Suchergebnisse

Abstract Background The 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children's nutrient intake at lunchtime and in total diet by level of deprivation. Methods We conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children's diets. Results 368 and 624 children participated in 2003–4 and 2008–9 respectively. At lunchtime, between 2003–4 and 2008–9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008–9 compared with 2003–4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation. Conclusions By 2008–9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain. Additional interventions to promote equitable nutrition in children are needed to support legislative measures and maximise their impact.

The need to address the increasing obesity rates of children living in the United Kingdom has become a Government priority. It has been recognized that a public health level approach as opposed to an individual approach is potentially one way forward. The wider food environment should be designed so that the 'healthier choice' is the easiest choice; this includes public sector settings such as hospitals. Due to Private Finance Initiative deals many hospitals do not own their premises and therefore do not have control over the types of shops and outlets permitted to operate on site. Many of these outlets sell and promote food and drinks high in sugar, fat and salt undermining health messages developed by the UK National Health Service. Financial incentives have been provided to encourage hospitals to promote healthier food choices; however few outlets have complied with all the set targets. The aim of this qualitative interview study is to determine the dietary perceptions and needs of parents whose children attend a large children's hospital in the North East of England. A purposive sample of parents whose children attend the hospital as an in- or out-patient will be invited to participate in a one-to-one in-depth interview to share their views of the wider hospital food environment. Interviews will be conducted until data saturation is reached and Framework Analysis will be adopted for interview analysis. These findings will inform a larger study to pilot-test an intervention to facilitate healthier food choice in hospital settings.