School Lunch Research Articles

Administrative Burden in the Cafeteria: Evidence from School Meal Participation in Shared Buildings

Administrative Burden in the Cafeteria: Evidence from School Meal Participation in Shared Buildings

Comparison of Food Selection with the National School Lunch Program Meal Pattern Guidelines and Assessment of Children's Food Intake and Waste Using Digital Photography in a School Cafeteria.

Background: School lunch is an important nutritious food source for children. The National School Lunch Program (NSLP) meal patterns guidelines have been established to promote healthier school lunches. This pilot study compared food selection during lunch in a school cafeteria with the NSLP meal pattern guidelines. Food intake and waste were also examined in relation to food selection. Methods: In a cross-sectional design, data were collected from children in the 1st, 6th, and 10th grades from a school in the United States. The digital photography of foods method was used to assess children's food selection, intake, and waste at lunch over 3 weeks. Results were presented as percentage, frequency, and mean ± standard deviation. Results: About 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day. Food selection in these grades consistently fell below the NSLP guidelines, with 69%, 79.8%, and 86.9% of children selecting less than the guidelines for energy, respectively. On average, only 10.4% of children selected vegetables at or above the guidelines. About 41% of the selected energy, 43% of fruits, 43% of vegetables, and 56% of milk were discarded as plate waste across all grades. Conclusions: Selection of energy and vegetables was consistently below the NSLP guidelines, yet almost half of the selected fruits, vegetables, and milk were wasted by children. Initiatives to enhance meal quality and variety, along with nutrition education interventions and school policies, are needed to improve food selection and intake and reduce food waste.

Impact of the School Food Environment on Dietary Choices and Body Mass Index Among Adolescents: A Case Study of Secondary Schools in Suakoko District, Bong County, Liberia

Adolescence is a critical period for developing lifelong dietary habits, and the school food environment plays a significant role in shaping these behaviors. With increasing rates of obesity and malnutrition among adolescents, understanding the influence of the school food environment is crucial, particularly in sub-Saharan Africa, where traditional diets are transitioning towards more processed, calorie-dense foods. This study aimed to assess the impact of the school food environment on dietary choices and body mass index (BMI) among adolescents in Suakoko District, Bong County, Liberia. A cross-sectional design was employed involving 275 students from 23 randomly selected public and private secondary schools. Data were collected using structured questionnaires, direct observations of the school food environment, and anthropometric measurements. Statistical analysis, including chi-square tests, was conducted to explore the relationships between school food environment, dietary choices, physical activity, and BMI. The results revealed that 64% of the students did not frequently choose fruits and vegetables, with food choices primarily influenced by availability and taste. A significant relationship was found between physical activity and nutritional status (p = 0.017), with regular physical activity being linked to a healthier BMI. However, no significant associations were found between school promotion of healthy eating, nutrition education, or the presence of school gardens, and students’ BMI. In conclusion, although schools play a vital role in shaping dietary habits, this study emphasizes the need for more effective interventions to improve access to nutritious foods and promote physical activity. Addressing the gaps in school infrastructure and enhancing nutrition education could contribute to better health outcomes for adolescents in Liberia.

Validation of Nutrition Literacy Questionnaire for High School Students

Background: Nutrition literacy is the individuals' motivation and ability to obtain, process, and understand nutrition information and the skills needed in order to make appropriate nutrition decisions. The present study was conducted to determine the validity and reliability of the Chongqing Middle School Nutrition Literacy Scale (CM-NLS). Methods: The CM-NLS questionnaire was translated into Farsi and then back-translated, and its face validity and quantitative and qualitative content validity were investigated in a descriptive-cross-sectional study. This review was conducted using the opinions of expert faculty members. Besides, the Persian version was tested in a sample of 400 students of the first grade of high school in Bandar Anzali city. For this purpose, two schools were randomly selected and sampled using census method. Cronbach's alpha test method was used to examine reliability, and confirmatory factor analysis was used to evaluate construct validity (RMSEA=0.062). Results: In checking face validity, changes were made in the questionnaire, and some items were removed in content validity evaluation by calculating content validity ratio (CVR) and content validity index (CVI). In reliability analysis, Cronbach's alpha coefficient was calculated as 0.74 for functional literacy, 0.82 for interactive literacy, and 0.84 for critical literacy. The results of confirmatory factor analysis showed a good fit to measure the construct validity. Conclusions: Based on the results obtained, the CM-NLS questionnaire with 33 items, is a valid and reliable tool and can be used to measure the nutrition literacy of high school students.

Co-Design and Refinement of Curriculum-Based Foodbot Factory Intervention to Support Elementary School Nutrition Education.

School-based nutrition education interventions can support the development of children's food literacy and healthy eating habits. The Foodbot Factory serious game was developed to support school nutrition education based on Canada's Food Guide and Ontario curriculum. The objective of this research was to refine the Foodbot Factory intervention to include curriculum-based lesson plans that had a high-level of acceptability by stakeholders to support implementation by teachers in classrooms. A co-design approach was used to engage teacher and dietitian stakeholders in developing five lesson plans for the intervention, who contributed to creating the intervention content in three stages. The stages included reviewing and providing feedback on the initial draft of the lesson plans, participating in facilitated discussion rounds to come to a consensus on the changes required, and completing a final review of the intervention's acceptability. Qualitative data included notes on the lesson plans and recordings from meetings that were analyzed thematically. During the first co-design stage, major revisions were suggested for two-fifths of the lessons by stakeholders. Further stakeholder suggestions were discussed and integrated into the intervention from facilitated discussions, improving the lesson plan content and intervention feasibility. All stakeholders agreed that the final version of the intervention was acceptable and would support classroom nutrition education. Five lesson plans were created and compiled into a unit plan, containing additional teaching resources, to support nutrition education with Foodbot Factory. The co-design process greatly improved the Foodbot Factory intervention and its feasibility for classroom implementation. Including diverse stakeholder perspectives led to unique and different insights to improve the intervention.

School food policy in secondary schools in England and its impact on adolescents' diets and dental health: the FUEL multiple-methods study.

School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = -2.78 g, 95% confidence interval -4.66 to -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. We need to develop healthy secondary-school food provision models that meet pupils' preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. This trial is registered as ISRCTN68757496. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children’s lunches in England and Scotland: a natural experiment

BackgroundThe Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4–7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren.MethodsData from the UK National Diet and Nutrition Survey (2008–2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4–7 years, n = 835) was compared to the change in an unexposed control group (8–11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups.ResultsBefore UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions.ConclusionsThis study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children’s diet.

SOME CONSIDERATIONS ABOUT SCHOOL MEALS IN ESPÍRITO SANTO

This article aims to analyze the National School Feeding Program (PNAE) in the state of Espírito Santo from a geographical perspective. It provides a historical overview of programs aimed at family farming and fighting hunger in Brazil, highlighting the importance of issues that permeate food, such as globalization, hunger, and the land structure of Espírito Santo, as well as their consequent impact on food production in the state. The objective is to show how the Program is important for those who produce food (farmers) and for those who consume it (students in state public schools), and that it can still be improved.

Perceptions and experiences of Universal School Meals in California: Qualitative insights from school food service directors on participation, stigma, and operational benefits and challenges.

Universal school meals (USM) aim to eliminate barriers to school meal access by providing free meals to all students regardless of family income. During the COVID-19 pandemic, United States Department of Agriculture waivers allowed schools nationwide to offer meals free of charge to all students. While USM programs have demonstrated positive effects on student health and participation, limited research has focused on the perspectives of Food Service Directors (FSD) who manage them. The study aims to explore the operational benefits and challenges encountered by FSDs, and their perceptions of the benefits of USM for students and parents during the implementation of USM during the 2021-22 school year. Qualitative using semi-structured interviews. Twenty-nine California FSDs selected through purposive sampling to ensure diversity in district size, urbanicity, and student eligibility for free or reduced-price meals. Interviews were conducted via Zoom in Spring 2022. Thematic analysis using an immersion-crystallization approach. FSDs perceived multiple benefits of USM, including increased meal participation, reduced stigma around free meals, and strong support for USM from parents and school communities. They believed consistent access to meals improved learning readiness and behavior. Operationally, FSDs reported increased administrative efficiency and the elimination of student meal debt. However, higher meal demand led to increased workloads compounded by staffing shortages, challenges in hiring and retention, and supply issues exacerbated by the pandemic. California's Kitchen Infrastructure and Training grants supported equipment upgrades. Despite challenges, FSDs were optimistic about the future of USM and expressed a strong desire for its continuation. FSDs perceived USM as beneficial for improving meal access, reducing stigma, and enhancing administrative efficiency. However, sustaining these benefits requires addressing operational challenges through targeted support and investments. Future research should assess the long-term viability of USM and strategies for overcoming challenges outside the pandemic context.

Sustainability assessment of educational approaches as food waste prevention measures in school catering

A large proportion of school meals are wasted, leading to missed opportunities to nourish pupils, environmental impacts, and economic losses. This intervention study evaluated the long-term efficacy of three educational approaches (giving feedback to guests via plate waste tracker, pedagogic meals, and kitchen workshops) in reducing plate waste in school canteens across Europe (Austria, Germany, and Sweden). Following the intervention, a sustainability assessment was conducted, including environmental, economic, and social perspectives. The results showed that the plate waste tracker significantly reduced plate waste, by 17% (4 g/guest) from an already lower baseline level of 23 g/guest, while demonstrating long-term efficacy with sustained waste reduction up to 15 months post-implementation. This reduction lowered the environmental impacts (by 212 kg carbon dioxide equivalents per school & year) and nutrient losses (1018 MJ, 12 kg protein, and 4 kg fiber per school & year), while proving cost-effective with a payback period of only 1-2 years. Therefore, despite upfront costs and implementation barriers, food waste reduction measures in school canteens provide substantial long-term benefits across environmental, economic, and social dimensions, making them a valuable investment for sustainable school meal programs.

Food Swamps and Food Deserts Impact on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Mortality in US Counties

Lacking access to quality food may increase the risk of MASLD. We investigated associations between food environment factors (food deserts and food swamps) and MASLD-related mortality across the United States (US). MASLD-related deaths were obtained from the National Vital Statistics System (NVSS) (2016-2020) and food environment factors from Food Environment Atlas (FEA). Food deserts are areas where low-income residents have limited access to affordable and nutritious food due to a scarcity of nearby grocery stores. Food swamps are areas oversaturated with outlets offering limited healthy food options. Counties in the highest mortality quartile (4th quartile) compared to the lowest mortality quartile (1st quartile) were predominantly located in the South region (78.7% vs. 23.5%) and rural areas (76.1% vs. 26.6%). These counties also had higher rates of elderly residents (19.4% vs. 16.5%), Hispanic residents (13.1% vs. 10.5%), household crowding (2.83% vs. 2.37%), no broadband internet subscription (23.9% vs. 12.7%), no high school diploma (16.1% vs. 9.0%), poverty rates (30.2% vs. 18.5%), unemployment rates (6.4% vs. 4.7%), food deserts (8.7% vs. 5.8%) and food swamp ratio (5.69 vs. 4.28) (all p-values <.001). After adjusting for county socio-demographic and clinical factors and regions, mixed-effects linear regression models showed significant differences in mortality rates (per 100,000) between counties with the highest versus lowest quartiles of food deserts (25.65 vs. 12.75, adjusted difference = 3.66 [95% CI: 2.66-4.72]) and food swamps (27.13 vs. 20.15 per 100,000, adjusted difference = 3.57 [95% CI: 2.44-4.71]). In the United States, addressing socio-demographic and food environment disparities is paramount to reduce MASLD-related mortality.

The effect of obligatory versus voluntary school food standard implementation on the fulfillment of the school food standard requirements in Germany

BackgroundIn high income countries there is increased focus on health- and sustainability aspects concerning school feeding. To ensure this in Germany, a school food standard (SFS) was established. Implementation of the SFS is mandatory only in some federal states and has remained voluntary in others. The aim of this first exploratory study is to analyze school lunch menus regarding their fulfillment of the SFS requirements and detect differences between obligatory and voluntary implementation of the SFS. MethodsAfter drawing a random sample of schools and reaching out for voluntary participation in this study, school menus of federal states with obligatory (OSFS) and voluntary (VSFS) SFS implementation were collected and analyzed. The SFS criteria are based on the conditions observed in the menu for a four-week mixed diet menu, an ovo-lacto-vegetarian dish, additional criteria for menu planning and menu criteria. In addition, we estimated binominal logistic regression models and two-step multiple regression models to control for the effects of geographical factors and socioeconomic status to the fulfillment of the SFS criteria. ResultsWe assessed 48 menus from OSFS federal states and 102 menus from VSFS federal states. OFSF menus met the requirements to a higher extent and exhibited a better dietary pattern. School food-standardized meals included significantly less breaded and deep-fried components (96 % vs. 79 %, p = 0.009), contained more whole grain products (83 % vs. 30 %, p < 0.001) and fewer meat products (60 % vs. 25 %, p < 0.001), more fruits (81 % vs. 63 %, p = 0.023) and more vegetables, legumes and salad (85 % vs. 61 %, p = 0.002). Menus with SFS obligation emphasized nutrient optimized menus significantly more frequently (42 % vs. 28 %, p < 0.001) and used unambiguous designations of meals more often (96 % vs. 82 %, p = 0.023). They contain more regional products (33 % vs. 13 %, p = 0.003), more organic products (71 % vs. 41 %, p < 0.001) and meat from animal friendly husbandry (21 % vs. 7 %, p = 0.012). The effects of the covariates were rarely significant. ConclusionSchool menus with obligatory use of the SFS met the requirements to a greater extent and contain healthier and sustainable food components more frequently. Nevertheless, results show that even in federal states with obligational use, the standard implementation is not fulfilled completely. Further research is needed to detect barriers in the daily implementation of the SFS.

Universal free school meals and children’s bodyweight. Impacts by age and duration of exposure

We study the impact on children’s bodyweight of switching from means-tested to universal provision of nutritious free school meals in England. We exploit the roll-out of universal provision across Local Authorities to estimate effects at different ages and durations of exposure, based on nurse-collected, population-wide health data for state school children. Exposure to universal free lunches reduces obesity prevalence and BMI among children aged 4–5 and 10–11, but older children’s bodyweights are less responsive than younger children’s. We find tentative evidence that effects may be cumulative, as impacts are largest for those exposed to universal free school meals throughout primary school.

Analysis of the Frequently Served Menus and Trends in Nationwide School Lunch Meals: 2021∼2023 Data from the School Meal Menu Information on the NEIS Open Educational Information Portal

Analysis of the Frequently Served Menus and Trends in Nationwide School Lunch Meals: 2021∼2023 Data from the School Meal Menu Information on the NEIS Open Educational Information Portal

Nutritional assessment of parent-packed school lunches in selected private pre - schools in Kalingalinga, Lusaka Zambia

Background: The nutritional quality of parent-packed school lunches is crucial for the health and academic performance of children. In Lusaka's Kalingalinga area, there is limited data on the factors influencing these packed lunches, especially in private schools. This study explores the nutritional content of school lunches packed by parents, assesses their knowledge and attitudes towards nutrition, and identifies key factors influencing their food choices. Methodology: A quantitative and qualitative research design was employed, with data collected through structured questionnaires from 303 parents and guardians of children attending private schools in Kalingalinga, Lusaka. The demographic characteristics, knowledge of nutrition, and factors influencing food choices were analyzed using descriptive statistics, a 24-hour food frequency questionnaire (FFQ), and Chi-square tests. SPSS version 23.0 was used for data analysis. Results: The majority of respondents were female (67.0%) and within the 18-25 age group (39.3%). Most had completed secondary education (57.4%) and were employed full-time (67.3%). Despite 95.7% acknowledging the importance of nutrition, 78.2% lacked knowledge of the nutritional content of the foods they packed. Sugary drinks (54.5%) and processed foods (51.2%) were frequently packed, while balanced meals and fruits were less consistent. The main factors influencing food choices were cost (53.1%) and peer pressure (25.4%), with only 7.3% considering nutritional value. Chi-square tests showed that occupation had a marginal relationship with adherence to nutritional guidelines (p=0.053), while age and education had no significant association. Conclusion and Recommendations: The findings reveal a gap in parents' knowledge regarding nutrition, impacting the quality of school lunches. Targeted nutritional education and policies promoting healthier eating are recommended to improve children's health in Kalingalinga, Lusaka

Avoiding hedonic contrast to increase acceptance of healthy sustainable school meals

Abstract To promote sustainable eating in schools, new approaches for embracing plant-based (PB) meals are needed. Hedonic contrast (HC) describes how liking for one item is influenced by the recent experience of other items of different hedonic valence. Despite its established impact on liking, HC’s effect on intake, particularly in repeated exposure experiments, is limited. Moreover, its effect on food-related emotions remains largely unexplored. Hence, this study investigated how HC influences liking, emotions and intake of an innovative co-created PB dish, served as part of a course meal, at school in a repeated exposure study. Two groups of students (N (HC) =71, mean age=14.5 and N (control) =57, mean age=15.3) were served the same neutrally liked main PB dish (pumpkin stuffed lentils balls (LPA)) after a starter dish (rice with vegetables) which was altered in taste through seasoning and cooking methods to be more (HC) or less (control) tasty. The exposure was repeated once/week for 5 consecutive weeks. Liking and emotional responses for the dishes were recorded through a questionnaire and food consumption by weighting plate waste. HC led to lower liking (p = 0.037) and lower positive emotions (cheerful, pleasure) with high arousal (surprise) for LPA, while increasing negative valence emotions (disappointed). Moreover, LPA consumption was significantly lower in the HC group vs the control (45% vs 60% respectively, p = 0.040), resulting in lower protein intake in the HC group (p = 0.029). The effects of HC remained stable with time. This study, for the first time, reveals a sustained rise in food-related positive high arousal emotions, when foods are presented following less liked food. Since new foods evoking positive valence and high arousal emotions have higher chances to be appreciated than foods evoking positive valence and low arousal emotions, this work opens new perspectives on how to propose new, healthier and more sustainable PB dishes in school canteens. Key messages • Avoiding negative contrast between school meals is a promising strategy to ensure higher liking, intake and increased positive emotions over repeated exposure for innovative plant-based dishes. • To enhance adolescent’s acceptance and uptake of new plant-based dishes in school canteens, it is better to serve them after less tasty options.

School canteens healthier for children and the planet in the Valencian Region

Abstract Issue SchoolFood4Change (SF4C), an EU Horizon 2020 project in 12 EU countries, aims at making school meals healthier for children and the planet through innovative and sustainable food procurement, promotion of planetary health diets and cooking, and a Whole School Food Approach. In the Valencian Region two subsequent market dialogues (MDs) were organised to explore a new school food procurement and feeding model. Description In our context, most children have lunch at school daily. SF4C sees schools as catalysts for a systemic change. Two intersectoral MDs were conducted with the participation of public authorities, food procurers, cooks and schools. The first one MD1, 23 attendees, used a gamification dynamic through building blocks. MD2, 58 participants, used a World Cafe methodology to analyse nutritional, environmental, educational, social and economic determinants. Results MD1 highlighted the need to increase food education in the curricula, value regional products and cuisine, improve culinary training and reduce food waste. It suggested establishing percentages of local and organic products in tenders and improving communication between the public administration and the educational community. MD2 emphasised the objective of promoting the Mediterranean diet and sustainability in canteens. To that end, participants identified the importance of establishing requirements in public tenders, annual planning of procurement, optimising logistics and integrating the canteen into the educational project. This would enhance predictability, economic sustainability, and social support for a new innovative model. Lessons Structured interaction between stakeholders was essential to devise innovative and sustainable solutions. The creation and dynamization of intersectoral working groups is an effective public health strategy to build networks for the co-creation of viable alternatives to achieve a healthier and more environmentally sustainable school feeding. Key messages • Structured interaction in intersectoral working groups is an effective public health strategy for the co-creation of viable alternatives to make school feeding healthier for children and the planet. • Tailored innovative and sustainable solutions entail a framework for structured discussions, specific context analysis, negotiations between stakeholders and locally adaptation of good practices.

Lunchbox content and dietary outcomes of Dutch primary school children explored by sociodemographics

Abstract Background Most children fail to meet recommended guidelines for a healthy diet. Children living in low socioeconomic areas are less likely to have healthy eating behaviours. In this study we investigated the food Dutch primary school children bring from home, and their dietary, health and school related outcomes explored by sociodemographics. Methods 5 primary schools, with high deprivation scores and a high percentage of overweight, have been included in this study (ClinicalTrials.gov NCT06058325). With observations in September 2023 we mapped the content of lunchboxes, including snacks, of children. Questionnaires for all parents and children in grade 5-8 focused on dietary and health outcomes of children and perceived class factors. Preliminary baseline data were analysed using descriptive statistics. Exploratory analyses will be conducted to show differences by sociodemographics (e.g. age, sex, parental financial stress). Results 297 lunchboxes were observed, 98.7% contained sandwiches, half being brown bread. Most children brought fruit from home for either lunch or morning snack, 13.8% not at all. 21.9% brought vegetables. 135 children completed the questionnaire: 43.0% boys, mean age 9.3 years old (SD 1.12). Children ate fruit and vegetables on an average of 5.9 (SD 1.69) and 4.9 (SD 2.23) days a week. Whereas 80% of children eats fruit every day at school, only 20% of children eats vegetables every day at school. Most children perceived their health as good (89.3%) and felt happy (89.6%). On a scale of 1 (low) to 5 (high), they rated concentration, social climate and comfort in class an average of 3.8 (SD 1.05), 4.3 (SD 1.07) and 4.3 (SD 0.92) respectively. Conclusions Lunchboxes of Dutch primary school children mainly contain sandwiches. Whereas most children eat fruit at school, the majority of children do not eat vegetables at school. A healthy school lunch might increase vegetable consumption of children and could affect health and school related outcomes. Key messages • Most Dutch primary school children eat sandwiches during lunch at school, but in half of the cases this is not brown bread as recommended by nutritional guidelines. • Most Dutch primary school children bring fruit to eat as snack or lunch, but no vegetables to eat at school. The majority also self-reported the lack of eating vegetables at school on a daily basis.

Overcoming barriers in implementing healthy school nutrition policies: insights from Ukraine

Abstract The general mortality rate from NCDs in Ukraine exceeds that in European Union countries, (Yurochko et al., 2023) exacerbated by the ongoing war. Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases (NCDs). Despite its significance, ensuring healthy eating habits, particularly during the early stages of life at the period of setting lifelong habits (Jackson et al., 2020; Riley et al., 2018), remains a challenge. Besides, school-based settings represent an ideal environment for effective intervention because they offer a shared common physical, academic, and social space (Tapia-Fonllem et al., 2020). Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions. Qualitative analysis reveals barriers such as inadequate human resources, funding constraints, resistance from the food industry, and ineffective communication strategies at the family level. Moreover, there exists a disjointed understanding of nutrition standards. However, collaborative efforts with civil society, empowerment of nursing roles, strategic utilization of grants and fundraising, engagement with the food industry, and the adoption of a family-oriented approach emerge as crucial enablers for successful policy implementation. These findings offer theoretical foundations for fostering healthier nutrition environments within schools. This research serves as a roadmap for policymakers and educators striving to create sustainable and effective strategies for promoting healthy eating among early school-age children in Ukraine and beyond. Study finds human resource shortages, funding constraints, and food industry resistance as major barriers to school nutrition policy. Recommendations include collaborative approaches, nurse involvement, and aligned standards for effective school nutrition policy. Key messages • Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases. • Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions.

Improving inclusive school food practices with parent voices

ABSTRACT In Canadian schools, food and drink offerings have yet to be explicitly incorporated in most inclusive food policies and practices. With the growing number of vegetarian and vegan (veg*n) families and literature documenting their marginalisation, this study sought to explore parents’ experiences within Ontario schools for their children who eat plant-based diets, yet also unearthed how limited choices negatively affected the good health and well-being of lactose and gluten intolerant students, as well as other dietary needs. Taking a narrative inquiry-inspired approach, interviews were conducted with 11 parents. In most schools, veg*n options were not available, and as a result, students felt socially excluded and, at times, were physically left out, which adversely affected their well-being and interrupted their learning. Most parents also felt unsupported when advocating for their children. All parents recommended partnerships for the goals of inclusion and quality education, by forming inclusive school food policies, teaching about a range of diet diversity, including why people adopt these, such as for health, animal welfare, sustainability, religion, culture, and more. By informing school food policies with parent voices, students can benefit from reduced inequalities and good health and well-being. Doing so would foster peace, justice and strong institutions.