RESUMEN
INTRODUCTION: Unhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school daily, including lunchtime, so the school setting becomes crucial for promoting healthy diets and lifestyle habits. While there is a large body of literature on the impact of school food policies on health and non-health outcomes, it is essential to identify which policies are effective and can be recommended for implementation to ensure the efficient use of resources. This article presents a protocol for a scoping review that aims to map the current published literature on the effects of school food policies on health outcomes, acceptance and affordability in secondary school children in Europe. Moreover, the scoping review will map the measurements used to assess health outcomes, acceptance and affordability. METHODS AND ANALYSIS: The scoping review protocol and review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. To identify eligible studies, we will search MEDLINE, PsycINFO, CINAHL and Web of Science. The reference lists of the included articles will be checked for additional studies. In addition, country-specific ministry reports from Member States of the European Union, the UK, Norway, Iceland and Switzerland will be identified. The WHO and European Commission websites will also be searched for relevant reports. The scoping review will include literature published until 20 September 2023. No restrictions to study design and language will be applied. Screening and data extraction will be carried out independently by three reviewers. Disagreements will be resolved by discussion. A pretested data charting table will be used to extract key information. Findings will be presented in tabular and visualised summaries and a narrative summary. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. Our dissemination strategy comprises peer-reviewed publications, conference presentations and recommendations to policy-makers.
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Política Nutricional , Instituciones Académicas , Adolescente , Niño , Humanos , Europa (Continente) , Servicios de Alimentación/economía , Proyectos de Investigación , Literatura de Revisión como Asunto , Salud Infantil , Salud del AdolescenteRESUMEN
States in the U.S. are newly implementing universal school meal (USM) policies, yet little is known about the facilitators of their success and the challenges they confront. This study evaluated the challenges and facilitators faced by school food authorities (SFAs) implementing California's universal school meal (USM) policy during its inaugural year (2022-2023) using an online survey. In March 2023, 430 SFAs reported many benefits, including increased meal participation (64.2% of SFAs) and revenues (65.7%), reduced meal debt (41.8%) and stigma (30.9%), and improved meal quality (44.3%) and staff salaries (36.9%). Reported challenges include product/ingredient availability (80.9%), staffing shortages (77.0%), vendor/distributor logistics issues (75.9%), and administrative burden (74.9%). Top facilitators included state funding (78.2%) and increased federal reimbursement (77.2%). SFAs with fewer students eligible for free or reduced-price meals (as opposed to SFAs with more) reported greater increases in meal participation and reductions in stigma but also more administrative burdens. Larger SFAs reported greater increases in revenues, staff salaries, and improvements in meal quality than smaller SFAs but also more challenges. Overall, California's USM policy has enhanced student access to healthy meals while mitigating social and financial barriers. Understanding California's experience can inform other jurisdictions considering or implementing similar policies.
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Servicios de Alimentación , Política Nutricional , Instituciones Académicas , California , Humanos , Servicios de Alimentación/economía , Comidas , Encuestas y Cuestionarios , NiñoRESUMEN
OBJECTIVE: This study aims at comparing two Italian case studies in relation to schoolchildren's plate waste and its implications, in terms of nutritional loss, economic cost and carbon footprint. DESIGN: Plate waste was collected through an aggregate selective weighting method for 39 d. SETTING: Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved. RESULTS: With respect to the served food, in Parma, the plate waste percentage was lower than in Lucca (P < 0·001). Fruit and side dishes were highly wasted, mostly in Lucca (>50 %). The energy loss of the lunch meals accounted for 26 % (Parma) and 36 % (Lucca). Among nutrients, dietary fibre, folate and vitamin C, Ca and K were lost at most (26-45 %). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50 %, Parma; 79 %, Lucca) and nutrients, particularly for fat (85 %, Parma; 89 %, Lucca). Plate waste was responsible for 19 % (Parma) and 28 % (Lucca) of the carbon footprint associated with the food supplied by the catering service, with starchy food being the most important contributor (52 %, Parma; 47 %, Lucca). Overall, the average cost of plate waste was 1·8 /kg (Parma) and 2·7 /kg (Lucca), accounting respectively for 4 % and 10 % of the meal full price. CONCLUSION: A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.
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Huella de Carbono , Servicios de Alimentación , Almuerzo , Instituciones Académicas , Italia , Niño , Humanos , Servicios de Alimentación/economía , Servicios de Alimentación/estadística & datos numéricos , Femenino , Masculino , Dieta/economía , Dieta/estadística & datos numéricos , Valor Nutritivo , Ingestión de EnergíaRESUMEN
BACKGROUND: Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. METHODS AND FINDINGS: This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). CONCLUSIONS: Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. TRIAL REGISTRATION: ISRCTN registry ISRCTN87225572.
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Comportamiento del Consumidor , Dieta , Ingestión de Energía , Servicios de Alimentación , Valor Nutritivo , Obesidad/prevención & control , Tamaño de la Porción , Lugar de Trabajo , Adulto , Conducta de Elección , Comercio , Dieta/efectos adversos , Dieta/economía , Femenino , Preferencias Alimentarias , Servicios de Alimentación/economía , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/etiología , Salud Laboral , Estudios Prospectivos , Reino Unido , Lugar de Trabajo/economía , Adulto JovenRESUMEN
The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.
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COVID-19/epidemiología , Servicios de Alimentación/economía , COVID-19/economía , Niño , Estrés Financiero , Inseguridad Alimentaria/economía , Servicios de Alimentación/estadística & datos numéricos , Humanos , Comidas , Pandemias , SARS-CoV-2/aislamiento & purificación , Instituciones Académicas , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of AgricultureRESUMEN
Few online food ordering systems provide tailored dietary feedback to consumers, despite suggested benefits. The study aim was to determine the effect of providing tailored feedback on the healthiness of students' lunch orders from a school canteen online ordering system. A cluster randomized controlled trial with ten government primary schools in New South Wales, Australia was conducted. Consenting schools that used an online canteen provider ('Flexischools') were randomized to either: a graph and prompt showing the proportion of 'everyday' foods selected or a standard online ordering system. Students with an online lunch order during baseline data collection were included (n = 2200 students; n = 7604 orders). Primary outcomes were the proportion of foods classified as 'everyday' or 'caution'. Secondary outcomes included: mean energy, saturated fat, sugar, and sodium content. There was no difference over time between groups on the proportion of 'everyday' (OR 0.99; p = 0.88) or 'caution' items purchased (OR 1.17; p = 0.45). There was a significant difference between groups for average energy content (mean difference 51 kJ; p-0.02), with both groups decreasing. There was no difference in the saturated fat, sugar, or sodium content. Tailored feedback did not impact the proportion of 'everyday' or 'caution' foods or the nutritional quality of online canteen orders. Future research should explore whether additional strategies and specific feedback formats can promote healthy purchasing decisions.
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Conducta Infantil , Dieta Saludable , Retroalimentación Psicológica , Conducta Alimentaria , Servicios de Alimentación , Intervención basada en la Internet , Instituciones Académicas , Estudiantes/psicología , Factores de Edad , Niño , Preescolar , Comportamiento del Consumidor , Dieta Saludable/economía , Ingestión de Energía , Femenino , Servicios de Alimentación/economía , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Planificación de Menú , Nueva Gales del Sur , Valor Nutritivo , Ingesta Diaria RecomendadaRESUMEN
Digital food environments are now commonplace across many food service and retail settings, influencing how the population orders and accesses foods. As such, digital food environments represent a novel platform to deliver strategies to improve public health nutrition. The purpose of this review was to explore the impact of dietary interventions embedded within online food ordering systems, on user selection and purchase of healthier foods and beverages. A systematic search of eight electronic databases and grey literature sources was conducted up to October 2020. Eligible studies were randomized controlled trials and controlled trials, designed to encourage the selection and purchase of healthier products and/or discourage the selection and purchase of less-healthy products using strategies delivered via real-world online food ordering systems. A total of 9441 articles underwent title and abstract screening, 140 full-text articles were assessed for eligibility, and 11 articles were included in the review. Meta-analysis of seven studies indicated that interventions delivered via online food ordering systems are effective in reducing the energy content of online food purchases (standardized mean difference (SMD): -0.34, p = 0.01). Meta-analyses including three studies each suggest that these interventions may also be effective in reducing the fat (SMD: -0.83, p = 0.04), saturated fat (SMD: -0.7, p = 0.008) and sodium content (SMD: -0.43, p = 0.01) of online food purchases. Given the ongoing growth in the use of online food ordering systems, future research to determine how we can best utilize these systems to support public health nutrition is warranted.
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Preferencias Alimentarias , Servicios de Alimentación , Costos y Análisis de Costo , Servicios de Alimentación/economía , Humanos , Internet , Sesgo de Publicación , Riesgo , Sodio/análisisRESUMEN
The national school breakfast and lunch programs administered by the United States Department of Agriculture (USDA) are a cornerstone of the nation's nutrition safety net for children from low-income families [...].
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Dieta Saludable/economía , Servicios de Alimentación/economía , Disparidades en el Estado de Salud , Política Nutricional , Servicios de Salud Escolar/economía , Adolescente , Peso Corporal , Desayuno , Niño , Preescolar , Costos y Análisis de Costo , Dieta Saludable/normas , Femenino , Servicios de Alimentación/legislación & jurisprudencia , Humanos , Almuerzo , Masculino , Estado Nutricional , Pobreza , Servicios de Salud Escolar/legislación & jurisprudencia , Instituciones Académicas , Estados UnidosRESUMEN
The school environment plays an important role in children's diets and overall health, and policies for universal free school meals have the potential to contribute to positive child health outcomes. This systematic review evaluates studies examining the association between universal free school meals and students' school meal participation rates, diets, attendance, academic performance, and Body Mass Index (BMI), as well as school finances. The search was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A search for studies published in economically developed countries published through December 2020 was performed in PubMed, Education Resources Information Center (ERIC), Thomson Reuters' Web of Science, and Academic Search Ultimate, followed by examining the references in the resultant literature. A total of 47 studies were identified and the Newcastle-Ottawa Scale (NOS) was applied to assess bias. Nearly all studies examining universal free school meals found positive associations with school meal participation. Most studies examining universal free school meals that included free lunch found positive associations with diet quality, food security, and academic performance; however, the findings of studies examining only universal free breakfast were mixed. Research findings were similarly mixed when examining attendance as an outcome. Concerns about adverse outcomes on student BMI were not supported by the literature; in fact, several studies detected a potentially protective effect of universal free school meals on BMI. Research examining the impact of universal free meals on school finances was limited, but suggest that lower-income school districts in the U.S. may have positive financial outcomes from participation in universal free school meal provisions. Additionally, providing free meals to students may be associated with improved household incomes, particularly among lower-income families with children. Further research is needed to examine the financial implications of universal free meals for both school districts and families. Overall, universal free school meals may have multiple benefits for students and countries should consider universal free school meal provisions with strong nutrition guidelines. (PROSPERO registration: CRD42020221782).
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Rendimiento Académico , Índice de Masa Corporal , Seguridad Alimentaria , Servicios de Alimentación , Comidas , Instituciones Académicas , Estudiantes , Adolescente , Desayuno , Niño , Dieta , Femenino , Servicios de Alimentación/economía , Humanos , Almuerzo , MasculinoRESUMEN
The Community Eligibility Provision (CEP) of the Healthy, Hunger-Free Kids Act of 2010 allows the provision of universal free meals (UFMs) in high-poverty school areas. Participation in UFM programs, including through CEP, could reduce meal costs due to economies of scale and a lower administrative burden. We analyzed the School Nutrition and Meal Cost Study (SNMCS) data from 508 UFM-eligible schools (103 UFMs) to evaluate whether meal costs varied by UFM status. We used school-level data to address the non-random selection to UFMs with inverse probability of treatment weighting (IPTW). We estimated a generalized linear model with a log link and gamma distribution to predict meal costs by UFM status and school size. Full costs among medium and large schools were marginally lower in UFM schools for lunch (-$0.673; 95% CI: -1.395, 0.0499; p = 0.068) and significantly lower for breakfast (-$0.575; 95% CI: -1.077, -0.074; p = 0.025). UFM was not associated with meal costs among smaller schools. Healthy Eating Index scores did not vary significantly by UFMs, suggesting that lower costs could be achieved without an adverse effect on nutritional quality. This analysis is limited by the lack of identified student percentage (ISP) data needed to definitively identify CEP eligibility, although results were robust to sensitivity analyses addressing the lack of ISP data. The potential policy impact of these findings emphasizes the need for future studies that assess ISP and cost with more recent data and longitudinal designs.
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Asistencia Alimentaria/economía , Comidas , Valor Nutritivo , Instituciones Académicas , Costos y Análisis de Costo , Dieta Saludable , Servicios de Alimentación/economía , Humanos , Hambre , Almuerzo , Pobreza , EstudiantesRESUMEN
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.
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COVID-19 , Inocuidad de los Alimentos , Servicios de Alimentación , Pandemias/economía , SARS-CoV-2 , COVID-19/economía , COVID-19/epidemiología , Congresos como Asunto , Servicios de Alimentación/economía , Servicios de Alimentación/legislación & jurisprudencia , Servicios de Alimentación/organización & administración , Servicios de Alimentación/normas , HumanosRESUMEN
The emergence of COVID-19 in the United States led most states to close or severely limit the capacity of their early child-care and education (ECE) programs. This loss affected millions of young children, including many of the 4.6 million low-income children who are provided free meals and snacks by their ECE programs through support from the federal Child and Adult Care Food Program (CACFP).Although Congress swiftly authorized waivers that would allow CACFP-participating ECE programs to continue distributing food to children, early evidence suggests that most ECE programs did not have the capacity to do so, leaving a fragmented system of federal, state, and local food programs to fill the gaps created by this loss.Critical steps are needed to repair our nation's fragile ECE system, including greater investment in CACFP, to ensure the nutrition, health, and development of young children during the COVID-19 pandemic and beyond.
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COVID-19/epidemiología , Guarderías Infantiles , Asistencia Alimentaria/economía , Servicios de Alimentación , Comidas , Niño , Preescolar , Inseguridad Alimentaria , Servicios de Alimentación/economía , Servicios de Alimentación/estadística & datos numéricos , Humanos , Pobreza , Estados UnidosRESUMEN
Childhood obesity remains a pressing public health concern. Children consume a substantial amount of their caloric intake while in school, making the passage of the Healthy Hunger-Free Kids Act (HHFKA) in 2010 and the subsequent improvements to the school meal standards a key policy change. Using data from the School Nutrition and Meal Cost Study, this paper seeks to re-examine the association between students' (N = 1963) weight status and participation in the National School Lunch Program (NSLP) and School Breakfast Program (SBP) since the implementation of these policy changes to determine whether, and how, this relationship has changed. After controlling for a wide array of student characteristics and school-level fixed effects, findings from the multivariate regression analyses indicate that usual participation in the school meal programs has no clear association with students' weight status, which contradicts findings from earlier studies conducted prior to the passage of the HHFKA. These findings are discussed in relation to changes in the demographic composition of usual NSLP participants over time.
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Peso Corporal , Costos y Análisis de Costo , Asistencia Alimentaria , Servicios de Alimentación , Servicios de Salud Escolar , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Adolescente , Índice de Masa Corporal , Niño , Costos y Análisis de Costo/estadística & datos numéricos , Femenino , Asistencia Alimentaria/economía , Servicios de Alimentación/economía , Humanos , Masculino , Política Nutricional , Obesidad Infantil/epidemiología , Obesidad Infantil/prevención & control , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/organización & administración , Instituciones Académicas/economía , Instituciones Académicas/organización & administración , Estados Unidos , Adulto JovenRESUMEN
The Healthy, Hunger-Free Kids Act strengthened competitive food standards (i.e., Smart Snacks), but an exemption allows reimbursable meal entrées that do not meet Smart Snack standards to be sold as "competitive entrées" on the same day they are served in the reimbursable meal, and the following day. Proposed rollbacks would enable these competitive entrées to continue to be sold on a third day, increasing the availability of competitive foods exempt from Smart Snacks standards. This study compared the Healthy Eating Index (HEI) scores of potential competitive entrées alone versus full reimbursable school lunches, and examined the nutritional characteristics of potential competitive entrées. Data were from a national sample of 1108 schools from the School Nutrition and Meal Cost Study. Linear regression models, accounting for school-level and state and district policy characteristics, found that HEI scores of competitive entrées were an average of 30 points lower than HEI scores of reimbursable lunches, with greater differences in small and rural schools. Less than 1% of common potential competitive entrees met Smart Snack standards, primarily due to higher sodium and saturated fat levels. The proposed rollbacks are estimated to potentially add approximately 662 mg of sodium and 3 g of saturated fat over three days (1103 mg sodium and 5 g saturated fat over a week) on average relative to Smart Snacks limits. Instead of increasing opportunities to sell competitive entrées, their sales should be further limited.
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Dieta Saludable/estadística & datos numéricos , Servicios de Alimentación/normas , Adhesión a Directriz/estadística & datos numéricos , Almuerzo , Política Nutricional , Servicios de Salud Escolar/normas , Comercio , Dieta Saludable/economía , Dieta Saludable/normas , Servicios de Alimentación/economía , Adhesión a Directriz/economía , Humanos , Modelos Lineales , Valor Nutritivo , Servicios de Salud Escolar/economía , Bocadillos , Estados Unidos , United States Department of Agriculture/normasAsunto(s)
Infecciones por Coronavirus , Asistencia Alimentaria/organización & administración , Ciencia de la Implementación , Pandemias , Neumonía Viral , Adolescente , COVID-19 , Niño , Preescolar , Asistencia Alimentaria/economía , Servicios de Alimentación/economía , Abastecimiento de Alimentos , Humanos , Política Nutricional , Salud Pública , Instituciones Académicas , Estados UnidosRESUMEN
OBJECTIVES: The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. STUDY DESIGN: The study design was cross-sectional analyses of questionnaire data collected in April 2020. METHODS: Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. RESULTS: Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. CONCLUSIONS: In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.
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Infecciones por Coronavirus/prevención & control , Asistencia Alimentaria/estadística & datos numéricos , Servicios de Alimentación/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Cuarentena/legislación & jurisprudencia , Adolescente , COVID-19 , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Neumonía Viral/epidemiología , Reino Unido/epidemiologíaRESUMEN
This study aimed to determine the impact of 2017 revisions to the Child and Adult Care Food Program (CACFP) nutrition standards on foods and beverages served and meal costs in family child care homes (FCCHs). Our pre-post study utilized four weeks of menus and food receipts from 13 FCCH providers in Boston, MA prior to CACFP nutrition standards changes in 2017 and again one year later, resulting in n = 476 menu observation days. We compared daily servings of food and beverage items to the updated standards. Generalized estimating equation models tested for changes in adherence to the standards and meal costs. FCCHs offered more whole grains and less juice and refined grains from baseline to follow-up. FCCHs were more likely to meet the revised whole grain standard at follow-up (OR = 2.7, 95% CI: 1.4, 5.2, p = 0.002), but rarely met all selected standards together. Inflation-adjusted meal costs increased for lunch (+$0.27, p = 0.001) and afternoon snack (+$0.25, p = 0.048). FCCH providers may need assistance with meeting CACFP standards while ensuring that meal costs do not exceed reimbursement rates.
Asunto(s)
Guarderías Infantiles/estadística & datos numéricos , Dieta/economía , Dieta/métodos , Servicios de Alimentación/economía , Comidas , Necesidades Nutricionales , Boston , Preescolar , Femenino , Servicios de Alimentación/estadística & datos numéricos , Humanos , Masculino , Política NutricionalRESUMEN
The U.S. Department of Agriculture's (USDA) Child and Adult Care Food Program (CACFP) updated meal pattern standards took effect in October 2017. The aim of this quasi-experimental, pre-post study is to identify changes in food and beverage practices of CACFP-participating centers due to implementation of updated CACFP meal patterns over a 21-month period. Eight hundred and fifty-eight centers located in 47 states and the District of Columbia completed a survey (primarily electronic) at both time points (67.6% follow-up response rate). Multivariable logistic regressions with robust standard errors assessed changes over time, accounting for repeated observations within each site. From baseline to follow-up, centers reported the increased familiarity and implementation, albeit with time, money, and staffing-related challenges. Significant improvements were seen in not serving sugary cereals or flavored milk, in serving 100% whole grains, and serving processed meats less than once a week. While CACFP-participating centers reported making significant progress in meeting the updated meal pattern standards and suggested best practices within 15-19 months of their effective date, reported compliance and adherence to the standards and best practices was not universal. USDA, state agencies, and technical assistance providers should work to provide centers with additional guidance to help them with implementation.
Asunto(s)
Guarderías Infantiles/estadística & datos numéricos , Dieta/economía , Dieta/métodos , Servicios de Alimentación/economía , Comidas , Necesidades Nutricionales , Boston , Preescolar , Femenino , Servicios de Alimentación/estadística & datos numéricos , Humanos , Masculino , Política Nutricional , Estados UnidosRESUMEN
The Healthy, Hunger-Free Kids Act (HHFKA), a public law in the United States passed in 2010, sought to improve the healthfulness of the school food environment by requiring updated nutrition standards for school meals and competitive foods. Studies conducted since the passage of the HHFKA indicate improvements in the food environment overall, but few studies have examined whether these improvements varied by the socioeconomic and racial/ethnic composition of students in schools. To better understand the extent of disparities in the school food environment after HHFKA, this paper examined differences in the healthfulness of school food environments and the nutritional quality of school lunches by the school poverty level and racial/ethnic composition of students using data from the School Nutrition and Meal Cost Study. Results from chi-square analyses showed lower proportions of high poverty, majority black, and majority Hispanic schools had access to competitive foods, while higher proportions of these schools had a school wellness policy in addition to a district wellness policy. The overall nutritional quality of school lunches, as measured by total Healthy Eating Index (HEI)-2010 scores, did not vary significantly across school types, although some HEI component scores did. From these findings, we concluded that there were disparities in the school food environment based on the socioeconomic and racial/ethnic composition of students in schools, but no significant disparities in the overall nutritional quality of school lunches were found.
Asunto(s)
Dieta Saludable/estadística & datos numéricos , Servicios de Alimentación/tendencias , Disparidades en Atención de Salud/estadística & datos numéricos , Política Nutricional/legislación & jurisprudencia , Servicios de Salud Escolar/tendencias , Etnicidad/estadística & datos numéricos , Servicios de Alimentación/economía , Servicios de Alimentación/legislación & jurisprudencia , Disparidades en Atención de Salud/etnología , Humanos , Almuerzo , Valor Nutritivo , Grupos Raciales/estadística & datos numéricos , Servicios de Salud Escolar/economía , Servicios de Salud Escolar/legislación & jurisprudencia , Instituciones Académicas , Factores Socioeconómicos , Estados UnidosRESUMEN
OBJECTIVE To analyze how the profile of food purchases from family farming under the National School Feeding Program (PNAE) is related to socioeconomic and demographic indicators in Brazilian capitals. METHODS This cross-sectional and descriptive study was based on secondary data from 2016 and 2017 from the Brazilian government. We used demographic and socioeconomic data, as well as the amount of federal funding; the percentage used purchases of food from family farming and the public call notices. RESULTS The capitals in the largest quartile of HDI and funding by the federal government used less than 30% of the resource for the purchase of crops from family farming in 2016. All capitals of the Northern region used more than 30%, while the Southern and Southeastern regions did not comply with the legislation. We highlight that most analyzed food items were in natura. CONCLUSIONS The implementation of this public policy occurs unequally in Brazilian capitals, with greater difficulty in those supposedly with better institutional structure and higher volume of resources destined to the National School Feeding Program. The program, however, maintains its potential for the promotion of adequate and healthy food in schools, due to the quality of food included in public calls.