Evaluation of a College-Level Nutrition Course With a Teaching Kitchen Lab

ObjectiveTo evaluate the impact of a college nutrition course with a teaching kitchen lab on students’ attitudes, self-efficacy, and behaviors about healthful eating and cooking.MethodsPreintervention and postintervention design, and anonymous online survey of sociodemographic information and students’ attitudes and self-efficacy about consuming fruits, vegetables, and whole grains and about cooking, self-reported intake, and cooking behaviors.ResultsTwo-hundred and fourteen participants enrolled in the study during 5 semesters. Of these, 171 (80%) had complete pretest and posttest data. Attitudes and self-efficacy scores about consuming fruits, vegetables, whole grains, and cooking were significantly higher in the posttest (vs pretest; all P < 0.0001). Self-reported intake of fruits (P < 0.0001) and vegetables (P = 0.0006) also increased. Cooking frequency increased (P < 0.0001), skipping meals frequency decreased (P < 0.0001), whereas no significant changes were observed for eating out, take-out, or premade meals frequency.Conclusions and ImplicationsA college nutrition course with a teaching kitchen lab could improve healthful eating and promote cooking in young adults.     

A Pilot Comprehensive School Nutrition Program Improves Knowledge and Intentions for Intake of Milk and Milk Alternatives Among Youth in a Remote First Nation

ObjectiveTo evaluate the impact of a pilot comprehensive school nutrition program modeled on Social Cognitive Theory on knowledge, intentions, self-efficacy, and intake of milk and milk alternatives (MMA) in First Nations youth.MethodsA pilot school nutrition program was implemented at Peetabeck Academy in Fort Albany, Ontario in May, 2010. The Knowledge, Self-Efficacy, and Intentions Questionnaire (KSIQ) and Waterloo Web-based Eating Behavior Questionnaire (WEB-Q) were used to assess change in attitudes and behavior from pre- to postprogram.ResultsThe KSIQ preprogram (n = 26), postprogram (n = 19); WEB-Q preprogram (n = 30), postprogram (n = 10). Improved knowledge (6.0 ± 1.5 vs 6.9 ± 1.5, P = .05) and intention scores (9.6 ± 4.4 vs 11.3 ± 4.1, P = .01) were observed.Conclusions and ImplicationsA comprehensive school nutrition program can improve knowledge and intentions for intake of MMA in First Nations youth. Environmental constraints beyond the school environment need to be addressed.     

Compared to Pre-prepared Meals,Fully and Partly Home-Cooked Meals in Diverse Families with Young Children Are More Likely to Include Nutritious Ingredients

Background

Interest in initiatives that promote home cooking has been increasing, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families.

Culinary Nutrition Education Improves Home Food Availability and Psychosocial Factors Related to Healthy Meal Preparation Among Children

ObjectiveTo evaluate the effectiveness of a culinary nutrition education intervention on children's home food availability and psychosocial factors related to healthy meal preparation.DesignRandomized-controlled trial.SettingSchools in Kuala Lumpur, Malaysia.ParticipantsEighty-three school children aged 10–11 years and their parents.InterventionTwelve weeks of culinary nutrition education with 5 hands-on healthy meal preparation modules and a module with parents on home food availability (conducted every 2 weeks).Main Outcome MeasuresPsychosocial factors (knowledge, attitude, practice, and self-efficacy) related to healthy meal preparation and home food availability (fruits, vegetables, healthful foods, and less healthful foods) assessed via children and parents, respectively, using validated questionnaires at baseline, postintervention, and 3-month follow-up.AnalysisRepeated measures ANOVA.ResultsIntervention group had a higher (P < 0.001) mean knowledge score (mean difference, 1.2), attitude (mean difference, 2.6), practice (mean difference, 4.4) and self-efficacy (mean difference, 3.9) of healthy meal preparation as compared with control group across 3-time points. Improvements were seen in the availability of fruits (mean difference, 3.0; P < 0.001), vegetables (mean difference, 2.4; P < 0.001), healthful foods (mean difference, 1.5; P < 0.001) and less healthful foods (mean difference, ?0.9; P = 0.001), favoring the intervention group.Conclusion and ImplicationsCulinary nutrition education had positive impact on children's psychosocial factors and home food availability, demonstrating the potential to improve children's nutrition.     

Impact of the Updated USDA School Meal Standards,Chef-Enhanced Meals,and the Removal of Flavored Milk on School Meal Selection and Consumption

BackgroundIn Fall 2012, updated US Department of Agriculture school meal standards went into effect and did not result in increased food waste overall. However, consumption of school foods, especially fruits and vegetables, remains low. Therefore, strategies to improve school meal consumption are necessary.ObjectiveThis study evaluated the combined impact of the updated school meal standards and chef-enhanced, healthier meals, and the removal of flavored milk on students’ school food selection and consumption compared with students in control schools.DesignThe Project MEALS (Modifying Eating and Lifestyles at School) study was a cafeteria-based quasi-experimental intervention conducted during the 2012 to 2013 school year.Participants/settingParticipants were students (n=1,309) in grades 3 through 8 attending four intervention and four control schools in two low-income, urban school districts.InterventionChef-enhanced school meals and the removal of flavored milk combined with the updated US Department of Agriculture school meal standards.Main outcome measuresChanges in school meal selection and consumption were examined using plate waste methodology.Statistical analyses performedLogistic regression and mixed-model analysis of variance adjusting for student demographics and schools/students as a random effect (students nested within schools) were used to examine differences in selection and consumption before (Fall 2012) and after (Spring 2013) a chef-based intervention with the updated school meal standards.ResultsAfter the chef-based intervention was implemented, there were no significant differences in entrée, vegetable, or fruit selection. Significantly fewer students selected milk compared with students in control schools (56.8% vs 94.0%; P<0.0001) and milk consumption was significantly lower (54.8% vs 63.7%; P=0.004). However, consumption was significantly greater for vegetables (62.2% vs 38.2%; P=0.005) and fruits (75.2 vs 59.2%; P=0.04) in the intervention schools compared with control schools. There were no significant differences in entrée consumption.ConclusionsSchools collaborating with chefs can be an effective method to improve the consumption of fruits and vegetables with the updated US Department of Agriculture school meal standards. Further research should examine the longer-term impact of the removal of flavored milk from schools to determine whether the lower selection and consumption rates persist.     

Cooking Matters for Kids Improves Attitudes and Self-Efficacy Related to Healthy Eating and Cooking

ObjectiveTo assess changes in self-efficacy and attitudes related to healthy eating and cooking in Cooking Matters for Kids participants.DesignPrepost study design.SettingCooking Matters for Kids programs offered by 35 organizations.ParticipantsPredominantly third- to fifth-grade children participating in Cooking Matters for Kids lessons during fiscal years 2012–17 with matched presurvey and postsurveys (n = 18,113).Intervention(s)Cooking Matters for Kids consists of six 2-hour experiential nutrition and cooking education lessons.Main Outcome Measure(s)Self-efficacy related to healthy eating and cooking and attitudes toward healthy foods assessed through the Cooking Matters for Kids Participant Survey.AnalysisChanges from the presurvey to postsurvey were assessed using mixed models and repeated measures ordered logistic regression accounting for clustering by course. Effect sizes were calculated using Cohen d for repeated measures. A Bonferroni adjustment was used to correct for multiple comparisons (α = 0.025).ResultsBoth overall and individual self-efficacy and attitude scores improved from presurvey to postsurvey (P < 0.0001). The effect sizes were 0.35 for overall self-efficacy score and 0.17 for overall attitude score.Conclusions and ImplicationsParticipation in Cooking Matters for Kids was associated with improvements in self-efficacy and attitudes related to healthy eating and cooking.     

Child Involvement in Choosing a Recipe,Purchasing Ingredients,and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia

ObjectiveTo investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment.DesignQuasi-experimental.SettingTwo schools in Bilbao, Spain.ParticipantsA total of 202 children (aged 8–9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group.InterventionThree 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities.Main Outcome MeasuresFood neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches.AnalysisChi-square test of independence, ANCOVA, and t tests were performed.ResultsStudents from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups.Conclusions and ImplicationsBoth interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.     

Impact of a School-Based Cooking Curriculum for Fourth-Grade Students on Attitudes and Behaviors Is Influenced by Gender and Prior Cooking Experience

ObjectiveTo compare effects of the Cooking With Kids (CWK) cooking and tasting curriculum (CWK-CT) with a less-intense, tasting-only curriculum (CWK-T) and to conduct a non-treatment comparison on fourth graders' cooking self-efficacy (SE), cooking attitudes (AT), and fruit and vegetable preferences (FVP).DesignPre–post, quasi-experimental, 2 cohorts.SettingEleven low-income public schools in a Southwestern city.ParticipantsFourth-grade students, 50% female and 84% Hispanic.InterventionsSchool-based experiential nutrition education program of 5 2-hour cooking and/or 5 1-hour fruit and vegetable tasting lessons throughout the school year.Main Outcome MeasuresCooking self-efficacy, AT, and FVP were assessed with 3 tested, validated scales administered in a 37-item survey pre- and post-classroom intervention.AnalysisGeneral linear modeling with gender and prior cooking experience were fixed factors.ResultsAmong 961 students, CWK positively affected FVP, especially in CWK-CT students and males (P = .045 and .033, respectively); vegetable preference drove this outcome. Independent of treatment, students without cooking experience (61% male) had more than twice the gains in cooking self-efficacy (P = .004) and an improved AT response (P = .003).Conclusions and ImplicationsCooking With Kids increased FVP, especially with vegetables. Greatest gains in preferences and self-efficacy were seen in boys without prior cooking experience. For fourth graders, experiential nutrition education improved cognitive behaviors that may mediate healthful food choices.     

Exacerbated Postprandial Oxidative Stress Induced by the Acute Intake of a Lipid Meal Compared to Isoenergetically Administered Carbohydrate,Protein, and Mixed Meals in Young,Healthy Men

Objective: To compare the oxidative stress response following isocaloric consumption of a lipid, carbohydrate, protein, and mixed meal.

Design: Ten young (27.3 ± 7.0 years), healthy (body mass index = 24.9 ± 4.0 kg·m^?2) men consumed isocaloric test meals on 4 separate days, separated by 1 week, in a random-order crossover design. Blood samples were collected premeal and at 1, 2, 4, and 6 hours postmeal and assayed for various markers of oxidative stress, as well as triglycerides (TAG) and glucose. Total area under the curve (AUC) was calculated for each variable, and a 4 × 5 analysis of variance (ANOVA) was used to further analyze data.

Results: Significant meal effects were noted for hydrogen peroxide AUC (p = 0.004), with values higher for the lipid meal compared with all other meals (p < 0.05). Contrasts revealed greater AUC for TAG (p = 0.05), malondialdehyde (p = 0.002), and nitrate/nitrite (p = 0.02) for the lipid meal compared with the protein meal. With regard to the ANOVA, oxidative stress values were highest for the lipid meal and increased from 2–6 hours postmeal following lipid ingestion (p < 0.05). No other meals resulted in a significant increase in oxidative stress (p > 0.05).

Conclusions: These data indicate that when controlling for total dietary energy, a lipid meal results in the greatest increase in postprandial oxidative stress in a sample of young, healthy men.     

Impacts of A Taste of African Heritage: A Culinary Heritage Cooking Course

ObjectiveTo examine changes in cooking and dietary behaviors and health outcomes following participation in A Taste of African Heritage, a culinary heritage cooking course.DesignOne group, pre-post program design, surveys, and physical assessments.SettingCommunity centers, churches, health care settings, homes, and housing complexes.ParticipantsParticipants (n = 586, 84% women) were recruited by partner organizations from 2013–2018 across 21 states and the District of Columbia.Intervention(s)A 6-week cooking curriculum that teaches history, nutrition, and cooking techniques to reconnect participants with the vibrant, healthy traditions of the African Diaspora.Main Outcome Measure(s)Weekly frequency of cooking, food group intake, and exercise assessed by surveys, measured weight, waist circumference, and blood pressure.AnalysisLinear and logistic mixed-effects models with random intercepts for participant and teacher, sex and site type as covariates comparing pre-post physical measurements and binary behavioral outcomes, P < 0.0033 for statistical significance after Bonferroni correction.ResultsIntake frequencies of fruit, vegetable, and greens and exercise frequency were improved from preprogram to postprogram (all P < 0.0021). Weight, waist circumference, and systolic blood pressure were also improved from preprogram to postprogram (all P <0.0001).Conclusions and ImplicationsParticipation in A Taste of African Heritage was associated with positive behavior changes and health outcomes. Integrating cultural heritage and behaviors are positive components to connect participants to healthy old ways or traditions.     

Ecological Momentary Assessment of the Breakfast,Lunch, and Dinner Family Meal Environment in Racially/Ethnically Diverse and Immigrant Households

ObjectiveTo describe meal characteristics across breakfast, lunch, and dinner family meals in racially/ethnically diverse and immigrant/refugee households via ecological momentary assessment; identify real-time meal characteristics associated with family meal frequency; and identify qualitative themes regarding parents’ perspectives about meal characteristics and meal types that influence family meal frequency.DesignCross-sectional study.SettingIn-home visits.ParticipantsChildren aged 5–7 years (n = 150) and their families from diverse and low-income households.Main Outcome Measure(s)Mixed methods.AnalysisMultiple linear regression and hybrid deductive and inductive content analysis.ResultsQuantitative results indicated several similar meal characteristics occurring across weekdays and weekend days and by meal type (eg, parent prepared the meal, food mostly homemade, meal eaten at table) and some significant negative associations (P < .05) between meal characteristics and family meal frequency (eg, fast food for family meals). Eight main qualitative themes with several subthemes supported and expanded the quantitative findings and added depth to interpretation of the findings.Conclusions and ImplicationsResults identified specific meal characteristics both quantitatively and qualitatively that may inform the development of interventions to increase the frequency of family meals so that more families can benefit from the protective nature of family meals.     

Family Meals among New Zealand Young People: Relationships with Eating Behaviors and Body Mass Index

ObjectiveTo examine the relationship between family meals and nutrition behaviors of adolescents.DesignSecondary analysis of Youth'07, a nationally representative survey.SettingSecondary schools in New Zealand.ParticipantsRandomly selected adolescents (aged 13-17 years, n = 9,107) completed a multimedia and anonymous survey about their health.Variables MeasuredBody mass index and eating behaviors.AnalysisMultiple logistic regression equations were used to determine the associations between family meals and body size and dietary behaviors, controlling for demographic variables.ResultsNearly 60% of young people shared a meal with their families 5 or more times in the previous week. Frequent family meals were associated with greater consumption of fruits and vegetables (P < .001), and breakfast (P < .001). Adolescents who frequently shared family meals were also more likely to report that what they ate in the past week was healthy than adolescents who did not (P < .001). There was no relationship between frequency of family meals and body mass index (P = .60).Conclusions and ImplicationsData from the current study suggest that family meals cannot be used as a single strategy for obesity prevention, but they may provide an important opportunity for young people to consume healthy food.     

Watching TV Cooking Programs: Effects on Actual Food Intake Among Children

ObjectiveTo test the effects of a cooking program on healthy food decisions.DesignAn experimental between-subjects design with 3 conditions: healthy, unhealthy, and control.SettingClass settings in 5 different schools.ParticipantsOne hundred twenty-five children between 10 and 12 years of age.InterventionsVideo clips of cooking program containing healthy foods versus cooking program containing unhealthy foods versus control program.Main outcome measuresHealthy versus unhealthy food choice.AnalysisLogistic regression analysis, with the control condition as a reference in the first contrast test and the unhealthy food condition as a reference in the second contrast, to examine effects on food choice between conditions.ResultsChildren who watched the cooking program with healthy foods had a higher probability of selecting healthy food than children who watched the cooking program with unhealthy foods (P = .027), or with the control condition (P = .039).Conclusions and ImplicationsThese findings indicated a priming effect of the foods the children were exposed to, showing that nutrition education guided by reactivity theory can be promising. Cooking programs may affect the food choices of children and could be an effective method in combination with other methods to improve their dietary intake.     

Impact of a Behavioral Intervention on Diet,Eating Patterns,Self-Efficacy,and Social Support

ObjectiveTo examine the effectiveness of a structured multimodal behavioral intervention to change dietary behaviors, as well as self-efficacy and social support for engaging in healthier diets.MethodsA quasi-experimental design was used to assign sites into intervention and comparison groups. Data were collected at baseline, 3 months, and 6 months. The intervention group participated in Texercise Select, a 12-week lifestyle enhancement program. Multiple mixed-effects models were used to examine nutrition-related changes over time.ResultsFor the intervention group, significant improvements were observed for fast food consumption (P = .011), fruit/vegetable consumption (P = .008), water consumption (P = .009), and social support (P < .001) from baseline to 3 months. The magnitude of these improvements was significantly greater than changes in the comparison group.Conclusions and ImplicationsFindings suggest the intervention's ability to improve diet-related outcomes among older adults; however, additional efforts are needed to maintain changes over longer periods.     

Geospatial Reach of the Maryland COVID-19 School Meals Response: Spring 2020

ObjectiveExamine characteristics of pandemic meal site (n = 602) location and meals served per site in Maryland, Spring 2020, following federal/state waivers for local meal site placement decision-making.MethodsUsing geographic information systems, we connected meal sites to census tract-level data and generated service areas from sites and distances from population-weighted census tract centroids to the closest pandemic meal site. Regression analysis determined associations of census tract pandemic meal site count and meals served per site with socioeconomic and demographic variables.ResultsCensus tracts with more meal sites were urban (P < 0.001), food deserts (P < 0.001), and had higher percentages of children in poverty (P < 0.001). Sites serving fewer meals were in food deserts (P < 0.001) and areas with more children in poverty (P < 0.001).Conclusions and ImplicationsWaivers allowing local meal site placement decision-making supported meal sites in high-need areas. Geospatial approaches could optimize site locations to ensure maximum reach to populations in need. Additional supports may be needed to ensure children in poverty areas receive meals distributed at these sites.     

Evaluation of diet quality and its associated factors among adolescents in Kuala Lumpur,Malaysia

BACKGROUND/OBJECTIVES

This study aims to determine contribution of meal frequency, self-efficacy for healthy eating, and availability of healthy foods towards diet quality of adolescents in Kuala Lumpur, Malaysia.

SUBJECTS/METHODS

This study was conducted among 373 adolescents aged from 13 to 16 years old. Diet quality of the respondents was assessed using the Healthy Eating Index for Malaysians. Meal frequency, self-efficacy for healthy eating, and availability of healthy foods were assessed through the Eating Behaviours Questionnaire (EBQ), self-efficacy for healthy eating scale, and availability of healthy foods scale, respectively.

RESULTS

The majority of the respondents (80.7%) were at risk of poor diet quality. Males (mean = 34.2 ± 8.2%) had poorer diet quality than females (mean = 39.9 ± 9.0%) (t = -5.941, P < 0.05). Malay respondents (mean = 36.9 ± 8.7%) had poorer diet quality than Indian respondents (mean = 41.3 ± 10.0%) (F = 2.762, P < 0.05). Age (r = 0.123, P < 0.05), self-efficacy for healthy eating (r = 0.129, P < 0.05), and availability of healthy foods (r = 0.159, P < 0.05) were positively correlated with the diet quality of the respondents. However, meal frequency was not correlated with the diet quality of the respondents. Multiple linear regression analysis showed that being a male, being a Malay, low self-efficacy for healthy eating, and low availability of healthy foods contributed significantly towards poor diet quality among respondents.

CONCLUSIONS

In short, sex, ethnicity, self-efficacy for healthy eating, and availability of healthy foods were associated with diet quality among adolescents. Health practitioners should take into consideration of differences in sex and ethnicity during implementation of nutrition-related intervention programs. Self-efficacy for healthy eating and availability of healthy foods should be included as important components in improving diet quality of adolescents.     

Foods Served in Child Care Programs Participating in the Child and Adult Care Food Program and Alignment with Program Meal Patterns

ObjectiveAssess Child and Adult Care Food Program (CACFP) program compliance with meal component requirements for children aged 3-5 years by program type, and describe foods and beverages most commonly served.DesignCross-sectional analysis of 1-week menu surveys during winter/spring 2017.SettingUS CACFP-participating child care programs.ParticipantsNationally representative multistage cluster sample of 664 programs: 222 child care centers, 247 Head Start programs, 195 family child care homes.Main Outcome Measure(s)Percentage of meals including required components; frequently served foods and beverages.AnalysisMean percentages; 2-tailed t tests; alpha = 0.05 significance level.ResultsMost breakfasts (97%), lunches (88%), and afternoon snacks (97%) included all required CACFP meal components. Most breakfasts included fruits (96%), but not vegetables; 16% included a meat/meat alternate. Most lunches (81%) included both fruits and vegetables. Afternoon snacks were mostly grains/breads (80%) and fruits (57%). Most frequently served foods included 1% unflavored milk and fresh fruits such as apples and bananas. Most menus limited juice, offered low-sugar cereal, and did not include flavored milk; very few menus included noncreditable foods with added sugar.Conclusions and ImplicationsMost CACFP meals provided required components, but there is room for improvement, particularly for increasing vegetables served and limiting foods high in added sugar and fat.