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Obesity in children is increasing over the last decades and the majority of children in Europe fails to have a healthy diet. In the Netherlands, the majority of primary schools do not provide a (healthy) school lunch. However, previous research shows some positive effects. Within the current study the investigators want to implement healthy school lunches in the city of Rotterdam, a city with a very diverse youth population. The main objective of the healthy school lunch project is to evaluate the effectiveness and feasibility of providing healthy school lunches.
This is a prospective, single center, intervention study using a cross-over design with 3 measurement moments to collect data on effects and feasibility. Additional feasibility data will be collected throughout the study via questionnaires for teachers.
The study population is derived from primary schools participating in the "Enjoy Being Fit!" program in the city of Rotterdam. Children (4-12 years old) from these schools are eligible to participate in this study. Children from participating primary schools will take part in observations and complete questionnaires (only grade 5 to 8). Parents and teachers will complete questionnaires.
Together with individual schools and stakeholders a healthy school-lunch concept will be developed and implemented for half a school year. Data will be collected on three time points during the school year.
Questionnaires for children and parents will focus on dietary behaviour/food intake, taste preferences, perceived health, and the satisfaction with the healthy school lunch (also for teachers). Atmosphere in the class during lessons and during lunch will be measured in questionnaires for children and teachers. The questionnaire for parents also focuses on affordability of a healthy school lunch. Observation forms will be used to score on one day what snack and lunch children bring to/get at school.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | No Intervention | Students will bring their own lunch box in the control period. | |
| Intervention group | Experimental | Students will get a healthy lunch at school in the intervention period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Healthy school lunch | Other | The healthy school lunch will be co-created together with school staff, parents, and children, and should be healthy according guidelines of the Dutch nutrition center. |
| Measure | Description | Time Frame |
|---|---|---|
| Dietary content of children's lunches - assessed by an observation form | Observation of type and amount of bread, topping, drinks, fruits, vegetables, and other food products | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| General dietary behaviour of children - assessed by a questionnaire | (consumption of breakfast, fruit, vegetable, water, sugar sweetened beverages -children and parents) Questions adapted from the GGD (Dutch municipal health service) health monitor. | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Demographic variables - assessed by a questionnaire | age, gender, country of birth | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Type of dietary requirement(s) - assessed by a questionnaire |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Wilma Jansen, Dr. ir. | Contact | +31107038460 | w.jansen.1@erasmusmc.nl | |
| Annemieke Wargers, Msc | Contact | a.wargers@erasmusmc.nl |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Public Health, Erasmus MC University Medical Center | Recruiting | Rotterdam | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34579117 | Background | Hahnraths MTH, Willeboordse M, van Assema P, Winkens B, van Schayck CP. The Effects of the Healthy Primary School of the Future on Children's Fruit and Vegetable Preferences, Familiarity and Intake. Nutrients. 2021 Sep 17;13(9):3241. doi: 10.3390/nu13093241. | |
| 32398052 | Background | van Kleef E, Rongen FC, Vingerhoeds MH, Dijkstra SC, Seidell JC. Improving dietary intake during lunch through the provision of a healthy school lunch at Dutch primary schools: design of a pretest-posttest effectiveness study. BMC Public Health. 2020 May 12;20(1):662. doi: 10.1186/s12889-020-08807-1. |
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A data sharing statement will be finalized when known which percentage of participants consent for sharing data outside of our own organization.
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The investigators will use a cross-over design, which means participating schools have both a control and intervention period during academic year 2023-2024. Schools will be randomized into group A or B, starting with either an intervention or control period.
During the intervention period, schools will organize a healthy lunch for all children during four days a week for a duration of half an academic year (approximately 18 weeks). During the control period, children will bring their own lunch box.
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| Perceived health of children - assessed by a questionnaire | Questions adapted from the GGD (Dutch municipal health service) health monitor: general health, in past week, in past 3 months. | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Taste preferences of children - assessed by a questionnaire | Self-reported questions on taste of different fruits (n=12) and vegetables (n=16). Questions adapted from the Healthy Primary School of the Future study | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Concentration in class - assessed by a questionnaire | Self-reported question on the ability to concentrate in class. For children reported on individual level. For teachers reported on class level. | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Atmosphere in class - assessed by a questionnaire | Self-reported questions on the atmosphere in class. For children reported on individual level. For teachers reported on class level. | Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Financial situation of parents - assessed by a questionnaire | Questions adapted from the GGD (Dutch municipal health service) health monitor: difficulties making ends meet & inability to do things due to lack of money | During intervention arm: depending on the group either approximately 18 weeks after baseline or approximately 36 weeks after baseline |
| Satisfaction of the healthy school lunch - assessed by a questionnaire | Self-reported questions partly adapted from the Healthy School Lunch study and partly constructed by the research team. Satisfaction questions focused on: participation, content of lunch, organization, reasons to participate, continuation. Descriptives will be presented. | During intervention arm: depending on the group either approximately 18 weeks after baseline or approximately 36 weeks after baseline |
The kind and amount of dietary requirements will be collected by using a self-reported question.
Descriptives will be presented.
| Three times during academic year 2023-2024: baseline/approximately 18 weeks/approximately 36 weeks |
| Feasibility data on implementation and sustainability - assessed by a questionnaire | Feasibility data on implementation and sustainability will be collected via self-reported questions constructed by the research team. Questions will focus on implementation, organization, time investment, sustainability. Open answers will be analyzed qualitatively. | Every month during academic year 2023-2024: baseline/1 month/2 months/ 3 months/ 4 months/ 5 months/ 6 months/ 7 months/ 8 months/ 9 months |
| 39414278 | Derived | Wargers A, Polychronakis K, Nieboer D, Raat H, Jansen W. Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study. BMJ Open. 2024 Oct 16;14(10):e083534. doi: 10.1136/bmjopen-2023-083534. |