School lunch menus in Spain. A review on recommendations and policy.

INTRODUCTION: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community. MATERIAL AND METHODS: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered. RESULTS: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules. CONCLUSIONS: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations.

Celiac disease screening by immunochromatographic visual assays: results of a multicenter study.

OBJECTIVE: To assay the efficiency for celiac disease (CD) screening of 2 immunochromatographic visual stick assays based on human recombinant tissue transglutaminase (tTG). One was the antitissue transglutaminase antibodies (AtTGA) stick for IgA/G antibodies to tTG detection, the other was the AtTGA/antigliadin antibodies (AGA) stick for IgA antibodies for tTG and/or gliadins. PATIENTS AND METHODS: In a prospective multicenter study, 4 pediatric gastroenterology units from Spain and 2 from Latin America enrolled 72 control children with a normal small bowel mucosa and 113 untreated patients with CD with Marsh type 3 lesions. RESULTS: Evaluation of results by the gastroenterologists and by 2 independent observers at the coordination center showed a remarkably low interobserver variability. For the AtTGA stick, sensitivity was 96.5% and specificity was 98.6%. The AtTGA/AGA stick displayed a sensitivity of 94.5% and a specificity of 98.6% for AtTGA and a sensitivity of 63.1% and a specificity of 95.2% for AGA. The highest efficiency and positive likelihood ratio was obtained for the AtTGA stick, higher than for IgA AtTGA by enzyme-linked immunosorbent assay. One additional advantage was that previous investigation of total serum IgA levels could be eluded. The IgA AtTGA/AGA stick, with an efficiency of 95.1%, compared with 89.2% when the combined results of the 2 enzyme-linked immunosorbent assays were considered, turned out to be an excellent diagnostic tool for infants with no IgA deficiency. CONCLUSION: These 2 assays are extremely efficient for CD screening, by combining a high diagnostic accuracy with the simplicity and rapidity of visual methods.