Digital Food Retail: Public Health Opportunities.

For over two decades, digital food retail services have been emerging alongside advances in mobile technology and improved access to wi-fi. Digitalization has driven changes within the food environment, complicating an already complex system that influences food-related behaviors and eating practices. Digital food retail services support an infrastructure that enhances commercial food systems by extending access to and availability of highly processed foods, further escalating poor dietary intakes. However, digital food retail services are heterogeneous-food delivery apps, online groceries, and meal kits-and can be feasibly adapted to nutrition interventions and personalized to individual needs. Although sparse, new evidence indicates great potential for digital food retail services to address food insecurity in urban areas and to support healthy eating by making it easier to select, plan, and prepare meals. Digital food retail services are a product of the digital transformation that reflect consumers' constant need for convenience, which must be addressed in future research and interventions. This paper will discuss public health opportunities that are emerging from the global uptake of digital food retail services, with a focus on online groceries, food delivery apps, and meal kits.

Disparities in the Healthfulness of School Food Environments and the Nutritional Quality of School Lunches.

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.

Sodium content of bread from bakeries in Maputo, Mozambique: trends between 2012 and 2018.

OBJECTIVE: To assess the Na content and price of bread available in bakeries in the city of Maputo in 2018 and describe trends since 2012. DESIGN: Cross-sectional evaluation of bread sold in twenty bakeries in the city of Maputo. Three loaves of white and three loaves of brown bread were collected from each bakery when available, and Na contents were quantified by flame photometry. To assess trends, samples of white bread collected in 2012 and analysed using the same methodology were compared with samples of white bread collected in 2018 from the same bakeries. SETTING: City of Maputo, capital of Mozambique. RESULTS: In 2018, the mean (range) Na content in mg/100 g of white and brown breads were 419·1 (325·4-538·8) and 389·8 (248·0-609·0), respectively. Non-compliance with Na targets in bread according to the South African regulation (<380 mg/100 g) was observed in 70 % of white and 43 % of brown bread samples. A total of twelve bakeries had samples evaluated in both 2012 and 2018; among these, the mean Na content in white bread decreased by just over 10 % - the mean difference (95 % CI) was 46·6 mg/100 g (1·7, 91·5); and there was a significant increase of 3·7-5·4 meticais in the mean price per 100 g of white bread. CONCLUSIONS: The Na content of bread available in bakeries in the city of Maputo decreased in recent years despite the absence of a specific regulation in Mozambique.

Educación para una gastronomía saludable: retos y oportunidades en la alimentación institucional / Healthy gastronomy education: challenges and opportunities in the institutional food service

Introducción: la población demanda una gastronomía saludable (un binomio entre gastronomía y nutrición), por lo que debe incluir los conocimientos de alimentación y la salud. Salud, educación y gastronomía se complementan entre sí. La alimentación institucional debe ser saludable y, a su vez, placentera. Objetivos: recopilar actividades, recursos e intervenciones que se han llevado a cabo en diversos centros de alimentación institucional (comedores escolares, residencias y hospitales), donde se incluyen los conocimientos sobre gastronomía y alimentación saludable como método de enseñanza a diferentes niveles. Métodos: se ha realizado una revisión de las acciones y/o materiales elaborados para educar en gastronomía saludable desde distintos ámbitos de la alimentación institucional. Además, se ha realizado una búsqueda de artículos científicos en las bases de datos PubMed, Dialnet y Google académico. Resultados: los talleres del gusto son un material educativo complementario y muy útil para el profesorado de Educación Infantil y Primaria. Los menús de las instituciones geriátricas deben tener un buen aporte nutricional y una buena calidad organoléptica que estimule el bienestar y la socialización de los usuarios, ya que en la vejez se producen pérdidas sensoriales que afectan al placer de comer. El modelo alimentario en el hospital está adaptado principalmente a las necesidades de salud de los usuarios, y debe alcanzar una idoneidad gastronómica que produzca bienestar durante la estancia. Conclusiones: la alimentación institucional plantea retos en la elaboración, la conservación, la calidad y el valor nutritivo de los alimentos, así como en la seguridad alimentaria y en sus implicaciones en la salud de las poblaciones, y, desde el punto de vista gastronómico, como rutina diaria en grupos de población vulnerables (escolares, personas hospitalizadas o adultos mayores)

Introduction: the population demands a healthy gastronomy (binomial Gastronomy and Nutrition), so it must include knowledge of food and health. Health, Education and Gastronomy complement each other. The institutional food service must be healthy and at the same time pleasant. Objectives: collect activities, resources and interventions that have been carried out in various institutional food services (school lunches, nursing homes and hospitals) where knowledge about gastronomy and healthy eating has been included as a teaching method at different levels. Methods: a review of the actions and/or materials developed to educate on healthy gastronomy from different areas of collective catering has been carried out, as well as the search for scientific articles in the PubMed, Dialnet and Google academic databases. Results: the Taste Workshops are complementary and useful educational material for the teachers of Infant and Primary School Education. The menus of nursing home must have a good nutritional contribution and organoleptic quality that stimulates the well-being and socialization of the users, considering that in old age sensory losses affects the pleasure of eating. The alimentary model in the hospital is adapted mainly to the health needs of the users and must reach a gastronomic suitability that will produce well-being during the stay. Conclusions: institutional food service poses challenges in food preparation and conservation, quality and food safety, nutritional value of food and its implications for the health of populations, and from the point of view of gastronomy, since it involves a daily routine in groups of vulnerable population such as schoolchildren, hospitalized people or the elderly

[Healthy gastronomy education: challenges and opportunities in the institutional food service]. / Educación para una gastronomía saludable: retos y oportunidades en la alimentación institucional.

INTRODUCTION: the population demands a healthy gastronomy (binomial Gastronomy and Nutrition), so it must include knowledge of food and health. Health, Education and Gastronomy complement each other. The institutional food service must be healthy and at the same time pleasant. OBJECTIVES: collect activities, resources and interventions that have been carried out in various institutional food services (school lunches, nursing homes and hospitals) where knowledge about gastronomy and healthy eating has been included as a teaching method at different levels. METHODS: a review of the actions and/or materials developed to educate on healthy gastronomy from different areas of collective catering has been carried out, as well as the search for scientific articles in the PubMed, Dialnet and Google academic databases. RESULTS: the Taste Workshops are complementary and useful educational material for the teachers of Infant and Primary School Education. The menus of nursing home must have a good nutritional contribution and organoleptic quality that stimulates the well-being and socialization of the users, considering that in old age sensory losses affects the pleasure of eating. The alimentary model in the hospital is adapted mainly to the health needs of the users and must reach a gastronomic suitability that will produce well-being during the stay. CONCLUSIONS: institutional food service poses challenges in food preparation and conservation, quality and food safety, nutritional value of food and its implications for the health of populations, and from the point of view of gastronomy, since it involves a daily routine in groups of vulnerable population such as schoolchildren, hospitalized people or the elderly.

Introducción: la población demanda una gastronomía saludable (un binomio entre gastronomía y nutrición), por lo que debe incluir los conocimientos de alimentación y la salud. Salud, educación y gastronomía se complementan entre sí. La alimentación institucional debe ser saludable y, a su vez, placentera.Objetivos: recopilar actividades, recursos e intervenciones que se han llevado a cabo en diversos centros de alimentación institucional (comedores escolares, residencias y hospitales), donde se incluyen los conocimientos sobre gastronomía y alimentación saludable como método de enseñanza a diferentes niveles.Métodos: se ha realizado una revisión de las acciones y/o materiales elaborados para educar en gastronomía saludable desde distintos ámbitos de la alimentación institucional. Además, se ha realizado una búsqueda de artículos científicos en las bases de datos PubMed, Dialnet y Google académico.Resultados: los talleres del gusto son un material educativo complementario y muy útil para el profesorado de Educación Infantil y Primaria. Los menús de las instituciones geriátricas deben tener un buen aporte nutricional y una buena calidad organoléptica que estimule el bienestar y la socialización de los usuarios, ya que en la vejez se producen pérdidas sensoriales que afectan al placer de comer. El modelo alimentario en el hospital está adaptado principalmente a las necesidades de salud de los usuarios, y debe alcanzar una idoneidad gastronómica que produzca bienestar durante la estancia.Conclusiones: la alimentación institucional plantea retos en la elaboración, la conservación, la calidad y el valor nutritivo de los alimentos, así como en la seguridad alimentaria y en sus implicaciones en la salud de las poblaciones, y, desde el punto de vista gastronómico, como rutina diaria en grupos de población vulnerables (escolares, personas hospitalizadas o adultos mayores).

Simply delivered meals: a tale of collaboration.

Western medicine is undergoing a transition toward transparency of quality and costs, and healthcare systems are striving to achieve the Triple Aim, a framework for improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. Meanwhile, there is growing recognition of the impact of social determinants of health and a new federal requirement for nonprofit hospitals to implement prevention strategies. A specialized meal delivery program called Simply Delivered for ME (SDM) was formed in an effort to improve care and reduce 30-day hospital readmission rates.The Maine Medical Center (MMC) partnered with the Southern Maine Agency on Aging to offer SDM on a voluntary basis to high-risk Medicare patients already enrolled in the Community-based Care Transition Program (CCTP) at MMC. We report the results of the 2-year intervention in terms of 30-day hospital readmission rates and cost measures (ie, return on investment and cost savings).Of the 622 MMC patients who received SDM during the 24 months, the 30-day readmission rate was 10.3% (compared with the 16.6% 30-day rate of hospital readmission at baseline [ie, before the adoption of CCTP]) for all-cause readmissions. The cost savings for reduced readmissions were $212,160. The return on investment was 387%, or a benefit-cost ratio of $3.87 for every $1.00 spent on meals. Programs such as SDM may reduce the rate of hospital readmission among high-risk older adults and, thereby, yield lower healthcare costs.

Frequency of Hospital Use Before and After Home-Delivery Meal by Meals On Wheels, of Tarrant County, Texas.

BACKGROUND: Patients recently discharged from the hospital are vulnerable and are at high risk for readmission. Home-delivered meals may be beneficial in improving their health and facilitating independent living in the community. The purpose of this study was to identify the association between home-delivered meals and use of hospital services. METHODS: This study includes 120 clients recently discharged from an inpatient hospital stay or from an emergency department (ED) visit who received meal services from Meals On Wheels, Inc., of Tarrant County. Healthcare utilization data was extracted from the Dallas-Fort Worth Hospital Council Foundation, a regional all claims database used by over 90% of hospitals in Dallas-Fort Worth area. Signed tests and generalized linear models (GLM) were performed. RESULTS: A total of 16,959 meals were delivered from March 2013 through March 2014. Each client received an average of 6.19 meals per week. The average number of ED visits decreased from 5.03 before receipt of meals to 1.45 after receipt of meals, z = -5.23, p < .001. The average number of hospitalizations decreased from 1.33 to .83, z = -7.29, p < .001. The average length of stay per hospitalization decreased from 5.47 days to 2.34 days, z = -5.84, p < .001. Clients who received more meals were less likely to experience ED visits and hospitalizations after controlling for demographic characteristics and levels of physical functioning. CONCLUSION: The findings of this study indicate that home-delivered meals services may contribute to a reduction in hospital based care services among frail and vulnerable adults. Additional studies should consider the short and long-term effects of home-delivered meals services on healthcare utilization and the potential to decrease healthcare costs.

Background and elements of the linkage between the Brazilian school feeding program and family farming. / Antecedentes e elementos da vinculação do programa de alimentação escolar do Brasil com a agricultura familiar.

Since 2009, legislation of the National School Feeding Program of Brazil (PNAE) institutionalizes its linkage with family farming as it establishes the requirement that at least 30% out of the total financial resources allocated by the federal government to the states and municipalities for school feeding must be used in the purchase of products directly from this sector. This study analyzes the process of drafting this legislation, focusing on the elements related to the procurement from family farming, through a historical contextualization, and it also presents a graphical representation with the main elements of this linkage: its objectives, target population, actions implemented and expected results. Actors involved with the drafting of the legislation were interviewed. The analyses show that the procurement from family farming is a far-reaching initiative in terms of the concept, execution and results. It has also showed that a strong articulation between the actors and institutions of the different sectors involved is critical to its success. The education, agriculture, planning, procurement and civil society sectors should work articulately at national, state and local level. The results of this study demonstrate that initiatives like this, of institutional procurement from family farming, which are currently being implemented in several countries, constitute as an important strategy of food and nutrition security, for the fulfillment of the human right to adequate food and the promotion of long-term sustainable development.

Desde 2009, legislação do Programa Nacional de Alimentação Escolar do Brasil (PNAE) institucionaliza a sua vinculação com a agricultura familiar ao estabelecer a obrigatoriedade de que, pelo menos, 30% do total dos recursos financeiros repassados pelo governo federal aos estados e municípios para a alimentação escolar devem ser utilizados na compra de produtos diretamente desse setor. Este estudo analisa o processo de construção desta legislação mediante contextualização histórica, focando nos elementos relacionados à compra da agricultura familiar e, também, apresenta uma representação gráfica com os principais elementos da vinculação: objetivos, público-alvo, ações implementadas e resultados esperados. Foram entrevistados atores envolvidos na construção da legislação. As análises evidenciam que a compra da agricultura familiar pelo PNAE é uma iniciativa de amplo alcance, do ponto de vista conceitual, de execução e de resultados. Também se evidenciou que, para o seu êxito, é fundamental uma ampla articulação entre os atores e órgãos dos vários setores envolvidos, assim como múltiplas estratégias implementadas pelas distintas esferas de governo. Dessa maneira, setores da educação, agricultura, planejamento, compras e sociedade civil devem articular-se em nível nacional, estadual e local. Os resultados deste estudo demonstram que iniciativas como essas, de compras institucionais da agricultura familiar, que estão sendo implantadas atualmente em vários países, configuram-se como importante estratégia de segurança alimentar e nutricional, de cumprimento do direito humano à alimentação adequada e de promoção do desenvolvimento sustentável a longo prazo.

Desde 2009, la legislación del Programa de Nacional Alimentación Escolar de Brasil (PNAE) institucionaliza su vinculación con la agricultura familiar, al establecer la obligatoriedad de que por lo menos un 30% del total de los recursos financieros asignados por el gobierno federal a los departamentos y municipios para la alimentación escolar, deben ser utilizados en la compra de productos directamente de ese sector. Este estudio analiza el proceso de creación de esta legislación, mediante contextualización histórica, enfocándose en los elementos relacionados con la compra de la agricultura familiar y, también, presenta una representación gráfica con los principales elementos de la vinculación: objetivos, público-objetivo, acciones implementadas y resultados esperados. Se entrevistaron a actores involucrados en la construcción de la legislación. Los análisis evidencian que la compra de la agricultura familiar por parte del PNAE es una iniciativa de amplio alcance, desde el punto de vista conceptual, de ejecución y de resultados. También se evidenció que, para su éxito, es fundamental una amplia articulación entre los actores y órganos de los diferentes sectores involucrados, así como múltiples estrategias implementadas por las distintas esferas de gobierno. De esta manera, sectores de educación, agricultura, planeamiento, compras y sociedad civil deben coordinarse en nivel nacional, departamental y local. Los resultados de este estudio demuestran que iniciativas como estas, de compras institucionales de la agricultura familiar, que están siendo implantadas actualmente en varios países, constituyen importante estrategia de seguridad alimentaria y nutricional, de cumplimiento del derecho humano a la alimentación adecuada y de promoción del desarrollo sostenible a largo plazo.

The effect of new purchase criteria on food procurement for the Brazilian school feeding program.

OBJECTIVE: To explore the effect of the school feeding program purchase criteria on the quantity, variety and origin of food products acquired for school meals in a municipality in Brazil. METHOD: Analysis of purchase lists for two years prior and two years after implementation of the purchase criteria (2010). The origin (family farms (FF)/other providers (OP)) and nutritional characteristics (recommended/controlled) of food products were studied, registering annual varieties (n) and daily quantities (kg/day); contrast of proportions was applied. RESULTS: The acquisition of recommended products increased, and the quantity of controlled products decreased (p = 0.005). Purchase of legumes and vegetables (p < 0.05) increased and high sugar foods decreased (p = 0.02). The majority of food products in 2010 and 2011 were acquired from OP (64% and 61%), although FF provided the greatest proportion of legumes and vegetables. Ten new varieties of recommended products were incorporated, 9 of which were acquired from FF. CONCLUSION: The criteria of direct purchase from family farms resulted in an increase in the variety and quantity of healthy foods in the schools in the municipality.

Antecedentes e elementos da vinculação do programa de alimentação escolar do Brasil com a agricultura familiar / Antecedentes y elementos de la vinculación del programa de alimentación escolar de Brasil con la agricultura familiar / Background and elements of the linkage between the Brazilian school feeding program and family farming

Resumo: Desde 2009, legislação do Programa Nacional de Alimentação Escolar do Brasil (PNAE) institucionaliza a sua vinculação com a agricultura familiar ao estabelecer a obrigatoriedade de que, pelo menos, 30% do total dos recursos financeiros repassados pelo governo federal aos estados e municípios para a alimentação escolar devem ser utilizados na compra de produtos diretamente desse setor. Este estudo analisa o processo de construção desta legislação mediante contextualização histórica, focando nos elementos relacionados à compra da agricultura familiar e, também, apresenta uma representação gráfica com os principais elementos da vinculação: objetivos, público-alvo, ações implementadas e resultados esperados. Foram entrevistados atores envolvidos na construção da legislação. As análises evidenciam que a compra da agricultura familiar pelo PNAE é uma iniciativa de amplo alcance, do ponto de vista conceitual, de execução e de resultados. Também se evidenciou que, para o seu êxito, é fundamental uma ampla articulação entre os atores e órgãos dos vários setores envolvidos, assim como múltiplas estratégias implementadas pelas distintas esferas de governo. Dessa maneira, setores da educação, agricultura, planejamento, compras e sociedade civil devem articular-se em nível nacional, estadual e local. Os resultados deste estudo demonstram que iniciativas como essas, de compras institucionais da agricultura familiar, que estão sendo implantadas atualmente em vários países, configuram-se como importante estratégia de segurança alimentar e nutricional, de cumprimento do direito humano à alimentação adequada e de promoção do desenvolvimento sustentável a longo prazo.

Resumen: Desde 2009, la legislación del Programa de Nacional Alimentación Escolar de Brasil (PNAE) institucionaliza su vinculación con la agricultura familiar, al establecer la obligatoriedad de que por lo menos un 30% del total de los recursos financieros asignados por el gobierno federal a los departamentos y municipios para la alimentación escolar, deben ser utilizados en la compra de productos directamente de ese sector. Este estudio analiza el proceso de creación de esta legislación, mediante contextualización histórica, enfocándose en los elementos relacionados con la compra de la agricultura familiar y, también, presenta una representación gráfica con los principales elementos de la vinculación: objetivos, público-objetivo, acciones implementadas y resultados esperados. Se entrevistaron a actores involucrados en la construcción de la legislación. Los análisis evidencian que la compra de la agricultura familiar por parte del PNAE es una iniciativa de amplio alcance, desde el punto de vista conceptual, de ejecución y de resultados. También se evidenció que, para su éxito, es fundamental una amplia articulación entre los actores y órganos de los diferentes sectores involucrados, así como múltiples estrategias implementadas por las distintas esferas de gobierno. De esta manera, sectores de educación, agricultura, planeamiento, compras y sociedad civil deben coordinarse en nivel nacional, departamental y local. Los resultados de este estudio demuestran que iniciativas como estas, de compras institucionales de la agricultura familiar, que están siendo implantadas actualmente en varios países, constituyen importante estrategia de seguridad alimentaria y nutricional, de cumplimiento del derecho humano a la alimentación adecuada y de promoción del desarrollo sostenible a largo plazo.

Abstract: Since 2009, legislation of the National School Feeding Program of Brazil (PNAE) institutionalizes its linkage with family farming as it establishes the requirement that at least 30% out of the total financial resources allocated by the federal government to the states and municipalities for school feeding must be used in the purchase of products directly from this sector. This study analyzes the process of drafting this legislation, focusing on the elements related to the procurement from family farming, through a historical contextualization, and it also presents a graphical representation with the main elements of this linkage: its objectives, target population, actions implemented and expected results. Actors involved with the drafting of the legislation were interviewed. The analyses show that the procurement from family farming is a far-reaching initiative in terms of the concept, execution and results. It has also showed that a strong articulation between the actors and institutions of the different sectors involved is critical to its success. The education, agriculture, planning, procurement and civil society sectors should work articulately at national, state and local level. The results of this study demonstrate that initiatives like this, of institutional procurement from family farming, which are currently being implemented in several countries, constitute as an important strategy of food and nutrition security, for the fulfillment of the human right to adequate food and the promotion of long-term sustainable development.

How to engage across sectors: lessons from agriculture and nutrition in the Brazilian School Feeding Program.

OBJECTIVE: To provide insights for nutrition and public health practitioners on how to engage with other sectors to achieve public health goals. Specifically, this study provides lessons from the example of integrating family farming and a nutrition into a legal framework in Brazil on how to successfully shift other sectors toward nutrition goals. METHODS: The study analyzed policy processes that led to a Brazilian law linking family farming with the National School Feeding Program. Main actors involved with the development of the law were interviewed and their narratives were analyzed using a well-established theoretical framework. RESULTS: The study provides five key lessons for promoting intersectorality. First, nutrition and health practitioners can afford to embrace bold ideas when working with other sectors. Second, they should engage with more powerful sectors (or subsectors) and position nutrition goals as providing solutions that meet the interests of these sector. Third is the need to focus on a common goal - which may not be explicitly nutrition-related - as the focus of the intersectoral action. Fourth, philosophical, political, and governance spaces are needed to bring together different sectors. Fifth, evidence on the success of the intersectoral approach increases the acceptance of the process. CONCLUSIONS: This study on policy processes shows how a convergence of factors enabled a link between family farming and school feeding in Brazil. It highlights that there are strategies to engage other sectors toward nutrition goals which provides benefits for all sectors involved.

The School Food Environment and Obesity Prevention: Progress Over the Last Decade.

The school food environment-including when and where children obtain food and the types of options available during the school day-plays an important role in children's consumption patterns. Thus, childhood obesity prevention efforts often focus on altering the school food environment as a mechanism for improving student dietary intake. This review examines the role school food programs and policies play in improving children's diet, weight, and health. Overall, research suggests that significant improvements have been made in school nutrition policies and programs. Due to the recent program changes made as a result of the 2010 Healthy, Hunger-Free Kids Act, an emphasis was placed on research conducted over the past decade and especially on the evaluation of foods and beverages served and sold since implementation of this national law. This review also examines remaining gaps in the literature and opportunities for further improvements in school food programs and policies.

How to engage across sectors: lessons from agriculture and nutrition in the Brazilian School Feeding Program

ABSTRACT OBJECTIVE To provide insights for nutrition and public health practitioners on how to engage with other sectors to achieve public health goals. Specifically, this study provides lessons from the example of integrating family farming and a nutrition into a legal framework in Brazil on how to successfully shift other sectors toward nutrition goals. METHODS The study analyzed policy processes that led to a Brazilian law linking family farming with the National School Feeding Program. Main actors involved with the development of the law were interviewed and their narratives were analyzed using a well-established theoretical framework. RESULTS The study provides five key lessons for promoting intersectorality. First, nutrition and health practitioners can afford to embrace bold ideas when working with other sectors. Second, they should engage with more powerful sectors (or subsectors) and position nutrition goals as providing solutions that meet the interests of these sector. Third is the need to focus on a common goal - which may not be explicitly nutrition-related - as the focus of the intersectoral action. Fourth, philosophical, political, and governance spaces are needed to bring together different sectors. Fifth, evidence on the success of the intersectoral approach increases the acceptance of the process. CONCLUSIONS This study on policy processes shows how a convergence of factors enabled a link between family farming and school feeding in Brazil. It highlights that there are strategies to engage other sectors toward nutrition goals which provides benefits for all sectors involved.

Role of School Meal Service in Nutrition.

School meal service programs are essential for children's long-term nutrition and health promotion. The programs vary in content, depending on the economic condition, health condition and the food supply situation in each country. Children are encouraged to improve their nutrition, and choose healthy foods and learn good dietary habits through school meals and nutrition education. In Japan, the school lunch program started in 1889. The percentage of elementary schools serving school lunches had reached 99.2% in 2014, and the Nutrition Teacher system started in 2004. Nutrition teachers are to play the roles of teachers on food and nutrition education in addition to managers of foodservice operations in schools. Nutrition teachers are expected to have effects on school nutrition programs by providing meal service together with nutrition education. And so, significant effort is needed from both academia and the field to raise the related nutritional issues.

Beyond Neighborhood Food Environments: Distance Traveled to Food Establishments in 5 US Cities, 2009-2011.

INTRODUCTION: Accurate conceptualizations of neighborhood environments are important in the design of policies and programs aiming to improve access to healthy food. Neighborhood environments are often defined by administrative units or buffers around points of interest. An individual may eat and shop for food within or outside these areas, which may not reflect accessibility of food establishments. This article examines the relevance of different definitions of food environments. METHODS: We collected data on trips to food establishments using a 1-week food and travel diary and global positioning system devices. Spatial-temporal clustering methods were applied to identify homes and food establishments visited by study participants. RESULTS: We identified 513 visits to food establishments (sit-down restaurants, fast-food/convenience stores, malls or stores, groceries/supermarkets) by 135 participants in 5 US cities. The average distance between the food establishments and homes was 2.6 miles (standard deviation, 3.7 miles). Only 34% of the visited food establishments were within participants' neighborhood census tract. Buffers of 1 or 2 miles around the home covered 55% to 65% of visited food establishments. There was a significant difference in the mean distances to food establishments types (P = .008). On average, participants traveled the longest distances to restaurants and the shortest distances to groceries/supermarkets. CONCLUSION: Many definitions of the neighborhood food environment are misaligned with individual travel patterns, which may help explain the mixed findings in studies of neighborhood food environments. Neighborhood environments defined by actual travel activity may provide more insight on how the food environment influences dietary and food shopping choices.