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School ‘NutriAgent’ Handbook To effectively improve and monitor the eating environment at school, teachers and parents should take the following actions: Reinforce nutritional knowledge. Use various monitoring tools skilfully to achieve constant improvements in the eating environment at school. Communicate with the school, parents, students and food suppliers (including lunch suppliers and tuck shop operators) frequently to improve the nutritional quality of lunches or snacks available at school and strengthen cooperation between parents and schools. 1. Reinforce nutritional knowledge To monitor and improve the healthy eating environment at school, surveillance team members should have basic nutritional knowledge and know how to use various monitoring tools properly. This chapter is intended to deepen the nutritional knowledge of the Nutri-agents through giving key introductions on the following nutrition-related aspects: Nutritional Guidelines on School Lunch for Primary School Students Nutritional Guidelines on Snacks for Primary School Students Frequently Asked Questions (FAQs) on Healthy Eating How to read nutrition labelling 1.1 Key points of Nutritional Guidelines on School Lunch for Primary School Students The Guidelines mainly aim to ensure that the lunch taken by schoolchildren can achieve energy balance, prevent them from consuming too much fat, sugar, and salt while increasing fibre intake. An ideal and healthy lunch should be able to meet one third of the daily nutritional needs of a schoolchild. In accordance with the local Food Guide Pyramid promoted by the Department of Health, a healthy lunch should have grains and cereals as the main ingredients, with dishes mainly comprised of vegetables and some meat.. A lunch box should provide grains and cereals, vegetables, and meat (and its substitute) in the ratio of 3:2:1 by volume. © October 2007 Department of Health, Government of the HKSAR All rights reserved. 6 School ‘NutriAgent’ Handbook The recommended lunch serving sizes for junior and senior primary students are as follows: Food group Recommended Recommended Examples of 1 serving quantity for quantity for P.1-3 students P.4-6 students Grains and cereals At least 4 servings At least 5 servings Vegetables At least 1 serving At least 1 serving Meat, poultry, fish, eggs, and beans 1- 2 servings 1 1/2 - 2 1/2 servings © October 2007 Department of Health, Government of the HKSAR All rights reserved. Rice, cooked = 1/5 bowl = 40 g Rice noodle, cooked = 1/5 bowl = 40 g Egg noodle, cooked = 1/4 bowl = 40 g Spaghetti or macaroni, cooked = 1/3 bowl = 50 g Bread, without skin = 1/2 slice = 20 g Leafy vegetables (e.g. lettuce), raw = 1 bowl = 55 g Leafy vegetables (e.g. Chinese cabbage, spinach), cooked = 1/2 bowl = 85 g Gourds (e.g. wax gourd, zucchini), cooked = 1/2 bowl = 90 g Mushrooms, cooked = 1/2 bowl = 80 g Beef, pork, chicken, or fish, cooked = 40 g Shrimp, cooked = 8 small = 40 g Whole egg, cooked = 1 large = 50 g Tofu, firm = 1/3 bowl = 85 g Beans (e.g. Hyacinth beans, kidney beans), cooked = 1/2 bowl = 90 g 7 School ‘NutriAgent’ Handbook Fruit At least 1/2 serving At least 1/2 serving Fats and 2 servings oils maximum (Used during food preparation and cooking processes) 2 servings maximum Orange (unpeeled) = 1 medium = 130 g Apple (unpeeled) = 1 medium = 106 g Banana (unpeeled) = 1/2 large = 68 g Grapes = 1/2 bowl = 80 g Fresh orange juice = 3/4 cup = 186 g Dried fruit e.g. raisin = 1/2 pack = 42 g Vegetable oils (e.g. corn, peanut, canola or olive oil) = 1 teaspoon = 4.5 g Salad dressing (e.g. mayonnaise, Thousand Island or Italian dressing) = 1 tablespoon = 15 g *Remark 1:Suppliers should supply at least 21/2 servings of fruits during a 5-day week. Remark 2:1 cup or 1 bowl = 240 ml To promote schoolchildren have a higher intake of fibre and lower intake of fat/oils, lunch suppliers should observe ALL of the following good practices when serving ALL school lunches: Vegetables are supplied every day Only vegetable oils (such as corn oil, canola oil, olive oil, and peanut oil) in limited amount are used for cooking All visible animal fat and excess oil used in cooking are removed before serving © October 2007 Department of Health, Government of the HKSAR All rights reserved. 8 School ‘NutriAgent’ Handbook Lunch prepared for schoolchildren should follow the principle of “low-salt, low-sugar, and low-fat” and “high-fibre”. Common lunch food item categories are shown in the following table: Encouraged Food Items (ALL of the following food categories should be included in AT LEAST ONE menu choice on ALL school days) Whole grains (e.g. red rice, vegetable rice, corn rice, or wholemeal bread) Reduced fat dairy products or other calcium-rich food items (e.g. tofu, soy milk with calcium fortified, and spinach) Limited Food Items (ANY of the following items should not be served on more than 2 school days per week) Grains and cereals with added fat or oil (e.g. fried rice, fried noodles, baked rice, or noodles with sauce) Fatty cut of meat and poultry with skin (e.g. ox belly, spare ribs, chicken wings, chicken, duck, or goose with skin) Whole fat dairy products (e.g. whole fat milk, regular cheese, and yoghurt) Processed or preserved meat, egg and vegetable products (e.g. BBQ pork, bacon, ham, sausages, preserved mustard green, and pickled cucumber) Sauce or gravy with high salt or fat content *(e.g. black bean sauce, black pepper sauce, and fermented soybean curd paste) Strongly Discouraged Food Items (The following items should not be included in ALL menu choices) Deep-fried food items (e.g. deep-fried pork chop, French fries, deep-fried chicken leg, spring roll, and deep-fried dumpling with curry stuff) Food items with added animal fat, plant-based of saturated fat, and hydrogenated fat (e.g. butter, lard, margarine, palm oil, or coconut oil) Desserts or beverages with more than 10 grams or 2 teaspoons of added sugar in each serving (e.g. tetra-pack drinks, fizzy drinks or, sweetened green tea) Items with very high salt content (e.g. salted fish, salted egg) * Remark: It is recommended that sauce or gravy with high salt or fat content should be served sparingly and separately. © October 2006 Department of Health All rights reserved. 9 School ‘NutriAgent’ Handbook 1.2 Key points of Nutritional Guidelines on Snacks for Primary School Students “Snack” is defined as a small amount of food taken between meals and not required for every children. However, due to a small stomach volume and high activity level, the three main meals may not meet children’s daily nutritional needs. Children are always hungry and need snacks at mid-meal time. Nutritious snacks help children have adequate intake of energy and nutrients, promote growth and development. Nevertheless, snacks should be served only when children are hungry at mid-meal time and not spoil the appetite of children for the next meal. Snacks should: Belongs to the food pyramid Be served in small amount Be served 1.5-2hours apart from the main meals Be served with beverages and water is the major drink Users may refer to the opinions offered in this chapter for reviewing and deciding the categories of food items and beverages sold to students. In addition, parents may refer to the following grouping when buying and preparing food for children as snacks: Snacks to Choose More –Food and beverages rich in one or more of the nutrients while low in fat, added sugar, and salt should be encouraged as the major choices. Snacks to Choose in Moderation – Food and beverage items contain one or more nutrients but also have fat, added sugar or salt, so that their consumption should be limited. These food items should be taken not more than 2 to 3 times per week. Snacks to Choose Less – Food and beverage items that are low in nutritional value or high in fat, added sugar or salt. These items are strongly discouraged against the risk of chronic diseases, e.g. obesity, heart disease, diabetes, and high blood pressure, etc. © October 2006 Department of Health All rights reserved. 10 School ‘NutriAgent’ Handbook Food Group Grains and cereals Snacks to Choose More Snacks to Choose in Moderation Snacks to Choose Less White bread, whole wheat bread, including whole wheat bread, wholemeal bread with added nuts and raisin bread Unsweetened or low-sugar breakfast cereals and cereal bars High-fibre or plain biscuits and crackers Boiled corn or corn kernels Unsweetened or low-sugar oat drinks Fresh vegetables (e.g. cucumbers, carrots, cherry tomatoes) Green salad (with minimal amount of low-fat salad dressing or plain yoghurt) Pickled or preserved vegetables, salted seaweeds Salad with whole fat salad dressings Fresh fruit Dried fruit without added sugar (e.g. apricots, prunes and raisins) Baked dried fruit chips e.g. apple chips Fruit platter or salad (without or minimal amount of low-fat salad dressing) Freshly blended fruit Dried fruit with added sugar or canned fruit in syrup (even if served without syrup) Sweetened fruit juices Canned fruit in juice Canned fruit in syrup (if served with syrup) Vegetables Fruit © October 2006 Department of Health All rights reserved. Refined breakfast cereals with added sugars or fat/oil(e.g. cocoa bubbles and frosted corn flakes) Plain sponge cake Biscuits coated with chocolate or sandwich biscuits Cream-filled buns, cakes Chocolate muffins, pastry, cookies Instant noodles French fries, deep-fried sweet potatoes Crisps and chips 11 School ‘NutriAgent’ Handbook juice without added sugar, 100% natural fruit juice Meat, beans, nuts Dairy products Canned tuna in water without added salt, or lean fresh meat (e.g. beef, chicken breast, turkey slices) as sandwich filling Boiled egg Bean curd dessert without added sugar Unsweetened or low-sugar soy milk Unsalted nuts or beans e.g. almonds, peanuts, cashew nuts, peas Low-fat or skimmed milk without added sugar Low-fat yoghurt or cheese e.g. plain yoghurt or fruit yoghurt without added sugar, low-fat cheese Food Group Unhealthy Snack Choices Food items high in oil, sugar and salt © October 2006 Department of Health All rights reserved. Chicken wings Ham, bacon and sausages Pan-fried or steamed dumplings Minced fish “Siu mai” Salted roasted nuts and beans Bean curd dessert with added sugar Sweetened soy milk Whole fat milk, yoghurt and cheese All deep-fried food items(e.g. deep-fried chicken wings, fish fillets, “fish ball”) Beef or pork jerky Ice cream, ice blocks Sauces e.g. curry sauce, black pepper sauce, soy sauce Confectionery (e.g. candies, chocolate) All sugary fizzy drinks or tetra-pack drinks Cordials and 3-in-1 instant drinks 12 School ‘NutriAgent’ Handbook 1.3 FAQ on healthy eating About Food 1. A: Is potato vegetable? Potato is usually classified into the “Grains and Cereals” group because it is high in carbohydrate but low in fibre. Other plant foods in the “Grains and Cereals” group include corn, taro, sweet potato, and carrot, but they are also counted as “Vegetables” for their high fibre content. Pumpkin is in the “Vegetables” group only. 2. Would low fat dairy products (e.g. milk, yoghurt or cheese) be less nutritious? A: Dairy products are rich in protein and calcium and calcium is good for children’s development of teeth and bones. In fact, the protein and calcium content are similar in low-fat and whole fat dairy products, excepts fat content is lower in the low-fat ones. To promote healthy weight and heart health, it is recommended toddlers aged 3 year-old or above to have low-fat dairy products and have skimmed ones from the age of 6 year-old. 3. A: Is chicken healthier than beef? Actually, the nutritional profile is different between red meat likes pork, beef and lamb and white meat like fish and skinless chicken. For example, red meat is richer in iron, which promote the production of red blood cells, whereas white meat has less fat than the red ones. Therefore, both types have their respective advantages. Under the healthy eating principle of “Having good variety of foods”, we just have to choose lean red meat or white meat in appropriate amount and prepare them in the way that is low in fat, salt and sugar, this is part of our healthy balanced diet. 4. What does “serving/portion” mean? What is the difference between “serving/portion” and “serving/portion size”? “Serving/portion” is an indicator commonly used by the nutritional profession in describing how much food an individual should take from different food categories daily; whereas “serving/portion size” is for describing how big a “serving/portion” is. For example, we should eat 3 servings of vegetables every day; and 1 serving of vegetables means approximately 1/2 bowl of cooked vegetables, or 1 bowl of uncooked vegetables. A: © October 2006 Department of Health All rights reserved. 13 School ‘NutriAgent’ Handbook 5. A: Is drinking long-boiled soup or marrowbone soup good for our body? Many people think that long-boiled marrowbone soup is rich in calcium that would benefit the development of bone. In fact, a children aged 6-12 year-old requires 800-1000mg of calcium everyday and a bowl of long-boiled marrowbone soup only contains about 2mg of calcium. In addition, the boiling process not only cannot release the calcium from the pig’s bones into the soup; but a massive amount of fat (especially saturated fat) in the bone marrow will go into the soup and thus not recommended to have. Parents is suggested to make clear soup with gourds, vegetables, legume, fish or lean meat. About Fats and Oils 1. What are the healthy kinds of edible oil? A: Healthier choices of plant oil, such as olive oil, canola oil, or corn oil, may be used. They contain more unsaturated fat. Yet bear in mind that all kinds of oil contains same amount of calories, excessive intake may also cause obesity and affect our health. 2. What is palm oil? Is it easily found in food? A: Palm oil is extracted from the fruit of palm trees. Although it is a kind of plant oil, it is high in saturated fat and excessive intake may increase the blood cholesterol level and the risk of cardiovascular diseases or stroke. Given palm oil is low in cost, many manufacturers use palm oil for food production. It is commonly found in ready-to-eat food or snacks e.g. instant noodles, cup noodles, potato chips, shrimp crackers, or stuffed biscuits. We may also pay more attention to the ingredient list on packaging when buying food to see if it is produced with palm oil. 3. Is grape seed oil healthy? A: Grape seed oil has a high content of unsaturated fat and antioxidant. Also, its smoke point is higher than other types of oil, about 250℃. It is suitable for different cooking methods, e.g. as a sauce for cold food, pan-frying, stir-frying, deep-frying, baking etc. It is a healthy and convenient choice. © October 2006 Department of Health All rights reserved. 14 School ‘NutriAgent’ Handbook 4. A: Is rice bran oil a healthy kind of fat? Yes. It is because rice bran oil contains a high level of unsaturated fat, which may help reduce blood cholesterol level and the risk of cardiovascular diseases. 5. A: Is olive oil suitable for cooking? The smoke point of cooking oil for frying should exceed 200℃ since cooking oil will be oxidized and produce carcinogenic compounds if it is heated up above its smoke point. In general, the smoke point of extra virgin olive oil is 190℃, suitable for salad, dip and pan-frying with small amount of oil, etc. While extra light olive oil with smoke point of 216-238℃, is suitable for baking, stir-frying and deep frying. 6. Is margarine healthier than butter that we can feel free to use more for spread? A: Using margarine instead of butter as spread will not be healthier. It is because some margarine in market have gone through hydrogenation and thus contain trans fat, which will also adversely affect our bad cholesterol (low density lipoprotein cholesterol) level and increase the risk of cardiovascular diseases or stroke. Moreover, margarine has the same level of calories as butter, which may also lead to obesity if consumed excessively. About Fruits and Vegetables 1. Nowadays, a lot of vegetables in the market contain agricultural pesticides and yet the Department of Health is suggesting people to have more vegetables. What should we do? A: The Centre for Food Safety of the Food and Environmental Hygiene Department regularly takes sample of vegetables for testing of pesticide residue to ensure that vegetables available in the market meet the standard for safe eating by members of the public. To further decrease the intake of pesticide residue, we can: © October 2006 Department of Health All rights reserved. 15 School ‘NutriAgent’ Handbook wash vegetables well in clean running water for several times and immerse in clear water for an hour, boil in water for one minute and discard the water used, or remove the outer leaves. 2. Apart from fresh fruit and vegetables, different kinds of canned and frozen vegetables, dried fruit and vegetables and juice can be found in the market. How can we choose? A: All the different kinds of fruit and vegetables above are classified in the “Fruit and Vegetables” group. But there are better choices as follow: Fresh fruit and vegetables require the least process, thus most of the nutrients can be retained. Therefore, it is the best choice, frozen ones are the second best choice. Nutrients may be destroyed during the food process of canned fruit and preservatives, salt or sugar are usually added in. It therefore not recommended to have them frequently. Dried fruit and vegetables also have gone through process, flavourings and preservatives may be added and thus not as good as the fresh ones. Freshly blended fruit and vegetable juice requires several manual process steps, vitamins and fibre may be lost. Moreover, harmful bacteria may be present if fruit and vegetable juice is handled improperly during process or kept in room temperature for a long time. 3. A: Are there any fruit and vegetables should be avoided? The following fruit and vegetables are not classified in to the “Fruit and Vegetables” group and should be avoided because they are high in fat, sugar or salt. Fruit and vegetables are high in fat (e.g. coconut, durian, olive, etc.) Deep-fried vegetable or with large amount of added fat (e.g. vegetable tempura, fried onion rings, fried taro wedges and salad with lots of salad dressing) Fruit and vegetable juice with added sugar (e.g. condensed fruit juice) Fruit desserts with added sugar (e.g. mango pudding, red bean sweet soup, mango sago dessert with pomelo, etc.) Preserved fruit and vegetables with lot of salt (e.g. pickled choi-sum, pickled mustard, pickled cucumber, preserved fruit, etc.) Canned or bottled vegetable juice 4. What are the differences in nutritive value between different kinds of vegetable? © October 2006 Department of Health All rights reserved. 16 School ‘NutriAgent’ Handbook A: Different edible parts of vegetable have different nutritive value: - Leafy vegetables are rich in carotene, vitamin C, folate, calcium and dietary fibre - Fruits, squashes and gourds are rich in carotene, vitamin C and water - Beans and legumes are rich in protein, carbohydrate, B vitamins, calcium and dietary fibre - Mushrooms and seaweeds are rich in protein, B vitamins, minerals and dietary fibre. To promote having good variety of food, we should choose different kinds of vegetables. 5. A: What should we pay attention to when buying fruit and vegetables? When buying fruit and vegetables, please pay attention to the following: - Buy fruit and vegetables form shops with license and hygienic environment - Do not buy damaged or spoiled fruit and vegetables - Avoid to buy cut fruit. If so, please pay attention to food safety and ensure cut fruit has been stored at 4℃ or below - Try to avoid fruit juice which has not been pasteurized and handled properly (e.g. freshly made fruit juice by hawkers) 6. A: How to process fruit and vegetables to ensure good food hygiene? When buying fruit and vegetables, please pay attention to the following: - After buying fruit and vegetables, store them in refrigerator as soon as possible - After buying frozen fruit and vegetables, they should be stored in sealed container and refrigerator at 0℃ or below. Defrost is not required prior to cooking. We can wash them with water and cooked in boiling water or steamed till done. - Cut or peeled fruit and vegetables should be wrapped properly and stored in the upper compartment of the refrigerator and separated from meat to avoid cross contamination. They should be consumed as soon as possible. - Discard cut or peeled fruit and vegetable if stored in ambient environment for more than 2 hours. - Wash our hands with soup and water thoroughly prior to handling fruit, vegetables and other foods. - Wash fruit and vegetables thoroughly with clear water despite it is peeled. © October 2006 Department of Health All rights reserved. 17 School ‘NutriAgent’ Handbook - 7. A: 8. A: Use different cutting board and utensils to handle fruit and vegetables (ready-to-eat food) and meat (non-ready-to-eat). Many people say that nutrients will be lost in the course of high-heat cooking and immersing vegetables. Is that true? Yes. Excessive immersing and washing or over-cooking of vegetables may cause nutrient loss. The followings are some easy tips to keep the nutrients in fruit and vegetables: - Wash vegetables with clean water first and then immerse them into water for about 60 minutes to remove pesticide residue. Detergent exclusively for vegetable may also be used to shorten the immersing time. - Avoid cutting fruit and vegetables prior to immersing - Avoid cutting fruit and vegetables into tiny size - Avoid over-cooking of vegetables, we may steam or blanch vegetables in 60℃ water prior to cooking by other methods. - Avoid to cook fruit and vegetables in excessive amount of water. Add them into boiling water only to avoid heating them up in cool water slowly. - When make soup, cook meat first and add vegetables at last. How much vegetable should children have in the other two regular meals if they cannot have them in breakfast? Children should have two servings of vegetables or more every day and one serving of vegetables means one bowl of uncooked vegetables or half bowl of cooked vegetables. So, if children cannot have vegetables in breakfast, then they should eat the sufficient quantity evenly from lunch, dinner or mid-meals. About Lunch 1. A: Many lunch suppliers claim that green leafy vegetables are difficult to process and would easily become yellow after cooking, so they are not appealing to children. What should we do? If the colour of green leafy vegetables is hard to keep, lunch suppliers may consider other vegetables, such as cabbage, zucchini, Chinese mushroom, straw mushroom, tomato, or Chinese cabbage, etc. © October 2006 Department of Health All rights reserved. 18 School ‘NutriAgent’ Handbook 2. A: Even if healthy options are available, children still like choosing the unhealthy ones. How can lunch suppliers help them choose a healthy lunch? Lunch suppliers should avoid supplying unhealthy options. Meanwhile, they can highlight the healthy options to facilitate parents’ education to children about choosing a healthy lunch box. Suppliers may also use “Today’s Special” in menu or bonus point reward scheme to encourage children to opt for the healthy lunch boxes. 3. A: How many calories should be provided in a children’s lunch? A lunch should provide one-third of the nutrients and calories children need daily, approximately 600-650 kcal. 4. Can the food quantity in lunch for junior primary students be same as for senior primary students? As the daily nutritional needs of junior primary students are different from senior primary students, the formers need less grains and cereals and meat. However, there is no major difference in the need of fruit and vegetables. For details of recommended serving quantity, please refer to the Nutritional Guidelines on Lunch for Primary Students. A: 5. A: 6. A: What is the calories or nutrients intake ratio between breakfast, lunch, and dinner? The three meals should each provide one-third of the calories or nutrients needed for a day. The food provided by the current school lunch supplier is not quite healthy, while parents do not have time to prepare lunch for their children. What could be done? Parents may refer to the Nutritional Guidelines on Lunch for Primary Students produced by the Department of Health and reflect the problem of nutritional imbalance in school lunch to the schools’ dedicated working group for catering service to children, and advise the working group to send a delegate to request the supplier to improve the nutritional quality of school lunch. 7. Since meat is rich in protein, is that eating less rice and more from the dishes can take in more nutrients so that children grow faster? A: No. Cereals and grains (i.e. rice, noodles and bread) are rich in carbohydrate and vitamins, they should be the most eaten to provide energy for daily activities and body’s functioning. While meat is rich in protein, but its fat and cholesterol © October 2006 Department of Health All rights reserved. 19 School ‘NutriAgent’ Handbook contents are higher than grains and cereals (except fried rice and fried noodles), excessive intake not only may promote weight gain, but also harm heart health. The ratio of grains and cereals, vegetable and meat of healthy lunch / dinner is 3:2:1 by volume. 8. A: It is recommended in the Nutritional Guidelines on Lunch for Primary Students that school children should eat most grains and cereals and least meat. Would this hamper children’s growth and development? In fact, adults and children do not need a large intake of protein daily. Small amount of meat, eggs or beans and legumes everyday can provide the protein we need to maintain our normal functioning and growth of our body. Children aged 6-12 year-old are recommended to have 3-5 taels of meat or its substitutes every day (1 tael meat = the size of 1 table tennis ball). Therefore, it is almost half of the daily need of meat for them if a lunch provides 2 taels of meat. About Snacks 1. A: Why do children have snacks? If children can have a balanced diet for all the three main meals daily with sufficient intake of calories and nutrients, snacks will surely not be a must. But children with a small stomach that their nutritional needs may not be fulfilled solely from the food from the main meals. In addition, children have high physical activity level, they burn energy and lose water easily during learning or doing exercise. Snacks may thus play a supplementary role. But please remember that snacks are just supplements, they should not be consumed excessively and could not replace the main meals. 2. How to prepare snacks for children? A: Parents may make reference to the Nutritional Guidelines on Snacks for Primary Students by the Department of Health to prepare “3 Lows, 1 high” healthy snacks that feature carbohydrate. To avoid spoiling the appetite of the next main meals, snacks should be provided in small amount and 1.5-2 hours apart form the main meals. © October 2006 Department of Health All rights reserved. 20 School ‘NutriAgent’ Handbook 3. Children just love to choose fried and deep-fried snacks. What should we do? A: We can first reduce children’s weekly frequency of having fried and deep-fried snacks, replaced with fruit and vegetables. In fact, children have a good adaptability that they will soon adapt the new taste. Therefore, parents should be patient and provide them different kinds of fresh food, make the foods appealed to them by the fresh taste and bright colours, healthy eating habits will then be cultivated gradually. 4. A: 5. A: 6. A: Can we use tetra-pack drinks or sweet drinks to attract children if they do not like water for replenishment? Adequate water is vital to the body. It helps digest and absorb food, propel metabolism and prevent constipation. Parents should always encourage children to drink more water. Sweetened drinks may promote weight gain because of their high sugar content. In general, children need about 6-8 glasses of fluid every day with water as the major drinks, low-fat milk, low sugar soymilk, fresh or pure fruit juice, clear soup, etc. are good choices as well. Is it true that children should skip breakfast to avoid over-eating if they have snacks during recess? No. After sleeping for the whole night, the food eaten last nigh has been digested and our blood sugar level is lower when wake up in the morning. Having breakfast, not only avoid over-eating at recess or lunch due to furious hunger, but also boost children’s’ thinking and learning. As for the beginning of a day, breakfast should feature grains and cereals (e.g. bread, rice congee or oat porridge) to provide sufficient energy. The probiotic drinks in the market are believed to be healthy. Are they good to children? Although some research studies have demonstrated the probiotic promote bowl health and help reduce the risk of some disease featured diarrhoea. However, the probiotic drinks in the market in general are added with sugar, over-consumption may cause excessive intake of sugar and energy, it thus classified as “Snacks to Choose in Moderation”. © October 2006 Department of Health All rights reserved. 21 School ‘NutriAgent’ Handbook 7. A: 8. A: Can sports drinks (or electrolyte-charging drinks) be used for water for children? Sports drinks or electrolyte-charging drinks are specially designed for person who participants in prolonged sport activities (e.g. a 1.5 hour football match). Compare with water, these drinks contain sugar, some may even contain caffeine. Therefore, the best drink for children to replenish water loss during learning and doing exercise is water. Are food products with nutrition claims, e.g. low-fat, sugar free, fat free etc. healthier options? The purpose of food products with nutrition claim is for consumer to identify healthier option easier. You may see the cholesterol free potato chip, fat free wine gums, etc. before. Despite the potato chips are cholesterol fee, they are still high in fat. Despite the wine gums are fat free, they are high in sugar. They are not good to our health if having a lot. When we shop for food, we should not only rely on the nutrition claims, we should consider its nutritive value entirely. About Diet and Lifestyle 1. How to define if a child is over- or under-weight? A: To assess a child whether he/she is over- or under-weight, we should first measure his/her height and weight, and find out its meeting point using the “Weight-for-Height Chart” on page 25 and 26 in this chapter. If the meeting point is - in the shadow area (81-119% of the weight-height median), represents normal weight - below the shadow area (80% or below of the weight-height median), represents underweight - above the shadow area (120% or above of the weight-height median), represents overweight. In both cases of overweight and underweight, or if a child’s height-weight ratio changes sharply within a short period of time, professional advice from physicians or dietitians should be sought. © October 2006 Department of Health All rights reserved. 22 School ‘NutriAgent’ Handbook 2. My child has an imbalanced diet. What should I do? A: Firstly, parents have to concede that there would be a couple of types of food children would normally dislike. Serious nutritional problem will not be provoked given they are not rejecting a whole food group. It is because foods from the same group provide similar nutrients. For example, if a child does not like capsicum, parents can replace with leafy vegetables other vegetables. When cultivate children to have a good variety of food, parents should not force them to eat their disliked food, as it will worsen children’s resistance to that food. On the other hands, parents should continuously encourage their children to try their disliked food, add other colourful ingredients or food they like to make it more appeal. Just put in a tiny bit for the child to try at first. If the child is fine with that, increase the amount gradually. 3. A: My child is on the thin side. No matter what he is given to eat, he still does not gain any weight. What should I do? We should first use the Weight for Height chart to assess our children’s body weight. If children are underweight, there are many underlying reasons, e.g. genetic factors or acquired poor dietary habits. However, parents may first observe the everyday dietary habits of their children, such as: - Are main meals nutritious (each main meal includes at least 3 food groups)? - Are children having too much unhealthy snacks? - Are the snack times too close to the main meals? All these inappropriate dietary habits hamper children’s absorption of nutrients. Parents could help their children develop regular dietary pattern, prepare more healthy and nutritious meals or snacks for them. Besides, having more exercises promotes their body development and nutrient absorption. If there is still no substantial improvement, professional advice from physicians or dietitians should be sought. 4. Children just love sugary food. Can we replace sugar with artificial sweetener? A: Artificial sweeteners generally refer to the “low-calorie” sweet-tasting compounds that can replace “sugar” to augment the sweetness in food, and they were thus named. However, the taste of sweeteners can be far sweeter than generic “sugar”. If they were used in children’s diet, the children would become more addicted to sweetness. This would in turn make them take in excess sugar from other food. Therefore, children are usually encouraged to gradually change © October 2006 Department of Health All rights reserved. 23 School ‘NutriAgent’ Handbook their current eating habits and accept food that tastes more plainly or less sweetly. 5. My child shows a trend of being overweight, but he does not have an imbalanced diet. However he will be hungry if giving him too little. What should I do? A: Parents do not need to be too nervous and worry when their children show a trend of being overweight. There is no need to help children lose weight with those popular fad diets or slimming methods. We just have to encourage our children to do sufficient amount of exercise and have a balanced diet, they will gradually return to the healthy weight range when they grow taller. To make children to have a healthy and balanced diet, parents may make reference to the Nutritional Guidelines on Lunch for Primary Students and the Nutritional Guidelines on Snacks for Primary School Students by the Department of Health, take the “3 lows, 1 high” (low-salt, low-sugar, low-fat, and high-fibre) as principle. The proposed servings also fit for other main meals (e.g. breakfast and dinner). Please remember physical and mental development would very likely be affected if over-dieting or losing weight by inappropriate methods during the developmental stage of children. 6. Although oil is seldom used in cooking, why my child is still overweight? A: Apart from fat and oil, excessive intake of any kind of food will also cause over intake of calories, which may be stored as fat in our body. To help children grow healthily and have a standard body weight, parents can make reference to the Food Guide Pyramid of the Department of Health and pay attention to the daily food intake of children. Parents should also encourage children to do sufficient amount of exercise since the lifestyle of “sit more, move less” reduces calorie expenditure and results in calorie surplus. 7. My child wants night snacks. What should I do? A: Parents should understand their children’s need and the reason of night snacks. Would it be insufficient eating in the day? Or is it just a bad habit? If children are hungry that they could not fall asleep, parents may give them small amount of food, e.g. soda crackers, bread, or low fat milk, etc. Having a large amount of food should be strictly avoided. If having night snacks is simply a bad habit, parents should teach them properly to help them cultivate healthy eating habits. © October 2006 Department of Health All rights reserved. 24 School ‘NutriAgent’ Handbook © October 2006 Department of Health All rights reserved. 25 School ‘NutriAgent’ Handbook © October 2006 Department of Health All rights reserved. 26 School ‘NutriAgent’ Handbook 1.4 How to read nutrition labeling Since various food groups are available on the market, we should learn how to read the labels on the packages to achieve a healthy and balanced diet. Today, many food manufacturers have listed the nutritional contents of food on the package so that we can be better informed of its nutritional value, compare it with other food items of the same group and select the healthier ones for schoolchildren. In addition, nutrition facts on the label can help people who are on special diets (e.g. people have diabetes or heart disease) choose the right food and thus help control their conditions. 1.4.1 What is a nutrition labelling? Nutrition labelling usually shows the nutrient content of food in tables to provide the public with nutrition information about the food. © October 2006 Department of Health All rights reserved. 27 School ‘NutriAgent’ Handbook 1.4.2 Steps to read nutrition labelling: 1) Serving Size According to the information shown on this nutrition label, the pack of food can be divided into 4 servings, each equating to around 1 packet, which is about 200g. 2) Calories in the food Each serving size provides about 320Kcal of energy, of which 15Kcal is from fat in the food. 3) Nutrients in the food Besides, each serving provides 69g of carbohydrate, 2g of dietary fibre, and 6g of protein. However, people do not necessarily take the same serving as described by the nutrition label. For example, if you consume 250g of the food, i.e. 1.25 servings, you actually take in 1.25 times of what is listed on the label. © October 2006 Department of Health All rights reserved. 28 School ‘NutriAgent’ Handbook 1.4.3 How to make healthier food choices using nutrition labelling? Energy and nutrient content are usually shown by “per serving”, “per 100 g” for solid food, or “per 100 ml” for liquid food. “Serving size” may use “cup”, “spoon”, or a fraction of the food in total (e.g. 1/2, 1/3) as the labelling unit to inform consumers of their actual intake of energy and nutrients after consuming the food. Labelling in terms of “per 100 g” or “per 100 ml” may help consumers compare the nutritional value of different food items directly and make healthier and more appropriate choices. Take the following nutrition labels of two brands of milk as example: Milk A Milk B Through comparing the “per 100 ml” labelling on these two brands of milk, Milk A is found healthier as it contains more protein, calcium and dietary fibre with less energy and fat. Consumers may compare the nutritional value of various food items in this way to find out the ones that better meet their needs. 1.4.4 Nutrient content claims Nutrient content claims, such as ‘high calcium’, ‘low fat’, ‘sugar free’, or ‘low calorie’, are usually shown on food packages to illustrate the content of nutrients in the food. Nutrient content claims adopted by the Codex Alimentarius Commission (Codex) are as follows: Component Claim Conditions not more than Energy Low 40 kcal (170 kJ) per 100 g (solids); or 20 kcal (80 kJ) per 100 ml (liquids) Free 4 kcal per 100 ml (liquids) Low 3 g per 100 g (solids); or 1.5 g per 100 ml (liquids) Free 0.5 g per 100 g (solids) or 100 ml (liquids) Fat © October 2006 Department of Health All rights reserved. 29 School ‘NutriAgent’ Handbook Saturated fat Low * 1.5 g per 100 g (solids) 0.75 g per 100 ml (liquids) In addition, energy from saturated fat should not exceed 10% of total energy Cholesterol Free 0.1 g per 100 g (solids) or 100 ml (liquids) Low * 0.02 g per 100 g (solids) 0.01 g per 100 ml (liquids) Free 0.005 g per 100 g (solids) or 100 ml (liquids) For foods claimed to be “low in cholesterol“ and “cholesterol free”, its saturated fat content should not exceed: 1.5 g per 100 g (solids) 0.75 g per 100 ml (liquids) In addition, energy from saturated fat should not exceed 10% of total energy Sugars Free 0.5 g per 100 g (solids) or 100 ml (liquids) Sodium Low 0.12 g per 100 g Very low 0.04 g per 100 g Free 0.005 g per 100 g * In the case of the claim “low in saturated fat”, trans fatty acids should be taken into account where applicable. This provision consequentially applies to foods claimed to be “low in cholesterol“ and “cholesterol free”. Materials in this chapter are mainly from the Health, Welfare and Food Bureau and the Food and Environmental Hygiene Department. © October 2006 Department of Health All rights reserved. 30 School ‘NutriAgent’ Handbook 2. Tools for monitoring the eating environment at school Undoubtedly, provision of more healthy food choice can definitely promote healthy eating to students. To facilitating schools selecting appropriate school lunch supplier that can provide healthy and tasty lunch, beneficial to the promotion of healthy eating at school, the Department of Health has developed a ‘Database on School Lunch Suppliers’ and ‘Selecting the Right School Lunch Supplier’ proposed procedure and points to be noted in selecting school lunch supplier. Furthermore, a selection checklist has also been drafted for schools’ and parents’ reference. The ultimate goal is to keep the mechanism fair, open and transparent. The above mentioned materials have been uploaded onto the thematic website: http://www.eatsmart.gov.hk. Selecting right school lunch supplier is obviously a crucial step making students eat healthier. However, there is still a long way to go. We may need to regularly monitor the provision of school lunch and find ways to motivate and reinforce students’ healthier choose. To help schoolchildren develop good eating habits at school, we encourage lunch suppliers, tuck shop operators, parents, and school personnel to cultivate an environment conducive to healthy eating at school through close cooperation. It is suggested that the representatives of schools and parents’ associations use the surveillance forms in this chapter to monitor the nutritional quality of lunch and snack and the pace of healthy eating promotion at school. 2.1 Surveillance tool for school lunch –Nutritional Quality Evaluation Form of School Lunch Lunch quality will be monitored every month. The school may appoint two teachers or parents to take this responsibility. Lunch quality should be evaluated in five consecutive days of one week each month selected by the person in charge. Materials required are: Categorization of Lunch Food Item (Page 33 of this section); Nutritional Quality Evaluation Form of School Lunch (Page 34 of this section); and Lunches of the week © October 2006 Department of Health All rights reserved. 31