Healthy and Safe School Cafeteria Program: a randomized controlled study

BALESTRIN, Mariana; KIRSTEN, Vanessa Ramos; WAGNER, Mario Bernardes

doi:10.1590/1678-9865202235e210265

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Sumário

ORIGINAL • Rev Nutr 35 • 2022 • https://doi.org/10.1590/1678-9865202235e210265 copy

Healthy and Safe School Cafeteria Program: a randomized controlled study

Programa Cantinas Escolares Saudáveis e Seguras: um estudo controlado randomizado

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To assess the effect of an educational intervention program focused on health risk conditions, based on an assessment of the hygiene and quality of food sold in school cafeterias.

Methods

This is a controlled, parallel, randomized, two-arm, community study. Public and private schools with cafeterias were invited to participate. This study was conducted in 27 school cafeterias in northern and northwestern Rio Grande do Sul, a state in southern Brazil. Representatives of the school communities in the intervention group received an educational program consisting of 160-hour distance training. The most relevant outcomes were the assessment of the hygienic conditions and composition of the menus sold in school cafeterias. All outcomes were analyzed as intention-to-treat and per-protocol. For the analysis of continuous data with normal distribution, an analysis of covariance and the Generalized Linear Model were used. The level of statistical significance considered was p<0.05 for a 95% CI.

Results

No statistically significant difference was observed between the intervention group and the control group in the studied outcomes. There was a reduction of 76.2 points in the score for hygienic handling conditions (95% CI: -205 to 357; p=0.581). Regarding menu composition, the difference between groups was 0.48% (95% CI: -2.69 to 3.64; p=0.760) for ultra-processed foods, 0.23% (95% CI: -1.13 to 1.60; p=0.740) for processed foods, and 1.02% (95% CI: -2.59 to 4.64; p=0.581) for fresh foods.

Conclusion

There is not enough evidence to conclude that the intervention had a positive impact on any of the outcomes studied.

Keywords
Food and nutrition education; Nutrition policy; School feeding; School health services; Snacks

Module	Goals
Unit 1 - Starting healthy schools	Present relevant information about children’s and adolescents’ health Study how schools and cafeterias can promote healthy and proper eating Understand the importance of implementing healthy school cafeterias and reasons to change Know the current laws that regulate food supply in school cafeterias
Unit 2 - What is healthy eating?	Know the concept of adequate and healthy eating Learn what is healthy eating based on the Brazilian Population Food Guide
Unit 3 - Cafeteria and industrialized foods	Know the effects of industrialized food consumption on students’ health Learn how to choose foods by reading labels and nutritional information
Unit 4 - Healthy snacks	Provide suggestions for healthy and creative snacks to be offered in school cafeterias
Unit 5 - Food hygiene	Learn about the importance of adopting good practices in food handling to ensure the health quality and safety of the food sold in school cafeterias
Unit 6 - Food and nutrition education	Present educational strategies and activities to promote adequate and healthy eating in the school setting
Unit 7 - How to profit from healthy school cafeterias and successful experiences	Present strategies on how to profit from healthy food marketing and show successful experiences in planning and implementing healthy school cafeterias
Unit 8 - Schedule of activities and how to keep school cafeterias healthy	Propose a schedule of actions that must be carried out for schools to implement and maintain a healthy school cafeteria

Group	Descrption	Exemples
Fresh (green)	Fresh, minimally processed foods, and culinary preparations without the addition of culinary ingredients.	Water, fruit, sweet potato, corn, fruit salad, unsweetened natural juice
Processed food (yellow)	Processed foods and culinary preparations with added culinary ingredients^* * The culinary ingredients group was incorporated into this group, as cafeterias do not sell these foods in isolation.	Coconut water, peanuts, coffee with sugar, homemade tea, rapadura (a sweet of Azorean or Canarian origin in the form of small bricks, with a flavor and composition similar to brown sugar), sweet and salty popcorn, brown sugar, natural juice with sugar. Preparations with less than five ingredients
Ultra-processed food (red)	Ultra-processed food	Chocolate milk, candy, cereal bar, biscuit, isotonic drinks, industrialized cakes, fudge, hot dog, machine coffee, industrialized teas, chocolate, donuts, gummies, jelly, ice cream, hamburger, bread, popsicles, lollipops, ice cream, sandwich, snacks and toast with sausages, snacks, industrialized juices. Preparations with five or more ingredients

Characteristics	Intervention (n=14)		Control (n=13)		Total (n=27)
Characteristics	n	%	n	%	n	%
Public school	9	64	8	62	17	63
Number of students ≥500	7	50	7	54	14	52
Outsourced cafeteria management	10	71	9	69	19	70
Presence of school meals (PNAE)	9	64	10	77	19	70
Presence of a nutritionist	1	7	1	8	2	7

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E-mail: sbi.submissionrn@puc-campinas.edu.br

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[1] Correspondence to: M BALESTRIN. E-mail: mari_dalmolin@hotmail.com.

Variables		Intervention		Control		Adjusted differences (95% CI)^* * Adjusted by baseline values, p means statistical significance. M: Mean; SD: Standard Deviation.	p-value
		Baseline (n=14)	Follow-up (n=14)	Baseline (n=13)	Follow-up (n=13)
		M±SD	M±SD	M±SD	M±SD
Intention-to-treat
	Hygienic condition score	1292±417	1165±388	1187±387	1047±370	76.2 (-205–357)	0.58
Menu composition (%)
	Ultra-processed	92.6±8.49	91.6±7.81	87.7±10.27	87.4±8.42	0.48 (-2.69–3.64)	0.76
	Processed	1.61±1.91	1.56±1.90	3.87±5.94	3.94±6.04	0.23 (-1.13–1.60)	0.74
	Fresh	5.75±7.79	6.92±7.34	8.39±9.81	8.78±8.75	1.02 (-2.59–4.64)	0.58
	Food quality score	6.56±8.09	7.66±7.53	10.3±9.59	10.69±8.05	-0.37 (-4.37–3.62)	0.86
Variables		Intervention		Control		Adjusted differences (95% CI)^* * Adjusted by baseline values, p means statistical significance. M: Mean; SD: Standard Deviation.	p-value
		Baseline (n=12)	Follow-up (n=12)	Baseline (n=8)	Follow-up (n=8)
		M±SD	M±SD	M±SD	M±SD
Per protocol
	Hygienic condition score	1348±357	1200±339	1285±434	1056±440	131 (-239–501)	0.47
Menu composition (%)
	Ultra-processed	93.4±7.48	92.1±6.67	87.0±11.7	86.4±8.71	1.45 (-2.89–5.79)	0.49
	Processed	1.88±1.94	1.80±1.95	2.19±3.63	2.29±3.98	0.14 (-1.36–1.64)	0.86
	Fresh	4.77±6.21	6.10±5.80	10.8±10.5	11.4±8.59	-0.40 (-4.78–3.98)	0.86
	Food quality score	5.69±6.81	6.97±6.19	11.9±10.9	12.48±8.42	-2.05 (-6.61–2.50)	0.38