To analyse the purchase of food for school feeding, according to the extent and purpose of industrial processing and variety, exploring the feasibility of achieving the requirements and recommendations of the Brazilian School Feeding Programme, and the variety of unprocessed or minimally processed foods according to the purchase of ultra-processed foods.

Secondary data from 2016 from the Accountability Management System of the National Fund for Educational Development, concerning the food items purchased, were used to explore the feasibility of the requirements and recommendations. The foods were grouped according to the NOVA classification system. Variety was assessed by counting different types of unprocessed or minimally processed foods.

Brazil.

3698 Brazilian municipalities.

Energy share from unprocessed or minimally processed foods was 44·1 % while that of ultra-processed foods was 29·9 %. The average of unprocessed or minimally processed food types purchased annually was 33·8 items. Of the municipalities, 35·8 % were within the limit established for the expenditure of funds for the purchase of processed and ultra-processed foods, while 8·7 % followed the recommendation for variety. The proportion of ultra-processed foods did not influence the variety of food items purchased.

The results showed the feasibility of achieving the requirements and recommendations and underscored the importance of continued efforts to promote the inclusion of unprocessed or minimally processed foods in the school feeding programme while addressing the challenges associated with expenditure limits of processed and ultra-processed foods and enhancing variety, which is strategic to promote adequate and healthy meals.

This study evaluated the impact of the Addis Ababa School Feeding Program (SFP) on educational outcomes.

Single-group repeated measurement/longitudinal study design and multistage stratified sampling design were followed. Effect sizes estimates, repeated measures ANOVA, Chi-square, Generalised Additive Mixed Model and mixed effects negative binomial regression were used. Academic scores, attendance and dropout and height and weight of schoolchildren were collected.

School Feeding Programs in Addis Ababa, Ethiopia.

Schoolchildren in primary schools and school directors and teachers in fifteen randomly selected schools for Key Informant Interview (KII).

Anthropometric measurements of 4500 schoolchildren were taken from 50 schools. Academic scores of 3924 schoolchildren from 46 schools, class attendance records of 1584 schoolchildren from 18 schools and annual enrolment records of 50 schools were gathered. School meals achieved a minimum to large scale effects on educational outcomes with effect sizes (η 2) of academic scores (boys = 0·023, girls = 0·04), enrolment (girls = 0·001, boys = 0·05) and attendance (Cramer’s V = 0·2). The average scores of girls were significantly higher than that of boys (P < 0·0001). Height-for-age in all schoolchildren (P < 0·01) and BMI-for-age Z-scores in adolescent girls of 15–19 years (P < 0·0001) never had a significant positive relationship with average scores. Significant relation was observed between nutritional status and attendance (P = 0·021). KII showed that SFP created convenient teaching–learning environment and reduced hunger in schools, while boosting enrolment, attendance and academic performance among the schoolchildren.

The Addis Ababa SFP has positively contributed to educational outcomes. Strengthening the program would enhance nutritional outcomes and diminish educational inequalities.

To assess the association between the consumption of school meals offered by the National School Feeding Program (PNAE, in the Portuguese acronym) and the diet quality of adolescents aged 11 to 19 years from Brazilian public schools.

Cross-sectional.

Public schools in Brazil.

A sample of 12 260 adolescents aged 11 to 19 years from 2015 National School Health Survey. High consumption of PNAE school meals were considered when the adolescents consumed school meals 5 d/week. Food consumption data were obtained from a 7-d FFQ and converted into three diet quality assessment scores, namely (1) consumption of healthy foods; (2) consumption of unhealthy foods and (3) overall diet quality. Crude and adjusted linear regression models were used to test the association between high consumption to school meals (daily consumption) and each diet quality score.

More than one-fifth of the adolescents (21·5 %) reported high consumption of school meals. High consumption of school meals was directly associated with the score of the overall diet quality (adjusted coefficient = 0·18; 95 % CI 0·07, 0·30) and healthy food consumption (adjusted coefficient = 0·42; 95 % CI 0·26, 0·57), and inversely associated with the unhealthy food consumption score (adjusted coefficient = −0·23; 95 % CI −0·35, −0·10).

Our results showed that the consumption of PNAE meals may contribute to healthy eating promotion in Brazil.

To estimate usual diets among Brazilian children regarding the consumption of school meals and social vulnerability risks.

A cross-sectional study. School meal consumers were considered those children who reported consuming school meals ≥3 times/week. Social vulnerability risk was classified by an index. Dietary intake was evaluated by one 24 h dietary recall for the whole sample; a second 24 h dietary recall was administered in a sub-sample (38·6 %). The National Cancer Institute’s method was used to estimate children’s usual intake of nutrients and food groups.

Municipal public schools from Belo Horizonte, Brazil.

Children (n 1357) aged 8–12 years.

Half of the sample lived in low/medium social vulnerability risk areas and 27·9 % were school meal non-consumers. School meal consumers more frequently lived in high/very high social vulnerability risk areas (76·2 v. 68·7 %). Children with low/medium social vulnerability risk had a higher mean intake of thiamin (1·13 v. 1·04 mg) and a lower mean intake of candy (1·35 v. 1·42 g). Consumption of school meals among children under high/very high social vulnerability risk was associated with higher mean consumption of vitamin C (31·9 v. 24·1 mg), unprocessed/minimally processed foods (956·3 v. 851·9 g), fruits (128·5 v. 90·9 g) and vegetables (58·2 v. 47·1 g). Ultra-processed food product consumption was lower among school meal consumers (136·2 v. 187·7 g), especially ultra-processed beverages (252·5 v. 305·7 g).

Consuming school meals was associated with a better usual diet quality, particularly among those with higher social vulnerability risk.

To evaluate the profile of food acquisition in the National School Feeding Program according to the extent and purpose of food processing in three municipalities of southern Brazil during the implementation period of Law 11.947/2009.

Descriptive cross-sectional study. Data for 2008–2010 involved quantities, prices and types of suppliers for food items purchased. In total, 1529 purchases were analysed. The items were classified into the following groups: G1 (unprocessed/minimally processed), G2 (culinary ingredients), G3 (processed), G4 (ultra-processed). Quantities of purchased foods were converted into energy and average prices ($US/4184 kJ (1000 kcal)) were calculated. The proportion of each food group in total purchases was expressed as both a percentage of total energy and a percentage of total expenditure. Data analysis was carried out in Stata version 12.1.

Three municipalities in southern Brazil.

Relative contribution to total energy purchased was high for G1 (49·8 %; G2, 23·8 %; G3, 4·5 %; G4, 21·8 %). Among acquisitions from family farming, G1 represented 51·3 % of the total energy purchased; G2, 9·9 %; G3, 19·7 %; G4, 19·0 %. Total cost was as follows: G1, 61·6 %; G2, 3·9 %; G3, 18·5 %; G4, 16·0 %. Prices for food products from family farms were consistently higher. Average price from family farms was 1·3; from conventional suppliers, 0·9.

The implementation of Law 11.947/2009 produced a positive effect on the regional profile of food purchases for the School Feeding Program. However, there is still considerable potential to promote health by strengthening relationships between family farming and school feeding.

To assess the school food environment in terms of breakfast consumption, school meals, learners’ lunch box, school vending and classroom activities related to nutrition.

Cross-sectional survey.

Ninety purposively selected poorly resourced schools in South Africa.

Questionnaires were completed by school principals (n 85), school feeding coordinators (n 77), food handlers (n 84), educators (n 687), randomly selected grade 5 to 7 learners (n 2547) and a convenience sample of parents (n 731). The school menu (n 75), meal served on the survey day, and foods at tuck shops and food vendors (n 74) were recorded.

Twenty-two per cent of learners had not eaten breakfast; 24 % brought a lunch box, mostly with bread. Vegetables (61 %) were more often on the school menu than fruit (28 %) and were served in 41 % of schools on the survey day compared with 4 % serving fruit. Fifty-seven per cent of learners brought money to school. Parents advised learners to buy fruit (37 %) and healthy foods (23 %). Tuck shops and vendors sold mostly unhealthy foods. Lack of money/poverty (74 %) and high food prices (68 %) were major challenges for healthy eating. Most (83 %) educators showed interest in nutrition, but only 15 % had received training in nutrition. Eighty-one per cent of educators taught nutrition as part of school subjects.

The school food environment has large scope for improvement towards promoting healthy eating. This includes increasing access to vegetables and fruit, encouraging learners to carry a healthy lunch box, and regulating foods sold through tuck shops and food vendors.

The present paper analyses the advances and challenges of the school feeding programme in Brazil (PNAE), as part of the Brazilian experience building up an integrated food and nutrition security national system. It explores the role of policy and regulatory frameworks in constructing quality service delivery and intersectoral integration.

Review of PNAE and federal government technical documents and studies, legislation, minutes of meetings and official documents of the National Council of Food and Nutrition Security from 2003 to 2011.

Food insecurity has decreased significantly in Brazil in the last decade, indicating that appropriate choices were made in terms of public policies and institutional arrangements, which other countries can learn from.

Brazil food and nutrition security system; school feeding; school food.

Brazil's integrated food and nutrition security policy approach promoted intersectorality in the food system, articulating actions to guarantee access to healthy food and to strengthen family farming. The quality of school meals has progressively improved; in particular, the availability of fruits and vegetables increased. However, national standards regarding menu composition have not yet been met. Regulations were an important factor, along with the policy approach linking food production, nutrition, health and education. Challenges are related to conflict of interests and to farmers’ insufficient capacity to meet supply requirements and comply with technical procedures.

Local food production, school meals and nutrition education can be linked through integrated programmes and policies, improving access to healthier foods. Government leadership, strong legislation, civil society participation and intersectoral decision making are determinant.

To provide an overview of the status of monitoring and evaluation (M&E) of school feeding across sub-Saharan Africa and to reflect on the experience on strengthening M&E systems to influence policy making in low-income countries.

Literature review on the M&E of school feeding programmes as well as data from World Food Programme surveys.

Sub-Saharan Africa.

Countries implementing school feeding.

Only two randomized controlled impact evaluations have been implemented in sub-Saharan Africa. Where M&E data collection is underway, the focus is on process and service delivery and not on child outcomes. M&E systems generally operate under the Ministry of Education, with other Ministries represented within technical steering groups supporting implementation. There is no internationally accepted standardized framework for the M&E of school feeding. There have been examples where evidence of programme performance has influenced policy: considering the popularity of school feeding these cases though are anecdotal, highlighting the opportunity for systemic changes.

There is strong buy-in on school feeding from governments in sub-Saharan Africa. In response to this demand, development partners have been harmonizing their support to strengthen national programmes, with a focus on M&E. However, policy processes are complex and can be influenced by a number of factors. A comprehensive but simple approach is needed where the first step is to ensure a valid mandate to intervene, legitimizing the interaction with key stakeholders, involving them in the problem definition and problem solving. This process has been facilitated through the provision of technical assistance and exposure to successful experiences through South–South cooperation and knowledge exchange.

To assess the nutritional quality of prepared foods available to primary-school children.

Prepared foods available in a public and private school were sampled daily for 4 weeks (a total of forty-five samples) and chemically analysed for protein, fat, carbohydrate, iron, salt and sodium. The results were compared to the nutritional standards for children aged 7–10 years.

Alfenas, south-eastern Brazil.

The concentration of protein, lipid, iron and sodium and the energy values of the foods at the private school were significantly higher than those at the public school. No differences were seen in the carbohydrate and salt values. The range of macronutrients was more balanced at the public school in relation to fat and protein. Foods at the private school were, in general, energy-dense. At both the public and private school, they provided the minimum energy and iron. Salt content was over twice the maximum amount, and that for sodium was over three times the amount, in both the public and private school.

Overall, foods prepared at the public school were better nutritional quality than those at the private school and those offered in public schools in some developed countries. This finding can probably be explained by the fact that a nutritionist, as required by law, was responsible for planning the menus at the public school. However, corrective action is needed to adjust for the wide variability in energy and nutrient content during weekdays and in the sodium content of prepared foods available in both the public and private school.

To evaluate the long-term effect on micronutrient status of a β-carotene-, iron- and iodine-fortified biscuit given to primary school children as school feeding.

Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years (n=108); in addition, cross-sectional data from three subsequent surveys conducted in the same school are reported.

A rural community in KwaZulu-Natal, South Africa.

Children aged 6–11 years attending the primary school where the biscuit was distributed.

There was a significant improvement in serum retinol, serum ferritin, haemoglobin, transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention. However, when the school reopened after the summer holidays, all variables, except urinary iodine, returned to pre-intervention levels. Serum retinol increased again during the next 9 months, but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays; this pattern was repeated in two further cross-sectional surveys. Haemoglobin gradually deteriorated at each subsequent assessment, as did serum ferritin (apart from a slight increase at the 42-month assessment at the end of the school year).

This study has shown that fortification of a biscuit with β-carotene at a level of 50% of the Recommended Dietary Allowance (RDA) was enough to maintain serum retinol concentrations from day to day, but not enough to sustain levels during the long school holiday break. Other long-term solutions, such as local food production programmes combined with nutrition education, should also be examined. The choice of the iron compound used as fortificant in the biscuit needs further investigation.