Sustainable and Nutritional Recommendations for the Development of Menus by School Food Services in Spain.

BACKGROUND: Recommendations for the development of school menus can promote healthier, more sustainable food systems. In Spain, these recommendations depend on regional governments (Autonomous Communities-CCAAs) that develop their own guides. The objective of this study was to explore the nutritional and sustainability recommendations for the development of menus by school food services in Spain. METHODS: Guides were reviewed that were available on the official web pages of the councils of health and education. Twenty-four variables were studied and organized into three categories: characteristics, nutritional recommendations and sustainability. The number of recommendations included in each guide was counted. The weekly frequency of the suggested food provision for each food group was calculated, as was the average, median, standard deviation, confidence interval and interquartile index. RESULTS: Overall, 13 guides were reviewed from different CCAAs. All of them included at least three of the nutritional recommendations, two suggested restrictions in the provision of foods with high quantities of salt and six suggested restrictions in foods with high levels of trans and saturated fats and sugars. All except one guide recommended the weekly provision of foods by food group: protein-rich foods (n = 8), cereals and root vegetables (n = 6), vegetables (n = 5.2) and fruit (n = 4.3). Of the eight criteria for sustainability studied, nine guides included one or none. CONCLUSIONS: Guides for the provision of meals at school in Spain promote the incorporation of healthy foods; however, they rarely restrict foods with high levels of fat, salt and sugar, and the promotion of food sustainability is only just beginning. These guides should be reviewed and updated to include recommendations that promote healthy and sustainable food systems.

School Fruit and Vegetables Scheme: Characteristics of Its Implementation in the European Union from 2009/10 to 2016/17.

The "School Fruit and Vegetables Scheme" (SFVS) was proposed in 2009/10 as a strategy to support the consumption of Fruit and Vegetables (FV), decrease rates of obesity, improve agricultural income, stabilize markets, and ensure the current and future supply of these foods. However, there is little information about how it was carried out in the EU. Given the potential of the SFVS to support healthier, more sustainable food systems, the objective of this study was to identify the characteristics of SFVS implementation from 2009/10 to 2016/17 in the EU. A longitudinal, observational, and retrospective study was carried out based on secondary data. A total of 186 annual reports of the Member States (MS) participating in the SFVS from 2009/10 to 2016/17 were consulted: European and national budget, funds used from the EU, participating schools and students, duration of the SFVS, FV offered, and application of sustainability criteria, expenditure per student, days of the week, the quantity of FV offered per student and other indicators were calculated. The majority of MS participated in the SFVS during the study period with a heterogeneous implementation pattern in terms of funds used, coverage, duration, quantity (totals and by portion), and cost of FV distributed per student. The sustainability criteria for the FV distribution were also not applied uniformly in all the MS. Establishing minimum recommendations for SFVS implementation are recommended to maximize the benefits of the SFVS. The results may be useful for planning new strategies to help address and improve current health and environmental problems.

Facilitating Factors and Opportunities for Local Food Purchases in School Meals in Spain.

The objective of this study is to explore the facilitating factors and opportunities that can promote the implementation of local food purchase (LFP) in Spanish school meals in the opinions of key informants (IK). A qualitative study was carried out based on in-depth interviews with 14 KI capable of influencing Spanish food policy (Representatives of consumers and/or producers, representatives of organizations that promote LFP, and representatives of the government and/or academics). They were asked about opportunities and facilitating factors for implementation of LFP. Interviews were recorded and transcribed. A qualitative content analysis was carried out with Atlas ti. The analysis of the interviews produced two categories that include factors that- in the interviewees' opinions- can promote LFP (social fabric and policy) and three categories that bring together the factors that represent opportunities for implementation in school meal programs in Spain (the policy agenda, regional characteristics and regional context). The overlap between social and political demands were considered to be facilitating factors for LFP. Furthermore, in the opinions of KI, the presence of health and sustainability issues on the public agenda, the existence of a structured productive system and political changes represent an opportunity to implement LFP.

Comparisons of summer break effect on anthropometric profile, body composition and somatotype between adolescent swimmers and less active adolescents / Comparación del efecto de las vacaciones de verano en el perfil antropométrico, la composición corporal y el somatotipo entre nadadores adolescentes y adolescentes menos activos

OBJECTIVE: The aim of this study was to compare changes in anthropometric profile, body composition, and somatotype of adolescent swimmers and less active adolescents. METHOD: We selected 16 swimmers and 8 less active adolescents. The swimmers were divided based on the amount of swimming activity performed per week. A longitudinal study with repeated measures was carried out. The anthropometric profile, body composition, and somatotype were assessed before and after the summer break from swimming activity. RESULTS: Both groups of swimmers showed more changes in anthropometric profile, body composition, and somatotype than the less active adolescents. The very active swimmers showed a higher increase in the sum of the two central skinfolds than peripheral ones (p = 0.018). Both groups of swimmers had a great increase of the percent change in the sum of the two central skinfolds (medium active swimmers: p = 0.006, medium effect size = 0.72; very active swimmers: p = 0.001, medium effect size = 0.64). CONCLUSIONS: The fat component seems to be more variable than the muscular and bone component during 55 - 65 days of summer break from swimming activity. The two groups of swimmers showed a preferential accumulation of central fat after the summer break compared to the less active adolescents. The suprailiac and abdominal skinfolds could be used as early predictive measurements to assess changes in body fat

OBJETIVO: El objetivo del estudio fue comparar los cambios en el perfil antropométrico, la composición corporal y el somatotipo entre nadadores adolescentes y adolescentes sedentarios. MÉTODO: Se llevó a cabo un estudio longitudinal con medidas repetidas. Se analizó el perfil antropométrico, la composición corporal y el somatotipo antes y después del verano. Se seleccionaron 24 adolescentes: 16 nadadores y 8 sedentarios. Los nadadores se dividieron en dos grupos según los minutos de entrenamiento realizado por semana: actividad intensa = 960 minutos, actividad media = 480 minutos. RESULTADOS: Los nadadores mostraron mayores cambios en el perfil antropométrico, la composición corporal y el somatotipo respecto a los adolescentes sedentarios tras el verano. Ambos grupos de nadadores tuvieron un aumento en la suma de los dos pliegues centrales (nadadores de actividad media: p = 0.006, tamaño de efecto medio = 0.72; nadadores de actividad intensa: p = 0.001, tamaño de efecto medio = 0.64). Los nadadores de actividad intensa mostraron un aumento en la suma de los dos pliegues centrales frente a los periféricos (p = 0.018). CONCLUSIONES: En nadadores adolescentes, la grasa corporal parece ser más variable frente al componente muscular y óseo después del verano. Ambos grupos de nadadores mostraron una acumulación preferencial de grasa central después del verano frente a los adolescentes sedentarios. Los pliegues centrales podrían usarse como medidas predictivas tempranas para evaluar los cambios en la grasa corporal

[Spanish update of the Kidmed questionnaire, a mediterranean diet quality index in children and adolescents.] / El índice de calidad de la dieta mediterránea en la infancia y la adolescencia (KIDMED). Propuesta de actualización para países hispano hablantes.

Since 2004 the KIDMED questionnaire has been used to evaluate adherence to the mediterranean diet in children and adolescents. During the last decade, there was a paradigm shift about the daily consumption of fruit juice and whole grains. These changes have led to an update of the KIDMED questionnaire in English. We propose an update of the spanish version of the KIDMED questionnaire. We propose deleting 'or fruit juice' from the first question. In the eighth question we propose adding 'whole-grain' to the daily consumption of pasta and rice. In the ninth question, we propose adding 'whole cereals or whole grains' to the consumption of cereals or grain over breakfast. The twelfth question is reformulated as: "Skips breakfast". We propose some modifications to the spanish version KIDMED questionnaire to provide a tool according to the new recommendations for a healthy diet in children and adolescents.

El cuestionario KIDMED ha sido utilizado desde 2004 para evaluar la adherencia a la dieta mediterránea de niños y adolescentes. Desde entonces, ha habido un cambio de paradigma en referencia al consumo diario de zumos de fruta y al consumo de cereales integrales. Proponemos una actualización del cuestionario KIDMED en lengua española. En la primera pregunta se propone quitar la expresión "o un zumo natural". En la octava pregunta se añade el término "integral" al consumo diario de pasta y arroz. En la novena pregunta se añade el término "integral" al consumo de cereales y derivados en el desayuno. En la duodécima pregunta se propone la siguiente reformulación: "Salta el desayuno". Con este trabajo se proponen algunas modificaciones al cuestionario KIDMED en lengua española, con el fin de suministrar una herramienta conforme a las nuevas recomendaciones que se han ido implementando en los últimos años para poder considerar si una dieta es correcta en niños y adolescentes.

Valoración del documento de consenso sobre alimentación en centros educativos para evaluar menús escolares / Assessment of the consensus document on food in educational centres to evaluate school menus

OBJETIVO: Explorar la aplicabilidad del Documento de Consenso sobre Alimentación en los Centros Educativos (DCSECE) para evaluar la adecuación de los menús escolares a las recomendaciones de una alimentación saludable. MÉTODO: Estudio transversal en el que se analizaron menús mensuales de 28 centros de educación infantil y primaria de Andalucía y Canarias. Los datos se extrajeron mediante un protocolo ad hoc basado en las recomendaciones del DCSECE, las cuales se dividieron en categorías y subcategorías de alimentos. Se estudió la oferta semanal de cada una de las categorías y subcategorías de alimentos y se comparó con las recomendaciones del DCSECE. RESULTADOS: La mayoría de los centros presentó una oferta superior a la recomendación para la categoría de hortalizas y verduras, otras guarniciones y otros postres; inferior para la de arroz, pasta, elaborados y ensaladas; y ajustada para la de legumbres, carnes, pescado y huevos. Por subcategorías, se observó el predominio de vegetales cocidos en la categoría de hortalizas y verduras, en perjuicio de las ensaladas, y una oferta elevada de carnes procesadas en la categoría de carnes. CONCLUSIONES: El DCSECE puede ser un instrumento útil para evaluar la oferta alimentaria en los menús escolares, pero precisa una mayor especificidad en las recomendaciones para identificar la adecuación de los menús a una alimentación saludable

OBJECTIVE: To explore the applicability of the Consensus Document on School Food Programmes in Educational Centres (DCSECE) to evaluate the adaptation of school menus to healthy eating recommendations. METHOD: Transversal study that analyzes monthly school menus from 28 early-childhood education and primary education centres in Andalusia and Canary Islands (Spain). Data were collected using an ad-hoc protocol based on the DCSECE recommendations and divided into food categories and subcategories. We studied the weekly menu offering of each of the foods by category and subcategory and compared them to the DCSECE recommendations. RESULTS: The majority of the schools offered better meals than as specified by the recommendations, in terms of vegetables, other garnishes and other deserts. They offered poorer quality meals in the categories of rice, pasta, prepared foods and salads, and had an equivalent offering in terms of pulses, meats, fish and eggs. By subcategory, we observed the predominance of cooked vegetables in the vegetable category as compared to salads, and the predominance of processed meats in the meats category. CONCLUSIONS: The DCSECE could be a useful instrument for evaluating the nutritional offering of school menus. However, there is a need for greater specificity in the recommendations, in order to identify whether these menus adhere to healthy eating recommendations

[Assessment of the consensus document on food in educational centres to evaluate school menus]. / Valoración del documento de consenso sobre alimentación en centros educativos para evaluar menús escolares.

OBJECTIVE: To explore the applicability of the Consensus Document on School Food Programmes in Educational Centres (DCSECE) to evaluate the adaptation of school menus to healthy eating recommendations. METHOD: Transversal study that analyzes monthly school menus from 28 early-childhood education and primary education centres in Andalusia and Canary Islands (Spain). Data were collected using an ad-hoc protocol based on the DCSECE recommendations and divided into food categories and subcategories. We studied the weekly menu offering of each of the foods by category and subcategory and compared them to the DCSECE recommendations. RESULTS: The majority of the schools offered better meals than as specified by the recommendations, in terms of vegetables, other garnishes and other deserts. They offered poorer quality meals in the categories of rice, pasta, prepared foods and salads, and had an equivalent offering in terms of pulses, meats, fish and eggs. By subcategory, we observed the predominance of cooked vegetables in the vegetable category as compared to salads, and the predominance of processed meats in the meats category. CONCLUSIONS: The DCSECE could be a useful instrument for evaluating the nutritional offering of school menus. However, there is a need for greater specificity in the recommendations, in order to identify whether these menus adhere to healthy eating recommendations.

El índice de calidad de la dieta mediterránea en la infancia y la adolescencia (KIDMED). Propuesta de actualización para países hispanohablantes / Spanish update of the KIDMED questionnaire, a mediterranean diet quality index in children and adolescents

El cuestionario KIDMED ha sido utilizado desde 2004 para evaluar la adherencia a la dieta mediterránea de niños y adolescentes. Desde entonces, ha habido un cambio de paradigma en referencia al consumo diario de zumos de fruta y al consumo de cereales integrales. Proponemos una actualización del cuestionario KIDMED en lengua española. En la primera pregunta se propone quitar la expresión "o un zumo natural". En la octava pregunta se añade el término "integral" al consumo diario de pasta y arroz. En la novena pregunta se añade el término "integral" al consumo de cereales y derivados en el desayuno. En la duodécima pregunta se propone la siguiente reformulación: "Salta el desayuno". Con este trabajo se proponen algunas modificaciones al cuestionario KIDMED en lengua española, con el fin de suministrar una herramienta conforme a las nuevas recomendaciones que se han ido implementando en los últimos años para poder considerar si una dieta es correcta en niños y adolescentes

Since 2004 the KIDMED questionnaire has been used to evaluate adherence to the mediterranean diet in children and adolescents. During the last decade, there was a paradigm shift about the daily consumption of fruit juice and whole grains. These changes have led to an update of the KIDMED questionnaire in English. We propose an update of the spanish version of the KIDMED questionnaire. We propose deleting 'or fruit juice' from the first question. In the eighth question we propose adding 'whole-grain' to the daily consumption of pasta and rice. In the ninth question, we propose adding 'whole cereals or whole grains' to the consumption of cereals or grain over breakfast. The twelfth question is reformulated as: "Skips breakfast". We propose some modifications to the spanish version KIDMED questionnaire to provide a tool according to the new recommendations for a healthy diet in children and adolescents

Parenteral Nutrition in Patients with Inflammatory Bowel Disease Systematic Review, Meta-Analysis and Meta-Regression.

Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and characterized by the inflammation of the gastrointestinal tract. This study is to understand how the use of parenteral nutrition (PN) can affect the adult population diagnosed with IBD. We conducted a systematic review, meta-analysis, and meta-regression. From the different databases (MEDLINE, Scopus, Cochrane, LILACS, CINAHL, WOS), we found 119 registers with an accuracy of 16% (19 registers). After a full-text review, only 15 research studies were selected for qualitative synthesis and 10 for meta-analysis and meta-regression. The variables used were Crohn's Disease Activity Index (CDAI), albumin, body weight (BW), and postoperative complications (COM). PN has shown to have efficacy for the treatment of IBD and is compatible with other medicines. The CDAI and albumin improve, although the effect of PN is greater after a while. However, the effect on the albumin could be less than the observed value in the meta-analysis due to possible publication bias. The BW does not change after intervention. COM utilizing PN has been observed, although the proportion is low. More studies specifically referring to ulcerative colitis (UC) and Crohn's disease (CD) are needed to develop more concrete clinical results.

Enteral Nutrition in Patients with Inflammatory Bowel Disease. Systematic Review, Meta-Analysis, and Meta-Regression.

Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and is characterized by inflammation of the gastrointestinal tract. One of the possible treatments for this pathology is a change in the type of diet, of which enteral nutrition (EN) is one. This study is to understand how the use of EN can affect the adult population diagnosed with IBD. We conducted a systematic review, meta-analysis, and a meta-regression. On the different databases (MEDLINE, Scopus, Cochrane, LILACS, CINAHL, WOS), we found 363 registers with an accuracy of 12% (44 registers). After a full-text review, only 30 research studies were selected for qualitative synthesis and 11 for meta-analysis and meta-regression. The variables used were Crohn's disease activity index (CDAI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). EN has been shown to have efficacy for the treatment of Crohn's disease and is compatible with other medicines. As for the CDAI or rates of remission, there were no differences between enteral and parenteral nutrition. Polymeric formulas have shown better results with respect to the CRP. The long-term treatment could dilute the good CDAI results that are obtained at the start of the EN treatment.

Implementation of the European School Fruit and Vegetables Scheme in Spain (2009-2017).

The School Fruit and Vegetables Scheme (SFVS) implemented by the European Union in 2009/2010 aims to improve the diet of students and to support agricultural markets and environmental sustainability. The objective of this study was to identify the characteristics of the School Fruit and Vegetables Scheme implementation from 2009 to 2017 in Spain and its autonomous communities. A descriptive, longitudinal, observational, and retrospective study was carried out on the basis of document analysis of SFVS reports. We studied the average budget for Spain and its autonomous communities (AC), the number of students enrolled, the cost of the SFVS by student and by day, the duration of the SFVS, the quantity of fruits and vegetables (FV) per student and day (g), the variety of FV, the recommendation to include local, seasonal, and organic foods, and the educational activities (EA). The results were studied by the AC which are territorial entities of Spain. The budget almost doubled during the study, thanks mainly to EU funds. However, the number of students increased only from 18% in 2009 to 20% in 2016. The quantity of FV increased from 2579 to 4000 tons, and the duration of the SFVS increased from 9.8 to 19.6 days. In the AC, there were variations in EA, in the number of enrolled students (7.4% to 45.6%), in the cost per student (from €2.3 to €28), and in the duration in days (5.6 to 70 days). The recommendation to include local, seasonal, and organic foods was implemented in five of the eight years studied. The development and scope of the SFVS in Spain are still insufficient to generate an equitable healthy dietary pattern in the school population. However, the SFVS has generated an economic market for agricultural production due to the amount of FV distributed in each academic course.