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Thesis Defense

Catherine and Emily will rock your world

Catherine Saade

on 13 December 2013

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Transcript of Thesis Defense

Thesis defense
Catherine Saade
Emily Shaw
March 28, 2013

A comparison of nutrients
provided and nutrients consumed
among students with lunches brought from home or lunches served at school

Importance of childhood nutrition
Food and nutrient intake patterns of children
The National School Lunch Program
Evaluation of the National School Lunch Program
Healthier US Schools Challenge
Lunches brought from home
Introduction and Overview
Method development
Subject selection
Informed consent
Validation of methods
Study data collection
Practicing Methods
Visual Estimation of Portion Sizes
Test tray
LBFH were weighed before and after students ate
Researchers' ability to estimate food portions was determined statistically valid
Validation of Methods
SMI standards for NSLP lunches
NSLP lunches were less likely to meet SMI standard for calories
Carbohydrate intake of students with LBFH
No SMI guidelines for cholesterol or sodium
Students who qualified for free or reduced cost lunch but brought lunch from home
Students who did not qualify for a free or reduced lunch brought lunch from home
HUSSC as a voluntary wellness program in schools
Students who participate in NSLP are provided with and consume more nutritious meals than those with LBFH
Beneficial to:
Increase students participation in NSLP
Increase availability of low cost, healthy options offered in schools
Increase home education
Incorporation of wellness programs
Improve quality
Promote health environments
Challenges & Barriers
Insufficient funding and time
Effect on revenue
Need for education and support from non-staff and students
Current environment - possible areas of involvement
School personal to influence nutrition and wellness
Wellness programs/policies
Implemented & follow through
Wharton et al (2008)
Disconnect between school personnel
McDonnell et al (2006)
Involvement of LBFH requirements
How to make changes to LBFH
Chicago school district
Terms and Definitions
Lunches Brought From Home

National School Lunch Program

based on the food that was brought from home or provided at school

what a student actually ate during the lunch period
NSLP vs SMI standards
NSLP participants were more likely to meet SMI standards for:
total fat, protein, calcium, iron, vitamin A, vitamin C
Salad bars
Blanchette and Brug (2005) made recommendations to increase fruit and vegetable intake:
classroom curriculum
parent/home curriculum
school food service
Carbohydrate intake of students with LBFH
Greater proportion of carbohydrate-rich foods than NSLP
cookies, bread, salty snacks, sweets
Carbohydrate intake in NSLP lunches
milk, meat breading and grain mixtures such as tortillas, bread, rolls, pizza crust
Data Collection
Student Selection
Data Collection
"Before" photo
Special Thanks:
Our project team and thesis team-
Dr Ethan Bergman
Tim (MC Data Wi$e) Englund
Linda Cashman
Tracee Watkins
Katie Weigt Taylor

Mom and Dad
Mari and Lex, and all my very much appreciated family and friends for their love and support

Importance of Childhood Nutrition
Nutrition and Obesity
Importance of Childhood Nutrition
Nutrition and Educational Performance
Importance of Childhood Nutrition
Food and Nutrient Intake Patterns of Children
Food and Nutrient Intake Patterns of Children
Evaluation of National School Lunch Program
School Nutrition Dietary Assessment (SNDA)

School Meal Initiative for Healthy Children (SMI)

SNDA-III Findings

Institute of Medicine Recommendations

Krukowski's Findings with IOM Recommendations
National School Lunch Program
Federal Laws Supporting
Healthier US Schools Challenge (HUSSC)
USDA Team Nutrition
Improving quality of food being served
Provide students with nutrition education
Provide students with physical education and opportunities for physical activity
HUSSC Distinction Levels
Lunches Brought From Home
Lack of regulations and research
Rainville (2001)
Johnson et al (2009)
Johnson et al (2012)
The purpose of this study was to
investigate the differences between
what was provided to and consumed
by elementary school students who
attended schools participating in HUSSC. Both NSLP lunches and
LBFH were evaluated and researchers
used digital photography to
collect data.

Method Development
Computer database management system
Digital Photos
Correlated with Student ID numbers
Subject Selection and Informed Consent
Inclusion criteria:
Elementary school in Washington State
HUSSC distinction in 2011-12
Geographic location
Socioeconomic status
Passive consent
Letter to parents/guardians
Opt-out list
Percentage of Students Meeting Provided Nutrients
Within 5% of SMI Guidelines
NSLP versus LBFH
Percentage of Students Meeting Consumed Nutrients
Within 5% of SMI Guidelines
NSLP versus LBFH
Nutrient Content of Provided Lunches VS. Type of Lunch by Free/Reduced Status
Students who qualified for free or reduced cost lunch but brought lunch from home
HUSSC as a wellness program in schools
Mom and Greg
The Shaw family for allowing us to live at their cabin during data collection
My wonderful husband for putting up with me during this process

HUSSC Menu Requirements
HUSSC School Polices
Poor nutrition during childhood is associated with:
Cardiovascular disease
Type II Diabetes
WHO 2010
Over 40 million children <5 years overweight
Prevalence among children age 6-11
1980 - 6.5%
2008 - 19.6%
Nutrients Provided
Nutrients Consumed
Nutrient Content Versus Type of Lunch
Gender of Students Compared to Type of Lunch
Nutrient Content of Consumed Lunches VS. Type of Lunch by Free/Reduced Status
Childhood Obesity
Increased intake of high caloric foods low in nutrient density
Factors Influencing
Poor environmental conditions
Lack of nutrition knowledge
Lack of physical activity
Poor performance associated with poor nutrition
Datar & Strum (2006)
Not-overweight to overweight from K-3rd
Reduction in test scores
Increased behavior problems
More school absences
Figlio & Wincicki (2005)
Key nutrients linked to cognitive ability
Increased test scores with increased calories
Osendarp et al (2007)
Micronutrient supplementation
Increased verbal learning and memory
Recommended Dietary Allowance
Ensure adequacy to meet needs
School lunches provide 1/3 of calories and protein
Uncommon deficiency within American children
Dietary Guidelines for Americans
%30 caloric intake Fat
<10% caloric intake Saturated Fat
Deficiencies - "Malnutrition"
Overabundance of non-nutrient dense foods
Obesity & Micronutrient deficiencies
Garcia et al (2009) - Lower blood concentrations of antioxidants with increased BMI
Offical Journal of the American Academy of Pediatrics
Iron deficiency more prevalent with higher BMI
Lower test scores
Mild iron deficiency has negative effects
Method Development
Custom Database
USDA's Child Nutrition Database
School districts' food service directors
Food manufacturer online resources
Nutrient Information
Calorie, carbohydrate, protein, fat, saturated fat, fiber, sodium, calcium, vitamin C, vitamin A and iron
Child Nutrition Programs
National School Lunch Act
Child Nutrition Act
Agricultural Act of 1949;
Sections 32 and 416
The Styrofoam lunch trays would be placed here, under the web cam, for before and after pictures
Computers were linked so either could be used. This allowed for students to move through the process quicker.
Visually Identified
Verbal consent
Opt out list checked
Numbered tray prior to service
Directed to researchers' table
Lunch unpacked & placed onto numbered tray
"Before" Photo
Student name linked to ID number
ID number & tray number entered into computer system
Picture was taken
Open containers
Food & beverages recorded in "notes"
Instructed to return when they finished eating for "after' photo
Data Collection
"After" Photo
"After" Photo
Returned with tray and remaining food
"Anything consumed not in 'before' picture?"
Removed empty containers, wrappers, etc
Recall before photo using tray number
Picture was taken
Trays thrown away
Data Collection
After photo collection:
Amounts were recorded
Before amounts entered as measured amount or provided portion
After amounts recorded as percent remaining
Linked to date, tray number & student ID
Data Analysis
500 LBFH & 500 NSLP
Data analyzed with IBM SPSS software 21.0
Alpha = 0.05
Chi-square test
Gender influenced LBFH vs NSLP
Key nutrient content of LBFH vs NSLP
Post hoc & t-tests
Provided and consumed considered separately
Chi-square test
Percentage meeting SMI guidelines within 5%
Eligibility status - free or reduced
Demographic information
Nutrient Content of provided and consumed; NSLP versus LBFH
Percentage of students meeting provided and consumed nutrients with 5% of SMI guidelines; NSLP versus LBFH
Nutrient Content of provided and consumed lunches; free/reduced status
Total of 1085 lunches
547 NSLP
538 LBFH
33 students opted out
Demographic Information
759 lunches
354 NSLP
404 LBFH
NSLP lunches were less likely
to meet SMI standard for calories
Should the focus be on calories served?
Dietary needs can be met by addressing nutrient density
Lower nutrient quality, increased caloric density.
A more nutritious meal would have been provided if an NSLP meal had been provided.
Many possible reasons why they may not be receiving NSLP lunch.
Students who did not qualify for free or reduced cost lunch usually brought a lunch from home.
As expected; LBFH were less nutrient dense than NSLP
Implements USDA's requirements
-school-wide practices
Initiatives on a smaller scale
Ex: San Francisco school district
NSLP lunches provided more cholesterol and sodium than LBFH
Mostly from frozen foods; heated to be served
Ex: hamburgers, tacos, burritos, and hot dogs
Changes to reduce sodium and cholesterol served in NSLP may involve training staff to make fresher options
No SMI Guidelines for Cholesterol or Sodium
Full transcript