Sustainable and acceptable school meals through optimization analysis: an intervention study

Patricia Eustachio Colombo, Emma Patterson, Anna Karin Lindroos, Alexandr Parlesak, Liselotte Schäfer Elinder, Patricia Eustachio Colombo, Emma Patterson, Anna Karin Lindroos, Alexandr Parlesak, Liselotte Schäfer Elinder

Abstract

Background: School meals hold considerable potential to shape children's diets and reduce food-related greenhouse gas emissions (GHGE)-in the short and long term. This study applied linear optimization to develop a GHGE-reduced, nutritionally adequate, and affordable school lunch menu. The effects on food waste, consumption and pupils' satisfaction with the meals were evaluated.

Methods: A pre-post design was employed to assess the effects of implementing an optimized lunch menu on daily food waste, consumption, and pupils' school meal satisfaction in three schools (grades 0-9) from one Swedish municipality. A food list containing amounts, prices, nutrient content, and GHGE-values of all foods used for a previously served (baseline) four-week lunch menu was created. Using linear programming, this food list was optimized for minimum deviation and constrained to ensure nutritional adequacy and a reduced climate impact. The optimized food list was developed into a new (intervention) four-week lunch menu by a professional meal planner, following the baseline menu as closely as possible. The baseline and intervention menus were served for four weeks, respectively, with a two week break in between. Prepared, wasted and leftover food were weighed daily by the school kitchen staff during both periods. Interrupted time series analysis assessed mean and slope differences in daily food waste and consumption between the two periods. School lunch satisfaction was assessed with an online questionnaire at baseline and during the intervention.

Results: Optimization resulted in a food list that was 40% lower in GHGE, met all nutrient recommendations for school meals, and cost 11% less compared to baseline. The intervention menu was served as planned, with only minor changes required (for practical reasons). Plate waste, serving waste, consumption and school lunch satisfaction did not differ significantly from baseline, in any of the schools.

Conclusions: The findings demonstrate that school meals can successfully be improved regarding health and environmental sustainability using linear optimization, without negative effects on food waste, consumption or cost. This approach offers the necessary flexibility to tailor menus towards different priorities and could therefore be transferred to other types of meal services.

Trial registration: The trial is registered at clinicaltrials.gov (NCT04168632 Fostering Healthy and Sustainable Diets Through School Meals (OPTIMAT).

Keywords: Agenda 2030; Children; Public meals; Sustainable diets.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Food group quantities (g/pupil/day) before (dark blue columns) and after (light blue columns) optimization. The green part indicates the amount increased by the linear programming algorithm; The red parts indicate the amount that was removed from a food group but replaced by other foods of the same food group
Fig. 2
Fig. 2
Scatterplots based on ITS analysis displaying plate waste per pupil and consumption per pupil in School 2 as an example. Panel a represents the daily amount of plate waste per pupil during the baseline period (measurement day 0–20, graphs to the left), and the intervention period (measurement day 21–40, graphs to the right); Panel b represents the daily consumption per pupil during the baseline period (measurement day 0–20, graphs to the left), and the intervention period (measurement day 21–40, graphs to the right); Vertical line represents the first day of serving the new menu; P ≥ 0.05 for parameter estimates (β1 and β2) from the ITS analysis

References

    1. Campbell B, Beare D, Bennett E, Hall-Spencer J, Ingram J, Jaramillo F, et al. Agriculture production as a major driver of the Earth system exceeding planetary boundaries. Ecol Soc [Internet]. 2017 Oct 12 [cited 2019 Feb 15];22(4). Available from: .
    1. IPCC . Climate change and land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. Intergovernmental Panel on Climate Change: Geneva, Switzerland; 2019.
    1. Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1345–1422. doi: 10.1016/S0140-6736(17)32366-8.
    1. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT–lancet commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447–492. doi: 10.1016/S0140-6736(18)31788-4.
    1. UN General Assembly. Transforming our world : the 2030 Agenda for Sustainable Development. UN General Assembly; 2015 Oct. Report No.: A/RES/70/1.
    1. UNFCCC. The Paris Agreement [Internet]. 2015 [cited 2017 Jul 21]. Available from: .
    1. FAO . Sustainable diets and biodiversity - directions and solutions for policy research and action proceedings of the international scientific symposium biodiversity and sustainable diets united against hunger. Rome: Food and Agriculture Organization of the United Nations; 2012.
    1. Department for Environment, Food and Rural Affairs. Procuring the Future Sustainable Procurement National Action Plan: Recommendations from the Sustainable Procurement Task Force. London; 2006.
    1. Oostindjer M, Aschemann-Witzel J, Wang Q, Skuland SE, Egelandsdal B, Amdam GV, et al. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children’s diet and food consumption? A cross-national comparative perspective. Crit Rev Food Sci Nutr. 2017;57(18):3942–3958. doi: 10.1080/10408398.2016.1197180.
    1. The Swedish National Agency for Education. Statistik om förskola, skola och vuxenutbildning. Swedish. (Statistics on preschool, school and adult education) [Internet]. [cited 2020 May 27]. Available from: .
    1. The Swedish Food Agency . Bra mat i skolan: råd för förskoleklass, grundskola, gymnasieskola och fritidshem. Swedish. (good school meals: guidelines for primary schools, secondary schools and youth recreation centres) The Swedish Food Agency: Uppsala; 2018.
    1. Eustachio Colombo P, Patterson E, Elinder LS, Lindroos AK. The importance of school lunches to the overall dietary intake of children in Sweden: a nationally representative study. Public Health Nutr. 2020;21:1–11.
    1. School Food Sweden. What is SkolmatSverige? | SkolmatSverige [Internet]. [cited 2019 Sep 30]. Available from: .
    1. Darmon N, Ferguson EL, Briend A. A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming. J Nutr. 2002;132(12):3764–3771. doi: 10.1093/jn/132.12.3764.
    1. Parlesak A, Tetens I, Jensen JD, Smed S, Blenkuš MG, Rayner M, et al. Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets. PLOS ONE. 2016 okt;11(10):e0163411.
    1. Vieux F, Perignon M, Gazan R, Darmon N. Dietary changes needed to improve diet sustainability: are they similar across Europe? Eur J Clin Nutr. 2018;72(7):951. doi: 10.1038/s41430-017-0080-z.
    1. Perignon M, Masset G, Ferrari G, Barré T, Vieux F, Maillot M, et al. How low can dietary greenhouse gas emissions be reduced without impairing nutritional adequacy, affordability and acceptability of the diet? A modelling study to guide sustainable food choices. Public Health Nutr. 2016;19(14):2662–2674. doi: 10.1017/S1368980016000653.
    1. Macdiarmid JI, Kyle J, Horgan GW, Loe J, Fyfe C, Johnstone A, et al. Sustainable diets for the future: can we contribute to reducing greenhouse gas emissions by eating a healthy diet? Am J Clin Nutr. 2012;96(3):632–639. doi: 10.3945/ajcn.112.038729.
    1. Reynolds CJ, Horgan GW, Whybrow S, Macdiarmid JI. Healthy and sustainable diets that meet greenhouse gas emission reduction targets and are affordable for different income groups in the UK. Public Health Nutr. 2019;22(08):1503–1517. doi: 10.1017/S1368980018003774.
    1. Horgan GW, Perrin A, Whybrow S, Macdiarmid JI. Achieving dietary recommendations and reducing greenhouse gas emissions: modelling diets to minimise the change from current intakes. Int J Behav Nutr Phys Act. 2016;13:46. doi: 10.1186/s12966-016-0370-1.
    1. Wilson N, Nghiem N, Mhurchu CN, Eyles H, Baker MG, Blakely T. Foods and dietary patterns that are healthy, low-cost, and environmentally sustainable: a case study of optimization modeling for New Zealand. PLoS One. 2013;8(3):e59648. doi: 10.1371/journal.pone.0059648.
    1. Gazan R, Brouzes CMC, Vieux F, Maillot M, Lluch A, Darmon N. Mathematical optimization to explore Tomorrow’s sustainable diets: a narrative review. Adv Nutr. 2018;9(5):602–616. doi: 10.1093/advances/nmy049.
    1. Ribal J, Fenollosa ML, García-Segovia P, Clemente G, Escobar N, Sanjuán N. Designing healthy, climate friendly and affordable school lunches. Int J Life Cycle Assess. 2016;21(5):631–645. doi: 10.1007/s11367-015-0905-8.
    1. Eustachio Colombo P, Patterson E, Schäfer Elinder L, Lindroos AK, Sonesson U, Darmon N, et al. Optimizing school food supply: integrating environmental, health, economic, and cultural dimensions of diet sustainability with linear programming. Int J Environ Res Public Health. 2019;16(17):3019. doi: 10.3390/ijerph16173019.
    1. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–355.
    1. Bandura A. Social cognitive theory. In: Donsbach W, editor. The international encyclopedia of communication. John Wiley & Sons, Ltd: Chichester, UK; 2008.
    1. The National Food Agency. Livsmedelsdatabasen version 20181024. Swedish. (The food database version 20170314). [Internet]. The National Food Agency; [cited 2017 Apr 24]. Available from: .
    1. International Organization for Standardization. ISO 14040:2006 - Environmental management -- Life cycle assessment -- Principles and framework [Internet]. [cited 2017 Oct 9]. Available from: .
    1. International Organization for Standardization. ISO 14044:2006 - Environmental management -- Life cycle assessment -- Requirements and guidelines [Internet]. [cited 2017 Oct 9]. Available from: .
    1. Florén B, Amani P, Davis J. Climate database facilitating climate smart meal planning for the public sector in Sweden. Int J Food Syst Dyn. 2017;8(1):72–80.
    1. Dantzig GB. Maximization of a linear function of variables subject to linear inequality. In: Koopmans TC, editor. Activity analysis of production and allocation. 1947. pp. 339–347.
    1. European Comission - Joint Research Centre (DG JRC). Environmental Impact of Products (EIPRO) - Environmental Impact of Products (EIPRO). 2006. Report No.: Technical report EUR 22284 EN.
    1. Mason AJ. OpenSolver - An Open Source Add-in to Solve Linear and Integer Progammes in Excel. In: Klatte D, Lüthi H-J, Schmedders K, editors. Operations Research Proceedings 2011 [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012 [cited 2017 Dec 21]. p. 401–6. Available from: .
    1. The Swedish Food Agency [Internet]. [cited 2019 Jul 12]. Available from: .
    1. School Food Sweden. [cited 2017 Nov 28]. Available from: .
    1. Lindroos AK, Sipinen JP, Axelsson C, Nyberg G, Landberg R, Leanderson P, et al. Use of a web-based dietary assessment tool (RiksmatenFlex) in Swedish adolescents: comparison and validation study. J Med Internet Res. 2019;21(10):e12572. doi: 10.2196/12572.
    1. Johansson H, Kvarth M. An internet based school meal questionnaire – Questions produced for Skolmatsakademin in Västra Götaland [Internet] [Bacherlor’s thesis]. [Gothenburg]: Gothenburg University; 2009. Available from: .
    1. R Core Team. R: A language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing; 2019 [cited 2018 Feb 1]. Available from: .
    1. UNFCCC. Climate-Efficient School Kitchens and Plant-Powered Pupils | Germany | UNFCCC [Internet]. [cited 2019 Sep 11]. Available from: .
    1. Lombardini C, Lankoski L. Forced choice restriction in promoting sustainable food consumption: intended and unintended effects of the mandatory vegetarian day in Helsinki schools. J Consum Policy. 2013;36(2):159–178. doi: 10.1007/s10603-013-9221-5.
    1. Vieux F, Perignon M, Gazan R, Darmon N. Dietary changes needed to improve diet sustainability: are they similar across Europe? Eur J Clin Nutr. 2018;72(7):951–960. doi: 10.1038/s41430-017-0080-z.
    1. Tyszler M, Kramer G, Blonk H. Just eating healthier is not enough: studying the environmental impact of different diet scenarios for Dutch women (31–50 years old) by linear programming. Int J Life Cycle Assess. 2016;21(5):701–709. doi: 10.1007/s11367-015-0981-9.
    1. Milner J, Green R, Dangour AD, Haines A, Chalabi Z, Spadaro J, et al. Health effects of adopting low greenhouse gas emission diets in the UK. BMJ Open. 2015;5(4):e007364. doi: 10.1136/bmjopen-2014-007364.
    1. Green R, Milner J, Dangour AD, Haines A, Chalabi Z, Markandya A, et al. The potential to reduce greenhouse gas emissions in the UK through healthy and realistic dietary change. Clim Chang. 2015;129(1–2):253–265. doi: 10.1007/s10584-015-1329-y.
    1. Vieux F, Dubois C, Duchêne C, Darmon N. Nutritional Quality of School Meals in France: Impact of Guidelines and the Role of Protein Dishes. Nutrients [Internet]. 2018 Feb [cited 2019 Sep 13];10(2). Available from: .
    1. Payne CL, Scarborough P, Cobiac L. Do low-carbon-emission diets lead to higher nutritional quality and positive health outcomes? A systematic review of the literature. Public Health Nutr. 2016;19(14):2654–2661. doi: 10.1017/S1368980016000495.
    1. Perignon M, Vieux F, Soler L-G, Masset G, Darmon N. Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets. Nutr Rev. 2017;75(1):2–17. doi: 10.1093/nutrit/nuw043.
    1. Elinder LS, Heinemans N, Zeebari Z, Patterson E. Longitudinal changes in health behaviours and body weight among Swedish school children--associations with age, gender and parental education--the SCIP school cohort. BMC Public Health. 2014;14:640. doi: 10.1186/1471-2458-14-640.
    1. Kainulainen K, Benn J, Fjellström C, Palojoki P. Nordic adolescents’ school lunch patterns and their suggestions for making healthy choices at school easier. Appetite. 2012;59(1):53–62. doi: 10.1016/j.appet.2012.03.012.
    1. Thomas J, Sutcliffe K, Harden A, Oakley A, Oliver S, Rees R, et al. Children and healthy eating: a systematic review of barriers and facilitators [Internet]. Centre for Reviews and Dissemination (UK); 2003 [cited 2019 Sep 16]. Available from: .
    1. Van Cauwenberghe E, Maes L, Spittaels H, van Lenthe FJ, Brug J, Oppert J-M, et al. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and “grey” literature. Br J Nutr. 2010;103(6):781–797. doi: 10.1017/S0007114509993370.
    1. Kaljonen M, Peltola T, Salo M, Furman E. Attentive, speculative experimental research for sustainability transitions: an exploration in sustainable eating. J Clean Prod. 2019;206:365–373. doi: 10.1016/j.jclepro.2018.09.206.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci IS. 2011;6:42. doi: 10.1186/1748-5908-6-42.
    1. Appleton KM, Hemingway A, Rajska J, Hartwell H. Repeated exposure and conditioning strategies for increasing vegetable liking and intake: systematic review and meta-analyses of the published literature. Am J Clin Nutr. 2018;108(4):842–856. doi: 10.1093/ajcn/nqy143.
    1. Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003;78(3 Suppl):633S–639S. doi: 10.1093/ajcn/78.3.633S.
    1. Barré T, Perignon M, Gazan R, Vieux F, Micard V, Amiot M-J, et al. Integrating nutrient bioavailability and co-production links when identifying sustainable diets: how low should we reduce meat consumption? PLoS One. 2018;13(2):e0191767. doi: 10.1371/journal.pone.0191767.
    1. Franco D, Martins AJ, López-Pedrouso M, Purriños L, Cerqueira MA, Vicente AA, et al. Strategy towards replacing pork Backfat with a linseed Oleogel in frankfurter sausages and its evaluation on physicochemical, nutritional, and sensory characteristics. Foods Basel Switz. 2019;26:8(9).
    1. Heck RT, Fagundes MB, Cichoski AJ, de Menezes CR, Barin JS, Lorenzo JM, et al. Volatile compounds and sensory profile of burgers with 50% fat replacement by microparticles of chia oil enriched with rosemary. Meat Sci. 2019;148:164–170. doi: 10.1016/j.meatsci.2018.10.017.
    1. Maillot M, Vieux F, Amiot MJ, Darmon N. Individual diet modeling translates nutrient recommendations into realistic and individual-specific food choices. Am J Clin Nutr. 2010;91(2):421–430. doi: 10.3945/ajcn.2009.28426.
    1. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013 Nov 27;310(20):2191.

Source: PubMed

3
Abonner