A qualitative study exploring the perceptions of children, parents and school staff towards the development and implementation of school lunch provision within primary schools in the Netherlands.

BACKGROUND: There is no tradition of serving school lunches in primary schools in the Netherlands. Most children tend to bring their own packed lunch, however these are often nutritionally suboptimal. While school lunch provision can aid healthy eating behavior amongst children, its introduction would constitute a profound change for children, parents and school staff. Therefore, this qualitative study aims to explore children's, parents and school staffs' perceptions of both the current lunch situation and the implementation of school lunch provision within primary schools in the Netherlands. METHODS: In this qualitative study we conducted nine interviews with school principals, 98 interviews with children, and held six focus groups with teachers and six with parents at primary schools in two Dutch cities. The data was analysed via iterative coding. RESULTS: The results showed that most children and parents are satisfied with the current lunch situation, although existing school food policies are not always put in place. Most teachers felt that children had insufficient time to consume their lunch in the current situation. The children were generally positive about the idea of a school lunch, and stressed that it was important to have the ability to choose. While both parents and school staff saw school lunch provision as an opportunity to educate families about healthy food options, they also expressed concern about who would be responsible, as well as the financial and organizational implications of its introduction. CONCLUSIONS: Perceptions of children, parents and school staff about a school provided lunch are mixed. A complex intervention such as a new school lunch program is difficult to envisage for all parties involved and more research is needed regarding the effects, organization, logistics and the costs of school lunch provision in the Netherlands.

Which factors promote and prohibit successful implementation and normalization of a healthy school lunch program at primary schools in the Netherlands?

BACKGROUND: A school provided healthy lunch might help to improve the nutritional quality of children's lunches. However, in the Netherlands, school lunch programs are not common. The aim of this study was to identify factors that promote or inhibit the implementation of a school lunch program at primary schools, from the viewpoint of school professionals. METHODS: A cross-sectional online survey was conducted among 204 primary school professionals. The normalization process theory and its four constructs (i.e. coherence, cognitive participation, collective action, reflective monitoring) were used to develop questions and interpret findings. Descriptive statistics were used for 14 multiple choice questions (yes, no, don't know) and thematic content analysis for qualitative responses. RESULTS: Participants had a shared understanding about how a lunch program differed from current practices. Most participants had the same view on the rationale for implementation (coherence), such as equality among children. Sixty percent expected that a healthy school lunch will contribute to healthier eating by the children. Participants showed different degrees of cognitive participation (46% indicated that healthy school lunch is good idea). Commitment depended on their belief whether providing a healthy lunch was part of their responsibility as school and 30% expected a large effect on their daily work (collective action). When appraising school lunch implementation (reflective monitoring), participants' concerns focused on feasibility and adaptability of a program in their own school. CONCLUSIONS: The introduction of a school lunch program will require substantial effort, although there is considerable support and understanding about potential benefits. The findings point to a number of preconditions for large-scale introduction, including the need for support-both financially and organizationally-bottom-up involvement of teachers, children and parents and freedom to adapt the program.

Content of lunchboxes of Dutch primary school children and their perceptions of alternative healthy school lunch concepts.

OBJECTIVE: To investigate the content of lunchboxes of primary school children and to examine children's support and preferences for alternative healthy school lunch concepts. DESIGN: A cross-sectional study among Dutch children from seven primary schools. The content of the lunchboxes was assessed by photographs. Support and preferences for alternative lunch concepts were examined via a self-reported questionnaire. Linear regression analyses were used to investigate the associations between children's support and preferences and sex, educational group and migration background. SETTING: The Netherlands. PARTICIPANTS: Primary school children. RESULTS: A total of 660 children were included (average 9·9 years old). Most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts 'Sandwiches prepared by the children themselves' and a 'hot lunch buffet' had the highest mean support, while the concept 'a healthy lunch brought from home' was the most preferred concept. Small significant differences were observed depending on sex, educational group and migration background. CONCLUSION: Lunchboxes of Dutch children contained sandwiches and a drink but rarely fruit and vegetables. Among different alternatives, children reported the highest support for the preparation of their own sandwiches in class or a hot lunch buffet. Future studies should investigate if these alternative lunch concepts improve the dietary intake of children.

Reading Food Experiences from the Face: Effects of Familiarity and Branding of Soy Sauce on Facial Expressions and Video-Based RPPG Heart Rate.

Food experiences are not only driven by the food's intrinsic properties, such as its taste, texture, and aroma, but also by extrinsic properties such as visual brand information and the consumers' previous experiences with the foods. Recent developments in automated facial expression analysis and heart rate detection based on skin color changes (remote photoplethysmography or RPPG) allow for the monitoring of food experiences based on video images of the face. RPPG offers the possibility of large-scale non-laboratory and web-based testing of food products. In this study, results from the video-based analysis were compared to the more conventional tests (scores of valence and arousal using Emojis and photoplethysmography heart rate (PPG)). Forty participants with varying degrees of familiarity with soy sauce were presented with samples of rice and three commercial soy sauces with and without brand information. The results showed that (1) liking and arousal were affected primarily by the specific tastes, but not by branding and familiarity. In contrast, facial expressions were affected by branding and familiarity, and to a lesser degree by specific tastes. (2) RPPG heart rate and PPG both showed effects of branding and familiarity. However, RPPG heart rate needs further development because it underestimated the heart rate compared to PPG and was less sensitive to changes over time and with activity (viewing of brand information and tasting). In conclusion, this study suggests that recording of facial expressions and heart rates may no longer be limited to laboratories but can be done remotely using video images, which offers opportunities for large-scale testing in consumer science.

Some insights into the development of food and brand familiarity: The case of soy sauce in the Netherlands.

With the increasing globalization, new unfamiliar flavors gradually find their way into local Western cuisines. The mechanisms behind the successful integration of novel flavors into local cuisines are largely unknown. This study investigates the effects of frequency of soy sauce use, levels of food neophobia, and brand specificity on liking of a relatively unknown flavor in the Netherlands, soy sauce. A total of eighty-nine (26 men and 63 women; mean age 47.5 ± 17.7 years) high- and low-frequency users of soy sauce rated liking of five soy sauces separately presented with and without branding information. Liking of four soy sauces with the typical salty and savory flavor increased with increasing frequency of use, and with decreasing levels of food neophobia. Another soy sauce with additives resulting in a distinctive taste was liked irrespective of the frequency of use. Soy sauces, which were recognized correctly or incorrectly as the participants' own familiar brand, received 50% higher or lower liking ratings than other soy sauces, respectively. Furthermore, users of one of the brands preferred the taste of their own brand over that of other brands, whereas users of the other brands did not show such specificity, indicating clear differences in specificity of liking soy sauce among the various user groups. This study provides insights into consumer liking and preference of semi-familiar foods, revealing the contribution of consumer traits and brand familiarity that may influence the spread of unfamiliar foods.

Effect of Branding and Familiarity of Soy Sauces on Valence and Arousal as Determined by Facial Expressions, Physiological Measures, Emojis, and Ratings.

Food experiences can be summarized along two main dimensions: valence and arousal, which can be measured explicitly with subjective ratings or implicitly with physiological and behavioral measures. Food experiences are not only driven by the food's intrinsic properties, such as its taste, texture, and aroma, but also by extrinsic properties such as brand information and the consumers' previous experiences with the foods. In this study, valence and arousal to intrinsic and extrinsic properties of soy sauce were measured in consumers that varied in their previous experience with soy sauce, using a combination of explicit (scores and emojis), implicit (heart rate and skin conductance), and behavioral measures (facial expressions). Forty participants, high- and low-frequency users, were presented with samples of rice and three commercial soy sauces without and with brand information that either matched or non-matched the taste of the soy sauce. In general, skin conductance and facial expressions showed relatively low arousal during exposure to the brand name and again lowest arousal during tasting. Heart rate was lowest during exposure to the brand name and increased during tasting probably resulting from the motor activity during chewing. Furthermore, the results showed that explicit liking and arousal scores were primarily affected by the taste of the specific soy sauce and by the participants' previous experience with soy sauces. These scores were not affected by branding information. In contrast, facial expressions, skin conductance, and heart rate were primarily affected by (1) the participants' level of experience with soy sauce, (2) whether or not branding information was provided, and (3) whether or not the branding information matched with the taste. In conclusion, this study suggests that liking scores may be most sensitive to the food's intrinsic taste properties, whereas implicit measures and facial expressions may be most sensitive to extrinsic properties such as brand information. All measures were affected by the consumers' previous food experiences.

Improving dietary intake during lunch through the provision of a healthy school lunch at Dutch primary schools: design of a pretest-posttest effectiveness study.

BACKGROUND: Since there is a shift from eating lunch at home to eating lunch at primary schools in the Netherlands, providing a school lunch may be an important opportunity to improve the diet quality of Dutch children. Therefore, the aim of this Healthy School Lunch project is to encourage healthy eating behavior of children at primary schools by offering a healthy school lunch, based on the guidelines for a healthy diet. In this study, two research questions will be addressed. The first research question is: What and how much do children consume from a self-served school lunch and how do they evaluate the lunch? The second research question is: Do children compensate healthier school lunches by eating less healthy outside school hours? The purpose of this paper is to report the rationale and study design of this study. METHODS: In the Healthy School Lunch project children in grades 5-8 (aged 8-12 years) of three primary schools in the Netherlands will receive a healthy school lunch for a 6-month period. To answer research question 1, lunch consumption data will be collected at baseline and again at 3- and 6-months. This will be measured with lunch photos and questionnaires among children. To answer the second research question, a quasi-experimental, pre-test post-test intervention-comparison group design (3 intervention schools and 3 comparison schools) will be carried out. Potential compensation effects will be measured with a single brief questionnaire among parents at the three intervention and three comparison schools at month 6 of the lunch period. The school lunch will also be evaluated by parents (discussion groups) and teachers and support staff (brief questionnaires). DISCUSSION: Results of this study will provide valuable information to influence future school lunch interventions and policies. TRIAL REGISTRATION: This study is registered at the Netherlands trial register (NTR): trialregister.nl, Trial NL7402 (NTR7618), registered retrospectively at 2018-11-13.

What's for lunch? The content and quality of lunches consumed by Dutch primary schoolchildren and the differences between lunches consumed at home and at school.

BACKGROUND: Lunch is an important part of a healthy diet, which is essential for the development, growth and academic performance of school-aged children. Currently there is an increasing number of Dutch primary schoolchildren who are transitioning from eating lunch at home to school. There is limited knowledge about the current quality of the lunches consumed by primary schoolchildren in the Netherlands and whether there are any differences between lunches consumed at home or at school. To investigate differences in content and quality of lunches consumed by Dutch primary schoolchildren at home and at school. METHODS: Cross-sectional study among 363 Dutch primary schoolchildren aged 4-12 years based on the first two years of the 2012-2016 Dutch National Food Consumption Survey. Demographic characteristics were obtained through a questionnaire. Diet was assessed with two non-consecutive 24-h dietary recalls. Quality of lunches was assessed on their nutritional quality whether they fitted the nutritional guidelines. 'Nonparametric tests were used to examine the content and quality of the lunches between place of consumption and parental educational position. RESULTS: The most consumed lunch products among primary schoolchildren were bread, dairy products and sugar-sweetened beverages. Fruit and vegetable consumption was very low. Consumption of milk and other dairy products was higher among children who eat lunch at home than children who eat lunch at school (p < 0.01). Consumption of sugar-sweetened beverages was higher among children who eat lunch at school than children who eat lunch at home (p < 0.01), and at school a higher proportion of the drinks did not fit within the Dutch dietary recommendations (p < 0.01). CONCLUSIONS: The current content of the lunches consumed by Dutch primary schoolchildren leaves room for improvement, especially regarding fruit and vegetables. The statistically significantly higher consumption of sugar-sweetened beverages and lower consumption of milk and dairy products at school vs. home is worrisome, as currently more children in the Netherlands are transitioning to having lunch at school.

Changing the behaviour of children living in Dutch disadvantaged neighbourhoods to improve breakfast quality: Comparing the efficacy of three school-based strategies.

Children's breakfast habits are suboptimal. A novel school-based education programme was developed and tested with the aim of improving children's attitude, knowledge and breakfast quality. A pre- and post-test design was used with four conditions: group-based education, role modelling, tailored feedback with goal setting, and a combination of these three delivery modes. Two hundred eighty children from disadvantaged communities (9.3 ±â€¯0.8 years) participated in three lessons at school over a two-month period. Children's attitude, knowledge and breakfast behaviour were evaluated by a pre- and post-questionnaire completed by the children. A follow-up measure was executed at 24 weeks. The data were analysed by repeated measures ANOVA. At baseline, 90% of the children ate breakfast on the measurement day; 60-76% of the children ate breakfast daily. Between pre- and post-test, a significant time effect was found for children's attitude, self-efficacy, knowledge and behaviour (all p < 0.05). Children in the feedback condition improved most favourably: correct classification of breakfast products increased by 10 products (out of 44) and breakfast quality score improved by 25 points (on a 100-point scale). The feedback condition also resulted in positive changes in the home setting. The follow-up test showed a decline in children's knowledge and their breakfast quality across conditions. To conclude, this study showed that a three-lesson school programme based on individual feedback and goal setting is most effective for changing knowledge on breakfasting and self-reported breakfast quality among children aged 8-10 years living in disadvantaged neighbourhoods. To maintain effectiveness, longer-term programmes embedded in the school curriculum are needed to enhance breakfast quality. Future research should explore the optimal duration and intensity of such programmes and should incorporate the topic of suitable portion sizes.

The effect of a default-based nudge on the choice of whole wheat bread.

Consumer choices are often influenced by the default option presented. This study examines the effect of whole wheat bread as a default option in a sandwich choice situation. Whole wheat bread consists of 100% whole grain and is healthier than other bread types that are commonly consumed, such as brown or white bread. A pilot survey (N = 291) examined the strength of combinations of toppings and bread type as carrier to select stimuli for the main study. In the main experimental study consisting of a two (bread type) by two (topping type) between-subjects design, participants (N = 226) were given a free sandwich at a university stand with either a relatively unhealthy deep-fried snack (croquette) or a healthy topping. About half of the participants were offered a whole wheat bun unless they asked for white bun, and the other half were offered a white bun unless they asked for a whole wheat bun. Regardless of the topping, the results show that when the whole wheat bun was the default option, 108 out of 115 participants (94%) decided to stick with this default option. When the default of bread offered was white, 89 out of 111 participants (80%) similarly chose to stick with this default. Across conditions, participants felt equally free to make a choice. The attractiveness of and willingness to pay for the sandwich were not affected by default type of bread. This study demonstrated a strong default effect of bread type. This clearly shows the benefit of steering consumers towards a healthier bread choice, by offering healthier default bread at various locations such as restaurants, schools and work place canteens.

Breakfast barriers and opportunities for children living in a Dutch disadvantaged neighbourhood.

The objective of this study was to explore parents', children's, and experts' beliefs and experiences about breakfast motivation, opportunity, and ability and elicit their thoughts on effective interventions to encourage healthy breakfast consumption. The setting was a disadvantaged neighbourhood in Rotterdam, the Netherlands. Focus groups with mothers and children and semi-structured individual interviews with experts were conducted. Interview guides were developed based on the motivation, opportunity, and ability consumer psychology model. Thirty-two mothers of primary school children participated in five group discussions, eight focus groups were conducted with 44 children, and nine experts participated in interviews. Data from expert interviews and group discussions were coded and thematically analysed. The following themes emerged from the focus groups: (1) generally high motivation to have breakfast, (2) improved performance at school is key motivator, (3) limited time hinders breakfast, and (4) lack of nutritional knowledge about high quality breakfast. Experts mentioned lack of effort, knowledge, and time; financial constraints; and environmental issues (food availability) as barriers to breakfasting healthily. Several ways to encourage healthy breakfasting habits were identified: (1) involvement of both children and parents, (2) role models inspiring change, and (3) interactive educational approaches. Experts perceived more problems and challenges in achieving healthy breakfast habits than did mothers and children. Lack of opportunity (according to the children and experts) and ability (according to the experts) were identified, although the motivation to eat a healthy breakfast was present. Predominant barriers are lack of time and nutritional knowledge. Overall, findings suggest educational and social marketing approaches as interventions to encourage healthy breakfast consumption.

An In-Store Experiment on the Effect of Accessibility on Sales of Wholegrain and White Bread in Supermarkets.

Even though whole grain foods have various health benefits, consumers have been found not to eat enough of them. Nudging interventions are built on the premise that food purchases and consumption are strongly influenced by the environment in which decisions are made. Little research has been conducted to examine the influence of a small and inexpensive nudging intervention on bread choices in a real-life supermarket context. An in-store experiment was conducted in two six-week periods in two supermarkets to investigate the effects of accessibility on consumers' purchase of healthier whole grain and other types of bread. In the high accessibility condition, healthier bread was placed in a more convenient location for the shopper on the left side of the shelves where it was encountered first. In the low accessibility condition, it was placed on the right side. There were consistent significant differences in sales between supermarkets, types of bread, day of the week, but not between low and high accessibility. Additional research is needed to better understand the effects of convenience and accessibility on bread choices.

Sensory quality of drinking water produced by reverse osmosis membrane filtration followed by remineralisation.

Membrane filtration of ground, surface, or sea water by reverse osmosis results in permeate, which is almost free from minerals. Minerals may be added afterwards, not only to comply with (legal) standards and to enhance chemical stability, but also to improve the taste of drinking water made from permeate. Both the nature and the concentrations of added minerals affect the taste of the water and in turn its acceptance by consumers. The aim of this study was to examine differences in taste between various remineralised drinking waters. Samples selected varied in mineral composition, i.e. tap water, permeate, and permeate with added minerals (40 or 120 mg Ca/L, added as CaCO3, and 4 or 24 mg Mg/L added as MgCl2), as well as commercially available bottled drinking waters, to span a relevant product space in which the remineralised samples could be compared. All samples were analysed with respect to their physical-chemical properties. Sensory profiling was done by descriptive analysis using a trained panel. Significant attributes included taste intensity, the tastes bitter, sweet, salt, metal, fresh and dry mouthfeel, bitter and metal aftertaste, and rough afterfeel. Total dissolved solids (TDS) was a major determinant of the taste perception of water. In general, lowering mineral content in drinking water in the range examined (from <5 to 440 mg/L) shifted the sensory perception of water from fresh towards bitter, dry, and rough sensations. In addition, perceived freshness of the waters correlated positively with calcium concentration. The greatest fresh taste was found for water with a TDS between 190 and 350 mg/L. Remineralisation of water after reverse osmosis can improve drinking quality significantly.

Nudging children towards whole wheat bread: a field experiment on the influence of fun bread roll shape on breakfast consumption.

BACKGROUND: Many children do not eat enough whole grains, which may have negative health consequences. Intervention research is increasingly focusing on nudging as a way to influence food choices by affecting unconscious behavioural processes. The aim of this field study was to examine whether the shape of bread rolls is able to shift children's bread choices from white to whole wheat during breakfast to increase whole grain intake. METHODS: In a between-subjects experiment conducted at twelve primary schools in the Netherlands, with school as the unit of condition assignment, children were exposed to an assortment of white and whole wheat bread rolls, both varying in shape (regular versus fun). Children were free to choose the type and number of bread rolls and toppings to eat during breakfast. Consumption of bread rolls was measured at class level via the number of bread rolls before and after breakfast. In addition, children (N = 1113) responded to a survey including questions about the breakfast. RESULTS: Results of the field experiment showed that about 76% of bread consumption consisted of white bread rolls. Consumption of white bread rolls did not differ according to shape (all P-values > 0.18). However, presenting fun-shaped whole wheat bread rolls almost doubled consumption of whole wheat bread (P = 0.001), particularly when the simultaneously presented white bread rolls had a regular shape (interaction P = 0.02). Survey results suggest that slight increases in perceived pleasure and taste are associated with these effects. CONCLUSIONS: Overall, presenting whole wheat bread in fun shapes may be helpful in increasing consumption of whole wheat bread in children. Future research could examine how improving the visual appeal of healthy foods may lead to sustained behaviour changes.

Identification of salivary proteins at oil-water interfaces stabilized by lysozyme and beta-lactoglobulin.

In this research, we investigated the interaction occurring between oil-in-water emulsion droplets, stabilized by different emulsifiers, i.e. lysozyme and beta-lactoglobulin (beta-lg), and salivary proteins (SPs) with a molecular mass (M(r)) above about 10kDa. Different techniques, i.e. infrared spectroscopy, Western blotting, PAS staining and SDS-PAGE coupled to MS, were employed for this purpose. This study demonstrated the interaction between several salivary proteins and the emulsifiers at the oil-water interfaces. In particular, results show that the high M(r) mucin MUC5B was strongly bound to lysozyme stabilized emulsions, whereas beta-lg stabilized emulsions associated with MUC7 and, moderately, with MUC5B. Furthermore, we observed that salivary proteins in the range M(r) 10-100kDa associated differently with emulsion droplets. A large majority of SPs was found to interact with lysozyme stabilized emulsion droplets whilst in case of beta-lg stabilized emulsions, the SPs distribute more evenly between the fraction associated and non-associated with the droplets. A clear example is alpha-amylase (M(r) approximately 55kDa) which predominantly associates with lysozyme stabilized emulsion droplets, but not with beta-lg emulsion droplets. To conclude, our findings indicate that adsorption/association of salivary protein components onto the emulsion droplets is related to the type of emulsifying proteins at the oil-water interfaces and it is probably driven by the overall net charge at the droplet's oil-water interfaces, i.e. positive for lysozyme stabilized emulsions and negative for beta-lactoglobulin stabilized emulsion at neutral pH.

Saliva as research material: biochemical, physicochemical and practical aspects.

Whole saliva is a complex mixture of proteins and other molecules which originate from several sources. The biochemical and physicochemical properties of saliva contribute to the numerous functions of saliva in, e.g., speech, maintaining oral and general health, and food processing. Interest in saliva has increased in the last few years for its potential to diagnose viral, bacterial and systemic diseases. The use of saliva as research material may pose particular problems due to its inherent variability and instability. This review describes practical aspects of salivary as research material with emphasis on protein biochemistry and physical chemistry.

Complex formation in mixtures of lysozyme-stabilized emulsions and human saliva.

In this paper, we studied the interaction between human unstimulated saliva and lysozyme-stabilized oil-in-water emulsions (10 wt/wt% oil phase, 10 mM NaCl, pH 6.7), to reveal the driving force for flocculation of these emulsions. Confocal scanning laser microscopy (CSLM) showed formation of complexes between salivary proteins and lysozyme adsorbed at the oil-water interface and lysozyme in solution as well. To assess the electrostatic nature of the interaction in emulsion/saliva mixtures, laser-diffraction and rheological measurements were conducted in function of the ionic strength by adding NaCl to the mixture in the range between 0 and 168 mM. Increasing the ionic strength reduced the ability of saliva to induce emulsion flocculation as shown by the decreased floc size and the effect on the viscosity. Turbidity experiments with varying pH (3-7) and ionic strength also showed decreased complex formation in mixtures between saliva and lysozyme in solution upon NaCl addition up to 200 mM. Decreasing the pH increased the turbidity, in line with the increase of the positive net charge on the lysozyme molecule. We conclude that electrostatic attraction is the main driving force for complex formation between saliva components and lysozyme adsorbed at the oil droplets and in solution.