To provide an overview of school food and nutrition monitoring from 1980 to the Healthy Hunger-Free Kids Act of 2010 and data on school food availability in the USA.

A review of the history of school food and nutrition policy, monitoring and evaluation efforts in the USA over the past three decades.

USA.

School food service, school districts and schools nationwide.

The school food environment in the USA is governed by a patchwork of federal, state and local laws and policies. The federal government has primary authority over the school meal programmes and has recently issued updated regulations governing the food and nutrient requirements for meals sold or served through the National School Lunch and School Breakfast Programs. Competitive foods (i.e. foods and beverages sold/served outside the meal programmes) are governed primarily by state and district laws and policies, although new federal regulations are expected to set minimum standards in this area. The USA has a long history of data monitoring and evaluation funded by government and private foundations which has enabled decision makers to monitor progress and opportunities to improve the foods and beverages made available to students in school.

School food-related monitoring and evaluation research has been highly influential in influencing legislation and policy, leading to improvements in the foods and beverages available to children at school as part of planned meals and individual items sold outside the meal programmes. The lessons learned from the US experience provide insights that may be valuable for implementation, monitoring and evaluation of school food programmes in other countries.

Food insecurity, or lack of access to sufficient food for a healthful lifestyle, has been associated with many aspects of poor health. While the economic struggles among veterans of the wars in Iraq and Afghanistan have been documented, it is unknown how commonly this population struggles to afford food. Our purpose was to document the prevalence and correlates of food insecurity among US veterans of the wars in Iraq and Afghanistan.

A cross-sectional survey.

US military veterans who had served in the wars in Iraq and Afghanistan since October 2001.

Subjects responded to a survey mailed to them in summer 2012. Food security was measured by the US Household Food Security Module: Six Item Short Form. Demographic and behavioural health items were also included. Survey data were matched to medical record data from the Department of Veterans Affairs.

Over one in four veterans reported past-year food insecurity with 12 % reporting very low food security. Food-insecure veterans tended to be younger, not married/partnered, living in households with more children, earning lower incomes, had a lower final military pay grade, were more likely to use tobacco, reported more frequent binge drinking and slept less, compared with those who were food secure (P<0·05 for all associations listed).

Previously undocumented, the problem of hunger among our newest veterans deserves attention.

Our aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression.

In a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed.

After a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped).

Moderate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given.

We evaluated the effects of peanut consumption on lipid profiles, atherogenic index of plasma (AIP) and CHD risk in hypercholesterolaemic men.

Randomised crossover clinical trial.

Participants were randomly assigned to two groups. They were asked to consume peanut supplements (about 77 g) with their habitual diet for 4 weeks.

Fifty-four hypercholesterolaemic men with total cholesterol (TC) concentrations between 200 and 350 mg/dl.

Compared with the habitual diet, peanut supplementation of the habitual diet significantly reduced TC/HDL cholesterol (HDL-C) ratio (mean 1 (se 0·3) P = 0·001) and LDL cholesterol (LDL-C)/HDL-C ratio (mean 0·7 (se 0·2); P = 0·001). Peanut consumption increased HDL-C (mean 6·1 (se 1·5) mg/dl; P < 0·001) and total antioxidant capacity (TAC) (mean 1·2 (se 0·6) U/mL P = 0·04). In addition, peanut consumption significantly reduced the AIP (mean 0·1 (se 0·03) P = 0·01) and CHD estimated risk over 10 years based on systolic and diastolic blood pressures (mean 1·4 % (se 0·5 %) P = 0·004 and mean 2·2 % (se 0·5 %) P < 0·001, respectively).

Short-term peanut consumption might improve lipid profiles, the AIP and CHD risk in free-living hypercholesterolaemic men.

To analyse trends in food habits and food consumption from 1992 to 2003.

Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992–93 and ENCAT 2002–03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption.

Catalonia region, Northeastern Spain.

Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992–93 (1210 men and 1431 women) and 2060 from ENCAT 2002–03 (954 men and 1106 women), aged 10–75 years.

The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day−1) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day−1), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age.

Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as wholegrain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

The impact of food insecurity on mental health has not yet been examined in graduate students, a population widely considered at elevated risk for financial strain and negative mental health outcomes. This study aimed to derive initial prevalence estimates of food insecurity in a sample of current graduate students at a large state university and to elucidate the relationship between food insecurity and depression, anxiety and stress in this sample.

Cross-sectional online survey including the US Household Food Security Survey Module: Six-Item Short Form and the Depression, Anxiety, and Stress Scales (DASS-21).

University in the northeastern region of the USA.

Two hundred sixty-three graduate students.

In the present sample, 59·7 % of participants reported high/marginal food security, 18·5 % reported low food security and 21·8 % reported very low food security. Graduate students with very low food security reported significantly greater depression (η2 = 0·09), anxiety (η2 = 0·10) and stress (η2 = 0·10), compared with those with low food security and high food security (all P’s < 0·001).

Food insecurity occurred in nearly half of the graduate students surveyed, and very low food security was associated with elevated levels of depression, anxiety and stress. Findings highlight the need to address food insecurity and associated elevated mental health problems present among graduate students.

To examine how different definitions of meals and snacks can affect the associations of meal frequency (MF) and snack frequency (SF) with dietary intake and adiposity measures.

Based on 7 d weighed dietary record data, all eating occasions providing ≥210 kJ of energy were divided into meals or snacks based on contribution to energy intake (≥15 % or <15 %) or time (06.00–10.00, 12.00–15.00 and 18.00–21.00 hours; other). Diet quality was assessed using the Healthy Diet Indicator (HDI) and Mediterranean Diet Score (MDS).

Great Britain.

British adults aged 19–64 years (n 1487).

MF based on energy contribution was associated with higher intake of dietary fibre, lower intakes of non-milk extrinsic sugars and alcohol, and higher HDI (only men) and MDS. MF based on time was associated with higher HDI and MDS in women only. Conversely, irrespective of the definition of snacks, SF was associated with higher intakes of confectionery and alcohol, lower intakes of cereals, protein, fat and dietary fibre, and lower HDI (except for SF based on energy contribution in women) and MDS. After adjustment for potential confounders, MF based on time, but not MF based on energy contribution, was positively associated with BMI and waist circumference in men only. SF was positively associated with BMI and waist circumference, irrespective of the definition of snacks.

Higher SF was consistently associated with lower diet quality and higher adiposity measures, while associations with MF varied depending on the definition of meals and sex.

To investigate the relative efficacy of four popular weight-loss programmes on plasma lipids and lipoproteins as measures of CVD risk.

A multi-centred, randomised, controlled trial of four diets – Dr Atkins’ New Diet Revolution, The Slim-Fast Plan, Weight Watchers Pure Points programme and Rosemary Conley’s ‘Eat yourself Slim’ Diet and Fitness Plan – against a control diet, in parallel for 6 months.

The trial was conducted at five universities across the UK (Surrey, Nottingham, Ulster (Coleraine), Bristol and Edinburgh (Queen Margaret University College)) and involved the participation of 300 overweight and obese males and females aged 21–60 years in a community setting.

Significant weight loss was achieved by all dieting groups (5–9 kg at 6 months) but no significant difference was observed between diets at 6 months. The Weight Watchers and Rosemary Conley (low-fat) diets were followed by significant reductions in plasma LDL cholesterol (both −12·2 % after 6 months, P < 0·01), whereas the Atkins (low-carbohydrate) and Weight Watchers diets were followed by marked reductions in plasma TAG (–38·2 % and –22·6 % at 6 months respectively, P < 0·01). These latter two diets were associated with an increase in LDL particle size, a change that has been linked to reduced CVD risk.

Overall, these results demonstrate the favourable effects of weight loss on lipid-mediated CVD risk factors that can be achieved through commercially available weight-loss programmes. No detrimental effects on lipid-based CVD risk factors were observed in participants consuming a low-carbohydrate diet.

To describe vitamin D intakes in children and teenagers and the contribution from supplements and fortified foods in addition to the base diet.

Analysis of 7 d weighed food records collected during the Children's and Teens’ National Nutrition Surveys in Ireland. Food composition data for vitamin D were updated from international analytical sources.

Nationally representative cross-sectional dietary surveys.

Children (n 594; 5–12 years) and teenagers (n 441; 13–17 years).

Median vitamin D intakes were 1·9, 2·1 and 2·4 μg/d in 5–8-, 9–12- and 13–17-year-olds, respectively. The prevalence of vitamin D-containing supplement use was 21, 16 and 15 % in 5–8-, 9–12- and 13–17-year-olds and median intakes in users ranged from 6·0 to 6·7 μg/d. The prevalence of inadequate intakes, defined as the percentage with mean daily intakes below the Estimated Average Requirement of 10 μg/d, ranged from 88 to 96 % in supplement users. Foods fortified with vitamin D, mainly breakfast cereals, fat spreads and milk, were consumed by 71, 70 and 63 % of 5–8-, 9–12- and 13–17-year-olds. Non-supplement users who consumed vitamin D-fortified foods had median intakes of 1·9–2·5 μg/d, compared with 1·2–1·4 μg/d in those who did not consume fortified foods.

It is currently not possible for children consuming the habitual diet to meet the US Institute of Medicine dietary reference intake for vitamin D. In the absence of nationally representative 25-hydroxyvitamin D data in children, the implications of this observation for prevalence of vitamin D deficiency and health consequences are speculative.

To describe shared meal patterns and examine associations with dietary intake among young adults.

Population-based, longitudinal cohort study (Project EAT: Eating and Activity in Teens and Young Adults).

Participants completed surveys and FFQ in high-school classrooms in Minneapolis/St. Paul, MN, USA in 1998–1999 (mean age = 15·0 years, ‘adolescence’) and follow-up measures online or by mail in 2008–2009 (mean age = 25·3 years, ‘young adulthood’).

There were 2052 participants who responded to the 10-year follow-up survey and reported on frequency of having shared meals.

Among young adults, the frequency of shared meals during the past week was as follows: never (9·9 %), one or two times (24·7 %), three to six times (39·1 %) and seven or more times (26·3 %). Having more frequent family meals during adolescence predicted a higher frequency of shared meals in young adulthood above and beyond other relevant sociodemographic factors such as household composition and parental status. Compared with young adults who never had family meals during adolescence, those young adults who reported seven or more family meals per week during adolescence had an average of one additional shared meal per week. Having more frequent shared meals in young adulthood was associated with greater intake of fruit among males and females, and with higher intakes of vegetables, milk products and some key nutrients among females.

Nutrition professionals should encourage families of adolescents to share meals often and establish the tradition of eating together, and work with young adults to ensure that healthy food and beverage choices are offered at mealtimes.

Although recent studies have shown an inverse relationship between dairy consumption and metabolic abnormalities, we are aware of no study evaluating the association between dairy consumption and circulating levels of inflammatory markers. The current study was undertaken to assess the association between the consumption of high-fat and low-fat dairy products and circulating levels of inflammatory markers among Tehrani women aged 40–60 years.

In a cross-sectional study of 486 apparently healthy women aged 40–60 years, we assessed usual dietary intakes by means of an FFQ. Anthropometric measurements were made and fasting blood samples were taken for measuring inflammatory markers.

The reported mean (sd) daily intake of low- and high-fat dairy consumption was 85 (sd 23) and 101 (sd 29) g/d, respectively. After control for age, BMI, waist circumference and other potential confounders, low-fat dairy consumption was inversely associated with C-reactive protein (β = −0.04), IL-6 (β = −0.02) and soluble vascular cell adhesion molecule-1 (β = −0.06); with further adjustment for dietary intakes, the associations remained significant just for soluble vascular cell adhesion molecule-1 (β = −0.03). High-fat dairy intake was positively associated with log-transformed values of serum amyloid A (β = 0.08) and soluble vascular cell adhesion molecule-1 (β = 0.05), both before and after adjustment for all potential confounding variables. No overall significant associations were found between total dairy consumption and inflammation.

The current study indicates an independent relationship between high-fat as well as low-fat dairy consumption, not total dairy intake, and some markers of inflammation and endothelial dysfunction. Further studies are required to identify responsible components of dairy products and related mechanisms of action.

Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children.

One month after the earthquake, caregivers of 831 children aged 0–23 months were surveyed regarding receipt of unsolicited donations of BMS, and on recent child-feeding practices and diarrhoeal illness.

Community-level survey in an earthquake-affected district.

Primary caregivers of surveyed children.

In all, 75 % of households with an infant aged 0–5 months and 80 % of all households surveyed received donated infant formula; 76 % of all households received commercial porridge and 49 % received powdered milk. Only 32 % of 0–5-month-old infants had consumed formula before the earthquake, but 43 % had in the 24 h preceding the survey (P < 0·001). Consumption of all types of BMS was significantly higher among those who received donated commodities, regardless of age (P < 0·01). One-week diarrhoea incidence among those who received donated infant formula (25·4 %) was higher than among those who did not (11·5 %; relative risk = 2·12, 95 % CI = 1·34, 3·35). The rate of diarrhoea among those aged 12–23 months was around five times the pre-earthquake rate.

There were strong associations between receipt of BMS and changes in feeding practices, and between receipt of infant formula and diarrhoea. Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies.

The aim of the present study was to examine the mediation effects of changes in psychosocial determinants of physical activity (attitude, social support, self-efficacy, perceived benefits and barriers) on changes in physical activity.

One-year intervention study with baseline and 1-year post measures of physical activity habits and psychosocial correlates.

Fifteen middle schools.

Boys and girls (n = 2840) aged 11–15 years completed the validated questionnaires during class hours.

The product-of-coefficients test was used to asses the mediating effects. Self-efficacy for physical activity at school was found to be the only significant mediator of physical activity change. Specifically, self-efficacy for physical activity at school partly mediated the effect of the intervention on total and school-related physical activity change in the intervention group with parental support (P < 0.05). None of the other potential mediators, attitudes, social support, perceived benefits and perceived barriers, seemed to have had a positive effect. Even a suppressor effect was found for attitudes. Given that the effects of self-efficacy and attitudes were of opposite direction, the total mediated/suppressed effects of the intervention were not statistically significant.

Positive changes in total and school-related physical activity in adolescents could be partly explained by increases in self-efficacy for physical activity at school through a physical activity intervention in middle schools with parental support. However, the suppressor effect of attitudes decreased this effect. As this is one of the first true mediation analyses in this age group, further research is needed to replicate the importance of these mediators.

To evaluate patterns of physical activity (PA), the prevalence of physical inactivity and the relationships between PA and sociodemographic, clinical and biochemical parameters among Sri Lankan adults.

Descriptive cross-sectional study.

Nationally representative population-based survey conducted in Sri Lanka.

Data on PA and associated details were obtained from 5000 adults. PA was assessed using the International Physical Activity Questionnaire (short-form). A binary logistic regression analysis was performed using the dichotomous variable ‘health-enhancing PA’ (0 = ‘active’, 1 = ‘inactive’).

Sample size was 4485. Mean age was 46·1 (sd 15·1) years, 39·5 % were males. The mean weekly total MET (metabolic equivalents of task) minutes of PA among the study population was 4703 (sd 4369). Males (5464 (sd 5452)) had a significantly higher weekly total MET minutes than females (4205 (sd 3394); P < 0·001). Rural adults (5175 (sd 4583)) were significantly more active than urban adults (2956 (sd 2847); P < 0·001). Tamils had the highest mean weekly total MET minutes among ethnicities. Those with tertiary education had lowest mean weekly total MET minutes. In all adults 60·0 % were in the ‘highly active’ category, while only 11·0 % were ‘inactive’ (males 14·6 %, females 8·7 %; P < 0·001). Of the ‘highly active’ adults, 85·8 % were residing in rural areas. Results of the binary logistic regression analysis indicated that female gender (OR = 2·1), age >70 years (OR = 3·8), urban living (OR = 2·5), Muslim ethnicity (OR = 2·7), tertiary education (OR = 3·6), obesity (OR = 1·8), diabetes (OR = 1·6), hypertension (OR = 1·2) and metabolic syndrome (OR = 1·3) were all associated with significantly increased odds of being physically ‘inactive’.

The majority of Sri Lankan adults were ‘highly active’ physically. Female gender, older age, urban living, Muslim ethnicity and tertiary education were all significant predictors of physical inactivity. Physical inactivity was associated with obesity, diabetes, hypertension and metabolic syndrome.

Random population cross-sectional nutritional survey.

A random sample of 3534 people aged 2 to 24 years were interviewed by a team of 43 dietitians. The protocol included 24-hour recalls (a second 24-hour recall in 30% of the sample), a food-frequency questionnaire and other questions including lifestyles, knowledge and food preferences.

Participation rate in the survey was 68%. Of the boys, 91.2% and 92.2% of the girls in the sample usually had breakfast. Males aged 18 years and above and 14–17-year-old girls showed the lowest consumption rates. Some 4.1% of the sample did not have any food at all before lunch. Main sources of energy with breakfast were milk and dairy products (34%) and buns, cookies, croissants, etc. (24.6%). Some 44.7% of the sample was classified in the poor-quality breakfast group. Subjects from a low socio-economic background and low educated parents had lower Quality Breakfast Score.

The proportion of children having breakfast before attending school has increased in Spain in recent decades. However, intake of breakfast is not adequate in a large proportion of this population and a number of children and young people still do not eat anything before lunch. School-based nutrition education involving families, teachers and health professionals, supported by community actions, can contribute to improve this situation.

To analyse the association between socio-economic indicators and diet among 2-year-old children, by assessing the independent contribution of parental education and equivalent income to food intake.

The analysis was based on data from a prospective birth cohort study. Information on diet was obtained using a semi-quantitative food-frequency questionnaire. Low and high intake of food was defined according to the lowest and the highest quintile of food consumption frequency, respectively.

Four German cities (Munich, Leipzig, Wesel, Bad Honnef), 1999–2001.

Subjects were 2637 children at the age of 2 years, whose parents completed questionnaires gathering information on lifestyle factors, including parental socio-economic status, household consumption frequencies and children's diet.

Both low parental education and low equivalent income were associated with a low intake of fresh fruit, cooked vegetables and olive oil, and a high intake of canned vegetables or fruit, margarine, mayonnaise and processed salad dressing in children. Children with a low intake of milk and cream, and a high intake of hardened vegetable fat, more likely had parents with lower education. Low butter intake was associated with low equivalent income only.

These findings may be helpful for future intervention programmes with more targeted policies aiming at an improvement of children's diets.

To examine how Australian children's reported everyday food preferences reflect dietary recommendations, and the impact of sociodemographic factors on these associations.

Cross-sectional survey.

Three hundred and seventy-one parents of children aged 2–5 years, recruited from three socio-economic groups in two Australian cities, completed a survey on their child's liking for 176 foods and drinks on a 5-point Likert scale in addition to demographic descriptors. Preferences were compared with the recommendations of the Dietary Guidelines for Children and Adolescents in Australia and the Australian Guide to Healthy Eating.

Foods in the Extra Foods (non-nutritious foods) and Cereals groups of the Australian Guide to Healthy Eating were highly liked (mean: 4.02 and 4.01, respectively), whilst foods in the Vegetables group were liked least (mean: 3.01). A large percentage of foods in the Cereals and Extra Foods groups were liked (64% and 56%, respectively) in contrast to the other food groups, especially Vegetables (7%). Children liked foods that were higher in sugar (r = 0.29, P < 0.0001) and more energy-dense (r = 0.34, P < 0.0001) but not those higher in saturated fat (r = 0.16, P = 0.03), total fat (r = 0.12, P = 0.12) or sodium (r = 0.10, P = 0.18). Sociodemographic variables (e.g. socio-economic status, parental education, children's age and sex) explained little of the variation in children's food preferences.

Australian pre-school children's food preferences align with dietary guidelines in some respects, but not others. Interventions are needed to shift children's preferences away from non-nutritious foods that are high in energy density and sugar, and towards vegetables and fruits.

To examine associations between breakfast cereal consumption and iron status and identify dietary patterns that might improve iron status in this vulnerable group.

Analysis of data from the UK National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years, including dietary intakes calculated from 4-day weighed records.

Data were used from 904 children with haematological measurements, excluding those taking iron supplements; 20% had low iron stores (ferritin < 10 μg l−1) while 8% were anaemic (Hb < 11 g dl−1).

High cereal consumers had significantly higher iron intakes than low cereal consumers (classified by tertiles) but the 10% difference in mean ferritin levels was not significant (P = 0.067). Lower intakes of vitamin C and meat among high consumers of cereal may have diluted the impact of cereal iron on iron status. When children were reclassified according to their intakes of vitamin C and iron from meat and breakfast cereals, the group with high (above median) intakes of two or more factors had a higher mean haemoglobin (Hb) level and a lower prevalence of anaemia compared with the group with low (below median) intakes of all three dietary constituents.

Nutritional advice that aims to improve iron status should emphasize not only rich sources of iron but also factors that may enhance or inhibit absorption. Strategies to optimize iron status in this vulnerable age group include consuming an iron-fortified breakfast cereal, vitamin C-rich fruit or drink at breakfast, and avoiding tea with (or after) meals.

To assess a county population's exposure to different types of food sources reported to affect both diet quality and obesity rates.

Food permit records obtained from the local health department served to establish the full census of food stores and restaurants. Employing prior categorization schemes which classified the relative healthfulness of food sources based on establishment type (i.e. supermarkets v. convenience stores, or full-service v. fast-food restaurants), food establishments were assigned to the healthy, unhealthy or undetermined groups.

King County, WA, USA.

Full census of food sources.

According to all categorization schemes, most food establishments in King County fell into the unhealthy and undetermined groups. Use of the food permit data showed that large stores, which included supermarkets as healthy food establishments, contained a sizeable number of bakery/delis, fish/meat, ethnic and standard quick-service restaurants and coffee shops, all food sources that, when housed in a separate venue or owned by a different business establishment, were classified as either unhealthy or of undetermined value to health.

To fully assess the potential health effects of exposure to the extant food environment, future research would need to establish the health value of foods in many such common establishments as individually owned grocery stores and ethnic food stores and restaurants. Within-venue exposure to foods should also be investigated.