a 3rd grade class, mean caloric intake was recorded at 67.3% (32.7% plate waste) of solid foods, while sugar-sweetened beverage intake reported a 94.6% intake. This study reported no significant consumption change in the macronutrient ratio. Intake showed significantly reduced levels of calories, sodium, cholesterol, and fiber from the home-packed lunches (p < 0.05). The packed school lunch consumption rates for this class were similar to those reported for the regulated in-school (hot) lunches. Calories, sodium, and cholesterol intake are within childhood meal recommendations. What is encouraging is that the children were not "filling up" on more processed foods at the expense of nutrient dense foods. Of concern is that these meals still fall short on several parameters, especially low fruit/vegetable intake and high simple sugar consumption. Overall, intake moved in a healthier direction compared to the meals packed from home.

Children's School-Day Nutrient Intake in Ontario: A Cross-Sectional Observational Study Comparing Students' Packed Lunches from Two School Schedules

This study compared the caloric and nutrient values of packed lunch contents and consumption in the Balanced School Day (BSD) (two 20 min eating periods) versus the Traditional Schedule (TS) (one 20 min lunch). Foods consumed during school were assessed by direct food observation in 321 grade 3 and 4 students, aged 7−10 years, at 9 BSD and 10 TS elementary schools in Ontario. Packed lunch contents in the BSD were significantly higher than the TS in energy (3128.14 ± 1100.36 vs. 2658.98 ± 951.34 kJ, p < 0.001, respectively). Similarly, carbohydrates, total sugar, protein, fat, saturated fatty acids (SFA), calcium, iron, and sodium were significantly higher in the BSD versus TS packed lunches. Correspondingly, students in the BSD consumed significantly more energy, carbohydrates, total sugar, and SFA compared to the TS. Overall, lunches brought by students in the BSD schedule provided more energy across all macronutrients, with only a few micronutrients showing increased amounts, suggesting two 20 min eating opportunities could contribute to excess caloric intake during school, potentially contributing to the prevalence of childhood overweight and obesity in Canada. Furthermore, packed lunches in both schedules had excess amounts of nutrients of concern and much work is needed to ensure that children in Canada receive nutritious lunches at school.

Gender Differences in Nutritional Quality and Consumption of Lunches Brought from Home to School

Gender difference in the lunches brought from home to school and the amount consumed by elementary and intermediate school students were examined using data collected from 12 schools in Texas. The amount and nutritional quality of food items brought and consumed was evaluated, by comparing the results to the 2012 school meal standards, and Dietary Reference Intakes (DRIs). Almost all lunches brought from home contained grain and meat/meat alternatives, and the amount brought and consumed exceeded the NSLP standards. The majority of students did not bring fruits, vegetables, and whole grain foods, but those who brought consumed most of what they brought. Among elementary school students, only 9% of boys and 14% of girls brought vegetables and the amount brought and consumed did not meet the standards. Although carbohydrate and protein consumption were adequate for boys and girls, the intakes of micronutrients and fiber did not meet the requirements across both genders at both school levels. Overall, lunches brought from home were not well balanced and did not meet NSLP standards and DRIs. It is imperative to identify strategies to improve the nutritional quality of lunches brought from home considering gender difference in food choice and educating parents and children on what is a healthy well-balanced lunch.

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.

Home packed food for nursery children in United Arab Emirates provides suboptimal quality

BACKGROUND: Early childhood nutrition is associated with health outcomes later in life, hence developing health promoting habits from an early age is imperative. OBJECTIVE: The aim of this study was to assess the nutritional adequacy of home-packed food brought to the nurseries by attending children. METHODS: In a cross sectional study conducted in 7 nurseries in Abu Dhabi, United Arab Emirates 315 food-boxes were assessed through detailed food observations at the nurseries prior to mealtimes. The food content was evaluated using the Alberta Guidelines for nursery food, Canada. RESULTS: Most food boxes contained refined grains (77.5%), fruits (74.6%), sweet/full fat dairy products (77.5%), discretionary-calorie-food-items (70.6%). Emirati children were offered sweetened drinks significantly more (p < 0.001). Non-dairy protein sources, vegetables, low-fat-natural-dairy products were offered to 45.4%, 44.1% and 3.9% of children, respectively. Overall, 70.2% of the food-boxes contained not-recommended food and 63.1% of the children were served a very poor food combination. CONCLUSIONS: Despite frequent inclusion of recommended food, many food boxes were nutritionally inadequate due to their low content of whole grains, low-fat dairy products, vegetables and animal proteins and high content of sweet food and drinks. The inadequate dietary patterns necessitate developing nutrition guidelines for nurseries in Abu Dhabi.

Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial

Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.

Community Eligibility Provision and School Meal Participation among Student Subgroups

BACKGROUND

The National School Lunch and Breakfast Programs help to reduce food insecurity and improve nutrition. The Community Eligibility Provision (CEP) enables high-poverty schools to offer breakfast and lunch at no cost to all students. This study examines associations between CEP and participation among students eligible for free or reduced-price meals ("FRPM"), possibly eligible ("near-cutoff"), or ineligible ("full-price").

METHODS

Using data from the 2013-2015 Healthy Communities Study, we compared school breakfast and lunch participation between 842 students in K-8 at 80 CEP schools and 1463 students at 118 schools without CEP. Cross-sectional difference-in-difference (DID) models compared meal participation among near-cutoff and full-price groups to that in the FRPM group.

RESULTS

Overall, FRPM students had high participation in school lunch and breakfast at both types of schools. In adjusted DID models, lunch participation among near-cutoff students was 12 points higher in CEP versus comparison schools (p < .05). Among full-price students, breakfast participation was 20 points higher and lunch participation 19 points higher in CEP than comparison schools (p < .001).

CONCLUSIONS

Community Eligibility Provision improves access to school breakfast and lunch in high-poverty schools, particularly for students who are near or above the cutoff for FRPM eligibility.

Konsumsi Sayur dan Buah pada Siswa Sekolah Dasar (Studi pada Makan Siang Sekolah dan Bekal)

ABSTRACTBackground: The consumption for vegetable and fruit in Indonesia was lower than recommendation World Health Organization 400g/day. School lunch and packed lunch could increased consumption of vegetable and fruit.Objective: To analyze differences vegetable and fruit consumption between school lunch and packed lunch group.Method: This was a cross-sectional study involving 155 students with 47 sampels for school lunch and 108 sampels for packed lunch group in SD Muhammadiyah 4 Surabaya. Respondents were interviewed with questioner using food recall method for 2x24 hours, observed intake of vegetables and fruit during lunch and intake a day compared between school lunch and packed lunches. Data were analyzed using independent t-test.Result: Average consumption of vegetables and fruit between two groups was significant, vegetables (p<0.001) and fruit (p<0.001). The amount of vegetable and fruit consumption in the school lunch group averages 26.66 g and 25.53 g and packed lunch groups only 5.09 g and 3.24 g. There was no difference in two groups for consumption of vegetables (p = 0.322) and fruit (p = 0.473). Amount of consumption of vegetables and fruits a day in school lunch group was 28.88 g and 31.81 g, while in packed lunch group only 18.08 g and 25.46 g.Conclusions: There were differences of the consumption of vegetables and fruits between two groups. School lunch and packed lunch standard to increase intake and reduce vegetables and fruits waste in school lunch is needed.ABSTRAKLatar belakang: Konsumsi sayur dan buah di Indonesia tergolong rendah dibanding anjuran World Health Organization 400g/hari. Upaya meningkatkan asupan sayur dan buah anak usia sekolah ialah melalui program makan siang sekolah dan bekal.Tujuan: Menganalisis perbedaan konsumsi sayur dan buah antara kelompok makan siang sekolah dan bekal.Metode: Penelitian Cross-sectional ini melibatkan 155 siswa yang dibagi menjadi 47 siswa kelompok makan siang sekolah dan 108 siswa kelompok bekal. Penelitian dilakukan di SD Muhammadiyah 4 Surabaya. Kuesioner yang digunakan adalah food recall selama 2x24 jam, observasi asupan sayur dan buah ketika makan siang dan asupan sehari dibandingkan antara makan siang sekolah dan bekal. Analisis menggunakan uji independen t-test.Hasil: Rata-rata konsumsi sayur dan buah saat makan siang pada kelompok makan siang sekolah dan kelompok bekal menunjukkan perbedaan signifikan yakni sayur (p<0,001) dan buah (p<0,001). Jumlah konsumsi sayur dan buah pada kelompok makan siang sekolah rata-rata 26,66 g dan 25,53 g dan kelompok bekal hanya 5,09 g  dan 3,24 g. Rata-rata konsumsi sayur dan buah sehari tidak ada perbedaan pada 2 kelompok baik sayur (p=0,322) dan buah (p=0,473). Jumlah konsumsi sayur dan buah sehari kelompok makan siang sekolah ialah 28,88 g dan 31,81 g, sedangkan pada kelompok bekal hanya 18,08 g dan 25,46 g.Kesimpulan: Terdapat perbedaan konsumsi sayur dan buah antara kelompok makan siang sekolah dengan bekal. Perlu adanya standar makan siang sekolah dan makanan bekal untuk meningkatkan asupan dan mengurangi sisa sayur dan buah pada makanan siang sekolah.

What's for lunch? The content and quality of lunches consumed by Dutch primary schoolchildren and the differences between lunches consumed at home and at school

Background

Lunch is an important part of a healthy diet, which is essential for the development, growth and academic performance of school-aged children. Currently there is an increasing number of Dutch primary schoolchildren who are transitioning from eating lunch at home to school. There is limited knowledge about the current quality of the lunches consumed by primary schoolchildren in the Netherlands and whether there are any differences between lunches consumed at home or at school. To investigate differences in content and quality of lunches consumed by Dutch primary schoolchildren at home and at school.

Methods

Cross-sectional study among 363 Dutch primary schoolchildren aged 4–12 years based on the first two years of the 2012–2016 Dutch National Food Consumption Survey. Demographic characteristics were obtained through a questionnaire. Diet was assessed with two non-consecutive 24-h dietary recalls. Quality of lunches was assessed on their nutritional quality whether they fitted the nutritional guidelines. ‘Nonparametric tests were used to examine the content and quality of the lunches between place of consumption and parental educational position.

Results

The most consumed lunch products among primary schoolchildren were bread, dairy products and sugar-sweetened beverages. Fruit and vegetable consumption was very low. Consumption of milk and other dairy products was higher among children who eat lunch at home than children who eat lunch at school (p < 0.01). Consumption of sugar-sweetened beverages was higher among children who eat lunch at school than children who eat lunch at home (p < 0.01), and at school a higher proportion of the drinks did not fit within the Dutch dietary recommendations (p < 0.01).

Conclusions

The current content of the lunches consumed by Dutch primary schoolchildren leaves room for improvement, especially regarding fruit and vegetables. The statistically significantly higher consumption of sugar-sweetened beverages and lower consumption of milk and dairy products at school vs. home is worrisome, as currently more children in the Netherlands are transitioning to having lunch at school.

Ecological momentary assessment of eating and dietary intake behaviors in children and adolescents: A systematic review of the literature

The objective of this review was to summarize associations between ecological momentary assessment (EMA)-measured contextual factors and eating and dietary intake behaviors in children and adolescents. The inclusion criteria were availability of the study in English and use of EMA to study eating and dietary intake behaviors among children and/or adolescents (ages<18). Literature searches were conducted in PsycInfo and PubMed databases across all dates until December 2018. A modified Checklist for Reporting EMA Studies was used to assess quality of studies. Eighteen articles from 15 independent studies were included in the systematic review. Contextual factors examined in relation to children's eating in studies included affect and stress; cognitive factors; social and environment factors; behavioral factors; and caregiver-related factors. Studies suggested there is strong evidence that cognitive and social factors have an effect on eating and dietary intake behaviors while the association between affect and eating and dietary intake behaviors remains mixed. Future studies should consider timing of effects, measure choice, individual difference and contextual factors, and developmental context.

Highlighting of Urinary Sodium and Potassium among Indonesian Schoolchildren Aged 9-12 Years: The Contribution of School Food

Background

Sodium (Na) and potassium (K), the essential nutrients, have vital role in promoting cellular growth including growth and development of children. Excessive Na intake and inadequate K consumption, which consequently increases the risk of cardiovascular disease, have been reported. Spot electrolyte urine was highly correlated and validated with gold standard to estimate electrolyte dietary intake. This study aimed at predicting sodium and potassium intake using morning spot urine among Indonesian schoolchildren.

Methods

A cross-sectional study was carried out in 155 healthy elementary students aged 9–12 years. Spot urine samples were collected and analyzed for Na, K, and creatinine. Predicted 24 h Na and K excretions were compared to the Indonesian recommendation dietary allowances. The Na and K contribution from school food was reported by observing directly and the dietary recall method.

Results

A total of 80 boys and 75 girls recruited as samples in this study demonstrated that their estimated urinary Na and K were 105.42 ± 66.05 mmol/day and 16.39 ± 12.57 mmol/day, respectively. Na intake was on average higher than recommended; meanwhile, almost all subjects showed very low compliance of K intake recommendation. Furthermore, food intake at school contributed to those conditions. Na and K content of school food contributed 33% and 29% of the daily intake of each nutrient and contributed 125% and 25% higher than the Na and K school standard, respectively.

Conclusions

Indonesian schoolchildren aged 9–12 years are categorized by excessive Na intake and very deficient K intake. The present study highlights the need for policies in the environmental school setting to reduce Na intake and K intake.

Effect of implementing school meals compared with packed lunches on quality of dietary intake among children aged 7-13 years

Strategies are needed to improve the dietary habits of children. The aim of the present study was to evaluate the effect of implementing a school food programme on the dietary quality of lunches consumed by school children aged 7–13 years compared with packed lunches brought from home. A secondary objective was to investigate if a possible effect would differ between the younger children and the older. A quasi-experimental study design with four intervention schools and four matched control schools was conducted. In total, 984 school children participated. Data on packed lunches were collected at baseline. At the 1st follow-up the children in the intervention schools were offered free school meals and at the 2nd follow-up children paid for their school meals. The control group had packed lunches at all measurements. A digital photographic method combined with a Meal Index of dietary Quality (Meal IQ) was used for dietary assessment. Multilevel modelling was employed for data analyses. The quality of dietary intake was improved when free school meals were offered (P = 0·004); if the school meals were paid for the use was limited and no difference in change in dietary quality was found (P = 0·343). The school food programme had no difference in effect according to age (P = 0·083). In conclusion, offering a free school meal had a positive effect on dietary quality of the lunches consumed by school children aged 7–13 years. No effect was measured when the school meals were not provided for free. The dietary effect did not depend on age.

Nutritional value of school meals and their contributions to energy and nutrient intakes of rural school children in Enugu and Anambra States, Nigeria

Background

Nutritional deficiencies among school children may hinge on inadequate nutrient intake. School meals should improve nutrient intakes by providing a third of recommended daily energy and nutrient intakes (RNI). The study aimed at evaluating school meals served in three rural schools to determine if they met one third of the RNI of the children. This will enhance meal planning.

Methods

Food samples (20 g) that constituted the school meals were collected for five consecutive days from three schools where school lunch programme was implemented. These were put in labelled small air tight plastic containers and stored in deep freezers in the Department of Home Science, Nutrition and Dietetics, University of Nigeria, Nsukka. The samples were analysed chemically using standard methods. Portion sizes of foods were obtained and the contributions made by these meals to the children's RNI were calculated. Results were presented in percentages and means ± standard deviations.

Results

The results showed that energy value of the meals ranged from 32.27 - 243.4 Kcal/100 g. The school meals contained carbohydrate (0.7 - 48.4 g), protein (0.69 - 12.6 g), vitamin C (0.7 - 8.22 mg), vitamin A (3.0 - 255.5 RE), iron (0.05 - 1.7 mg), calcium (3.0 -120 mg) and zinc (0.14 - 3.0 mg) per 100 g of food consumed. They contributed 16.4 - 25.5% energy, 53.4 - 116.9% protein, 66.0 - 159.5% vitamin A, 37.3 - 45.7% vitamin C, 13.2 - 28.5% calcium, 5.9 - 20.6% iron and 35.1 - 92.9% zinc to the children's daily requirements.

Conclusion

The school meals provided over one third of the RNI for protein, vitamins A and C, and zinc but did not meet a third of the RNI for energy, calcium and iron.

Consumption of foods and beverages in elementary schools: Results of the implementation of the general guidelines for foods and beverages sales in elementary schools in Mexico, stages II and III

The Mexican government developed the General Guidelines for the dispensing or distribution of foods and beverages at food sales in elementary schools (Guidelines). The objective is to evaluate the consumption of food and beverages during school hours, in two different stages of the implementation of the Guidelines: stages II (2011-2012) and stage III (2012-2013) in 565 elementary school students. We constructed three categories of consumption according to the origin of food: Home, food brought from home; School, food purchased at school and Both, food from home and food purchased at school. The main results showed that there are differences in both stages in energy intake according to the foods' origin; the category of School has the lowest energy and macronutrients consumption, as well as the closer compliance with de Guidelines recommendations in both stages, while the category of Both has a higher consumption and the less compliance with the Guidelines. This may be indicating an improvement in school guidelines and it is also reflecting the need to reinforce orientation for a healthy diet with respect to foods brought from home. It is necessary to continue with periodic evaluations to measure fulfillment with the Guidelines.

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.

Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students

BACKGROUND

Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans.

OBJECTIVE

The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source).

DESIGN

An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year.

PARTICIPANTS/SETTING

Fourth- and fifth-grade students (N=3,944) completed a diary-assisted 24-hour food recall.

MAIN OUTCOME MEASURES

The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home.

STATISTICAL ANALYSIS

Analysis of variance, χ² test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed.

RESULTS

School lunch eaters had a higher mean±standard deviation overall diet quality score (HEI-2010=49.0±11.3) compared with students who ate a lunch obtained from home (46.1±12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch).

CONCLUSIONS

Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on children's diet quality.

Development of a Method to Observe Preschoolers' Packed Lunches in Early Care and Education Centers

BACKGROUND

As early childhood education (ECE) centers become a more common setting for nutrition interventions, a variety of data collection methods are required, based on the center foodservice. ECE centers that require parents to send in meals and/or snacks from home present a unique challenge for accurate nutrition estimation and data collection. We present an observational methodology for recording the contents and temperature of preschool-aged children's lunchboxes and data to support a 2-day vs a 3-day collection period.

METHODS

Lunchbox observers were trained in visual estimation of foods based on Child and Adult Care Food Program and MyPlate servings and household recommended measures. Trainees weighed and measured foods commonly found in preschool-aged children's lunchboxes and practiced recording accurate descriptions and food temperatures. Training included test assessments of whole-grain bread products, mixed dishes such as macaroni and cheese, and a variety of sandwich preparations. Validity of the estimation method was tested by comparing estimated to actual amounts for several distinct food types. Reliability was assessed by computing the intraclass correlation coefficient for each observer as well as an interrater reliability coefficient across observers. To compare 2- and 3-day observations, 2 of the 3 days of observations were randomly selected for each child and analyzed as a separate dataset. Linear model estimated mean and standard error of whole grains, fruits and vegetables, and amounts of energy, carbohydrates, protein, total fat, saturated fat, dietary fiber, thiamin, riboflavin, niacin, vitamins A and C, calcium, iron, sodium, and dietary fiber per lunch were compared across the 2- and 3-day observation datasets.

RESULTS

The mean estimated amounts across 11 observers were statistically indistinguishable from the measured portion size for each of the 41 test foods, implying that the visual estimation measurement method was valid: intraobserver intraclass correlation coefficients ranged from 0.951 (95% CI 0.91 to 0.97) to 1.0. Across observers, the interrater reliability correlation coefficient was estimated at 0.979 (95% CI 0.957 to 0.993). Comparison of servings of fruits, vegetables, and whole grains showed no significant differences for serving size or mean energy and nutrient content between 2- and 3-day lunch observations.

CONCLUSIONS

The methodology is a valid and reliable option for use in research and practice that requires observing and assessing the contents and portion sizes of food items in preschool-aged children's lunchboxes in an ECE setting. The use of visual observation and estimation with Child and Adult Care Food Program and MyPlate serving sizes and household measures over 2 random days of data collection enables food handling to be minimized while obtaining an accurate record of the variety and quantities of foods that young children are exposed to at lunch time.

Impact of school lunch type on nutritional quality of English children’s diets

Objective

Nutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type.

Design

A cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches.

Setting

Fifty-four primary schools across England.

Subjects

Children (n 2709) aged 6–8 years.

Results

Children having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day.

Conclusions

Compared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake.

The relationship between school lunch attendance and the food intakes of French schoolchildren aged 3-17 years

OBJECTIVE

Recently, school meal composition regulations have been implemented in France in order to improve the nutritional status of children. The present study investigated the link between school lunch attendance and the food intakes of schoolchildren aged 3-17 years.

DESIGN

Second French cross-sectional dietary survey (2006-2007). Eating frequencies were assessed for twenty-four food groups with a 7 d food record. Eating locations were recorded for main meals. Food group intakes at weekday lunches were compared for the school canteen and for other locations. The children's overall dietary intake was compared based on school lunch attendance.

SETTING

Mainland France.

SUBJECTS

Schoolchildren aged 3-17 years (n 1068).

RESULTS

Lunchtime food intake differed between the school canteen and other locations. Some intakes at school canteens were more in accordance with the regulations (more fruit and vegetables, fish and dairy products, and less sandwiches, soft drinks, chocolate and confectionery), whereas others highlighted needs for improvement (more sweet biscuits and pastries, ice cream and dairy desserts, pizzas and salty pastries). Many of these differences were also observed in the children's overall diet: children regularly attending school lunches ate more mashed fruit, fish and sweet biscuits or pastries, and less sandwiches and soft drinks. The link between school lunch attendance and overall diet was less pronounced in secondary-school children.

CONCLUSIONS

School canteen attendance is associated with both potentially beneficial and deleterious differences in the lunchtime and overall diets of French children. These findings are important to consider when setting national regulations for school meal composition.

Did school food and nutrient-based standards in England impact on 11-12Y olds nutrient intake at lunchtime and in total diet? Repeat cross-sectional study

Introduction

In September 2009, middle and secondary schools in England were required to comply with food and nutrient-based standards for school food. We examined the impact of this policy change on children’s lunchtime and total dietary intake.

Methods

We undertook repeat cross-sectional surveys in six Northumberland middle schools in 1999–2000 and 2009–10. Dietary data were collected from 11–12 y olds (n = 298 in 1999–2000; n = 215 in 2009–10). Children completed two consecutive 3-day food diaries, each followed by an interview. Linear mixed effect models examined the effect of year, lunch type and level of socio-economic deprivation on children’s mean total dietary intake.

Results

We found both before and after the introduction of the food and nutrient-based standards children consuming a school lunch, had a lower per cent energy from saturated fat (−0.5%; p = 0.02), and a lower intake of sodium (−143 mg; p = 0.02), and calcium (−81 mg; p = 0.001) in their total diet, compared with children consuming a home-packed lunch. We found no evidence that lunch type was associated with mean energy, or absolute amounts of NSP, vitamin C and iron intake. There was marginal evidence of an association between lunch type and per cent energy NMES (p = 0.06). In 1999–2000, children consuming a school lunch had a higher per cent energy from fat in their total diet compared with children consuming a home-packed lunch (2.8%), whereas by 2009–10, they had slightly less (−0.2%) (year by lunch type interaction p<0.001; change in mean differences −3%).

Conclusions

We found limited evidence of an impact of the school food and nutrient-based standards on total diet among 11–12 year olds. Such policies may need to be supported by additional measures, including guidance on individual food choice, and the development of wider supportive environments in school and beyond the school gates.

A repeat cross-sectional study examining the equitable impact of nutritional standards for school lunches in England in 2008 on the diets of 4-7y olds across the socio-economic spectrum

Background

The 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children’s nutrient intake at lunchtime and in total diet by level of deprivation.

Methods

We conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children’s diets.

Results

368 and 624 children participated in 2003–4 and 2008–9 respectively. At lunchtime, between 2003–4 and 2008–9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008–9 compared with 2003–4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation.

Conclusions

By 2008–9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain. Additional interventions to promote equitable nutrition in children are needed to support legislative measures and maximise their impact.

The effects of the Food Dudes Programme on children’s intake of unhealthy foods at lunchtime

Aims:

Although previous research has shown the Food Dudes Programme increases children’s lunchtime fruit and vegetable consumption, research has seldom evaluated whether the intervention can decrease the consumption of high-fat and high-sugar foods. This study is the first, independent evaluation of the Food Dudes Programme to explore whether the programme could change children’s lunchtime fruit and vegetable consumption and consumption of high-fat and high-sugar foods following the intervention and explore any relationship between these variables.

Methods:

The Food Dudes Programme was evaluated in 15 primary schools in the West Midlands, United Kingdom ( n = 2,433) at baseline (pre-intervention), and three months and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals).

Results:

A significant increase in the consumption of lunchtime fruit and vegetables was found at three months for children in the intervention schools, but only for those eating school-supplied lunches. For children consuming school meals, consumption of high-fat and high-sugar foods for children in the intervention and control schools increased over time. No relationship was found between increases in fruit and vegetable consumption and decrease in consumption of high-fat and high-sugar foods following the Food Dudes intervention.

Conclusions:

The Food Dudes Programme has a limited effect on decreasing consumption of high-fat and high-sugar foods at lunchtime. Targeting unhealthy food consumption in addition to increasing fruit and vegetable consumption may facilitate this. Restricted access to high-fat and high-sugar foods may also reduce intake; however, this needs to be part of a multi-faceted approach to changing children’s dietary patterns involving the whole school community.

The association between organic school food policy and school food environment: results from an observational study in Danish schools

AIMS

School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments.

METHODS

The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The 'organic' schools were compared to 'non-organic' schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools.

RESULTS

Data indicates that 20 'organic' schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school (p = .032), recommending children to eat healthily (p = .004).

CONCLUSIONS

The study suggests that organic food policies in schools may have potential to support a healthier school food environment.

Parental provision and children's consumption of fruit and vegetables did not increase following the Food Dudes programme

Purpose

– This study is based on previous research which suggests that the Dudes programme increases children's fruit and vegetable consumption for school-provided meals by assessing its effectiveness in increasing the provision and consumption of fruit and vegetables in home-provided meals.

Design/methodology/approach

– Two cohorts of children participated from six schools in the West Midlands in the UK, one receiving the Food Dudes intervention and a matched control group who did not receive any intervention. Participants were children aged four to seven years from six primary schools, three intervention (n=123) and three control schools (n=156). Parental provision and consumption of fruit and vegetables was assessed pre-intervention, then three and 12 months post-intervention. Consumption was measured across five consecutive days in each school using digital photography.

Findings

– No significant increases in parental provision or consumption were found at three or 12 months for children in the intervention schools, however, increases were evident for children in the control group.

Research limitations/implications

– Further development of the Food Dudes programme could develop ways of working with parents and children to increase awareness of what constitutes a healthy lunch.

Originality value

– This is the first independent evaluation to assess the influence of the Food Dudes programme on parental provision and children's consumption of lunchtime fruit and vegetables.

The impact of food and nutrient-based standards on primary school children's lunch and total dietary intake: a natural experimental evaluation of government policy in England

In 2005, the nutritional content of children's school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children's total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4-7 years (n = 385 in 2003-4; n = 632 in 2008-9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children's mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change -128 mg, 95% CI: -183 to -73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (-1.8%, -2.8 to -0.9) and saturated fat (-1.0%; -1.6 to -0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children's total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children's diet.

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

Considering the lack of uniformity regarding school meals in Europe, information on adolescents' school lunch patterns is of public health importance. Thus, the aim of this analysis was to describe and evaluate lunchtime energy and food intake of European adolescents at different lunch locations. Data on nutritional and health-related parameters were derived from the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). A sub-sample of 891 adolescents (47% male) with plausible data on total and lunchtime energy intake (2 × 24 h recall) as well as usual lunch location was considered. Food intake was compared to lunch of the Optimized Mixed Diet (OMD) for children and adolescents. Although energy intake was nearly in line with the recommendations, food intake was suboptimal compared to the OMD regardless of usual lunch location. Adolescents had more potatoes and less sweets at school, and more drinks (water, coffee and tea) and vegetables at home when each compared with the other locations. Food intake of adolescents getting their lunch elsewhere was characterized by the smallest amounts of potatoes and the highest amounts of sweets. Although lunch patterns may differ among countries, schools in Europe do not seem to reveal all their potential to offer access to a healthy lunch for adolescents yet.

School lunches v. packed lunches: a comparison of secondary schools in England following the introduction of compulsory school food standards

OBJECTIVES

To compare food choices and nutrient intakes of pupils taking a school lunch or a packed lunch in eighty secondary schools in England, following the introduction of the food-based and nutrient-based standards for school food.

DESIGN

Cross-sectional data collected between October 2010 and April 2011. Pupils' lunchtime food choices were recorded over five consecutive days.

SETTING

Secondary schools, England.

SUBJECTS

A random selection of 5925 pupils having school lunches and 1805 pupils having a packed lunch in a nationally representative sample of eighty secondary schools in England.

RESULTS

The differences in the specific types of food and drink consumed by the two groups of pupils are typical of differences between a hot and cold meal. On average, school lunches as eaten contained significantly more energy, carbohydrate, protein, fibre, vitamin A, folate, Fe and Zn than packed lunches, and 8 % less Na.

CONCLUSIONS

Although neither school lunches nor packed lunches provided the balance of nutrients required to meet the nutrient-based standards (based on about one-third of daily energy and nutrient requirements), school lunches generally had a healthier nutrient profile, with lower Na and percentage of energy from fat, and higher fibre and micronutrient content. These differences were greater than those reported prior to the introduction of compulsory standards for school lunches. In order to ensure more pupils have a healthy lunch, schools could introduce and enforce a packed lunch policy or make school meals the only option at lunchtime.

Accuracy and reliability of direct observations of home-packed lunches in elementary schools by trained nutrition students

Increased attention has been directed toward the school food environment because children consume important contributions toward their daily food intake while at school. In Canada, most elementary school students bring a lunch to school and there are minimal data on the composition and consumption of these lunches. Dietary assessment of home-packed lunches is challenging compared with assessment of standardized school meals due to greater diversity of items, nonstandard portions, and opaque containers. We assessed accuracy and reliability of a food observation method whereby upper-year nutrition students (n=15) were trained to assess packed lunch contents and intake in elementary schools. Accuracy and reliability was assessed during 2010-2011 in three observational phases: sample lunches, volunteer-consumed lunches, and elementary school students' lunches (n=32). Observers accurately identified 96% and 95% of items in the sample and volunteer lunches, respectively. Similarly, they accurately reported portion sizes for 86% and 94% of the items in the sample and volunteer lunches, thus showing improvements in successive phases. Interobserver reliability for amount consumed, by portion size and macronutrient content, ranged from 0.79 to 0.88 in the volunteer-consumed lunches and 0.78 to 0.86 in the students' lunches, with a majority ≥0.80. It is noteworthy that the analyses for the amount consumed were conducted as absolute amounts with no allowances for discrepancies, which differs from other interobserver reliability assessments where as much as 25% discrepancy is considered agreement. Observers with prior nutrition knowledge assessed packed lunch contents and intake accurately and reliably by direct observation in an elementary school setting.

Nutritional quality of children's school lunches: differences according to food source

OBJECTIVE

To assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school).

DESIGN

Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed.

SETTING

Elementary schools in Prince Edward Island, Canada.

SUBJECTS

Grade 5 and 6 students (n 1980).

RESULTS

Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school.

CONCLUSIONS

The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.

Increasing children's lunchtime consumption of fruit and vegetables: an evaluation of the Food Dudes programme

OBJECTIVES

Although previous research has shown that the Food Dudes programme increases children's fruit and vegetable consumption at school, there has been limited evaluation of the extent to which changes are maintained in the long term. Furthermore, despite knowledge that the nutritional content of home-supplied meals is lower than that of school-supplied meals, little consideration has been given to the programme's impact on meals provided from home. The present study therefore assessed the long-term effectiveness of the Food Dudes programme for both school- and home-supplied lunches.

DESIGN

Two cohorts of children participated, one receiving the Food Dudes intervention and a matched control group who did not receive any intervention. Consumption of fruit and vegetables was assessed pre-intervention, then at 3 and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals).

SETTING

Fifteen primary schools, six intervention (n 1282) and seven control schools (n 1151).

SUBJECTS

Participants were children aged 4-11 years.

RESULTS

A significant increase in the consumption of fruit and vegetables was found at 3 months for children in the intervention schools, but only for those eating school-supplied lunches. However, increases were not maintained at 12 months.

CONCLUSIONS

The Food Dudes programme has a limited effect in producing even short-term changes in children's fruit and vegetable consumption at lunchtime. Further development work is required to ensure the short- and long-term effectiveness of interventions promoting fruit and vegetable consumption in children such as the Food Dudes programme.

Lunchtime food and nutrient intakes of secondary-school pupils; a comparison of school lunches and packed lunches following the introduction of mandatory food-based standards for school lunch

Objective

To compare the key differences between school lunches and packed lunches as eaten in eleven secondary schools in England, 21 months after the food-based standards for school lunch became mandatory, but before the introduction of nutrient-based standards.

Design

Data on 358 school lunches and 139 packed lunches were collected in May and June 2008 from pupils attending secondary schools in Sheffield, Manchester, Leicester City and Essex. Fieldwork was conducted over five consecutive school days at each school. Fieldworkers randomly selected five pupils taking a school lunch and five pupils bringing a packed lunch each day. All food and drink items chosen by pupils were weighed and recorded. Leftovers were also weighed.

Setting

Eleven state-maintained, co-educational secondary schools from four local authorities in England.

Subjects

Four hundred and ninety-seven pupils aged 11–16 years.

Results

Pupils taking school lunches, on average, had significantly higher intakes of energy, protein, carbohydrate, NSP, vitamin C, folate, Fe and Zn than pupils bringing a packed lunch to school. Mean intakes of protein, fat and vitamin C from both types of lunch met the nutrient-based standards and school lunches also met standards for carbohydrate, NSP and energy.

Conclusions

Nutrient intakes from school lunches were more favourable than those from packed lunches, but typically failed to meet nutrient-based standards for school food. A combination of continued improvements to school food, educating pupils to make healthier choices and policies to encourage pupils to eat at school or bring healthier packed lunches is needed.

School lunches and lunches brought from home: a comparative analysis

BACKGROUND

Considerable effort has been put forth to improve the nutritional quality of school meals by the National School Lunch Program (NSLP). However, a large percentage of children do not obtain their meals from school and instead bring lunch from home. Little research has focused on the content of these lunches. The purpose of the current study was to examine differences between school lunch and lunch brought from home.

METHODS

Children in the 2nd grade from seven schools in a large suburban school district were observed on three separate days. A total of 2107 observations were made, with 38.5% of these being lunches brought from home. Chi-squared analyses evaluated differences in the presence of specific food items between school lunch and lunch brought from home.

RESULTS

Compared to children with a school lunch, children with a lunch brought from home were significantly less likely to have fruits (75.9% vs. 45.3%), vegetables (29.1% vs. 13.2%), and dairy (70.0% vs. 41.8%) (p < 0.001). Children with a lunch from home were more likely to have snacks high in sugar and/or fat (17.5% vs. 60.0%) and non 100% fruit juice/fruit drink (0.3% vs. 47.2%) (p < 0.001) than children with a school lunch.

CONCLUSIONS

The NSLP has been widely criticized; however, conducting a comparison in this manner demonstrates advantages to children obtaining school lunches. Although it was beyond the scope of this study to examine diet quality (e.g., actual intake and nutrient/caloric density), these results provide compelling evidence that lunches brought from home should be an area of emphasis for research and intervention.

Food sustainability education as a route to healthier eating: evaluation of a multi-component school programme in English primary schools

Promising approaches to the promotion of healthier eating among children in primary school settings include the opportunity to practise practical cooking and growing, promoting the take up of healthier school meals and nutritional education. However, less is known about the potential for strategies that integrate approaches through a focus on food sustainability issues--such as the promotion of awareness about local, seasonal, organic, fair trade and higher animal welfare foods. This paper presents an evaluation of the Food for Life Partnership, a multi-component programme that sought to address both the health and sustainability aspects of food. The study consisted of a two-stage cross-sectional survey of Years 5 and 6 students (ages 9-11) in 30 primary schools at enrolment and after 18-24 months, combined with an analysis of programme delivery. Higher self-reported fruit and vegetable consumption in the second stage survey was associated with a range of indicators of school participation in the programme. These included the reform of school meal procurement and preparation; experiential food growing, cooking and farm-based education and improved opportunities for stakeholder engagement. The study therefore develops a case for multilevel programmes that incorporate sustainability issues alongside experiential food education in primary school settings.

Food and drink consumption at school lunchtime: the impact of lunch type and contribution to overall intake in British 9-10-year-old children

OBJECTIVE

To examine the differences in dietary intakes of children consuming school meals and packed lunches, the contribution of lunchtime intake to overall dietary intake, and how lunchtime intake relates to current food-based recommendations for school meals.

DESIGN

Cross-sectional analysis of overall intake of macronutrients and food choice from 4 d food diaries and school lunchtime intake from the two diary days completed while at school.

SETTING

Norfolk, UK.

SUBJECTS

One thousand six hundred and twenty-six children (aged 9-10 years) attending ninety Norfolk primary schools.

RESULTS

At school, lunchtime school meal eaters consumed more vegetables, sweet snacks, chips, starchy foods and milk, and less squash/cordial, fruit, bread, confectionery and savoury snacks than packed lunch eaters. These differences were also reflected in the overall diet. On average school meal eaters met the School Food Trust (SFT) food-based standards, while food choices among packed lunch eaters were less healthy. The contribution of food consumed at school lunchtime to overall diet varied by food and lunch type, ranging from 0.8 % (milk intake in packed lunches) to 74.4 % (savoury snack intake in packed lunches).

CONCLUSIONS

There were significant differences in the foods consumed by school meal and packed lunch eaters, with food choices among school meal eaters generally in line with SFT standards. The food choices made at school lunchtime make a significant contribution to overall diet.

The quality of midday meals eaten at school by adolescents; school lunches compared with packed lunches and their contribution to total energy and nutrient intakes

OBJECTIVE

To compare food and nutrient intakes from midday meals provided by schools with those from packed lunches and to estimate the contribution from food eaten at midday to the total daily energy and nutrient intakes of teenagers.

DESIGN

Dietary data were recorded in 4 d estimated diaries of which 2 d were school days. The school day data were analysed for total and midday energy and nutrient intakes. The latter were compared with the recommendations of the Caroline Walker Trust (CWT).

SETTING

Cambridgeshire, UK, 2006.

SUBJECTS

Teenagers (n 757) aged 14-15 years, from eighteen secondary schools, who reported food eaten at school.

RESULTS

The contribution to total daily energy intake from all lunches eaten at school was 29 % (boys) and 28 % (girls). School meals provided greater quantities of protein, starch, carotene and folate but also more saturated fats and Na than packed lunches. Intakes of energy and several nutrients fell below the CWT recommendations for both types of lunch. School meals and packed lunches provided different types of foods; greater quantities of rice, pasta and vegetables in school meals; more yoghurt, cheese, fruit and juices but also more confectionery and soft drinks in packed lunches.

CONCLUSIONS

There has been concern that schoolchildren who are not opting for lunch provided by schools are compromising the overall quality of their diet, but the present study showed small differences in nutrient content between packed and school lunches. These data were collected in 2005–2007 before the government programme of improvements reached secondary schools.

Exploring school and home food environments: perceptions of 8-10-year-olds and their parents in Newcastle upon Tyne, UK

OBJECTIVE

To use an innovative mixed-method approach to analyse and describe 8-10-year-olds' home and school food environments.

DESIGN

A mixed-method approach to collect qualitative and quantitative data was used, in which pupils took photographs over four days to record their food intake and food environment. The photographs were discussed in focus groups. A combination of lunchtime observations and questionnaires completed by parents were used to build up a picture of the children's home and school food environments.

SETTING

A primary school in a suburb of Newcastle upon Tyne, UK.

SUBJECTS

Twenty-seven children aged 8-10 years consented to take part in the study. Twenty-four returned cameras, and eighteen parents completed questionnaires.

RESULTS

Photographs illustrated a range of locations throughout the home where children consumed food. Children's photographs revealed they ate less often with family and more often in front of the television than reported in parental questionnaires. Emergent themes during focus group discussions revealed a strong preference for packed lunches and dissatisfaction with school dinners. In this small sample, children's eating habits and preferences showed few associations with either gender or the deprivation level of the area in which they lived.

CONCLUSIONS

The children's home food environments showed a great deal of variation, with parents being key moderators of food availability and consumption. While the school's food provisions met national nutritional standards, the social aspects of having a packed lunch appeared to be a positive aspect of eating at school.

Higher Quality Intake From School Lunch Meals Compared With Bagged Lunches

Studies show that nutritional quality of lunches brought from home is poor when compared with school lunches. Most of these studies were conducted in the United Kingdom, while studies of this type are limited in the United States. Therefore, this study compared lunch food, nutrient, and energy intake by lunch type (school lunch vs bagged lunch) in 2 schools in a Midwest metropolitan area of the United States. Food intake data were collected from 129 children with meal observation procedures. Energy, food, and nutrient intakes were estimated using Nutrition Data System for Research software and compared with t tests by lunch type. Children eating school lunches had higher intakes of protein; vitamins A, D, and K; and calcium and lower intakes of energy, fat, carbohydrate, vitamin E, and sugar compared with children eating bagged lunches. The ratios of mean protein and calcium consumption to minimum required values tended to be greater for children eating school lunches compared with those eating bag lunches. Children eating bag lunches had lower vegetable intake and higher whole grain and fruit intakes and higher meal energy density compared with children eating school lunch. Findings support parent nutrition education to improve the nutritional quality of bagged lunches.

Short communicationKey differences between school lunches and packed lunches in primary schools in England in 2009

OBJECTIVE

To compare the key differences between school lunches and packed lunches as consumed in a nationally representative sample of primary schools, 6-8 months after the nutrient-based standards for school lunch became mandatory.

DESIGN

Data on 6580 pupils' school lunches and 3422 pupils' packed lunches were collected between February and April 2009 from pupils attending primary schools in England. Fieldwork was conducted over five consecutive school days. Fieldworkers randomly selected ten pupils taking a school lunch and five pupils bringing a packed lunch each day at each school, and recorded and weighed all food and drink items consumed, as well as any leftovers.

SETTING

A nationally representative sample of 136 state-maintained primary schools in England.

SUBJECTS

A total of 10 002 pupils aged 4-12 years.

RESULTS

Mean intakes of protein, fat, saturated fat and vitamin C from both types of lunch met the nutrient-based standards. Pupils taking school lunches on average consumed significantly more protein, NSP, vitamin A, folate and Zn and less fat, saturated fat, non-milk extrinsic sugars (NMES), Na, Ca, vitamin C and Fe than pupils taking packed lunches. Energy intakes were low in both groups.

CONCLUSIONS

Packed lunches were less likely to accord with food-based or nutrient-based standards than school lunches. Higher levels of Na, NMES, fat and percentage energy from saturated fat emphasise the difficulties associated with optimising nutrient intakes from packed lunches.

Children’s lunchtime food choices following the introduction of food-based standards for school meals: observations from six primary schools in Sheffield

Objective

To describe the lunchtime choices and nutritional intake of primary-school-aged children in England 4 months after the introduction of interim food-based standards for school lunches.

Design

Cross-sectional 2 d weighed food records collected in January and February 2007.

Setting

Six primary schools in Sheffield, England.

Subjects

One hundred and twenty-three pupils aged 8–10 years.

Results

Vegetables (81 % v. 8 %) and cakes and biscuits (43 % v. 23 %) were chosen more frequently by pupils consuming a school lunch, while fruit (40 % v. 36 %), meat products (18 % v. 14 %), confectionery (72 % v. 0 %), savoury snacks (69 % v. 0 %) and drinks not meeting the school food standards (40 % v. 0 %) were chosen more often by pupils eating a packed lunch. Mean energy intake was lower in the school lunch group compared with the packed lunch group (1402 (sd 573) v. 2192 (sd 619), P = 0·005). Nutrient density (per MJ energy) was significantly better in school meals for key nutrients including protein (9·8 (sd 2·7) v. 6·3 (sd 1·9) g), fat (7·4 (sd 2·7) v. 10·6 (sd 2·8) g), NSP (2·8 (sd 1·3) v. 1·1 (sd 0·4) g), vitamin A (151·3 (sd 192·8) v. 69·1 (sd 55·6) μg), folate (29·6 (sd 11·6) v. 17·0 (sd 7·0) μg), iron (1·3 (sd 0·3) v. 0·9 (sd 0·3) mg) and zinc (1·1 (sd 0·4) v. 0·7 (sd 0·3) mg).

Conclusions

Schools were largely compliant with the interim food-based standards for school meals 4 months after their introduction. Within the context of the new standards, children taking a school lunch are more likely to eat a more nutritious lunch, in terms of less high-fat/salt/sugar foods and nutrient density. The introduction of nutrient-based standards is warranted. Efforts to improve the lunchtime intake of children taking a packed lunch are also required.

School and workplace meals promote healthy food habits

Objective

The present study is to describe, on the basis of recent Finnish population surveys, (i) the frequencies of school and worksite canteen use, (ii) the determinants of having a hot lunch during school or working hours and (iii) the associations of lunch eating patterns with food habits.

Setting

The study summarises mainly basic reports and studies concerning catering services conducted in Finland based on nationally representative population surveys.

Design and subjects

Cross-sectional study. The most important surveys cited in this paper are the School Health Promotion Study, the Work and the Working Conditions survey, the National FINDIET 2002 Study, and the Health Behavior and Health among Finnish Adult Population survey.

Results

School lunch is eaten by on average 70–90 % of children aged 9–18 years. Of all employees, 30 % eat at a worksite canteen daily, whereas 30 % of men and 45 % of women eat packed lunches. Nationally representative cross-sectional population surveys show that the use of catering services is associated with more healthy food habits; schoolchildren eating school meals and employees eating lunch at a worksite canteen tend to make food choices closer to nutritional recommendations as compared to those not using catering services to the same degree.

Conclusions

Some evidence exists that catering services in schools and worksites contribute to healthy eating habits in the population. In order to verify the positive role of catering services more scientific research with prospective and intervention design studies will be needed.

A comparison of British school meals and packed lunches from 1990 to 2007: meta-analysis by lunch type

Primary school children in the UK have the choice of a school meal provided by the school or a packed lunch provided from home. Currently, more than half of primary school children have a packed lunch. New food-based standards for school meals were introduced in English primary schools in 2006, followed by nutrient-based standards in 2008. No formal comparisons of primary school lunches by lunch type have been undertaken to date. The present review identified seven studies from 1990 to 2007 measuring lunchtime nutrient intake in children aged 5–11 years having a school meal and children having a packed lunch. Pooled estimates for each nutrient were as follows: energy intake was 543 (95 % CI 233, 854) kJ higher in packed lunches; total sugar intake was 14·0 (95 % CI 10·3, 17·7) g higher in packed lunches; non-milk extrinsic sugar intake was 11·7 (95 % CI 7·3, 16·2) g higher in packed lunches; saturated fat intake was 4·7 (95 % CI 2·4, 7·1) g higher in packed lunches and Na intake was 357 (95 % CI 174, 539) mg higher in packed lunches. Differences between school meals and packed lunches were larger for all nutrients after the introduction of food-based standards compared with the period of no standards. However, differences between before and after standards did not reach statistical significance. The nutritional quality of packed lunches is poor compared with school meals. The introduction of food-based standards for school meals in 2006 has moderately improved the nutrient content of school meals, slightly widening the nutritional gap between school meals and packed lunches.

Nutritional composition, assessed by chemical analyses, of prepared foods available for primary-school children: a comparison of public and private schools

Objective

To assess the nutritional quality of prepared foods available to primary-school children.

Design

Prepared foods available in a public and private school were sampled daily for 4 weeks (a total of forty-five samples) and chemically analysed for protein, fat, carbohydrate, iron, salt and sodium. The results were compared to the nutritional standards for children aged 7–10 years.

Setting

Alfenas, south-eastern Brazil.

Results

The concentration of protein, lipid, iron and sodium and the energy values of the foods at the private school were significantly higher than those at the public school. No differences were seen in the carbohydrate and salt values. The range of macronutrients was more balanced at the public school in relation to fat and protein. Foods at the private school were, in general, energy-dense. At both the public and private school, they provided the minimum energy and iron. Salt content was over twice the maximum amount, and that for sodium was over three times the amount, in both the public and private school.

Conclusions

Overall, foods prepared at the public school were better nutritional quality than those at the private school and those offered in public schools in some developed countries. This finding can probably be explained by the fact that a nutritionist, as required by law, was responsible for planning the menus at the public school. However, corrective action is needed to adjust for the wide variability in energy and nutrient content during weekdays and in the sodium content of prepared foods available in both the public and private school.

Reliability of the School Food Checklist for in-school audits and photograph analysis of children's packed lunches

BACKGROUND

Assessment of children's diets is problematic, typically relying on error-prone parent or child recall or reporting, or resource intensive direct observation. The School Food Checklist (SFC) is an objective instrument comprising of 20 food and beverage categories designed to measure the foods contained in children's packed lunches. The present study aimed to assess intra-rater and inter-rater reliability of each of the food and beverage categories of the SFC for both in-school audits and photograph analysis of children's school lunches.

METHODS

Participants comprised 176 children aged 5-8 years from five primary schools in Northern Metropolitan Melbourne. The SFC was used to measure the foods contained in children's packed lunches in the school setting and using photographs. Photograph analysis was conducted by the auditors 2-3 months after completion of in-school audits.

RESULTS

Both intra-rater [intra-class correlation coefficient (ICC) = 0.78-1] and inter-rater (ICC = 0.50-0.95) reliability analysis indicated strong agreement for in-school auditing. With the exception of the food category titled 'leftovers', there was strong intra-rater reliability for auditors' live audits and their analysis of photographs [ICC = 0.57-0.98 (Auditor 1); ICC = 0.72-0.90 (Auditor 2)], and strong inter-rater reliability for photograph analysis (ICC = 0.68-0.92).

CONCLUSIONS

The SFC is a reliable method of measuring the foods and beverages contained in children's packed lunches when used in the school setting or for photograph analysis. This finding has broad implications, particularly for the use of photograph analysis, because this approach offers a convenient and cost effective method of measuring what food and beverages children bring to school in home packed lunches.

Details and acceptability of a nutrition intervention programme designed to improve the contents of children's packed lunches

OBJECTIVE

To describe the 'Smart Lunch Box' intervention and provide details on feedback from the participants on the acceptability and usability of the intervention materials.

DESIGN

A cluster randomised controlled trial, randomised by school. English schools were stratified on percentage free-school-meals eligibility and attainment at Key Stage 2. A 'Smart Lunch Box' with supporting materials and activities on healthy eating was delivered to parents and children via schools in the intervention group. Feedback forms containing information on a total of fifteen intervention items were filled out by the parents and/or children participating in the intervention and were collected after each of the three phases of the intervention.

SETTING

Eighty-nine primary schools in England, Scotland, Wales and Northern Ireland, randomly selected; forty-four schools in the intervention arm.

SUBJECTS

A total of 1294 children, aged 9-10 years, took part in the trial. Of the 604 children in the intervention arm, 343 provided feedback after at least one of the three phases.

RESULTS

A median of twelve items out of a total of fifteen were used by responders. The two intervention items most likely to be used were the individual food boxes and the cooler bags. Whether a participant liked an item significantly affected whether they used it for all items except the cooler bag, fruity face and individual food boxes.

CONCLUSIONS

Practical intervention items aimed at parents are likely to be used in the longer term and therefore may be appropriate for use in an intervention strategy to improve packed lunches.

Serving of free school lunch to secondary-school pupils – a pilot study with health implications

Objective

To study whether service of a free school lunch has an impact on weight development and food intake among pupils at a lower secondary school, and to assess the association between self-perceived school behaviour and food intake.

Design

A controlled intervention study involving service of a free healthy school lunch to 9th grade pupils took place over 4 months, from January to May 2007. Weight and height were measured before and after the intervention. The pupils also completed a short FFQ and a questionnaire concerning self-perceived school behaviour and the classroom environment before and after the intervention. A healthy food score was calculated using the FFQ data.

Setting

All 9th graders at three different lower secondary schools in southern Norway were invited to participate. One school was randomly selected as the intervention school.

Subjects

Fifty-eight pupils (91 %) from the intervention school and ninety-two pupils (77 %) from the control schools participated.

Results

BMI did not increase among the girls at the intervention school, but increased significantly among the boys at the intervention school and among the control school groups. The healthy food score correlated positively with the trait ‘satisfied with schoolwork’ (P < 0·001). Fifteen per cent of the variance in food score could be explained by gender and the trait ‘satisfied with schoolwork’.

Conclusions

Serving of a healthy free school lunch to secondary-school pupils may result in restricted weight gain. Further studies are needed to clarify the impact of school meals on overweight and academic performance.