Perceived benefits and challenges of school feeding program in Addis Ababa, Ethiopia: a qualitative study.

Addis Ababa initiated a universal Home-Grown School Feeding Program (HGSFP) in February 2019 to address hunger and improve the educational outcomes of schoolchildren. This study aimed to document the perceived benefits and challenges of the HGSFP in Addis Ababa, where such information was lacking. In May 2023, a qualitative phenomenological study was conducted to collect data from 20 schools participating in the HGSFP. Data were collected through key informant interviews and focus group discussions (FGDs) involving 98 purposively selected participants. The study encompassed 48 student mothers in 5 FGDs, 20 student interviews, 20 school principals, and 10 experts from the Ministry of Education, Sub-cities, and the School Feeding Agency for in-depth interviews. Data collected in the local language were transcribed, translated into English, and thematically analysed using ATLAS-TI software. The study's findings unveiled the transformative impact of the HGSFP in Addis Ababa, Ethiopia. It demonstrated remarkable improvements in attendance, concentration, academic performance, reduced dropout rates, financial relief, enhanced behaviour, and a safer learning environment. However, urgent measures are imperative to tackle pressing challenges such as underpaid kitchen workers, operational issues, reduced reading time, rising food costs, limited market access, inadequate infrastructure, and growing dependency. To ensure the enduring sustainability of HGSFP, addressing challenges like workload reduction, kitchen infrastructure enhancement, government guideline implementation, promoting self-reliance, overcoming budget limitations, and addressing school gardening obstacles is vital.

It Is Back to School Time-The Status of Healthy School Meals for All Students.

This JAMA Forum discusses key government efforts to advance the availability of healthy school meals, the evidence of the effects of these efforts, and the role for health professionals.

Evaluation of the Climate Impact and Nutritional Quality of Menus in an Italian Long-Term Care Facility.

Global warming poses a significant threat to our planet, with the food sector contributing up to 37% of total greenhouse gas emissions. This study aimed to assess the climate change impact and healthiness of menus in a long-term care facility in Italy. We analyzed two 28-day cyclical menus using the carbon footprint (CF) and the Modified EAT-Lancet Diet Score (MELDS) to evaluate adherence to the Planetary Health Diet (PHD). Monte Carlo simulations were employed to explore 20,000 daily menu permutations. Results showed that the mean GHGEs of spring/summer and autumn/winter daily menus were 2.64 and 2.82 kg of CO2eq, respectively, with 99% of menus exceeding the 2.03 kg of CO2eq benchmark. Only 22% of menus were adherent to the PHD, with MELDSs ranging from 12 to 29. A strong inverse association between the CF and adherence to the PHD was observed. These findings suggest significant potential for reducing the CFs of meals served in nursing homes while promoting adherence to a planetary diet, presenting an opportunity to set new standards in caregiving and environmental sustainability.

Public Procurement Practices for Cereal Products in Polish Educational Institutions: Analysis and Implications for Nutrition Policy.

Public procurement of food is crucial for ensuring proper nutrition and the provision of high-quality products in public institutions like schools and kindergartens. It should be seen as an investment in health promotion, particularly for young children. Notably, when no quality criteria are specified, the cheapest and often lowest-quality products are typically selected. This study analyzed 1126 public procurement orders processed by schools and kindergartens in Poland between November 2022 and March 2023, with a focus on cereal products and their derivatives. Of these orders, 197 met the inclusion criteria, yielding a total of 5084 cereal products for detailed analysis. The study assessed the quantities ordered and the quality characteristics specified in the procurement documents. The results revealed that the most commonly described criteria pertained to product composition, especially typical characteristics and the absence of additives. Sensorial characteristics such as consistency and color were also frequently specified, while sustainable public procurement criteria were mentioned the least, indicating their marginal importance in current procurement practices. This underscores the critical importance of establishing minimum standards for describing cereal products in terms of sensorial characteristics, composition, and sustainability. Such standards are essential for improving the quality of grain products supplied to public institutions and ensuring that these institutions actively contribute to promoting healthy eating habits among children.

Assessing the Validity of Front-of-Pack Nutrition Labels for Evaluating the Healthiness of Mediterranean Food Choices: A Global Comparison.

In response to growing public health concerns, governments worldwide have implemented various nutrition labelling schemes to promote healthier eating habits. This study aimed to assess the consistency and effectiveness of these labels in an out-of-home context, specifically focusing on restaurant, hospitality, and institutional food service settings. In total, 178 different dishes from Spain were analysed using labels from the Mazocco method, the UK's traffic light system, the Health Star Rating (Australia), Nutri-Score (France), multiple traffic lights (Ecuador), and warning labels (Chile and Uruguay). The results demonstrated a generally low level of agreement among these labels (K < 0.40), indicating notable variability and a lack of consensus, which could hinder consumers' ability to make informed food choices in out-of-home settings. Nutri-Score classified the highest number of dishes as unhealthy (38%). This study underscores the need for an easy-to-understand labelling system tailored to each country's culinary and socio-cultural contexts to improve consumer decision-making in various dining environments. Future research should focus on developing and testing qualitative methods to more accurately gauge the nutritional quality of cooked dishes in diverse out-of-home settings, thereby enhancing public health outcomes. By addressing the specific needs of the home, restaurants, hospitality, and institutional food services, tailored labelling schemes could significantly improve consumers' ability to make healthier food choices.

A Web-Based Thai School Lunch Program Promotes Children's Heights: A Cross-Sectional Study in Rural Schools.

BACKGROUND: Nutrition has an impact on development and linear growth. However, a few studies examine the connections between children's age-standardized height and their nutritional status and diet quality. OBJECTIVES: This study aimed to find a relationship between dietary consumption and height for age among school students under a web-based Thai school lunch program. METHODS: Anthropometric data and nutrient consumption were obtained from 24-hour records. Nutrient consumption was calculated using Inmucal. The parent and custodian's data were from the electronic health records. RESULTS: Children's heights were not correlated with parents' heights (P<0.720). Moreover, children with low height-for-age Z-score (HAZ) had significantly lower intakes of minerals (iron, magnesium, and selenium) and vitamins (B6, B12, C, and E). On the other hand, magnesium, selenium, vitamin B12, and vitamin E intakes of the children with normal HAZ were higher than their custodians. CONCLUSION: The Thai school lunch program effectively maintains the normal HAZ of children. Nutritional education in the community is recommended.

Availability and consumption of hyper-palatable foods in an all-you-can-eat cafeteria among college freshmen.

INTRODUCTION: College campuses provide an expansive food environment, which may contribute to elevated risk of excess energy intake and weight gain among college students. All-you-can-eat style cafeterias often expose students to hyper-palatable foods (HPF), which may promote overeating. This study aimed to examine the availability of HPF in an all-you-can-eat college cafeteria, and to examine HPF intake during meals among undergraduates. METHOD: Publicly available cafeteria menu data from a Midwestern university were analyzed and included 25 meals. To determine the availability of HPF within the cafeteria meals, the standardized definition of HPF by Fazzino et al. (2019) was used, which specifies combinations of palatability-inducing nutrients at quantitative thresholds that may induce hyper-palatability. Participants (N = 225) who ate in the cafeteria in the past 24 h were presented with a list of all menu items for their corresponding cafeteria meal, and self-reported all items consumed. RESULTS: On average, 40 % (SD = 1.4) of total food items available per meal were HPF, with 68 % (SD = 3.6) of items with elevated fat and sodium. Regarding intake of HPF among students, approximately 64 % (SD = 31.4) of foods consumed were HPF, and 51 % (SD = 32.3) of items consumed had elevated fat and sodium. CONCLUSION: Findings indicated that college students may be regularly exposed to HPF in all-you-can-eat college cafeteria environments, and that students may consume cafeteria meals that are primarily comprised of HPF.

The SABER School Feeding policy tool: a 10-year analysis of its use by countries in developing policies for their national school meals programs.

Since its launch in 2011, 59 governments have used the World Bank's Systems Approach for Better Education Results (SABER) policy tool to design their national school-based health and nutrition programs. This tool guides governments to self-evaluate their education system policies against international benchmarks and identify actionable priorities to strengthen national programs. Thirty-two of the 49 countries in sub-Saharan Africa (65%) have undertaken a SABER review, and globally the approach has been adopted by 68% of the world's low-income countries and 54% of lower-middle-income countries. Analysis of 51 comparable SABER School Feeding surveys suggests that countries with longer established national school meals frameworks tend also to be more advanced in other policy areas, and vice versa. The SABER reviews consistently identify, perhaps predictably, that the weakest policy areas relate to program design, implementation and fiscal space. This analysis also found that the tool had an additional value in tracking the evolution of policies when implemented over several time points, and showed that policy areas become more advanced as national programs mature. These benefits of the tool are particularly relevant to the 98 countries that co-created the global School Meals Coalition in 2021. The Coalition member countries have the specific goal of enhancing coverage and support for the well-being of schoolchildren and adolescents affected by the school closures during the COVID-19 pandemic. The SABER tool has the demonstrated potential to implement, accelerate and track changes in school meals policy and, since it has been previously used by 74% (31/42) of low- and lower-middle-income countries in sub-Saharan Africa, is an already accepted element of the political economies of those countries and so has the potential to be deployed rapidly.

Cariogenicity and Calories of Meals Served at a Pre-Kindergarten School-Based Meal Program.

Purpose: To analyze the cariogenicity of meals served in a pre-kindergarten program and its potential influence on early childhood caries (ECC) risk in socioeconomically disadvantaged children. Methods: This study examined 123 school-provided meals over 43 days at the United Nation Childhood Development Center, part of the Oakland Unified School District pre-kindergarten program. Using cariogenicity indices developed by Evans et al., all items served were assessed for the cariogenic potential of both food and beverages. Results: The mean daily cariogenicity scores were 6.57±1.3 (standard deviation) for food and 2.89±0.78 for beverages. Breakfast foods were significantly more cariogenic than those served for lunch or supper (P<0.05). The mean daily calorie intake was 1,459±336, with lunch containing statistically higher calorie items compared to supper (P<0.05). While liquids may not significantly contribute to caries risk, breakfast foods emerged as a potential concern. Conclusions: This study's findings suggest that the food provided in school meals, particularly breakfast items, may impact early childhood caries risk among socioeconomically disadvantaged children. Given the prevalence of ECC and its societal burden, integrating assessments of food and beverage cariogenicity into school meal planning could be instrumental in mitigating ECC incidence. Collaboration between the United States Department of Agriculture and school districts in considering the cariogenic potential of foods may contribute to improved oral health outcomes in early childhood.

Mapping the existing evidence of the effects of school food policies on health, acceptance and affordability of secondary school children in Europe: a scoping review protocol.

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.

Eating vegetables at school lunchtimes: Pilot and feasibility studies testing strategies to improve intake.

Vegetable provision at schools in the UK has increased over recent years; however children still eat few of the vegetables that are served to them. Two experimental pilot and feasibility studies implemented a vegetables-served-first (study 1) plus experiential learning (study 2) approach to increase children's (3-5 years and 4-7 years respectively) vegetable consumption at school lunchtimes. Both studies involved vegetables-served-first 10-min before the rest of the meal, with experiential learning techniques (repeated exposure, "veg-first" dinner plates, vegetable songs, videos, and nutrition education) complementing the vegetable service in study 2. Study 1 (n = 38) found that vegetables-served-first, compared with serving all foods together, increased vegetable intake by ∼12 g. Study 2 (n = 69) found that vegetable consumption depended on individual schools. Schools where vegetable intake was low showed increases in consumption during intervention weeks, whereas schools with high vegetable intake showed little change. Acceptability of interventions was found to be good for children and schools that participated, although concerns about time to serve vegetables first and COVID-related environmental restrictions reduced feasibility for some schools. Child engagement could also be improved by offering a wider variety of vegetables during repeated exposure to reduce monotony. Future research should design interventions using co-design methods including schools to suit their context best, whilst also addressing the problem with a systems approach. Interventions which focus on child learning through experience need to take account of specific school environments including curricular needs, resources available for school lunch (including both time and space), provision of food, support from teachers and parents, and the culture around eating (e.g. encouragement, pressure to eat, lunchtime competing with playtime). Joined-up systems approaches could enhance both provision and uptake of vegetables at school meals.

Diversity and practice: local decision-making practices on multi-cultural diets for British Muslim school children (BMSC) and implications for social justice.

Introduction: British Muslim School Children (BMSC) are required to follow special halal dietary requirements in accordance with their religion, which is often not accounted for in British schools. This often leaves BMSC limited to a vegetarian diet while at school, despite this not being their chosen diet or preference. This study explores the perceptions of key stakeholders regarding fairness and accessibility of school meals for BMSC, as well as discussing school food provision for those maintaining a religious diet in light of social justice. This is in the context of limited knowledge previously being explored in the North East of England regarding procurement and decision-making at a systems level to cater for BMSC. Methods: A qualitative research design was conducted. A total of 62 participants (39 BMSC, 15 parents, and 8 school and catering staff) took part in a semi-structured interview or focus group. Participants were recruited from six schools, with these schools selected based on their differing levels of BMSC in attendance. This project took place between March 2022 and October 2023. Results/discussion: Results suggested that where schools already catered for diverse food requirements, inclusive of BMSC dietary needs, food choices were still limited in the options and amount available. School and catering staff stated that cost implications contributed to their menu development process. Despite this, there was an evident willingness to learn about the cultural food options and how these can be implemented in future school menus. Suggestions discussed included an increase in the use of halal meat in order to provide a more inclusive school food experience for BMSC.

Universal Free School Meals and School and Student Outcomes: A Systematic Review.

Importance: The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States. Objective: To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States. Evidence Review: An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome. Findings: The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making. Conclusions and Relevance: In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.

Quality and Quantity of School Lunch in Nanjing: Based on Data from the Sunshine Restaurant Supervision Platform.

School lunch plays an important role in children's healthy growth. Previous investigations revealed many problems with school lunches, including unreasonable dietary structure and insufficient micronutrients. This study aimed to assess the dietary structure and nutritional quality of lunches in Nanjing primary and middle schools. A stratified cluster random sampling method was used to select 44 schools that supply lunch in 12 districts in Nanjing, with two primary and two middle schools in each district. Twenty-four primary and twenty middle schools were selected. The Mann-Whitney U test was used to explore the influencing factors. Findings revealed a serious shortage of milk and fruit in school lunches; supply of eggs, fish, shrimp, and shellfish was less than half of the recommended quantity; livestock and poultry supply exceeded the recommended level by over four times. Energy and nutrition intake were suboptimal. Provision of energy, carbohydrates, vitamins (A, B1, B2, and C), calcium, and iron in urban primary schools was significantly higher than that in non-urban primary schools. The same pattern of significantly higher nutrients was equally seen in urban middle schools compared with non-urban middle schools, indicating that food supply was affected by regional economies. Therefore, it is urgent to improve the quality of lunches, with a particular focus on those in non-urban areas.

Nutritional status of school children in South-west Nigeria: Inferences from a national homegrown school feeding programme.

Background: The School Feeding Programme if properly executed has the capacity to improve the nutritional status of the school children. Objective: To assess the nutritional status of school children in Ondo State Nigeria given that the National Home-Grown School Feeding Programme (NHGSFP) has been operational in the state for over five years. Methods: This was a descriptive cross-sectional study. Results: A total of 234 subjects from public schools and 227 subjects from private schools were enrolled in the study. Their mean age was 8.23 ± 1.92 years. Wasting, overweight, obesity, underweight, and stunting were noted in 19.4%, 11.4%, 0.4%, 5.0%, and 20.7% of the children, respectively. The prevalence of stunting (30.3%) and wasting (23.9%) was more among subjects from the public schools. A significant association was found between Weight-for-Age Z-score, Height-for-Age Z-score, and BMI-for-Age Z-score and the children's school type (p < 0.005). Conclusion: Majority of the children showed normal growth, the rest were in both extremes of malnutrition, the subjects from private schools seem to present better nutritional status, although there is no baseline data to ratify this finding. A further study on this subject using the current finding as a baseline data is recommended.

Effects of increasing the availability of vegetarian options on main meal choices, meal offer satisfaction and liking: a pre-post analysis in a French university cafeteria.

BACKGROUND: Changing the food environment is an important public health lever for encouraging sustainable food choices. Targeting the availability of vegetarian main meals served in cafeterias substantially affects food choice, but acceptability has never been assessed. We examined the effects of an availability intervention at a French university cafeteria on students' main meal choices, meal offer satisfaction and liking. METHODS: A four-week controlled trial was conducted in a university cafeteria in Dijon, France. During the two-week control period, vegetarian main meals constituted 24% of the offer. In the subsequent two-week intervention period, this proportion increased to 48%, while all the other menu items remained unchanged. Students were not informed of the change. Student choices were tracked using production data, and daily paper ballots were used to assess student satisfaction with the meal offer and liking of the main meal they chose (score range [1;5]). Nutritional quality, environmental impact, and cost of production of meal choices were calculated for each lunchtime. Food waste was measured over 4 lunchtimes during control and intervention periods. An online questionnaire collected student feedback at the end of the study. RESULTS: Doubling availability of vegetarian main meals significantly increased the likelihood of choosing vegetarian options (OR = 2.57, 95% CI = [2.41; 2.74]). Responses of the paper ballots (n = 18,342) indicated slight improvements in meal offer satisfaction from 4.05 ± 0.92 to 4.07 ± 0.93 (p = 0.028) and in liking from 4.09 ± 0.90 to 4.13 ± 0.92 (p < 0.001) during control and intervention periods, respectively. The end-of-study questionnaire (n = 510) revealed that only 6% of students noticed a change the availability of vegetarian main meals. The intervention led to a decrease in the environmental impact of the main meals chosen, a slight decrease in nutritional quality, a slight increase in meal costs and no change in food waste. CONCLUSIONS: Doubling availability of vegetarian main meals in a university cafeteria resulted in a twofold increase in their selection, with students reporting being more satisfied and liking the main meals more during the intervention period. These results suggest that serving an equal proportion of vegetarian and nonvegetarian main meals could be considered in French university cafeterias to tackle environmental issues. TRIAL REGISTRATION: Study protocol and analysis plan were pre-registered on the Open Science Framework ( https://osf.io/pf3x7/ ).

Impact of free school lunch program on nutritional status and academic outcomes among school children in India: A systematic review.

INTRODUCTION: Mid-day meal programmes (MDM) were introduced in India to improve school attendance, nutritional status and educational outcomes of school children. Numerous primary studies have examined the impact of the MDM programmes on both nutritional and educational outcomes in various settings across the country. However, synthesising the findings from these studies has been challenging. To address this gap, we conducted a systematic review to assess the effects of MDM programmes on the nutritional and academic outcomes of school children in India. METHODS: A comprehensive literature search was conducted, and relevant studies published between 1997 and 2022 were included. Two reviewers independently conducted study selection, data extraction and risk of bias assessment. The results were synthesised descriptively. RESULTS: The systematic review included 31 studies. Among them, 16 studies focused on academic outcomes, while 18 studies reported children's nutritional status. Studies on MDM Scheme (MDMS) in children show mixed results on nutritional outcomes. While some studies show marginal improvements in height and weight measurements, others show no significant improvement. Regular MDMS access improves enrollment, attendance and retention rates for children, with lower dropout rates and higher academic achievement. However, its impact on academic performance remains unclear. CONCLUSION: The MDM programme in India was effective in improving the academic achievement and a few nutritional outcomes of school children, underscoring the importance of sustaining MDM programmes in India. PROTOCOL REGISTRATION NUMBER: The review was prospectively registered in PROSPERO (CRD42023391776). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023391776.

Changing the food environment in secondary school canteens to promote healthy dietary choices: a qualitative study with school caterers.

BACKGROUND: Typical adolescent diets do not meet current dietary recommendations. There is a need to address these dietary patterns to reduce the risk of obesity and other diet-related diseases. Schools provide an opportune setting to do so, as students consume a substantial proportion of their daily dietary intake whilst at school. There is a developing evidence base on the use of choice architecture (food choice cues) to promote healthy eating in school contexts. It is necessary to understand the acceptability and feasibility of implementing such interventions. We aimed to explore these factors from the perspectives of secondary school caterers. METHODS: We conducted qualitative interviews with caterers from secondary schools across the West Midlands, UK and national/regional catering representatives. A semi-structured topic guide and visual aid were used to guide interviews. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12. RESULTS: Twelve participants took part. Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Limits of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as they require minimal reflective motivation. Salient cues included enhancing the placement, presentation and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity. Student engagement was considered important. Some catering decision drivers conflicted with healthy food cues, and many felt that their role in healthy eating was limited due to the overwhelming influence of external food environments, adolescent resistance, and features of the secondary school canteen setting e.g. short duration of lunchtime, lack of space. However, caterers appeared motivated to implement healthy food cues and identified key opportunities for implementation, including integration into whole-school approaches to healthy eating. CONCLUSIONS: Interventions using healthy food cues appeared acceptable to secondary school caterers, key potential implementers of these strategies. Future interventions could incorporate strategies relating to placement, presentation and pricing to prompt healthy selections, and actions to engage the student body and improve the dining environment. Evaluations should consider potential impacts upon food purchasing, consumption and waste to address caterers' concerns about these issues.

The Role of School Health Promotion in Students' Dietary Intake during School Hours: A Qualitative Comparative Analysis.

Many children in the Netherlands do not adhere to dietary guidelines. Therefore, the Healthy School (HS) program stimulates healthier dietary intake of students through schools. However, evaluating the effectiveness of school health promotion in improving dietary intake is challenging due to the influence of contextual factors. Qualitative Comparative Analysis (QCA) considers these contextual factors. Therefore, we performed a QCA to examine which (combinations of) contextual factors contribute to the healthier dietary intake of students during school hours in primary schools (approximate age range children 4-12 years) and secondary schools (age range 12-18 years) when implementing the HS program for nutrition. Data were collected mainly through interviewing school staff and a school-level questionnaire in fifteen primary schools and twelve secondary schools. We included five factors for primary schools: implementation of the HS program for nutrition, degree of implementation, socioeconomic status, parental support, and student support. For secondary schools, we included school environment instead of parental and student support. For primary schools, the best results were obtained if the HS program for nutrition was implemented in high socioeconomic status schools with a combination of high implementation, parental support, and student support. Findings indicate that if secondary schools have an impeding environment and low socioeconomic status, implementation of the HS program for nutrition can result in healthier dietary intake.

Environmental Footprints in Food Services: A Scoping Review.

The collective meals market generates significant revenue for the world economy. Food services are responsible for consuming large amounts of water and energy, as well as generating a substantial volume of waste, which is often improperly disposed of. Given the unchecked expansion of food services, the lack of proper management of environmental resources can undermine sustainability principles, posing a threat to future generations. This scoping review aimed to synthesize the existing scientific literature on carbon and water footprints in food services, describing the main methods and tools used and what strategies have been proposed to mitigate the high values of these footprints. The search for articles was performed on 6 June 2024 in seven electronic databases, using MeSH Terms and adaptations for each database from database inception. The search for local studies was complemented by a manual search in the list of references of the studies selected to compose this review. It included quantitative studies assessing footprints (water or carbon) in food services and excluded reviews, studies that reported footprints for diets, and protocols. A total of 2642 studies were identified, and among these, 29 were selected for this review. According to the findings, it was observed that meats, especially beef, contribute more to water and carbon footprint compared to other proteins. Mitigation strategies for the water footprint include promoting plant-based diets, menu changes, and awareness.