Menu Review Research Articles

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006–2020 in Catalonia

BackgroundThe School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME’s recommendations in the meals provided by school cafeterias in Catalonia during the period 2006–2020.MethodsPre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System’s “Consensus document on nutrition in schools” and the Public Health Agency of Catalonia’s current guide “Healthy eating at school”. Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category.ResultsCompliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p = < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216).ConclusionsThe positive evolution in compliance with PReME’s recommendations provides evidence of the programme’s effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review.

Background: Children aged 2–11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children’s food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools. Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003–2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study. Results: Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool. Conclusions: The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.

Metodología de implementación de un programa de revisión de menús en comedores escolares

El objetivo del artículo es describir la metodología empleada en el desarrollo y ejecución del Programa de Revisión de Menús escolares en la ciudad de Barcelona y detallar las fases del proceso. Para llevar a cabo la estrategia se elaboró un protocolo de acción en el cual se detalla cómo proceder en cada fase. El protocolo se concibió como una herramienta interna en el marco del área de salud pública, en el que se detalla y secuencia la estrategia a seguir en la valoración de los menús escolares, así como el rol de los agentes implicados. Se constata la necesidad de un protocolo de acción estructurado y compartido por todos los agentes que permita trabajar para seguir promoviendo un estilo de vida saludable en el entorno escolar.

Understanding meaningful symptoms and challenges in people with Down syndrome and dementia: A qualitative study of caregivers’ perspectives

AbstractBackgroundPeople with Down syndrome are at an increased risk of developing Alzheimer’s Disease. As many more individuals with Down syndrome are now living into older adulthood, the prevalence of Alzheimer’s disease has risen significantly in this group. Identifying dementia symptoms in this setting can be daunting due to heterogeneous baseline function, cognition, and behaviour. Here, we interviewed caregivers to elicit their impressions of the most meaningful symptoms and challenges for people with Down Syndrome and dementia.MethodInitially, a dementia symptom menu was adapted for Down syndrome by four expert clinicians. We then recruited 10 caregivers of people with Down syndrome and dementia. Semi‐structured interviews began with open‐ended discussion of symptoms and challenges, followed by an in‐depth menu review. Interviews were facilitated by a research nurse, audio recorded and transcribed verbatim. Transcripts were reviewed by two researchers who coded quotes independently. Codes were discussed to identify emergent themes.ResultCaregivers ranged from 54‐77 years of age (median 65). Most were female (9/10) with ≥15 years of education (10/10). The person they cared for was 52‐61 years (median 58) with Down syndrome and a formal diagnosis (6/10) or clinical suspicion (4/10) of dementia. Chiefly, two themes were identified: caregiver burden and healthcare difficulties. Caregiver burden was expressed in many ways such as increased responsibilities, financial impact and emotional toll. Caregivers also described challenges with medical professionals who were not well‐equipped for these patients (“One [physician] was very honest with me and said ‘I have to tell you; I have no clinical experience with this’”). This was particularly noted by caregivers in rural areas. When asked to list their five most meaningful symptoms, caregivers reported behavioural changes (13/50, e.g. irritability/frustration) followed by cognitive decline (12/50, e.g. verbal repetition) and physical manifestations (11/50, e.g. incontinence).ConclusionIn eliciting views about the most meaningful symptoms and challenges, semi‐structured interviews identified two main themes: caregiver burden and healthcare difficulties. Although in people without Down syndrome cognitive decline is the hallmark of dementia, here caregivers interviewed frequently reported changes in behaviour and physical manifestations as most meaningful.

The Nutritional Value of Children's Menus in Chain Restaurants in the United Kingdom and Ireland

ObjectiveObesity in the United Kingdom and the Republic of Ireland is rising, as is the frequency of eating out in restaurants. The aim of this study was to investigate the nutritional quality of children's menus in restaurants. DesignCross-sectional review of menus aimed at children from 20 popular chain restaurants in the United Kingdom and Ireland. Main Outcome MeasuresTotal energy, fat, saturated fat, and salt were collected from every food item on the menu in each restaurant. All potential meal combinations were created. A total of 39,266 meals were analysed. AnalysisMeals were compared with UK nutritional guidelines. Meals from fast food and full-service restaurants and main meals and meal deals were compared. ResultsThe average meal for younger children (aged 2–5 years) contained 609 ±117 kcal, and for older children (6–12 years) 653 ± 136 kcal compared with guidelines of 364 and 550 kcal, respectively. A total of 68% of younger children's and 55% of older children's meals contained more total fat than recommended and more than 4 times the amount of saturated fat. Fast food restaurant meals contained less energy, fat, and salt than did full-service restaurants, and meal deals were less likely to meet dietary guidelines than were main meals alone. Conclusion and ImplicationsEating in chain restaurants, in particular meal deals, does not contribute positively to the diet of children in the United Kingdom and Ireland.

Barriers and Enablers to Implementation of Dietary Guidelines in Early Childhood Education Centers in Australia: Application of the Theoretical Domains Framework

ObjectiveTo identify perceived barriers and enablers to implementation of dietary guidelines reported by early childhood education center cooks, and barriers and enablers associated with greater implementation based on assessment of center menu compliance. DesignCross-sectional telephone interview. SettingEarly childhood education centers, New South Wales, Australia. ParticipantsA total of 202 cooks responsible for menu planning; 70 centers provided a menu for review of compliance with dietary guidelines. Main Outcome MeasureBarriers and enablers to dietary guideline implementation were determined using a tool assessing constructs of the Theoretical Domains Framework (TDF). Higher scores (≥6) for each construct indicated enablers to guideline implementation; lower scores (<6) suggested barriers. AnalysisMultivariable linear regression identified TDF constructs associated with greater guideline implementation. ResultsScores were lowest for reinforcement (mean, 5.85) and goals (mean, 5.89) domains, and highest for beliefs about consequences (mean, 6.51) and social/professional role and identity (mean, 6.50). The skills domain was positively associated with greater implementation of guidelines based on menu review (P = .01). Conclusions and ImplicationsCooks perceived social/professional role and identity, and beliefs about consequences to be enablers to dietary guideline implementation; however, only the skills domain was associated with greater implementation. There are opportunities to target the incongruence in perceptions vs reality of the barriers and enablers to implementation. Future research could examine the utility of the TDF to identify barriers and enablers to implementation to inform intervention development and for evaluating interventions to examine intervention mechanisms.

A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol

IntroductionThe implementation of dietary guidelines in childcare settings is recommended to improve child public health nutrition. However, foods provided in childcare services are not consistent with guidelines. The primary aim...

An Intervention to Increase Availability of Healthy Foods and Beverages in New York City Hospitals: The Healthy Hospital Food Initiative, 2010-2014.

BackgroundHospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served.Community ContextThe New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafés. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafés.MethodsHospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafés were evaluated at baseline and at the end of the HHFI to assess changes.OutcomeSixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15).InterpretationMost New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments.

Moving Forward with School Nutrition Policies: A Case Study of Policy Adherence in Nova Scotia.

Many Canadian school jurisdictions have developed nutrition policies to promote health and improve the nutritional status of children, but research is needed to clarify adherence, guide practice-related decisions, and move policy action forward. The purpose of this research was to evaluate policy adherence with a review of online lunch menus of elementary schools in Nova Scotia (NS) while also providing transferable evidence for other jurisdictions. School menus in NS were scanned and a list of commonly offered items were categorized, according to minimum, moderate, or maximum nutrition categories in the NS policy. The results of the menu review showed variability in policy adherence that depended on food preparation practices by schools. Although further research is needed to clarify preparation practices, the previously reported challenges of healthy food preparations (e.g., cost, social norms) suggest that many schools in NS are likely not able to use these healthy preparations, signifying potential noncompliance to the policy. Leadership and partnerships are needed among researchers, policy makers, and nutrition practitioners to address the complexity of issues related to food marketing and social norms that influence school food environments to inspire a culture where healthy and nutritious food is available and accessible to children.

Develop a Participatory Model in Nutrition Education to Prevent Childhood Obesity

Purpose: To investigate the effect of nutrition education and the engagement of students, parents and teachers in addressing school-specific environmental influences in eating problem. Design: This study adopted the action research process of diagnosing, action planning, taking action, evaluating, and specifying learning. Each of obese and non-obese male and female students was randomly selected based on physical screening based on obesity criteria. Dietary intake records were taken over seven days as the pre-intervention period. These four students, one of each of their parents and the teacher from the primary school, were given 3 sessions of nutrition education. After the nutrition education, dietary intake records were taken over the subsequent 7 days as the post-intervention period. Lunch observation and lunch menu review were included to identify eating problem of primary school children in school level. Findings: Students were found to consume less whole grains and more food items belonged to the “limited” and “strongly discouraged” as set in government lunch guidelines. Students’ dietary intakes before and after the nutrition education were found improved in their energy intake (p = 0.012), total fat, saturated fat, calcium, sodium, and cholesterol. Conclusion: A participatory model in elementary nutrition education could be effective.

Nutrition intervention for adults with intellectual or developmental disabilities residing in group homes: MENU‐AIDDs

Researchers with the CDC‐sponsored Montana Disability and Health Program developed the health promotion program Materials supporting Education and Nutrition for Adults with Intellectual or Developmental Disabilities (MENU‐AIDDs). The nutrition intervention was created via PAR research techniques to improve the nutrition and food systems in community‐based group homes for adults with IDD. To date, MENU‐AIDDs training and materials have been disseminated 90 group homes in Montana. This presentation will describe the MENU‐AIDDs nutrition intervention for adults with IDD and report on the results of the Montana dissemination and training of MENU‐AIDDs. Outcomes included measures of dietary intake (through menu review and food frequency questionnaire), residents’ body weights, and their gastrointestinal health improvements. Process evaluation results will also be shown, including group homes’ fidelity to the program and its acceptance by consumers, direct care staff, and home administrators. The value of MENU‐AIDDs is demonstrated as an acceptable, accessible, effective health promotion program to improve nutrition and nutrition‐related secondary conditions in community‐dwelling adults with IDD. Project funded through a cooperative agreement with the Centers for Disease Control and the Montana Department of Public Health and Human Services.

ISphere: A Free-Hand 3D Modeling Interface

Making 3D models should be an easy and intuitive task like free-hand sketching. This paper presents iSphere, a 24 degree of freedom 3D input device. iSphere is a dodecahedron embedded with 12 capacitive sensors for pulling-out and pressing-in manipulation on 12 control points of 3D geometries. It exhibits a conceptual 3D modeling approach for saving mental loads of low-level commands. Using analog inputs of 3D manipulation, designers are able to have high-level modeling concepts like pushing or pulling 3D surfaces. Our experiment shows that iSphere saved steps in the selection of control points in the review of menus and leading to a clearer focus on what to build instead of how to build it. Novices saved significant time learning 3D manipulation by using iSphere to making conceptual models. However, one tradeoff of the iSphere is its lack of fidelity in its analog input mechanism.