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In this article, we critically discuss a Swedish hospital foodservice reform by puttingfoodservice in a historical and social context and analyzing a case, “the most flexiblepatient foodservice system in Sweden,” by using Bacchi’s what’s the problem representedto be (WPR) approach. We show how hospital foodservice governance in Sweden hasbecome more focused on the individual patient as a consumer. Our analysis points outhow in political protocols and related policy materials freedom of choice, flexibility,and efficiency were articulated as drivers of change. Freedom of choice was argued toenhance quality, increase food intake, diminish demand for special diets and lower costs.This can be seen as empowering patients, but also shifting part of the responsibility ofnutrition care and health over to individuals, whether they want it or not. Flexibilitywas seen as beneficial for patient logistics regarding medical treatment and argued toimprove allocation of staff resources. Inefficiency was a characteristic attributed tothe old system, while the reform was an opportunity to modernize and be more costefficient.The new organizational structures may lead to tensions between foodserviceand healthcare. The changes, system flexibility and patient freedom of choice, are salientwithin a broader neoliberal discourse.

Objective: To explore the experiences of female dietetic students strictly following 2 different isocaloric diets.

Design: A qualitative study as part of a randomized controlled feeding trial with a crossover design. Data were collected through individual interviews conducted 1–35 days after the intervention.

Setting: A university in Sweden.

Participants: Normal-weight, healthy female dietetic students (n = 17), aged 18–30 years, who completed the full intervention.

Intervention: Two 4-week diet periods with a washout period in between. Participants followed either a diet based on the Nordic Nutrition Recommendations or a ketogenic low-carb high-fat diet, consuming preprepared meals.

Phenomenon of Interest and Variables: Participants’ experiences of following the imposed diets.

Analysis: Data were analyzed using content analysis techniques, resulting in 1 main theme, 2 categories, and 5 subcategories.

Results: Participants reported challenges with loss of control over food choices, unexpected effects of diet restrictions, and social visibility. They also highlighted the importance of contributing to science and the benefits for their future careers.

Conclusions and Implications: First-hand experiences of strict diets provided valuable insights into the complexities of dietary adherence, enhancing empathy and competence in future dietetic practice. Integrating practical diet experiences into education could improve dietary counseling skills.

Background: Child undernutrition remains a serious public health concern particularly in poor households where limited financial resources hinder proper child nutrition. Improving women’s access to productive resources and employment is crucial for addressing undernutrition. However, maternal employment may reduce the amount of time available for childcare, leading to poor child nutrition and health. This study explored rural community perceptions and experiences regarding maternal employment in relation to aspects of child nutrition and health in northeastern Uganda to inform the design of interventions that can effectively support maternal employment without compromising child nutrition and health.

Methods: Twelve gender-separated focus group discussions (FGDs) were conducted with pastoral and agro-pastoral communities in northeastern Uganda. Data from the FGDs were analysed using a constructivist grounded theory approach.

Results: Analysis of the FGD data revealed that cultural norms and economic pressure were crucial factors in maternal employment decisions. We constructed a model that represents maternal employment as a delicate balance to maximize the benefits for child nutrition and health while minimizing the negative consequences. The model comprises the core category, mothers’ solitary struggle for better child nutrition and health, and four interrelated categories: (1) mothers conforming to societal expectations, (2) mediating the effect of maternal employment on child nutrition and health, (3) suffering consequences of maternal employment, and (4) mothers striving for better child nutrition and health.

Conclusion: Access to income emerged as the main pathway through which maternal employment leads to better child nutrition and health. However, this benefit often comes at the cost of reduced time for childcare, which is perceived to be detrimental to child nutrition and health. Based on these results, enhancing access to productive resources and employment, particularly for women is crucial for addressing undernutrition. To ensure that maternal employment does not compromise childcare, policies must support the development and access to childcare options that are affordable and appropriate for women in rural areas and in informal employment to effectively balance employment and childcare.

Sweet foods occupy an ambiguous position in many people’s diets, perhaps especially for children and adolescents. The twin expectation that they both covet and limit their intake can create a dilemma not only in the home, but also in the school subject Home Economics (HE), which among other themes has a focus on food and health. In this study, we explored how Discourses on sweet foods were formed, reproduced, and challenged during 26 lessons in northern Sweden. Overall, sweet foods were constructed as desirable but also as unhealthy, disgusting, and unnecessary. They were used as a form of capital where ownership, distribution, and fairness were important, and students could mark friendships by sharing and gifting. Conversely, they could also use sweet foods to police, ridicule, question, or punish each other. Conflicts could arise around less-than-perfect results and students could withhold sweet foods from each other as a form of social rejection. Vague limits to intake placed responsibility for intake on the students themselves. We suggest that a contextualisation of the social, cultural, and health aspects of sweet foods in HE might help students acquire a more holistic Discourse of sweet foods and mitigate their social weaponisation.

BACKGROUND: The Karamoja region in the East African drylands is a rural, impoverished setting where pastoralism is increasingly replaced by other livelihood strategies. Understanding the socioeconomic contexts as well as their local variations is key for sustainable development of communities.

OBJECTIVE: The aim of the present paper is to describe the baseline survey of the Drylands Transform project, its setting, methods and key findings. METHODS: In June 2022, a survey was conducted with 944 randomly selected households at four study sites in the Karamoja border region of Kenya and Uganda. Data were analyzed using descriptive statistics.

RESULTS: Main livelihood forms were pastoralism and agropastoralism, while many households also relied on other sources of income. At some study sites, livestock keeping was abandoned by many residents due to cattle raiding and droughts. Only 4% of households were rated as food secure. The proportion of malnutrition among children aged 6-59 months varied across sites between 3% and 17% and was considerably higher among women.

CONCLUSIONS: Climate change, water shortage, social conflicts and marginalization pose barriers to food security and wellbeing for rural populations in the East African drylands. There are, however, opportunities for development through income diversification, the improvement of land health, the promotion of kitchen gardens and other measures of sustainable agriculture.

In sub-Saharan Africa, food insecurity remains high. In WestPokot, stakeholder perceptions of barriers and enablers to household food security and effectiveness of existing interventions were studied. Data collected through six FGDs and eight KIIs was analyzed through qualitative content analysis. Themes identified were extrinsic and intrinsic barriers, existing interventions for food security, perspectives on the effect of interventions, and resilience. In conclusion, handling barriers identified (e.g. lack of water, maternal workload), enhancing enablers (e.g. women empowerment), and adopting recommendations (e.g. creating enabling policies) are a way forward for food security and nutritional resilience in West Pokot and similar East African drylands.

The 2012 edition of the Nordic Nutrition Recommendations (NNR) included recommendations on breastfeeding, based on the most recent guidelines and recommendations from major national food and health authorities and organizations, systematic reviews, and some original research. For NNR 2023, the scope has been expanded and also includes formula feeding and the introduction of solid food. The main focus in this scoping review is on infants aged 0-12 months but also considers parts both before and beyond the first year, as the concept of 'the first 1000 days' emphasizes the importance of factors during pregnancy and the first 2 years of life for immediate and later health: physical as well as emotional and mental health. Breastmilk is the natural and sustainable way to feed an infant during the first months of life. Numerous studies have indicated immediate as well as long-term beneficial effects of breastfeeding on health for both the infant and the breastfeeding mother, and from a public health perspective, it is therefore important to protect, support, and promote breastfeeding. For full-term, normal weight infants, breastmilk is sufficient as the only form of nutrition for the first 6 months, except for vitamin D that needs to be given as supplement. The World Health Organization (WHO) and several other authoritative bodies therefore recommend exclusive breastfeeding during the first 6 months. Starting solids at about 6 months is necessary for both nutritional and developmental reasons. According to the European Food Safety Authority (EFSA) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), solid foods are safe to give from 4 months although exclusive breastfeeding until 6 months is the desirable goal. Breastfeeding can continue together with complementary foods as long as it is mutually desired by the mother and child. If breastfeeding is not enough or for some reason discontinued before the infant is 4 months of age, the infant should be fed infant formula, and, when possible, breastfeeding should be continued alongside the formula feeding. If the infant is 4 months or older, starting with solids together with continued breastfeeding and/or formula feeding is an option. Infant formulas have been developed for infants who are not breastfed or do not get enough breastmilk. Home-made formula should not be given.

Background: Inadequate energy intake among athletes can lead to low energy availability (LEA) which in turn can result in negative effects on athletic performance and physical and psychological health. This syndrome is known as relative energy deficiency in sports (REDs).

Objective: To map perceived changes in overall food intake among adolescent athletes during the previous year, as well as weekly changes during a 3-month period and to examine how these changes are associated with mental health, physical load and sex.

Methods: A total of 168 high school athletes from eight different sports participated. A baseline questionnaire examined changes in training habits and food intake in the past year, mental health (short version of the Warwick-Edinburgh Mental Well-being Scale (SWEMWBS)), injury history and previous periods of poor psychological health. Weekly digital questionnaires for 3 months tracked weekly physical and mental load and changes in food intake. Comparative and correlation analyses were performed with p<0.05 considered significant.

Results: A decreased food intake during the previous year was reported more often among athletes experiencing periods of poor mental health than those without such periods (10% vs 2%; p=0.034). Athletes who decreased their food intake reported lower mental well-being than athletes who increased their food intake (mean difference in SWEMWBS=4.69±1.57; p=0.021). Over a 3-month period, most athletes did not change their food intake, yet fluctuations in physical load were reported.

Conclusion: This study showed that athletes experiencing lower mental health or period(s) of poor mental health reported decreased food intake more often than those with better mental health or those without period(s) of poor mental health. In addition, the mismatch found between perceived weekly changes in overall food intake and changes in physical load during the same time period could potentially result in an increased risk for LEA.

Background: An increased intake of vegetable and fruit (VF) through school meals can contribute to the prevention of non-communicable diseases.

Objective: The purpose of this study was to investigate what types of VF 4th grade pupils (10–11 years old) choose, how much they eat when they are given the opportunity to serve themselves from the daily vegetable buffet available at lunch, and whether this varies with socioeconomic background and gender.

Design: A cross-sectional study design was used where pupils’ VF intake was measured during 5 days with a photographic method. In total, 196 pupils from nine public schools participated.

Results: The results show that pupils on average ate less than one type of VF per day from the vegetable buffet. Girls, pupils with a higher socio-economic status (SES) and those with a more frequent VF intake at home, ate more types of VF per day from the vegetable buffet than their counterparts. The median intake of VF from the vegetable buffet was generally low, 20.4 g/day. The intake was two thirds higher for pupils with higher SES in comparison with pupils with lower SES; 25 g/day versus14 g/day (P = 0.001). No gender differences in grams per day of VF were identified (P = 0.123).

Discussion: This study indicates that a well-stocked vegetable buffet as part of government-funded school lunch does not automatically contribute substantially to the recommended daily intake of VF among a sample of 4th grade pupils in a high-income country like Sweden.

Conclusions: The results of the study can be interpreted as a missed opportunity to increase the intentional consumption of VF among pupils in a way that would have implications for public health as well as attenuating differences between socioeconomic groups.

Aim: The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research.

Methods: The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05.

Results: Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals.

Conclusions: Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.