Energy and nutrient content of school lunches provided for children attending school-based nurseries: a cross-sectional study.

OBJECTIVE: To nutritionally analyse lunches provided for 3-4-year-old children attending school nurseries. Energy and nutrient content are compared with nutrient frameworks underpinning voluntary guidelines for early years settings (EYS) and mandatory standards for infant schools (4-7-year-olds). DESIGN: A cross-sectional study, recording all main meals, vegetarian meals, jacket potato options, sandwich options and all desserts and accompaniments provided over 5 consecutive days in each school. Two portions of each meal were collected each day and weighed. Recipe and portion weight data were entered into nutrient analysis software. SETTING: School nurseries where lunch was provided by the school. SUBJECTS: Nine schools, providing a total of 161 meals. RESULTS: Lunches contained more energy (1881 kJ/450 kcal), fat (15·5 g), free sugars (10·5 g) and Na (424 mg) than suggested by the nutrient framework for EYS. Carbohydrate (60·6 g), protein (16·8 g), fibre (6·7 g), Fe (2·4 mg), Zn (2·0 mg), Ca (202 mg), vitamin A (304 µg) and vitamin C (19 mg) also exceeded minimum recommendations. Compared with a revised nutrient framework for infant schools, energy was within range, whilst saturated fat, free sugars and Na were above maximum recommendations for this age group, and Zn was below. Sandwich meals were lower in vitamin C (P < 0·001-P = 0·05) and Fe (P = 0·012-P = 0·017) and higher in Na (P < 0·001-P = 0·003) and Ca (P < 0·001-P = 0·05). CONCLUSION: Lunches provided for children attending school nurseries are more in line with the framework for 4-7-year-olds. Free sugars, saturated fat and Na are areas of concern consistent with previous studies. Protein is three times more than recommended. Large portions of cakes and biscuits contribute to excess energy provision.

School lunch portion sizes provided for children attending early years settings within primary schools: A cross-sectional study.

BACKGROUND: In England, many children attend an early years' setting (EYS) that is part of a primary school. Where a school lunch is available, this is often the same for both EYS and school children. This study explored how school lunch portion sizes served for 3-4-year-old EYS children compared with portion size guidance for EYS and schools, given that recommendations are different for EYS and school-aged children. METHODS: Twelve schools were recruited in four local authorities, each of which provided a school lunch to children attending EYS (aged 3-4 years) and reception classes (aged 4-5 years) from the same menu. Two portions of each menu item were weighed, each day, for five consecutive days. Mean, median, standard deviation and correlation coefficient were calculated for each food item. RESULTS: Most caterers reported serving the same-sized portions to both 3-4-year-olds and 5-7-year-olds. Food items falling outside of the typical range for EYS were more commonly above the range (10 food items) than below it (6 food items). Notably, portions of cakes and biscuits were larger than recommended. Portion weights falling outside of the recommended range for 4-10-year-olds were usually too small (12 of 14 items). Some foods provided by the schools in the study did not have typical portion sizes for EYS as they were not 'good choices of foods to serve'. CONCLUSIONS: These results suggest caterers may not be following guidelines appropriate for all the children they are catering for.

Baby-led weaning: A thematic analysis of comments made by parents using online parenting forums.

BACKGROUND: Baby-led weaning (BLW) centres on making the baby an active partner, rather than a passive recipient of complementary feeding. Key features of BLW include self-feeding foods in their natural form, eating with the rest of the family and consuming family foods. This differs from traditional weaning (TW) where parents initially spoon feed purees, alongside finger foods, before graduating to more textured food. Previous research, however, has suggested parents may not fully adhere to one weaning style. The present study aimed to explore how the meaning and interpretation of BLW may contribute to the weaning style used. METHODS: Messages and responses posted on three UK parenting forums, and relating to complementary feeding, were analysed using an interpretive thematic approach. RESULTS: The characterisation of BLW by parents was varied, although they described BLW having an ethos which included trusting the baby, role modelling, developing confidence with food and sharing the social aspects of mealtimes. BLW also offered an alternative to those actively seeking something different or a default for those whose baby refused purees or spoon feeding. BLW felt like a natural progression, with low parental effort for some, and a source of anxiety, stress, choking risk and mess for others. Many parents struggled to find a process (what to eat and when) within BLW that they could follow. Finger foods were used synonymously with BLW, but many mixed/blurred aspects of both TW and BLW. CONCLUSIONS: The interpretation of BLW varies considerably between parents and a broader definition of BLW may be required, along with guidance on the process and purpose of BLW.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review.

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre-pregnancy body mass index greater than 25 kg m-2 are more likely than those with a body mass index in the ideal range (20-24.99 kg m-2 ) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Comparison of food and nutrient intake in infants aged 6-12 months, following baby-led or traditional weaning: A cross-sectional study.

BACKGROUND: A baby-led approach to weaning (BLW) encompasses self-feeding and self-selecting graspable foods, offering an alternative to traditional weaning (TW). This cross-sectional study explored adherence to characteristics of BLW and differences in food group exposure and nutrient intake between babies following either TW or BLW. METHODS: Nutritional data were collected via multiple-pass 24-h recall, following parental completion of an online survey. RESULTS: Infants were grouped according to age (6-8 months; TW [n = 36] and BLW [n = 24]) and (9-12 months; TW [n = 24] and BLW [n = 12]). BLW babies were more likely to be breast fed (p = 0.002), consumed a higher percentage of foods also consumed by their mother (p = 0.008) and were fed less purees (p < 0.001) at 6-8 months. TW babies were spoon fed more (p ≤ 0.001) at all ages. Amongst babies aged 6-8 months, total intake (from complementary food plus milk) of iron (p = 0.021), zinc (p = 0.048), iodine (p = 0.031), vitamin B12 (p = 0.002) and vitamin D (p = 0.042) and both vitamin B12 (p = 0.027) and vitamin D (p = 0.035) from complementary food alone was higher in babies following TW. Compared to TW, BLW babies aged 6-8 months had a higher percentage energy intake from fat (p = 0.043) and saturated fat (p = 0.026) from their milk. No differences in nutrient intake were observed amongst infants aged 9-12 months. Few differences were observed between groups in their number of exposures to specific food groups. CONCLUSIONS: TW infants had higher intakes of key micronutrients at 6-8 months, although there were few differences in nutritional intake at 9-12 months or food group exposure between babies following TW or BLW. BLW appears to be socially desirable. Guidance for parents is required, along with larger, longer-term studies, which explore the potential impact of BLW in later childhood.

Antenatal weight management: Diet, physical activity, and gestational weight gain in early pregnancy.

OBJECTIVE: to investigate women's physical activity levels, diet and gestational weight gain, and their experiences and motivations of behavior change. DESIGN: analysis of cross-sectional data collected during a longitudinal, cohort study examining physiological, psychological, sociodemographic, and self-reported behavioural measures relating to bodyweight. SETTING: women recruited from routine antenatal clinics at the Nottingham University Hospitals NHS Trust. PARTICIPANTS: 193 women ≤27 weeks gestation and aged 18 years or over. MEASUREMENTS & FINDINGS: measurements included weight and height, the Dietary Instrument for Nutrition Education (Brief Version), the International Physical Activity Questionnaire (Short Form), and open questions of perceptions of behaviour change. 50.3% (n=97) were overweight/obese, and women gained 0.26kg/wk (IQR 0.34kg/wk) since conception. The majority consumed low levels of fat (n=121; 63.4%), high levels of unsaturated fat (n=103; 53.9%), and used a dietary supplement (n=166; 86.5%). However, 41% (n=76) were inactive, 74.8% (n=143) did not consume high levels of fibre, and 90.0% (n=171) consumed less than 5 portions of fruit and vegetables a day. Body mass index category was not associated with diet, physical activity levels, or gestational weight gain. Themes generated from open-questions relating to behaviour change were: (1) Risk management, (2) Coping with symptoms, (3) Self-control, (4) Deviation from norm, (5) Nature knows best. CONCLUSIONS: early pregnancy is a period of significant and heterogeneous behaviour change, influenced by perceptions of risk and women's lived experience. Behaviour was influenced not only by perceptions of immediate risk to the fetus, but also by the women's lived experience of being pregnant. IMPLICATIONS FOR PRACTICE: There are exciting opportunities to constructively reframe health promotion advice relating to physical activity and diet in light of women's priorities. The need for individualized advice is highlighted, and women across all body mass index categories would benefit from improved diet and physical activity levels.

Celiac disease and bone fractures: a systematic review and meta-analysis.

CONTEXT: Celiac disease, an autoimmune disease induced by dietary gluten, is associated with metabolic bone disorders, such as low bone mineral density. However, it is unclear whether this translates into an association between celiac disease and such hard clinical outcomes as bone fractures. OBJECTIVE: To systematically review and pool the evidence for the relationship of celiac disease with prevalence and incidence of bone fractures. DATA SOURCES: We systematically searched Pubmed, Scopus, Web of Science, and Cochrane Library in January 2014 for studies of celiac disease and bone fractures. STUDY SELECTION: Observational studies of any design, in which bone fracture outcomes were compared in individuals with and without celiac disease were included. DATA EXTRACTION: Two investigators independently extracted results from eligible studies. DATA SYNTHESIS: In the meta-analyses of case-control and cross-sectional studies, bone fractures were almost twice as common in individuals with a clinically diagnosed celiac disease as in those without the disease. In the meta-analyses of prospective studies, celiac disease at baseline was associated with a 30% increase (95% confidence interval [CI]: 1.14, 1.50) in the risk of any fracture and a 69% increase in the risk of hip fracture (95% CI: 1.10, 2.59). The two studies of unrecognized celiac disease (elevated circulating concentrations of celiac disease-specific autoantibodies but no celiac disease diagnosis) had contradicting findings. CONCLUSION: Our findings suggest that clinically diagnosed celiac disease and bone fractures co-occur and that celiac disease was associated with an increased risk of hip fractures as well as fractures in general. Further research would be needed to determine whether unrecognized celiac disease is associated with the risk of bone fractures.

Lunchtime food and nutrient intakes of secondary-school pupils; a comparison of school lunches and packed lunches following the introduction of mandatory food-based standards for school lunch.

OBJECTIVE: To compare the key differences between school lunches and packed lunches as eaten in eleven secondary schools in England, 21 months after the food-based standards for school lunch became mandatory, but before the introduction of nutrient-based standards. DESIGN: Data on 358 school lunches and 139 packed lunches were collected in May and June 2008 from pupils attending secondary schools in Sheffield, Manchester, Leicester City and Essex. Fieldwork was conducted over five consecutive school days at each school. Fieldworkers randomly selected five pupils taking a school lunch and five pupils bringing a packed lunch each day. All food and drink items chosen by pupils were weighed and recorded. Leftovers were also weighed. SETTING: Eleven state-maintained, co-educational secondary schools from four local authorities in England. SUBJECTS: Four hundred and ninety-seven pupils aged 11-16 years. RESULTS: Pupils taking school lunches, on average, had significantly higher intakes of energy, protein, carbohydrate, NSP, vitamin C, folate, Fe and Zn than pupils bringing a packed lunch to school. Mean intakes of protein, fat and vitamin C from both types of lunch met the nutrient-based standards and school lunches also met standards for carbohydrate, NSP and energy. CONCLUSIONS: Nutrient intakes from school lunches were more favourable than those from packed lunches, but typically failed to meet nutrient-based standards for school food. A combination of continued improvements to school food, educating pupils to make healthier choices and policies to encourage pupils to eat at school or bring healthier packed lunches is needed.

Short communicationKey differences between school lunches and packed lunches in primary schools in England in 2009.

OBJECTIVE: To compare the key differences between school lunches and packed lunches as consumed in a nationally representative sample of primary schools, 6-8 months after the nutrient-based standards for school lunch became mandatory. DESIGN: Data on 6580 pupils' school lunches and 3422 pupils' packed lunches were collected between February and April 2009 from pupils attending primary schools in England. Fieldwork was conducted over five consecutive school days. Fieldworkers randomly selected ten pupils taking a school lunch and five pupils bringing a packed lunch each day at each school, and recorded and weighed all food and drink items consumed, as well as any leftovers. SETTING: A nationally representative sample of 136 state-maintained primary schools in England. SUBJECTS: A total of 10 002 pupils aged 4-12 years. RESULTS: Mean intakes of protein, fat, saturated fat and vitamin C from both types of lunch met the nutrient-based standards. Pupils taking school lunches on average consumed significantly more protein, NSP, vitamin A, folate and Zn and less fat, saturated fat, non-milk extrinsic sugars (NMES), Na, Ca, vitamin C and Fe than pupils taking packed lunches. Energy intakes were low in both groups. CONCLUSIONS: Packed lunches were less likely to accord with food-based or nutrient-based standards than school lunches. Higher levels of Na, NMES, fat and percentage energy from saturated fat emphasise the difficulties associated with optimising nutrient intakes from packed lunches.

Children's lunchtime food choices following the introduction of food-based standards for school meals: observations from six primary schools in Sheffield.

OBJECTIVE: To describe the lunchtime choices and nutritional intake of primary-school-aged children in England 4 months after the introduction of interim food-based standards for school lunches. DESIGN: Cross-sectional 2 d weighed food records collected in January and February 2007. SETTING: Six primary schools in Sheffield, England. SUBJECTS: One hundred and twenty-three pupils aged 8-10 years. RESULTS: Vegetables (81 % v. 8 %) and cakes and biscuits (43 % v. 23 %) were chosen more frequently by pupils consuming a school lunch, while fruit (40 % v. 36 %), meat products (18 % v. 14 %), confectionery (72 % v. 0 %), savoury snacks (69 % v. 0 %) and drinks not meeting the school food standards (40 % v. 0 %) were chosen more often by pupils eating a packed lunch. Mean energy intake was lower in the school lunch group compared with the packed lunch group (1402 (sd 573) v. 2192 (sd 619), P = 0·005). Nutrient density (per MJ energy) was significantly better in school meals for key nutrients including protein (9·8 (sd 2·7) v. 6·3 (sd 1·9) g), fat (7·4 (sd 2·7) v. 10·6 (sd 2·8) g), NSP (2·8 (sd 1·3) v. 1·1 (sd 0·4) g), vitamin A (151·3 (sd 192·8) v. 69·1 (sd 55·6) µg), folate (29·6 (sd 11·6) v. 17·0 (sd 7·0) µg), iron (1·3 (sd 0·3) v. 0·9 (sd 0·3) mg) and zinc (1·1 (sd 0·4) v. 0·7 (sd 0·3) mg). CONCLUSIONS: Schools were largely compliant with the interim food-based standards for school meals 4 months after their introduction. Within the context of the new standards, children taking a school lunch are more likely to eat a more nutritious lunch, in terms of less high-fat/salt/sugar foods and nutrient density. The introduction of nutrient-based standards is warranted. Efforts to improve the lunchtime intake of children taking a packed lunch are also required.