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School nutrition guidelines: overview of the implementation and evaluation

  • Matej Gregorič (a1), Larisa Pograjc (a2), Alenka Pavlovec (a3), Marjan Simčič (a4) and Mojca Gabrijelčič Blenkuš (a1)...
Abstract
Abstract Objective

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems.

Design

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).

Setting

Slovenian primary schools.

Subjects

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.

Results

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.

Conclusions

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.

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Corresponding author
* Corresponding author: Email Mojca.Gabrijelcic@nijz.si
References
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1. WaxmanA (2003) Prevention of chronic diseases: WHO global strategy on diet, physical activity and health. Food Nutr Bull 24, 281284.
2. BellisleF (2004) Effects of diet on behaviour and cognition in children. Br J Nutr 92, 227232.
3. TarasH (2005) Nutrition and student performance at school. J Sch Health 75, 199213.
4. World Health Organization (2008) School Policy Framework: Implementation of the WHO Global Strategy on Diet, Physical Activity and Health. Geneva: WHO.
5. VecchiarelliS, TakayanagiS & NeumannC (2006) Students’ perceptions of the impact of nutrition policies on dietary behaviours. J Sch Health 76, 540542.
6. PHEIAC Public Health Evaluation and Impact Assessment Consortium (2013) Evaluation of the implementation of the Strategy for Europe on Nutrition, Overweight and Obesity related health issues, Final report. Brussels: European Commission, Directorate General Health & Consumers; available at http://ec.europa.eu/health/nutrition_physical_activity/docs/pheiac_nutrition_strategy_evaluation_en.pdf
7. World Health Organization (2008) WHO Global Strategy on Diet, Physical Activity and Health: A Framework to Monitor and Evaluate Implementation. Geneva: WHO; available at http://www.who.int/dietphysicalactivity/M&E-ENG-09.pdf
8. CurrieC, ZanottiC, Morgan A et al., editors (2012) Social Determinants of Health and Well-Being Among Young People. Health Behaviour in School-aged Children (HBSC) Study: International Report from the 2009/2010 Survey. Copenhagen: WHO Regional Office for Europe.
9. KobeH, ŠtimecM, Hlastan RibičC et al. (2012) Food intake in Slovenian adolescents and adherence to the optimized mixed diet: a nationally representative study. Public Health Nutr 15, 600608.
10. GregoričM & KochV (2007) Prehranska kakovost zajtrka slovenskih srednješolcev. Zdrav Var 46, 8590.
11. ArtnikB, DrevA, DrglinZ et al. (2011) Neenakosti v zdravju in z zdravjem povezanih vedenjih slovenskih mladostnikov. Ljubljana: Inštitut za varovanje zdravja RS.
12. Fidler MisN, KobeH & ŠtimecM (2012) Dietary intake of macro- and micronutrients in Slovenian adolescents: comparison with reference values. Ann Nutr Metab 61, 305313.
13. World Health Organization (2006) Food and Nutrition Policy for Schools. Copenhagen: WHO Regional Office for Europe.
14. CondonES, CrepinsekMK & FoxMK (2009) School meals: types of food offered to and consumed by children at lunch and breakfast. J Am Diet Assoc 109, 6778.
15. AdamsonA, SpenceS, ReedL et al. (2013) School food standards in the UK: implementation and evaluation. Public Health Nutr 16, 968981.
16. JacobyHG (2002) Is there an intrahousehold ‘flypaper effect’? Evidence from a school feeding programme. Econ J 112, 196221.
17. AfridiF (2005) The Impact of Public Transfers on Intrahousehold Resource Allocation: Evidence from a Supplementary School Feeding Program. Ann Arbor, MI: University of Michigan; available at http://paa2005.princeton.edu/papers/50075
18. AlaimoK, OlsžonCM, FrongilloEA et al. (2001) Food insufficiency, family income, and health in US preschool and school-aged children. J Am Public Health Assoc 91, 781786.
19. St-OngeM, KellerK & HeymsfieldS (2003) Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr 78, 10681073.
20. Uradni list RS (2010) Zakon o šolski prehrani (ZŠolPre). Ljubljana: Uradni list 43; available at https://www.uradni-list.si/1/content?id=98032
21. Gabrijelčič BlenkušM, PograjcL, GregoričM et al. (2005) Smernice zdravega prehranjevanja v vzgojno izobraževalnih ustanovah: od prvega leta starosti naprej (National Dietary Guidelines for Healthy Nutrition in Kindergartens and Schools). Ljubljana: Ministrstvo za zdravje RS.
22. Maučec ZakotnikJ, Hlastan RibičC, PoličnikR et al. (2005) The National Programme of Food and Nutrition Policy 2005–2010. Ljubljana: Ministry of Health of the Republic of Slovenia.
23. StoryM, KaphingstKM, Robinson-O’BrienR et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.
24. LockK & JaimePC (2009) Do school based food and nutrition policies improve diet and reduce obesity? Prev Med 48, 4553.
25. CauwenbergheE, MaesL, SpittaelsH et al. (2010) Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and ‘grey’ literature. Br J Nutr 103, 781797.
26. NutbeamD & BaumanAE (2006) Evaluation in a Nutshell: A Practical Guide to the Evaluation of Health Promotion Programs. Sydney: McGraw-Hill.
27. NormanG (2010) Likert scales levels of measurement and the ‘laws’ of statistics. Adv Health Sci Educ Theory Pract 15, 625632.
28. WillcoxsonL & MillettB (2000) The management of organisational culture. Aust J Manage Organ Behav 3, 9199.
29. Hlastan RibičC, Maučec ZakotnikJ, Koroušić SeljakB et al. (2008) Praktikum jedilnikov zdravega prehranjevanja v vzgojno-izobraževalnih ustanovah (od prvega leta starosti naprej). Ljubljana: Ministrstvo za zdravje RS & Zavod RS za šolstvo.
30. PograjcL, PoličnikR & Hlastan RibičC (2008) Priročnik z merili kakovosti za živila v vzgojno-izobraževalnih ustanovah. Ljubljana: Ministrstvo za zdravje RS.
31. GregoričM, Gabrijelčič BlenkušM, KlančarK et al. (2010) Vrednotenje osnovnošolske prehrane glede ponudbe, načina planiranja in organiziranosti v letu 2010. Ljubljana: Inštitut za varovanje zdravja RS; available at http://www.ivz.si/publikacije?pi=3&_3_Filename=3697.pdf&_3_MediaId=3697&_3_AutoResize=false&pl=109-3.3
32. Rok SimonM, BajtM, BrcarP et al. (2010) Zdravje otrok in mladostnikov. In Zdravje v Sloveniji, pp. 5054 [J Trdič, M Gabrijelčič Blenkuš, T Kofol Bric et al., editors]. Ljubljana: Inštitut za varovanje zdravja RS.
33. BuzetiT, DjombaJK, Gabrijelčič BlenkušM et al. (2011) Health inequalities in Slovenia. Ljubljana: National Institute of Public Health.
34. Gabrijelčič BlenkušM (2001) Daily meal frequency of secondary school students from Ljubljana in relation to some of their other nutritional and life-style characteristics and body mass index – preliminary results. Zdrav Vestn 70, 269274.
35. KleiserC, MensinkGBM, Scheidt-NaveC et al. (2009) HuSKY: a healthy nutrition score based on food intake of children and adolescents in Germany. Br J Nutr 102, 610618.
36. KennedyET, OhlsJ, CarlsonS et al. (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.
37. ThieleS, MensinkGBM & BeitzR (2004) Determinants of diet quality. Public Health Nutr 7, 2937.
38. WaijersPMCM, FeskensEJM & OckéMC (2002) A critical review of predefined diet quality scores. Br J Nutr 97, 219231.
39. LazarouC & NewbyPK (2011) Use of dietary indexes among children in developed countries. Adv Nutr 2, 295303.
40. World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Joint WHO/FAO Expert Consultation. WHO Technical Report Seriesno. 916. Geneva: WHO.
41. German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research et al. (2004) Referenčne vrednosti za vnos hranil (Reference Values for Nutrient Intake), 1st ed. Ljubljana: Ministrstvo za zdravje RS.
42. WillettWC (2012) Nutritional Epidemiology. New York: Oxford University Press.
43. BinghamSA, WelchAA, McTaggartA et al. (2001) Nutritional methods in the European Prospective Investigation of Cancer in Norfolk. Public Health Nutr 4, 847858.
44. LivingstoneMB, PrenticeAM, StrainJJ et al. (1999) Accuracy of weighed dietary records in studies of diet and health. BMJ 300, 708712.
45. GregoričM, Gabrijelčič BlenkušM, CeglarK et al. (2012) Vrednotenje kosil osnovnošolske prehrane v letu 2011 na podlagi izbranega vzorca šol. Ljubljana: Inštitut za varovanje zdravja RS; available at http://img.ivz.si/janez/2060-5516.pdf
46. Koroušić SeljakB (2010) Web-based eHealth applications with reference to food composition data. Eur J Clin Nutr 64, 121127.
47. KasenburgerP (2005) Prehranjevalne navade in ocena hranilnih vrednosti toplih malic v podjetjih z organizirano prehrano. Magistrsko delo. Ljubljana: Univerza v Ljubljani, Biotehniška fakulteta.
48. SPSS, Inc. (2005) SPSS 14.0 Base User’s Guide. Chicago, IL: SPSS, Inc.
49. KostanjevecS, JermanJ & KochV (2012) The influence of nutrition education on the food consumption and nutrition attitude of schoolchildren in Slovenia. US–China Educ Rev 11, 953964.
50. KafatosA, ManiosY & MoschandreasJ (2005) Health and nutrition education in primary schools of Crete: follow-up changes in body mass index and overweight status. Eur J Clin Nutr 59, 10901092.
51. PowersAR, StruemplerBJ, GuarinoA et al. (2005) Effects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students. J Sch Health 75, 129133.
52. CullenKW, HartsteinJ, ReynoldsKD et al. (2007) Improving the school food environment: results from a pilot study in middle schools. J Am Diet Assoc 107, 484489.
53. LienN (2012) Does the school food environment influence the dietary behaviours of Norwegian 11-year-olds? The HEIA study. Scand J Public Health 40, 491497.
54. MatthewsA, NelsonM, KaurA et al. (2011) Where has all the chocolate gone? A national survey assesses the effects of recent legislation to improve the nutritional quality of English secondary-school vending. Public Health Nutr 14, 13941402.
55. MooreL, MooreGF, TapperK et al. (2007) Free breakfasts in schools: design and conduct of a cluster randomised controlled trial of the Primary School Free breakfast Initiative in Wales. BMC Public Health 7, 258.
56. ShemiltI, HarveyI, ShepstoneL et al. (2004) A national evaluation of school breakfast clubs: evidence from a cluster randomised controlled trial and an observational analysis. Child Care Health Dev 30, 413427.
57. OzerEJ (2007) The effects of school gardens on students and schools: conceptualization and considerations for maximizing healthy development. Health Educ Behav 34, 846863.
58. de SaJ & LockK (2008) Will European agricultural policy for school fruit and vegetables improve public health? A review of school fruit and vegetable programmes. Eur J Public Health 18, 558568.
59. WellsL & NelsonM (2005) The National School Fruit Scheme produces short-term but not longer-term increases in fruit consumption in primary school children. Br J Nutr 93, 537542.
60. LesnikT, Gabrijelčič BlenkušM, GregoričM et al. (2011) School Fruit Scheme Evaluation Report for the 2010/2011 School Year. Ljubljana: National Institute of Public Health of the Republic of Slovenia; available at http://ec.europa.eu/agriculture/sfs/documents/si_summary_evaluation_report_-_2010-2011_en.pdf
61. FrenchSA, StoryM, FulkersonJA et al. (2004) An environmental intervention to promote lower-fat food choices in secondary schools: outcomes of the TACOS Study. Am J Public Health 94, 15071512.
62. BlumJE, DaveeAM, BeaudoinCM et al. (2008) Reduced availability of sugar-sweetened beverages and diet soda has a limited impact on beverage consumption patterns in Maine high school youth. J Nutr Educ Behav 40, 341347.
63. CullenKW, WatsonK & ZakeriI (2008) Improvements in middle school student dietary intake after implementation of the Texas Public School Nutrition Policy. Am J Public Health 98, 111117.
64. DickM, LeeA, BrightM et al. (2012) Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia. Eur J Clin Nutr 66, 11241129.
65. SimčičI (2007) Organizacija šolske prehrane in oblikovanje cen prehranskih obrokov v vzgojnoizobraževalnih ustanovah. Ljubljana: Ministrstvo za zdravje RS.
66. ChambersS, LobbA, ButlerL et al. (2007) Local, national and imported foods: a qualitative study. Appetite 49, 208213.
67. HuFB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.
68. Poklar VatovecT (2008) Oblikovanje večkriterijskega modela za vrednotenje šolske prehrane v Sloveniji. Doktorska disertacija, Univerza v Ljubljani.
69. KralTV & RollsBJ (2004) Energy density and portion size: their independent and combined effects on energy intake. Physiol Behav 82, 131138.
70. SalamounMM, KizirianAS, TannousRI et al. (2005) Low calcium and vitamin D intake in healthy children and adolescents and their correlates. Eur J Clin Nutr 59, 177184.
71. Serra-MajemL (2001) Vitamin and mineral intakes in European children. Is food fortification needed? Public Health Nutr 4, 101107.
72. GouldR, RussellJ & BarkerME (2006) School lunch menus and 11 to 12 year old children's food choice in three secondary schools in England – are the nutritional standards being met? Appetite 46, 8692.
73. LambertJ, AgostoniC, ElmadfaI et al. (2004) Dietary intake and nutritional status of children and adolescents in Europe. Br J Nutr 92, 147211.
74. OxmanAD, BjorndalA, Bacerra-PosadaF et al. (2010) A framework for mandatory impact evaluation to ensure well informed public policy decisions. Lancet 375, 427431.
75. LeppoK, OllilaE, PenaS et al., (editors) (2013) Health in all Policies. Seizing Opportunities, Implementing Policies. Helsinki: Ministry of Social Affairs and Health.
76. van KammenJ, de SavignyD & SewankamboN (2006) Using knowledge brokering to promote evidence based policy-making: the need for support structures. Bull World Health Organ 84, 608612.
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