Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: barriers, facilitators and keys to success
Jilcott Pitts et al., JHND Early View
Healthy foodservice guidelines are being implemented in worksites and healthcare facilities to increase access to healthy foods by employees and public populations. However, little is known about the barriers to and facilitators of implementation. The present study aimed to examine barriers to and facilitators of implementation of healthy foodservice guidelines in federal worksite and hospital cafeterias.
Using a mixed-methods approach, including a quantitative survey followed by a qualitative, in-depth interview, we examined: (i) barriers to and facilitators of implementation; (ii) behavioural design strategies used to promote healthier foods and beverages; and (iii) how implementation of healthy foodservice guidelines influenced costs and profitability. We used a purposive sample of five hospital and four federal worksite foodservice operators who recently implemented one of two foodservice guidelines: the United States Department of Health and Human Services/General Services Administration Health and Sustainability Guidelines (‘Guidelines’) in federal worksites or the Partnership for a Healthier America Hospital Healthier Food Initiative (‘Initiative’) in hospitals. Descriptive statistics were used to analyse quantitative survey data. Qualitative data were analysed using a deductive approach.
Implementation facilitators included leadership support, adequate vendor selections and having dietitians assist with implementation. Implementation barriers included inadequate selections from vendors, customer complaints and additional expertise required for menu labelling. Behavioural design strategies used most frequently included icons denoting healthier options, marketing using social media and placement of healthier options in prime locations.
Lessons learned can guide subsequent steps for future healthy foodservice guideline implementation in similar settings.
Like many Wiley journals, the Journal of Human Nutrition and Dietetics occasionally publishes virtual issues. These are collections of papers that have been previously published in the journal which draw together work around a theme, generally with an associated editorial which discusses the collection. The papers that are presented in the virtual issues are free to access for an unlimited time, at no cost to the authors. The JHND archive of virtual issues contains:
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The new issue of JHND is now available. The issue features sections on Nutrition and pregnancy; Nutrition and childhood; Fatty acids and health; Cardiovascular disease and Coeliac disease.
Vitamin E supplementation inhibits muscle damage and inflammation after moderate exercise in hypoxia
Santos et al., JHND Early View
Exercise under hypoxic conditions represents an additional stress in relation to exercise in normoxia. Hypoxia induces oxidative stress and inflammation as mediated through tumour necrosis factor (TNF)-α release that might be exacerbated through exercise. In addition, vitamin E supplementation might attenuate oxidative stress and inflammation resulting from hypoxia during exercise. The present study aimed to evaluate the effects of vitamin E supplementation (250 mg) on inflammatory parameters and cellular damage after exercise under hypoxia simulating an altitude of 4200 m.
Nine volunteers performed three sessions of 60 min of exercise (70% maximal oxygen uptake) interspersed for 1 week under normoxia, hypoxia and hypoxia after vitamin E supplementation 1 h before exercise. Blood was collected before, immediately after and at 1 h after exercise to measure inflammatory parameters and cell damage.
Percentage oxygen saturation of haemoglobin decreased after exercise and recovered 1 h later in the hypoxia + vitamin condition (P < 0.05). Supplementation decreased creatine kinase (CK)-TOTAL, CK-MB and lactate dehydrogenase 1 h after exercise (P < 0.05). The exercise in hypoxia increased interleukin (IL)-6, TNF-α, IL-1ra and IL-10 immediately after exercise (P < 0.05). Supplementation reversed the changes observed after exercise in hypoxia without supplementation (P < 0.05).
We conclude that 250 mg of vitamin E supplementation at 1 h before exercise reduces cell damage markers after exercise in hypoxia and changes the concentration of cytokines, suggesting a possible protective effect against inflammation induced by hypoxia during exercise.
Core food intakes of Australian children aged 9–10 years: nutrients, daily servings and diet quality in a community cross-sectional sample
Whitrow et al., JHND Early View
The present study aimed to evaluate core food intakes in 9–10-year-old Australian children by considering adequacy of nutrient intakes, comparing servings of core food groups with Australian recommendations and scoring overall diet quality.
Children from an established community-based cohort study completed a semi-quantitative food frequency questionnaire. Daily intakes of energy, macronutrients, micronutrients, servings of core (i.e. nutrient-rich) foods and a diet quality index were calculated and compared with appropriate standards. Sex and socio-economic differences were examined.
The 436 children participating were from low to high socio-economic status families. As a group, over half of the children met estimated average requirements for key macro- and micronutrients, with the exception of fibre (inadequate in 41% of boys and 24% of girls). Children obtained 55% of their daily energy from core foods. Most children had fewer than the recommended servings of vegetables (91%) and meat/alternatives (99.8%), whereas boys generally ate fewer servings of grains and cereals than recommended (87%), and girls ate fewer servings of dairy (83%). Diet quality scores indicated room for improvement (median score of 26 for boys and 25 for girls, out of a maximum of 73 points).
As a group, a large proportion of children were able to meet their daily nutrient requirements. However, achieving this through noncore foods meant that diets were high in salt, saturated fat and sugar; more servings of core foods and greater dietary diversity would be preferable. These results suggest that families need more support to optimise dietary patterns of children in this age group.
A prospective study comparing prophylactic gastrostomy to nutritional counselling with a therapeutic feeding tube if required in head and neck cancer patients undergoing chemoradiotherapy in Thai real-world practice
Pramyothin et al., JHND Early View
Concurrent chemoradiotherapy (CRT) is the standard treatment for head and neck (HN) cancer patients. Most patients experience malnutrition and weight loss during treatment because of mucositis and difficulty in swallowing. Prevention of malnutrition may allow more patients to complete their treatment. The present study aimed to examine whether prophylactic gastrostomy tube (PGT) could reduce treatment interruption, prevent malnutrition and maintain quality of life, especially in Thai patients who generally do not accept feeding tubes.
A prospective study was performed on HN cancer patients undergoing CRT at a tertiary hospital in Thailand (n = 95). Before starting CRT, all patients received nutritional assessment and were counselled about the risks and benefits of PGT. According to patient discretion, they chose to have a PGT (experimental group) or only nutritional counselling with a therapeutic feeding tube if required (control group). During CRT, weight, degree of mucositis, delayed chemotherapy and/or radiotherapy, and nutritional status were recorded. Quality of life (Functional Assessment of Cancer Therapy – Head and Neck Scale; FACT-H&N) was compared between two groups.
There was no significant difference in the rates of delayed treatment. Mean weight loss was 3.1 and 4.8 kg in the experimental and control groups, respectively (P = 0.04). A higher proportion of patients in the control group experienced ≥10% weight loss (24% versus 4%; P = 0.03). In terms of quality of life, no significant difference in FACT-H&N score was found.
The results of the present study suggest that PGT provided similar quality of life without a reduction in treatment interruption. However, patients with PGT had significantly less weight loss (P = 0.04) during CRT.
Health claims using the term ‘sustained energy’ are trending but glycaemic response data are being used to support: is this misleading without context?
Marinangeli and Harding JHND Early View
One of the most recent food trends is the quest for products that provide ‘sustained energy’; a term that is garnering considerable attention within the marketplace. Often, ‘sustained energy’ health claims are based on a food’s post-prandial glycaemic response. However, are generalised health claims regarding ‘sustained energy’ valid when only supported by glycaemic response data? Without context, the short answer is: probably not. Health claims that link sustained energy to a glycaemic response, or any other attribute of a food or diet, require context to ensure that the public correctly interprets and experiences the claimed effect and is not misled in their quest for healthy foods that impose the desired physiological benefit.