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Background Internationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children’s canteen purchases and on schools’ canteen revenue was also assessed. Methods Australian primary schools with a canteen were randomised to receive a 12–14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as ‘red’ or ‘banned’) from regular sale and encouraged schools to ‘fill the menu’ with healthy items (classified as ‘green’). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015). Results Seventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without ‘red’ or ‘banned’ items (RR = 21.11; 95% CI 3.30 to 147.28; p  ≤ 0.01) and to have at least 50% of menu items classified as ‘green’ (RR = 3.06; 95% CI 1.64 to 5.68; p  ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = −1.51 g; 95% CI −2.84 to −0.18; p  = 0.028) compared to controls, but not in energy (difference = −132.32 kJ; 95% CI −280.99 to 16.34; p  = 0.080) or sodium (difference = −46.81 mg; 95% CI −96.97 to 3.35; p  = 0.067). Canteen revenue did not differ significantly between groups. Conclusion Poor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools. Trial registration Australian New Zealand Clinical Trials Registry ( ACTRN12613000311752 )

Background Promoting sustainable food systems is essential to ensuring both public health and environmental protection. University dining halls, as institutional food environments, provide a strategic opportunity to implement and evaluate sustainable dietary practices. Objective This study aimed to assess and optimize the sustainability of food menus in three military universities in Tehran by evaluating nutritional adequacy, environmental footprints (water and carbon), and economic cost. Methods In this cross-sectional analytical study, one-month food menus from three universities were analyzed. Nutrient content, cost, water footprint, and carbon emissions were calculated for each menu. Three optimization approaches—differing in menu design constraints—were developed and implemented using Linear Programming (LP) and Goal Programming (GP) to improve the sustainability of the menus while maintaining cultural acceptability. Results The original menus were high in energy and fat, with considerable variation across universities. Optimization led to significant improvements, especially in the third approach, which combined menu reformulation and new food item integration. Compared to baseline, this approach reduced the water footprint by 30%, carbon emissions by 36%, and food cost by 32%, while increasing the Nutrient Rich Food (NRF) index by 25%. Micronutrient analysis confirmed that optimized menus provided adequate intake of key nutrients, including vitamin D, iron, calcium, and fiber, while significantly reducing sodium and saturated fat. Conclusion Strategic optimization of institutional food menus can substantially enhance nutritional quality, reduce environmental impact, and maintain affordability. Military universities and other public institutions can serve as platforms to promote sustainable eating habits and support national health and climate goals.

Food exchange lists have been widely used in dietary practice in health and disease situations, but there are still no exchange lists for sports foods. The aim of this study was to apply a previous published methodology to design food exchange lists to the development of a sports food exchange list, with sport products available in Spain. A cross-sectional study of the nutritional composition of sports foods, regarding macronutrients and energy, was carried out. A total of 322 sports foods from 18 companies were selected, taking into account their interest in sports practice and with nutritional data provided by companies. Sports foods were divided into seven groups: sports drinks; sports gels; sports bars; sports confectionery; protein powders; protein bars; and liquid meals. A sports food composition database based on portion size usually consumed by athletes and/or recommended in commercial packaging was created. Within each sports foods group, different subgroups were defined due to differences in the main and/or secondary macronutrient. The definition of each exchange list with the amounts—in grams—of each sports food within each group and subgroup, was done using statistical criteria such as mean, standard deviation, coefficient of variation, and Z value. Final exchange values for energy and macronutrient have been established for each group and subgroup using a methodology to design food exchange lists previously published by the authors. In addition, those products with high Z values that can provide greater variability in dietary planning were included. The usefulness of sport foods lists as well as the use of an exchange system in the dietary practice of sports nutrition is discussed, and examples of how to use them with athletes are presented. This first sport foods exchange list showed in this study, with commercial sports products available in Spain, can be a novel tool for dietetic practice and also can allow sport nutrition professionals to develop another sport food list using the methodology described in this paper. Its management would allow dietitians to adapt dietary plans more precisely to the training and/or competition of the athlete.

Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP). In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models. USA in 2008-2009. Sixty child-care providers participating in CACFP in King County, Washington State. In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively). The results indicate that improving the nutritional quality of foods in child care may require higher food spending.

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems. The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation). Slovenian primary schools. A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation. The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements. The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

Background: Choice of food is an imperative aspect of quality of life for residents in Residential Aged Care Homes (RACHs), where overall choice and control is diminished upon entering a home to receive care. The purpose of this study was to examine the current strategies of menu planning in a range of RACHs in Australia, and whether this facilitated appropriate levels of choice for residents receiving texture modified and general diets. Methods: The study comprised a National Menu Survey using a new survey instrument collecting general information about the RACH and foodservice system, menu information and staffing information (n = 247); a national menu analysis (n = 161) and an observational case study of 36 meal environments. Results: Choice was low for the entire sample, but particularly for those receiving pureed texture modified diets. Evidence of menu planning to facilitate the inclusion of choice and alternatives was limited. Discussion: Regulation and monitoring of the Australian Aged Care Accreditation Standards needs to be strengthened to mandate improvement of the choice and variety offered to residents, particularly those on pureed texture modified diets. Further research on how menu choice and a lack of variety in meals affects the quality of life residents is needed in this context, but current evidence suggests the effect would be detrimental and undermine resident autonomy and nutritional status.

Objectives. We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias. Methods. Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. Results. A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs −2.8% control, P = .002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P = .04) were observed. There were no significant changes in student self-reported food choices. Conclusions. School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.

Purpose The purpose of this paper is to understand how chefs working at five star hotels perceive the menu planning process. Design/methodology/approach Case studies were used to deeply investigate the menu planning process of five star hotels. Data were drawn from in situ interviews and documentation, which were examined via content analysis. After the coding process, themes and categories were extracted and corroborated by direct quotations. Findings The findings revealed that the menu planning process can be classified into five major categories. The first category consists of the prerequisites of planning a menu. The second category is “key issues” and encapsulates the managerial, consumer, gastronomic, marketing and external aspects of menu planning. The third category highlights key actors’ responsibilities in the menu planning process, while the fourth category, “trial and improvement,” elaborates on the iterative process of menu design and the key players and issues involved with it. Finally, the last category outlines the difficulties of menu planning. Originality/value In the existing academic literature, most research conducted about menu planning only provides conceptual framework while empirical information remains unexamined. However, this qualitative study aims to clarify the components of menu planning in more detail in terms of five star hotel firms that offer various food and beverage operations. The present study is an attempt to fill a gap in the existing literature on the subject.

The aim of this study is to comprehensively describe nutritional care in German nursing homes (NHs) and to examine if nutritional care differs between small, medium and large NHs. Nationwide cross-sectional postal survey. Nursing homes. 541 NHs across Germany. Information on structural NH characteristics and nutritional care (food provision and menu planning, nursing care, and management and quality assurance) was collected by means of a questionnaire addressed to the management of a random sample of German NHs. NHs were grouped by size as small (≤ 50 beds), medium (50 - 100 beds) or large (> 100 beds) institutions. Frequencies were used to describe nutritional care, and Chi2-test to identify differences in nutritional care by NH size. Aspects in the domain of food provision and menu planning regarding food variety and choice were widely implemented in German NHs (77 - 100 %). Best results were achieved in the domain of nursing care, where all aspects were implemented in at least 68 % of the NHs. Aspects regarding management and quality assurance, especially those concerning staffing, i.e. the availability of an interface manager (14 %), an interdisciplinary nutrition team (12 %) and a dietician (42 %), were only rarely implemented. Differences by NH size were found between small and medium or large NHs. On the one hand, small NHs stated more often to consider individual capabilities of the residents with texture-modified food (81 % vs. 60 %, p <0.05) and produce more often hot meals at ward level on a regular base (46 % vs. 32 %, p <0.05) than large NHs. On the other hand, several aspects regarding food provision and menu planning, and management and quality assurance were significantly more often implemented in larger than smaller NHs. Whereas kitchen and nursing-related aspects of nutritional care seem to be widely implemented in German NHs, management and quality assurance demands are often not met. The differences found by NH size support the hypothesis that the number of residents living in a NH has an impact on how nutritional care is performed.

Abstract Background: The School Nutrition Advances Kids project tested the effectiveness of school-initiated and state-recommended school nutrition practice and policy changes on student dietary intake in low-income middle schools. Methods: Schools recruited by an application for grant funding were randomly assigned to (1) complete an assessment of nutrition education, policies, and environments using the Healthy School Action Tools (HSAT) and implement an action plan, (2) complete the HSAT, implement an action plan, and convene a student nutrition action team, (3) complete the HSAT and implement an action plan and a Michigan State Board of Education nutrition policy in their cafeteria à la carte, or (4) a control group. All intervention schools were provided with funding and assistance to make self-selected nutrition practice, policy, or education changes. Block Youth Food Frequency Questionnaires were completed by 1176 seventh-grade students from 55 schools at baseline and during eighth-grade follow-up. Nutrient density and food group changes for the intervention groups were compared to the control group, controlling for baseline dietary intake values, gender, race/ethnicity, school kitchen type, urbanization, and percent of students eligible for free or reduced-price meals. Analyses were conducted by randomization and based on changes the schools self-selected. Results: Improvements in students' nutrient density and food group intake were found when schools implemented at least three new nutrition practice changes and established at least three new nutrition policies. Students in schools that introduced mostly healthful foods in competitive venues at lunch demonstrated the most dietary improvements. Conclusions: New USDA nutrition standards for à la carte and vending will likely increase the healthfulness of middle school children's diets.