Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia

School meals make significant contributions to healthy dietary behaviour, at a time when eating habits and food preferences are being formed. We provide an overview of the approaches to the provision, regulation, and improvement of preschool and primary school meals in the UK, Sweden, and Australia, three countries which vary in their degree of centralisation and regulation of school meals. Sweden has a centralised approach; all children receive free meals, and a pedagogical approach to meals is encouraged. Legislation demands that meals are nutritious. The UK system is varied and decentralised. Meals in most primary schools are regulated by food-based standards, but preschool-specific meal standards only exist in Scotland. The UK uses food groups (starchy foods, fruit and vegetables, proteins and dairy) in a healthy plate approach. Australian States and Territories all employ guidelines for school canteen food, predominantly using a “traffic light” approach outlining recommended and discouraged foods; however, most children bring food from home and are not covered by this guidance. The preschool standards state that food provided should be nutritious. We find that action is often lacking in the preschool years, and suggest that consistent policies, strong incentives for compliance, systematic monitoring, and an acknowledgement of the broader school eating environment (including home provided food) would be beneficial

Fracture risk and impact in boys with Duchenne muscular dystrophy: A retrospective cohort study

Introduction/Aims: Boys with Duchenne muscular dystrophy (DMD) are at increased risk of fracture. This study investigated the incidence of fractures, factors contributing to risk of first fracture with emphasis on body mass index (BMI), and the impact of fractures on functional capacity in an Australian cohort of boys with DMD. Methods: A retrospective cohort study included boys with DMD who attended a pediatric neuromuscular clinic from 2011 to 2018. Information regarding fractures, anthropometry measurements, body composition and functional assessment was collected. Factors associated with first fracture risk were analyzed with Cox-proportional hazards. Longitudinal analysis of function post-fracture was also conducted. Results: This study included 155 boys with DMD. At least one fracture occurred in 71 (45%) boys; overall incidence of fractures was 399-per-10,000 persons-years. The first fracture was vertebral in 55%; 41% had non-vertebral fractures and 4% had both. Vertebral fractures occurred in significantly older (12.28 vs 9.28 y) boys with longer exposure to glucocorticoids (5.45 vs 2.50 y) compared to non-vertebral fractures. Boys with a history of fracture(s) had a steeper rate of functional decline (measured by Northstar Ambulatory Assessment score) than those with no recorded fractures. Discussion: A high fracture burden was observed in a large Australian cohort of boys with DMD. Further investigation is required to understand preventative strategies and modifiable risk factors to reduce the incidence of fractures in DMD. The impact on fractures on ambulatory capacity should be closely monitored

The Relationship between Obesity and Clinical Outcomes in Young People with Duchenne Muscular Dystrophy

Background: Duchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular disorder. Young people with DMD have high rates of obesity. There is emerging evidence that a higher BMI may negatively affect clinical outcomes in DMD. This study aimed to explore the relationship between obesity and clinical outcomes in DMD. Methods: This was a retrospective clinical audit of young people (two–21 years) with DMD. Height and weight were collected to calculate BMI z-scores to classify obesity, overweight and no overweight or obesity (reference category). Cox proportional hazards models determined the impact of obesity at five to nine years on clinical milestones including time to: loss of ambulation, timed function test cut-offs, obstructive sleep apnoea (OSA) diagnosis and first fracture. Results: 158 young people with DMD were included; most (89.9%) were steroid-treated. Mean follow-up was 8.7 ± 4.7 years. Obesity prevalence increased from age five (16.7%) to 11 years (50.6%). Boys with obesity at nine years sustained a fracture earlier (hazard ratio, HR: 2.050; 95% CI: 1.038–4.046). Boys with obesity at six to nine years were diagnosed with OSA earlier (e.g., obesity nine years HR: 2.883; 95% CI: 1.481–5.612). Obesity at eight years was associated with a 10 m walk/run in 7–10 s occurring at an older age (HR: 0.428; 95% CI: 0.207–0.887), but did not impact other physical function milestones. Conclusions: Although 50% of boys with DMD developed early obesity, the impact of obesity on physical function remains unclear. Obesity puts boys with DMD at risk of OSA and fractures at a younger age. Early weight management interventions are therefore important

Investigating business outcomes of healthy food retail strategies: a systematic scoping review

Metode kangguru bisa digunakan dalam perawatan bayi BBLR sebagai pengganti inkubator, caranya dengan meletakkan bayi yang telah diberi popok dan penutup kepala di antara payudara ibu dan ditutupi baju ibu yang berfungsi sebagai kantong kanguru. Dari studi pendahuluan di wilayah kerja Pusksesmas Kuala Kecamatan Kuala Kabupaten Langkat didata jumlah ibu hamil  tahun 2017 sebanyak 380 orang, yang bersalin 215 orang, di antaranya yang melahirkan  bayi BBLR sebanyak  19 bayi. Permasalahan dalam penelitian  ini adalah bagaimana gambaran pengetahuan ibu hamil tentang metode kanguru pada bayi BBLR di wilayah kerja Puskesmas Kuala Kecamatan Kuala Kabupaten Langkat Tahun 2017. Penelitian bersifat deskriptif. Populasi adalah  seluruh ibu hamil yang berkunjung saat penelitian dilakukan bulan Mei-Juni 2017 sebanyak 45 orang dan seluruhnya dijadikan sampel (total sampling).  Hasil penelitian diperoleh pengetahuan ibu  hamil di wilayah kerja Puskesmas Kuala Kecamatan Kuala Kabupaten Langkat Tahun 2017  tentang  pengertian metode kanguru mayoritas kurang, tentang  manfaat metode kanguru mayoritas kurang, tentang cara perawatan metode kanguru mayoritas kurang, dan pengetahuan ibu  hamil tentang  metode kanguru pada bayi berat lahir rendah mayoritas kurang. Disarankan kepada  ibu hamil agar berupaya menjaga kesehatan selama kehamilan agar kelak dapat melahirkan bayi yang sehat. Bagi tenaga kesehatan khususnya bidan agar lebih memotivasi dan meningkatkan penyuluhan tentang cara sehat selama kehamilan dan memberikan pengetahuan kesehatan tentang metode kanguru. Diharapkan peran serta keluarga terutama ayah terhadap upaya pencegahan bayi baru lahir dengan berat badan rendah dengan cara membantu ibu hamil memenuhi asupan gizi seimbang dan rutin melakukan pemeriksaan kepada petugas kesehatan

Investigating business outcomes of healthy food retail strategies: a systematic scoping review

Large changes to food retail settings are required to improve population diet.However, limited research has comprehensively considered the business implicationsof healthy food retail strategies for food retailers. We performed a systematic scopingreview to identify types of business outcomes that have been reported in healthyfood retail strategy evaluations. Peer‐reviewed and grey literature were searched.We identified qualitative or quantitative real‐world food or beverage retail strategiesdesigned to improve the healthiness of the consumer nutrition environment (eg,changes to the“marketing mix”of product, price, promotion, and/or placement).Eligible studies reported store‐or chain‐level outcomes for measures of commercialviability, retailer perspectives, customer perspectives, and/or community outcomes.11 682 titles and abstracts were screened with 107 studies included for review from15 countries. Overall item sales, revenue, store patronage, and customer level of sat-isfaction with strategy were the most frequently examined outcomes. There was alarge heterogeneity in outcome measures reported and in favourability for retailersof outcomes across studies. We recommend more consistent reporting of businessoutcomes and increased development and use of validated and reliable measurementtools. This may help generate more robust research evidence to aid retailers andpolicymakers to select feasible and sustainable healthy food retail strategies to bene-fit population health within and across countries.M.R.B. is supported by an Australian Government Research Training Program Scholarship and Deakin University. A.P. and K.B. are supported by Deakin University. E.L. is supported by an Australian Research Council (ARC) fellowship. T.B.R. is supported by an Australian Government Research Training Program Scholarship and Deakin University. N.B. is supported by a Departmental Scholarship from the Department of Nutrition, Dietetics and Food at Monash University. C.Z. is supported by an Australian Government Research Training Program Scholarship. J.B. is supported by Monash University