Meal Programs Research Articles

Nutritional Content and Health Profile of Single-Serve Non-Dairy Plant-Based Beverages.

A growing number of people are seeking a non-dairy plant-based beverage both for their personal health, and for the health of the planet. The aim of this study was to conduct a cross-sectional survey of single-serve plant-based beverages to assess their nutritional content and health profile. A total of 51 non-dairy plant-based beverages were analyzed from the nutrition label listed on the commercial package. The various beverages contained extracts of soy (n = 14), almonds (n = 13), oats (n = 12), peas (n = 7), banana (n = 2), coconut (n = 2), and rice (n = 1). Almost one-half (45%) of the single-serve beverages had 5 g or more of protein/serving. A total of 75% and 65% of the single-serve beverages had calcium and vitamin B12 levels, respectively, fortified to at least 20% of the Daily Value (DV), while only 28% had vitamin D fortification at the 20% DV level. Two-thirds of the single-serve beverages had high sugar levels, while 39% were low in sodium, 63% were low in fat, and 96% were low in saturated fat. The single-serve plant-based beverages had more protein, calcium, vitamin B12, and sugar but less fat than the non-dairy, multi-serve plant-based beverages/ serving. A limited number of single-serve beverages met the requirements of school meal programs.

Associations Between Meal Program Participation and Protein Intake in People Over 65 (NHANES 2013-2018)

Protein plays a critical role in healthy aging. Little research exists regarding the association between meal program participation and protein consumption among individuals 65 and older. The objective of this research is to provide health professionals with a better understanding of how meal program participation through delivery services or congregate sites may relate to nutritional status. We analyzed cross-sectional data on 2845 individuals ≥65 years old who participated in the National Health and Nutrition Examination Survey (NHANES) during 2013-2018. Using linear regression models, we explored relationships between meal participation and covariates ( sex, race, marital status, income, and age) on protein intake. Protein intake did not differ significantly between individuals who participated in meal programs and those who did not. However, among individuals who answered whether or not they participated in meal programs, race was significantly associated with decreased protein intake. Non-Hispanic Blacks experienced a two-day average 8.82 grams lower [SE:1.48; p<.0001] that their white counterparts. Similarly, Hispanic/Latinos’ two-day protein average was 4.29 grams lower [SE:2.05; p=0.0426]. The association between earning an income of <$20,000 per year and protein intake was also statistically significant [β: -8.44. SE:2.4, p=0.0014]. Understanding protein intake among older adults who utilize meal programs is a gap in current literature. Results from this research may inform questions that health professionals should include in their assessments of older adults and provide guidance for nutrition policies and meal programs for people over 65.

Eating Difficulties among Older Adults with Dementia in South Korean Long-Term Care Facilities: A Scoping Review

This study aims to synthesize existing literature concerning eating difficulties among older adults with dementia in long-term care facilities. A scoping review, using the framework proposed by Arksey & O'Malley (2005) and improved and supplemented by Levac et al. (2010), was conducted. Literature was searched from five bibliographic databases—Research Information Sharing Service (RISS), Korean studies Information Service System (KISS), National Digital Science Library (NDSJ), Korean Medical Database (KMBASE), DataBase Periodical Information Academic(DBPia), Google Scholar, and gray literature. Literature selection and characteristics were approved by two independent reviewers, using pre-tested forms to determine final inclusion. Eventually, 111 articles from 2012–2020 were identified, and the 11 articles were used for the final analysis. We found that primarily utilized Eating behavior scale (EBS) and Edinburgh feeding evaluation in dementia scale (EdFED) had utilized as measurement tools for evaluating eating behavior. The most common factors related to eating behavior of older adults with dementia included cognitive and physical functions in the individual domain, the caregiver's attitude toward eating in the inter-individual domain, and types of meal in the environmental domain. Therefore, it is essential to develop measurement tools that reflect the eating behavior of older adults with dementia, a comprehensive understanding of the eating behavior of old adults with dementia, and create effective interventions that can be implemented in the specificity of long-term care facilities in Korea. The results of this analysis are intended to be used as basis to develop a meal support programs for older adults with dementia.

Sustainability of the Aging Network's COVID-19 Responses: Isolated Impact or Transformative Change?

The COVID-19 pandemic mobilized individuals, organizations, and communities. Area Agencies and Aging (AAAs) and Title VI Native American Programs, core organizations of the network of community-based organizations (CBOs) that serve older adults and their families, pivoted their service delivery methods to provide life-sustaining services. Their long-standing expertise in community needs assessment, pre-existing cross-sectoral partnerships, and an infusion of emergency federal funding, enabled this rapid response. Recently concluded studies using key-informant interviews and national surveys of AAAs and Title VI programs highlight these service adaptations, from expansion of home-delivered meal programs to new partnerships in telehealth. These organizations also reported expansion of services offered and people served, and the emergence or strengthening of partnerships with other CBOs, businesses, and governmental organizations such as public health entities. For example, 78% of the respondents to the recent survey of AAAs reported that they have a role in vaccination outreach, scheduling support, or delivery. The papers in this symposium will use these new studies to describe the nature, origins, and potential sustainability of new and expanded services and partnerships. The Collective Impact Model for community change (introduced in the Stanford Social Innovation Review) will provide a framework for the discussion. Built on the importance of cross-sector coordination, the five pillars of success for collective rather than isolated impact are: a common agenda, mutually reinforcing activities, continuous communication, shared measurement, and a backbone organization. Each of these five pillars is relevant to the heightened community response during the pandemic, and to the likelihood of sustainability.

Effectiveness of an Intergenerational Service-Learning Program to Change Attitudes on Aging

This study evaluated the efficacy of a 10-hour intergenerational service-learning program administered to undergraduates to determine if it would increase knowledge about aging, improve attitudes about older adults, and reduce ageism more than a course with less service-learning activity. Making maximum impact on students in these areas in a short amount of time is particularly relevant in short, quarter-based university programs. A quasi-experimental design using a convenience sample compared pre-test and post-test scores between an experimental intervention (N=68) and a comparison (N=71) group on The Facts on Aging Quiz Multiple Choice version, Aging Semantic Differential, and Fabroni Scale on Ageism. Qualitative data via open-ended survey questions was also collected. The experimental intervention, the Lives Well Lived project, was based on a documentary film by the same name, which incorporates themes of successful aging. During the project students and older adults interviewed one another about living a life well lived, participated in a photo shoot, and created a Memoir for the older adult. The comparison group included two social visits to a congregate meal program. Results from multiple regression analysis showed that students in the intervention group had less ageist stereotypes and less negative bias about aging at post-test and qualitative data indicated they were more inclined to participate in intergenerational relationships in the future. Programs like this one that are longer and more relational may be useful for consideration in undergraduate gerontology courses in reducing ageism and promoting intergenerational relationships which benefit those of all ages.

Terrie Fox Wetle Award (2020): The Role of Home-Delivered Meals Programs in Improving Health and Promoting Community Independence for Older Adults

Dr. Terrie “Fox” Wetle is internationally recognized as a leader who conducts and advocates for multi-disciplinary and multi-method investigations centered on aging, public health and health care with direct implications for shaping policy and practice. This award lecture, given in Dr. Wetle’s name, will be presented by the 2020 award recipient, Kali Thomas, PhD. Dr. Thomas will present a line of multi-disciplinary and multi-method research focused on the impact of home-delivered meals as it relates to the health outcomes of homebound, food insecure older adults. Findings will include results from observational and intervention studies conducted at both the local and national levels. Examples of how this evidence has influenced policy and practice, including greater integration with healthcare, will be provided. The lecture will conclude with discussion about future opportunities for collaboration with community partners to measure and understand the impact of these vital social services on the lives of older adults.

Older Americans Act Meals Programs: Responding to the Pandemic

This session provides insights into how the pandemic challenged the capabilities and ingenuity of the Older Americans Act (OAA) programs and the aging network. Speakers will include key aging network stakeholders, who will discuss the overnight evolution of programs serving often isolated older adults.

Strategic Sodium Reduction Initiative Reduces Sodium in Meals Served at Older Adult Congregate Meal Program Sites

Excessive sodium consumption is a public health issue and congregate meal programs provide a unique opportunity to reduce sodium served to a large, at-risk population. A Sodium Reduction Initiative (SRI) was implemented in a congregate meal program that serves over 3,000 older adults. Nutrient analyses conducted at baseline and post-intervention were used to calculate average sodium reduction and the number of low sodium foods; targeted foods were categorized by strategy. Customer satisfaction surveys were collected at baseline and 3- and 6-months post-intervention. Kruskal Wallis and analysis of variance were used to compare sodium reduction differences. Chi-square analysis determined associations among strategies. The SRI impacted 55 foods, low sodium foods increased by 22%, and the average sodium per menu cycle was reduced by 21%. Replacement with a lower sodium food was the most frequently used strategy and had the largest sodium reduction. Sauces and main entrees were most frequently impacted, and thirteen ingredients accounted for 75% of all reduced-sodium foods. Over 50% of the 1,424 survey respondents consumed the reduced-sodium foods and food satisfaction remained stable from baseline to post-intervention. Congregate meals programs that target commonly used foods and key ingredients can significantly reduce sodium served to older adults.

Akshaya Patra: A Leader in Battling Classroom Hunger

Akshaya Patra, the world’s largest mid-day meal program run by a not-for-profit organization, was started in 2000 by serving approximately 1500 school going children in Bangalore, India. In 2009, the organization achieved a milestone of serving one million lunches to the school children. By 2021, it had been feeding more than 1.8 million children and aimed at feeding five million children by 2025. Akshaya Patra also offered its services to people affected during natural calamities like floods and earthquakes, and for the homeless living in shelter homes[2]. It was also the first NGO managed food programme in the world to receive the FSMS ISO 22000:2005 certification. The project received an entry in the Limca Book of Records and India Book of Records[3]. The organisation was able to successfully create a partnership model that included governmental funding, contribution from individuals and support from for-profit companies and not-for-profit organisations.

Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka

BackgroundHigh rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children.MethodsThe study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples.ResultsThe dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort.ConclusionsMidday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.

Crowd-out in school-based health interventions: Evidence from India’s midday meals program

Governments often rely on schools to implement multiple programs targeting child outcomes. How to improve the implementation of these programs is an important, open question. As part of a randomized controlled trial in Odisha, India, we measured the impacts of a nutrition program and a monitoring intervention on the implementation of a pre-existing school-based nutrition program, specifically the Indian government’s iron and folic acid supplementation (IFA) program. The new nutrition intervention distributed a micronutrient mix (MNM) to be added to school meals while the monitoring intervention varied the intensity of monitoring activities. We find that high intensity monitoring improved implementation of the government’s IFA program, while the MNM intervention crowded it out. The net effect is that high intensity monitoring improved child health, while the MNM intervention did not. Both crowd-out of the IFA program and sensitivity to monitoring were predominantly found among schools that were resource or capacity constrained.

Eating Difficulties among Older Adults with Dementia in South Korean Long-Term Care Facilities: A Scoping Review

Purpose: This study synthesized the literature on eating difficulties among older adults with dementia in long-term care facilities.Methods: A scoping review, using the framework proposed by Arksey &amp; O'Malley (2005) and supplemented by Levac et al. (2010), was conducted. Literature was searched from RISS, KISS, DBpia, PubMed, and CINAHL. Two reviewers independently selected studies and extracted their characteristics, using pre-tested forms to determine final inclusion. In total, 1283 articles were identified, and 13 articles were used for the final analysis.Results: The Eating Behavior Scale and the Edinburgh Feeding Evaluation in Dementia scale were the most widely utilized measurement tools. The most common factors related to eating behavior in older adults with dementia were cognitive and physical functions in the individual domain, the caregiver's attitude toward eating in the inter-individual domain, and meal type in the environmental domain.Conclusion: Measurement tools reflecting the eating behavior of older adults with dementia must be developed to obtain a comprehensive understanding of this issue and create effective interventions for the specific context of long-term care facilities in Korea. The results of this study are intended to serve as a basis to develop meal support programs for older adults with dementia.

A Technology Training Program to Alleviate Social Isolation and Loneliness Among Homebound Older Adults: A Community Case Study.

Despite substantial evidence of the negative health consequences of social isolation and loneliness and the outsized impact on older adults, evidence on which interventions are most effective in alleviating social isolation and loneliness is inconclusive. Further complicating the translation of evidence into practice is the lack of studies assessing implementation and scalability considerations for socialization programs delivered by community-based organizations (CBOs). Our primary objective was to describe the implementation barriers, facilitators, and lessons learned from an information and communication technology (ICT) training program aimed at reducing social isolation and loneliness for homebound older adults in a home-delivered meals program. Participants received in-home, one-on-one ICT training lessons delivered by volunteers over a 14-week period with the goal of increasing social technology use. To assess implementation facilitators and barriers, 23 interviews were conducted with program staff (n = 2), volunteers (n = 3), and participants (n = 18). Transcripts were analyzed using thematic analysis. Aspects that facilitated implementation included the organization's existing relationship with clientele, an established infrastructure to deliver community-based interventions, alignment of intervention goals with broader organizational aims, and funding to support dedicated program staff. Challenges to implementation included significant program staff time and resources, coordinating data sharing efforts across multiple project partners, participant and volunteer recruitment, and interruptions due to COVID-19. Implications of these facilitators and barriers for scalability of community-based ICT training interventions for older adults are described. Lessons learned include identifying successful participant and volunteer recruitment strategies based on organizational capacity and existing recruitment avenues; using a targeted approach to identify potential participants; incorporating flexibility into intervention design when working with the homebound older adult population; and monitoring the participant-volunteer relationship through volunteer-completed reports to mitigate issues. Findings from this formative evaluation provide insight on strategies CBOs can employ to overcome challenges associated with implementing technology training programs to reduce social isolation and loneliness for older adults, and thus improve overall well-being for homebound older adults. Recommendations can be integrated into program design to facilitate implementation of ICT programs in the community setting.

Farm-to-school nutrition programs with special reference to Egypt and Morocco

The United States’ Farm-To-School Program (F2SP) is a competitive grant program that targets participants of the National School Lunch Program and School Breakfast Program with the aim of increasing the quantity and frequency of locally sourced fruits and vegetables offered to children during the school year. This narrative review aims to summarize the outcomes of the F2SP’s interventions on child health and wellness using the research available to date and provide points to consider when implementing the F2SP outside of the United States, particularly in Egypt and Morocco. Analysis of the existing literature showed that both Egypt and Morocco have been beneficiaries of their aid and have seen improvements in the number of children receiving meals at school. With its centralized school meals system, and with support from the World Food Programme (WFP), Egypt has the infrastructure to set up and sustain a long term F2SP that will enrich local communities, grow local economies, and support the health of the next generation. As the WFP continues its work in Morocco, the focus should be maintained on developing a strong school meals system and addressing immediate food insecurity. The viability of such a program being implemented should be reassessed once outcomes from current hunger relief efforts become available. Additional research is needed to continue to study the feasibility, applicability, and impact of this program, especially as it would be applied in areas with no centralized school meals programs across North Africa. Keywords: Farm-to-school nutrition; school meals; Egypt; Morocco

A Content Analysis of Implementation Strategies Chosen by Virginia School Nutrition Directors

Objective: School-based interventions are common approaches to address childhood obesity; however, there is little understanding of strategies that can foster their implementation into schools. In this study, we aimed to identify goals and the specific strategies selected by school nutrition directors (SNDs) in Virginia to execute school-based interventions. Methods: Between 2018 and 2019, SNDs in Virginia participated in Team Nutrition workshops through which they created action plans. We carried out a content analysis of 132 action plans collected from 100 school divisions. We developed codes deductively and inductively. The codes captured plan completion, goals, and strategies. Each plan was independently coded by 2 coders. Results: Action plans included 1.2 goals (SD = 0.54) and 3.9 strategies per goal (SD = 2.1). Goals were most commonly related to improving menus or increasing participation in the school meal programs. The strategies varied based on the goals. However, obtaining buy-in from school personnel and students was the most commonly included goal (64.4%) across plans. The level of action plan completion decreased with each subsequent section of the worksheet. Conclusions: Emerging patterns identified in this study suggest SNDs’ strategy selection is based on goals and that trainings should be tailored to promote the development of skills required to execute optimal strategies.

Sustainable School Meal Programs in Sinda District, Zambia: A Qualitative Descriptive Study

Sustainable School Meal Programs in Sinda District, Zambia: A Qualitative Descriptive Study

Understanding the Key Factors of Older Adults' Continuance Intention in Congregate Meal Halls.

Eating congregate/community meals with friends promotes a balanced and healthy diet among older adults. It is helpful for postponing aging, preventing chronic diseases, and improving their quality of life. However, little research has examined the continuance intention for older adults with the congregate meal program in Taiwan. This study established a model for key factors of older adults’ continuance intention dining at senior meal halls, and hypotheses to explain them, and subsequently designed questionnaires and scales. By analyzing the longitudinal data collected from 416 individuals using survey questionnaires, we found that the perceived service quality is the main factor that affects the perceived satisfaction, and the perceived satisfaction of the older adults plays an important role in this survey. It showed that if the older adults are satisfied with the service quality provided by the senior meal halls, which will accordingly affect the post-use trust, they will show a positive continuance intention to participate in the senior meal halls. We also found that the older adults have positive views on the planning and service contents of the existing senior meal halls. Together, these results illustrate the process and provide comprehensive insights and evidence to create a better user experience and improve the satisfaction of the congregate meal for older adults.

How Did School Meal Access Change during the COVID-19 Pandemic? A Two-Step Floating Catchment Area Analysis of a Large Metropolitan Area.

SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students—especially those in low-income households—lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the “supply” (meal access points) and the “demand” (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals—especially for summer meal programs—could lead to positive long-term impacts on children’s health and well-being.

Nutrition Supports Deconstructed and Disrupted: An Evaluation of a Multilevel School-Based Intervention during the Time of COVID.

The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver–child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in breakfast consumption at home and a decrease in use of the school breakfast program (F(1.78, 74) = 19.64, p < 0.001, partial η2 = 0.21) and school lunch program (F(1.51, 74) = 23.30, p < 0.001, partial η2 = 0.24). Rates of FS and eating behaviors did not change significantly over time. Correlations of program usage and eating behaviors demonstrate the importance of promoting participation in school meal programs. BFF may have prevented significant decreases in FS during COVID-19.

A systematic review of the determinants of the nutritional quality of food for homeless populations

Abstract Introduction Studies assessing the nutritional quality of food provided to homeless population show deficiencies in micronutrients and excess fat, sugar and salt. The availability of cheap, energy-dense and nutrient poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homelessness population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise qualitative literature with the aim of understanding of the determinants of the nutritional quality of food provided to the homeless population. Methods This qualitative evidence synthesis will include English language primary research empirical studies from Europe, North America and Oceania. Searches will be conducted on Web of Science, CINAHL, Embase, Scopus, PsycINFO, Google Scholar, OpenGrey and ProQuest. Quality appraisal will be conducted using the Standards for Reporting Qualitative Research tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Results Demographic data on study participants and findings and quotations will be extracted. Thematic synthesis will be employed. Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this presentation. Conclusions Findings from this review will be used to develop best-practice guidelines for policy makers and service providers to improve the nutritional quality of food provided in the homeless sector. Key messages The determinants of the nutritional quality of food provided to the homeless population are influenced by multiple factors. This review will provide a comprehensive assessment of these determinants. This presentation will detail the iterative steps undertaken to conduct this systematic review.