Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial.
Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial.
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DOI：
10.1001/jamapediatrics.2014.3805
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发表时间：
2015-05
期刊：
影响因子：
26.1
通讯作者：
Rimm EB
中科院分区：
文献类型：
--
作者：
Cohen JF;Richardson SA;Cluggish SA;Parker E;Catalano PJ;Rimm EB
关于厨师强化菜单对学校食堂健康食品选择和消费的长期影响，人们知之甚少。此外，目前尚不清楚是否扩大接触其他促进健康食品的策略（例如，选择架构）也能改善食物选择或消费。评估厨师强化餐和延长接触选择架构对健康学校食品选择和消费的短期和长期影响。2011-2012学年，在2个城市低收入学区的14所中小学进行了一项基于学校的随机临床试验（意向治疗分析）。该研究包括2638名在参与学校就读的3至8年级学生（占合格参与者的38.4%）。学校首先被随机分配到一名专业厨师来改善学校膳食的适口性（厨师学校）或延迟干预（对照组）。为了评估选择架构（智能咖啡馆）的效果，3个月后，所有学校被随机分为智能咖啡馆干预组或对照组。学校的食物选择被记录下来，并用盘子浪费法测量消耗量。3个月后，与对照学校相比，厨师学校的蔬菜选择增加了（优势比[OR]， 1.75; 95% CI, 1.36-2.24），但对其他成分的选择或膳食消耗没有影响。在长期或延长接受厨师或智能咖啡干预后，与对照学校相比，厨师学校（or, 3.08; 95% CI, 2.23-4.25）、智能咖啡学校（or, 1.45; 95% CI, 1.13-1.87）和厨师加智能咖啡学校（or, 3.10; 95% CI, 2.26-4.25）的水果选择增加，厨师学校的消费量增加（or, 0.17; 95% CI, 0.03-0.30杯/天）。与对照学校相比，厨师学校（OR, 2.54, 95% CI, 1.83-3.54）、智能咖啡学校（OR, 1.91, 95% CI, 1.46-2.50）和厨师加智能咖啡学校（OR, 7.38, 95% CI, 5.26-10.35）的蔬菜选择增加，厨师学校（OR, 0.16, 95% CI, 0.09-0.22杯/d）和厨师加智能咖啡学校（OR, 0.13, 95% CI, 0.05-0.19杯/d）的消费量也有所增加；然而，仅仅是聪明的咖啡干预对消费没有影响。学校应该考虑与厨师合作，并使用选择架构来增加水果和蔬菜的选择。通过厨师强化餐来改善学校食物味道的努力应该仍然是一个优先事项，因为这是唯一能增加消费量的方法。这是在学生反复接触新食物7个月后才观察到的。因此，如果学校最初遇到阻力，就不应该放弃更健康的选择。clinicaltrials.gov标识符：NCT02309840
Little is known about the long-term effect of a chef-enhanced menu on healthier food selection and consumption in school lunchrooms. In addition, it remains unclear if extended exposure to other strategies to promote healthier foods (eg, choice architecture) also improves food selection or consumption. To evaluate the short- and long-term effects of chef-enhanced meals and extended exposure to choice architecture on healthier school food selection and consumption. A school-based randomized clinical trial was conducted during the 2011–2012 school year among 14 elementary and middle schools in 2 urban, low-income school districts (intent-to-treat analysis). Included in the study were 2638 students in grades 3 through 8 attending participating schools (38.4%of eligible participants). Schools were first randomized to receive a professional chef to improve school meal palatability (chef schools) or to a delayed intervention (control group). To assess the effect of choice architecture (smart café), all schools after 3 months were then randomized to the smart café intervention or to the control group. School food selection was recorded, and consumption was measured using plate waste methods. After 3 months, vegetable selection increased in chef vs control schools (odds ratio [OR], 1.75; 95% CI, 1.36–2.24), but there was no effect on the selection of other components or on meal consumption. After long-term or extended exposure to the chef or smart café intervention, fruit selection increased in the chef (OR, 3.08; 95% CI, 2.23–4.25), smart café (OR, 1.45; 95% CI, 1.13–1.87), and chef plus smart café (OR, 3.10; 95% CI, 2.26–4.25) schools compared with the control schools, and consumption increased in the chef schools (OR, 0.17; 95% CI, 0.03–0.30 cups/d). Vegetable selection increased in the chef (OR, 2.54; 95% CI, 1.83–3.54), smart café (OR, 1.91; 95% CI, 1.46–2.50), and chef plus smart café schools (OR, 7.38, 95% CI, 5.26–10.35) compared with the control schools, and consumption also increased in the chef (OR, 0.16; 95% CI, 0.09–0.22 cups/d) and chef plus smart café (OR, 0.13; 95% CI, 0.05–0.19 cups/d) schools; however, the smart café intervention alone had no effect on consumption. Schools should consider both collaborating with chefs and using choice architecture to increase fruit and vegetable selection. Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that also increased consumption. This was observed only after students were repeatedly exposed to the new foods for 7 months. Therefore, schools should not abandon healthier options if they are initially met with resistance. clinicaltrials.gov Identifier: NCT02309840