Strategies to Improve School Meal Consumption: A Systematic Review

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

A plant-based meal reduces postprandial oxidative and dicarbonyl stress in men with diabetes or obesity compared with an energy- and macronutrient-matched conventional meal in a randomized crossover study

Background Increased oxidative/dicarbonyl stress and chronic inflammation are considered key pathophysiological mediators in the progression of complications in obesity and type 2 diabetes (T2D). Lifestyle and diet composition have a major impact. In this study, we tested the effects of a vegan (V) and a conventional meat containg (M) meal, matched for energy and macronutrients, on postprandial oxidative and dicarbonyl stress, inflammatory markers and appetite hormones. Methods A randomised crossover design was used to evaluate T2D, obese with normal glucose tolerance and control participants (n = 20 in each group), with serum concentrations of analytes determined at 0, 120 and 180 min. Repeated-measures ANOVA was used for statistical analysis. Results In T2D subjects, we observed decreased postprandial concentrations of oxidised glutathione (p ˂ 0.001) and increased glutathione peroxidase activity (p = 0.045) after the V-meal consumption, compared with the M-meal. In obese participants, V-meal consumption increased postprandial concentrations of reduced glutathione (p = 0.041) and decreased methylglyoxal concentrations (p = 0.023). There were no differences in postprandial secretion of TNFα, MCP-1 or ghrelin in T2D or obese men, but we did observe higher postprandial secretion of leptin after the V-meal in T2D men (p = 0.002) compared with the M-meal. Conclusions The results show that a plant-based meal is efficient in ameliorating the postprandial oxidative and dicarbonyl stress compared to a conventional energy- and macronutrient-matched meal, indicating the therapeutic potential of plant-based nutrition in improving the progression of complications in T2D and obese patients. Registered under ClinicalTrials.gov Identifier No. NCT02474147.

UNDERSTANDING THE COLLECTIVISM DILEMMA: A QUALITATIVE ANALYSIS OF THE ROLE ETHNICITY PLAYS IN PROMOTING THE COLLECTIVIST BEHAVIOUR OF CHRISTIAN AND MUSLIM FAMILIES AT MEALTIMES

The findings show how ethnicity plays a significantly role in Sierra Leonean families meal consumption behaviour. It defines the social grouping of families, and demonstrates how they align with the type of language spoken, their cultural beliefs, the region or community they come from and most notably the assumptions they espoused at the dinner table. These factors are symbolic in defining the character of families at mealtimes, but it significance vary from family to family based on their ethnic orientation and the degree of acculturation experienced by them. This paper evaluates the role ethnicity plays in promoting the collectivist behaviour of Christian and Muslim families when they interact socially at mealtimes. This is emblematic of the fact that the cultural behaviour of families is never sacrosanct and inflexible, but changes from time to time based on their level of exposure to either a new environment and/or a new social group. Consequently, this paper highlights the role of ethnicity on the behaviour of Christian and Muslim families (husband and wife) at mealtimes and draw attention to its significance as crucially element of collectivism, particularly in relation to its role in the social interaction between similar and dissimilar gender groups. The authors critically reviewed the role ethnicity has on families meal consumption behaviour and presented a comparative analytical summary of how gender is critical to the meal behaviours of different gender and religious groups. The study evaluated the role ethnicity plays in families meal social interaction behaviour and highlighted factors such as affection, gender differentiation, education and hierarchy, as prime factors of the collectivistic behaviour of families. However, it was evident from the findings that failure to demonstrate emotional ties at mealtimes can debilitate families cohesiveness and display of common strength.

Eating architecture in adults at increased risk of type 2 diabetes: associations with body fat and glycaemic control

Eating architecture is a term that describes meal frequency, meal timing, and meal size and the daily variation in each of these. The aim of this study was to determine the relationship between components of eating architecture on body fat and markers of glycaemic control in healthy adults at increased risk of type 2 diabetes (T2DM). Participants (N=73, 39 males, age 58.8 [8.1] years, BMI 33.4 [4.4] kg/m2) recorded food intake and wore accelerometers and continuous glucose monitors (CGM) for 7-14 days under free-living conditions. Body fat and glycated haemoglobin (HbA1c) were also measured. The mean and day-to-day variation (calculated as the standard deviation during the monitoring period) of each component of eating architecture were calculated. Multivariable linear regression models were constructed for three separate outcome variables (body fat mass, mean CGM glucose, and HbA1c) for each component of eating architecture before and after adjustment for confounders. Higher variability in the time of first meal consumption was associated with increased body fat mass after adjusting for confounders (β=0.227, 95% CI: 0.019, 0.434, p=0.033). Increased variability in the time lag from waking to first meal consumption was also positively associated with increased HbA1c after adjustment (β=0.285, 95%CI: 0.040, 0.530, p=0.023). Low day-to-day variability in first meal consumption was associated with lower body fat and improved glucose control in adults at increased risk of T2DM. Routine consumption of meals may optimise temporal regulation to anticipate and respond appropriately to a glucose challenge.

The influence of nutritional state on the fatty acid composition of circulating lipid fractions: implications for their use as biomarkers of dietary fat intake

Background: The fatty acid (FA) composition of blood can be used as an objective biomarker of dietary FA intake. It remains unclear how the nutritional state influences the FA composition of plasma lipid fractions, and thus their usefulness as biomarkers in a non-fasted state. Objectives: To investigate the associations between palmitate, oleate and linoleate in plasma lipid fractions and self-reported dietary FA intake, and assess the influence of meal consumption on the relative abundance of these FA in plasma lipid fractions (i.e. triglyceride [TG], phospholipids [PLs] and cholesterol esters [CEs]). Design: Analysis was performed in plasma samples collected from 49 (34 males and 15 females) participants aged 26–57 years with a body mass index (BMI) between 21.6 and 34.2 kg/m2, all of whom had participated in multiple study visits, thus a pooled cohort of 98 data sets was available for analysis. A subset (n = 25) had undergone nutritional interventions and was therefore used to investigate the relationship between the FA composition of plasma lipid fractions and dietary fat intake. Results: Significant (P < 0.05) positive associations were observed between dietary polyunsaturated fat and linoleate abundance in plasma CE. When investigating the influence of meal consumption on postprandial FA composition, we found plasma TG palmitate significantly (P < 0.05) decreased across the postprandial period, whereas oleate and linoleate increased. A similar pattern was observed in plasma PL, whereas linoleate abundance decreased in the plasma CE. Conclusion: Our data demonstrate that the FA composition of plasma CE may be the lipid fraction to utilise as an objective biomarker when investigating recent (i.e. previous weeks-months) dietary FA intakes. In addition, we show that the consumption of a high-fat meal influences the FA composition of plasma TG, PL and CE over the course of the postprandial period, and therefore, suggest that fasting blood samples should be utilised when using FA composition as a biomarker of dietary FA intake.

Body Image and Restaurant Meal Consumption Among College Students

Objectives The aim of this study was to determine whether there is an association between body image satisfaction/dissatisfaction among college students and meal consumption at restaurants. Methods Four surveys were used to collect all data: NEMS-P, SATAQ-3, SATAQ-4 and the EDE-A. NEMS-P was used to assess the food and nutrition environment, SATAQ-3 was used to assess societal influences on body image, SATAQ-4 was used to assess the internalization of appearance ideals and the EDE-A survey was used to measure eating disorder psychopathology. Participants had to be enrolled as a student during the 2019–2020 academic year on the college campus where this study occurred to participate. Pearson and Spearman correlation were used to assess association between restaurant meal consumption and body image. Chi-square test was used to analyze categorial variables (n = 185). Results There was a significant association between students who were unhappy with their weight consuming meals more frequently at fast-food restaurants compared to sit down restaurants (P &lt; 0.001); there was also a significant association between students who were unhappy with their weight choosing to eat at a combination of restaurants (fast-food, food courts, cafeteria's etc.) more frequently than sit-down restaurants (P &lt; 0.05). A significant association was also noted between students who were unhappy with their shape choosing to eat more frequently at fast-food restaurants compared to sit-down restaurants (P &lt; 0.05). Conclusions A higher mix of fast-food and fast casual restaurants on the college campus may contribute to an obesogenic environment, while the availability of sit-down restaurants may contribute to a more healthful eating environment. Creating a supportive nutrition environment on college campuses by increasing the availability of healthy food choices and providing resources that can assist students with developing a healthy relationship with food and their bodies is important for overall health, well- being and academic success. Funding Sources N/A.

Meal Consumption Patterns Throughout the SNAP Benefit Cycle

Objectives Supplemental Nutrition Assistance Program (SNAP) recipient benefits and resources are scarce near the end of the benefit month, increasing food insecurity and worsening nutrition. Missing meals or changes in meal timing can disrupt physiologic circadian systems that impact obesity risk. We sought to study whether meal consumption patterns vary from the time since the last SNAP benefit disbursement. Methods We used the USDA National Household Food Acquisition and Purchase Survey (FoodAPS) database to identify peaks in daily meal (breakfast, lunch, dinner) consumption using piecewise linear regression consumption as a function of days since last SNAP benefit disbursement. We then used these peaks in multivariable logistic regression with meal consumption as the outcome. If no peak was identified, days since disbursement was considered linearly. Analyses were stratified by age (2–5 years, 6–17 years, 18–64 years, and &gt;65 years), adjusted for the primary respondent, free/reduced cost school meals, weekend survey day, multi-stage sampling design, and survey weights. Results There were 1,432 households and 4,850 individuals receiving SNAP, totaling 28,688 days of meal reporting data. Most participants were 18–64 years old (59.7%) and female (53.9%). For 6–17 year-olds, peak breakfast consumption was on day 25 and dinner on day 23. There was a significant decline after peak for breakfast (change in slope after peak −0.34, P = .005), but not dinner. For 18–64 year-olds, peak breakfast was on day 15 and lunch was on day 11, but the slope did not change significantly after these days. Other age and meal combinations did not identify a peak or have a significant linear association with days since the last snap benefit. Conclusions There were peaks in meal consumption in adolescents and working-age adults during the SNAP benefit month. Only for adolescents was there a decline in breakfast consumption after this peak. This pattern of missing breakfast and changes in meal timing may contribute to the risk of obesity. Additional research to understand what accounts for shifts in meal consumption across the benefit month, including SNAP benefit amount and benefit distribution timing (i.e., twice versus once per month), should be conducted to inform SNAP policies that work to curb the negative effects of food insecurity. Funding Sources University of Michigan.

A Plant-Based Meal Reduces Postprandial Oxidative and Dicarbonyl Stress in Men with Diabetes or Obesity more than an Energy- and Macronutrient-Matched Conventional Meal in a Randomized Crossover Study

Background: Increased oxidative/dicarbonyl stress and chronic inflammation are considered key pathological mediators in the progression of complications in type 2 diabetes (T2D) and obesity. Lifestyle and diet composition have a major impact. In this study, we tested the effects of a vegan (V) and a conventional meat containg (M) meal, matched for energy and macronutrients, on postprandial oxidative and dicarbonyl stress, inflammatory markers and appetite hormones. Methods: A randomised crossover design was used to evaluate T2D, obese and control participants (n=20 in each group), with serum concentrations of analytes determined at 0, 120 and 180 minutes. Repeated-measures ANOVA was used for statistical analysis.Results: Postprandial glucose, triglycerides and free fatty acid responses were similar after both meals. After the V-meal consumption, we observed decreased postprandial concentrations of oxidised glutathione (p˂0.001) and increased glutathione peroxidase activity (p=0.045) compared with the M-meal in T2D subjects. In obese participants, V-meal consumption increased postprandial concentrations of reduced glutathione (p=0.041) and decreased methylglyoxal concentrations (p=0.023). There were no differences in postprandial secretion of TNFa, MCP-1 or ghrelin, but we did observe higher postprandial secretion of leptin after the V-meal in T2D subjects (p=0.002) compared with the M-meal. Conclusions: The results show that a plant-based meal is efficient in ameliorating the postprandial oxidative and dicarbonyl stress compared to a conventional energy- and macronutrient-matched meal, indicating the therapeutic potential of plant-based nutrition in improving the progression of complications in T2D and obese patients.Registered under ClinicalTrials.gov Identifier No. NCT02474147.