Search Results (218)

Background and Aims: Anaphylaxis is a severe allergic reaction that can lead to life-threatening consequences. Despite growing awareness of food allergies, schools in Saudi Arabia remain underprepared to manage allergic reactions. This study aimed to evaluate the preparedness of primary schools in Rabigh, Saudi Arabia, in managing allergic reactions, with a focus on their policies and training practices to prevent food-related anaphylaxis. Methods: A cross-sectional survey was conducted involving all 24 primary schools in Rabigh. We used a previously published questionnaire that was translated into Arabic and contextually adapted; however, no formal psychometric validation was performed. The questionnaire assessed school preparedness to manage allergic reactions and existing protocols for allergy management. Data were analysed using IBM SPSS Statistics version 25 to examine associations between preparedness level and the presence of pupils with food allergy or anaphylaxis. Results: Nineteen schools (79%) completed the survey. Most schools (95%) had emergency communication systems, and 74% designated a staff member to manage allergic reactions. However, only 58% were aware of pupils with food allergies. Preventive measures such as food-handling guidance and a no-nut policy were present in most schools. Still, policies against food sharing and closer supervision of high-risk pupils were inconsistently implemented. A comparison between schools with and without pupils with allergies revealed that schools with such pupils were more likely to identify allergy risks and provide closer supervision during mealtimes (p = 0.042). Conclusions: While some primary schools in Rabigh reported strengths such as designated staff and emergency communication systems, substantial gaps were observed in preventive measures, including mealtime supervision and food-sharing policies. Preparedness varied across schools, with those without known allergic pupils less likely to implement preventive practices. These findings underscore the importance of standardised policies and regular staff training to ensure readiness for allergic emergencies in all schools. Full article

Farm-to-school (F2S) partnerships connect schools with local producers to enhance student access to healthy, local foods and support regional food systems. Despite widespread implementation, few studies have examined the system-level structures that facilitate effective and sustainable F2S efforts across diverse community contexts. This study utilized a mixed-methods system mapping approach to analyze four F2S systems on California’s Central Coast. Data sources included public data sources, in-person site observations, and local expert resources. The researchers hypothesized that successful F2S systems would share core features that support implementation and long-term sustainability, including aligned values among stakeholders, the presence of identified champions, and multi-directional pathways for food procurement and communication. They constructed system maps and compared them in order to identify both common structural features and context-specific adaptations. Findings support the hypothesis and highlight the critical role of community-based organizations and distributors and/or aggregators in brokering relationships, coordinating resources, and reducing administrative burdens. Institutionalization through wellness policy integration and district-level support further distinguished higher-functioning systems. Identified barriers included inequities in procurement infrastructure, limited funder engagement, and uneven access to local food sources. System mapping offers a valuable tool to understand, strengthen, and scale equitable F2S implementation. Full article

Background: School lunch programs play a crucial role in shaping the nutritional status and academic performance of children, making them a cornerstone of public health initiatives worldwide. Objective: To elucidate emerging trends and propose a comprehensive framework for free school lunch as a nutrition policy through a combined bibliometric approach and critical review. Methods: A bibliometric analysis was performed to identify key thematic areas, influential research, and knowledge gaps from global literature databases, followed by a critical review synthesizing insights on nutritional adequacy, socio-cultural considerations, policy effectiveness, and innovative practices in free school meal programs. Results: The analysis revealed an increasing focus on sustainability, food waste management, and integration of nutrition education within school curricula, alongside notable disparities in implementation and accessibility, particularly in low-income regions. Conclusions: We propose a future-oriented framework emphasizing stakeholder collaboration, culturally adaptive meal designs, and utilization of technology for personalized nutrition strategies, contributing to the optimization of school lunch programs and advancement of sustainable development goals, particularly Zero Hunger and Quality Education. Full article

Background/Objectives: Policy implementers play a crucial role in the effective delivery of policies aiming at promoting a healthy lifestyle in the most vulnerable populations. This study aimed to explore (a) policy implementers’ knowledge and perceptions of the policy framework promoting physical activity and healthy nutrition among children in need in Greece, and (b) self-perceived barriers and facilitators of the framework implementation. The term children in need refers to children who are at risk of poverty and/or social exclusion. Methods: A qualitative study design was employed consisting of semi-structured interviews with 25 policy implementers, who represented four delivery systems (health, social protection, food, and education sectors) from three geographical regions in Greece. Interviews were completed between November and December 2023. Thematic analysis was conducted using inductive and deductive approaches to identify key themes, following data management in the N-VIVO 14 software. Results: Commonly mentioned policies that study participants were involved in included school- and/or community-level-based behavioral interventions. Participants perceived policy implementation efforts that often relied on individual initiatives as inconsistent. Most participants argued that existing policies were not tailored to the needs of children in need. Major self-perceived barriers included limited personnel training, limited facilities and infrastructure, and lack of incentives or opportunities to encourage active participation. Major self-perceived facilitators included personnel motivation, integration of nutrition and physical education into school curricula, and provision of free school meals, which was associated with regular school attendance of children from the Roma communities. Conclusions: Individual, sociocultural, and structural issues are shown to persist across different delivery systems indicating the complexity of tackling obesogenic environments, especially among children in need. This is the first study in Greece to provide evidence on self-perceived barriers and facilitators and could inform ongoing national and European efforts to address obesogenic environments in children in need. Full article

Background/Objectives: Dietary patterns have changed over time, characterising a process of nutritional transition that reflects socioeconomic and demographic inequalities among different populations. This study assessed changes in dietary consumption patterns and the associated social determinants, comparing two time periods in a sample of individuals from a state in the Northeast Region of Brazil. Methods: Data from the 2008–2009 and 2017–2018 Household Budget Survey for the state of Paraíba were analysed, totalling 951 and 1456 individuals, respectively. Foods were categorised according to the NOVA classification and compared based on sociodemographic and economic variables. To determine the factors that most strongly explain the contribution of each NOVA food group to the diet, beta regression analysis was conducted. Results: Differences were observed between the two periods regarding the dietary contribution of the NOVA food groups, with a decrease in consumption of unprocessed foods and an increase in ultra-processed foods. Living in urban areas, being an adolescent, and having an income above the minimum wage were associated with reduced intake of unprocessed foods in both periods. Additionally, being an adolescent and having more than eight years of schooling were associated with higher consumption of ultra-processed foods. Conclusions: The population under study showed changes in food consumption, reflecting a transition process that is occurring unevenly across socioeconomic and demographic groups, thereby reinforcing social inequalities. These findings can guide priorities in food and nutrition policies, highlighting the need for intervention studies to evaluate the effectiveness of such actions. Full article

Background: Current food systems contribute significantly to poor public health and environmental degradation. With increasing rates of chronic disease and undernutrition globally and in the United States of America (U.S.), transforming food systems toward sustainability is a critical public health priority. Objectives: This narrative review aimed to summarize U.S. policies from the past decade relevant to sustainable food systems, focusing on four domains—availability, accessibility, affordability, and desirability—proposed by the 22nd Annual Harvard Nutrition Obesity Symposium. Methods: Systematic searches were conducted using MEDLINE (PubMed), Scopus, U.S. Congress websites, and Google searches. Studies and policies published between 2013 and 2023 that addressed at least one of the four domains were included. Policies were reviewed according to their alignment with the policy lifecycle framework, encompassing formulation through implementation. Results: A review of the final 632 articles explained that, despite growing interest in sustainable food systems, there is a lack of comprehensive U.S. policies that address the four domains in an integrated manner. Most initiatives were limited in scope, often school-based, and not explicitly sustainability-focused. Food availability and accessibility policies exist but remain fragmented, while affordability and desirability domains are severely underrepresented. Few laws or bills have been enacted or evaluated for population-level or environmental outcomes. Conclusions: Transforming U.S. food systems requires more robust evidence-based policy development and evaluation. There is an urgent need for integrated multisectoral policy frameworks to ensure health, equity, and sustainability across all food system domains. Full article

This study aimed to investigate food insecurity (FI) and its association with sociodemographic characteristics and behavioral and dental alterations in adolescents from a county in the inland of northeastern Brazil. Data on 192 adolescents aged 11–14 years were analyzed in the public school system in Juripiranga, Paraíba, Northeast Brazil. The adolescents and their guardians responded to the Brazilian Food Insecurity Scale, the Strength and Difficulties Questionnaire for the caregiver, the Strength and Difficulties Questionnaire for children and adolescents, and a sociodemographic questionnaire. Academic performance was observed by calculating the median of the final assessments of basic school subjects. The prevalence of FI was 69.19, and FI was associated with a family income of up to one minimum wage per month (prevalence ratio [PR]: 1.90; 95% confidence interval [95% CI]: 1.20–3.01), no practice of religion by the guardian (PR: 1.34; 95% CI: 1.04–1.73), behavior considered inappropriate by the guardian (PR: 1.33; 95% CI: 1.02–1.73), and academic performance (PR: 1.35; 95% CI: 1.05–1.72). FI is considered a complex and multifactorial problem that requires appropriate intervention to deal with multiple social determinants. The results point to the need for integrated public policies between the health, education, social assistance, and food security sectors. Full article

Background: While previous research on children’s diets has primarily focused on individual nutrients or foods, recent years have seen increasing attention to the analysis of dietary patterns. In school-aged children enrolled in the CroCOSI study, this research focused on identifying the dietary patterns and examining their potential links with childhood obesity. Methods: Data were collected from a nationally representative sample comprising 5608 children aged 7–10 years and their parents in this cross-sectional study. To evaluate the nutritional status of the children, BMI-for-age was assessed using z-score values. Results: A factor analysis using data from the FFQ revealed three dietary patterns: Western, Healthy, and Breakfast. Children who scored high for consumption of fruits, vegetables, fish, cheese, dairy products, and 100% fruit juice were categorized into the Healthy dietary pattern, whereas those with high scores for cereals and milk were assigned to the Breakfast dietary pattern. Conclusions: The Western dietary pattern did not show a significant relationship with obesity among school-aged children (OR = 1.00, 95% CI: 0.98–1.00; p = 0.11). The risk of obesity was lower among children following the Healthy (OR = 0.98, 95% CI: 0.98–0.99; p = 0.045) and Breakfast (OR = 0.96, 95% CI: 0.95–0.99; p = 0.001) dietary patterns.The results can help in creating food policies with the aim of reducing childhood obesity in Croatia. Full article

Background: Food insecurity and poor diet quality disproportionately affect U.S. children from low-income households, with summer school closures exacerbating risks. Federally funded programs like the Summer Food Service Program (SFSP) and SUN Bucks (Summer EBT) aim to address these challenges, yet evidence of their post-pandemic dietary impact remains limited. Objectives: This study examines the relationship between policy innovations, summer meal participation, food insecurity, and diet quality among children from low-income households in Prince George’s County, Maryland. Methods: A cross-sectional design analyzed data from 158 households in Prince George’s County Public Schools across two waves (early fall 2022 and 2023). Validated tools (USDA’s Six-Item Short Form and Dietary Screener Questionnaire) assessed food security and diet quality. Sociodemographic factors, program participation, and dietary deviations from the 2020–2025 Dietary Guidelines were analyzed. Multivariate logistic regression identified determinants of poor diet quality (≥2 guideline deviations), adjusting for ethnicity, age, and housing stability. Results: Only 32.28% of eligible households participated in summer meal programs, with non-participation driven by lack of awareness (53.68%) and transportation barriers (11.58%). Significant dietary gaps included inadequate whole grain intake (0.8 vs. 3.0 servings/day) and excessive added sugars (14% of daily calories). Summer meal participation was associated with reduced odds of poor diet quality (OR = 0.23, p = 0.030), while older age (OR = 52.97, p < 0.001) and very low food security (OR = 8.42, p = 0.036) increased risk. Hispanic ethnicity had lower odds (OR = 0.17, p = 0.019) despite higher baseline food insecurity. Conclusions: Summer meal participation was associated with improved dietary outcomes but faced systemic participation barriers. Findings support policy reforms, such as multilingual outreach and mobile meal distribution, to address identified gaps. Full article

Background: Children, including the estimated 7% with food allergy, spend most of their waking hours in school. Variations in school-based food allergy (FA) practices exist. We aimed to examine differences in FA management practices across schools in Canada and the United States (US). Methods: Parents of children with Immunoglobulin E (IgE)-mediated FA were recruited through social media to complete a survey evaluating the schools’ stock epinephrine, epinephrine storage locations, school type, and location. Data were described, analyzed using logistic and linear regressions, and then reported as odds ratios (ORs) and standardized coefficients (b), respectively, with corresponding 95% confidence intervals (95%CIs) and p < 0.05. This study was approved by the University of Manitoba Health Research Ethics Board. Results: Overall, 177 participants (14% [26/177] Canada, 86% [151/177] US) were included. Children were, on average, 4.92 ± 3.12 years and were commonly but not mutually exclusively allergic to tree nuts (50% Canada; 40% US) and peanuts (33% Canada; 29% US). Compared to US parents, Canadian parents were more likely to report epinephrine self-carriage by their children (OR = 4.58; 95%CI = 1.67–12.59). Parents with children age > 5 years were more likely to report epinephrine self-carriage by their children (OR = 3.70; 95%CI = 1.38–9.93) but less likely to report that their children’s school had an allergen-friendly zone (OR = 0.25; 95%CI = 0.06–0.99). Compared to US parents, Canadian parents were more likely to report their child’s school had anaphylaxis management policies (OR = 8.98; 95%CI = 1.11–72.42). Conclusions: Significant in-school FA management differences exist between countries. These findings stress the need for consistent policies and practices to ensure effective care. Full article

Objective: The objective of this article was to perform a comparative analysis of the changes in the availability of commercial food establishments around the schools in a Brazilian capital city. Methods: This is a comparative analysis between two cross-sectional panels performed in 2012 and 2019 in Florianópolis, Santa Catarina, Brazil. Secondary data from different sources were used. The location data of schools and establishments were georeferenced. For the analysis of the surroundings of schools, a network buffer of 800 m was considered. The establishments were classified based on the foods they primarily sold: fresh, mixed and ultra-processed foods. The chi-square and Wilcoxon tests were applied for the analyses, considering a significance level of 95% (p < 0.05). Results: The number of food establishments around schools increased by 63%. There was a statistically significant growth in mixed (p = 0.008) and ultra-processed (p = 0.024) food- selling establishments. Conclusion: We conclude that the increase in establishments selling ultra-processed foods around schools at the expense of establishments selling fresh food deserves attention. This condition requires public policies that help promote healthier environments, thus contributing to the health of schoolchildren. Full article

School food policy (SFP) that promotes nutritional behaviour is a national priority. Despite the role of school principals, teachers, and food service staff (FSS) in implementing SFP, their contribution to the current state of school food policy remains unexplored. The study aims to explore the perspective of these stakeholders on the effectiveness of SFP, barriers, and future recommendations for effective implementation. A qualitative study using 24 key informants interviews including principals (n = 6), teachers (n = 12), and FSS (n = 6) was conducted. From the list of private secondary schools, six schools were randomly selected. Principals, teachers, and FSS were selected through purposive sampling. A thematic approach was adopted for the data analysis. Interview data were categorised into three broad themes: (1) availability of school food policy, (2) barriers to enforcement, and (3) recommendations. Most participants stated that policy implementation is not enforced. The barriers are non-prioritised funding, resistance to change, and time constraints. The recommendations include regular training, activity manual development, seasonal food promotion, nutrition education, and leadership support. The study provides a deeper understanding of the role of key stakeholders in the current state of the effectiveness of SFP implementation. The inclusion of stakeholders is essential for a successful school food policy. Full article

Background: Food waste is a significant global issue with environmental, social, and economic consequences. In 2022, approximately 1.05 billion tons of food were wasted worldwide, with 220 million tons lost during the production and processing stages. Strategies to reduce food waste include full food utilization and the reuse of clean leftovers, which promote food security, efficient resource use, and the valorization of nutrients found in food. Objective: The aim of this study was to map existing scientific literature on nutritional intervention programs that incorporate full food utilization and the reuse of clean leftovers as tools for promoting sustainability and reducing food waste. The review seeks to consolidate existing knowledge, support public policy development, and encourage the adoption of sustainable food practices. Methods: A scoping review was conducted based on the Joanna Briggs Institute (JBI) manual and following the PRISMA-ScR checklist. The search was conducted in four scientific databases (PubMed, Embase, Cochrane Library, and Virtual Health Library) and included articles published between 2014 and 2025. Intervention studies promoting full utilization of plant-based foods and the reuse of clean leftovers were included. Results: After analyzing 2268 studies, 14 relevant studies were selected, with interventions including culinary workshops and educational programs on using parts of food typically discarded, such as peels and seeds. These programs were successful in reducing waste and promoting more sustainable and nutritious diets. Conclusions: Nutritional intervention programs that promote full food utilization and clean leftover reuse are effective in reducing waste and fostering sustainable diets. To maximize their impact, these practices should be integrated into public policies and scaled in institutional settings such as schools, hospitals, and community kitchens. Full article

Background: The prevalence of overweight and obesity has increased over the last three decades, becoming a major public health concern. This issue is particularly pressing in terms of the impact it has on the population of the Kingdom of Saudi Arabia (KSA). Thus, the aim of this research was to explore the nutritional and lifestyle habits of youth in the Al-Ahsa region of the KSA. Methods: This cross-sectional study included a total of 1270 secondary-school boys and girls (15–19 years) from all five of the Al-Ahsa Governorate districts. BMI and waist circumference measurements were recorded using anthropometric measurements, and the lifestyle–Arab Teens Lifestyle Survey (ATLS) was used to measure sedentary and eating habits. Results: Chi-square analysis revealed that a higher proportion of females (90.68%) than males (79.18%) exceeded two hours of daily sedentary time. Frequent sugary drink consumption (>3 times per week) was similar in males (67.40%) and females (66.11%). Students from different geographical locations showed significant differences in exceeding cut-off scores for fast food (χ² = 24.503, p < 0.001), cakes/doughnuts (χ² = 8.414, p = 0.015), sweets/candy (χ² = 19.613, p < 0.001), and energy drinks (χ² = 21.650, p < 0.001). Conclusions: Al-Ahsa is the largest governorate in the KSA. It has some of the largest health risks regarding obesity and poor lifestyle habits. This study highlights the major need for future research and policy interventions. Full article

Agroforestry systems (ASs) are increasingly recognized as effective strategies for ecological restoration and sustainable land use in semi-arid regions. This study aimed to evaluate the implementation and early outcomes of an AS established in a degraded urban area in the Brazilian semi-arid region. Specifically, we analyzed the system’s establishment process, estimated its costs, assessed structural development over time, and compared species performance and carbon accumulation across different biodiversity arrangements. After three years, the system accumulated 17.69 Mg ha⁻¹ of carbon and demonstrated significant basal area growth, particularly among fast-growing species such as Ceiba glaziovii, Gliricidia sepium, and Moringa oleifera. These species enhanced overall system productivity and likely contributed to increases in soil organic matter, facilitating the establishment of more demanding, slow-growing species. Cost analysis indicated a total implementation and maintenance estimate of BRL 57,468.79 ha⁻¹ (USD 11,096.29) over three years, with irrigation and maintenance accounting for 44.39%, labor and site preparation 31.59%, and seedling production 24.02%. Although the system proved viable under institutional support, its replicability for smallholders remains dependent on reliable water access or implementation aligned with the rainy season. The use of nursery seedlings enhanced seedling survival and system feasibility. The broader adoption of agroforestry in semi-arid regions will require supportive public policies and technical assistance. Strengthening government programs such as PNAE and PRONAF is essential, as these initiatives can promote system adoption by facilitating access to credit while also reducing costs, particularly when short-cycle crops grown within the system are sold to local schools. It is important to note that agroforestry costs vary depending on the intended objectives, species diversity, and arrangement design. Therefore, technical assistance is critical to guiding smallholders in selecting and implementing context-appropriate systems. Our findings reinforce the potential of agroforestry systems to promote carbon sequestration, restore degraded lands, and support food security and sustainable development in climate-vulnerable regions. Full article