Assessment of Hygiene Management Practices and Comparative Analysis of Regulatory Frameworks for Shared Kitchens across Different Countries.

Shared kitchens, where users share kitchen space, are becoming popular worldwide due to the economic cost savings of startup businesses. This study conducted monitoring of microbial and chemical hazards from prepared foods and the environment of shared kitchen facilities, surveyed shared kitchen operators, and compared shared kitchen regulations between Korea and other countries. The monitoring results indicate that the hygiene status of the facilities and the microbial and chemical hazards in the prepared foods were all within the standard specifications, showing significantly lower levels compared to regular restaurants (p < 0.05). In particular, concurrent-use and time-division types of open shared kitchens showed significantly lower levels of both hazards than separated-individual kitchens. Survey results of hygiene inspection also confirmed better hygiene management in concurrent-use and time-division types of open shared kitchens in Korea. However, more frequent cleaning and disinfection, hygiene inspections, and training are high economic burdens in the operation of shared kitchens compared to regular restaurants. Moreover, mandatory insurance subscriptions, the operator's responsibility in hygiene-related incidents, and high operational costs collectively challenge shared kitchens' competitiveness in the food service market. Critical reassessments of regulations utilizing the benefits of shared kitchens are needed to promote a safe dining culture and the growth of shared kitchen startup businesses.

Methods and measures in food service food safety research: A review of the published literature.

Purpose: Food handlers working in food service establishments need to perform appropriate and consistent food safety practices to ensure that the prepared food is safe for consumers to eat, as a failure to do so may lead to foodborne illness. It is important to have an in-depth understanding of food handler food safety behaviour in the food service sector to design targeted educational interventions and approaches to safeguard consumers. The purpose of this review is to provide insight to the existing body of research regarding food handler food safety in the food service sector, and to identify future research needs in terms of methods and measures. Methods: This study is a review of published food safety research studies (n = 118) focusing on food handlers in the food service sector conducted between 2001 and 2021. Data were collated regarding the methods used and the measures assessed in published studies to identify the gaps in current knowledge related to food safety in food service. Findings: The majority of studies were conducted in the United States (29%), Brazil (17%) and United Kingdom (7%). A large proportion were carried out in restaurants (70%). Less than a third of studies (28%) relied on a mixed method approach for data collection; and only 12% of studies assessed a combination of cognitive and behavioural measures. Observation was used in only 29% of studies. A lack of observational data detailing food safety practices such as handwashing, temperature control, separation and cleaning was determined. Significance: Such findings indicate a greater need for mixed method approach in future food safety research. It is recommended that the understanding of food handler food safety performance is best obtained through a combined assessment of cognitive and behavioural measures with subsequent triangulation of findings to reduce bias and to obtain reliable results.

Experiences and perceptions of people with celiac disease, food allergies and food intolerance when dining out.

Introduction: Eating out is a common practice in modern society. Celiac disease (CeD) and food allergy (FA) are among the most common conditions responsible for adverse reactions to food. Despite their different origins, both require treatment with restrictive diets (avoidance of gluten and/or specific allergens) and this results posing similar challenges when eating out. Our objective was to learn about the experiences/perceptions of consumers with CeD and FA when dining out, as well as the challenges they face in food service environments. Methods: An ad hoc questionnaire was used to record consumer perceptions, food service characteristics and resulting adverse reactions. Results: 377 individuals living in Santiago, Chile, provided complete information and were analyzed (160 CeD, 105 FA). 301 participants (79.8%) declared eating out, 33.6% reported experiencing an adverse reaction at least once while eating out. 94.4% of the 377 participants believed that the serving staff had little or no knowledge about his/her condition. Consumers reporting symptoms as severe adverse reactions were more common among celiac than allergic patients (p < 0.001). Discussion: The study showed no significant differences based on consumer-related characteristics (p:NS). The consequences of eating out did not vary based on individual's data, including diagnosis, age, frequency of eating out, adverse reactions experienced, or intensity. These findings suggest that the most important determinants of risk associated with eating out are characteristics of the food service, like availability of information, staff training, and establishment's facilities like equipment available, exclusive utensils for customers with special dietary needs and kitchen and bathrooms organization.

Individualised nutritional treatment increases the positive effects of a novel á la carte hospital food service concept: Results of a quasi-experimental study.

BACKGROUND & AIMS: One-third of hospitalised patients are at nutritional risk, and limited choice regarding meals and meal times, and inadequate nutritional support may contribute to inadequate nutritional intake during hospitalisation. The aim was to test the effect of a novel á la carte hospital food service concept as a stand-alone intervention and combined with individualised nutritional treatment. METHODS: Medical inpatients at nutritional risk were recruited for this three-arm quasi-experimental study. The control group received meals from the traditional bulk trolley food service system. Intervention group 1 (IG1) received meals from a novel á la carte food service concept with an electronic ordering system, whereas intervention group 2 (IG2) in addition to this received individualised nutritional treatment by a clinical dietitian. Nutritional intake and length of stay was measured, and patient satisfaction was assessed with purpose-designed questionnaires. RESULTS: 206 patients were included: 67 in the control group, 68 in IG1, and 71 in IG2. The proportion of participants reaching ≥75 % of both their energy and protein requirement was higher in IG1 compared to the control group (34 % vs. 12 %, p = 0.002) and higher in IG2 compared to IG1 (53 % vs. 34 %, p = 0.035). Length of stay was shorter in IG2 compared to the control group (6.0 vs. 8.7 days, p = 0.005). It was important to participants to be able to choose when and what to eat, and this preference was met to a larger extent in the intervention groups. CONCLUSION: The novel á la carte concept increases energy and protein intake in hospitalised patients, and the positive effects are increased, when the concept is used in combination with individualised nutritional treatment.

A world-first food service satisfaction questionnaire for use with family members of nursing home residents: expanding the toolkit of valid and reliable aged care food service satisfaction questionnaires.

OBJECTIVES: This study aimed to develop a valid and reliable food service satisfaction questionnaire for use by family members of residents in nursing homes. DESIGN: Questionnaire development and validation study conducted using COSMIN® benchmarks for excellence. SETTING: Nursing homes. PARTICIPANTS: Family members of residents in nursing homes. MEASUREMENTS: Content validity was established based on a review of the literature, qualitative interviews with family members (n = 9) and expert review (n = 10). Face validity was established in pilot testing with family members (n = 5). A 40-item questionnaire was developed for psychometric testing. Data from 414 family members was used to establish construct validity (Principal Components Analysis), with data from 101 of those family members used to evaluate reliability (internal consistency (Cronbach's alpha [α]) and temporal stability [weighted Kappa]). RESULTS: A two factor 24-item scale resulted, with excellent internal consistency (factor one: 11 items related to food and meals (α = 0.960); factor two: 13 items related to the mealtime experience (α = 0.907)). Temporal stability was moderate to near perfect (weighted Kappa: 0.461-0.875; p < 0.001). CONCLUSION: This world-first, valid and reliable, food service satisfaction questionnaire for use with family members of nursing home residents meets COSMIN® standards for excellence and complements the Flinders University resident and workforce food service satisfaction questionnaires also available for use in nursing homes.

Participation in the US Department of Agriculture's Summer Meal Programs: 2019-2021.

BACKGROUND: The US Department of Agriculture's (USDA) summer meal programs are designed to provide meals at no cost while school is out of session. In response to the COVID-19 pandemic, several regulatory waivers were enacted to facilitate meal distribution. The aim of this study was to assess the rates of meal distribution before and after these waivers were in effect. METHODS: Meal distribution patterns for 2019, 2020, and 2021 were examined through (1) a descriptive comparison of the number of participating districts, sponsors, meal sites, and meals distributed statewide, and (2) repeated measures ANOVAs to examine changes among districts in operation all years. RESULTS: The waivers were associated with an increase in the total number of participating districts, sponsors, and meal sites; an increase in the total number of meals distributed to children during the summer months; and an increase in meal distribution among sponsors that had been in place since 2019. CONCLUSION: Expanding the area eligibility criteria and enabling flexibility in meal distribution methods increased the number of meals provided. This study provides important preliminary evidence to suggest that the USDA should consider permanent regulatory changes to this program to maximize its reach.

Tracking progress toward a climate-friendly public food service strategy: assessing nutritional quality and carbon footprint changes in childcare centers.

BACKGROUND: Public food procurement and catering are recognized as important leverage points in promoting sustainable and healthy dietary habits. This study aimed to analyze changes in nutritional quality and carbon footprint (CF) of food service in childcare centers in the City of Copenhagen from 2018 to 2022, following a new climate-friendly food strategy in 2019. The strategy has a target of decreasing the CF of municipal food service by 25% before 2025 compared to a 2018 baseline. METHODS: Key initiatives in the municipality's strategy included creating guidelines for food-service providers to reduce their CF while ensuring meal nutritional quality and providing food professionals an advisory process to develop necessary competencies. In this quasi-experimental study, food procurement data from Copenhagen's childcare centers (n = 356 [2022]) from 2018 and 2022 were combined with CF and nutrient composition data. Dietary CF and food and nutrient content were calculated per 10 MJ of energy and compared to guideline targets. Furthermore, data for 2022 were analyzed separately for institutions that had received an advisory process (n = 87) and those that had not yet (n = 269). RESULTS: On average, the CF of the food procurement decreased by 15%, mainly driven by a decrease in ruminant meat purchases (-37%). While the procurement of plant-based protein sources (pulses, nuts, seeds) increased by 25%, it was still considerably below targets. Nutrient content did not substantially change, and recommendations for calcium, iron, vitamin D, sodium, and total and saturated fat were not met in either measurement year. Institutions that had received an advisory process had a 14% lower CF in 2022 than institutions that had not. CONCLUSIONS: With the observed 15% CF reduction, Copenhagen's childcare centers are on track to reach the 25% reduction goal outlined in the municipality's food strategy by 2025. Nutritional quality was largely unchanged, but further efforts to increase especially the consumption of plant-based protein sources, while simultaneously reducing meat and animal-based fat, and maintaining sufficient dairy consumption, are needed to improve nutritional quality and reach the target CF reduction in the coming years. Providing training for food professionals could play an important role in seeing the changes through.

Food Safety Practices of Food Handlers in China and their Correlation with Self-reported Foodborne Illness.

Food service facilities are important sites where foodborne diseases have been reported to occur frequently. This study aims to determine the correlation between self-reported foodborne diseases and food-safety practices followed by food handlers of various food service facilities. A cross-sectional survey was conducted from March 1, 2022 to December 30, 2022 in Wuhu City, Anhui Province, China. Data were collected through face-to-face interviews and having the selected food handlers fill in a self-compiled questionnaire. Of the 1072 food handlers included in the study, 88 (8.2%) reported having experienced symptoms of foodborne diseases in the past 4 weeks. The following food-safety practices correlated with self-reported foodborne diseases: (1) infrequently using 3-compartment sinks to separately clean different types of raw food materials (P < 0.05, OR = 2.312); (2) infrequently removing non-edible parts of aquatic products outside a specific room for food processing (P < 0.001, OR = 3.916); (3) infrequently immediately refrigerating cold dishes prepared in advance to be consumed later (P < 0.001, OR = 4.048); (4) often store perishable foods at 8-60°C in the indoor environment after cooking and before eating (P < 0.05, OR = 2.068); (5) infrequently reheating cooked perishable food stored at 8-60°C for more than 2 h before eating (P < 0.05, OR = 1.934); and (6) often storing raw and cooked food in the same container (P < 0.001, OR = 3.818). Hence, a better supervision of food-safety practices of catering workers may reduce the frequency of foodborne-disease outbreaks in food service facilities.

USDA Summer Meals Programs: Meeting the Nutritional Needs of Children.

BACKGROUND: Although research shows that children from households with low incomes have diet quality that is better during the school year vs the summer, very little research exists around the nutritional quality of summer meals available to children through the US Department of Agriculture's (USDA) summer meals programs. OBJECTIVE: The objective was to examine the extent to which summer meals contributed to meeting the daily nutritional goals from the 2015-2020 Dietary Guidelines for Americans (DGAs) for 9- to 13-year-olds. The current study also analyzed the types of food offered and the top food sources of energy and nutrients in summer lunches. DESIGN: This cross-sectional study analyzed a nationally representative sample of summer meal sites participating in the Summer Food Service Program (SFSP) or the Seamless Summer Option (SSO). SETTING: Weekly lunch menus were obtained from 731 summer meal sites operating in the summer of 2018 (SFSP sites: n = 578; SSO sites: n = 153). MAIN OUTCOME MEASURES: Outcome measures included the most frequently offered foods in the major food groups. The energy and nutrient content of lunches offered were estimated and compared with the daily nutritional goals provided by the 2015-2020 DGAs for 9- to 13-year-olds. STATISTICAL ANALYSES PERFORMED: Menu data were entered into USDA's SurveyNet and linked to the USDA's Food and Nutrient Database for Dietary Studies 2015-2016. Foods were classified into major and minor food groups from the USDA's School Nutrition and Meal Cost Study. The energy and nutrient values were compared with the daily nutritional goals provided by the DGAs for children ages 9 to 13 years. RESULTS: Summer lunches provided substantial contributions toward the daily goals for energy and nutrients for 9- to 13-year-olds. SSO programs provided significantly more vegetables than SFSP programs (P < 0.05) and contained significantly higher amounts of vitamins A (P < 0.05), C (P < 0.05), and iron (P < 0.05). Sodium amounts were below the daily limit for 9- to 13-year-olds across both program types. CONCLUSIONS: Although SSO lunches offered more vegetables than SFSP lunches, lunches served in both SSO and SFSP contributed substantially toward the daily goals for energy and nutrients.

Effectiveness of grease interceptors in food service establishments for controlling fat, oil and grease deposition in the sewer system.

The water industry worldwide experiences numerous sewer blockages each year, partially attributed to the accumulation of fat, oil and grease (FOG). Managing this issue involves various strategies, including the requirement for installation of grease interceptors (GIs) installation. However, the claimed efficacy of commercial GIs of eliminating 99 % of FOG has been questioned for many years because FOG deposit formation occurs despite food service establishments (FSEs) using GIs, therefore detailed understanding of FOG wastewater compositions and its removal by GIs is required. This study provides an insight into the key FOG components such as FOG particle size, metals and fatty acid (FA) profile in GI influent and effluent, and within the GI, at three different FSEs. Analysis of FAs identified substantial proportions of extra-long-chain FAs in the effluents, including arachidic (C20:0), behenic (C22:0), mead (C20:3), lignoceric (C24:0), and nervonic (C24:1) acids. In contrast, the household kitchen released palmitic (C16:0), oleic (C18:1) and linoleic (C18:2) acids. It was further observed that scums effectively remove the larger FOG particles, leaving only 10 % below 75.4 µm. Notably, FSEs which employed automatic dishwashers produced up to 80.4 % of particles ≤45 µm, whereas FSEs and household kitchen which used handwash sinks generated only 36.9 % and 26.3 % of particles ≤45 µm, respectively. This study demonstrated that the commercial GIs do not remove FOG entirely but clearly demonstrated that they discharge high concentrations of FOG with extra-long FFAs which were attributed to the occurrence of microbial activity and hydrolysis of triglycerides within the GI, potentially contributing to FOG deposition.

Emergency Free School Meal Distribution During the COVID-19 Pandemic in High-Poverty Urban Settings.

BACKGROUND: The coronavirus disease 2019 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who were reliant on subsidized school meals at risk of experiencing hunger. In response, the US Department of Agriculture mobilized the Summer Food Service Program and Seamless Summer Option program to provide emergency free school meals. There is a need to investigate the effectiveness of these programs in covering underresourced communities during the pandemic. OBJECTIVE: This study assessed associations between meal distribution and census tract demographics (ie, poverty level, race/ethnicity, and deprivation level based on social deprivation index score). DESIGN: An observational study using longitudinal meal distribution data collected over an 18-month period following school closures (March 2020 to August 2021). PARTICIPANTS AND SETTING: Monthly meal distribution data were collected for community sites serving 142 census tracts within 4 urban New Jersey cities predominantly populated by people with low incomes and from racial and ethnic minority groups. MAIN OUTCOME MEASURES: Main outcome measures were the number of meals served monthly by Summer Food Service Program and Seamless Summer Option meal sites. STATISTICAL ANALYSES PERFORMED: A 2-part multivariable regression approach was used to analyze the data. RESULTS: In the first step, logistic regression models showed that high-deprivation tracts were more likely to serve meals during the observed period (odds ratio 3.43, 95% CI 1.001 to 11.77; P = 0.0499). In the second step, among tracts that served any meals during the observed period, mixed effects negative binomial regression models showed that high-poverty and high-deprivation tracts served comparatively more meals (incidence rate ratio [IRR] 2.83, 95% CI 2.29 to 3.51; P < 0.001 and IRR 1.94, 95% CI 1.65 to 2.28; P < 0.001, respectively). CONCLUSIONS: Findings show that meal distribution during the pandemic was higher within census tracts with higher poverty and deprivation levels, indicating that underresourced communities with higher need had more free meals available during this unprecedented public health emergency.

Effects of campus dining sustainable practices on consumers' perception and behavioral intention in the United States.

BACKGROUND/OBJECTIVES: Sustainability has become one of the top priorities in the foodservice industry. With an increase in consumer interest in sustainability and educational opportunities in higher education, it is important to know what sustainable practices are implemented in campus dining and how sustainable practices affect consumers' responses. This study aims to identify the key sustainable practices in the campus dining context, and investigate the relationship by applying the stimulus-organism-response framework to determine whether the key sustainable practices influence consumers' perception and behavioral intentions. SUBJECTS/METHODS: The self-administered online survey was distributed to college students in 8 dining halls at a large southeastern university in the United States from September 20-October 10, 2019. A total of 382 valid questionnaires were collected, and factor analysis and multiple regressions were utilized to test the research model. RESULTS: This study identified 4 dimensions of campus sustainability with a total of sustainable practices: sustainable food, waste management, energy/water conservation, and recycling/reuse. Three dimensions of sustainable campus practices (i.e., sustainable food, waste management, recycling/reuse) played a significant role in consumers forming a perceived value while energy/water conservation did not significantly influence the consumers' perceived value toward the campus dining. Waste management was identified as the most important practice to enhance consumers' perceived value (ß = 0.330). Using sustainable food and recycling/reuse were ranked second and third, respectively (ß = 0.262, ß = 0.154). The findings confirmed the significant positive relationship between perceived value and revisit intentions. CONCLUSIONS: The findings support the inclusion of dining sustainability as a critical component in explaining college students' perceived value and revisit intention toward campus dining. Furthermore, this study provides practical implications for university administrators and foodservice operators to consider the key sustainable practices to meet the consumers' value and revisit intentions.

Challenges and Opportunities for Equity in US School Meal Programs: A Scoping Review of Qualitative Literature Regarding the COVID-19 Emergency.

The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families' needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity.

Assessment of Nutrient Levels Provided by General Hospital Patient Menus: A Cross-Sectional Study Carried Out in the Region of Murcia (Spain).

Disease-related malnutrition remains a health problem with a high prevalence that increases the risk of poor patient outcomes, in addition to an elevation of healthcare costs. The aim of this study was to evaluate the nutritional quality of the menus at Ribera Molina Hospital, including their adequacy regarding recommended daily nutrient intakes and the agreement with the theoretical nutrition information provided by catering. The mean levels of energy, macronutrients, vitamins, and minerals provided by the basal, diabetic, and soft diets were calculated through the weighing of plated food served throughout the first 14 days of February 2020. A nutritional overestimation was seen in the nutrition information provided by the catering compared to the values derived from weighing foods (p < 0.01). Despite this, the nutritional content calculated by weighing satisfied the energy and protein requirements of 203 hospitalized patients previously studied in the internal medicine area of the hospital. The mean age of these patients was 62 years, and the main causes of admission were lung, cardiovascular, renal, and digestive diseases. There seems to be an insufficient amount of vitamins E and D, as well as magnesium, on all the menus. A possible insufficient amount of calcium, potassium, zinc, and copper was observed in some of the menus studied. It is necessary to update the hospital prescription manual so the nutritional contents of the diets are accurate and based on the weighted and calculated values to improve the adequacy of diets prescribed to patients.

Healthy Food Policies Documented in University Food Service Contracts.

In the United States, there is an opportunity to improve the nutritional health of university students through the campus food environment. This project used a content analysis approach to investigate whether healthy food standards and policies were incorporated into the contract agreements between North Carolina (NC) public universities and their food service management companies. Food service contracts were collected from 14 NC public universities using food service management companies on campus. Each contract was evaluated using the 35-item North Carolina Food Service Policy Guidelines Assessment to examine four elements of the campus food environment: Beverages, Packaged Snacks, Prepared Foods, and Other (e.g., strategic placement of healthier food). Five university food service contracts incorporated no North Carolina Food Service Policy Guidelines, three university contracts included one to five guidelines, and six university contracts included six to nine guidelines. Altogether, 13 of the 35 guidelines were incorporated into at least one university food service contract. This project presents a cost and time-effective assessment method for determining if evidence-based nutrition guidelines have been included in university food service contracts. This approach and findings may lead to contract revisions to improve the campus food environment and, subsequently, the nutritional health of college populations.

Exploring dark kitchens in Brazilian urban centres: A study of delivery-only restaurants with food delivery apps.

Dark kitchen is a delivery-only restaurant that operates without direct contact with the consumer, has no premises for local consumption and sells exclusively through online platforms. The main objective of this work is to identify and characterise dark kitchens in three urban centres featured in the most used food delivery app in Brazil. To this end, data collection was conducted in two phases. In the first phase, through data mining, we collected information from restaurants in three cities (Limeira, Campinas and São Paulo - Brazil) that were provided in the food delivery app. A total of 22,520 establishments were searched from the central point of each of the cities. In the second phase, the first 1,000 restaurants in each city were classified as dark kitchens, standard, or undefined restaurants. A thematic content analysis was conducted to further distinguish the dark kitchen models. Of the restaurants evaluated, 1,749 (65.2%) were classified as standard restaurants, 727 (27.1%) as dark kitchens, and 206 (7.7%) as undefined. In terms of the characteristics of dark kitchens, they were more dispersed and located further away from the central points compared to standard restaurants. Meals in dark kitchens were cheaper than in standard restaurants, and had a lower number of user reviews. Most of the dark kitchens in São Paulo served Brazilian dishes, while in the smaller cities, Limeira and Campinas, it was mainly snacks and desserts. Six different models of dark kitchen were identified: Independent dark kitchen; shell-type (hub); franchise; virtual kitchen in a standard restaurant (different menu); virtual kitchen in a standard restaurant (similar menu but different name); and home-based dark kitchen. The modelling approach and methodology used to classify and identify dark kitchens is considered a contribution to science as it allows a better understanding of this fast growing sector of the food industry. This in turn can help to develop management strategies and policies for the sector. Our study is also of value to regulators to determine their proliferation through urban planning and to promote appropriate guidelines for dark kitchens as they differ from standard restaurants.

The impact of sodium reduction on overall nutrient content in Child and Adult Care Food Program meals.

OBJECTIVE: To understand the impact of Na reduction on the nutrient content of Child and Adult Care Food Program (CACFP) meals served through At-Risk Afterschool Meals (ARASM) without compromising the nutritional quality of the meals served. DESIGN: Sodium Reduction in Communities Program (SRCP) partnered with a CACFP ARASM programme from October 2016 to September 2021. We assessed changes in Healthy Eating Index 2015 (HEI-2015) food component scores and macro- and micronutrients using cross-sectional nutrient analyses of October 2016 and 2020 menus. SETTING: ARASM programme sites in Indianapolis, IN, USA. PARTICIPANTS: October 2016 and 2020 menus from one CACFP ARASM programme. INTERVENTION: Na reduction strategies included implementing food service guidelines, modifying meal components, changing procurement practices and facilitating environmental changes to promote lower Na items. RESULTS: From baseline in 2016 to 2020, fifteen meal components were impacted by the intervention, which impacted 17 (85 %) meals included in the analysis. Average Na per meal reduced significantly between 2016 (837·9 mg) and 2020 (627·9 mg) (P = 0·002). Between 2016 and 2020, there were significant increases in whole grains (P = 0·003) and total vegetables (P < 0·001) and significant reductions in refined grains (P = 0·001) and Na (P = 0·02), all per 1000 kcal served. CONCLUSIONS: This study demonstrates that Na content can be reduced in CACFP meals without compromising the nutritional quality of meals served. Future studies are needed to identify feasible best practices and policies to reduce Na content in the CACFP meal pattern.

Is meal order timing and flexibility key to improving patient satisfaction with hospital foodservice?

AIM: The aim of this study was to retrospectively evaluate and compare patient foodservice (FS) satisfaction using a validated tool and consistent methodology in an acute health service for four different FS models as the organisation transitioned through traditional model (TM), choice at point of service (CaPOS), bedside menu ordering systems (BMOS) and room service (RS) from 2013 to 2016. METHODS: Patient satisfaction data were collected using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. For the purposes of this study, patients' rating of their overall experience with FS (very good, good, okay, poor or very poor) was compared for each site and model. RESULTS: Satisfaction was significantly higher in the CaPOS and RS models compared with TM. BMOS, although somewhat higher, was not shown to be significantly higher than TM. The RS model was significantly higher than BMOS, but there was no significant difference observed between RS and CaPOS. CONCLUSION: FS models that support patient flexibility and meal ordering closer to the meal delivery time (as seen with RS and CaPOS) show higher patient satisfaction among hospital patients. It is recommended that sites consistently opt to include patient satisfaction as part of routine auditing. This would enable clear conclusions to be drawn regarding best practice FS models, based on specific and individual hospital requirements.

Why Patients Discard Their Food? A Qualitative Study in Iranian Hospitals.

Introduction: Food waste reflects inadequate food intake and is of economic and environmental importance. Therefore, understanding the underlying factors is a must to combat food waste. Methods: A qualitative study was conducted using semi-structured interviews with managers, nurses, nutritionists, food providers, kitchen staff, and inpatients at three hospitals in Tehran. Responses were recorded, coded, and analyzed thematically. Results: Forty-eight face-to-face interviews led to three core categories: 1. opinions/performance; 2. causes, related factors, and characteristics; and 3. rooting and suggestions. We found that the majority of the hospitalized patients did not consume their entire food. In spite of overall satisfaction with the quantity and quality of food, anorexia, personal taste, and poor quality of raw materials prohibited patients from eating. Also, rice was the most discarded food. Economic barriers were the most important hindrance to elevate the quality, and some strategies, like the supply of high-quality materials and recruiting skillful cooking team, were proposed to improve it. Conclusions: Our findings delineated a limited budget as the main barrier to improve the quality. Nevertheless, the low quality of hospital foods may actually impose a heavier economic burden due to food waste.

Mississippi School Food Service Directors' Interest and Experience With Local Food Procurement and Farm to School Activities.

BACKGROUND.: The purpose of this study was to collect updated school food service purchasing practices from K-12 public school food service directors (SFSD) in Mississippi and to determine their current abilities, experiences, and desires to engage in Farm to School (F2S) activities. METHODS.: The online survey was created using questionnaire items from existing F2S surveys. The survey opened in October 2021 and closed in January 2022. Descriptive statistics were used to summarize the data. RESULTS.: Of the 173 SFSD sent email invitations, 122 (71%) completed the survey. The most common fresh fruit and vegetable purchasing practices included Department of Defense Fresh Program (65%) and produce vendor (64%). Forty-three percent of SFSD purchased at least one locally sourced fruit and 40% purchased at least one locally sourced vegetable, while 46% did not purchase any locally sourced foods. The most common challenges for purchasing from farmers included no relationship with farmers (50%) and food safety regulations (39%). Sixty-four percent of SFSD were interested in at least one F2S activity. CONCLUSIONS.: Most SFSD do not purchase local foods directly from farmers and almost half do not purchase any local foods regardless of source. Lack of connection with local farmers is a significant challenge to F2S. Recently proposed framework by USDA for shoring up the food supply chain and transforming the food system may help reduce or remove ongoing challenges to F2S participation.