Optimizing school meals today : a pathway to sustainable dietary habits tomorrow

Food production and consumption substantially contribute to climate change and disease. School meals can reach children of every socioeconomic background and hold a near-unique potential to foster sustainable dietary habits in the young generation in both the short and long term. This thesis explored a pathway to designing and introducing children to climate friendly, nutritious, affordable and culturally appropriate—i.e. sustainable—school lunches. Study I explored the importance of school lunches to children’s overall diets in Sweden. Die-tary intakes of nutrients and food groups were calculated and compared between girls and boys as well as by pupils’ parental education. School lunches accounted for almost half of pupils’ vegetable intakes. The nutrient density was higher, and energy density lower, at lunch com-pared to foods consumed during the remaining weekday. Boys had higher intakes of red/pro-cessed meat, but lower intakes of dietary fiber and vegetables than girls. Differences in dietary intake based on pupils’ parental education suggests that school meals can play a role in com-pensating for poorer dietary quality in the home environment. Study II aimed to develop a holistic linear optimization strategy for achieving a sustainable Swedish school food supply. The developed strategy reduced greenhouse gas emissions (GHGE) from the school food supply by 40% with only small changes to the observed supply while also ensuring nutritional adequacy and affordability. Cost was reduced or comparable to baseline in all modeled solutions. Constraints applied to achieve higher levels of similarity to the observed supply prevented the linear optimization model’s capacity to reduce GHGE. Study III combined the optimization strategy developed in Study II with meal planning to design a sustainable 4-week lunch menu, which was tested in a school-based intervention study. Pre-post analyses evaluated the acceptability of the new menu by assessing effects changes to food waste, pupils’ school lunch consumption, and their satisfaction with school meals. The new menu was introduced in three Swedish primary schools (grades 0-9) without increasing food waste or change pupils’ consumption of, or satisfaction with, the school lunch. Study IV qualitatively evaluated the acceptability of the new sustainable school lunch menu. Focus group discussions explored pupils’ and kitchen staff’s experiences with the new menu as well as potential barriers and facilitators to successful implementation of sustainable school meals at scale. Experiences with the intervention varied among pupils and kitchen staff. Barri-ers included pupils’ unfamiliarity with eating plant-based meals and the lack of financial re-sources, adequate equipment and time for kitchen staff to prepare such meals. Aspects such as increased exposure to plant-based foods, knowledge, motivation, and stakeholder involvement were seen as facilitators to successful implementation. The findings of this thesis highlight how integrated methods and actions implemented in the school meal system could help to foster sustainable dietary habits in children and thus contrib-ute to meeting the needs of both human and planetary health

Potential health impact of increasing adoption of sustainable dietary practices in Sweden.

BACKGROUND: An urgent transition to more sustainable diets is necessary for the improvement of human and planetary health. One way to achieve this is for sustainable practices to become mainstream. We estimated the potential health impact of wider adoption of dietary practices deemed by consumers, researchers and stakeholders in Sweden to be niche, sustainable and with the potential to be scaled up. METHODS: A life table method was used to estimate the impact - changes in years of life lost (YLL) - over periods of 20 and 30 years in the Swedish population had the practices been adopted in 2010-11, when the last national adult dietary survey was conducted. The practices modelled were reducing red and processed meat (by 25, 50 and 100%), and assuming, for each stage, replacement by an equal weight of poultry/fish and vegetables +/- legumes; reducing milk intake (by 25, 50 and 100%); and reducing sugar-sweetened beverage intake (by 25, 50 and 100%). Using population data together with data on cause-specific mortality and relative risks for diet-disease outcomes, impacts were estimated for each scenario separately and in combination, for the outcomes ischaemic heart disease (IHD), ischaemic stroke, diabetes type 2 and colorectal cancer. RESULTS: For a "moderate" combination of scenarios (changes at the 50% level), reductions of 513,200 YLL (lower-upper uncertainty estimate 59,400-797,900) could have been achieved over 20 years and 1,148,500 YLL (135,900-1,786,600) over 30 years. The majority (over 90%) of YLLs prevented were related to IHD, and the majority were in men. The singular practice that had the most impact was reducing the intake of red and processed meat and replacing it with a mixture of vegetables and legumes. Reducing milk intake resulted in an increase in YLL, but this was compensated for by other scenarios. CONCLUSION: If these practices were more widely adopted, they would be expected to lead to improvements in public health in Sweden. Over the long term, this would translate to many premature deaths postponed or prevented from a number of chronic diseases, to the benefit of individuals, society, the climate and the economy

Impact on mortality of pathways to net zero greenhouse gas emissions in England and Wales: a multisectoral modelling study.

BACKGROUND: The UK is legally committed to reduce its greenhouse gas emissions to net zero by 2050. We aimed to understand the potential impact on population health of two pathways for achieving this target through the integrated effects of six actions in four sectors. METHODS: In this multisectoral modelling study we assessed the impact on population health in England and Wales of six policy actions relating to electricity generation, transport, home energy, active travel, and diets relative to a baseline scenario in which climate actions, exposures, and behaviours were held constant at 2020 levels under two scenarios: the UK Climate Change Committee's Balanced Pathway of technological and behavioural measures; and its Widespread Engagement Pathway, which assumes more substantial changes to consumer behaviours. We quantified the impacts of each policy action on mortality using a life table comprising all exposures, behaviours, and health outcomes in a single model. FINDINGS: Both scenarios are predicted to result in substantial reductions in mortality by 2050. The Widespread Engagement Pathway achieves a slightly greater reduction in outdoor fine particulate matter air pollution of 3·2 μg/m3 (33%) and, under assumptions of appropriate ventilation, a greater improvement in indoor air pollution (a decrease in indoor-generated fine particulate matter from 9·4 μg/m3 to 4·6 μg/m3) and winter temperatures (increasing from 17·8°C to 18·1°C), as well as appreciably greater changes in levels of active travel (27% increase in metabolic equivalent hours per week of walking and cycling) by 2050. Additionally, the greater reduction in red meat consumption (50% compared with 35% under the Balanced Pathway) by 2050 results in greater consumption of fruits (17-18 g/day), vegetables (22-23 g/day), and legumes (5-7 g/day). Combined actions under the Balanced Pathway result in more than 2 million cumulative life-years gained over 2021-50; the estimated gain under the Widespread Engagement Pathway is greater, corresponding to nearly 2·5 million life-years gained by 2050 and 13·7 million life-years gained by 2100. INTERPRETATION: Reaching net zero greenhouse gas emissions is likely to lead to substantial benefits for public health in England and Wales, with the cumulative net benefits being correspondingly greater with a pathway that entails faster and more ambitious changes, especially in physical activity and diets. FUNDING: National Institute for Health Research and the Wellcome Trust

Potential for positive biodiversity outcomes under diet-driven land use change in Great Britain

Background: A shift toward human diets that include more fruit and vegetables, and less meat is a potential pathway to improve public health and reduce food system-related greenhouse gas emissions. Associated changes in land use could include conversion of grazing land into horticulture, which makes more efficient use of land per unit of dietary energy and frees-up land for other uses. Methods: Here we use Great Britain as a case study to estimate potential impacts on biodiversity from converting grazing land to a mixture of horticulture and natural land covers by fitting species distribution models for over 800 species, including pollinating insects and species of conservation priority. Results: Across several land use scenarios that consider the current ratio of domestic fruit and vegetable production to imports, our statistical models suggest a potential for gains to biodiversity, including a tendency for more species to gain habitable area than to lose habitable area. Moreover, the models suggest that climate change impacts on biodiversity could be mitigated to a degree by land use changes associated with dietary shifts. Conclusions: Our analysis demonstrates that options exist for changing agricultural land uses in a way that can generate win-win-win outcomes for biodiversity, adaptation to climate change and public healt

Pathways to "5-a-day": modeling the health impacts and environmental footprints of meeting the target for fruit and vegetable intake in the United Kingdom.

BACKGROUND: Fruit and vegetable consumption in the United Kingdom is currently well below recommended levels, with a significant associated public health burden. The United Kingdom has committed to reducing its carbon emissions to net zero by 2050, and this transition will require shifts towards plant-based diets. OBJECTIVE: The aim was to quantify the health effects, environmental footprints, and cost associated with 4 different pathways to meeting the United Kingdom's "5-a-day" recommendation for fruit and vegetable consumption. METHODS: Dietary data based on 18,006 food diaries from 4528 individuals participating in the UK National Diet and Nutrition Survey (2012/13-2016/17) constituted the baseline diet. Linear programming was used to model the hypothetical adoption of the 5-a-day (400 g) recommendation, which was assessed according to 4 pathways differing in their prioritization of fruits versus vegetables and UK-produced versus imported varieties. Increases in fruit and vegetable consumption were substituted for consumption of sweet snacks and meat, respectively. Changes in life expectancy were assessed using the IOMLIFET life table model. Greenhouse gas emissions (GHGEs), blue water footprint (WF), and total diet cost were quantified for each 5-a-day diet. RESULTS: Achieving the 5-a-day target in the United Kingdom could increase average life expectancy at birth by 7-8 mo and reduce diet-related GHGEs by 6.1 to 12.2 Mt carbon dioxide equivalents/y; blue WFs would change by -0.14 to +0.07 km3/y. Greater reductions in GHGEs were achieved by prioritizing increased vegetable consumption over fruit, whereas the greatest reduction in WF was obtained by prioritizing vegetable varieties produced in the United Kingdom. All consumption pathways increased diet cost (£0.34-£0.46/d). CONCLUSIONS: Benefits to both population and environmental health could be expected from consumption pathways that meet the United Kingdom's 5-a-day target for fruit and vegetables. Our analysis identifies cross-sectoral trade-offs and opportunities for national policy to promote fruit and vegetable consumption in the United Kingdom

Optimizing School Food Supply: Integrating Environmental, Health, Economic, and Cultural Dimensions of Diet Sustainability with Linear Programming

There is great potential for reducing greenhouse gas emissions (GHGE) from public-sector meals. This paper aimed to develop a strategy for reducing GHGE in the Swedish school food supply while ensuring nutritional adequacy, affordability, and cultural acceptability. Amounts, prices and GHGE-values for all foods and drinks supplied to three schools over one year were gathered. The amounts were optimized by linear programming. Four nutritionally adequate models were developed: Model 1 minimized GHGE while constraining the relative deviation (RD) from the observed food supply, Model 2 minimized total RD while imposing stepwise GHGE reductions, Model 3 additionally constrained RD for individual foods to an upper and lower limit, and Model 4 further controlled how pair-wise ratios of 15 food groups could deviate. Models 1 and 2 reduced GHGE by up to 95% but omitted entire food categories or increased the supply of some individual foods by more than 800% and were deemed unfeasible. Model 3 reduced GHGE by up to 60%, excluded no foods, avoided high RDs of individual foods, but resulted in large changes in food-group ratios. Model 4 limited the changes in food-group ratios but resulted in a higher number of foods deviating from the observed supply and limited the potential of reducing GHGE in one school to 20%. Cost was reduced in almost all solutions. An omnivorous, nutritionally adequate, and affordable school food supply with considerably lower GHGE is achievable with moderate changes to the observed food supply; i.e., with Models 3 and 4. Trade-offs will always have to be made between achieving GHGE reductions and preserving similarity to the current supply

Vegobarometern : En undersökning av svenskarnas benägenhet att välja vegetarisk mat under åren 2016-2019

QC 20210518</p

Vegobarometern : En undersökning av svenskarnas benägenhet att välja vegetarisk mat under åren 2016-2019

QC 20210518</p

Knowledge about Sexual and Reproductive Health among School Enrolled Adolescents in Tololar, Nicaragua, A Cross-Sectional Study

Background: Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua. Methods: A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value &lt;0.05 was considered significant. Results: The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value &lt; 0.01) and knowledge increased significantly with age (p-value &lt; 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic. Conclusions: Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.MZ id : JPHI-18-2464</p

Knowledge about Sexual and Reproductive Health among School Enrolled Adolescents in Tololar, Nicaragua, A Cross-Sectional Study

Background: Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua. Methods: A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value &lt;0.05 was considered significant. Results: The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value &lt; 0.01) and knowledge increased significantly with age (p-value &lt; 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic. Conclusions: Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.<p>MZ id : JPHI-18-2464</p