A choice architecture intervention targeting school meals and water frequency intake: A school-based randomized trial

Our aim was to evaluate the impact of choice architecture on school meals and water intake frequency. We conducted a school-based randomized trial in seven elementary municipal public schools (control = 3; intervention = 4) in Rio de Janeiro, Brazil. The interventions group received the following modifications: (1) banner of the daily school meal menu and two superheroes, (2) waterproof tablecloths, (3) posters on healthy eating habits, (4) displays with playful names, (5) new containers for fruits, and (6) colored footprints for one month. Changes in school meals and daily water frequency consumption were evaluated through intention-to-treat analyses, using generalized estimating equations models for repeated measures, considering the classes' cluster effect. Data from 974 students in the fifth and sixth elementary school grades were analyzed (control = 356; intervention = 618). At baseline, 47.1% of students were female, with a mean age of 12 years (SD = 1.4), 39.2% reported daily consumption of school meals, and 45.7% consumed water from the school drinking fountain three or more times a day. We observed an increase in the odds of daily water intake in the intervention group compared to the control (OR = 1.4 95% CI = 1.1-1.9), no changes in the school meals (OR = 1.2 95% CI = 0.9; 1.6). Low-complexity strategies based on choice architecture applied in the school environment can be promising in increasing water intake frequency among elementary students in public schools. TRIAL REGISTRATION: This study was registered on the Clinicaltrials.gov platform under the number NCT03136016. Access: https://clinicaltrials.gov/ct2/show/NCT03136016.

Feasibility in meeting nutrient amounts of the National School Feeding Program and its relationship with the menu cost

We evaluated the feasibility of the menu adequacy regarding the nutritional constraints established by the National School Feeding Program (PNAE) and its relation to the cost. Each menu accounted for a given food combination within each food group. A diet optimization model comprising each set of foods was designed to obtain food quantities in order to meet the exigences of the PNAE at the lowest cost (menus with 20% and 30% of dietary reference intake for energy, macronutrients, calcium, iron, magnesium, zinc, vitamins A and C, also restrictions for sodium, saturated and trans fats, and added sugar). There was no feasible solution that accommodated all nutrient targets. Limiting components were calcium, sodium, and carbohydrates; but the menus were adequate for the other nutrients. There was a positive correlation between the menu cost and the frequency of meat and fruits, and a negative correlation with the contents of sodium and carbohydrates, and with the frequencies of rice and beans. The probability of obtaining carbohydrate adequacy was close to zero when the meat frequency was higher than one serving per week. In conclusion, it is unlikely to obtain menus that meet all the requirements of the PNAE.

Papass clinical trial protocol: a multi-component school-based intervention study to increase acceptance and adherence to school feeding

Background

One of the largest school feeding programs in the world is the National School Feeding Program of Brazil. However, results from the 2012 National School Health Survey indicated that only 22.8% of 9th grade students in Brazilian public school system consumed school meals. The literature presents few studies aiming to promote healthy food consumption in the school environment from interventions, which found inconclusive results. Thus, this study aims to present a protocol to evaluate the effectiveness of multi-component school-level interventions to increase adherence and acceptance to school feeding.

Methods

School-based multi-component clinical trial with students from 4th-9^h grade from 3 municipal schools of Sumidouro, Rio de Janeiro, Brazil, in 2019. The study design will be parallel, with 3 arms: Control group (without intervention); Intervention group 1 (changes in school environment) and Intervention group 2 (changes in menu and school environment). Interventions in the environment will be based on the principles of choices architecture and, the modification in the dishes that make up the menus offered to the students, on the factors that contribute to poor adherence and acceptance to school feeding, identified by focus groups. Adherence to school feeding will be assessed through a specific question in the questionnaire directed to the frequency of consuming school meals in the week, applied by researchers in three moments. Acceptance will be assessed from the acceptability test application with dishes served to students during the year. Statistical analyses will be performed using generalized linear models, which will be used to assess the impact of the intervention, and will include 3 main variables: intervention, time and the intervention x time interaction.

Discussion

This study will investigate if the impact of the implementation of interventions in the environment and in the dishes served to students may increase adherence and acceptance to school feeding. Positive results could show the effect of implementing interventions throughout Sumidouro’s public school system, as well as throughout the country, aiming to improve the consumption of school meals.

Trial registration

Brazilian Registry of Clinical Trials, RBR-7mf794. Date of registration: December 27, 2018.

Major food groups contributing to sodium intake in school-attending adolescents

BACKGROUND

Excessive sodium intake is a risk factor for developing systemic arterial hypertension. Increased blood pressure during childhood increases the risk of hypertension in adulthood. Assessing sodium intake across different eating places is important, as the meals offered in different places can influence dietary quality.

OBJECTIVE

This study aimed to assess the contribution of different food groups to the mean of sodium intake of school-attending adolescents in the city of Niterói, a metropolitan area of Rio de Janeiro, Brazil.

SUBJECTS

A total of 347 public school students aged between 10 and 18 years participated in the study.

METHODS

Food consumption was based on two 24-h dietary recalls. The reported items were grouped into 31 food groups and the percentage of contribution of each food group to total mean sodium intake was estimated. Sodium intake according to eating place was also estimated.

RESULTS

The food groups mostly contributing to total sodium intake were rice, beans, savory biscuits, breads, beef, poultry, processed meat, filled cookies, pasta and potatoes. The highest sodium intake within the food groups occurred at home, except for savory biscuits and pizza, which showed a higher sodium intake percentage at school. Savory biscuits were the third-most consumed item contributing to the total sodium intake and were the main source of sodium when consumed at school (48.9%).

CONCLUSION

Most sodium intake stemmed from ultra-processed food consumed at school. Therefore, actions to promote healthy eating habits within the school environment are necessary.

Composition and distribution of Darwinulidae (Crustacea, Ostracoda) in the alluvial valley of the upper Paraná River, Brazil

The occurrence and abundance of darwinulid ostracods, as well as environmental factors influencing these patterns, were investigated in the alluvial valley of the upper Paraná River. Ostracods were sampled from several substrates, like littoral sediments and pleuston, which included several aquatic macrophytes species, from 31 localities (lentic and lotic) belonging to different riverine systems. Eight darwinulid species were found, representing all genera from this family. Alicenula serricaudata, Vestalenula pagliolii, and Penthesilenula brasiliensis were the most common species. Cluster analysis based on the composition and abundance of darwinulid communities revealed the presence of five associations. Darwinula stevensoni, Vestalenula botocuda, and Penthesilenula aotearoa were almost exclusive to lotic environments. A Mantel multiple test showed that the occurrence and distribution of darwinulid ostracods were significantly related to types of habitat and systems, but not to abiotic variables. It thus seems that the hydrodynamic fluctuations of these environments are probably more important to darwinulid distribution than the limnological characteristics.