Many colleges are removing trays from their dining facilities in hope of reducing waste. How does not having a tray impact food choice?

A field study was conducted in a university cafeteria (n 417) on two evenings with identical menus, one with tray service and one without.

A dining hall of a large north-eastern university, USA.

Undergraduate students.

Trayless dining decreased the percentage of diners (average age 19·1 years) who took salad by 65·2 % but did not decrease the percentage who took dessert, leading to a markedly higher ratio of dessert to salad.

Cafeterias going trayless should consider complementary policies to encourage balanced diets.

To assess the effectiveness of an intervention programme to improve kindergarten children's eating and leisure habits in Israel.

A cluster-randomised controlled trial.

Six full-day kindergartens in Israel were randomly divided into three groups. Group A received the full intervention programme, which included lessons on good eating habits and daily physical exercise. Group B received a partial intervention of lessons only. Group C, the reference group, did not receive any intervention.

Children aged 4–6 years (n 204) were recruited for the study.

Objective data for weight and height were collected to calculate BMI Z-scores. Activity, sedentary time, sleeping hours and daily energy intake were assessed via a parental questionnaire. Nutritional knowledge was assessed by a single dietitian using a questionnaire addressed to the children. Assessments were done at baseline and at the end of the intervention.

After adjustment for baseline levels we observed a significant reduction in daily energy intake for the full intervention group A (P = 0·03). A positive intervention effect was demonstrated on nutritional knowledge in the partial intervention group B (P = 0·03), although no significant change was demonstrated for BMI Z-score.

The study supports the incorporation of education on healthy lifestyle habits and physical activity into the curricula of kindergartens.

To study the effects of school lessons about healthy food on adolescents’ self-reported beliefs and behaviour regarding the purchase and consumption of soft drinks, water and extra foods, including sweets and snacks. The lessons were combined with the introduction of lower-calorie foods, food labelling and price reductions in school vending machines.

A cluster-randomized controlled design was used to allocate schools to an experimental group (i.e. lessons and changes to school vending machines) and a control group (i.e. ‘care as usual’). Questionnaires were used pre-test and post-test to assess students’ self-reported purchase of extra products and their knowledge and beliefs regarding the consumption of low-calorie products.

Secondary schools in the Netherlands.

Twelve schools participated in the experimental group (303 students) and fourteen in the control group (311 students). The students’ mean age was 13·6 years, 71·5 % were of native Dutch origin and mean BMI was 18·9 kg/m2.

At post-test, the experimental group knew significantly more about healthy food than the control group. Fewer students in the experimental group (43 %) than in the control group (56 %) reported bringing soft drinks from home. There was no significant effect on attitude, social norm, perceived behavioural control and intention regarding the consumption of low-calorie extra products.

The intervention had limited effects on students’ knowledge and self-reported behaviour, and no effect on their beliefs regarding low-calorie beverages, sweets or snacks. We recommend a combined educational and environmental intervention of longer duration and engaging parents. More research into the effects of such interventions is needed.

To evaluate the impact on nutrition- and health-related practice of two methods of delivery of a nutrition and health intervention in Irish full-day-care pre-schools: training of pre-school managers only or training of managers and their staff.

A simple randomised study with pre-schools divided into two training groups: ‘manager trained’ and ‘manager and staff trained’. Direct observational data – food and fluid provision, physical activity, outdoor time, staff practices and availability of nutrition and health resources – were recorded during one full day spent in each pre-school both pre- and post-intervention, using a specifically developed and validated Pre-school Health Promotion Activity Scored Evaluation Form. Post-intervention, self-assessment data were also collected using the same evaluation tool.

Pre-schools, Midlands of Ireland.

A convenience sample of forty-two pre-schools registered with the Irish Health Service Executive.

From pre- to post-intervention, significant improvement (P < 0·05) in nutrition- and health-related practice was observed within both intervention delivery groups in all areas evaluated: environment, food service, meals and snacks. No additional effect attributable to staff training was observed. Scores assigned by direct independent observation were lower than pre-school self-assessment scores.

The implementation of a training intervention in pre-schools significantly improved practice with no significant benefit of additional staff training. Direct independent observation is required to quantify practice accurately.

To understand stakeholders’ perspectives on food waste in a universal free School Breakfast Program implementing a Breakfast in the Classroom model.

Semi-structured focus groups and interviews were conducted with school district stakeholders. Inductive methods were used to code resulting transcripts, from which themes were identified. The analysis provides a thematic analysis of stakeholders’ perspectives on food waste in the School Breakfast Program.

Ten elementary schools in a large urban school district implementing a universal free Breakfast in the Classroom model of the US national School Breakfast Program.

Elementary-school students (n 85), parents (n 86), teachers (n 44), cafeteria managers (n 10) and school principals (n 10).

Stakeholders perceived food waste as a problem and expressed concern regarding the amount of food wasted. Explanations reported for food waste included food-related (palatability and accessibility), child-related (taste preferences and satiation) and programme-related (duration, food service policies, and coordination) factors. Milk and fruit were perceived as foods particularly susceptible to waste. Several food waste mitigation strategies were identified by participants: saving food for later, actively encouraging children’s consumption, assisting children with foods during mealtime, increasing staff support, serving smaller portion sizes, and composting and donating uneaten food.

Stakeholders recognized food waste as a problem, reported myriad contributing factors, and have considered and employed multiple and diverse mitigation strategies. Changes to the menu and/or implementation logistics, as well as efforts to use leftover food productively, may be possible strategies of reducing waste and improving the School Breakfast Program’s economic, environmental and nutritional impact.

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems.

The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation).

Slovenian primary schools.

A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation.

The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements.

The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

The objective of the present study was to gain an understanding of the organizational characteristics and processes in two child-care centres that may influence adoption of the Alberta Nutrition Guidelines for Children and Youth (ANGCY).

In-depth qualitative case studies. Data were collected through direct observations, key informant interviews and field notes. Diffusion of Innovations theory guided the evaluation and intrinsic case analysis.

Two urban child-care centres in Edmonton, Alberta, Canada identified as exemplary early adopter cases.

Ten key informants comprised of directors, junior and senior staff members participated in interviews.

Organizational processes such as leadership, networking and knowledge brokering, health champions and organizational culture positively influenced adoption behaviour in child-care centres. A key determinant influencing organizational behaviour within both centres was the directors’ strong leadership. Acceptance of and adherence to the guidelines were facilitated by organizational factors, such as degree of centralization, formalization and complexity, level of staff training and education. Knowledge brokering by directors was important for transferring and exchanging information across the centre. All child-care staff embraced their informal role as health champions as essential to supporting guideline adherence and encouraging healthy food and eating environments.

Organizational processes and characteristics such as leadership, knowledge brokering and networking, organizational culture and health champions played an important role in the adoption of nutrition guidelines in child-care centres. The complex interplay of decision making, organization of work and specialization of roles influenced the extent to which nutrition guidelines were adopted.

The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising.

An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information.

Public sector-owned and -operated health facilities in Queensland, Australia.

One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48·2 % and 96·0 %, respectively.

Of facility managers, 78·4 % reported implementation of more than half of the A Better Choice requirements including 24·6 % who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising.

Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.

To determine the impact of an implementation intervention designed to introduce policies and practices supportive of healthy eating in centre-based child-care services. Intervention strategies included staff training, resources, incentives, follow-up support, and performance monitoring and feedback.

A quasi-experimental design was used to assess change over 20 months in healthy eating policy and practice in intervention and comparison child-care services.

The Hunter New England (HNE) region of New South Wales (NSW), Australia.

All centre-based child-care services (n 287) in the intervention region (HNE) were invited and 240 (91 % response rate) participated. Two hundred and ninety-six services in the rest of NSW were randomly selected as a comparison region and 191 participated (76 % response rate). A sub-analysis was conducted on those services that provided children food (n 196 at baseline and n 190 at follow-up). Ninety-six provided menus for analysis at baseline (HNE, n 36; NSW, n 50) and 102 provided menus at follow-up (HNE, n 50; NSW, n 52).

Services in the intervention region were significantly more likely to provide only plain milk and water for children (P = 0·018) and to engage parents in nutrition policy or programmes (P = 0·002). They were also more likely (P = 0·056) to have nutrition policy on home packed food. In addition, menus of services that provided lunch were significantly more likely to comply with healthy eating guidelines for sweetened drinks (P < 0·001), fruit (P < 0·001) and vegetables (P = 0·01).

An implementation intervention was able to modify policy and practice in a large number of child-care services so that they were more supportive of healthy eating.

The National Afterschool Association (NAA) standards specify the role of summer day camps (SDC) in promoting healthy nutrition habits of the children attending, identifying foods and beverages to be provided to children and staff roles in promoting good nutrition habits. However, many SDC do not provide meals. Currently, national guidelines specifying what children are allowed to bring to such settings do not exist, nor is there a solid understanding of the current landscape surrounding healthy eating within SDC.

A cross-sectional study design using validated measures with multiple observations was used to determine the types of foods and beverages brought to SDC programmes.

Four large-scale, community-based SDC participated in the study during summer 2011.

The types of foods and beverages brought by children (n 766) and staff (n 87), as well as any instances of staff promoting healthy eating behaviours, were examined via direct observation over 27 d. Additionally, the extent to which current foods and beverages at SDC complied with NAA standards was evaluated.

Less than half of the children brought water, 47 % brought non-100 % juices, 4 % brought soda, 4 % brought a vegetable and 20 % brought fruit. Staff foods and beverages modelled similar patterns. Promotion of healthy eating by staff was observed <1 % of the time.

Findings suggest that foods and beverages brought to SDC by children and staff do not support nutrition standards and staff do not regularly promote healthy eating habits. To assist, professional development, parent education and organizational policies are needed.

At the time of the study a number of schools within Wales had shortened the amount of time they allow for lunch break. The study investigated the association between length of lunch break and the dietary choices of students in secondary schools.

Student-level data, collected through anonymised questionnaires, included reported dietary choices and correlates of these; data on school approaches to food were collected through postal surveys. Multilevel analysis was used to study the independent association between lunch-break length and student dietary choice.

Data were collected from secondary schools in Wales that were part of the 2005/2006 Health Behaviour in School-aged Children (HBSC) study.

The final sample for analysis included data from 6693 students aged 11–16 years and 289 teachers from sixty-four secondary schools in Wales.

Once controlling for many individual-level and school-level factors, the length of time allowed for lunch across the range for schools included in the study (minimum =25 min, maximum =62·5 min) was associated with higher odds of students eating fruit for lunch (2·20; 95 % CI 1·18, 4·11) and fruit and vegetables on a daily basis (2·15; 95 % CI 1·33, 3·47) but lower odds of eating unhealthy foods on a daily basis (0·44; 95 % CI 0·24, 0·80).

Shorter lunch breaks are associated with less healthy dietary choices by students. Schools should consider the impact that lunch-break length has on student dietary choice as well as on other behaviours. Policy makers should work with schools in encouraging them to maintain lunch breaks of a length that allow pupils to make healthy choices.

A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The present study explored the associations between the socio-economic characteristics of the school environment and the school food environment.

A cross-sectional survey was conducted in 2008–2009. Descriptive and bivariate analyses were performed on data from public primary and secondary schools.

Quebec, Canada. The school food offering was observed directly and systematically by trained research assistants. Interviews were conducted to fully describe food offerings in the schools and schools’ child-care services.

A two-stage stratified sampling was used to build a representative sample of 143 French-speaking public schools. The response rate was 66·2 %.

The primary and secondary schools in low-density areas were more likely to be located near diners (primary: P=0·018; secondary: P=0·007). The secondary schools in deprived areas were less likely to have a regular food committee (P=0·004), to seek student input on menu choices (P=0·001) or to have a long lunch period (P=0·010). The primary schools in deprived areas were less likely to have a food service (P=0·025) and their meal periods were shorter (P=0·033).

The schools in areas with lower socio-economic status provided an environment less favourable for a healthy diet. From a public health perspective, the results of this analysis could assist policy makers and managers to identify actions to support the creation of favourable school environments.

Recently, school meal composition regulations have been implemented in France in order to improve the nutritional status of children. The present study investigated the link between school lunch attendance and the food intakes of schoolchildren aged 3–17 years.

Second French cross-sectional dietary survey (2006–2007). Eating frequencies were assessed for twenty-four food groups with a 7 d food record. Eating locations were recorded for main meals. Food group intakes at weekday lunches were compared for the school canteen and for other locations. The children’s overall dietary intake was compared based on school lunch attendance.

Mainland France.

Schoolchildren aged 3–17 years (n 1068).

Lunchtime food intake differed between the school canteen and other locations. Some intakes at school canteens were more in accordance with the regulations (more fruit and vegetables, fish and dairy products, and less sandwiches, soft drinks, chocolate and confectionery), whereas others highlighted needs for improvement (more sweet biscuits and pastries, ice cream and dairy desserts, pizzas and salty pastries). Many of these differences were also observed in the children’s overall diet: children regularly attending school lunches ate more mashed fruit, fish and sweet biscuits or pastries, and less sandwiches and soft drinks. The link between school lunch attendance and overall diet was less pronounced in secondary-school children.

School canteen attendance is associated with both potentially beneficial and deleterious differences in the lunchtime and overall diets of French children. These findings are important to consider when setting national regulations for school meal composition.

Understanding nutrient intakes among women of childbearing age within the USA is important given the accumulating evidence that maternal body weight gain and nutrient intakes prior to pregnancy may influence the health and well-being of the offspring. The objective of the present study was to evaluate nutritional status in women of childbearing age and to ascertain the influence of ethnicity and income on nutrient intakes.

Nutritional status was assessed using data on nutrient intakes through foods and supplements from the National Health and Nutrition Examination Survey. Biomarker data from the Centers for Disease Control and Prevention were used to assess nutritional status for selected nutrients. Poverty–income ratio was used to assess family income.

White (n 1560), African-American (n 889) and Mexican-American (n 761) women aged 19–30 and 31–50 years were included.

A nationally representative sample of non-pregnant women of childbearing age resident in the USA.

African-American women had the lowest intakes of fibre, folate, riboflavin, P, K, Ca and Mg. Women (31–50 years) with a poverty–income ratio of ≤1·85 had significantly lower intakes of almost all nutrients analysed. Irrespective of ethnicity and income, a significant percentage of women were not consuming the estimated recommended amounts (Estimated Average Requirement) of several key nutrients: vitamin A (~80 %), vitamin D (~78 %) and fibre (~92 %). Nutrient biomarker data were generally reflective of nutrient intake patterns among the different ethnic groups.

Women of childbearing age in the USA are not meeting nutrient intake guidelines, with differences between ethnic groups and socio-economic strata. These factors should be considered when establishing nutrition science advocacy and policy.

The present communication reports a strategy to calculate the intake of Fe based on data available for folic acid and evaluate the programme of flour fortification in Brazil.

Cross-sectional study conducted in Brazil during 2008 and 2009. A 2d dietary record of individuals was used. The usual intake of folic acid by sex and age group was estimated using the National Cancer Institute method. The quantity of folic acid and Fe established by mandatory food fortification in Brazil was used, and based on that quantity we calculated the amount of flour consumed and the intake of Fe from fortification and Fe from food. Then, the absorption of each nutrient was calculated.

Brazilian households (n 16 764).

Individuals (men and women, n 34 003, aged 10 to 60+ years) from a Brazilian nationwide survey.

Mean intake and absorption of Fe from fortification (electrolytic Fe) was low in men and women.

The impact from the consumption of fortified products is small in relation to Fe intake in Brazil. The strategy proposed to estimate Fe intake from the fortification programme indicates that the amount of flour intake observed in Brazil does not justify the current ranges of mandatory flour fortification and the form of Fe that is mainly used (electrolytic Fe).