The Impact of Salad Bars on Dietary Consumption Patterns in Elementary School Students

项目摘要 尽管水果和蔬菜（FV）作为健康饮食的重要组成部分， 不要食用这些食物的推荐份量。学校膳食占很大比例， 占儿童总膳食摄入量的比例。改变学校环境是一个具有成本效益和有效的 这是一种改善饮食摄入量的方法，可以显著影响小儿肥胖的恶性问题。的 2010年《健康无饥饿儿童法案》（HHFKA）规定，在全国学校午餐中加强对FVs的关注。 计划（NSLP），并特别要求儿童采取水果和/或蔬菜在吃饭（“服务”模式）。 然而，在这一任务规定下，人们对FV版浪费增加表示严重关切。与此同时， 国家大力支持学校沙拉吧，以此作为增加国家营养计划中的叶酸摄入量的一种手段。沙拉 在“服务”模式中，酒吧可能是一种特别有效的方法，因为它们促进了选择， 增加儿童的FV消费。然而，很少有实证研究调查了沙拉的影响 在学校的FV摄入量的酒吧。此外，虽然FV消费可以促进健康的体重管理， 这些食物取代了高热量的食物，因此非常需要更好地理解增加FV摄入量， 和沙拉吧，涉及儿童的饮食质量和能量摄入在午餐NSLP。这是特别 在低收入和种族/少数民族儿童中进行调查很重要，他们面临不成比例的肥胖风险 最有可能受到学校肥胖政策的影响，例如HHFKA，因为他们依赖学校 吃饭。这个时间敏感的应用程序将使用经过验证的方法，通过我们广泛的形成性工作， 对弗吉尼亚州北方学区的沙拉吧进行全面评估。这个区正在安装 在5年期间，向141所小学提供沙拉吧， 随机对照试验。具体来说，将随机选择12对匹配的学校：其中一半接受 沙拉台（干预）和半份预先分份的FVs，NSLP（对照）的标准。因此 团体将有不同的FV呈现方法;然而，所有学校都将根据一项政策运作， 学生至少要吃一份FV。学校将在标题I状态（社会经济状况的代理）上进行匹配 根据肥胖风险较高的种族/少数民族学生的比例。饮食摄入量将是 在每对学校的午餐时，在沙拉吧之前（基线）和之后4-6周进行客观评估， 安装（后），导致整个研究期间约14，160次午餐观察。我们还将获得 自助餐厅销售和NSLP参与数据，以研究沙拉吧如何影响这些关键的收入来源。 最后，我们将评估实施因素和自助餐厅人员的观点，以确定障碍， 促进者到沙拉吧，并为可持续发展工作提供信息。之前没有随机对照试验前瞻性地检查了 沙拉吧对FV和能量摄入的影响。因此，这项研究具有很大的潜力，为学校营养政策提供信息 以及旨在提高饮食摄入量和减少肥胖的计划。

PROJECT SUMMARY Despite the importance of fruits and vegetables (FVs) as essential components of a healthy diet, most children do not consume the recommended number of servings of these foods. School meals account for a significant portion of children's overall dietary intake. Changing the school environment is a cost-efficient and effective method for improving dietary intake and can significantly impact the pernicious problem of pediatric obesity. The 2010 Healthy Hunger-Free Kids Act (HHFKA) mandated enhanced focus on FVs in the National School Lunch Program (NSLP), and specifically requires children to take a fruit and/or vegetable at meals (the “serve” model). However, there are significant concerns over increased FV plate waste under this mandate. Simultaneously, there is great national support for school salad bars as a means to increase FV intake within the NSLP. Salad bars might be a particularly effective approach within the “serve” model, as they foster choice, which is linked to increased FV consumption in children. However, little empirical research has investigated the impact of salad bars on FV intake in schools. Further, although FV consumption can facilitate healthy weight management if these foods replace items high in calories, there is a great need to better understand how increasing FV intake, and salad bars, relates to children's diet quality and energy intake at lunch within the NSLP. This is particularly important to investigate in low income and racial/ethnic minority children, who face disproportionate obesity risks and are most likely to be impacted by school obesity policies, such as the HHFKA, given their reliance on school meals. This time-sensitive application will use validated methods, informed by our extensive formative work, to conduct a comprehensive evaluation of salad bars in a northern Virginia school district. This district is installing salad bars into 141 elementary schools over 5-years, facilitating the conduct of a waitlist control, cluster randomized controlled trial. Specifically, 12 pairs of matched schools will be randomly selected: half receiving a salad bar (Intervention) and half serving pre-portioned FVs only, standard under the NSLP (Control). Thus groups will have different FV presentation methods; however all schools will be operating under a policy requiring students to take at least one FV serving. Schools will be matched on Title I status (a proxy for socioeconomic status) and percent of racial/ethnic minority students based on higher obesity risk. Dietary intake will be objectively assessed at lunch in each pair of schools, prior to (baseline), and 4-6 weeks after salad bars are installed (post), resulting in ~14,160 lunch observations throughout the study duration. We will also obtain cafeteria sales and NSLP participation data to examine how salad bars impact these critical revenue sources. Finally, we will assess implementation factors and cafeteria personnel's perspectives, to identify barriers and facilitators to salad bars and inform sustainability efforts. No prior RCTs have prospectively examined the effects of salad bars on FV and energy intake. As such, this study has great potential to inform school nutrition policies and programs designed to enhance dietary intake and reduce obesity.