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Individuals from racial minority backgrounds, especially those in low income situations, are at increased risk for obesity. Family meals positively impact child nutritional health; however, there is limited evidence examining the impact on caregivers, particularly racial minority and income-restricted individuals. The objective of this intervention study was to determine the effect of Simple Suppers, a 10 week family meals program, on caregiver diet and nutrition outcomes. Intervention versus waitlist control participants were compared from baseline (T0) to post-intervention (T1). In addition, intervention participants were assessed at a 10 week follow-up time point (T2). This study was a two-group quasi-experimental intervention trial. Lessons (10 total) were delivered on a weekly basis for 90 min. Data were collected from intervention and waitlist control participants at T0 and T1, and intervention participants at T2. After baseline (T0) data collection, families enrolled in the immediate upcoming session of Simple Suppers (intervention group) or waited for 10 weeks (waitlist control group) to begin the program. Participants were caregivers of children ages 4-10 years. This study was conducted in a faith-based community center for underserved families in Columbus, Ohio. Primary outcomes were: diet quality assessed by Healthy Eating Index (HEI) total and component scores, and total energy intake (kcal/day); body mass index (BMI) (kg/m 2 ), waist circumference (cm), systolic and diastolic blood pressure (BP) (mmHG); and self-efficacy for having healthy meals and menu planning (both scalar). The impact of the intervention (T0:T1) was assessed using generalized mixed-effects linear regression models. Maintenance of change in study outcomes among intervention participants (T1:T2) was examined with paired t -tests. 109 caregivers enrolled in this study. The retention rate at T1 was 90% (i.e., 98 participants). 56 of 68 intervention participants completed T2, resulting in a retention rate of 82%. Almost all (99%) were female, 61% were Black, and 50% were between 31 and 40 years old. In total, 40% had low income and 37% had low or very low food security. At T1, intervention vs. waitlist controls had a lower daily energy intake ( p = 0.04), but an HEI-2010 component score for fatty acids (adequacy) that was lower indicating a lower dietary intake of fatty acids ( p = 0.02), and a component score for empty calories (moderation) that was significantly lower indicating a higher intake of empty calorie foods ( p = 0.03). At T1, intervention vs. waitlist controls also had a lower BMI ( p < 0.001) and systolic BP ( p = 0.04), and higher self-efficacy ( p = 0.03). There were no group differences in other outcomes. At T2, intervention participants maintained the changes in daily energy intake, BMI, systolic BP, and self-efficacy that improved during the intervention period. There was no change (improvement) in the component score for fatty acids; however, the component score for empty calories significantly improved ( p = 0.02). Engagement in the Simple Suppers program led to improvements in caregivers' daily caloric intake, weight status, systolic blood pressure, and self-efficacy for family meals. Future research should further explore the dietary and nutritional health benefits of family meals among caregivers at the highest risk for obesity.

Background: Major sporting event catering is a significant undertaking for foodservice providers, particularly with an increasing focus on sustainability, global health, and nutrition demands of athletes. Yet, the inclusion of nutrition expertise in catering varies significantly between events. Foodservice systems models are commonly used to evaluate foodservice operations but to date have not been applied to catering and nutrition at major sporting events., Objective: The aim of this exploratory case study was to gain in-depth insights of key stakeholders (catering management, chefs, organizers, and dietitians) regarding the integration of nutrition into the catering operation of a major global sporting event, with a focus on future continuity, and map this to the foodservice systems model using a program logic model., Setting: Semistructured interviews were conducted with 12 stakeholders during and after the 2018 Commonwealth Games, Gold Coast, Australia., Results: The 8 themes that emerged were related to planning and preparation, refining processes, improvement of the menu, better technology, increase in food allergies/intolerances, organization controls, experience of the workforce, and increased client knowledge of nutrition. The logic model demonstrated that the system is driven by policy and budget at the level of control prior to and during the planning phase but modified by the environment during operation., Conclusions: Despite recognition by stakeholders on the importance of change, there are barriers to the provision of suitable food. Integration of nutrition expertise into tender documents and budgets in major event catering will help ensure nutritionally adequate, culturally suitable, and safe menus for future events., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines., Objective: This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed., Methods: A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up., Results: No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable., Conclusions: Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted., Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx., (©Alice Grady, Luke Wolfenden, John Wiggers, Chris Rissel, Meghan Finch, Victoria Flood, David Salajan, Ruby O'Rourke, Fiona Stacey, Rebecca Wyse, Christophe Lecathelinais, Courtney Barnes, Sue Green, Vanessa Herrmann, Sze Lin Yoong. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.02.2020.)

To ensure the adequate supply of nutrients, a model food ration (MFR) should be used for planning the menu. The purpose of the study was to determine the effects of the nutrition education program on the compliance with MFR in 231 preschools. The average supply of food products (per child/day) with reference to the MFR was examined on the baseline and 3 to 6 months after education on the basis of 10-day menus and daily inventory reports (4620 in total). According to the recommendations, preschool should implement 70⁻75% of the recommended daily intake standards. Examined menus had too high content of meat and meat products, whereas vegetables, milk and fermented milk beverages, cottage cheese and eggs were served in scarce. Education significantly reduced the amount of meat (47.7 vs. 44.5 g), processed meat (16.2 vs. 14.4 g), sugar and sweets (15.9 vs. 14.4 g) and increased the amount of cereals, groats, rice (17.7 vs. 18.5 g), vegetables (164.3 vs. 170.8 g), milk and fermented milk beverages (200.3 vs. 209.5 g) but the compliance with the MFR remained poor. The evaluation of menus stressed the need for further modifying their composition. Education can positively affect the quality of nutrition; however, introduction of the legal nutritional regulations should be recommended.

Objective: Evidence suggests that improvements to the childcare nutrition environment can have a positive impact on child dietary intake. The primary aim of the present study was to assess, relative to usual care, the effectiveness of a multi-strategy implementation intervention in improving childcare compliance with nutrition guidelines. As a secondary aim, the impact on child dietary intake was assessed., Design: Parallel-group, randomised controlled trial design. The 6-month intervention was designed to overcome barriers to implementation of the nutrition guidelines that had been identified by applying the theoretical domains framework., Setting: Hunter New England region, New South Wales, Australia., Subjects: Forty-five centre-based childcare services., Results: There were no differences between groups in the proportion of services providing food servings (per child) compliant with nutrition guideline recommendations for all five (5/5) food groups at follow-up (i.e. full compliance). Relative to control services, intervention services were more likely to be compliant with guidelines (OR; 95 % CI) in provision of fruit (10·84; 1·19, 551·20; P=0·0024), meat and meat alternatives (8·83; 1·55, -; P=0·023), dairy (8·41; 1·60, 63·62; P=0·006) and discretionary foods (17·83; 2·15, 853·73; P=0·002). Children in intervention services consumed greater servings (adjusted difference; 95 % CI) of fruit (0·41; 0·09, 0·73; P=0·014) and vegetables (0·70; 0·33, 1·08; P<0·001)., Conclusions: Findings indicate that service-level changes to menus in line with dietary guidelines can result in improvements to children's dietary intake. The study provides evidence to advance implementation research in the setting as a means of enhancing child public health nutrition.

Introduction: The implementation of dietary guidelines in childcare settings is recommended to improve child public health nutrition. However, foods provided in childcare services are not consistent with guidelines. The primary aim of the trial is to assess the effectiveness of a web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines regarding food provision to children in care., Methods and Analysis: A parallel group randomised controlled trial will be undertaken with 54 childcare services that provide food to children within New South Wales, Australia. Services will be randomised to a 12-month intervention or usual care. The experimental group will receive access to a web-based menu planning and decision support tool and online resources. To support uptake of the web program, services will be provided with training and follow-up support. The primary outcome will be the number of food groups, out of 6 (vegetables, fruit, breads and cereals, meat, dairy and 'discretionary'), on the menu that meet dietary guidelines (Caring for Children) across a 1-week menu at 12-month follow-up, assessed via menu review by dietitians or nutritionists blinded to group allocation. A nested evaluation of child dietary intake in care and child body mass index will be undertaken in up to 35 randomly selected childcare services and up to 420 children aged approximately 3-6 years., Ethics and Dissemination: Ethical approval has been provided by Hunter New England and University of Newcastle Human Research Ethics Committees. This research will provide high-quality evidence regarding the impact of a web-based menu planning intervention in facilitating the translation of dietary guidelines into childcare services. Trial findings will be disseminated widely through national and international peer-reviewed publications and conference presentations., Trial Registration: Prospectively registered with Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12616000974404., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: The aim of this study was to investigate if a protein-enriched menu in conjunction with individualized dietary counseling would increase energy and protein intake in hospitalized patients at nutrition risk compared with providing the protein-enriched menu as a stand-alone intervention., Method: Data from medical and surgical hospitalized patients were prospectively collected and compared with a historical intervention group (HIG). Primary outcome was the number of patients achieving >75% of energy and protein requirements. Secondary outcomes included mean energy and protein intake (adjusted for body weight [ABW]), readmission rate, and the number of patients with a baseline intake <50% of energy and protein requirement, who increased to ≥50%., Results: In the intervention group (IG), 92% vs 76% in the HIG reached >75% of energy requirements ( P = .04); 90% in the IG vs 66% in the HIG reached >75% of protein requirements ( p = <0.01). The IG had a significantly higher mean intake of energy and protein compared with the HIG: ABW, 31 kcal kg -1 vs 25 kcal kg -1 ( P < .01) and 1.2 g protein kg -1 vs 0.9 g protein kg -1 ( P < .001). More than 85% of the patients with a baseline <50% of the EP requirement achieved ≥75% of the energy and protein requirement. No difference between readmission rates was found., Conclusion: Providing a protein-enriched menu in conjunction with individualized dietary counseling significantly increased protein and energy intake in hospitalized patients at nutrition risk.

Background: While there are number of frameworks which focus on supporting the implementation of evidence based approaches, few psychometrically valid measures exist to assess constructs within these frameworks. This study aimed to develop and psychometrically assess a scale measuring each domain of the Theoretical Domains Framework for use in assessing the implementation of dietary guidelines within a non-health care setting (childcare services)., Methods: A 75 item 14-domain Theoretical Domains Framework Questionnaire (TDFQ) was developed and administered via telephone interview to 202 centre based childcare service cooks who had a role in planning the service menu. Confirmatory factor analysis (CFA) was undertaken to assess the reliability, discriminant validity and goodness of fit of the 14-domain theoretical domain framework measure., Results: For the CFA, five iterative processes of adjustment were undertaken where 14 items were removed, resulting in a final measure consisting of 14 domains and 61 items. For the final measure: the Chi-Square goodness of fit statistic was 3447.19; the Standardized Root Mean Square Residual (SRMR) was 0.070; the Root Mean Square Error of Approximation (RMSEA) was 0.072; and the Comparative Fit Index (CFI) had a value of 0.78., Conclusions: While only one of the three indices support goodness of fit of the measurement model tested, a 14-domain model with 61 items showed good discriminant validity and internally consistent items. Future research should aim to assess the psychometric properties of the developed TDFQ in other community-based settings.

Objective: Menu labelling has been identified as a potential strategy to help individuals make healthier choices when eating out. Although adolescents eat out often, little research involving menu labelling has been conducted with this population. The objectives of the present study were to: (i) gather qualitative information from adolescents regarding use of menu labels when eating out; (ii) gather adolescents' suggestions for optimal ways to design menu labels; and (iii) examine differences between adolescents living in communities of different socio-economic status., Design: Qualitative. Five focus groups of five to ten participants., Setting: Austin, TX, USA, 2012., Subjects: Forty-one adolescents living in diverse communities recruited using a snowballing technique at public and private recreation centres (twenty-four females; twenty-two African American)., Results: Participants reported that menu labelling, in general, does not influence food selections when eating out. Among participants living in low-income communities, food purchases were based on price, taste and familiarity. Among participants living in high-income areas, food purchases were based on quality and ability to satiate (among boys). According to participants, effective ways to present menu labels are by matching calorie levels with physical activity equivalents or through simple graphics., Conclusions: For adolescents, providing menu labels in their current format may not be an effective strategy to increase healthy food selection. Given that the current menu label format has been set by federal policy in the USA cannot be easily changed, research to determine how this format can be best presented or enhanced so that it can have an impact on all US sub-populations is warranted.

Objective: Early childhood settings are promising avenues to intervene to improve children's nutrition. Previous research has shown that a nutrition award scheme, Start Right - Eat Right (SRER), improves long day care centre policies, menus and eating environments. Whether this translates into improvements in children's dietary intake is unknown. The present study aimed to determine whether SRER improves children's food and nutrient intakes., Design: Pre-post cohort study., Setting: Twenty long day care centres in metropolitan Adelaide, South Australia, Australia., Subjects: Children aged 2-4 years (n 236 at baseline, n 232 at follow-up)., Methods: Dietary intake (morning tea, lunch, afternoon tea) was assessed pre- and post-SRER implementation using the plate wastage method. Centre nutrition policies, menus and environments were evaluated as measures of intervention fidelity. Comparisons between baseline and follow-up were made using t tests., Results: At follow-up, 80 % of centres were fully compliant with the SRER award criteria, indicating high scheme implementation and adoption. Intake increased for all core food groups (range: 0·2-0·4 servings/d, P<0·001) except for vegetable intake. Energy intake increased and improvements in intakes of eleven out of the nineteen nutrients evaluated were observed., Conclusions: SRER is effective in improving children's food and nutrient intakes at a critical time point when dietary habits and preferences are established and can inform future public health nutrition interventions in this setting.

Objective: To examine characteristics potentially associated with school lunch fruit and vegetable waste, both overall and pre/post implementation of the Healthy, Hunger-Free Kids Act., Design: Multi-year (2010-2013) cross-sectional study using pre- and post-meal digital photographs of students' school lunch trays to estimate fruit and vegetable availability and consumption. Fruit and vegetable items were categorized for factors suspected to impact waste: prior farm to school years, placement (main menu, salad bar), procurement (local, conventional), preparation (cooked, raw) and meal component (entrée, side, topping). Analyses to assess within-category differences in waste volume were performed using a Tobit model., Setting: Wisconsin elementary schools participating in farm to school programmes, USA., Subjects: Children in third to fifth grade., Results: Many within-factor differences were detected overall and/or across time. Cooked fruits were wasted less than raw, while cooked vegetables were wasted more than raw. Where identified, locally sourced items were wasted more than conventionally sourced (+0·1 cups, P<0·0001) and salad bar items more than main menu items (+0·01 cups, P<0·0001). Increasing prior farm to school years decreased waste (-0·02 cups, P<0·0001). Items previously tried were wasted at the same volume whether reported as liked or not. New school lunch meal pattern requirement implementation did not uniformly impact fruit and vegetable waste across all categories and there was no change in waste for seven of fifteen assessed categories., Conclusions: Many factors impact elementary students' school lunch waste. These factors may be helpful for school food-service authorities to consider when planning school menus.

Objective: To establish the degree of knowledge and adherence to the Spanish National Health System recommendations on nutrition in schools in the Autonomous Community of Madrid., Methods: Cross-sectional study of a random sample of 182 secondary schools from Madrid, during 2013-2014 school year. Information on the characteristics of the schools and the knowledge of the recommendations was collected by internet and telephone interviews, as well as a copy of the school menu. The average number of rations per week offered for each food item and the percentage of schools within the recommended range were calculated. The overall adherence was obtained as the mean of food items (0-12) within the range., Results: 65.5% of the schools were unaware of the national recommendations. The supply of rice, pasta, fish, eggs, salad and fruit was lower than recommended, whereas for meat, accompaniment and other desserts was higher. The percentage of schools within the range for each food item varied between 13% and 95%. The mean of overall adherence was 6.3, with no differences depending on whether the menu was prepared or not at schools or there was or not a person in charge of nutrition standards., Conclusions: The degree of adherence to the recommendations was variable, being advised to increase the supply of cereals, eggs, fish, salad and fruit. Programs for dissemination and implementation of the recommendations, leaded by trained professionals, are required to improve the nutritional value of school menu., (Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.)

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., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: In Brazil, menus for public child daycare centers (PDC) must be planned by a nutritionist in order to meet the infants' nutritional needs and to conform to dietary recommendations. Failure to follow them may jeopardize the infants' health and growth. Therefore, the objectives of this study were to investigate the compliance of actually served lunch menus with the prescribed menus, according to age (7- to 12-month-olds and 13- to 24-month-olds) and whether prescribed and served menus followed the recommended dietary guidelines., Methods: Five PDCs were randomly selected for observation, out of 14 existing in the city of Concordia, Brazil. Data collection was carried out during 6 consecutive weeks in September (fall/winter menus) and October (spring/summer menus) in order to cover the menus representative of the entire year., Results: Of 60 lunches recorded, only 20% of them matched the prescribed ones entirely; none of the lunches served to infants aged 7-12 months did so. Fourteen food items were prescribed 157 times throughout the year. Omission (number of times on menu but not served) was the most frequent form of noncompliance in the younger group: 62.4% (98/157). Foods more frequently omitted by the cooks were beef, pork, chicken, and lentils. Compliance with dietary guidelines was higher in the prescribed menus and in those actually served to the 13- to 24-month-old age group., Conclusions: Infants in the 7- to 12-month-old group may be more vulnerable to nutritional inadequacies because menus served to them were less compliant with the prescribed menus. Dietetics professionals should improve the variety of foods on the menus as well as supervise their execution.

Objective: To develop a software to plan and evaluate school meals according to the main national and international standards for foods and nutrition., Design: Development of software., Setting: Public schools, Portugal., Subjects: School meals for students., Results: The System of Planning and Evaluation of School Meals (SPARE) is a software that allows the planning of school meals in an effective and organized way, according to the main national and international standards for food and nutrition. The regular use of this tool enables the evaluation, monitoring and verification towards continuous improvement of the quality of school meals., Conclusions: The SPARE software aims to promote healthy eating by focusing on the planning and production of safe and adequate meals in the school environment. This software can be adapted to different age groups and to different contexts, attending to specific nutritional and food standards.

Background: School recess before lunch (e.g., reverse recess) has been suggested as a means to improve dietary intake and classroom behavior but limited research explores this school-based policy. This pilot study tests the impact of recess scheduling on dietary intake at school lunch., Methods: A mixed methods approach included assessment of dietary intake assessed by measured plate waste on five non-consecutive days at Madras Elementary School, Madras, Oregon, United States (n = 104 intervention; 157 controls). Subjects included primary school children in grades kindergarten, first and second. Logistic regression was used to test associations between recess timing and dietary intake. Four focus groups involving teachers and staff explored reactions to the intervention. Qualitative data was transcribed verbatim and assessed for key themes., Results: Milk consumption was 1.3 oz greater in the intervention group (5.7 oz vs. 4.4 oz); and 20% more of the intervention participants drank the entire carton of milk (42% vs. 25%, p < 0.0001). Intervention participants were 1.5 times more likely to meet the nutritional guidelines for calcium (≥267 mg, p = 0.01) and fat (≤30% of total energy, p = 0.02). Consumption of entrees, vegetables, and fruits did not differ between groups. Teachers perceived recess before lunch beneficial to classroom behavior and readiness to concentrate following lunch., Conclusions: The recess before lunch intervention yielded increased milk consumption; the nutritional and social benefits observed warrant policy change consideration. Future research should assess the impact of recess before lunch in larger districts.

The dietary reference intakes (DRIs) are a set of reference intake levels for nutrients that can be used for planning diets and assessing nutrient inadequacies of individuals and groups. Since the publication of the DRI reports 1997-2004, the reference intake levels have been used for various purposes. While DRIs have been used appropriately for planning and assessing diets for many different situations, there have been instances in which specific DRI categories have not been applied as intended. In this review, cases are described in which DRIs were applied correctly, as well as cases from the growing number of examples in which the wrong DRI was used or DRIs were used incorrectly., (© 2013 International Life Sciences Institute.)

Background: Most young children are in child care. Previous studies suggest that children may receive insufficient vegetables, and foods and beverages with added sugars, fats, and sodium in these settings. None have compared the nutritional quality of meals to snacks., Methods: Directors from 258 full-day child-care centers in two urban counties of southwestern Ohio were surveyed via telephone in the fall of 2009 about their nutrition practices, and asked to provide a current menu. Lunch and afternoon snack menus were categorized according to average weekly frequency for fruits, vegetables, lean meats, juice (100%), and sweet or salty foods served. Frequencies were compared by meal occasion (lunch vs. snack) using the Fisher exact test., Results: Most (60%) directors reported serving 2% milk to children ≥3 years; 31% served whole milk. Menu analysis demonstrated the composition of lunches differed from snacks (p<0.0001) in all food categories. A total of 87% centers rarely (<1 time per week) listed nonstarchy vegetables for snacks, but 67% of centers included them at lunch ≥3 times per week. Juice (100%) was on snack menus >2 times per week in 37% centers, but in only 1 center as a regular component of lunch. Similarly, 87% centers listed sweet and salty foods at snack ≥3 times per week, but rarely at lunch., Conclusions: Despite efforts to improve children's diets in child care, meals-and particularly snacks-still lack whole fruits and nonstarchy vegetables and contain added sugars and fats. Snacks represent a missed opportunity to improve the nutritional quality of foods served in childcare.

Background: The study investigated how nutrient standards affected the number of kilocalories and grams of fat and saturated fat in competitive foods offered and sold in 3 high schools., Methods: The study is a quasi-experimental design with 3 schools serving as the units of assignment and analysis. The effect of the nutrient standards was measured by the change in kilocalories and grams of fat and saturated fat in offerings and purchases of competitive foods pre- and postimplementation of the standards. A paired sample t-test was used to compare kilocalories and grams of fat and saturated fat pre- and postimplementation of nutrition standards., Results: After the implementation of the nutrition standards, students in 3 high schools purchased significantly smaller numbers of kilocalories and grams of fat and saturated fat, during the postpolicy school year of 2007-2008 than during the prepolicy school year of 2004-2005., Conclusion: Using nutrient standards to guide the selection of competitive foods offered in school cafeterias may positively affect intake of kilocalories, total grams of fat, and total saturated fat of those foods. The quantitative assessment is novel and demonstrates the reduction in kilocalories and fat in both the competitive food offerings and purchases as a result of nutrient standards., (© 2012, American School Health Association.)

Background: 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., Objective: 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., Design: 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)., Participants/setting: Adult primary food shoppers and preparers with at least one child in the household aged 3 to 17 years., Intervention: Group education session and support tools (pocket guide, shopping list, refrigerator magnet, weekly e-mail messages, and biweekly mailings)., Main Outcome Measures: Surveys of knowledge, attitudes, and behaviors and two 24-hour telephone dietary recalls at baseline and after an 8-week intervention period., Statistical Analyses: Examined time-by-treatment interactions in outcome measures., Results: Compared to controls, NRF participants increased meal planning (+24.2% vs ?4.9%; P<0.01), ability to identify nutrient-rich foods (+60.2% vs +24.6%; P<0.001), and use of shopping lists (+14.1% vs +3.3%; nonsignificant trend), and consumed more vegetables and fruits (P<0.05). 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., Conclusions: 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., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Aim: to diagnose the situation regarding the infrastructure, organization of school meals, the kind of products available for students at school and the school policy on the promotion of healthy eating in the context of the increasing frequency of obesity among children and young people., Method and Material: The research tool was the questionnaire "School environment and health", including a section on the facilities, organization of meals and the school's policy on healthy eating. It made use of the questions from the international HBSC (Health Behaviour in School-aged Children) school questionnaire. The anonymous questionnaire was sent out by post and was returned by 520 head masters of primary, lower-secondary and cluster schools. This means that 74.3% of the randomly chosen sample of schools responded., Results: Almost 2/3 of the schools had a canteen and a school store. Hot meals were served in 84% of the schools but only in 28% of them to more than 50% of the students. School breakfast was organized by half of the schools of which 23% had it in all the classes. Almost all the schools served free meals for students with special needs. Most schools, particularly lower-secondary provided access to sweets, sweet drinks and salty snacks. Only 7-25% of schools have a written policy on limiting such products and increasing the consumption of fruits, vegetables, milk and whole-grain bread products. In on going national programmes: "A Glass of Milk" had a 74% participation rate (only 25% of the lower-secondary schools) and "Fruits in School" 38% (6% lower-secondary schools). The "Keep Fit" educational programme was implemented in 28% of primary schools and in 72% of lower-secondary schools., Conclusions: The majority of schools in Poland still do not appreciate the need for all students to eat a meal in school and have not become involved in prophylactic activities designed to prevent obesity. The undertaken activities are incoherent. There is a need to create a policy on healthy nutrition at school at the national, regional, local and school level.

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., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

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., (2009 Elsevier Ltd. All rights reserved.)

Objective: To assess the adequacy and variability of the diet served to Tarahumara children in indigenous boarding schools., Material and Methods: Records of food and drinks served for meals, weighed daily, were obtained from Monday through Friday for 10 consecutive weeks in two selected boarding schools. Nutrient intake for Tuesdays, Wednesdays and Thursdays was calculated and analyzed for weeks 3, 5 and 7., Results: The number of food items used per week ranged from 33 to 46. The most frequently utilized items were cooking oil, fortified corn tortilla, milk, onion, sugar and beans. Total energy served per day fluctuated between 1309 and 2919 Kcal; proteins comprised 10.5 to 21.2% (45 to 127 g/day), carbohydrates 40.7 to 61.9% (145 to 433 g/day), and lipids 22.5 to 48.1% (45 to 125 g/day) of the total. Daily micronutrient content ranges were: iron 15-33 mg, calcium 686-1795 mg, zinc 8-19 mg, vitamin A 118-756 mcg, vitamin B(9) 42-212 mcg, and vitamin B(12) 0.8-5 mcg., Conclusion: There was significant daily variability in the diet, which was hypercaloric due to the high lipid content, and yet insufficient in vitamins B(9), B(12) and A.

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.

The goal of this project was to assess the cost of purchasing 1-month of nutritionally adequate, familiar, healthy food plans for African American seniors and families in Roxbury, Massachusetts. Model 7-day food plans were developed and tested using focus groups. The food plans were translated into shopping lists and prices were collected at 2 local grocery stores. Results found that the average estimated monthly food cost for both groups exceeded the benefit and food budget set by 2 agencies. It was concluded that many low-income people living in Roxbury have limited access to affordable healthy food options; this issue should be addressed as a matter of public health policy.

Introduction: Dietary control and nutrient intake are critical aspects of any metabolic study, but this is especially true in the case of bed rest studies. We sought to define nutritional requirements, develop menus, and implement them during long-duration head-down bed rest studies., Methods: The dietary goals were to provide 100% of subjects' nutrient requirements and to maintain subjects' bodyweight to within 3% of their weight on the third day of head-down bed rest. The research dietitian and metabolic kitchen staff are an important part of the multidisciplinary team required to implement a bed rest study., Results: We report herein the planning steps and nutrient intake results from 13 subjects. We also provide insight into some of the dietary challenges that arise during long-duration bed rest studies., Discussion: Regardless of the overall objective of the bed rest study to be performed, nutrition must be carefully planned, implemented, and monitored to prevent results from being compromised.

Background: Children's food intakes do not meet dietary recommendations. Meals offered through the National School Lunch Program and School Breakfast Program make substantial contributions to school-aged children's diets., Objectives: This article describes foods offered in school meals and consumed by children at lunch and breakfast, and differences in foods consumed by children who did and did not participate in the school meal programs., Design: Data were collected as part of the third School Nutrition Dietary Assessment Study, a cross-sectional, nationally representative study conducted in 2005. School menu surveys were used to identify the foods offered in school meals, and 24-hour dietary recalls were used to assess the foods children consumed., Subjects/setting: Foodservice managers in 398 public schools and 2,314 children (grades 1 to 12) from 287 of these schools participated in the study., Statistical Analyses Performed: Descriptive tabulations report percentages of daily menus that offered and percentages of children that consumed specific food groups and foods at lunch and breakfast. Two-tailed t tests were used to assess differences between school meal program participants and nonparticipants., Results: Most school menus offered nonfat or 1% milk, fruit or 100% juice, and vegetables daily. Starchy vegetables were more common than dark green/orange vegetables or legumes. School lunch participants were significantly more likely than nonparticipants to consume milk, fruit, and vegetables, and significantly less likely to consume desserts, snack items, and beverages other than milk or 100% juice. At breakfast, participants were significantly more likely than nonparticipants to consume milk and fruit (mainly 100% juice), and significantly less likely to consume beverages other than milk or 100% juice., Conclusions: Consumption of school meals is positively related to children's intakes of key food groups at lunch and breakfast. Offering more fresh fruit, whole grains, and a greater variety of vegetables could lead to additional health benefits.

Background: Concerns about the diets of school-aged children and new nutrition recommendations for the US population have increased interest in the nutritional quality of meals available through the National School Lunch Program and School Breakfast Program., Objective: This article updates national estimates of the food energy and nutrient content of school meals and compares these estimates to federal nutrient standards established under the 1995 School Meals Initiative for Healthy Children., Design: Data were collected as part of the third School Nutrition Dietary Assessment Study, a nationally representative cross-sectional study fielded during school year 2004-2005. Menu and recipe data for a typical school week were collected in a mail survey with telephone assistance. Nutrient information for common commercially prepared food items was obtained from manufacturers, to supplement the Food and Nutrient Database for Dietary Studies used to analyze the data. Analyses were conducted for meals offered and meals served to (selected by) children., Subjects/setting: Samples of 130 public school districts that offered federally subsidized school meals, and 398 schools within those districts, participated in the study. Foodservice managers in each school completed a menu survey., Statistical Analyses Performed: Descriptive tabulations present weighted means, proportions, and standard errors for elementary, middle, and high schools, and for all schools combined., Results: Most schools offered and served meals that met the standards for protein, vitamins, and minerals. Fewer than one third of schools met the standards for energy from fat or saturated fat in the average lunch, whereas three fourths or more met the fat standards in school breakfasts. For both meals, average levels of sodium were high and fiber was low relative to Dietary Guidelines for Americans 2005 recommendations., Conclusions: For school meals to meet nutrient standards and promote eating behaviors consistent with the Dietary Guidelines, future policy, practice, and research should focus on reducing levels of fat and sodium and increasing fiber.

Background: Enhancements to current dietary advice to prevent chronic disease are of great clinical and public health importance. The OmniHeart Trial compared 3 diets designed to reduce cardiovascular disease (CVD) risk-one high in carbohydrate and 2 that replaced carbohydrate with either unsaturated fat or protein. The lower carbohydrate diets improved the CVD risk factors. Several popular diets claiming health benefits emphasize carbohydrate, fat, or protein or various combined approaches., Objective: The objective of this study was to compare the macronutrient contents of the OmniHeart trial diets to those of several popular diets and to evaluate each diet for consistency with national health guidelines., Design: The macronutrient contents of 7-d menu plans from the OmniHeart Study, Dietary Approaches to Stop Hypertension (DASH), Zone, Atkins, Mediterranean, South Beach, and Ornish diets were evaluated for consistency with the US Food and Nutrition Board's Acceptable Macronutrient Distribution Ranges (AMDRs) and with the dietary recommendations of several health organizations., Results: The OmniHeart diets fulfilled the major AMDRs, but, of the popular diets, only the Zone diet did. The OmniHeart diets were generally consistent with national guidelines to prevent cancer, diabetes, and heart disease, whereas most popular diets had limitations for fulfilling one or more guidelines., Conclusions: Although the OmniHeart protein and unsaturated fat diets were superior to the carbohydrate diet in improving CVD risk, all 3 study diets were consistent with national guidelines to reduce chronic disease risk, which suggests that the guidelines might now be fine-tuned to optimize disease prevention. Popular diets vary in their nutritional adequacy and consistency with guidelines for risk reduction.

Objective: To compare the nutritional value of meals provided by companies participating in the Workers' Meal Program in the city of São Paulo, Brazil, to the nutritional recommendations and guidelines established by the Ministry of Health for the Brazilian population., Methods: The 72 companies studied were grouped according to economic sector (industrial, services, or commerce), size (micro, small, medium, or large), meal preparation modality (prepared on-site by the company itself, on-site by a hired caterer, or off-site by a hired caterer), and supervision by a dietitian (yes or no). The per capita amount of food was determined based on the lunch, dinner, and supper menus for three days. The nutritional value of the meals was defined by the amount of calories, carbohydrates, protein, total fat, polyunsaturated fat, saturated fat, trans fat, sugars, cholesterol, and fruits and vegetables., Results: Most of the menus were deficient in the number of fruits and vegetables (63.9%) and amount of polyunsaturated fat (83.3%), but high in total fat (47.2%) and cholesterol (62.5%). Group 2, composed of mostly medium and large companies, supervised by a dietician, belonging to the industrial and/or service sectors, and using a hired caterer, on averaged served meals with higher calorie content (P<0.001), higher percentage of polyunsaturated fat (P<0.001), more cholesterol (P=0.015), and more fruits and vegetables (P<0.001) than Group 1, which was composed of micro and small companies from the commercial sector, that prepare the meals themselves on-site, and are not supervised by a dietitian. Regarding the nutrition guidelines set for the Brazilian population, Group 2 meals were better in terms of fruit and vegetable servings (P<0.001). Group 1 meals were better in terms of cholesterol content (P=0.05)., Conclusions: More specific action is required targeting company officers and managers in charge of food and nutrition services, especially in companies without dietitian supervision.

Objectives: To conduct a needs assessment of all aspects of food provision in a residential home and to evaluate a subsequent nutrition intervention., Design: An intervention study using a before and after design. A participatory approach was adopted and quantitative and qualitative methods used throughout. The intervention involved a revised menu, kitchen equipment, and establishing wholesale shopping and food donations., Setting: A residential home for senior citizens in Guyana., Results: Meals at the home were nutritionally inadequate and deeply unpopular with the residents. Intakes of fruits and vegetables were low and the home was heavily reliant on donated soya mince and rice. Meals were served within an eight-hour period to accommodate the staff's hours of work. Cutbacks in the food budget indicated that the financial state of the home explained some of the problems. The intervention was unable to address all problems identified, but led to substantial improvements in the nutritional adequacy of the food provided following the inclusion in the menu of a number of nutrient-dense foods such as chicken liver. The new menu was acceptable to the cooks and largely popular with the residents, although some problems persisted., Conclusions: The results show that improvements in the nutrient profile of the diet could be achieved with a flexible, community-based, participatory approach that addressed all elements of a home's food provision system. The changes also proved largely popular with the residents, thus potentially contributing to their quality of life.

Purpose: Texture-modified diets offered in long-term care (LTC) facilities are often prepared from the regular menu, planned using Canada's Food Guide to Healthy Eating. The appropriateness of protein levels of puréed diets in LTC facilities was determined., Methods: Protein content was measured in 29 duplicate diets, collected from 20 urban LTC facilities in Saskatchewan (SK) and Ontario (ON). Mealtime puréed food intakes of 20 LTC residents were assessed. The target protein levels were calculated as estimated average requirements plus one or two standard deviations of intake, thus allowing for moderate (16%) or low (2.5%) risk of inadequacy, respectively., Results: The duplicate diets provided 57.9 +/- 7.9 and 85.4 +/- 31.1 g/day of protein in SK and ON, respectively. Protein intake of SK LTC residents consuming puréed food averaged 54 +/- 19 g/day. Only 43% of the SK puréed diets provided more than 59 g/day of protein and none provided more than 78 g/day; in contrast, 87% and 40% of ON puréed diets provided more than 59 and 78 g/day of protein, respectively., Conclusions: In-house prepared puréed diets do not consistently provide sufficient protein levels to ensure a low risk of inadequacy for the LTC residents consuming these diets.

Currently, the only treatment for any food hypersensitivity (including food allergy) is the dietary avoidance of the causative allergen, using an elimination diet. In addition to being used for the management of food hypersensitivity, an elimination diet may also be used in the diagnosis of food allergy. Dietary exclusion should be managed by a dietitian or other health professional with nutritional expertise to ensure that the exclusion does not lead to a nutritionally-deficient diet. There are three main types of elimination diets: single-food exclusion; multiple-food exclusion; the 'few-food' diet, which requires the avoidance of a large number of allergens and therefore concentrates on the foods that can be included rather than the foods that need to be avoided. Any sort of elimination diet is hard to manage. Thus, as well as ensuring that the diet is nutritionally adequate, it is essential that families are given advice and support relevant to their circumstances to aid them in the day-to-day management of the diet, so that it remains varied and enjoyable for food-allergy sufferers. This approach involves advice about which alternative foods are available, provision of 'free-from' recipes and guidance on which nutritional supplements are needed to meet their nutritional needs.

Unlabelled: The purpose of the present study was to investigate if smaller but energy and protein enriched meals could improve energy and nutrient intakes in elderly geriatric patients. Ten patients, between 77 and 87 years of age were included in the study, performed at a Geriatric rehabilitation ward. The first week after inclusion, the patients were offered a three days' standard hospital menu and the second week, a three days' energy and protein-enriched menu. The consumption of food and the fluid intake were recorded using a pre-coded food record book during both the menus and analysed by the Swedish National Food Administration. The patients' energy requirements were calculated according to the Nordic Nutrition Recommendation for elderly subjects. When the standard hospital menu was offered, six patients had lower energy intake, -67 to -674 kcal/day, than the calculated energy requirements. The daily energy intake increased by 37 %, with the energy and protein-enriched menu compared with the standard hospital menu. Furthermore, the daily intake of protein, fat, carbohydrate, certain vitamins and minerals was significantly higher with the energy and protein-enriched menu compared with the standard hospital menu., Conclusion: This study showed that the intake of energy and nutrients increased with the energy and protein-enriched menu in elderly patients on a geriatric rehabilitation ward.

Dietary intervention studies of human beings produce valuable information regarding dietary effects on biological processes and risk factors for chronic diseases. Using the well-controlled feeding approach, participants consume only foods that have been precisely prepared in a research kitchen, whereas in behavioral counseling studies, participants self-select their foods within guidelines. Because controlled feeding studies meticulously control experimental diets, they are intellectually and logistically challenging to conduct. They afford exciting opportunities for dietetic professionals in designing protocols, developing budgets, and collaborating in multidisciplinary research teams. Research dietitians use food composition data and chemical analysis of menus to prepare research diets with precision. They determine the energy requirements of subjects and adjust diets as required, most often for weight maintenance, throughout the study. All people involved in research must be attentive to the ethical treatment of the study participants while motivating them to adhere to the protocol requirements. Dietitians possess many of these skills, but may require training specific to well-controlled feeding studies. Information related to the conduct of controlled feeding studies has recently become more accessible. We provide an overview of well-controlled feeding study methodologies, proficiencies for planning and implementing these studies, and training resources.

Previous studies on optimization of crew diets have not accounted for choice. A diet selection model with crew choice was developed. Scenario analyses were conducted to assess the feasibility and cost of certain crew preferences, such as preferences for numerous-desserts, high-salt, and high-acceptability foods. For comparison purposes, a no-choice and a random-choice scenario were considered. The model was found to be feasible in terms of food variety and overall costs. The numerous-desserts, high-acceptability, and random-choice scenarios all resulted in feasible solutions costing between 13.2 and 17.3 kg ESM/person-day. Only the high-sodium scenario yielded an infeasible solution. This occurred when the foods highest in salt content were selected for the crew-choice portion of the diet. This infeasibility can be avoided by limiting the total sodium content in the crew-choice portion of the diet. Cost savings were found by reducing food variety in scenarios where the preference bias strongly affected nutritional content.

The previous three articles in this series reviewed current nutritional advice to help maintain health during pregnancy (Vol 9(17): 1133-8), weaning (Vol 9(21): 2205-16) and in childhood (Vol 10(1): 26-310. This article reviews current thinking on what constitutes a health diet for the individual who has left childhood behind, but has not yet encountered many of the changes associated with old age. Most people enjoy food, and also believe that a good diet will improve their health. This article aims to review current thinking on what constitutes a healthy diet for the adult.