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Kokkorou M, Spinelli S, Dinnella C, Monteleone E. Interventions based on sensory-hedonic strategies and on nudging to facilitate vegetable and pulses consumption in the school environment. Compr Rev Food Sci Food Saf 2024; 23:e13312. [PMID: 38462822 DOI: 10.1111/1541-4337.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024]
Abstract
Childhood and adolescence shape lifelong taste preferences and dietary habits, making them crucial periods for promoting healthy and sustainable eating. As students consume up to half of their daily energy intake at school, school interventions can have a significant impact on promoting plant-based diets. Although the benefits of promoting plant-based diets on children's and adolescents' health and environmental sustainability are well established and various studies report promising effects of interventions based on sensory-hedonic strategies and on nudging in promoting vegetables and pulses in schools, a comprehensive collection of those reports is lacking. Therefore, this systematic review aims to collect published literature on the above interventions in schools that focus on promoting the consumption of vegetables and pulses to children and adolescents. Three databases-PubMed, Scopus, and Web of Science-were searched over all years until March 2022 using pre-specified terms. From the 10.488 studies identified, a total of 57 studies reporting sensory-hedonic (e.g., manipulating food sensory properties or their hedonic value) or nudging (e.g., changing the presentation) interventions targeting children and/or adolescents in schools and aiming at promoting vegetables and/or pulses were included. Overall, interventions based on sensory-hedonic strategies (either enhancing the perception of well-accepted flavor and texture or manipulating their hedonic value) and on nudging (through incentives and prompts) are effective in promoting vegetables and pulses. A gap in the literature was identified for interventions targeting adolescents and promoting pulses. Finally, multicomponent interventions, rather than using one strategy alone, could be more successful.
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Affiliation(s)
- Margarita Kokkorou
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
| | - Sara Spinelli
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
| | - Caterina Dinnella
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
| | - Erminio Monteleone
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
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Palmer S, Burton-Obanla A, Goon S, Allison T, Mitchell A, Bogdonas K, Fombelle M, Hoffman A, Smith J, McCaffrey J, Prescott MP. Policy, Systems, and Environmental Changes in Child Nutrition Programs: A Systematic Literature Review. Adv Nutr 2024; 15:100116. [PMID: 37716534 PMCID: PMC10700153 DOI: 10.1016/j.advnut.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023] Open
Abstract
The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and environmental (PSE) change strategies are being implemented in child nutrition programs. An evaluation of the current evidence supporting PSE interventions in school nutrition programs is needed to facilitate evidence-based practices across the nation for programs. This systematic review aims to determine the quality and breadth of available evidence of the effectiveness of PSE strategies on the consumption and waste of fruits, vegetables, milk, and water in the NSLP. The inclusion criteria required studies to occur in a United States K-12 school setting, data collection after 2012, report consumption and waste findings for fruit, vegetable, milk, or water, and be an original research article. Articles included in the review are restricted to positive or neutral quality. Thirty studies are included, policy level (n = 4), systems level (n = 8), environmental level (n = 10), and multi-category (n = 8). Results from positively rated policy-level studies suggest that recess before lunch may increase milk consumption, whereas removing flavored milk may decrease consumption. System-level studies of offering vegetables first in isolation of other meal components and offering spiced vegetables compared with traditional preparations may increase vegetable consumption, and locally procuring produce may increase fruit and vegetable consumption. Environmental-level studies such as water promotion strategies such as placing cups near drinking fountains may increase water consumption. Improving the convenience, attractiveness, and palatability of fruits and vegetables may increase consumption. Future PSE research in child nutrition programs should incorporate implementation aides and metrics into their study designs to allow a better understanding of how to sustain interventions from the perspective of school nutrition professionals.
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Affiliation(s)
- Shelly Palmer
- Department of Food Science and Human Nutrition, University of Illinois Urbana Champaign, Champaign, IL, United States
| | - Amirah Burton-Obanla
- Division of Nutritional Sciences, University of Illinois Urbana Champaign, Champaign, IL, United States
| | - Shatabdi Goon
- University of Illinois Extension, Urbana, IL, United States
| | | | - Ana Mitchell
- Division of Nutritional Sciences, University of Illinois Urbana Champaign, Champaign, IL, United States
| | | | | | - Ashley Hoffman
- University of Illinois Extension, Urbana, IL, United States
| | - Jenna Smith
- University of Illinois Extension, Urbana, IL, United States
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Cohen JFW, Hecht AA, Hager ER, Turner L, Burkholder K, Schwartz MB. Strategies to Improve School Meal Consumption: A Systematic Review. Nutrients 2021; 13:3520. [PMID: 34684521 PMCID: PMC8538164 DOI: 10.3390/nu13103520] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023] Open
Abstract
School meals can play an integral role in improving children's diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students' access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., "Smarter Lunchroom") techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students' access to flavored milk. Several studies found increases in students' meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).
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Affiliation(s)
- Juliana F. W. Cohen
- Department of Public Health and Nutrition, Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
| | - Amelie A. Hecht
- Institute for Research on Poverty, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, USA;
| | - Erin R. Hager
- Departments of Pediatrics and Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Kara Burkholder
- College of Liberal Arts and Science, University of Connecticut, Storrs, CT 06269, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA;
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