UNASSIGNED: British Muslim School Children (BMSC) are required to follow special halal dietary requirements in accordance with their religion, which is often not accounted for in British schools. This often leaves BMSC limited to a vegetarian diet while at school, despite this not being their chosen diet or preference. This study explores the perceptions of key stakeholders regarding fairness and accessibility of school meals for BMSC, as well as discussing school food provision for those maintaining a religious diet in light of social justice. This is in the context of limited knowledge previously being explored in the North East of England regarding procurement and decision-making at a systems level to cater for BMSC.
UNASSIGNED: A qualitative research design was conducted. A total of 62 participants (39 BMSC, 15 parents, and 8 school and catering staff) took part in a semi-structured interview or focus group. Participants were recruited from six schools, with these schools selected based on their differing levels of BMSC in attendance. This project took place between March 2022 and October 2023.
UNASSIGNED: Results suggested that where schools already catered for diverse food requirements, inclusive of BMSC dietary needs, food choices were still limited in the options and amount available. School and catering staff stated that cost implications contributed to their menu development process. Despite this, there was an evident willingness to learn about the cultural food options and how these can be implemented in future school menus. Suggestions discussed included an increase in the use of halal meat in order to provide a more inclusive school food experience for BMSC.

BACKGROUND: Unhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school daily, including lunchtime, so the school setting becomes crucial for promoting healthy diets and lifestyle habits. While there is a large body of literature on the impact of school food policies on health and non-health outcomes, it is essential to identify which policies are effective and can be recommended for implementation to ensure the efficient use of resources. This article presents a protocol for a scoping review that aims to map the current published literature on the effects of school food policies on health outcomes, acceptance and affordability in secondary school children in Europe. Moreover, the scoping review will map the measurements used to assess health outcomes, acceptance and affordability.
METHODS: The scoping review protocol and review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. To identify eligible studies, we will search MEDLINE, PsycINFO, CINAHL and Web of Science. The reference lists of the included articles will be checked for additional studies. In addition, country-specific ministry reports from Member States of the European Union, the UK, Norway, Iceland and Switzerland will be identified. The WHO and European Commission websites will also be searched for relevant reports. The scoping review will include literature published until 20 September 2023. No restrictions to study design and language will be applied. Screening and data extraction will be carried out independently by three reviewers. Disagreements will be resolved by discussion. A pretested data charting table will be used to extract key information. Findings will be presented in tabular and visualised summaries and a narrative summary.
BACKGROUND: This scoping review does not require ethical approval. Our dissemination strategy comprises peer-reviewed publications, conference presentations and recommendations to policy-makers.

BACKGROUND: In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, \"the Policy\") was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors\' awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy.
METHODS: Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants.
RESULTS: Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that \"Hospitals should be good role models.\" Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options.
CONCLUSIONS: The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.

UNASSIGNED: The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States.
UNASSIGNED: To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States.
UNASSIGNED: An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome.
UNASSIGNED: The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making.
UNASSIGNED: In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.

Since its launch in 2011, 59 governments have used the World Bank\'s Systems Approach for Better Education Results (SABER) policy tool to design their national school-based health and nutrition programs. This tool guides governments to self-evaluate their education system policies against international benchmarks and identify actionable priorities to strengthen national programs. Thirty-two of the 49 countries in sub-Saharan Africa (65%) have undertaken a SABER review, and globally the approach has been adopted by 68% of the world\'s low-income countries and 54% of lower-middle-income countries. Analysis of 51 comparable SABER School Feeding surveys suggests that countries with longer established national school meals frameworks tend also to be more advanced in other policy areas, and vice versa. The SABER reviews consistently identify, perhaps predictably, that the weakest policy areas relate to program design, implementation and fiscal space. This analysis also found that the tool had an additional value in tracking the evolution of policies when implemented over several time points, and showed that policy areas become more advanced as national programs mature. These benefits of the tool are particularly relevant to the 98 countries that co-created the global School Meals Coalition in 2021. The Coalition member countries have the specific goal of enhancing coverage and support for the well-being of schoolchildren and adolescents affected by the school closures during the COVID-19 pandemic. The SABER tool has the demonstrated potential to implement, accelerate and track changes in school meals policy and, since it has been previously used by 74% (31/42) of low- and lower-middle-income countries in sub-Saharan Africa, is an already accepted element of the political economies of those countries and so has the potential to be deployed rapidly.

School lunch plays an important role in children\'s healthy growth. Previous investigations revealed many problems with school lunches, including unreasonable dietary structure and insufficient micronutrients. This study aimed to assess the dietary structure and nutritional quality of lunches in Nanjing primary and middle schools. A stratified cluster random sampling method was used to select 44 schools that supply lunch in 12 districts in Nanjing, with two primary and two middle schools in each district. Twenty-four primary and twenty middle schools were selected. The Mann-Whitney U test was used to explore the influencing factors. Findings revealed a serious shortage of milk and fruit in school lunches; supply of eggs, fish, shrimp, and shellfish was less than half of the recommended quantity; livestock and poultry supply exceeded the recommended level by over four times. Energy and nutrition intake were suboptimal. Provision of energy, carbohydrates, vitamins (A, B1, B2, and C), calcium, and iron in urban primary schools was significantly higher than that in non-urban primary schools. The same pattern of significantly higher nutrients was equally seen in urban middle schools compared with non-urban middle schools, indicating that food supply was affected by regional economies. Therefore, it is urgent to improve the quality of lunches, with a particular focus on those in non-urban areas.

BACKGROUND: Typical adolescent diets do not meet current dietary recommendations. There is a need to address these dietary patterns to reduce the risk of obesity and other diet-related diseases. Schools provide an opportune setting to do so, as students consume a substantial proportion of their daily dietary intake whilst at school. There is a developing evidence base on the use of choice architecture (food choice cues) to promote healthy eating in school contexts. It is necessary to understand the acceptability and feasibility of implementing such interventions. We aimed to explore these factors from the perspectives of secondary school caterers.
METHODS: We conducted qualitative interviews with caterers from secondary schools across the West Midlands, UK and national/regional catering representatives. A semi-structured topic guide and visual aid were used to guide interviews. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12.
RESULTS: Twelve participants took part. Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Limits of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as they require minimal reflective motivation. Salient cues included enhancing the placement, presentation and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity. Student engagement was considered important. Some catering decision drivers conflicted with healthy food cues, and many felt that their role in healthy eating was limited due to the overwhelming influence of external food environments, adolescent resistance, and features of the secondary school canteen setting e.g. short duration of lunchtime, lack of space. However, caterers appeared motivated to implement healthy food cues and identified key opportunities for implementation, including integration into whole-school approaches to healthy eating.
CONCLUSIONS: Interventions using healthy food cues appeared acceptable to secondary school caterers, key potential implementers of these strategies. Future interventions could incorporate strategies relating to placement, presentation and pricing to prompt healthy selections, and actions to engage the student body and improve the dining environment. Evaluations should consider potential impacts upon food purchasing, consumption and waste to address caterers\' concerns about these issues.

BACKGROUND: Mid-day meal programmes (MDM) were introduced in India to improve school attendance, nutritional status and educational outcomes of school children. Numerous primary studies have examined the impact of the MDM programmes on both nutritional and educational outcomes in various settings across the country. However, synthesising the findings from these studies has been challenging. To address this gap, we conducted a systematic review to assess the effects of MDM programmes on the nutritional and academic outcomes of school children in India.
METHODS: A comprehensive literature search was conducted, and relevant studies published between 1997 and 2022 were included. Two reviewers independently conducted study selection, data extraction and risk of bias assessment. The results were synthesised descriptively.
RESULTS: The systematic review included 31 studies. Among them, 16 studies focused on academic outcomes, while 18 studies reported children\'s nutritional status. Studies on MDM Scheme (MDMS) in children show mixed results on nutritional outcomes. While some studies show marginal improvements in height and weight measurements, others show no significant improvement. Regular MDMS access improves enrollment, attendance and retention rates for children, with lower dropout rates and higher academic achievement. However, its impact on academic performance remains unclear.
CONCLUSIONS: The MDM programme in India was effective in improving the academic achievement and a few nutritional outcomes of school children, underscoring the importance of sustaining MDM programmes in India.
UNASSIGNED: The review was prospectively registered in PROSPERO (CRD42023391776). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023391776.

BACKGROUND: Changing the food environment is an important public health lever for encouraging sustainable food choices. Targeting the availability of vegetarian main meals served in cafeterias substantially affects food choice, but acceptability has never been assessed. We examined the effects of an availability intervention at a French university cafeteria on students\' main meal choices, meal offer satisfaction and liking.
METHODS: A four-week controlled trial was conducted in a university cafeteria in Dijon, France. During the two-week control period, vegetarian main meals constituted 24% of the offer. In the subsequent two-week intervention period, this proportion increased to 48%, while all the other menu items remained unchanged. Students were not informed of the change. Student choices were tracked using production data, and daily paper ballots were used to assess student satisfaction with the meal offer and liking of the main meal they chose (score range [1;5]). Nutritional quality, environmental impact, and cost of production of meal choices were calculated for each lunchtime. Food waste was measured over 4 lunchtimes during control and intervention periods. An online questionnaire collected student feedback at the end of the study.
RESULTS: Doubling availability of vegetarian main meals significantly increased the likelihood of choosing vegetarian options (OR = 2.57, 95% CI = [2.41; 2.74]). Responses of the paper ballots (n = 18,342) indicated slight improvements in meal offer satisfaction from 4.05 ± 0.92 to 4.07 ± 0.93 (p = 0.028) and in liking from 4.09 ± 0.90 to 4.13 ± 0.92 (p < 0.001) during control and intervention periods, respectively. The end-of-study questionnaire (n = 510) revealed that only 6% of students noticed a change the availability of vegetarian main meals. The intervention led to a decrease in the environmental impact of the main meals chosen, a slight decrease in nutritional quality, a slight increase in meal costs and no change in food waste.
CONCLUSIONS: Doubling availability of vegetarian main meals in a university cafeteria resulted in a twofold increase in their selection, with students reporting being more satisfied and liking the main meals more during the intervention period. These results suggest that serving an equal proportion of vegetarian and nonvegetarian main meals could be considered in French university cafeterias to tackle environmental issues.
BACKGROUND: Study protocol and analysis plan were pre-registered on the Open Science Framework ( https://osf.io/pf3x7/ ).

The collective meals market generates significant revenue for the world economy. Food services are responsible for consuming large amounts of water and energy, as well as generating a substantial volume of waste, which is often improperly disposed of. Given the unchecked expansion of food services, the lack of proper management of environmental resources can undermine sustainability principles, posing a threat to future generations. This scoping review aimed to synthesize the existing scientific literature on carbon and water footprints in food services, describing the main methods and tools used and what strategies have been proposed to mitigate the high values of these footprints. The search for articles was performed on 6 June 2024 in seven electronic databases, using MeSH Terms and adaptations for each database from database inception. The search for local studies was complemented by a manual search in the list of references of the studies selected to compose this review. It included quantitative studies assessing footprints (water or carbon) in food services and excluded reviews, studies that reported footprints for diets, and protocols. A total of 2642 studies were identified, and among these, 29 were selected for this review. According to the findings, it was observed that meats, especially beef, contribute more to water and carbon footprint compared to other proteins. Mitigation strategies for the water footprint include promoting plant-based diets, menu changes, and awareness.