An ethnographic study exploring factors that minimize lunch waste in Tokyo elementary schools.

OBJECTIVE: To explore factors that minimize lunch waste in Tokyo elementary schools and to consider how such factors can be modified and applied in US schools. DESIGN: Focused ethnographic study using interviews, observation, participant observation and document review. Data were analysed using thematic analysis. SETTING: Tokyo, Japan. PARTICIPANTS: Five school dietitians participated in the study. Data collection methods included in-depth interviews, observation of nutrition education lessons, participant observation of school lunchtime and review of relevant school documents (e.g. lunch menus, food waste records). RESULTS: Five themes emerged from the analysis: (i) reinforcement of social norms to eat without waste; (ii) menu planning to increase exposure to unfamiliar and/or disliked foods; (iii) integration of food and nutrition education into the school curriculum; (iv) teacher lunchtime practices related to portion sizes, distributing leftover food and time management; and (v) engagement of students in reducing school lunch waste. Practical and tangible applications to US schools include measuring and reporting lunch waste to influence social norms, teaching students about the importance of reducing food waste, offering flexible school lunch portion sizes and providing students with meaningful opportunities to contribute to solving the problem of school lunch waste. CONCLUSIONS: Japan offers a model for minimizing school lunch waste through a holistic approach that includes factors that operate at and interact across multiple levels of society. Modifying and applying such an approach in US schools is worth considering given the urgent need to address food waste in order to support healthy diets and sustainable food systems.

Efectos de un programa alternativo de promoción de la alimentación saludable en comedor escolar / Effects of an alternative program to promote healthy eating in school canteen

Resumen El objetivo del estudio fue determinar los efectos sobre los hábitos alimentarios de escolares en una intervención educativa alternativa al modelo convencional de promoción de alimentación a un centro con comedor y proyecto de huerto ecológico. Estudio observacional descriptivo de corte transversal y comparativo de 111 niños y niñas entre 9 y 12 años, en el periodo 2013-15. Se comparó un colegio con intervención alternativa con otro que únicamente incluía contenidos propios del currículo de Educación Infantil y Primaria, mediante evaluación de adherencia a la dieta mediterránea del alumnado con cuestionario validado Kidmed. El centro de intervención presentó mayor adherencia a la dieta mediterránea que el centro control. En el centro de intervención el porcentaje de alumnado con dieta óptima (64,52%) fue mayor que los que necesitaban mejorar su dieta (33,87%), mientras que en el centro fue inferior (42,86% y 51,02% respectivamente). Los escolares del centro de intervención presentaron mayor porcentaje de respuestas afirmativas en ítems Kidmed. El programa de promoción de alimentación saludable alternativo del centro de intervención podría ser efectivo para la adquisición de una dieta de mayor adherencia a la dieta mediterránea.

Abstract The objective of this study was to determine the effects on school feeding habits in an educational intervention alternative to the conventional model of feeding promotion to a center with school canteens and ecological garden project. Cross-sectional and comparative descriptive observational study of 111 boys and girls between 9 and 12 years old, in the 2013-15 period. A school with alternative intervention was compared with another one that only included contents of the Infant and Primary Education curriculum, by means of evaluation of adherence to the mediterranean diet of the students with a validated Kidmed questionnaire. The intervention center presented greater adherence to the mediterranean diet than the control center. In the intervention center, the percentage of students with optimal diet (64.52%) was higher than those who needed to improve their diet (33.87%), contrary to what occurs in control center (42.86% and 51.02% respectively). The students of the intervention center presented a higher percentage of affirmative answers in Kidmed test. The program of promotion of healthy alternative food of the intervention center could be effective for the acquisition of a diet of greater adherence to the mediterranean diet.

[Effects of an alternative program to promote healthy eating in school canteen]. / Efectos de un programa alternativo de promoción de la alimentación saludable en comedor escolar.

The objective of this study was to determine the effects on school feeding habits in an educational intervention alternative to the conventional model of feeding promotion to a center with school canteens and ecological garden project. Cross-sectional and comparative descriptive observational study of 111 boys and girls between 9 and 12 years old, in the 2013-15 period. A school with alternative intervention was compared with another one that only included contents of the Infant and Primary Education curriculum, by means of evaluation of adherence to the mediterranean diet of the students with a validated Kidmed questionnaire. The intervention center presented greater adherence to the mediterranean diet than the control center. In the intervention center, the percentage of students with optimal diet (64.52%) was higher than those who needed to improve their diet (33.87%), contrary to what occurs in control center (42.86% and 51.02% respectively). The students of the intervention center presented a higher percentage of affirmative answers in Kidmed test. The program of promotion of healthy alternative food of the intervention center could be effective for the acquisition of a diet of greater adherence to the mediterranean diet.

El objetivo del estudio fue determinar los efectos sobre los hábitos alimentarios de escolares en una intervención educativa alternativa al modelo convencional de promoción de alimentación a un centro con comedor y proyecto de huerto ecológico. Estudio observacional descriptivo de corte transversal y comparativo de 111 niños y niñas entre 9 y 12 años, en el periodo 2013-15. Se comparó un colegio con intervención alternativa con otro que únicamente incluía contenidos propios del currículo de Educación Infantil y Primaria, mediante evaluación de adherencia a la dieta mediterránea del alumnado con cuestionario validado Kidmed. El centro de intervención presentó mayor adherencia a la dieta mediterránea que el centro control. En el centro de intervención el porcentaje de alumnado con dieta óptima (64,52%) fue mayor que los que necesitaban mejorar su dieta (33,87%), mientras que en el centro fue inferior (42,86% y 51,02% respectivamente). Los escolares del centro de intervención presentaron mayor porcentaje de respuestas afirmativas en ítems Kidmed. El programa de promoción de alimentación saludable alternativo del centro de intervención podría ser efectivo para la adquisición de una dieta de mayor adherencia a la dieta mediterránea.

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas.

OBJECTIVE: This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months. DESIGN: This study used a pre-posttest study design, with data collected before and after 3 months of HDM services. SETTING: Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas. PARTICIPANTS: Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months. MEASUREMENTS: The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month. RESULTS: After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk. CONCLUSION: Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

Effectiveness of nutritional interventions addressed to elderly persons: umbrella systematic review with meta-analysis.

Background: The number of Europeans aged over 65 will double between 2010 and 2060, reaching 30% of the European population. Nutrition is emerging as a key element of healthy life since both obesity and malnutrition are established risk factors for morbidity and disability. The aim of this umbrella review (UR) is to summarize the findings of all current systematic reviews (SRs) and meta-analyzes (MAs) on the effectiveness of nutritional intervention designed to promote healthy aging in older individuals. Methods: Eligible articles published in English or Italian between January 2000 and May 2016 were identified in six databases. Only studies that analyzed nutritional interventions in the population of 65 years and over, or papers specifically targeting older adults were deemed eligible. Results: Twenty-eight papers, out of which twenty-five SRs and three MAs, met the inclusion criteria and were included in this umbrella SR. Supplementation with vitamin D and other kind of products was highly effective in preventing falls and fractures. Furthermore, several interventions, ranging from the prescription of supplements to environmental and organizational programs, resulted in an improvement in energy and protein intake, as well as positive weight outcomes. Positive findings were also found for the elderly at risk of malnutrition and for older patients with dementia. Conclusions: The findings of this UR indicate that the use of a wide range of supplements and environmental and organizational intervention improve a number of anthropometric, nutritional and functional indices in the elderly.

Food Waste in the National School Lunch Program 1978-2015: A Systematic Review.

BACKGROUND: Food waste studies have been used for more than 40 years to assess nutrient intake, dietary quality, menu performance, food acceptability, cost, and effectiveness of nutrition education in the National School Lunch Program (NSLP). OBJECTIVE: Describe methods used to measure food waste and respective results in the NSLP across time. METHODS: A systematic review using PubMed, Science Direct, Informaworld, and Institute of Scientific Information Web of Knowledge was conducted using the following search terms: waste, school lunch, plate waste, food waste, kitchen, half method, quarter method, weight, and photography. Studies published through June 2015 were included. The systematic review followed preferred reporting items for systematic reviews and meta-analyses recommendations. RESULTS: The final review included 53 articles. Food waste methodologies included in-person visual estimation (n=11), digital photography (n=11), direct weighing (n=23), and a combination of in-person visual estimation, digital photography, and/or direct weighing (n=8). A majority of studies used a pre-post intervention or cross-sectional design. Fruits and vegetables were the most researched dietary component on the lunch tray and yielded the greatest amount of waste across studies. CONCLUSIONS: Food waste is commonly assessed in the NSLP, but the methods are diverse and reporting metrics are variable. Future research should focus on establishing more uniform metrics to measure and report on food waste in the NSLP. Consistent food waste measurement methods will allow for better comparisons between studies. Such measures may facilitate better decision making about NSLP practices, programs, and policies that influence student consumption patterns across settings and interventions.

A Cross-Sectional Study of the Relationship between Nutrition Label Use and Food Selection, Servings, and Consumption in a University Dining Setting.

BACKGROUND: Nutrition labels at the point of purchase are recommended to improve food choice, yet food choice does not always translate into food consumption. It is important to understand the relationship between label use, food selection, servings, and consumption. Previous research, which has relied on self-reported intake or inferred label use or intake based on sales data, has not adequately answered this question. OBJECTIVE: To combine survey and meal photographic data to compare food selection, servings, and consumption between label users and nonusers. DESIGN: Diners were surveyed in two cross-sectional waves during the fall 2014 semester. Food selections were recorded, and pre- and postmeal photographs were taken of diners' plate. Photographs were coded to identify the selection, servings, and consumption of MyPlate food categories. PARTICIPANTS/SETTING: Convenience sample of 1,069 diners (39% women, 53% freshman) in two university dining halls. Students had to be older than age 18 years and just beginning their meal to participate. MAIN OUTCOME MEASURES: Selection, servings, and consumption of MyPlate food categories for label users and nonusers. STATISTICAL ANALYSES PERFORMED: Differences in food selection were tested via χ2 tests, and differences in adjusted least squares means for servings and consumption were tested via t tests. RESULTS: A greater proportion of nutrition label users selected fruits, vegetables, and beans and fewer selected potatoes compared with nonusers. In addition, fewer label users selected fried foods and foods with added sugars (all P values <0.05). Label users served themselves and consumed more vegetables and fewer potatoes and refined grains compared with nonusers (all P values <0.05). CONCLUSIONS: Our results suggest label users behave differently compared with nonusers. Based on the meals observed, these differences appear more qualitative in nature (selecting different foods) than quantitative (selecting more or less food).

Healthy food availability and participation in WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) in food stores around lower- and higher-income elementary schools.

OBJECTIVE: The nutritional intake of schoolchildren is affected not only by what is consumed at school but also by what is available in food outlets near schools. The present study surveys the range of food outlets around schools and examines how the availability of healthy food in the food stores encountered varies by income status of the school and by store participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food assistance programme. DESIGN: Network buffer zones were created to reflect a quarter-mile (400 m) walk from elementary schools with lower- and higher-income student populations in Oakland, CA, USA. All food outlets within these zones were categorised by type, and audits were conducted within food stores using a checklist to assess for the presence or absence of twenty-eight healthy items (in five domains). SETTING: Mid-sized city in the USA. SUBJECTS: Food outlets near public elementary schools. RESULTS: There were considerably more food outlets around lower-income schools. Food stores near higher-income schools had higher scores in two of the five domains (healthy beverages/low-fat dairy and healthy snacks). However, there were more food stores near lower-income schools that accepted WIC vouchers. Stratification showed that WIC stores scored higher than non-WIC stores on four of the five domains. CONCLUSIONS: Although higher-income students have more access to healthy food in the environment surrounding their school, this disparity appears to be mitigated by stores that accept WIC and offer more healthy snacking options. Federal programmes such as this may be particularly valuable for children in lower-income areas.

Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program.

Serum 25-hydroxyvitamin D (25(OH)D) status in older adults enrolled in community-based meal programs is not well characterized. The objective was to identify predictors of poor serum 25(OH)D status and the response to vitamin D supplementation in a convenience sample from the Older Americans Act Nutrition Program (OAANP) in northeast Georgia (N = 158, mean age = 77 years, 81% women, 69% Caucasian, 31% African American). Mean serum 25(OH)D was 55nmol/l, and intakes of vitamin D and calcium from foods were very low. Vitamin D insufficiency (25(OH)D 25- < 50 nmol/l) occurred in 36.7%. Vitamin D deficiency occurred in 8.2% (25(OH)D < 25 nmol/l) and was associated with low milk intake, low sunlight exposure, receiving meals at home, tobacco use, depression, dementia, antianxiety medication, poor instrumental activities of daily living, and low calf circumference (p < or = 0.05). When non-supplement users (n = 28) were given a multivitamin with vitamin D (10 microg/d) and calcium (450 mg/d) for 4 months, 25(OH)D increased from 50 to 78 nmol/l, the prevalence of poor vitamin D status (25(OH)D < 50 nmol/l) decreased from 61% to 14%, and serum alkaline phosphatase decreased by 10% (p < 0.01). High body weight appeared to attenuate the increase in 25(OH)D in response to the multivitamin supplement (p < or = 0.05). In conclusion, OAANP services did not prevent poor vitamin D and calcium status, but a supplement with vitamin D and calcium was beneficial.

Acceptability of soymilk as a calcium-rich beverage in elementary school children.

Dairy products are the main source of calcium in the National School Lunch Program. Children who avoid dairy products because of lactose intolerance or other concerns can benefit from the availability of another calcium-rich beverage in the National School Lunch Program. This study assessed whether elementary school children would select and consume calcium-fortified soymilk in school cafeterias and whether the addition of soymilk would increase the percentage of students selecting a calcium-rich beverage at lunch. The ratio of saturated fat to calcium consumed from calcium-rich beverages with and without the availability of soymilk was also determined. After 4 weeks of soymilk availability, 22.3% of students chose soymilk and consumed an average of 58% of each carton, whereas 77.6% chose dairy milk and consumed an average of 52.6%. Total calcium-rich beverage selection with lunch increased from 79% to 83.1%. Calcium consumption per gram of saturated fat consumed from calcium-rich beverages also rose from 194 mg to 237 mg with the addition of soymilk.

Using smart card technology to monitor the eating habits of children in a school cafeteria: 2. The nutrient contents of all meals chosen by a group of 8- to 11-year-old boys over 78 days.

OBJECTIVE: The aim of the study was to test the abilities of the newly created smart card system to track the nutrient contents of foods chosen over several months by individual diners in a school cafeteria. METHODS: From the food choice and composition of food data sets, an Access database was created encompassing 30 diners (aged 8-11 years), 78 days and eight nutrients. Data were available for a total of 1909 meals. RESULTS: Based upon population mean values the cohort were clearly choosing meals containing higher than the recommended maximum amounts for sugar and lower than the recommended minimum amounts of fibre, iron and vitamin A. Protein and vitamin C contents of meals chosen were well above minimum requirements. Over the 1909 meals, nutrient requirements were met 41% of the time. CONCLUSIONS: The system created was very effective at continually monitoring food choices of individual diners over limitless time. The data generated raised questions on the common practice of presenting nutrient intakes as population mean values calculated over a few days. The impact of heavily fortified foods on such studies in general is discussed.

Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, Connecticut.

The goal of the present study was to examine the association of the Food Stamp Program with the food security and dietary intake of low-income children from Hartford, CT, who were enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC). We compared the food and nutrition situation of low-income preschoolers who received food stamps (FS, n = 59) with that of those who did not receive food stamps (NFS, n = 40). Children were an average age of 2.7 +/- 0.6 y, and 95% were receiving WIC benefits at the time of the study. Groups were comparable in demographic characteristics, but the socioeconomic status of the FS group was lower than that of the NFS group (P < 0.05). Food security was assessed with the Radimer/Cornell hunger scale, and dietary intake was assessed with a single 24-h recall and a 14-item food frequency questionnaire. Multivariate analyses within the FS group indicated that a monthly duration of food stamps of <4 wk was a predictor of household food security (odds ratio 0.10, 95% confidence interval 0.02-0.56). Food stamp use was associated with above-median energy-adjusted intakes of vitamin B-6 (3.13, 1.16-8.45), folate (2.92, 1.09-7.81) and iron (3.72, 1.31-10.54). The NFS children were more likely to consume <8 mg iron/d (3.73, 1.09-12.80). These results suggest that the Food Stamp Program is associated with food security and preschoolers' micronutrient intake.

Effect of income and WIC on the dietary intake of preschoolers: results of a preliminary study.

Dietary composition of energy and four nutrients targeted by the Supplemental Food Program for Women, Infants, and Children (WIC) were assessed among a random sample of 106 children aged 1 to 5 years. Fifty-one percent of children were from households with incomes above WIC eligibility levels. Of the 49% of children from households eligible for WIC by income, 42% participated in WIC. Children from low-income households were significantly more likely to have low dietary intakes of energy, vitamin C, and iron than children from higher-income households. Low-income children participating in WIC were significantly less likely to have low iron intakes than children who were eligible by income level but not participating in WIC. The percentage of children with low intakes of vitamin A and calcium did not significantly vary by household income level or by participation in WIC. Data from this preliminary study indicate that low-income children in the sample surveyed are at higher risk for consuming diets low in energy and two of four nutrients targeted by the WIC program than are children from higher-income households and that participation in WIC improves the iron intake of low-income children.

Nutritional improvement of poor urban preschool children. A 1983-1977 comparison.

The nutritional status of preschool children from 1,219 families living in an urban poverty area was surveyed in 1983 and these results were compared with findings from a similar survey of the same community done in 1977. A second comparison was made of children whose families participated in a commodity supplementary food program and those whose families did not participate. Results of the 1983 survey indicated improvements in median serum levels of vitamins A and C, hemoglobin, and red blood cell volume. Nevertheless, 9% to 18% of the children had low or deficient levels of vitamins A, C, B1, and B2, hemoglobin, serum iron, and transferrin saturation. Also a greater number of the preschoolers were categorized as thin. Annual incomes for families had significantly decreased from 1977 when the median value for food recipients was +3,078 to a median of +1,848 in 1983. Considering the decrease in other resources, federal food assistance programs seem to be the only identifiable factor contributing to the improvement in nutritional status over 1977.