School meal provision, health, and cognitive function in a Nordic setting – the ProMeal-study: description of methodology and the Nordic context

Abstract

BackgroundSchool meals, if both nutritious and attractive, provide a unique opportunity to improve health equality and public health.ObjectiveTo describe the study rationale, data collection, and background of participants in the study ‘Prospects for promoting health and performance by school meals in Nordic countries’ (ProMeal). The general aim was to determine whether overall healthiness of the diet and learning conditions in children can be improved by school lunches, and to capture the main concerns regarding school lunches among children in a Nordic context.DesignA cross-sectional, multidisciplinary study was performed in Finland, Iceland, Norway, and Sweden on pupils (n=837) born in 2003.ResultsIn total 3,928 pictures of school lunches were taken to capture pupils’ school lunch intake. A mean of 85% of all parents responded to a questionnaire about socioeconomic background, dietary intake, and habitual physical activity at home. Cognitive function was measured on one occasion on 93% of the pupils during optimal conditions with a Stroop and a Child Operation Span test. A mean of 169 pupils also did an Integrated Visual and Auditory Continuous Performance Test after lunch over 3 days. In total, 37,413 10-sec observations of classroom learning behavior were performed. In addition, 753 empathy-based stories were written and 78 focus groups were conducted. The pupils had high socioeconomic status.ConclusionsThis study will give new insights into which future interventions are needed to improve pupils’ school lunch intake and learning. The study will provide valuable information for policy making, not least in countries where the history of school meals is shorter than in some of the Nordic countries.

Preschool and School Meal Policies: An Overview of What We Know about Regulation, Implementation, and Impact on Diet in the UK, Sweden, and Australia

“…We know of few published high quality longitudinal studies or randomised controlled trials evaluating the impact of school meal policies on nutrition behaviour, diet quality, and health [ 107 , 108 , 109 , 110 , 111 ], although some are currently underway [ 112 , 113 , 114 ]. A more rigorous evaluation of the benefits of school meals on diet quality and health outcomes (such as obesity), including longitudinal studies or randomised controlled trials, are needed to assess the impact of policies, particularly on reducing inequalities in diet and health.…”

Composition of School Meals in Sweden, Finland, and Iceland: Official Guidelines and Comparison With Practice and Availability

“…All food and drinks for the reference portions served at the participating schools during the study period were photographed from 2 angles, above and at 45° angle, weighed (Philips kitchen scale HR2391/00 3 kg capacity, accuracy 1 g) and recorded in a standardized protocol. The photos were used as an additional aid to analyze and confirm the food available …”

The lived experiences of school lunch: an empathy-based study with children in Sweden

“…The current research was based on the Swedish part of an interdisciplinary Nordic project called 'Prospects for promoting health and performance by school meals in Nordic countries' (ProMeal) (see Waling et al 2016). Data were collected from 171 (93 girls, 78 boys), aged 10-11 years, and belonging to fourteen classes from nine Swedish compulsory schools situated in a county in northern Sweden.…”