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Sheffield, United Kingdom

Objective: To describe the lunchtime choices and nutritional intake of primary-school-aged children in England 4 months after the introduction of interim food-based standards for school lunches.Design: Cross-sectional 2 d weighed food records collected in January and February 2007.Setting: Six primary schools in Sheffield, England.Subjects: One hundred and twenty-three pupils aged 8-10 years.Results: Vegetables (81 % v. 8 %) and cakes and biscuits (43 % v. 23 %) were chosen more frequently by pupils consuming a school lunch, while fruit (40 % v. 36 %), meat products (18 % v. 14 %), confectionery (72 % v. 0 %), savoury snacks (69 % v. 0 %) and drinks not meeting the school food standards (40 % v. 0 %) were chosen more often by pupils eating a packed lunch. Mean energy intake was lower in the school lunch group compared with the packed lunch group (1402 (sd 573) v. 2192 (sd 619), P = 0.005). Nutrient density (per MJ energy) was significantly better in school meals for key nutrients including protein (98 (sd 27) v. 6.3 (sd 1.9) g), fat (7.4 (sd 2.7) v. 10.6 (sd 2.8) g), NSP (2.8 (sd 1.3) v. 1.1 (sd 0.4) g), vitamin A (151.3 (sd 192.8) v. 69.1 (sd 55.6) g), folate (29.6 (sd 11.6) v. 17.0 (sd 7.0) -mu;g), iron (1.3 (sd 0.3) v. 0.9 (sd 0.3) mg) and zinc (1.1 (sd 0.4) v. 0.7 (sd 0.3) mg).Conclusions: Schools were largely compliant with the interim food-based standards for school meals 4 months after their introduction. Within the context of the new standards, children taking a school lunch are more likely to eat a more nutritious lunch, in terms of less high-fat/salt/sugar foods and nutrient density. The introduction of nutrient-based standards is warranted. Efforts to improve the lunchtime intake of children taking a packed lunch are also required. © 2010 The Authors.

Stevens L.,School Food Trust | Nelson M.,School Food Trust
Journal of Human Nutrition and Dietetics | Year: 2011

Background: The Low Income Diet and Nutrition Survey described the food consumption and nutrient intake of UK children in low income households in 2003-2005. Methods: To describe food consumption and nutrient intake associated with school meals and packed lunches, based on a cross-sectional analysis of 680, 24-h dietary recalls from 311 school children aged 4-11years. Results: In children from low income households, pupils who took a packed lunch consumed more white bread, fats and oils, crisps and confectionery and fewer potatoes (cooked with or without fat) at lunchtime compared to other pupils. Many of these differences persisted when diet was assessed over the day. For younger pupils (4-7years), packed lunches provided the least amount of folate, the highest amount of sodium, and the highest average percentage of food energy from fat and saturated fatty acids (SFA) compared to free school meals (FSMs). Over the whole day, in both younger (4-7years) and older (8-11years) children, there were no notable differences in energy or nutrient intake between those eating a packed lunch or a school meal. Older children's packed lunches contributed a significantly higher proportion of fat, SFA, calcium and sodium to the day's nutrient intake compared to a FSM. Conclusions: In children from low income households, packed lunches are less likely to contribute towards a 'healthier' diet compared to a school meal. The difference was more apparent in younger children. Key differences were the high consumption of sodium, SFA and non-milk extrinsic sugars by pupils who had packed lunches. © 2011 The Authors. Journal compilation © 2011 The British Dietetic Association Ltd.

Savovic J.,University of Bristol | Jones H.E.,University of Bristol | Altman D.G.,University of Oxford | Harris R.J.,Public Health England | And 14 more authors.
Health Technology Assessment | Year: 2012

Background: The design of randomised controlled trials (RCTs) should incorporate characteristics (such as concealment of randomised allocation and blinding of participants and personnel) that avoid biases resulting from lack of comparability of the intervention and control groups. Empirical evidence suggests that the absence of such characteristics leads to biased intervention effect estimates, but the findings of different studies are not consistent. Objectives: To examine the influence of unclear or inadequate random sequence generation and allocation concealment, and unclear or absent double blinding, on intervention effect estimates and between-trial heterogeneity, and whether or not these influences vary with type of clinical area, intervention, comparison and outcome measure. Data sources and methods: Data were combined from seven contributing meta- epidemiological studies (collections of meta-analyses in which trial characteristics are assessed and results recorded). The resulting database was used to identify and remove overlapping meta-analyses. Outcomes were coded such that odds ratios < 1 correspond to beneficial intervention effects. Outcome measures were classified as mortality, other objective or subjective. We examined agreement between assessments of trial characteristics in trials assessed in more than one contributing study. We used hierarchical Bayesian bias models to estimate the effect of trial characteristics on average bias [quantified as ratios of odds ratios (RORs) with 95% credible intervals (CrIs) comparing trials with and without a characteristic] and in increasing between-trial heterogeneity. Results: The analysis data set contained 1973 trials included in 234 meta-analyses. Median kappa statistics for agreement between assessments of trial characteristics were: sequence generation 0.60, allocation concealment 0.58 and blinding 0.87. Intervention effect estimates were exaggerated by an average 11% in trials with inadequate or unclear (compared with adequate) sequence generation (ROR 0.89, 95% CrI 0.82 to 0.96); between-trial heterogeneity was higher among such trials. Bias associated with inadequate or unclear sequence generation was greatest for subjective outcomes (ROR 0.83, 95% CrI 0.74 to 0.94) and the increase in heterogeneity was greatest for such outcomes [standard deviation (SD) 0.20, 95% CrI 0.03 to 0.32]. The effect of inadequate or unclear (compared with adequate) allocation concealment was greatest among meta-analyses with a subjectively assessed outcome intervention effect (ROR 0.85, 95% CrI 0.75 to 0.95), and the increase in between-trial heterogeneity was also greatest for such outcomes (SD 0.20, 95% CrI 0.02 to 0.33). Lack of, or unclear, double blinding (compared with double blinding) was associated with an average 13% exaggeration of intervention effects (ROR 0.87, 95% CrI 0.79 to 0.96), and between-trial heterogeneity was increased for such studies (SD 0.14, 95% CrI 0.02 to 0.30). Average bias (ROR 0.78, 95% CrI 0.65 to 0.92) and between-trial heterogeneity (SD 0.37, 95% CrI 0.19 to 0.53) were greatest for meta-analyses assessing subjective outcomes. Among meta-analyses with subjectively assessed outcomes, the effect of lack of blinding appeared greater than the effect of inadequate or unclear sequence generation or allocation concealment. Conclusions: Bias associated with specific reported study design characteristics leads to exaggeration of beneficial intervention effect estimates and increases in between-trial heterogeneity. For each of the three characteristics assessed, these effects were greatest for subjectively assessed outcomes. Assessments of the risk of bias in RCTs should account for these findings. Further research is needed to understand the effects of attrition bias, as well as the relative importance of blinding of patients, care-givers and outcome assessors, and thus separate the effects of performance and detection bias. Funding: National Institute for Health Research Health Technology Assessment programme. © Queen's Printer and Controller of HMSO 2012.

Storey H.C.,School Food Trust | Pearce J.,School Food Trust | Ashfield-Watt P.A.L.,School Food Trust | Wood L.,School Food Trust | And 2 more authors.
European Journal of Clinical Nutrition | Year: 2011

Background/Objectives:Adequate nutrition is considered important for learning, but there is little robust research on the association between diet and learning in school-aged children in industrialized countries. This study investigated the effect of tailored modifications to the food and dining experience in secondary schools on learning-related behaviours.Subjects/Methods: In 2008, 12 co-educational secondary schools in England were recruited. Schools were randomly allocated to receive a tailored action plan and support to modify their food provision and dining environment over a 15-week period (intervention or to control). Learning-related behaviours were systematically observed during post-lunchtime classes at all schools. Observations were made by trained observers using a validated protocol to determine whether pupils were on-task (concentrating and alert) or off-task (disruptive or disengaged).Results:In total, 156 pupils were observed (control n58, intervention n98) at baseline (12 210 and 20 560 observations, control and intervention, respectively) and at follow-up (16 846 and 23 462, respectively). On-task and off-task behaviours were similar across treatment groups at baseline. At follow-up, intervention group pupils were 18% more likely to be on-task (odds ratio (OR) 1.18, 95% confidence interval ((95% CI) 1.05-1.33) and 14% less likely to be off-task (OR 0.86, 95% CI 0.75-0.98) compared with control group pupils.Conclusions:This study suggests that modifying food provision and the dining environment can improve learning-related behaviours of secondary school pupils in the post-lunch period. This finding supports ongoing investment and interventions by local authorities across the United Kingdom to improve school food and lunchtime dining facilities. © 2011 Macmillan Publishers Limited All rights reserved.

Nelson M.,School Food Trust
Public Health Nutrition | Year: 2013

Objective To estimate the costs per relevant unit (pupils and meals) associated with improvements to school food and the potential economic and health gains that may result. Design Calculation of costs per relevant unit (pupils and meals) based on (i) Department for Education expenditure to support improvements in school food, 2005-2011 and (ii) measures of the changes in the number of pupils taking school lunch and the number of meals served over the same time period; plus examples of the use of linked data to predict longer-term economic and health outcomes of healthier eating at school. Setting England. Subjects Local authorities, government departments and non-departmental public bodies. Results Analysis of investment over a 6-year period indicates that costs of setting up and maintaining a change organization such as the School Food Trust were low in relation to short-term benefits in nutrition and behaviour. Models that predict long-terms gains to the exchequer and to quality-adjusted life years need further elaboration. Conclusions Modest levels of government investment in the delivery and promotion of healthier school food is likely to yield both short-term and long-term benefits in relation to nutrition, learning, economics and health. Copyright © The Authors 2012.

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