In 2005, the nutritional content of children’s school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children’s total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4–7 years (n = 385 in 2003–4; n = 632 in 2008–9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children’s mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change −128 mg, 95% CI: −183 to −73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (−1.8%, −2.8 to −0.9) and saturated fat (−1.0%; −1.6 to −0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children’s total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children’s diet.

Dietary intake is a complex behaviour to accurately measure (1) . Twenty-four hour recalls are a popular choice for dietary surveys as they are quick to administer, do not require the participant to be literate (2) and are less burdensome to complete compared to other dietary assessment methods (3) . Technology offers the potential to make dietary assessment more convenient, intuitive and engaging for users. It also ensures consistency of coding and significantly reduces the cost as nutritional output can be generated without the need for manual coding and data entry.INTAKE24 is an online multiple pass 24hr dietary recall developed for use with 11-24 year olds in Scottish food and nutrition surveys.INTAKE24 was developed from an original prototype tool called SCRAN24 (4) . The system development was an iterative process involving four cycles of user interaction, evaluation and further development. Evaluation focussed mainly on the usability of the system (e.g. how easy it is to learn and use) and on the users experience while interacting with the system (e.g. how satisfying, enjoyable and motivating the system is to use) (5) . User evaluation was conducted with 80 participants; 20 at each stage. Researcher observation, 'think aloud' techniques, and eye tracking, were used to identify aspects of the system users found confusing. Feedback was gathered using semi-structured interviews and a system usability scale. In addition, each participant completed an interviewer led recall after completing INTAKE24 in order to identify any food and drink items missed. This fed into the development of the prompts within the system and served to gauge accuracy.In response to user feedback and observations during user testing the system interface was flattened so a single interface screen handled all aspects of the recall (e.g. free text entry, looking up foods in the database, portion size estimation). Improved search functionality and navigation around the system were also influenced through feedback from users at each stage. The time taken to complete the system reduced significantly throughout the user testing and accuracy of reported intakes improved for all nutrients except Vitamin C as can be seen in the table below.Integrating observation and post-completion interviews allowed us to obtain maximum information to feed into the design process; refining the system to have the best possible tool for use in the field.This work was funded by the Food Standards Agency, Scotland.

scran24 was very well received by young people and was relatively quick to complete. The accuracy and precision was close to that of similar computer-based systems currently used in dietary studies.

IntroductionIn September 2009, middle and secondary schools in England were required to comply with food and nutrient-based standards for school food. We examined the impact of this policy change on children’s lunchtime and total dietary intake.MethodsWe undertook repeat cross-sectional surveys in six Northumberland middle schools in 1999–2000 and 2009–10. Dietary data were collected from 11–12 y olds (n = 298 in 1999–2000; n = 215 in 2009–10). Children completed two consecutive 3-day food diaries, each followed by an interview. Linear mixed effect models examined the effect of year, lunch type and level of socio-economic deprivation on children’s mean total dietary intake.ResultsWe found both before and after the introduction of the food and nutrient-based standards children consuming a school lunch, had a lower per cent energy from saturated fat (−0.5%; p = 0.02), and a lower intake of sodium (−143 mg; p = 0.02), and calcium (−81 mg; p = 0.001) in their total diet, compared with children consuming a home-packed lunch. We found no evidence that lunch type was associated with mean energy, or absolute amounts of NSP, vitamin C and iron intake. There was marginal evidence of an association between lunch type and per cent energy NMES (p = 0.06). In 1999–2000, children consuming a school lunch had a higher per cent energy from fat in their total diet compared with children consuming a home-packed lunch (2.8%), whereas by 2009–10, they had slightly less (−0.2%) (year by lunch type interaction p<0.001; change in mean differences −3%).ConclusionsWe found limited evidence of an impact of the school food and nutrient-based standards on total diet among 11–12 year olds. Such policies may need to be supported by additional measures, including guidance on individual food choice, and the development of wider supportive environments in school and beyond the school gates.

Fieldwork for the Diet and Nutrition Survey of Infants and Young Children (DNSIYC) was carried out during 2011 to provide detailed quantitative information on food and nutrient intakes, nutrient sources and nutritional status of a representative sample of infants aged 4-18 months in the UK. In 2009-10 a preliminary study was carried out to assess the effectiveness and validity of using calibrated utensils to measure food and drink consumption in infants aged 4-18 months. The aim was to determine if the use of calibrated utensils influenced the portion size offered to the infant and so affect their daily nutrient intake.Food and drink intakes of 50 infants in North-East England were recorded using both an ESTIMATED and a WEIGHED 4-day food diary in random order, completed by the infant's parent/carer, over a 2 week period. Parents were provided with 4 graduated containers for food preparation and serving (2 · 150 ml and 2 · 300 ml), as well as 6 spoons (1.25 ml-15 ml), and were encouraged to use these to record all portion sizes in the ESTIMATED diary. Volume measures were converted to gram weights by the application of conversion factors, calculated for each food and drink consumed.The table below shows the mean daily intakes for each method. 41 % of the sample had mean daily intakes (g) for the estimated method which were within 10 % of the weighed intakes. 96 % were within 50 % of the weighed intakes. There was no difference in mean intakes between the two methods for different food types e.g. discrete food items and amorphous foods. Mean daily intakes Weighed EstimatedFood weight (g) 932 958 Energy (kcal) 721 776 The results indicated that the estimated intake method, supported by the use of measuring equipment, gave very similar results to those of weighed intakes. However the diary coding stage for these pilot data found the use of the equipment resulted in a much slower coding rate and a high number of queries. Based on the number of participants taking part in the main stage of DNSIYC, it was calculated many more coders would be required to manage the queries and meet deadlines. The final decision was to proceed with a household measures approach for dietary data collection; this method required no additional equipment and fewer coding resources. Although the household measures method has been extensively used in older age groups, (1) further work is proposed to validate this method against weighed intakes in 4-18 month infants. The study will follow the same method described above and will determine whether the household measures approach results in similar intakes as the weighed method.