Evaluation of the Climate Impact and Nutritional Quality of Menus in an Italian Long-Term Care Facility.

Global warming poses a significant threat to our planet, with the food sector contributing up to 37% of total greenhouse gas emissions. This study aimed to assess the climate change impact and healthiness of menus in a long-term care facility in Italy. We analyzed two 28-day cyclical menus using the carbon footprint (CF) and the Modified EAT-Lancet Diet Score (MELDS) to evaluate adherence to the Planetary Health Diet (PHD). Monte Carlo simulations were employed to explore 20,000 daily menu permutations. Results showed that the mean GHGEs of spring/summer and autumn/winter daily menus were 2.64 and 2.82 kg of CO2eq, respectively, with 99% of menus exceeding the 2.03 kg of CO2eq benchmark. Only 22% of menus were adherent to the PHD, with MELDSs ranging from 12 to 29. A strong inverse association between the CF and adherence to the PHD was observed. These findings suggest significant potential for reducing the CFs of meals served in nursing homes while promoting adherence to a planetary diet, presenting an opportunity to set new standards in caregiving and environmental sustainability.

Public Procurement Practices for Cereal Products in Polish Educational Institutions: Analysis and Implications for Nutrition Policy.

Public procurement of food is crucial for ensuring proper nutrition and the provision of high-quality products in public institutions like schools and kindergartens. It should be seen as an investment in health promotion, particularly for young children. Notably, when no quality criteria are specified, the cheapest and often lowest-quality products are typically selected. This study analyzed 1126 public procurement orders processed by schools and kindergartens in Poland between November 2022 and March 2023, with a focus on cereal products and their derivatives. Of these orders, 197 met the inclusion criteria, yielding a total of 5084 cereal products for detailed analysis. The study assessed the quantities ordered and the quality characteristics specified in the procurement documents. The results revealed that the most commonly described criteria pertained to product composition, especially typical characteristics and the absence of additives. Sensorial characteristics such as consistency and color were also frequently specified, while sustainable public procurement criteria were mentioned the least, indicating their marginal importance in current procurement practices. This underscores the critical importance of establishing minimum standards for describing cereal products in terms of sensorial characteristics, composition, and sustainability. Such standards are essential for improving the quality of grain products supplied to public institutions and ensuring that these institutions actively contribute to promoting healthy eating habits among children.

Quality and Quantity of School Lunch in Nanjing: Based on Data from the Sunshine Restaurant Supervision Platform.

School lunch plays an important role in children's healthy growth. Previous investigations revealed many problems with school lunches, including unreasonable dietary structure and insufficient micronutrients. This study aimed to assess the dietary structure and nutritional quality of lunches in Nanjing primary and middle schools. A stratified cluster random sampling method was used to select 44 schools that supply lunch in 12 districts in Nanjing, with two primary and two middle schools in each district. Twenty-four primary and twenty middle schools were selected. The Mann-Whitney U test was used to explore the influencing factors. Findings revealed a serious shortage of milk and fruit in school lunches; supply of eggs, fish, shrimp, and shellfish was less than half of the recommended quantity; livestock and poultry supply exceeded the recommended level by over four times. Energy and nutrition intake were suboptimal. Provision of energy, carbohydrates, vitamins (A, B1, B2, and C), calcium, and iron in urban primary schools was significantly higher than that in non-urban primary schools. The same pattern of significantly higher nutrients was equally seen in urban middle schools compared with non-urban middle schools, indicating that food supply was affected by regional economies. Therefore, it is urgent to improve the quality of lunches, with a particular focus on those in non-urban areas.

Food Safety Exam Phrasing for Food Service Employees.

In many jurisdictions, foodservice workers are required to obtain food handler certification via written examination before being able to work. This study investigated the effect of the readability, or the ease in which one can read and comprehend written text, of food handler exam questions on exam performance. It was hypothesized that the reduction in cognitive load by improving the readability of exam questions would lead to improved scores. Participants received training in personal hygiene and basic food safety and were tested on their knowledge using questions that were worded using the traditional phrasing and updated phrasing that has improved readability. The results indicate that improved readability had a significant difference in the personal hygiene section but not on the basic food safety section. These results are due, in part, to the types of cognitive load (intrinsic vs. extraneous) that are required to solve different types of problems.

National Policies to Limit Food Marketing and Competitive Food Sales in Schools: A Global Scoping Review.

School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, gray literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess the implementation and efficacy of existing policies.

The Quality of Lunches Brought from Home to School: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis, spanning studies published between 1995 and 2021, investigates various aspects of lunches brought from home (LBFH) to school by children. These meals, in contrast to those provided by the National School Lunch Program (NSLP), lack strict nutritional standards. Despite the availability of NSLP lunches, ∼40% of US children opt for LBFH. This review aims to assess the food content and nutritional quality of LBFH, their adherence to NSLP standards in terms of nutrition and cost, effectiveness of intervention programs designed to enhance their nutritional quality and parental and student perceptions of LBFH. The comprehensive literature search yielded 28 eligible papers, with 16 included in meta-analysis. LBFH commonly include fruits (50%), yet vegetables (17%) and dairy (25%) are less prevalent. They frequently contain snacks (50%), sweets (48%), and sugar-sweetened beverages (31%). Compared with school lunches, LBFH exhibit lower levels of calcium, protein, iron, fiber, and vitamin A, and higher levels of carbohydrates and saturated fat. Intervention programs had no effect on quality of LBFH. On average, LBFH ($1.81) cost slightly less than lunches served at school ($1.98), without accounting for free/reduced-price meals in the calculation. The cost of school lunch for pre-k and kindergarten children became $11.32, nearly 4 times higher than that of LBFH ($2.92), after replicating the meal at home and accounting for meal preparation time. Parents preferred LBFH over school lunches because of concerns related to the quality of school meals served. This study concludes that LBFH are generally less nutritious compared with lunches provided by NSLP. Future research needs to further explore ways to improve parent perception of NSLP. Especially with many states making free meals available to all children, identifying effective ways in promoting and increasing NSLP participation can ensure more children have access to nutritionally balanced and affordable lunches.

How effective is nutrition training for staff running after school programs in improving quality of food purchased and meal practices? A program evaluation.

OBJECTIVES / PURPOSE: After school programs represents a setting for promoting healthy dietary habits. The aim of this study was to evaluate how effective the after school program staff perceived nutrition training aiming to improve quality of food purchased and meal practices. We further aimed to assess the changes in purchase of primarily fish and fish products, whole grains and fruit and vegetables, by collecting receipts from food purchase before and after the intervention. RESULTS: This is a mixed methods study. Group interviews with after school staff were carried out and the data was analyzed deductively according to the RE-AIM framework. Receipts from food purchase were collected. Findings from the qualitative interviews indicated that the intervention had been a positive experience for the staff and suggested a new way of working with promoting healthy foods in after school program units. Although there were some challenges reported, the staff made necessary adjustments to make the changes possible to sustain over time. Findings from the receipts support the changes reported by the staff. These showed increased purchase of vegetables, fish, and whole grain in all four after school program units. After school programs in similar settings may expand on these findings to improve the students' dietary habits.

School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity.

INTRODUCTION: Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income. METHODS: Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023. RESULTS: Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats. CONCLUSIONS: HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.

Robust implementation of school food policy is needed to improve nutritional outcomes of children in European and Western Pacific countries: A systematic review.

OBJECTIVE: The present systematic review explored compliance status with school food policies in Europe and the Western Pacific regions, challenges and facilitators of policy compliance, and its impact on children's diets and nutrient intakes. RESEARCH METHODS: An electronic search for full-text research articles published between January 2009 and July 2023 was conducted in Science Direct and PubMed scientific databases. RESULTS: A total of 659 titles and abstracts were screened, and final data was extracted from 34 included studies. Results showed low compliance with the school food policy in Europe and the Western Pacific regions. The European schools chad better compliance than the Western Pacific, and supportive interventions improved policy adherence. Impact assessment studies reported that the implementation of the school food policy increased fruit and vegetable consumption, thus increasing nutrient intakes (vitamin A, vitamin D, iron, calcium, folate, and dietary fibers). However, its impact on the availability and consumption of foods high in fat, sugar, and salt (HFSS) was less conclusive. The effects of the policy on the school food environment indicated no significant improvement. CONCLUSION: Results highlighted the need for additional support and surveillance at the school level to ensure adequate policy compliance.

Examining school nutrition policies and their effect on the promotion of low-nutrient foods in the context of sports advertising.

OBJECTIVES: Despite recommendations to implement nutrition standards in schools, low-nutrient foods and high-energy drinks are still some of the most important challenges for school management and students' purchasing and consumption behavior. In this regard, the aim of the present study is to examine school nutrition policies and their effect on the promotion of low-nutrient foods in the context of sports advertising. METHODS: A partial least square technique with SmartPLS 3.0 and bootstrapping with 500 resamples was used to examine the effect of food marketing on school nutrition policies and students' nutritional involvement. Online surveys were done through The Iranian Educational Network of students and measured on a 5-point Likert scale. The survey questionnaire consisted of 3 scales to measure the following: school nutrition policies, advertising of low-nutrient foods, and student nutritional involvement. RESULTS: Results from a sample of 382 Iranian high school students revealed that low-nutrient food advertising has a significant effect on student consumption, and the greatest overall effect on students' nutritional involvement. School nutrition policies were affected by media, endorsement, and the environmental advertising, whereas school financial capabilities had the greatest direct effect on students' nutritional involvement. CONCLUSIONS: These findings suggest that advertising through sports media plays a mediating role in school nutrition policies and student nutritional involvement. Policy changes to restrict food marketing for young people must include both television and non-broadcast media.

Proposta de categorização dos serviços de alimentação no Estado do Rio de Janeiro com foco no risco sanitário de doenças transmitidas por alimentos / Proposal for the categorization of food services in the State of Rio de Janeiro with a focus on the sanitary risk of foodborne diseases

A Categorização dos serviços de alimentação com foco no risco sanitário de Doenças Transmitidas por Alimentos no Brasil foi uma experiência pontual e exitosa com o Projeto de Categorização da Copa do Mundo FIFA® de 2014. Devido a Lei Federal de liberdade econômica nº13.874 de 20 de setembro de 2019, que classifica os serviços de alimentação como atividades de baixo risco, as Vigilâncias Sanitárias devem rever o planejamento de suas ações. O objetivo geral desse trabalho foi formular uma proposta para implantar o sistema de Categorização dos serviços de alimentação no Estado do Rio de Janeiro. Para isso foi realizada uma pesquisa aplicada com análise documental que derivou o desenvolvimento de produtos tecnológicos e inovadores. Elaborou-se um roteiro para auxiliar na escrita do ato normativo da Categorização de serviços de alimentação; uma planilha para facilitar o cálculo do risco sanitário; um guia e um vídeo orientativo para auxiliar o processo de implantação da Categorização dos serviços de alimentação. Os produtos desenvolvidos podem ser utilizados para a autoavaliação do serviço de alimentação e pelas Vigilâncias Sanitárias nas inspeções com foco no risco de Doenças Transmitidas por Alimentos. O resultado da Categorização será comunicado ao público consumidor informando a qualidade sanitária dos serviços de alimentação categorizados. A elaboração dessa proposta subsidia os estados e municípios para o processo de implantação da Categorização, bem como auxilia na mensuração do risco sanitário dos serviços de alimentação, planejamento das ações de Vigilância Sanitária com base no risco, valorização dos serviços de alimentação que investem nas Boas Práticas de Manipulação de Alimentos e comunicação da categoria ao consumidor para que faça uma escolha consciente.

Categorization of food services with a focus on the health risk of Foodborne Diseases was a sharp and successful experience during the 2014 FIFA® World Cup in Brazil. Due to the Federal Economic Freedom Act nº 13.874 of September 20, 2019, which classifies food actions by the Health Public Surveillance. The main idea of this project was to formulate a proposal to install The Categorization of food services in the state of Rio de Janeiro. Technological research was carried out with an analysis that resulted in the development of technological and innovative products. A script was created for the surveillance inspector to assist in the writing of the normative act of The Categorization for food services; a spreadsheet to make the calculation of Foodborne Diseases health risks easier; a guide and an orientation video were made on the process of installing The Categorization for food services and establishing the inspection score parameters. The developed products can be used for the self-evaluation of food services and by the Health Surveillance agents in their inspections, always focusing on the risk of Foodborne Diseases. The score of the Sanitary Inspection will be communicated to the consumer audience, informing the sanitary quality of the food service. This proposal sponsors the states and counties for the implementation process of The Categorization, as well as in the measurement of the sanitary risks of food services. The Sanitary Surveillance plan is based on health risks from Foodborne Diseases and the appreciation of food services that invest in Proper Food Handling Practices and the communication from the grade received on the sanitary inspection to the consumer so that they make an informed and smart decision about where they eat.

Healthy Canteen Certification Seal: a proposal for the promotion of appropriate and healthy diets in school canteens / Selo de Certificação Cantina Saudável: uma proposta para a promoção da alimentação adequada e saudável em cantinas escolares

ABSTRACT Objective Although school is considered a suitable space for health promotion, there have been difficulties adopting healthy eating practices due to many ultra-processed foods offered in school canteens and irregularities in Food and Nutrition Education actions. This study aimed to propose a certification seal to encourage school canteens' managers in Brazil to adopt actions for the Promotion of Appropriate and Healthy Diets. Methods It is a methodological study in which the "Healthy Canteen Certification Seal" was developed, containing ten guidelines based on the Dietary Guidelines for the Brazilian Population. The instrument was built based on national and international documents and later was consensually agreed upon by experts using the Delphi method. Results Ten guidelines for the Seal were developed around the following topics: the creation of a Council, availability of written and accessible standards; stimulation of water intake; offer of natural foods, limitation of processed and ultra-processed foods, promotion of educational actions, prohibition of abusive food advertisements, structural changes, and staff training. The overall evaluation of the proposal by the experts was positive concerning its relevance, and more than 70% of positive results were attained for all guidelines. The participants agreed that the Seal would contribute to expanding and enhancing healthy eating practices in schools. Conclusion We believe that this proposal will encourage educational institutions to adopt and implement actions for the Promotion of Appropriate and Healthy Diets, thus contributing to ensuring Food and Nutrition Safety for students.

RESUMO Objetivo Embora a escola seja considerada um espaço adequado para a promoção da saúde, dificuldades na adoção de práticas alimentares saudáveis têm sido observadas devido à oferta de uma grande quantidade de alimentos ultraprocessados em cantinas escolares e irregularidades nas ações de Educação Alimentar e Nutricional. Este estudo teve por objetivo propor um selo de certificação para estimular cantinas escolares do Brasil a adotarem ações de Promoção da Alimentação Adequada e Saudável. Métodos Trata-se de um estudo de natureza metodológica no qual se desenvolveu o instrumento "Selo de Certificação Cantina Saudável", contendo dez orientações coerentes com as diretrizes do Guia Alimentar da População Brasileira. O instrumento foi elaborado com base em documentos nacionais e internacionais e posteriormente pactuado via consenso com especialistas por meio da metodologia Delphi. Resultados As dez orientações foram elaboradas em torno das seguintes questões: criação de um Conselho, presença de normas escritas e acessíveis, incentivo à ingestão de água, oferta de alimentos in natura e limitação de processados e ultraprocessados, estímulo a ações educativas, proibição de propagandas abusivas sobre alimentos, mudanças estruturais e treinamento de funcionários. A avaliação global da proposta pelos especialistas foi positiva quanto à sua relevância, sendo obtidos resultados superiores a 70% para todas as orientações. Os participantes concordaram que o Selo contribuirá para ampliar e aprimorar a alimentação saudável nas escolas. Conclusão Acredita-se que essa proposta incentivará as instituições educativas a aderirem e implementarem ações de Promoção da Alimentação Adequada e Saudável, devendo contribuir para a garantia da segurança alimentar e nutricional dos escolares.

Academy of Nutrition and Dietetics: Revised 2021 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Management of Food and Nutrition Systems.

Management of food and nutrition systems (MFNS) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for food and nutrition services within an organization. RDNs in MFNS are frequently employed in acute care, but also expand into a multitude of other settings in which management of nutrition and foodservice is required, for example, foodservice departments in assisted living and post-acute and long-term care; colleges and universities, kindergarten through grade 12 and pre-kindergarten schools and childcare; retail foodservice operations; correctional facilities; and companies that produce, distribute, and sell food products. RDNs in MFNS aim to create work environments that support high-quality customer-centered care and services, attract and retain talented staff, and foster an atmosphere of collaboration and innovation. The Management in Food and Nutrition Systems Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for RDNs in MFNS for 3 levels of practice: competent, proficient, and expert. The SOPP describes 6 domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOPP depict how these standards apply to practice. The standards and indicators for RDNs in MFNS are written with the leader in mind-to support an individual in a leadership role or who has leadership aspirations. The SOPP is intended to be used by RDNs for self-evaluation to assure competent professional practice.

An Integrated Control Plan in Primary Schools: Results of a Field Investigation on Nutritional and Hygienic Features in the Apulia Region (Southern Italy).

Data concerning overweight and obesity in children and adolescent populations are alarming and represent one of the most serious public health problems of our time. Moreover, it is demonstrated that the school environment may play an important role in health promotion with regard to nutritional aspects. This article reports the results of a study conducted in the Apulia region (Southern Italy), aimed at providing an integrated surveillance of the behaviors related to nutrition habits in students and the hygienic and nutritional conditions of the school's canteens attended by enrolled students. To this purpose, a sample of 501 students attending primary school (third class-children approximately eight years old) replied to a validated questionnaire, and official controls (OC), of both food and nutritional safety, were performed in 22 primary schools. A team of healthcare professionals carried out the study, and the implementation of all the prescribed improvement actions were subsequently verified through follow-up OC. The results of our study show a critical situation in the student sample, with 41.3% of children having a weight excess (overweight or obesity). With regard to the children's behaviors, only 59.8% of children ate at least one fruit or had a fruit juice for breakfast, and 10.8% did not have breakfast at all. Overall, 40.1% of the total children played outdoors the afternoon before the survey and 45% reported going to school on foot or by bicycle. During the afternoon, 83.5% of the sample watched television or used video games/tablets/mobile phones, while 42.3% played sports. The schools had an internal canteen with on-site preparation of meals in 36.4%, the remaining 63.6% received meals from external food establishments. With regard to OC, for the hygienic-sanitary section, eleven prescriptions were issued, in the great part related to the structure and organization of the canteen. For the nutritional section, nine corrective actions were prescribed, mainly related to official documents and management. The follow-up OC showed that all prescriptions were subsequently addressed. Eating at school was less frequent among obese and overweight students compared with those with normal weight. Although this evidence needs to be further confirmed, it highlights the potential role that the school canteens may play in health promotion and prevention of nutritional disorders. On the other hand, in order to fulfill its health promotion task, the school canteens have to comply with official regulations and guidelines; therefore, OC during the management of the food service at school are needed.

Improving the Food Environment in Washington State-Run Correctional Facilities: The Healthy Commissary Project.

Improvements to correctional facilities' food environment can provide healthier food and beverage options for incarcerated individuals, a population disproportionately affected by chronic disease. This article describes efforts to increase healthy options in the commissary program at Washington State correctional facilities from 2017 to 2019, and the role of a multidisciplinary collaboration between the state's Department of Corrections, Department of Health, and Statewide Family Council. Through the development, implementation, and promotion of nutrition standards, the nutritional quality of foods and beverages in the commissary program improved.

Implementation of Minimum Nutrition Standards and Best Practices in Childcare Centers.

BACKGROUND: The federal Child and Adult Care Food Program (CACFP) provides reimbursable meals to 4.6 million children annually and sets nutrition standards for foods served. Licensing regulations in many states extend these rules to nonparticipating programs. OBJECTIVE: To evaluate the quality of meals and snacks served in Connecticut licensed childcare centers in 2019 and assess implementation of a state licensing requirement to adhere to CACFP minimum nutrition standards in all centers. DESIGN: Cross-sectional survey. PARTICIPANTS/SETTING: Two hundred licensed childcare centers in Connecticut in 2019. MAIN OUTCOME MEASURES: Meal/snack quality was assessed based on menus. Foods/beverages listed were compared to the minimum CACFP nutrition standards and optional best practices. Surveys completed by center directors measured center characteristics. STATISTICAL ANALYSIS: Logistic and linear multivariable regression models tested differences in centers' adherence to nutrition standards and best practices by CACFP participation status. RESULTS: CACFP centers complied with more required nutrition standards than non-CACFP centers (an adjusted mean of 4.7 vs 3.4 standards among programs serving meals, P < 0.001), with particularly large mean differences for whole grains and low-fat milk. Implementation of optional best practices, except for beverages, was relatively low among all centers, especially for snacks. Compliance (adjusted mean number of minimum nutrition standards met) was greater among centers accredited by the National Association for the Education of Young Children and those using a registered dietitian or a sponsoring agency to prepare menus and receiving food from a vendor. Recent completion of nutrition training was associated with greater mean implementation of best practices. CONCLUSIONS AND IMPLICATIONS: Better adherence to minimum nutrition standards and best practices among CACFP-participating childcare centers contributed to higher nutritional quality of meals and snacks offered. Snack quality would benefit most from greater compliance with nutrition standards. Providers outside of CACFP need additional supports in the implementation of licensing regulations to improve the food environment for young children.

Identification and Critical Appraisal of Food Service Satisfaction Questionnaires for Use in Nursing Homes: A Systematic Review.

BACKGROUND: Food service provision in nursing homes is a complex, adaptive system through which multiple stakeholders interface. Organizational stakeholders include staff involved in preparing and delivering meals. Consumer stakeholders are the end users including residents and family. Questionnaires can be an economical and efficient method of measuring food service satisfaction in nursing homes and a powerful quality improvement tool. OBJECTIVE: (1) To identify questionnaires that measure food service satisfaction of various stakeholders in a nursing homes and (2) to critically appraise the psychometric properties of identified questionnaires. METHODS: Five electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Medline, ProQuest, Scopus, and Cochrane) in April 2020. Data from the eligible studies were extracted, and the psychometric properties were critically appraised using the Consensus-Based Standards for the Selection of Health Measurement Instruments. RESULTS: This review identified 129 studies that used a questionnaire to measure food service satisfaction in nursing homes. Of those, 107 studies representing 75 unique general nursing home satisfaction questionnaires were excluded for failing to adequately explore aspects related to food service. From the remaining 22 studies, 7 food service satisfaction questionnaires were identified; 5 intended for consumers (residents) and 2 intended for organizational stakeholders (staff). Using the Consensus-Based Standards for the Selection of Health Measurement Instruments quality criteria, most questionnaires had flaws in content validity and construct validity, primarily due to small sample sizes. No questionnaires explored food service satisfaction from the family perspective. CONCLUSIONS: Nursing homes collect satisfaction information for accreditation, marketing, benchmarking, and quality improvement. Although questionnaires are easy to administer, the quality of the data they collect is impacted by the validity and reliability of the questionnaires used. Using unreliable satisfaction data may mean that nursing homes are not accurately able to understand the impact of changes in the system on stakeholder satisfaction.

Analytical Assessment and Nutritional Adequacy of School Lunches in Sintra's Public Primary Schools.

School meals present several cost benefits overtime at the short, medium, and long term for individuals and society. This cross-sectional study aims to analyse the nutritional composition and evaluate the adequacy of school lunches. One hundred and fifty-eight samples were collected and analysed from 10 primary schools in Sintra's municipality, served during one week. On average, energy (27.7% daily energetic requirements) and carbohydrate (48.1%) contents did not reach the reference values, and the content of protein (19.5%) exceeded the reference value (p < 0.05). The mean total fat (28.8%) and saturated fatty acids (5.4%) content complied with the recommendations. The mean salt (1.7 g) and dietary fibre (8.3 g) content exceeded the reference value but did not differ significantly from the recommendations. Addressing school canteens is crucial, not only in a nutritional approach, but also as an opportunity to achieve healthier, sustainable, and accessible food systems, aligned with the Sustainable Development Goals 2030. We highlighted the importance of evaluating evidence-based practices and disseminated practice-based evidence regarding the adequacy of school lunches.

The impact of COVID-19 on food systems, safety, and security-a symposium report.

Our food systems depend on complex interactions between farmers and food producers, local and federal governments, and consumers. Underlying these interactions are economic, environmental, and societal factors that can impact the types of food available, access to food, affordability, and food safety. The recent SARS-CoV-2 global pandemic has affected multiple aspects of our food systems, from federal governments' decisions to limit food exports, to the ability of government agencies to inspect food and facilities to the ability of consumers to dine at restaurants. It has also provided opportunities for societies to take a close look at the vulnerabilities in our food systems and reinvent them to be more robust and resilient. For the most part, how these changes ultimately affect the safety and accessibility of food around the world remains to be seen.

Availability of Lower-Sodium School Lunches and the Association with Selection and Consumption among Elementary and Middle School Students.

BACKGROUND: During 2010, the US Department of Agriculture updated the school meals standards, including three progressively decreasing sodium targets. The Target 1 standards went into effect in 2014, but during 2018, the US Department of Agriculture delayed the Target 2 standards until 2024 and eliminated the Target 3 standards citing concerns regarding the availability and acceptability of lower-sodium foods. In addition, there are currently no sugar standards, and it is unknown whether sugar is substituted for salt in lower-sodium school foods. OBJECTIVE: To examine the availability, selection, and consumption of school lunches already in alignment with the Target 2 and 3 sodium levels and the association between sodium and sugar. DESIGN: An observational cafeteria-based study conducted during fall 2018. PARTICIPANTS AND SETTING: Students (n = 1985) in grades three through eight attending 13 elementary/kindergarten through eighth-grade schools in a large, urban school district in New England. MAIN OUTCOME MEASURES: Availability, selection, and consumption were examined using plate waste methodology. STATISTICAL ANALYSES PERFORMED: Mixed-model analysis of variance accounting for student demographic characteristics with schools/students as a random effect (students nested within schools) were used to examine differences in availability, selection, and consumption. Linear regression was used to examine the association between sodium and sugar in the school foods. RESULTS: The majority of meals selected (87%) and consumed (98%) were already in alignment with the Target 2 standards. There were significant inverse associations between sodium levels and consumption; each 100-mg increase in sodium was associated with a decrease in consumption by 2% for entrées (P = 0.002) and 5% for vegetables (P = 0.01). When examining the association between sodium and sugar, each 10-mg reduction in sodium was associated with 1-g increase in sugar among entrées (P < 0.0001), whereas there was a significant positive association between sodium and sugar with vegetables and condiments. CONCLUSIONS: This study provides some evidence that schools may already have the ability to provide lower-sodium meals that are acceptable to students, and therefore the recent rollbacks to the sodium standards may be unwarranted. Study findings suggest that the US Department of Agriculture should take under consideration policies that would limit added sugar for school meals as sugar may be substituted for salt.