Relationship Between Food Security, Nutrition Security, and Diabetes: the Role of Supplemental Nutrition assistance Program Participation

BACKGROUND: Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood. OBJECTIVES: This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers. METHODS: Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding. RESULTS: Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; CONCLUSIONS: This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation

Outcome Evaluation of a Pilot Study Using “Nudges”

Background: Every school day, over 31 million U.S. children eat school lunches. Unfortunately, students often do not choose the healthy options in the school cafeteria. This paper describes outcome results of a pilot study using “nudges” to improve elementary school students’ fruits and vegetables selections. Methods: A pilot study was conducted from January to May 2012, in six intervention schools and 2 control schools. A behavioral economics-based intervention was conducted using “nudges” or cues from the cafeteria (staff encouragement to select fruit and vegetables, food labels, “Harvest of the Month” posters), school (morning announcement messages, prompts regarding cafeteria food selections), and parents (school newsletter articles, parent listserve messages) to promote students’ selection of fruits and vegetables in the school cafeteria. The serving data from the point-of-service machine provided fruits and vegetables served per student per day. Results:There were no significant differences in the number of servings of fruits and vegetables served per student per day, averaged over the study period. Process data revealed low implementation of the intervention components, which may partially explain results. Conclusions: Low implementation of nudges led to non-significant results in this pilot study. However, providing environmental cues are important and warrant further research with full implementation. Starting 2012, the new meal pattern includes two vegetables and a fruit serving for lunch; and two fruit servings for breakfast. Minimal cost interventions should be explored to facilitate successful implementation of new school meal guidelines

Fruit and Vegetable intake and Home Nutrition Environment among Low-income Minority Households With Elementary-Aged Children

Racial/ethnic and socioeconomic differences were shown to have an influence on child fruit and vegetable intake. This study examined the associations between parent and child fruit and vegetable intake and the home nutrition environment among Hispanic/Latino and African American families. Through a cross-sectional study design, self-reported surveys

Gender Differences in Nutritional Quality and Consumption of Lunches Brought from Home to School

Gender difference in the lunches brought from home to school and the amount consumed by elementary and intermediate school students were examined using data collected from 12 schools in Texas. The amount and nutritional quality of food items brought and consumed was evaluated, by comparing the results to the 2012 school meal standards, and Dietary Reference Intakes (DRIs). Almost all lunches brought from home contained grain and meat/meat alternatives, and the amount brought and consumed exceeded the NSLP standards. The majority of students did not bring fruits, vegetables, and whole grain foods, but those who brought consumed most of what they brought. Among elementary school students, only 9% of boys and 14% of girls brought vegetables and the amount brought and consumed did not meet the standards. Although carbohydrate and protein consumption were adequate for boys and girls, the intakes of micronutrients and fiber did not meet the requirements across both genders at both school levels. Overall, lunches brought from home were not well balanced and did not meet NSLP standards and DRIs. It is imperative to identify strategies to improve the nutritional quality of lunches brought from home considering gender difference in food choice and educating parents and children on what is a healthy well-balanced lunch

Changes in foods selected and consumed after implementation of the new National School Lunch Program meal patterns in southeast Texas

Objective: We compared elementary students' school lunches selected and consumed before (Spring, 2011) and after (Spring, 2013) implementation of the new National School Lunch Program meal patterns in the fall of 2012. Method: Students in eight elementary schools in one Southeast Texas school district were observed during lunch: foods selected/consumed were recorded. The percentage of students who selected each food group was compared between years, as were the differences in the consumption and the percent of food consumed by year, for students who selected the food group. All analyses controlled for student gender and grade and school free/reduced price meal status. Results: Observations were conducted for 472 (2011) and 573 (2013) students. Significantly more 2013 students selected fruit, 100% juice, total fruit + 100% juice, other vegetables, whole grains, protein foods and milk, but fewer selected starchy vegetables. For those students selecting them, significantly more total fruit + 100% juice and red–orange vegetables, but significantly less other vegetables, legumes, and protein foods were consumed. There were no differences in waste of fruit, whole grains, or vegetables, with the exception of legumes. More legumes were wasted in 2013 than 2011. Conclusion: The findings that students had similar consumption rates for fruit, whole grains, and most vegetables in this study are encouraging. Regular monitoring of student food selection and consumption at school is needed to assess whether the new meal patterns improve intake at school

Dietary Intake among Children Attending Childcare Centers: Impact of the New CACFP Meal Guidelines

Through the Healthy, Hunger-Free Kids Act of 2010, USDA (US Department of Agriculture) made the first major changes in the CACFP (Child and Adult Care Food Program) meal and snack menu patterns. Childcare centers that serve low-income families qualify to participate and receive reimbursement for meals and snacks served. The purpose of this study was to assess what changes in children’s dietary behaviors occurred as a result of the new CACFP meal pattern requirements. This study evaluated these changes at childcare centers operating in Houston and San Antonio, Texas, USA, areas enrolled in the CACFP, pre- (Spring 2016) and post-implementation (Fall 2016–Spring 2017) of the new meal patterns. Dietary intake was assessed via observations of children, 3–5 years old, conducted at breakfast, lunch, and snack times. Results showed improvements in adjusted means of several nutrients and food groups consumption, post-implementation of new CACFP meal guidelines compared to baseline, specifically intake of whole grains, milk, and juice. Additional studies are needed to confirm the impact of the revised CACFP meal patterns along with strategies to assist providers in meeting the new standards to increase the access to and intake of items in accordance with the CACFP meal pattern requirements in childcare settings

Perspectives on Barriers to Eating Healthy Among Food Pantry Clients

Objective: To explore perspectives on barriers of eating healthy among food pantry clients. Methods: Food pantry clients participated in focus groups/interviews. Qualitative data were coded and analyzed using content analyses and grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Results: Fifty-four clients from 10 pantries participated in interviews/focus groups and completed questionnaires. Two major themes emerged: concern over obesity and other chronic diseases, and barriers to healthy eating. Several subthemes for barriers to healthy eating were identified: financial uncertainty, cost of healthy foods, lack of time, rationing food within family, lack of transportation, lack of adequate kitchen equipment, lack of nutrition knowledge and skills, and social support network. Conclusions: Issues identified above and those identified by others working with low-income populations need to be systematically addressed and incorporated into programs and nutrition education interventions for this group

The Feasibility of Using "Nudges" in the School Food Environment to Influence Healthy Food Choices at School

Every schoolday, over 31 million U.S children eat school lunches. Unfortunately, students often do not choose the healthy options in the cafeteria. This study used formative research to design a behavioral economics-based intervention of “nudges” or cues from the cafeteria (cafeteria staff encouragement, food labels, Harvest of the Month posters), school (morning announcement messages, writing prompts about cafeteria foods), and parents (school newsletter articles, parent listserv messages) to promote student selection of fruit and vegetables in the cafeteria. A pilot study of the intervention was conducted from January to May 2012 in six intervention schools and two control schools. There were no significant differences in the number of servings of fruit and vegetables served per student per day, averaged over the study period. Process data revealed low implementation of the intervention components, which may partially explain results

The costs and calorie content of à la carte food items purchased by students during school lunch

School environments influence student food choices. À la carte foods and beverages are often low nutrient and energy dense. This study assessed how much money students spent for these foods, and the total kilocalories purchased per student during the 2012–2013 school year. Six elementary and four intermediate schools in the Houston area provided daily food purchase transaction data, and the cost and the calories for each item. Chi-square analysis assessed differences in the number of students purchasing à la carte items by grade level and school free/reduced-price meal (FRP) eligibility. Analysis of covariance assessed grade level differences in cost and calories of weekly purchases, controlling for FRP eligibility. Intermediate grade students spent significantly more on à la carte food purchases and purchased more calories (both p < 0.001) than elementary school students. Lower socioeconomic status (SES) elementary and intermediate school students purchased fewer à la carte foods compared to those in higher SES schools (p < 0.001). Intermediate school students purchased more à la carte foods and calories from à la carte foods than elementary students. Whether the new competitive food rules in schools improve student food selection and purchase, and dietary intake habits across all grade levels remains unknown. Keywords: National School Lunch Program, Elementary schools, Intermediate schools, À la carte foods, Competitive foods, Costs, Calorie

Culinary Education Programs for Children in Low-Income Households: A Scoping Review

Child obesity in the United States is at an all-time high, particularly among underserved populations. Home-cooked meals are associated with lower rates of obesity. Helping children develop culinary skills has been associated with improved nutrition. The purpose of this study is to report results from a scoping review of culinary education interventions with children from low-income families. Three databases and hand searches of relevant articles were examined. Retained articles met inclusionary criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, as appropriate. A data extraction template was developed. Data were independently extracted and verified. Only nine out of 370 articles met the inclusionary criteria and were included in the review. Most interventions were school-based, used a quasi-experimental design, and recruited minority children. Children-only was the primary intervention focus. Primary outcomes were mostly psychosocial from child self-report. Most interventions focused on children only and were guided by Social Cognitive Theory. Most reported stakeholder involvement; however, type and degree varied. All had an in-person component; only one used technology. Few reported training program leaders. Culinary education programs for children from low-income families could benefit from a broader theoretical grounding, program leader training, and greater parental involvement