Ultra-processed food consumption is associated with variations in daily routines in elementary schoolchildren during the COVID-19 pandemic in Chile.

OBJECTIVE: To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile. DESIGN: Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics. SETTING: Low- and middle-income neighbourhoods in southeastern Santiago, Chile. PARTICIPANTS: Children from the Food Environment Chilean Cohort (n 428, 8-10 years old). RESULTS: Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: ß = -0·19, (95 % CI -0·40, 0·02)) and school characteristics (model 2: ß = -0·20, (95 % CI -0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant. CONCLUSIONS: Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.

Changes in children's and adolescents' dietary intake after the implementation of Chile's law of food labeling, advertising and sales in schools: a longitudinal study.

BACKGROUND: In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement. METHODS: Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy. RESULTS: Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy. CONCLUSIONS: After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school.

Children's Perceptions about Environmental Sustainability, Food, and Nutrition in Chile: A Qualitative Study.

Food is inextricably linked to human health and environmental sustainability; however, very little is known about children's perceptions of the concept of sustainability in the context of food choices. We aimed to explore the perceptions of Chilean schoolchildren about environmental sustainability, food, and nutrition. Eight online focus groups were conducted with boys and girls aged 8-9 (n = 30). Questions related to environmental sustainability, pocket money, and food characteristics such as price, front-of-package (FOP) warning label, and eco-labels were included. Data analysis was conducted using ATLAS.ti through a hybrid content analysis approach. Five central themes were identified: (1) children's favorite snacks, (2) knowledge of sustainability, (3) sustainability and eco-labels use, (4) healthfulness of food products, and (5) pocket money and food prices. Most children were not aware of the meaning of "environmental sustainability", but the concept was understood when it was explained in plain language. Participants showed awareness about the environmental impact of their eating behavior, had a positive perception of eco-labels, and identified food with fewer warning labels as "better" options. Results indicate that children understand the concept of sustainability in food if it is communicated clearly, and that eco-labels may be an effective tool in that effort.

The Role of Food and Beverage Companies in Transforming Food Systems: Building Resilience at Multiple Scales.

Food and beverage companies are increasingly aware of the risks posed by climate change and many are interested in addressing them by building resilience along their supply chains. Financial incentives for environmental, social, and governance criteria further motivate mitigation action by firms. To achieve sustainable outcomes, human and ecological systems must be managed for resilience. The scientific community and food and beverage firms must collaborate in the development of measurable and verifiable indicators that support adaptation and mitigation action along food supply chains. This article identifies 3 areas in which a synergistic progress would set a resilient trajectory toward sustainability: 1) incentives for sustainable intensification, 2) expanded reporting standards, and 3) pre-competitive collaborations. Incremental, clear, and measurable steps can be taken to adapt food supply chains to the pressing challenges imposed by climate change, mitigate further emissions, and bring producers and consumers along in the journey towards planetary health.

Teachers' self-perception of their dietary behavior and needs to teach healthy eating habits in the school.

Through focus groups, we explored 22 third- to fifth-grade teachers' perceptions about their eating habits, including barriers and facilitators to healthy eating. It also explored teachers' thoughts about how to teach students healthy eating habits. The information was transcribed and treated using the content analysis technique. Results were evaluated using the concept of majority and minority group and presented in a sequential way: teachers' perceptions about eating habits, barriers to healthy eating, teacher's culinary habits, abilities to teach students healthy eating habits through Information and Communication Technologies, and cooking activities. Teachers' eating habits were poor, with lack of time, money, and will to improve. They had culinary habits skills and the desire to instruct and guide their students in eating healthier food. They need a program with Information and Communication Technologies and cooking workshops to apply in the classroom.

[Validity of an instrument for assessing food consumption, food habits and cooking skills in 8-11 years old students]. / VALIDACIÓN DE UN INSTRUMENTO PARA EVALUAR CONSUMO, HÁBITOS Y PRÁCTICAS ALIMENTARIAS EN ESCOLARES DE 8 A 11 AÑOS.

INTRODUCTION: An instrument to measure food knowledge, food consumption, cooking skills, food habits and food expenses at school is necessary to assess changes in food practices. OBJECTIVE: To validate an instrument to measure changes in food knowledge, food consumption, cooking skills, food habits and food expenses in Chilean school children 8 - 11 years from third to fifth grade. METHODS: A validation of a questionnaire with 42 questions was conducted in two stages: the first to assess temporal stability, concordance and internal consistency in 45 children. The second one to apply the survey, modified with the results of the first stage, in 90 children assessing internal consistency. RESULTS: The first survey with 42 questions showed a reasonable temporal stability, concordance and internal consistency for cooking skills, habits and food expenditure at school. Internal consistency was good for food consumption, but not so good for food knowledge. In the final validation with 90 children, there was good consistency for food consumption but bad for food knowledge. Besides, children with cooking skills ate more healthy food and those who expended more money at school, consumed less healthy food. CONCLUSIONS: Food knowledge questions were eliminated from the instrument, which was elaborated with 28 questions about food consumption, cooking skills, food habits and food expenses at school. This instrument is useful to assess changes in food and nutrition education interventions in 8 -11 years children, in particular to measure cooking skills and food expenses at school.

Introducción: Para medir cambios en prácticas alimentarias, se requieren instrumentos que midan conocimiento, consumo, habilidades culinarias, hábitos y gastos en alimentos en las escuelas. Objetivo: Validar un instrumento que permita medir cambios en conocimiento, consumo, habilidades culinarias, hábitos y gastos en niños de 8 a 11 años, de tercero a quinto básico, en escuelas públicas de Chile. Métodos: Se realizó un estudio de validación de un cuestionario de 42 preguntas de conocimiento, consumo, habilidades culinarias, hábitos y gastos en la escuela. Se realizó en dos etapas: la primera en 45 niños para evaluar la estabilidad temporal, concordancia y consistencia interna. La segunda fue aplicar el instrumento modificado con los resultados de la primera etapa en 90 niños para medir consistencia interna. Resultados: El cuestionario aplicado en los 45 niños mostró estabilidad temporal, concordancia y consistencia interna aceptables para habilidades culinarias, hábitos y gastos en la escuela. La consistencia fue buena para frecuencia de consumo, pero mala en conocimiento. En la validación final con 90 niños, se confirmó la buena consistencia para frecuencia de consumo y mala para conocimiento. Se observó que aquellos niños con habilidades culinarias, consumen más alimentos saludables y los que gastan más dinero en la escuela, consumen menos alimentos saludables. Conclusiones: Al instrumento se le quitaron las preguntas de conocimiento, quedando con 28 preguntas de consumo, habilidades culinarias, hábitos y gasto en alimentos en las escuelas. Este instrumento es útil para medir cambios en intervenciones educativas en alimentación y nutrición en niños de 8 a 11 años.

Validación de un instrumento para evaluar consumo, hábitos y prácticas alimentarias en escolares de 8 a 11 años / Validity of an instrument for assessing food consumption, food habits and cooking skills in 8-11 years old students

Introducción: Para medir cambios en prácticas alimentarias, se requieren instrumentos que midan conocimiento, consumo, habilidades culinarias, hábitos y gastos en alimentos en las escuelas. Objetivo: Validar un instrumento que permita medir cambios en conocimiento, consumo, habilidades culinarias, hábitos y gastos en niños de 8 a 11 años, de tercero a quinto básico, en escuelas públicas de Chile. Métodos: Se realizó un estudio de validación de un cuestionario de 42 preguntas de conocimiento, consumo, habilidades culinarias, hábitos y gastos en la escuela. Se realizó en dos etapas: la primera en 45 niños para evaluar la estabilidad temporal, concordancia y consistencia interna. La segunda fue aplicar el instrumento modificado con los resultados de la primera etapa en 90 niños para medir consistencia interna. Resultados: El cuestionario aplicado en los 45 niños mostró estabilidad temporal, concordancia y consistencia interna aceptables para habilidades culinarias, hábitos y gastos en la escuela. La consistencia fue buena para frecuencia de consumo, pero mala en conocimiento. En la validación final con 90 niños, se confirmó la buena consistencia para frecuencia de consumo y mala para conocimiento. Se observó que aquellos niños con habilidades culinarias, consumen más alimentos saludables y los que gastan más dinero en la escuela, consumen menos alimentos saludables. Conclusiones: Al instrumento se le quitaron las preguntas de conocimiento, quedando con 28 preguntas de consumo, habilidades culinarias, hábitos y gasto en alimentos en las escuelas. Este instrumento es útil para medir cambios en intervenciones educativas en alimentación y nutrición en niños de 8 a 11 años (AU)

Introduction: An instrument to measure food knowledge, food consumption, cooking skills, food habits and food expenses at school is necessary to assess changes in food practices. Objective: To validate an instrument to measure changes in food knowledge, food consumption, cooking skills, food habits and food expenses in Chilean school children 8 - 11 years from third to fifth grade. Methods: A validation of a questionnaire with 42 questions was conducted in two stages: the first to assess temporal stability, concordance and internal consistency in 45 children. The second one to apply the survey, modified with the results of the first stage, in 90 children assessing internal consistency. Results: The first survey with 42 questions showed a reasonable temporal stability, concordance and internal consistency for cooking skills, habits and food expenditure at school. Internal consistency was good for food consumption, but not so good for food knowledge. In the final validation with 90 children, there was good consistency for food consumption but bad for food knowledge. Besides, children with cooking skills ate more healthy food and those who expended more money at school, consumed less healthy food. Conclusions: Food knowledge questions were eliminated from the instrument, which was elaborated with 28 questions about food consumption, cooking skills, food habits and food expenses at school. This instrument is useful to assess changes in food and nutrition education interventions in 8 -11 years children, in particular to measure cooking skills and food expenses at school (AU)

Validación de un instrumento para evaluar prácticas alimentarias en familias chilenas de escolares de 4 a 7 años / Validation of an instrument to measure food practices in chilean families of school children aged 4-7 years

Introduction: It is necessary to assess family food habits in school children to cope with infant obesity. Objective: Designing and validation of an instrument to measure food habits and food knowledge in Chilean preschool and school families based on dietary guidelines. Methods: A pilot study in 30 preschool and school-age parents was carried-out. A questionnaire to measure food habits and food knowledge in parents was elaborated by researchers considering an expert group opinion. This questionnaire was applied twice with a 15 days interval, evaluating temporal stability, internal consistency and inter-personal agreement. Afterwards, the questionnaire was applied to 59 parents calculating the internal consistency of the instrument. Results: The questionnaire had 55 questions in 4 sections. The instrument had questions about food and nutrition information about the families. A good inter-personal agreement resulted for almost all the questions about food and nutrition information (0.5-1.0). The correlation between the first and second test (test-retest) was high (0.6-1.0), as well as the internal consistency (0.75). In the section about frequency consumption in parents and children food consumption at home and school there was a high internal consistency for the two observers (0,85-0,92 and 0,87-0,90). Conclusions: The instrument is valid and useful to be utilized in preschool and school families intervened with nutrition education, and this methodology can be replied in other studies (AU)

Introducción: Para enfrentar el problema de la obesidad infantil, es necesario evaluar prácticas alimentarias en familias de escolares. Objetivo: Elaborar y validar un instrumento para medir actitudes, conocimientos y hábitos alimentarios en familias chilenas de escolares de prebásica y básica basado en las guías alimentarias. Métodos: Se realizó un estudio piloto en 30 padres de escolares de prebásica y básica. Se diseñó un cuestionario por los investigadores del estudio considerando la opinión de un grupo de expertos, para medir actitudes, conocimientos hábitos alimentarios en los padres de los escolares. Para la validación del cuestionario, se aplicó en 2 ocasiones, con 15 días de intervalo y se evaluó estabilidad temporal, consistencia interna y concordancia inter-observadores. Posteriormente se aplicó a una muestra de 59 padres y se calculó la consistencia interna del instrumento. Resultados: El cuestionario quedó conformado por 55 preguntas, agrupadas en 4 secciones. Se encontró una buena concordancia inter-observadores para casi todas las preguntas de la sección conocimientos en alimentación y hábitos alimentarios (0,5-1,0). La correlación entre la primera aplicación y la segunda (test-retest) fue elevada (0,6-1,0), así como la consistencia interna (0,75). En la sección frecuencia de consumo del padre y en la de alimentación del niño en el hogar y colegio, la consistencia interna para los dos observadores fue elevada (0,85-0,87; 0,92-0,90; respectivamente). Conclusiones: El instrumento es útil y válido para ser aplicado en familias de escolares de prebásica y básica intervenidas con educación nutricional y esta metodología puede ser replicada en estudios similares (AU)

[Effect of a nutrition education intervention on consumption of fruits, vegetables and fish in families of prescholers and scholers]. / Efecto de una intervención educativa sobre el consumo de frutas, verduras y pescado en familias de niños preescolares y escolares.

The objective of this study was to assess the impact of a nutrition education intervention on fruits, vegetables and fish consumption in pre-school and school age children families, through a three months education intervention with a pre-post evaluation in 27 intervened families and 32 controls from public schools in Santiago, Chile. A food-frequency questionnaire on fruits, vegetables and fish, and a survey on food and nutrition knowledge, attitudes and practices were applied to children and their parents. The intervention consisted in six 90 minutes cooking workshops, including the utilization of videos and photovoice for those who cooked in the families. Results showed a significant more consumption of fruits, vegetables and fish in the intervened than in the control group (test de Kolmogorov-Smirnov, test de Wilcoxon, p < 0.05). Comparing pre-post consumption by group, significance differences were for the intervened group in all cases. (test de Wilcoxon for paired samples, p < 0.05). In parents, fruit consumption increased 135.8 g, vegetables 19.5 g, and fish 10,2 g per day. In children, the increase in fruits was 92.1 g, vegetables 65.9, and fish 5.2 g per day. All the intervened families (n = 22) introduced a significant healthy food improvement at home. Results showed that it is possible to change food habits in families with the implementation of a nutrition education intervention including cooking workshops, videos and photovoice.

Efecto de una intervención educativa sobre el consumo de frutas, verduras y pescado en familias de niños preescolares y escolares / Effect of a nutrition education intervention on consumption of fruits, vegetables and fish in families of prescholers and scholers

El objetivo del estudio fue evaluar el efecto de una intervención educativa sobre el consumo de frutas, verduras y pescado en familias de niños preescolares y escolares mediante una intervención de tres meses y una evaluación antes y después, en 27 familias intervenidas y 32 controles, de colegios municipales de una comuna de Santiago, Chile. Al inicio y final de la intervención se aplicó a cada niño y su padre una encuesta de frecuencia de consumo de frutas, verduras y pescado y de conocimientos, actitudes y prácticas de alimentación familiar. La intervención consistió en seis talleres de cocina de 90 minutos cada uno para los encargados de la preparación de alimentos en el hogar, utilizando además video y fotografía participativa. Los resultados mostraron un mayor consumo de frutas, verduras y pescado en el grupo intervenido (test de Kolmogorov-Smirnov, test de Wilcoxon, p<0,05). Al comparar el consumo pre-post por grupo, las diferencias resultaron significativas para el intervenido en todos los casos (test de Wilcoxon para muestras pareadas, p<0,05). En los padres, el consumo de frutas aumentó en 135,8 g, el de verduras en 19,5 g y el de pescado en 10,2 g diarios. En los niños, las frutas aumentaron 92,1 g, las verduras 65,9 g y el pescado 5,2 g al día. Todas las familias intervenidas (n=22) incorporaron algún cambio significativo en la alimentación saludable de su hogar. Los resultados muestran que es posible realizar cambios en los hábitos alimentarios de las familias, con la implementación de una intervención educativa que incluya talleres de cocina y materiales audiovisuales.

The objective of this study was to assess the impact of a nutrition education intervention on fruits, vegetables and fish consumption in pre-school and school age children families, through a three months education intervention with a pre-post evaluation in 27 intervened families and 32 controls from public schools in Santiago, Chile. A food-frequency questionnaire on fruits, vegetables and fish, and a survey on food and nutrition knowledge, attitudes and practices were applied to children and their parents. The intervention consisted in six 90 minutes cooking workshops, including the utilization of videos and photovoice for those who cooked in the families. Results showed a significant more consumption of fruits, vegetables and fish in the intervened than in the control group (test de Kolmogorov-Smirnov, test de Wilcoxon, p<0,05). Comparing pre-post consumption by group, significance differences were for the intervened group in all cases. (test de Wilcoxon for paired samples, p<0,05). In parents, fruit consumption increased 135.8 g, vegetables 19.5 g, and fish 10,2 g per day. In children, the increase in fruits was 92.1 g, vegetables 65.9, and fish 5.2 g per day. All the intervened families (n=22) introduced a significant healthy food improvement at home. Results showed that it is possible to change food habits in families with the implementation of a nutrition education intervention including cooking workshops, videos and photovoice.

[Validation of an instrument to measure food practices in Chilean families of school children aged 4-7 years]. / Validación de un instrumento para evaluar prácticas alimentarias en familias chilenas de escolares de 4 a7 años.

INTRODUCTION: It is necessary to assess family food habits in school children to cope with infant obesity. OBJECTIVE: Designing and validation of an instrument to measure food habits and food knowledge in Chilean preschool and school families based on dietary guidelines. METHODS: A pilot study in 30 preschool and school-age parents was carried-out. A questionnaire to measure food habits and food knowledge in parents was elaborated by researchers considering an expert group opinion. This questionnaire was applied twice with a 15 days interval, evaluating temporal stability, internal consistency and inter-personal agreement. Afterwards, the questionnaire was applied to 59 parents calculating the internal consistency of the instrument. RESULTS: The questionnaire had 55 questions in 4 sections. The instrument had questions about food and nutrition information about the families. A good inter-personal agreement resulted for almost all the questions about food and nutrition information (0.5-1.0). The correlation between the first and second test (test-retest) was high (0.6-1.0), as well as the internal consistency (0.75). In the section about frequency consumption in parents and children food consumption at home and school there was a high internal consistency for the two observers (0.85-0.92 and 0.87-0.90). CONCLUSIONS: The instrument is valid and useful to be utilized in preschool and school families intervened with nutrition education, and this methodology can be replied in other studies.

Introducción: Para enfrentar el problema de la obesidad infantil, es necesario evaluar prácticas alimentarias en familias de escolares. Objetivo: Elaborar y validar un instrumento para medir actitudes, conocimientos y hábitos alimentarios en familias chilenas de escolares de prebásica y básica basado en las guías alimentarias. Métodos: Se realizó un estudio piloto en 30 padres de escolares de prebásica y básica. Se diseñó un cuestionario por los investigadores del estudio considerando la opinión de un grupo de expertos, para medir actitudes, conocimientos hábitos alimentarios en los padres de los escolares. Para la validación del cuestionario, se aplicó en 2 ocasiones, con 15 días de intervalo y se evaluó estabilidad temporal, consistencia interna y concordancia inter-observadores. Posteriormente se aplicó a una muestra de 59 padres y se calculó la consistencia interna del instrumento. Resultados: El cuestionario quedó conformado por 55 preguntas, agrupadas en 4 secciones. Se encontró una buena concordancia inter-observadores para casi todas las preguntas de la sección conocimientos en alimentación y hábitos alimentarios (0,5-1,0). La correlación entre la primera aplicación y la segunda (test-retest) fue elevada (0,6-1,0), así como la consistencia interna (0,75). En la sección frecuencia de consumo del padre y en la de alimentación del niño en el hogar y colegio, la consistencia interna para los dos observadores fue elevada (0,85-0,87; 0,92-0,90; respectivamente). Conclusiones: El instrumento es útil y válido para ser aplicado en familias de escolares de prebásica y básica intervenidas con educación nutricional y esta metodología puede ser replicada en estudios similares.