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

项目总结 尽管水果和蔬菜(FV)是健康饮食的重要组成部分，但大多数儿童 不要摄入推荐数量的这些食物。学校用餐占相当大的一部分 儿童总膳食摄入量的一部分。改变学校环境是划算和有效的 这是一种改善饮食摄入量的方法，可以显著影响儿童肥胖的有害问题。这个 2010年健康无饥饿儿童法案(HHFKA)要求在国家学校午餐中加强对FV的关注 计划(NSLP)，并特别要求儿童在用餐时吃水果和/或蔬菜(“服务”模式)。 然而，在这项任务下，人们对增加的FV板废物有很大的担忧。同时， 在NSLP中，学校沙拉吧作为增加FV摄入量的一种手段，得到了全国的大力支持。沙拉 在“发球”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，这与 儿童的FV消耗量增加。然而，很少有实证研究调查沙拉的影响。 学校有吸食FV的酒吧。此外，尽管FV消费可以促进健康的体重管理，但如果 这些食物取代了高卡路里的食物，很有必要更好地了解增加FV摄入量， 和沙拉吧，与儿童的饮食质量和午餐能量摄入量有关。这是特别的 在低收入和种族/少数民族儿童中进行调查很重要，他们面临着不成比例的肥胖风险 考虑到他们对学校的依赖，他们最有可能受到学校肥胖政策的影响，比如HHFKA 一顿饭。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工作来实现 对北弗吉尼亚州一个学区的沙拉吧进行全面评估。这个地区正在安装 沙拉吧在5年内进入141所小学，促进了对等候名单的控制，集群 随机对照试验。具体来说，将随机选择12对匹配的学校：一半获得 沙拉吧(干预)和一半只提供预先分割的FV，根据NSLP(控制)的标准。因此， 团体将有不同的FV展示方法；然而，所有学校都将在要求 学生至少参加一次FV服务。学校将在标题I地位(社会经济状况的代表)上进行匹配 身份)和基于较高肥胖风险的种族/少数民族学生的百分比。饮食摄入量将是 在每一对学校的午餐时，在沙拉吧之前(基线)和之后4-6周进行客观评估 安装(POST)，导致在整个研究期间观察到约14,160个午餐。我们还将获得 自助餐厅销售和NSLP参与数据，以检查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，以确定障碍和 促进者提供沙拉吧，并为可持续发展努力提供信息。之前的随机对照试验还没有前瞻性地检查过这些影响 在FV和能量摄入上的沙拉吧。因此，这项研究具有为学校营养政策提供信息的巨大潜力。 以及旨在增加膳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.