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BackgroundObesity has been identified as an emerging health concern for Chinese American children; however, very little is known about diets in Asian American children.ObjectiveTo assess the feasibility of assessing diet of urban Chinese American children in an applied (school) setting and to gain insight on diet and drivers of dietary intakes from community nutrition experts.DesignData were from the Food Journal Project 2017, a school-based pilot study conducted by a multi-sector collaboration, and qualitative data from nutrition and community experts.Participants/SettingChildren aged 8-12 (n=83) completed two dietary assessments using a food diary from January-June 2017. Children were then interviewed using the food diary as a guide; dietary data were entered into the ASA24 system by study staff. Chinese American children were compared to non-Chinese peers with respect to nutrient intake and the Healthy Eating Index 2010 (HEI-2010). Six semi-structured interviews and one panel discussion including two registered dietitians and community leaders with working knowledge of the Chinese American community were conducted from January-June 2018.Main Outcome MeasuresNutrient intake and HEI-2010 scores.Statistical Analyses PerformedChi-squared and t-test comparisons, with statistical significance set at α=0.05.ResultsAdjusted for caloric intake, Chinese American children consumed 20% more sodium, 21% more protein but 27% less sugar compared to non-Chinese children. With regards to the HEI-2010, Chinese American children had less favorable whole grains and sodium scores; and more favorable seafood protein and empty calories scores compared to non-Chinese children. Qualitative data underscored the current burden of diet-related health disparities among Chinese American children and suggested Chinese American receptivity to family-based nutritional and cooking education interventions.ConclusionsSodium reduction and increasing whole grain intakes may be warranted in Chinese American children but should be verified with additional studies. Interventions to improve nutrition in this understudied population are critical.Research SnapshotResearch QuestionWhat are typical dietary intakes and current community and family-based challenges related to healthy eating in Chinese American children – an understudied disparity group?Key FindingsChinese American schoolchildren have high sodium and low whole grain intakes compared to non-Chinese peers. These specific dietary disparities work in concert with low physical activity levels and cultural norms in contributing to diet-related health disparities in this group. Family-based nutrition education and potential focus of dietetic counseling on sodium and whole grain intake areas are indicated to address these disparities.

Obesity has been identified as an emerging health concern for Chinese American children; however, very little is known about diets in Asian American children. The objective of our paper was to describe the dietary intakes of urban Chinese American schoolchildren using a state-of-the-art approach for dietary assessment. Data for this analysis come from the Food Journal Project 2017, a pilot and feasibility study conducted by a multi-sector collaboration. Children aged 8-12 (n=83) completed two dietary assessments using a food diary from January-June 2017. Children were then interviewed using the food diary as a guide and dietary data were entered into the online ASA24 system by study staff. Chinese American children were identified using surname, and were compared to non-Chinese peers with respect to nutrient intake and the Healthy Eating Index 2010 (HEI-2010). Chinese American children consumed more sodium dense diets, more protein, and less sugar compared to non-Chinese children. With regards to the HEI-2010, Chinese American children had less favorable whole grains and sodium scores; and more favorable seafood protein and empty calories scores compared to non-Chinese children. Sodium reduction and increasing whole grain intakes may be warranted in this group, but should be verified with additional studies.

Introduction Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity. This is a concern given that public facilities often provide a significant amount of food for consumption by vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and/or serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada. Methods To inform further policy action on healthy food procurement in a Canadian context, we: (1) conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food, and (2) hosted a consensus conference in September 2014. The consensus conference invited experts with public health/nutrition policy research expertise, as well as health services and food services practitioner experience, to review evidence, share experiences, and develop a consensus statement/recommendations on healthy food procurement in Canada. Results Findings from the evidence synthesis and consensus recommendations for healthy food procurement in Canada are described. Specifically, we outline recommendations for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers. Conclusion Implementation of healthy food procurement policies can increase Canadians’ access to healthier foods as part of a broader vision for food policy in Canada.

The Nutrition Facts (NF) label was established to help individuals monitor their nutrient intake and select healthier foods. This tool is particularly useful for individuals for whom dietary improvements are recommended, such as those with hypertension. Study objectives were to examine the independent association between hypertension and frequency of use of the NF label for sodium information and determine whether frequent use in individuals with hypertension was associated with differences in mean sodium intake assessed through 24-hour urine samples. Data came from the New York City Community Health Survey Heart Follow-Up Study, a cross-sectional study conducted in 2010 in a representative sample of New York City adults (n=1,656). Participants were asked questions regarding frequency of checking the NF label and also had 24-hour urine samples collected to assess actual sodium intake. Results indicated that hypertension was associated with frequent use of the NF label for sodium information (adjusted odds ratio 1.71, 95% CI 1.07 to 2.73). In individuals with hypertension, sodium intake did not differ between frequent vs nonfrequent use of the NF label for sodium information (3,084 mg/day vs 3,059 mg/day; P=0.92). Although individuals with hypertension compared to those with no hypertension had 71% higher odds of frequently using the NF label for sodium information, suggesting they may be interested in decreasing sodium intake, sodium intake did not differ by frequency of NF label use among those with hypertension. Future research should explore strategies to ensure that when nutrition information is used, it is translated into meaningful results, especially in individuals with health concerns such as hypertension.

Poor diet is a leading cause of disability, death, and rising health care costs. Government agencies can have a large impact on population nutrition by adopting healthy food purchasing policies. In 2007, New York City (NYC) began developing a nutrition policy for all foods purchased, served, or contracted for by City agencies. A Food Procurement Workgroup was created with representatives from all City agencies that engaged in food purchasing or service, and the NYC Health Department served as technical advisor. The NYC Standards for Meals/Snacks Purchased and Served (Standards) became a citywide policy in 2008. The first of its kind, the Standards apply to more than 3,000 programs run by 12 City agencies. This paper describes the development process and initial implementation of the Standards. With more than 260 million meals and snacks per year covered, the Standards increase demand for healthier products, model healthy eating, and may also affect clients' food choices beyond the institutional environment. Our experience suggests that implementation of nutrition standards across a wide range of diverse agencies is feasible, especially when high-level support is established and technical assistance is available. Healthy procurement policies can ensure that food purchased by a jurisdiction supports its public health efforts.

Objective: To describe the characteristics, nutrition-related knowledge, practices, and attitudes of staff managing cafeterias in New York City (NYC) hospitals. Methods: An in-person survey was administered over 7 months to cafeteria managers from hospitals participating in the NYC Department of Health and Mental Hygiene's Healthy Hospital Food Initiative. The survey assessed nutrition knowledge and attitudes; hospital cafeteria practices; and nutrition standards and policies. The majority of questions required a yes or no response, followed by an open-ended request for details related to the response. Other questions were multiple choice or used 5-point Likert scales to measure respondent perceptions. Results: Seventeen cafeteria managers completed the survey. Less than a third of respondents had training in nutrition, and less than a quarter of hospitals followed nutrition standards for food offered in the cafeteria. Most respondents thought cafeterias could play a role in reducing sodium consumption, yet less than half correctly identified the largest sources of sodium in the average diet. The most commonly cited limitation to making healthy changes in the cafeteria was perceived lack of demand for healthy foods/customer support. Conclusion: Characteristics, nutrition knowledge, practices, and attitudes of hospital cafeteria managers vary. Communication with consumers and education of staff who lack training and experience in nutrition may be important focus areas for hospitals looking to improve their food environment.

Background Hospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served. Community Context The New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafés. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafés. Methods Hospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafés were evaluated at baseline and at the end of the HHFI to assess changes. Outcome Sixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15). Interpretation Most New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments.

Most hospital patient meals are considered regular-diet meals; these meals are not required to meet comprehensive nutrition standards for a healthy diet. Although programs exist to improve nutrition in hospital food, the focus is on retail settings such as vending machines and cafeterias vs patient meals. New York City's Healthy Hospital Food Initiative (HHFI) provides nutrition standards for regular-diet meals that hospitals can adopt, in addition to retail standards.This study was undertaken to describe regular-diet patient menus before and after implementation of the HHFI nutrition standards.The study involved pre- and post- menu change analyses of hospitals participating in the HHFI between 2010 and 2014.Eight New York City hospitals, selected based on voluntary participation in the HHFI, were included in the analyses.Nutritional content of regular-diet menus were compared with the HHFI nutrition standards.Nutrient analysis and exact Wilcoxon signed-rank tests were used for the analysis of the data.At baseline, no regular-diet menu met all HHFI standards, and most exceeded the daily limits for percentage of calories from fat (n=5), percentage of calories from saturated fat (n=5), and milligrams of sodium (n=6), and they did not meet the minimum grams of fiber (n=7). Hospitals met all key nutrient standards after implementation, increasing fiber (25%, P0.01) and decreasing sodium (-19%, P0.05), percentage of calories from fat (-24%, P0.01), and percentage of calories from saturated fat (-21%, P0.05). A significant increase was seen in fresh fruit servings (667%, P0.05) and decreases in full-fat and reduced-fat milk servings (-100%, P0.05), refined grain servings (-35%, P0.05), and frequency of desserts (-92%, P0.05).Regular diet menus did not comply with the HHFI nutrition standards at baseline. Using the HHFI framework, hospitals significantly improved the nutritional quality of regular-diet patient menus. The standards were applied across hospitals of varying sizes, locations, menu types, and food service operations, indicating feasibility of this framework in a range of hospital settings.

Poor diet is a leading cause of disability, death, and rising health care costs. Government agencies can have a large impact on population nutrition by adopting healthy food purchasing policies. In 2007, New York City (NYC) began developing a nutrition policy for all foods purchased, served, or contracted for by City agencies. A Food Procurement Workgroup was created with representatives from all City agencies that engaged in food purchasing or service, and the NYC Health Department served as technical advisor. The NYC Standards for Meals/Snacks Purchased and Served (Standards) became a citywide policy in 2008. The first of its kind, the Standards apply to more than 3,000 programs run by 12 City agencies. This paper describes the development process and initial implementation of the Standards. With more than 260 million meals and snacks per year covered, the Standards increase demand for healthier products, model healthy eating, and may also affect clients' food choices beyond the institutional environment. Our experience suggests that implementation of nutrition standards across a wide range of diverse agencies is feasible, especially when high-level support is established and technical assistance is available. Healthy procurement policies can ensure that food purchased by a jurisdiction supports its public health efforts.

For many Americans, what we eat daily is determined by the available foods in institutional settings such as schools, day care centers, workplaces, hospitals, correctional facilities, and senior centers. Guidelines supporting healthy and sustainable food service at institutions can assist in increasing the availability of healthy choices, thus influencing the diet of a large portion of the US population. The increase in market demand for healthier foods due to institutional guidelines can affect the food system at large, potentially leading to a general overall increase in the production and availability of healthier foods. Healthy and sustainable food service guidelines, such as the US Department of Health and Human Services (HHS)8 and the General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines) or the 2009 Institute of Medicine school meal nutrition recommendations, can be used for procuring, preparing, serving, and selling healthier foods and beverages with the intent of improving the quality of dietary intake and increasing the ecological benefits to the food system (1, 2).