Anne Dahl Lassen

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables

OBJECTIVE To analyse the 5-year sustainability of a worksite canteen intervention of serving more fruit and vegetables (F&V). DESIGN Average F&V consumption per customer per meal per day was assessed in five worksite canteens by weighing F&V served and subtracting waste. Data were collected by the canteen staff during a 3-week continuous period and compared to data from the same five canteens measured at baseline, at end point and at 1-year follow-up. The intervention used a participatory and empowering approach, self-monitoring and networking among the canteen staff, management and a consultant. The method focused on providing ideas for increased F&V for lunch, making environmental changes in the canteens by giving access to tasteful and healthy food choices and reducing the availability of unhealthy options. SETTING Five Danish worksites serving from 50 to 500 meals a day: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility. SUBJECTS Worksite canteen managers, canteen staff. RESULTS Four of the five worksite canteens were able to either maintain the intervention or even increase the consumption of F&V. The average increase from baseline to 5-year follow-up was 95 g per customer per meal per day (18, 144, 66, 105 and 141 g, respectively). On average, the five canteens at the long-term follow-up had an F&V consumption of 208 g/meal per customer. CONCLUSIONS The present study indicates that sustainability of F&V is possible in worksites where the participatory and empowering approach, self-monitoring, environmental change, dialogue with suppliers and networking among worksite canteens are applied.

The modernization of hospital food service – findings from a longitudinal study of technology trends in Danish hospitals

Purpose – Hospital food has come into focus during the last decade due to reports of under‐nutrition and at the same time food service has undergone significant changes. The aim of this paper is to document and discuss the change in technology and logistics used in the Danish hospital food service during the years 1995‐2003. Further, the aim is to discuss possibilities for integrating food production and patient nutrition at hospitals in order to improve patient nutrition.Design/methodology/approach – The empirical data consist of quantitative serial data on Danish hospital food service collected over a period starting in 1995 and ending in 2003. Data have been collected as part of two large surveys describing the food service systems in Danish hospitals in 1995 and in 2003. Both surveys were carried out by the Food Research Department of the Danish Food Authorities. Answers were compared by means of Chi‐square (χ2) tests with Yates’ correction. Two‐sided p‐values <0.05 were considered significant.Finding...

Salt content in canteen and fast food meals in Denmark.

Background A high salt (=NaCl) intake is associated with high blood pressure, and knowledge of salt content in food and meals is important, if the salt intake has to be decreased in the general population. Objective To determine the salt content in worksite canteen meals and fast food. Design For the first part of this study, 180 canteen meals were collected from a total of 15 worksites with in-house catering facilities. Duplicate portions of a lunch meal were collected from 12 randomly selected employees at each canteen on two non-consecutive days. For the second part of the study, a total of 250 fast food samples were collected from 52 retail places representing both city (Aarhus) and provincial towns. The canteen meals and fast food samples were analyzed for chloride by potentiometric titration with silver nitrate solution, and the salt content was estimated. Results The salt content in lunch meals in worksite canteens were 3.8±1.8 g per meal and 14.7±5.1 g per 10 MJ for men (n=109), and 2.8±1.2 g per meal and 14.4±6.2 g per 10 MJ for women (n=71). Salt content in fast food ranged from 11.8±2.5 g per 10 MJ (burgers) to 16.3±4.4 g per 10 MJ (sausages) with a mean content of 13.8±3.8 g per 10 MJ. Conclusion Salt content in both fast food and in worksite canteen meals is high and should be decreased.

Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003

Background:Since 1995, significant efforts by authorities and researchers have been directed towards addressing the nutritional problems in Danish hospitals and nursing homes.Aim:The purpose of this study was to investigate whether the increased focus on nutritional problems in patients and nursing home residents has resulted in measurable progress.Design:A questionnaire-based study was carried out among foodservice managers in Danish hospitals (n=96) and nursing homes (n=898) in 1995 and 2002/3 (n=90) and (n=682), respectively. The study used compliance with selected issues in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food and nutrition contact persons, employing official recommendations and offering choice between three different menu energy levels.Results:Hospitals had a higher compliance compared to nursing homes. In 1995, this was the case for all questions asked and differences were statistically significant. Also in 2002/3, hospitals had a higher compliance, except in the case of established feedback routines. Differences were statistically significant. The results indicate that nutritional care is higher on the agenda in hospital, than in nursing homes. However, very little progress can be seen in compliance when results are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3.Conclusion:The attempts to improve the nutritional status of hospital patients and nursing home residents seem to have failed. Still, the initiatives taken to improve the situation seem relevant. Especially the nursing homes might benefit from advantage of these experiences.

Nutritional effects of microwave cooking

Several studies have shown that microwave cooking, if properly used, does not change the nutrient content of foods to a larger extent than conventional heating. In fact, suggests that there is a tendency towards greater retention of many micronutrients with microwaving, probably due to the shorter preparation time. Does not describe non‐thermal effects. The main problem with microwaving is the uneven heating of the food, which has raised concern regarding microbiological safety. Microwaving infant formula and breast milk has become increasingly popular. The content of nutrients and antibacterial factors in milk are maintained unchanged provided the final temperature does not exceed 60°C.

Effectiveness of offering healthy labelled meals in improving the nutritional quality of lunch meals eaten in a worksite canteen

Healthier meal selections at restaurants and canteens are often limited and not actively promoted. In this Danish study the effectiveness of a healthy labelling certification program in improving dietary intake and influencing edible plate waste was evaluated in a quasi-experimental study design. Employees from an intervention worksite canteen and a matched control canteen were included in the study at baseline (February 2012), after completing the certification process (end-point) and six month from end-point (follow-up) (total n=270). In order to estimate nutrient composition of the consumed lunch meals and plate waste a validated digital photographic method was used combining estimation of food intake with food nutrient composition data. Food satisfaction was rated by participants using a questionnaire. Several significant positive nutritional effects were observed at the intervention canteen including a mean decrease in energy density in the consumed meals from 561kJ/100g at baseline to 368 and 407kJ/100g at end-point and follow-up, respectively (P<0.001). No significant changes were seen with regard to food satisfaction and plate waste. In the control canteen no positive nutritional effects were observed. The results of the study highlight the potential of using healthy labelling certification programs as a possible driver for increasing both the availability and awareness of healthy meal choices, thereby improving dietary intake when eating out.

A workplace feasibility study of the effect of a minimal fruit intervention on fruit intake

OBJECTIVE The main purpose of the study was to investigate the feasibility of using workplaces to increase the fruit consumption of participants by increasing fruit availability and accessibility by a minimal fruit programme. Furthermore, it was investigated whether a potential increase in fruit intake would affect vegetable, total energy and nutrient intake. DESIGN A 5-month, controlled, workplace study where workplaces were divided into an intervention group (IG) and a control group (CG). At least one piece of free fruit was available per person per day in the IG. Total fruit and dietary intake was assessed, using two 24 h dietary recalls at baseline and at endpoint. SETTING Eight Danish workplaces were enrolled in the study. Five workplaces were in the IG and three were in the CG. SUBJECTS One hundred and twenty-four (IG, n 68; CG, n 56) healthy, mainly normal-weight participants were recruited. RESULTS Mean daily fruit intake increased significantly from baseline to endpoint only in the IG by 112(se 35) g. In the IG, mean daily intake of added sugar decreased significantly by 10·7(se 4·4) g, whereas mean daily intake of dietary fibre increased significantly by 3·0(se 1·1) g. Vegetable, total energy and macronutrient intake remained unchanged through the intervention period for both groups. CONCLUSIONS The present study showed that it is feasible to increase the average fruit intake at workplaces by simply increasing fruit availability and accessibility. Increased fruit intake possibly substituted intake of foods containing added sugar. In this study population the increased fruit intake did not affect total energy intake.

Development and validation of a new simple Healthy Meal Index for canteen meals

OBJECTIVE Nutrition evaluation tools should be developed both for scientific purposes and to encourage and facilitate healthy nutritional practices. The purpose of the present study was to develop and validate a simple food-based Healthy Meal Index (HMI) reflecting the nutritional profile of individual canteen meals. DESIGN The development process included overall model selection, setting nutritional goals and defining scoring systems and thresholds. Three index components were included: (i) contents of fruit and vegetables, (ii) fat content and quality and (iii) contents of wholegrain products and potatoes. The development was built on the principles embodied by the Plate Model, but providing more specificity in some areas. The simple HMI was validated against weighed and chemically analysed food and nutrient content of a representative sample of canteen meals. The sample was split into four categories according to the total index score and compared across categories. SETTING A total of 180 meals from fifteen worksite canteens. RESULTS Average energy density decreased significantly across categories (from 876 kJ/100 g to 537 kJ/100 g, P < 0.001). Also, the content of total and saturated fat, carbohydrate and fruit and vegetables varied across categories with higher score values being closer to dietary guidelines (P < 0.001). CONCLUSIONS The simple HMI was successful in ranking canteen meals according to their nutritional quality. The index provides a valuable tool to both researchers and food and nutrition professionals, e.g. caterers and dietitians, who wish to evaluate nutritional quality of meals in line with the recommendations for healthier eating without the use of nutrition calculation programs.

Workforce gender, company size and corporate financial support are predictors of availability of healthy meals in Danish worksite canteens

OBJECTIVE Environmental strategies at worksites may help consumers change dietary behaviour towards a more healthy diet. The present study aimed to evaluate the availability of healthy meal options at Danish worksite canteens and to identify predictors of worksite canteens providing healthy meals. DESIGN A self-administered questionnaire was randomly mailed to 1967 worksite canteen managers. Besides information and characteristics about the canteen and the worksite, the canteen managers specified the menus available. Two different health groups (Healthy and Less Healthy) were defined in three different meal categories (Sandwiches, Hot meals and Salads) as well as a combined category (Combined) combining all the three meal categories. The characteristics of the worksites were compared with regard to the different health groups. SETTING Randomly selected Danish worksite canteens. SUBJECTS 553 Danish worksite canteen managers replied, resulting in a response rate of 29 %. RESULTS Only 12 % of the canteens applied to the Healthy group combining all the three meal categories. In particular, worksites with more than 75 % female employees served healthy menus on a frequent basis. The size of the worksite was positively correlated with more healthy meal options. Furthermore, the present study suggests a positive relationship between corporate financial support and the availability of healthy meal options. CONCLUSIONS Among the selected variables studied, workforce gender, company size and corporate financial support were significant predictors of the availability of healthy meal options in worksite canteens. More research is needed on the role that variance in organisation environment plays for the potential of worksite intervention, to make a difference in terms of healthy eating.

Plate waste and intake of school lunch based on the New Nordic Diet and on packed lunches: A randomised controlled trial in 8- to 11-year-old Danish children

The aim of the present study was to compare total food intake, total and relative edible plate waste and self-reported food likings between school lunch based on the new Nordic diet (NND) and packed lunch from home. In two 3-month periods in a cluster-randomised controlled unblinded cross-over study 3rd- and 4th-grade children (n 187) from two municipal schools received lunch meals based on NND principles and their usual packed lunch (control). Food intake and plate waste (n 1558) were calculated after weighing lunch plates before and after the meal for five consecutive days and self-reported likings (n 905) assessed by a web-based questionnaire. Average food intake was 6 % higher for the NND period compared with the packed lunch period. The quantity of NND intake varied with the menu (P < 0·0001) and was positively associated with self-reported likings. The edible plate waste was 88 (sd 80) g for the NND period and 43 (sd 60) g for the packed lunch period whereas the relative edible plate waste was no different between periods for meals having waste (n 1050). Edible plate waste differed between menus (P < 0·0001), with more waste on soup days (36 %) and vegetarian days (23 %) compared with the packed lunch period. Self-reported likings were negatively associated with percentage plate waste (P < 0·0001). The study suggests that portion sizes need to be considered in new school meal programmes. New strategies with focus on reduction of plate waste, childrens likings and nutritious school meals are crucial from both a nutritional, economic and environmental point of view.