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Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a "teachable moment." The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.

Background Insects have recently been identified as a more sustainable protein-dense food source and may represent a viable alternative to conventional animal-derived proteins. Objectives We aimed to compare the impacts of ingesting lesser mealworm– and milk-derived protein on protein digestion and amino acid absorption kinetics, postprandial skeletal muscle protein synthesis rates, and the incorporation of dietary protein–derived amino acids into de novo muscle protein at rest and during recovery from exercise in vivo in humans. Methods In this double-blind randomized controlled trial, 24 healthy, young men ingested 30 g specifically produced, intrinsically l-[1-13C]-phenylalanine and l-[1-13C]-leucine labeled lesser mealworm– or milk-derived protein after a unilateral bout of resistance-type exercise. Primed continuous l-[ring-2H5]-phenylalanine, l-[ring-3,5-2H2]-tyrosine, and l-[1-13C]-leucine infusions were applied, with frequent collection of blood and muscle tissue samples. Results A total of 73% ± 7% and 77% ± 7% of the lesser mealworm and milk protein–derived phenylalanine was released into the circulation during the 5 h postprandial period, respectively, with no significant differences between groups (P 0.05). Incorporation of mealworm and milk protein-derived l-[1-13C]-phenylalanine into de novo muscle protein was greater after exercise than at rest (P 0.05). Conclusions Ingestion of a meal-like amount of lesser mealworm–derived protein is followed by rapid protein digestion and amino acid absorption and increases muscle protein synthesis rates both at rest and during recovery from exercise. The postprandial protein handling of lesser mealworm does not differ from ingesting an equivalent amount of milk protein concentrate in vivo in humans. This trial was registered at www.trialregister.nl as NL6897.

The food industry is confronted with a pressure to reduce waste and to make agreements on donating surplus food to charitable organizations. Charitable organizations such as food banks and soup kitchens can use these donations in preparing food parcels or meals for their clients. For soup kitchens, donation management is strongly influencing menu planning, and conversely, menu planning considerations have a strong impact on donation management decisions. To make the best use of (mostly highly perishable) food donations, we develop an MILP model for integrated donation management and menu planning that proposes a menu plan and suggests which (part of the) donations to accept. The combination of menu planning and donation management is essential for soup kitchens, but has not been studied before. The model is used to assess the impact of contracts on a strategic or tactical level, and captures operational decision making due to the integration of donation management and menu planning. To deal with meal variety considerations and to resemble planning practices, the developed model is solved in a rolling horizon. The results show that (i) the use of donations reduces overall costs for the soup kitchen; (ii) despite the short shelf life of donations, most donations can be used efficiently; and (iii) meal variety can be easily ensured and food donations increase this variety. In addition to the benefits for soup kitchens, the approach has implications for waste reduction in food supply chains, by structural/contractual donations of surplus food by retailers.

Introduction Large chain restaurants have reduced calories in their new menu items. No research has examined the calorie content of items eliminated from these menus. Methods Data are from the MenuStat project (2012–2015), which includes 66 of the 100 largest U.S. chain restaurants (n=27,238 items), to compare: (1) mean calories for items on the menu in all years compared with those dropped after 2012 and (2) mean calories for items new in 2013 or 2014 that stayed on the menu compared with items new in 2013 or 2014 that were dropped. The data were analyzed in 2016. Results Menu items that were dropped from the menu relative to those on the menu in all years had 71 more calories (p=0.02). New items that were dropped relative to new items that stayed on the menu had 52 more calories (p=0.04). Conclusions Items dropped from chain restaurant menus are significantly higher in calories than items that remain on the menu. Eliminating higher-calorie items from restaurant menus may have a significant and positive impact on population health by reducing calorie intake without relying on individual behavior, which is very resistant to change.

Consuming too much sodium is associated with increased risk for cardiovascular disease, and restaurant foods are a primary source of sodium. This study assessed recent trends in sodium content of menu items in U.S. chain restaurants.Data from 21,557 menu items in 66 top-earning chain restaurants available from 2012 to 2016 were obtained from the MenuStat project and analyzed in 2017. Generalized linear models were used to examine changes in calorie-adjusted, per-item sodium content of menu items offered in all years (2012-2016) and items offered in 2012 only compared with items newly introduced in 2013, 2014, 2015, and 2016.Overall, calorie-adjusted sodium content in newly introduced menu items declined by 104 mg from 2012 to 2016 (p0.02). However, the magnitude and direction of these changes varied by menu category and restaurant type; sodium content, particularly for main course items, was high. Sodium declined by 83 mg in fast food restaurants, 19 mg in fast casual restaurants, and 163 mg in full service restaurants. Sodium in appetizer and side items newly introduced in 2016 increased by 266 mg compared with items on the menu in 2012 only (p0.01). Sodium in main courses newly introduced in 2016 declined by 124 mg compared with items on the menu in 2012 only (p=0.01), with the greatest decline, 207 mg (p=0.03), among salads.Average, adjusted, per-item sodium content was lower in newly introduced items in large chain restaurants. However, sodium content of core and new menu items remain high, and reductions are inconsistent across menu categories and restaurant types.

Background: School canteens represent an opportune setting in which to deliver public health nutrition strategies because of their wide reach and frequent use by children. Online school-canteen ordering systems, where students order and pay for their lunch online, provide an avenue to improve healthy canteen purchases through the application of consumer-behavior strategies that have an impact on purchasing decisions.Objective: We assessed the efficacy of a consumer-behavior intervention implemented in an online school-canteen ordering system in reducing the energy, saturated fat, sugar, and sodium contents of primary student lunch orders.Design: A cluster-randomized controlled trial was conducted that involved 2714 students (aged 5-12 y) from 10 primary schools in New South Wales, Australia, who were currently using an online canteen ordering system. Schools were randomized in a 1:1 ratio to receive either the intervention (enhanced system) or the control (standard online ordering only). The intervention included consumer-behavior strategies that were integrated into the online ordering system (targeting menu labeling, healthy food availability, placement, and prompting).Results: Mean energy (difference: -567.25 kJ; 95% CI: -697.95, -436.55 kJ; P < 0.001), saturated fat (difference: -2.37 g; 95% CI: -3.08, -1.67 g; P < 0.001), and sodium (difference: -227.56 mg; 95% CI: -334.93, -120.19 mg; P < 0.001) contents per student lunch order were significantly lower in the intervention group than in the control group at follow-up. No significant differences were observed for sugar (difference: 1.16 g; 95% CI: -0.50, 2.83 g; P = 0.17).Conclusions: The study provides strong evidence supporting the effectiveness of a consumer-behavior intervention using an existing online canteen infrastructure to improve purchasing behavior from primary school canteens. Such an intervention may represent an appealing policy option as part of a broader government strategy to improve child public health nutrition. This trial was registered at www.anzctr.org.au as ACTRN12616000499482.

Background Poor diet quality has been linked to increased risk of many chronic diseases and premature mortality. Less research has considered dietary habits in relation to disease-free life expectancy. Objectives Our objective was to investigate the association of diet quality with cardiometabolic disease–free life expectancy between ages 50 and 85 y. Methods Diet quality of 8041 participants of the Whitehall II cohort study was assessed with the Alternative Healthy Eating Index 2010 (AHEI-2010) in 1991–1994, 1997–1999, and 2002–2004. The measurement of diet quality closest to age 50 for each participant was used. We utilized repeat measures of cardiometabolic disease (coronary heart disease, stroke, and type 2 diabetes) from the first observation when participants were aged ≥50 y. Multistate life table models with covariates age, gender, occupational position, smoking, physical activity, and alcohol consumption were used to estimate total and sex-specific cardiometabolic disease–free life expectancy from age 50 to 85 y for each AHEI-2010 quintile, where the lowest quintile represents unhealthiest dietary habits and the highest quintile the healthiest habits. Results The number of cardiometabolic disease–free life-years after age 50 was 23.9 y (95% CI: 23.0, 24.9 y) for participants with the healthiest diet, that is, a higher score on the AHEI-2010, and 21.4 y (95% CI: 20.6, 22.3 y) for participants with the unhealthiest diet. The association between diet quality and cardiometabolic disease–free life expectancy followed a dose–response pattern and was observed in subgroups of participants of different occupational position, BMI, physical activity level, and smoking habit, as well as when participants without cardiometabolic disease at baseline were excluded from analyses. Conclusions Healthier dietary habits are associated with cardiometabolic disease–free life expectancy between ages 50 and 85.

OBJECTIVES: This research explored the relationship between greenhouse gas emissions (GHGE) and nutrient density of lunches served at a large urban school district in New England to support menu planning. We hypothesized that nutrient density would be inversely associated with GHGE. METHODS: The school district provided information on lunch menus for the 2018–2019 school year. Nutrient density was calculated using the Nutrient Rich Food hybrid score (NRFh). Data on GHGE of foods and agricultural commodities was obtained from the database of Food Impacts on the Environment for Linking to Diets. Under the Offer vs. Serve provision, the school district allows students to select from a variety of lunch combinations to receive a federally reimbursable meal. Federally reimbursable meals must contain at least three meal components and one meal component must be a fruit or vegetable. We calculated the correlation between GHGE and NRFh for all qualifying reimbursable lunch combinations offered during the 2018–2019 school year. RESULTS: We assessed 120,746 possible reimbursable lunch combinations. The mean GHGE and NRFh of lunches was 0.76 kg CO(2) eq lunch(−1) and 1.93, respectively. There was a weak negative correlation (r = −0.15) between GHGE and NRFh. Entrees of lunches with the lowest GHGE (≤ 5(th) percentile) and highest NRFh (≥ 95(th) percentile) contained grains, tofu, and legumes, and in few instances cheese and poultry. Entrees of lunches with the highest GHGE (≥ 95(th) percentile) and lowest NRFh (≤ 5(th) percentile) contained beef or beef and cheese. Lunches with the lowest GHGE (≤ 5(th) percentile) did not include fluid milk. Foods with low NRFh were high in sodium and/or saturated fat, foods with high NRFh contained nuts, seeds, and/or whole grains. CONCLUSIONS: Greenhouse gas emissions and nutrient density are only weakly correlated for school lunches; this suggests that nutritiousness of foods should not be used to predict GHGE for school lunches. Our findings show that schools currently provide options which are highly nutritious and produce low GHGE, however the question remains on how to encourage the consumption of these options. FUNDING SOURCES: This research was funded by the Danone Institute North America.

OBJECTIVES: This study aimed to explore the perceived barriers to fruit and vegetable intake among Korean young adults in their 20s, and the potential to increase it. METHODS: An on-line survey was conducted from February 18th to 24th, 2020 to a total of 1, 277 Korean young adults in their 20s. An on-line survey questionnaire was developed to assess respondents’ preference, acceptance, perceived daily intake level of fruit and vegetables, and perceived barriers in each step from planning, purchasing, storing, to preparation/cooking. Descriptive statistics were calculated, and significant differences in fruit and vegetable consumption (i.e., preference, acceptance perceived daily intake level) were measured according to respondents’ socio-demographic characteristics (gender, education level. income level, and type of household) by using t-tests and ANOVA. Significant differences in perceived barriers were analyzed across three groups (low, medium, and high) based on perceived daily intake level of fruit and vegetables. Multiple linear regression analyses, adjusted for gender, income/education level and household type, were performed to examine the associations between barriers and perceived daily intake level of fruit and vegetables. RESULTS: On an average, preference and acceptance exceeded perceived daily intake level of both fruit and vegetables. The perceived daily intake level of both fruit and vegetables were significantly lower in female, low-income, and single-person household groups. The perceived barriers to each step from menu through preparation/cooking were rated significantly higher in low-intake groups of both fruit and vegetables. The results of multiple regression analyses revealed that menu planning was the major barrier to both fruit and vegetable consumption, followed by storing. CONCLUSIONS: This study suggests that future interventions address perceived barriers associated with menu planning and storing of both fruit and vegetables to boost the consumption among Korean young adults. Special attention needs to be paid to those who are female, with lower incomes, and living in single-person households. FUNDING SOURCES: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT).

Menu labeling can help people select foods and beverages with fewer calories and is a potential population-based strategy to reduce obesity and diet-related chronic diseases in the United States.The aim of this cross-sectional study was to examine the prevalence of menu-labeling use among adults and its association with sociodemographic, behavioral, and policy factors.The 2012 Behavioral Risk Factor Surveillance System data from 17 states, which included 100,141 adults who noticed menu labeling at fast-food or chain restaurants ("When calorie information is available in the restaurant, how often does this information help you decide what to order?") were used. Menu-labeling use was categorized as frequent (always/most of the time), moderate (half the time/sometimes), and never. Multinomial logistic regression was used to examine associations among sociodemographic, behavioral, and policy factors with menu-labeling use.Overall, of adults who noticed menu labeling, 25.6% reported frequent use of menu labeling, 31.6% reported moderate use, and 42.7% reported that they never use menu labeling. Compared with never users, frequent users were significantly more likely to be younger, female, nonwhite, more educated, high-income, adults who were overweight or obese, physically active, former- or never-smokers, less than daily (1 time/day) consumers of sugar-sweetened beverage, and living in states where menu-labeling legislation was enacted or proposed.Menu labeling is one method that consumers can use to help reduce their calorie consumption from restaurants. These findings can be used to develop targeted interventions to increase menu-labeling use among subpopulations with lower use.

In this paper, a three-step methodology is proposed for assigning foods with measured glycaemic index (GI) values to GI classes by using the fuzzy c-means classification technique, assigning foods with no measured GI values to GI classes by using the fuzzy pattern recognition technique, and estimating the glycaemic load (GL) values of foods with no measured GI values. In this methodology, the decision rules for menu planning are also defined, and a Linear Programming-based (LP-based) diet model is developed with the objective function of minimizing the total dietary glycaemic load and the constraints of the daily nutritional requirements. An application based on the real data of GI, GL, and nutritional values of the foods is also provided.

OBJECTIVES: A short-term intervention designed to test the feasibility of Veterans to adopt a whole-food, plant-based (WFPB) diet has not been tested. The specific aims of this study were to (1) determine the feasibility of Veterans adopting a WFPB diet within four weeks, following a plant-strong protocol, (2) determine the effectiveness on participant's cardiovascular risk factors and dietary patterns and (3) compare the results to Veterans following the American Heart Association or Diabetic Diets. METHODS: Prospective, nonrandomized, pilot study of overweight or obese hyperlipidemic Veterans naive to lipid lowering drugs. The first 4 participants were assigned the control group, the next 6 were assigned the intervention. Participants in the control group who met inclusion/exclusion criteria after completion of control intervention could cross-over into the intervention group. The intervention was a four-week program which included individual education on a WFBP diet, (including menu planning and making grocery lists), a grocery store tour, cooking skills, substitutions and food preparation, and challenges dining out. Participants in the control arm received the standard of care. Anthropometrics, biochemical measures, and dietary intake patterns were obtained at baseline and five weeks. RESULTS: Eight male Veterans (mean 57 years old) completed the study, (n = 4 control, n = 6 intervention, 2 crossed over). Ability to adopt a WFBP diet was 83%. Data from diet adopters were compared to the control. Both groups had a significant decrease in LDL from baseline (12% control and 19% in intervention, P = 0.04 each). Veterans in the intervention group had a significant decrease in weight (3%, P = 0.04) and reported: gassiness, better digestion, more energy and better sleep. CONCLUSIONS: Veterans were able to adopt a WFBP diet and experienced a favorable change in LDL cholesterol. Resources needed to conduct the intervention preclude widespread implementation. Further research is needed to determine if less resource intensive programs are feasible and effective for long-term sustainability and determine which Veterans may benefit most. FUNDING SOURCES: Carl T Hayden Medical Research Foundation.

Menu engineering is a popular technique deployed by restaurant operators to assess menu item popularity and profitability, and guide key decisions including menu item pricing, sell strategies, and menu design. While traditional menu engineering models have been criticized for their underlying assumption of menu item interdependency, there has been little focus in the literature on addressing this shortcoming. In this paper, we address one type of interdependency, menu item substitution. We propose a holistic 5-stage approach to menu item pricing and menu placement that leverages own- and cross-pricing elasticity data to account for within-category substitutes. We present a field experiment, using two years of data from 48 outlets within a U.S. steakhouse restaurant chain, to demonstrate how this approach can be applied in a restaurant setting. We also provide empirical support for the positive net revenue effects of menu item pricing, and menu placement, decisions that account for within-category substitutes.

Background Controlled-feeding trials are challenging to design and administer in a free-living setting. There is a need to share methods and best practices for diet design, delivery, and standard adherence metrics. Objectives This report describes menu planning, implementing, and monitoring of controlled diets for an 8-wk free-living trial comparing a diet pattern based on the Dietary Guidelines for Americans (DGA) and a more typical American diet (TAD) pattern based on NHANES 2009-2010. The objectives were to 1) provide meals that were acceptable, portable, and simple to assemble at home; 2) blind the intervention diets to the greatest extent possible; and 3) use tools measuring adherence to determine the success of the planned and implemented menu. Methods Menus were blinded by placing similar dishes on the 2 intervention diets but changing recipes. Adherence was monitored using daily food checklists, a real-time dashboard of scores from daily checklists, weigh-backs of containers returned, and 24-h urinary nitrogen recoveries. Proximate analyses of diet composites were used to compare the macronutrient composition of the composite and planned menu. Results Meeting nutrient intake recommendations while scaling menus for individual energy intake amounts and food portions was most challenging for vitamins D and E, the sodium-to-potassium ratio, dietary fiber, and fatty acid composition. Dietary adherence for provided foods was >95%, with no differences between groups. Urinary nitrogen recoveries were ∼80% relative to nitrogen intake and not different between groups. Composite proximate analysis matched the plan for dietary fat, protein, and carbohydrates. Dietary fiber was ∼2.5 g higher in the TAD composite compared with the planned menu, but ∼7.4 g lower than the DGA composite. Conclusions Both DGA and TAD diets were acceptable to most participants. This conclusion was supported by self-reported consumption, quantitative weigh-backs of provided food, and urinary nitrogen recovery. Dietary adherence measures in controlled-feeding trials would benefit from standard protocols to promote uniformity across studies. The trial is registered at clinicaltrials.gov as NCT02298725.

Objective Evaluate the impact of Smarter Lunchrooms strategies on student selection of vegetable subgroups and fruit in Montana Schools. Secondary objectives include student participation in the lunch program, collaboration with key partners, and menu variety. Description 10 Montana schools participated in the Smarter Lunchrooms intervention during the 2017-2018 school year. Schools were trained to select and implement at least three strategies from the Smarter Lunchrooms Scorecard, with at least one focusing on fruits or vegetables; engage students in the process; include taste testing; and use new recipes to increase menu variety. Schools followed the Four Step Path to Building a Smarter Lunchroom (Smarter Lunchrooms Movement, Cornell University) to select and implement strategies: Spot, Plan, Do, and Prove. Evaluation The project was evaluated by collecting data at pre and post intervention within 10 schools: average daily participation rates, Smarter Lunchrooms Scorecard, production records, weights (ounces) of fruit and vegetables available and amounts selected, photographs, and a survey. Conclusions and Implications Across the 10 participating schools, the project resulted in a significant increase in student's selection of fruits and the following vegetable subgroups with the use of Smarter Lunchrooms strategies: red/orange, dark green, and peas/beans/legume vegetables. Effective strategies included offering whole fresh fruit in an eye-appealing bowl or display; enhancing the appeal of the salad bar; incorporating colorful signage; and purposefully offering more vegetable choices. Post survey results of participating schools indicated 50% led taste tests; 60% stated that the project helped increase collaboration with key partners; 60% tried new vegetable recipes, and 100% of the schools indicated their willingness to continue using Smarter Lunchrooms techniques. This study implies that schools can nudge students to make healthier choices through simple behavioral economics techniques and purposeful menu planning. Grant Year 2016

Although a number of various traditional foods and diversity of cooking styles and techniques were available in Sri Lanka, today most of them are getting lost as a result of ‘modernization’ dietary patterns. However, in Sri Lanka,a very limited number of researcheshave been conducted on traditional foods. Therefore, surveys about traditional foods and dishes are essential to cut down many problems related with the modernized foods and to increase use of locally available food sources. In Sri Lanka, there are many recipe books but they do not give an idea about nutrition composition. The survey was conducted to develop a recipe book by including traditional Sri Lankan food recipes and their nutrition composition. Different food recipes were collected from adult women in different areas (08 districts) by home visits, face to face interviews and through telephone calls. Further, available traditional recipes were collected by reviewing the recipe books and searching internet. The amount of ingredients for solid foods were measured by using household measures and home scale and expressed as grams. Liquid foods were measured by measuring cylinder and household measures and expressed as millilitres. The recipes which were taken from telephone calls were prepared at the University dietetics laboratory. Nutrition compositions of recipes were calculated using the Food Base 2000 software. The developed recipe book consists of 50 recipes of Sri Lankan traditional foods, the method of preparation as well as the nutritional composition. The recipes in the book have been presented under five food categories; cereal based foods, sweets, dishes, mallum and kola kenda / herbal drinks. Thus, the developed recipe book provides different recipes with way of preparation and nutrition composition of them. Therefore, this can be used as an educational tool for menu planning.

Problem statement the nutrition field is becoming increasingly important and complex. Nutrition software is a particularly valuable tool for health professionals, which can offer support for both practitioners and students. Scope the project aimed to create a software useful both for learning and in practice, which gathers relevant scientific information, equations and tools necessary when providing nutritional services and structures them along the recommended steps to be followed.Method data was collected from European and international guides, recommendations and from the scientific literature. It was structured in multiple modules within the software.Findings and result the resulted software offers support for scheduling patients, keeping patient records, carrying out the nutrition care process, calculating recipes, planning and analyzing food menus. Conclusions and Recommendation: The software has a scientific basis and follows the latest recommendations. It can be used as a learning environment, where students can apply their knowledge and critical thinking in order to explore different types of interventions, in a controlled manner.

Programs that recognize restaurants for offering healthful options have emerged as a popular strategy to address the obesity epidemic; however, program fidelity and business responses to such programs are rarely assessed. This study sought to examine how retail restaurants in Los Angeles County chose to comply with participation criteria required by the Choose Health LA Restaurants initiative in the region; the program recognizes restaurants for offering reduced-size portions and healthy children's meals. Menus of all restaurants that joined within 1 year of program launch (n = 17 restaurant brands) were assessed for changes. Nine of the 17 brands made changes to their menus to meet participation criteria for reduced-size portions while 8 of the 10 restaurant brands that offered children's menus made changes to improve the healthfulness of children's meals. Results of this comparative assessment lend support to restaurant compliance with program criteria and menu improvements, even though they are voluntary, representing an important step toward implementing this strategy in the retail environment.

Precise data on food chemical composition is crucial for any quantitative nutrition research and indispensable for evaluation and planning of computer-based menus. Moreover, exact food chemical composition is of the utmost importance in composing specific diets that may be low in certain essential nutrients. Therefore, this research evaluated a weekly vegan menu using three different food composition databases (FCDB): the Croatian, the official Danish Food Composition Database and the United States Department of Agriculture (USDA) – National Nutrient Database for Standard Reference. Significant differences ( p

Background Supply-side reductions to the calories in chain restaurants are a possible benefit of upcoming menu labeling requirements. Purpose To describe trends in calories available in large U.S. restaurants. Methods Data were obtained from the MenuStat project, a census of menu items in 66 of the 100 largest U.S. restaurant chains, for 2012 and 2013 (N=19,417 items). Generalized linear models were used to calculate (1) the mean change in calories from 2012 to 2013, among items on the menu in both years; and (2) the difference in mean calories, comparing newly introduced items to those on the menu in 2012 only (overall and between core versus non-core items). Data were analyzed in 2014. Results Mean calories among items on menus in both 2012 and 2013 did not change. Large restaurant chains in the U.S. have recently had overall declines in calories in newly introduced menu items (–56 calories, 12% decline). These declines were concentrated mainly in new main course items (–67 calories, 10% decline). New beverage (–26 calories, 8% decline) and children's (–46 calories, 20% decline) items also had fewer mean calories. Among chain restaurants with a specific focus (e.g., burgers), average calories in new menu items not core to the business declined more than calories in core menu items. Conclusions Large chain restaurants significantly reduced the number of calories in newly introduced menu items. Supply-side changes to the calories in chain restaurants may have a significant impact on obesity prevention.

Planning is an essential component of home meal preparation. While level of health consciousness permeates both activities, this relationship is underexplored in the scientific literature. Using a mixed-methods convergent parallel design this study identified the reasoning behind meal planning and compared the characteristics of meals planned by high and low health-conscious adults during a simulated shopping task in a supermarket store. Participants were assigned a task where they were asked to choose ingredients to prepare a hot evening meal for a last-minute guest. High Health Conscious (HHC) participants planned healthier meals with more whole grains/breads/pasta, fruits, and vegetables than Low Health Conscious (LHC) participants. HHC participants mentioned not only health-related motives, but also ingredients' characteristics and cooking habits as influencers of their choices. LHC individuals focused on their own preferences, acknowledged that they struggled with the skills needed to prepare a meal and considered the presence of a guest as the only reason why they would prepare a meal. The mixed methods approach enabled us to link the participants' reasoning with the quantitative differences between meals planned by them - HHC individuals planned healthier meals and manifested closeness to the act of cooking. This suggests that the link between health interest and learning how to cook deserves to be further explored.

This study investigated the generation of trolley food waste at the ward level in a hospital in order to provide recommendations for how practice could be changed to reduce food waste. Three separate focus group discussions were held with four nurses, four dietitians and four service assistants engaged in food service. Furthermore, single qualitative interviews were conducted with a nurse, a dietitian and two service assistants. Observations of procedures around trolley food serving were carried out during lunch and supper for a total of 10 weekdays in two different wards. All unserved food items discarded as waste were weighed after each service. Analysis of interview and observation data revealed five key themes. The findings indicate that trolley food waste generation is a practice embedded within the limitations related to the procedures of meal ordering. This includes portion size choices and delivery, communication, tools for menu information, portioning and monitoring of food waste, as well as the use of unserved food. Considering positive changes to these can be a way forward to develop strategies to reduce trolley food waste at the ward level.

The purpose of this study was to test the feasibility and efficacy of implementing a 4-week menu plan combined with individual counselling among people with type 2 diabetes.A 12-week pilot study with a pretest and post-test design was conducted among 15 participants with type 2 diabetes. The menu plan incorporated the overall recommendations of the Canadian Diabetes Association nutrition therapy guidelines and considered factors such as the accessibility, availability and acceptability of foods. Change in glycated hemoglobin (A1C) was the primary outcome, and secondary outcomes were changes in serum lipid, anthropometric and dietary measures.Mean (±SD) age of the participants was 59.3±9.9 years, and duration of diabetes was 8.1±8.3 years. After the program, A1C decreased by 1.0%±0.86% (p0.05). There were significant reductions (p0.05) in weight, body mass index, waist circumference and fat mass and increased high-density lipoprotein cholesterol. No significant changes were observed in dietary measures except for perceived dietary adherence score, which increased significantly (p0.05). Participants reported using the menu plan an average of 5.0±1.9 days a week and attended, on average, 4 of 6 counselling sessions.Menu planning and individual counselling were demonstrated to be feasible and effective for diabetes management, and they represent a simple and practical approach to implement the nutritional recommendations for diabetes in Canada.

Objective To compare changes in nutrient levels of school meals before and after implementation of nutrition interventions at five school districts in two, large U.S. counties. School menu changes were compared against national school meal recommendations. Methods A large urban school district in Los Angeles County (LAC), California and four school districts in suburban Cook County (SCC), Illinois implemented school meal nutrition interventions. Nutrition analyses were conducted for school breakfast and lunch before and after changes were made to the meal programs. Means, % change, and net calories (kilocalories or kcal) offered as a result of the nutrition interventions were calculated. Results School districts in both counties made district-wide changes in their school breakfast and lunch menus. Menu changes resulted in a net reduction of calories, sugar, and sodium content offered in the meals. Net fewer calories offered as a result of the nutrition interventions were estimated to be about 64,075 kcal per student per year for LAC and 22,887 kcal per student per year for SCC. Conclusions Nutrition interventions can have broad reach through changes in menu offerings to school-aged children and adolescents. However, further research is needed to examine how these changes affect student food selection and consumption.

Objective To assess the amount of food waste by meal components according to the new National School Lunch Program guidelines among pre-kindergarten and kindergarten students. Methods For 5 consecutive school days in 1 elementary school, the research team collected school lunch trays and separated meal components into bins relative to each food or beverage appearing on the school's daily menu. Bins were weighed in grams and converted to ounces and cups at the end of each lunch period. Results The researchers examined 304 meals from 1 pre-kindergarten class and 5 kindergarten classes. Of 4,988 oz of food and beverages served, 2,261 oz (45.3%) were wasted during 1 full school week, totaling 141 lb. The greatest amount of food waste was generated from vegetables, the main entree, and milk, respectively. Conclusions and Implications Strategies to reduce food waste in school lunch should be researched and implemented.

Background Several studies in Saudi Arabia indicated adolescents’ diet to be low in fiber, calcium, and vitamin D while sugar, salt, and fat content were high. Since adolescents spend half of their day at school, schools play an important role in students’ daily nutrient intake. Objective The objective of this study was to assess the nutritional content of breakfast meals (the main meal served) in Saudi Arabian all-girl intermediate and secondary public schools in Mecca as well as obstacles to serving healthier food options. Study Design, Settings, Participants This was an exploratory, descriptive study. Forty six intermediate schools and 43 secondary schools were randomly selected to participate in this study. The researcher visited each school and conducted a face-to-face survey on operations with foodservice staff and lists of foods served were collected. Measurable Outcome/Analysis Foods served were analyzed using Diet Analysis Plus, 10th Edition. Independent-sample t-tests were used to measure nutrient (calories, protein, fat, carbohydrates, calcium, iron, vitamin D, and sodium) differences between school types. Additional data on the school food service operations, staff and menu planning was collected through questionnaires. Results There were no significant differences (P > .05) between nutrient content of food served based on school level. Results indicated low content of calcium, iron, and vitamin D, and high content of sugar and sodium of foods served. Students’ refusal to purchase healthy food options (69% of all schools) and their preference for unhealthy foods were the main barriers to serving healthy foods. Most (76%) of the foodservice managers did not have a nutrition background but were responsible for food ordering and planning food lists. Conclusion Findings indicated that schools offered foods of low nutritional quality. The lack of nutrition-related educational background by foodservice managers as well as students’ preferences contributed to low nutrient density in the offered foods. There is a need for better training of staff as well as education of the students as to the importance of healthier dietary choices. Funding None.

Objective To evaluate the efficacy and consumer preferences of calorie labeling on menus. Design Between-group experiment. Participants were randomized to view menu items according to 1 of 4 experimental conditions: no calorie information, calorie-only information, calorie plus health statement (HS), and calorie plus the Physical Activity Scale. Participants selected a snack and then rated menus from all conditions on the level of understanding and perceived effectiveness. Setting University of Waterloo, Canada. Participants A total of 213 undergraduate university students recruited from classrooms. Main Outcome Measures The calorie amount of menu selection and ratings of understandability and perceived effectiveness. Analysis Linear regression models and chi-square tests. Results Participants who selected items from menus without calorie information selected snacks with higher calorie amounts than participants in the calorie-only condition (P = .002) and the calorie plus HS condition (P = .001). The calorie plus HS menu was perceived as most understandable and the calorie plus calorie plus Physical Activity Scale menu was perceived as most effective in helping to promote healthy eating. Conclusions and Implications Calorie labeling on menus may assist consumers in making healthier choices, with consumer preference for menus that include contextual health statements.

The federal menu labeling law will require chain restaurants to post caloric information on menus, but the impact of labeling is uncertain.The goal of the current study was to examine the effect of menu labeling on calories purchased, and secondarily, to assess self-reported awareness and use of labels.Single-community pre-post-post cross-sectional study. Data were collected in 2008-2010 and analyzed in 2011-2012.50 sites from 10 chain restaurants in King County, Washington, selected through stratified, two-stage cluster random sampling. A total of 7325 customers participated. Eligibility criteria were: being an English speaker, aged ≥ 14 years, and having an itemized receipt. The study population was 59% male, 76% white non-Hispanic, and 53% aged40 years.A regulation requiring chain restaurants to post calorie information on menus or menu boards was implemented.Mean number of calories purchased.No significant changes occurred between baseline and 4-6 months postregulation. Mean calories per purchase decreased from 908.5 to 870.4 at 18 months post-implementation (38 kcal, 95% CI=-76.9, 0.8, p=0.06) in food chains and from 154.3 to 132.1 (22 kcal, 95% CI=-35.8, -8.5, p=0.002) in coffee chains. Calories decreased in taco and coffee chains, but not in burger and sandwich establishments. They decreased more among women than men in coffee chains. Awareness of labels increased from 18.8% to 61.7% in food chains and from 4.4% to 30.0% in coffee chains (both p0.001). Among customers seeing calorie information, the proportion using it (about one third) did not change substantially over time. After implementation, food chain customers using information purchased on average fewer calories compared to those seeing but not using (difference=143.2 kcal, p0.001) and those not seeing (difference=135.5 kcal, p0.001) such information.Mean calories per purchase decreased 18 months after implementation of menu labeling in some restaurant chains and among women but not men.

This study assessed the performance of entrees in Chinese chain restaurants based on revised menu engineering that incorporated factors including labor costs and indirect operating expenses (IOEs) and variable return-to-scale (VRS) data envelopment analysis (DEA). We collected panel data on 20 entrees covering three-month periods that included both the peak and slump operating periods of the year for two same-brand chain restaurants. The empirical results indicated that revised menu engineering and output-oriented VRS-DEA may provide specific criteria for identifying entrees to be replaced and retained, respectively. The DEA further provided return-to-scale and output surplus analyses of each inefficient entree for further improvement, which the menu engineering could not offer. The financial performance observed when using the VRS-DEA model is expected to be better than the performance observed when using a revised menu engineering model.

To characterize associations between perceived time constraints for healthy eating and work, school, and family responsibilities among young adults.Cross-sectional survey.A large, Midwestern metropolitan region.A diverse sample of community college (n = 598) and public university (n = 603) students.Time constraints in general, as well as those specific to meal preparation/structure, and perceptions of a healthy life balance.Chi-square tests and multivariate logistic regression (α = .005).Women, 4-year students, and students with lower socioeconomic status perceived more time constraints (P.001-.002); students with lower socioeconomic status were less likely to have a healthy balance (P ≤ .003). Having a heavy course load and working longer hours were important predictors of time constraints among men (P.001-.004), whereas living situation and being in a relationship were more important among women (P = .002-.003).Most young adults perceive time constraints on healthy dietary behaviors, yet some young adults appear able to maintain a healthy life balance despite multiple time demands. Interventions focused on improved time management strategies and nutrition-related messaging to achieve healthy diets on a low time budget may be more successful if tailored to the factors that contribute to time constraints separately among men and women.

The Nutrient Rich Foods (NRF) approach to eating uses the NRF Index, a nutrient profiling metric to help consumers choose foods that contain more vitamins, minerals, and other nutrients per kilocalorie. Research is needed to test the efficacy of dietary guidance using nutrient profiling systems to rank foods.To examine whether nutrition education and supporting materials would increase understanding of the NRF approach and improve food shopping, meal planning, consumption of nutrient-rich foods, and diet quality.Unbalanced randomized controlled trial conducted in February to May 2009 with participants assigned to NRF education group (n=128) or control group receiving standard nutrition education (n=61).Adult primary food shoppers and preparers with at least one child in the household aged 3 to 17 years.Group education session and support tools (pocket guide, shopping list, refrigerator magnet, weekly e-mail messages, and biweekly mailings).Surveys of knowledge, attitudes, and behaviors and two 24-hour telephone dietary recalls at baseline and after an 8-week intervention period.Examined time-by-treatment interactions in outcome measures.Compared to controls, NRF participants increased meal planning (+24.2% vs ?4.9%; P0.01), ability to identify nutrient-rich foods (+60.2% vs +24.6%; P0.001), and use of shopping lists (+14.1% vs +3.3%; nonsignificant trend), and consumed more vegetables and fruits (P0.05). NRF participants improved overall diet quality as shown by their scores on the Healthy Eating Index (P=0.04) and NRF scale scores (nonsignificant trend). Significant improvements were observed in Healthy Eating Index component scores for total fruit; whole fruit; whole grains; saturated fat; and energy from solid fats, alcohol, and added sugars.Findings of this study showed that a consumer education program increased participants' use of the NRF approach and improved diet quality. Larger and longer-term studies are needed to confirm the findings and better understand processes of change.

The US Department of Agriculture's Child and Adult Care Food Program (CACFP) serves 2.3 million children by providing monetary subsidies for food to participating child-care providers. This cross-sectional study tested the hypothesis that higher reimbursement rates for food result in higher food expenditures and higher nutritional quality of foods served in family child-care homes participating in CACFP. Sixty family home child-care providers were recruited in 2008-2009 from King County, Washington. Half the sample received higher reimbursements and the other half received the lower rates. Participants provided a 5-day menu of meals/snacks served and food shopping receipts. The nutritional quality of foods served was assessed from portion-standardized menus. Nutritional quality was quantified as the mean adequacy (mean percent of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking menus with receipts. Student's t tests for independent samples and general linear models were used to test for between-group differences. The two groups of providers were socioeconomically and demographically similar with comparable professional backgrounds. However, higher reimbursement providers had significantly greater menu expenditures than the lower reimbursement group ($2.36 vs $1.96/child/day; P=0.031). Reimbursement level was not associated with a difference in calories, but menus of higher reimbursement providers showed a significantly higher mean nutritional adequacy (64.5% vs 56.3%; P=0.033). The finding that reimbursement rates were positively associated with food expenditures and the nutritional quality of foods served suggests that raising CACFP reimbursements can improve child nutrition.

This study investigated both the historical development and future trends of restaurant cuisine in America. Italian cuisine is used as the basis of a prediction model. The study identifies the historical factors in menu trends in Italian–American cuisine; the factors that will influence culinary trends in the future, and whether the results can be applied to the development of a prediction model that will predict how restaurant cuisine in America may develop. This study used both qualitative (focus groups) and quantitative (online survey) methods. The growing popularity of Italian cuisine in the United States will continue to shape the evolution of America's restaurant cuisine.

The present study quantitatively explored the effects of mothers' perceived time pressure, as well as meal-related variables including mothers' convenience orientation and meal preparation confidence, on the healthiness of evening meals served to school-aged children (5-18 years old) over a 7-day period. A sample of 120 employed mothers, who identified themselves as the chief meal-preparers in their households, completed a brief, self-report, meal-related questionnaire. Results revealed that mothers' perceived time pressure did not significantly predict meal healthiness. Mothers' confidence in their ability to prepare a healthy meal was the only unique, significant predictor of a healthy evening meal. Mothers who were more confident in their ability to prepare a healthy meal served healthier evening meals than those who were less confident. In addition, mothers' perceived time pressure and convenience orientation were negatively related to healthy meal preparation confidence. Results suggest that mothers' perceived time pressure and convenience orientation, may indirectly compromise meal healthiness, by decreasing mothers' meal preparation confidence. Practical and theoretical implications of the study's findings are discussed.

Participation in family meals has been associated with benefits for health and social development of children. The objective of the study was to identify the impact of mothers' work of caring through planning regularly scheduled meals, shopping and cooking, on children's participation in family meals. Parents of children aged 9-11 or 13-15 years from 300 Houston families were surveyed about parents' work, meal planning for and scheduling of meals, motivations for food purchases, importance of family meals, and children's frequency of eating dinner with their families. The children were interviewed about the importance of eating family meals. Hypotheses were tested using path analysis to calculate indirect and total effects of variables on the outcome variable of frequency of children eating dinner with their family. Mothers' belief in the importance of family meals increased likelihood of children eating dinner with families by increasing likelihood that mothers planned dinner and that dinners were regularly scheduled. Mothers' perception of time pressures on meal preparation had a negative, indirect effect on the frequency of children's participation in family dinners by reducing mothers' meal planning.

The original 9-point scale, developed by the U.S. army for menu planning for their canteens, consisted of a series of nine verbal categories representing degrees of liking from ‘dislike extremely’ to ‘like extremely’. For subsequent quantitative and statistical analysis, the verbal categories are generally converted to numerical values: ‘like extremely’ as ‘9’, ‘dislike extremely’ as ‘1’. Yet, sometimes what is termed a 9-point hedonic scale is an unstructured numerical scale, labeled at the ends with ‘dislike extremely’ and ‘like extremely’. The former scale requires consumers to categorize foods according to how much they are liked or not; the latter requires the consumers to differentiate numerically between the foods in terms of the relative degree of liking for each. Foods that were placed in the same verbal category for the former scale might be given different numerical scores on the second scale. To illustrate this, consumers rated five chocolates, in a series of experiments, on these two types of 9-point scale (verbal categories only vs numbers only) and the proportion responding differently to the two scales ranged from 100% to 79%. This indicated that numerical data obtained from both types of 9-point scale were not interchangeable. It also suggested that consumers were using different cognitive strategies for verbal categories and numbers. To check that the difference was not caused by the fact that the verbal categories were bipolar and the numbers unipolar, the experiment was repeated using a bipolar number scale (–4 through 0 to +4). The same results were obtained. For comparison, a 9-point hedonic scale including both verbal categories and numbers together, was also used. The results for this scale showed a greater similarity to the version of the 9-point scale consisting only of verbal categories than the unstructured numerical version. Stimulus equalizing bias was used as a tool to make a preliminary investigation into the cognitive strategies involved for the two versions of the scale. The hypothesized relative strategy was confirmed for the unstructured numerical scale but the hypothesized absolute strategy was not confirmed for the scale using only verbal categories; the strategy appeared to have relative elements. Regardless of the precise nature of the cognitive strategies used for two versions of the scale, they do not give the same results and data obtained from each version should be compared with caution.

Objective This study examined the feasibility of eliciting dietary changes in subjects recruited from a diverse primary care setting in Michigan using a written, one-page plan, either alone or with telephone counseling. Methods A total of 96 subjects were enrolled from 9/28/06 to 5/7/07 (49% minorities). Subjects were randomized into three groups. Group 1 received written materials. Group 2 received written materials plus a one-page form that asked them to make a specific daily plan for substituting one less nutritious food with two servings of fruits and vegetables. Group 3 received the written materials, the one-page form and telephone counseling from a dietitian. Results Subject retention was 76% for the 12-week study. Subjects in Groups 1, 2 and 3 changed their mean intakes of fruit and vegetables by 0.4, −0.7 and 1.4 servings/day, respectively. Participants in Group 3 lost an average of 0.73 kg, increased their perception of the importance of eating fruits and vegetables, and 63% increased their serum levels of carotenoids by 20% or more. Conclusion Recruitment through a primary care clinic was effective. Formulation of a written plan combined with telephone counseling appears to be promising for improving fruit and vegetable intakes and warrants more definitive study.

This study examines the provision of hospital meals from the patients' viewpoint, with the aim of improving hospital food service. Patients were approached in early 2008 in a National Health Service hospital in the South of England and invited to comment on the good and bad aspects of eating in hospital. Comments were collected in an abbreviated "key word" format which incurred the minimum of bias and allowed emergent themes to be analysed both quantitatively and qualitatively. Seven main themes emerged, of which "food" and "choice" were mentioned most frequently, but had a low ratio (1.8 and 1.7, respectively) of approving over disapproving comments. The next most mentioned theme, "service staff", showed the highest approving/disapproving ratio (4.8) overall. Less frequent themes were: "meals and lifestyle", "timing and routine", "service quality" and "food quantity". These data, together with qualitative analysis of the responses showed patients' views of hospital food to be positive, on the whole meeting or surpassing their expectations. However, these expectations were low, the experience of eating in hospital contrasted unfavourably with home, and the meals were at best a distraction from the rigours of hospital treatment. Service staff were positively regarded because they offered an important opportunity for "normal" discourse with a non-medical person. On the basis of the findings, changes are recommended in the management of service staff, menus, food presentation, nutritional intake and patients' lifestyle. Of these, the first is likely to have most impact on the experience and viewpoint of hospital patients.

Objective To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. Design Two-group randomized control trial; intervention versus usual EFNEP curriculum. Setting Texas EFNEP classes. Participants 1,104 EFNEP clients in 100 classes. Intervention Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. Main Outcome Measures Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. Analysis Mixed-model repeated measures analysis of variance. Results 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. Conclusion and Implications Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.

This study aimed to understand parents’ evaluations of the way they integrated work-family demands to manage food and eating. Employed, low/moderate-income, urban, U.S., Black, White, and Latino mothers (35) and fathers (34) participated in qualitative interviews exploring work and family conditions and spillover, food roles, and food-choice coping and family-adaptive strategies. Parents expressed a range of evaluations from overall satisfaction to overall dissatisfaction as well as dissatisfaction limited to work, family life, or daily schedule. Evaluation criteria differed by gender. Mothers evaluated satisfaction on their ability to balance work and family demands through flexible home and work conditions, while striving to provide healthy meals for their families. Fathers evaluated satisfaction on their ability to achieve schedule stability and participate in family meals, while meeting expectations to contribute to food preparation. Household, and especially work structural conditions, often served as sizeable barriers to parents fulfilling valued family food roles. These relationships highlight the critical need to consider the intersecting influences of gender and social structure as influences on adults’ food choices and dietary intake and to address the challenges of work and family integration among low income employed parents as a way to promote family nutrition in a vulnerable population.

Objective Nursing facilities often provide enhanced or fortified foods as part of a "food-first" approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss. The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal (breakfast, lunch, and supper) calorie and protein intakes in long-term care residents. Design A randomized cross-over design was used to compare investigator-weighed food intakes under three menu conditions: control (no meals enhanced); lunch only enhanced; and both breakfast and lunch enhanced. Two breakfast foods (juice and hot cereal) and two lunch foods (soup and potato side dish) were chosen for enhancement. Subjects/setting Participants were 33 nursing home residents from a facility in South Florida (average age=87.3 years). Statistical analysis Repeated-measures analysis of variance was used to test the effects of the within-subjects factor (control, lunch enhanced, breakfast and lunch enhanced conditions), the between-subjects factor (smaller vs bigger eater), and the interaction on intakes (gram, kilocalories, and protein). Results Results revealed that bigger eaters consumed considerably more calories when breakfast foods, but not lunch foods, were enhanced. Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced. Overall daily protein intakes were not substantially increased by food enhancement. These data suggest that for an enhanced food program to be most effective for smaller eaters, who are at greatest risk for undernutrition and weight loss, it should include several enhanced foods at more than one meal.