Effective promotion and support of breastfeeding requires reliable data on breastfeeding duration, particularly of exclusive breastfeeding (EBF). Maternal retrospective recall of breastfeeding duration is often used to assess breastfeeding rates and trends in a certain population, but recall accuracy is limited by potential recall bias or imprecision of memory. Objective of this study was to examine mothers’ ability to accurately recall their breastfeeding duration at 12 months postpartum after individual recall periods of 6, 8 or 10 months. This assessment has been embedded into the web-based nationwide prospective survey on breastfeeding and infant nutrition SuSe-II 2017–19 in Germany. A set of 2–3 simple recall questions on duration of EBF (as defined by World Health Organization) and any breastfeeding (ABF) has been compared to prospective maternal reports of breastfeeding at 2, 4 and 6 months as reference. Data pairs of recalled duration and reference duration were provided by 572 mothers for EBF and 163 mothers for ABF. On average, duration of EBF and ABF differs statistically significantly between methods, but deviations are small (2–3 weeks), and tend to increase with longer recall period. For both, EBF and ABF, at a tolerance level of ±2 weeks, the recall overestimates breastfeeding duration in about 50

Objectives:Several metabolic diseases require indicated diets, often including special foods and supplements. The assessed scenario calculations aim to quantify the additional expenses caused by necessary dietary treatment in children and adolescents in alignment with a healthy diet based on the 'optimized mixed diet'. The optimized mixed diet fulfils the nutrient requirements for all ages (1-18 y) by adjusting the food amounts to their age-dependent energy requirements. Methods:For the food cost calculation, a sample patient (age group 4<7 y) was used. To determine additional costs, the 7-day model menu of the optimized mixed diet was modified based on specific requirements for each disease. Nutritional adequacy of all menus was assured using nutrition software 'Diät 2020'. Food amounts for all different age groups 1<18 years were determined by using calculation factors. Menu costs were calculated using current food prices collected in two supermarkets, pharmacies and online; lowest available prices were recorded. Results:Fourteen diseases were expected to cause additional costs and included in the calculations. The average additional costs of all diseases amounted for 48.88 €/mo for the reference group. The range for the expected additional costs for the reference group was between approx. 16 €-101 €/mo. Conclusions:The results of this first assessment of food costs required by certain metabolic diseases shall provide guidance for possible targeted financial support for caregivers of children with special dietary needs in Germany, from which other countries may benefit likewise.

PURPOSE:The COVID-19 pandemic had an impact on obstetrics and breastfeeding, but data from hospital experiences are rare. This study assessed routines of breastfeeding management in maternity hospitals before and during the pandemic. METHODS:In the SINA study (Breastfeeding in North Rhine-Westphalia, Germany) between October 2021 and March 2022 hospitals had experienced the pandemic for more than one year. In the statewide cross-sectional survey, chief physicians and responsible ward staff were interviewed by phone about breastfeeding support structures and practices before the pandemic, as well as any changes due to the pandemic. The Recommendations of the German National Breastfeeding Committee based on the 'Ten Steps to Successful Breastfeeding' of the World Health Organization and the United Nations Children's Fund, served as a reference for creating a Breastfeeding Promotion Index (scaled 0-10 points) and analyze associations between breastfeeding promotion and hospital characteristics. RESULTS:In the study sample (n = 36 hospitals) the BPI did not differ in terms of perinatal care level, annual birthrate, staff qualification or maternal length of stay, but was higher for Breastfeeding Friendly certification and higher breastfeeding rate at discharge. Core components of breastfeeding support were not affected by the pandemic. Extent and formats of staff training and antenatal breastfeeding information changed drastically, mostly to digital formats, which most hospitals planned to retain beyond the pandemic. CONCLUSION:As an experiment born out of necessity the pandemic may raise awareness of challenging trends as shortened maternal stay and may encourage hospitals to expand digital formats of breastfeeding information for staff and mothers.

BackgroundErucic acid is a long-chain monounsaturated fatty acid that enters the food chain mainly via rapeseed oil. In 2016, the European Food Safety Authority (EFSA) issued a tolerable daily intake (TDI) of 7 mg/kg bodyweight per day, based on animal models in which a high intake of erucic acid leads to reversible myocardial lipidosis. Since erucic acid is also found in breast milk, maternal dietary exposure should be kept as low as possible.ObjectiveDue to a lack of data on individual food sources and consumption quantities of erucic acid in breastfeeding women, a pilot study was conducted to assess dietary intake.MethodsA validated semiquantitative Food Frequency Questionnaire (FFQ), including specific questions on the main food sources of erucic acid, was administered to 89 breastfeeding women at 1, 4, and 12 weeks postpartum (pp). Erucic acid concentrations were mainly derived from food analyses from Germany.ResultsMedian erucic acid exposure was largely constant throughout the breastfeeding period (1, 4, and 12 weeks pp: 0.79, 0.47, 0.60 mg/kg BW/d, respectively), but interindividual variations were large. The major food sources of erucic acid were pastries with 28% (assuming rapeseed oil as an ingredient), followed by rapeseed oil used in the household (22%), mustard (24%), and salmon (16%). In various scenarios of erucic acid intake, even individuals with high consumption remained far below the TDI (7 mg/BW/d). Maternal predictors of the use of rapeseed oil in the household could not be identified.ConclusionThe erucic acid exposure of breastfeeding mothers with the usual diet in Germany is likely far below the EFSA TDI.Trial RegistrationGerman Clinical Trials Registry: DRKS00023072

BACKGROUND:Adolescence is a key developmental stage marked by physiological and behavioural changes. Eating behaviour, modifiable and sex-dependent, may be altered and linked to future health issues. This cross-sectional study aims to assess whether eating behaviours and body composition are associated in an adolescent sample. METHODS:Participants aged 12.5-17.5 years were recruited from 10 European cities, with valid data on age, sex, socio-demographic status, body composition and physical activity and who had also completed the specific eating behaviour questionnaire "Eating Behaviour and Weight Problems Inventory for Children". Different linear regression models were adjusted for relevant confounders, and ANCOVA models were performed. RESULTS:Eating Behaviours related to weight concerns, dietary restraint, emotional eating, fear of weight gain, healthy nutrition and figure dissatisfaction were strongly positively associated with higher Body Mass Index (BMI), Fat Mass Index (FMI) and Waist Circumference (WC), especially in males (betas resulting from the association between these behavioural subscales and body composition in males, ranged from 0.174 to 0.974 for BMI, 0.172 to 0.930 for FMI, and 0.128 to 0.889 for WC). The strongest association was detected in the weight concerns subscale for both males and females. CONCLUSION:Eating behaviours across all domains are significantly linked to body composition, with variations depending on the specific behavioural domain and the adolescent's sex. These findings are critical for identifying specific behavioural patterns that contribute to obesity and related health issues, providing new insights for more targeted prevention strategies during this crucial stage of development.

Background. Climate change causes an increased number of hot days, especially in urban areas. This can cause heat stress in the human body. Despite being a vulnerable group, data on thermoregulation and sweat loss in heat for young children are missing. Therefore, model calculations can serve as an alternative. Objective. This small-scale case study compares climate data from the study site Bochum, eligible as an urban heat island in Central European temperate climate zone, to available climate data of physiological model calculations of young children's thermoregulation to assess transferability. Methods. The climate station in Bochum provides 13 weather variables. For the comparison, data of the summers 2020-'23 were used. Literature was screened for physiological model calculations for children aged 3-6 years in real-life scenarios. Results. The annual temperature in Bochum has risen within the past decades, nevertheless ambient temperature of 30 degrees C has rarely been exceeded in 2020-'23. Only one study using real weather data from Tokyo, Japan was suitable for displaying a model of a young child under heat stress in a real-life scenario. The maximum ambient temperature of the model calculation (36.5 degrees C) was only surpassed once in Bochum during the study period. Conclusion. Thus, the model calculations of Tokyo's climate scenario are not fully transferable to Bochum as a model city in Central European temperate climate zone. Consequently, further research is needed. This analysis can nevertheless serve as an impetus to initiate action on this growing public health problem in young children in Central Europe.

Children and adolescents with rare diseases represent a population that may be at risk for an avoidant/restrictive food intake disorder (ARFID). This study aimed to quantitatively examine the symptoms of ARFID in a sample of children and adolescents with rare diseases and their association with sociodemographic characteristics, eating disorder psychopathology, health-related quality of life (HRQoL), and mental health. In this observational study, data from 309 families of children with rare diseases drawn from a multicenter clinical study were used to estimate the prevalence of ARFID symptoms in children and adolescents aged 8–21 years in Germany was estimated via self-report (n = 169) and parent report (n = 502). Differences between the sample of individuals with rare diseases and normative population data, between those with and without ARFID symptoms, and between subgroups of rare diseases were investigated. Additionally, correlations between eating disorder psychopathology, sociodemographic, and psychosocial variables were investigated. The prevalence of symptoms of ARFID was relatively high, with a relevant difference between self-report (3.6

Global climate change requires a paradigm change in diets, especially in affluent countries, with a reduction of animal-based food, including children. This will have direct consequences for Vitamin B12 supply as animal-based foods are the only food source. We examined these potential consequences using the German food based dietary guidelines for infants, children, and adults in Germany as the basis for the model calculation. The guidelines for 4 representative age groups were examined, representing exclusive milk feeding (2 months), complementary feeding (8 months), and mixed family diet (children: 4-6 years, adolescents: 11-14 years). For each age group (except 2 months), the contribution of animal-based food groups (milk/dairy, meat, fish, eggs) to the total daily intake of vitamin B12 was calculated based on 7-day menus with recipes for all meals. This allowed us to assess the potential Vitamin B12 deficits due to food group exclusion. Even in the guidelines diets, including exclusive breastfeeding, the vitamin B12 intakes just reached the reference values in all age groups. In infants on complementary feeding and also later in children and adolescents, cow's milk was by far the most important source of vitamin B12. Among the other animal-based foods, meat (16.9%-23.0%) ranked first, followed by fish (11.0%-16.5%), and eggs (8.1%). In our analysis of the German food-based guidelines for infant, child, and adolescent diets, the increased planetary health due to reduction of milk intake turned out severely to compromise vitamin B12 intake. In children, a reduction in the consumption of animal foods to improve the health of the planet must be weighed against the risk of inadequate intake of individual nutrients.

Eine gesunde Ernährung von Anfang an ist eine wichtige Voraussetzung für Gesundheit, Wachstum, Entwicklung und Leistungsfähigkeit. Gesunde Ernährung im Kindes- und Jugendalter kann darüber hinaus zur Prävention weit verbreiteter Krankheiten im Erwachsenenalter beitragen. Mit den am Forschungsdepartment für Kinderernährung (FKE) entwickelten lebensmittel- und mahlzeitenbasierten Ernährungskonzepten, dem Ernährungsplan für das 1. Lebensjahr und der sich nahtlos anschließenden Optimierten Mischkost für Kinder und Jugendliche (einschließlich entsprechender Speisepläne), liegen wissenschaftlich basierte, international publizierte, praktisch bewährte, einfach vermittelbare und nachhaltige Ernährungskonzepte für das gesamte Wachstumsalter vor. Die leicht verständlichen semiquantitativen Empfehlungen und grafischen Darstellungen der Ernährungskonzepte erleichtern den Transfer der Empfehlungen in die Bevölkerung; darüber hinaus richten die Konzepte sich an Entscheidungsträger. Diese Konzepte bilden die Grundlage zur Beratung der Familien durch Kinder- und Jugendärzt:innen und Ernährungsfachkräfte.

A healthy diet right from the start is an important prerequisite for health, growth, development and performance. Furthermore, healthy nutrition in childhood and adolescence can also contribute to the prevention of widespread diseases in adulthood. The food-based and meal-based dietary concepts developed at the Research Department of Child Nutrition (FKE), the dietary scheme for the first year of life and the seamlessly following optimized mixed diet for children and adolescents (including corresponding menus), are scientifically based, internationally published, practically proven, simply mediated and sustainable dietary concepts for the entire growing age. The easy to understand semiquantitative recommendations and graphic illustrations of the nutrition concepts facilitate the transfer of the recommendations to the population; furthermore, the concepts are also aimed at decision makers. These concepts form the basis for the counselling given to families by pediatricians and nutritionists.

The staff of maternity hospitals play an essential role in the start of breastfeeding. This study assessed specific aspects of breastfeeding promotion in German hospitals using the recommendations of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). To identify specific hospital practices and structures that are in compliance with the recommendations and those that still need to be improved. A cross-sectional survey and descriptive analysis was conducted in 109 German hospitals. This web-based questionnaire examined the structural conditions and usual handling of breastfeeding support. Recommendations were reported using sub-criteria. The implementation of the sub-criteria ranged from less than 25% to more than 90%. Hospitals were more likely to have a breastfeeding policy (85.3%, n = 93) than a breastfeeding coordinator (73.4%, n = 80). Immediate skin-to-skin contact after birth and early breastfeeding initiation were implemented more frequently after a vaginal (89.9%, n = 98 and 71.6%, n = 78) than after Cesarean delivery (45.9%, n = 50 and 54.1%, n = 59). Additional feeding of fluids was usually restricted to a medical indication (70.6%, n = 77), however, the decision to feed formula was rarely made by hospital staff alone (27.5%, n = 30). Large hospitals (> 1000 births/year) had a written breastfeeding policy and a breastfeeding coordinator more frequently than smaller hospitals (p < 0.01, Fisher's exact test). The use of sub-criteria of WHO recommendations helped identify critical parts of breastfeeding promotion in hospitals, providing concrete starting points for targeted interventions. This differentiated approach could be promising for future analyses of breastfeeding promotion.

Um die Qualität von ambulanter Adipositastherapie für Kinder und Jugendliche zu sichern, ist die Überprüfung von Behandlungsstandards durch eine Zertifizierung wesentlich. Für Behandlungszentren ist diese mit Aufwand (z. B. Beschaffung und Aufbereitung von Daten) verbunden. Vor dem Hintergrund des Rückgangs zertifizierter Zentren in Deutschland (2015: 54 vs. 2022: 29) resultiert das Ziel, explorativ die Hintergründe zu erfassen, um Optimierungsempfehlungen abzuleiten. Im Jahr 2022 wurde im zuständigen Fachverband (Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA) der Deutschen Adipositas-Gesellschaft) eine explorative Querschnittserhebung unter den 431 Mitgliedern durchgeführt. Der digitale Fragebogen beinhaltete standardisierte offene und geschlossene Fragen zur Zertifizierung sowie persönliche Angaben. Die explorativen Daten von 80 Fragebögen wurden deskriptiv ausgewertet. Gründe für die Ablehnung einer Zertifizierung waren die Kosten und Personalaufwand, die Bereitstellung von qualifiziertem Personal, formale Anforderungen und Abläufe der Zertifizierung und die Notwendigkeit der Generierung eines wirtschaftlichen Mehrwertes durch eine Zertifizierung, wie die Anerkennung der Einrichtung als zertifiziertes Zentrum durch die Kostenträger. Die Ergebnisse deuten zwei Optimierungsempfehlungen an: 1.) verbindliche Regelungen zur Therapiekostenübernahme für zertifizierte Zentren durch Kostenträger, 2.) Reduktion des personellen Aufwandes für die Zertifizierung, die z. B. durch eine Reduktion formaler Anforderungen sowie Digitalisierung möglich erscheint. Künftige Studien sollten die explorativen Ergebnisse validieren.

Introduction. Families in Germany who live in poverty receive citizens' benefits (B & uuml;rgergeld) within the context of welfare legislation. Basic rates for children and adolescents are included in these benefits and staggered into three groups according to age. The need for nutrition is the largest category of the basic rate. The Optimized Mixed Diet (OMD) is a practical concept of a healthy diet for children and adolescents aged 1-18 years. Traditional and home-cooked meals are preferred. The aim of this project was to calculate the food costs of the OMD based on the underlying 7-day meal plan. Methods. The lowest shelf prices of 87 different foods from the OMD were recorded during market inspections in different food retailers (1 supermarket, 1 discounter; November 2022, Bochum, Germany). The nutrition basic rate was compared to the total food costs per month in accordance with the age groups of the welfare legislation as well as of the German Nutrition Society (DGE) reference values. Furthermore, the contributions of the food groups were determined based on total costs and total energy intake of the OMD. Results. The food costs of the OMD are covered 101-109% by the standard nutritional rate of the citizens' benefits for every age group of the welfare legislation. The costs for the more narrowly defined DGE age groups are covered as well with a few exceptions. The main cost drivers of the OMD were vegetables/raw foods, and the main energy sources were bread/cereal products. Discussion. The current citizens' benefits can cover the nutritional requirement of children and adolescents, provided that meals are self-cooked and low-priced foods are used. The question remains to what extent the social needs for participation can be fulfilled as well.

Purpose The transition to a planetary health diet goes along with the increase of plant-based alternatives to milk available on the market. Therefore, it is necessary to assess the consequences of replacing milk with plant-based drinks on the nutrient intake of young children on a balanced diet. Methods An internet search was conducted on plant-based drinks available on the German market. Scenarios of nutrient intake were calculated in which fluid cow’s milk was replaced by plant-based drinks in the menus of the Optimized Mixed Diet (OMD), the guideline balanced diet for children in Germany. Results Six different drinks made from legumes (soy), cereals (oats) and nuts (almonds) in three characteristic product types (basic, no fortification / basic + fortification / special products for children) were analyzed. The replacement had hardly any effect on the intake of energy and protein. However, the consequences for micronutrients were remarkable. By replacing milk with non-fortified plant-based drinks (around 80% of products on the market) the daily intake of calcium, vitamin B2, B12, and iodine was reduced to around 50%; with the fortified products, only the intake of iodine was reduced. With the children’s products, the supply of the micronutrients examined was maintained within the OMD. Conclusions The lack in important nutritional components (calcium, B12, B2, and iodine) as a consequence of replacement of cow’s milk with most of the plant-based drinks on the current market on nutrient intake of young children can hardly be foreseen by parents. Even minor-looking changes to a balanced diet require an expert opinion of advisors. Trial registration Number and date of registration for prospectively registered trials.

The global climate crisis requires a paradigm shift in dietary concepts, respecting the needs of children. A global reference diet has been suggested by the EAT-Lancet Commission. On this basis, the detailed “Planetary Health Diet Index” (PHDI) has been proposed. The objective of this assessment is (1) to apply the PHDI to the Food-Based Dietary Guidelines, the so-called Optimized Mixed Diet (OMD) for children and adolescents in Germany in its original composition and (2) to check how the planetary value of the OMD could be improved by modifying food selection within meals while keeping the high nutrient densities of the guideline diet. The PHDI specifies 16 food groups and their proportion of total daily energy intake. The PHDI of the original OMD was calculated by assigning the foods of the 7-day menu to the PHDI food groups in order to score them. In this way, it became apparent which food groups had the potential to improve the sustainability. The diet was then updated by either reducing or increasing individual foods from these food groups in the meals and deriving the resulting PHDI. The nutrient densities of the original and updated daily OMD were calculated. The original diet obtained a PHDI score of 68.24 points, representing 45.5

Von Armut betroffene Familien in Deutschland erhalten im Rahmen der Sozialgesetzgebung (SGB) existenzsichernde Leistungen. Das Bürgergeld umfasst auch Regelsätze für Kinder und Jugendliche, gestaffelt in 3 Altersgruppen. Der Bedarf für Ernährung ist die größte Kategorie des Regelsatzes. Die Optimierte Mischkost (OMK) ist ein praxisnahes Konzept einer gesunden Ernährung für Kinder und Jugendliche im Alter von 1–18 Jahren. Herkömmliche Lebensmittel und selbsthergestellte Speisen werden bevorzugt. Ziel des Projektes war es, die Lebensmittelkosten der OMK anhand des zugrunde liegenden 7‑Tage-Speiseplans zu berechnen. Es wurden die niedrigsten Regalpreise der 87 Lebensmittel der OMK im Lebensmitteleinzelhandel (1 Supermarkt, 1 Discounter; November 2022, Bochum) erfasst. Der Ernährungsregelsatz wurde mit den Lebensmittelkosten pro Monat nach den SGB-Altersgruppen sowie nach den Altersgruppen der Deutschen Gesellschaft für Ernährung (DGE) verglichen. Weiterhin wurden die Beiträge der Lebensmittelgruppen zu den Gesamtkosten und der Gesamtenergiezufuhr der OMK aufgeschlüsselt. Die Kosten der OMK wurden mit dem Ernährungsregelsatz des Bürgergeldes für die 3 SGB-Altersgruppen zu 101–109

Despite the health benefits of breastfeeding only 57

Social disparities in breastfeeding may result in inequalities of maternal and child health-related future perspectives. In-hospital breastfeeding promotion, information, and support impact short- and long-term breastfeeding practices. This study, which was performed in 2021/2022 in the context of the COVID-19 pandemic, examined prepandemic interrelations between in-hospital breastfeeding promotion, information, and support in the federal state North Rhine-Westphalia (NRW), Germany, and the socioeconomic structure of the hospitals' catchment areas. Breastfeeding promotion, information, and support were operationalized using a Breastfeeding Promotion Index (BPI) based on the "Ten Steps to Successful Breastfeeding" postulated by the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) and adapted for Germany by the National Breastfeeding Committee. The socioeconomic structure of the districts hosting the hospitals was assessed by the German Index of Socioeconomic Deprivation (GISD), which was developed by the Robert Koch Institute and is established for Public Health issues. This was complemented by the head physicians' estimations of the predominant socioeconomic status in their hospitals' catchment areas. Statistical analyses were performed using the non-parametric Jonckheere-Terpstra's test. For correlation analyses, Spearman's Rho and Kendall tau c were used. A low socioeconomic status was associated with a lower BPI and, vice versa, a high socioeconomic status with a higher BPI. These relationships were stronger when using the head physicians' estimations than the GISD. Higher breastfeeding rates at discharge as estimated by the maternity ward staff were favored by a higher BPI and a higher regional socioeconomic status. These data suggest that hospitals may be able to assess their need for intensified breastfeeding promotion and support strategies by identifying the predominant socioeconomic status of their catchment areas. The results also point to the "disproportionate care law" which may still apply in the well-established German healthcare system.

Global climate change causes rising of the average temperature as well as an increased number of days with extreme heat, even in the temperate climate of Germany. Children are a particularly vulnerable group according to heat stress and consequentially water loss. Even small changes in the water balance can lead to functional impairments. Therefore, quantification of exact water loss as well as the knowledge of hydration status changes in children under heat stress are important and can contribute to renewing water intake recommendations in accordance with climate change. This may promote approaching public health issues. In this study water loss, hydration status data and voluntary water intake of children are collected. Therefore, 3–6 years old children from a German kindergarten are recruited. Weight, urine osmolality and saliva osmolarity are measured twice a day on two different testing days with different temperatures (day 1: hot summer day with heat peak; day 2: fall-like day with neutral temperatures). In-between the tests on each day, the children are exposed to these climate scenarios by playing outside for 2 h just like the usual daily routine. The drinking amount as well as the activity during the observational time is recorded. Additionally, the collected data is compared to previously published data on computed estimation of body core temperature changes and water loss in heat on a theoretically modelled 3-year-old child. The weight difference before and after exposure (in dependence of the water intake), provides information about the water loss (thermoregulation) in the observation period. The comparison of newly collected data with modelled water loss can elaborate variations in climate and physiological responses and provide information about, whether the model calculation can be transferred to German conditions. Furthermore, hydration status changes, as reflected by the urine osmolality, are expected to be different between the two test days depending on the extent to which the higher water loss through sweating is compensated by different water intake through voluntary drinking. By means of the collected data, drinking recommendations for children may be aligned and specified in accordance to different climate scenarios. German Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00033942,19th August 2024.

Aim The aim of this survey was to assess the feasibility and acceptance of a free breakfast offer (model project “School Breakfast”) at interested primary schools in the city of Bonn, Germany, with a focus on the food offer and framework conditions. Subject and methods In 2019, all 54 primary schools were invited to participate in the new offer. To evaluate the project, a semi-structured questionnaire was used for data collection in an interview with the person responsible for the breakfast in each of the participating schools. For the nutritional assessment of the food offer, the schools' self-selected food choices were compared with the breakfast recommendations of the Optimized Mixed Diet (OMD) for children and adolescents in Germany. Results Fourteen of the 54 schools (26%) participated in the project. The motivation for participation was most often the observation that children brought breakfast of poor quality. Breakfast was offered on almost all school days, and children could decide whether they wanted to take advantage of the food offer. Of the four components of breakfast required in the OMD, 100% of schools regularly offered vegetables and fruits, 79% offered cereal products and milk products, and 36% a beverage. Acceptance by the pupils was evaluated positively by the schools. Conclusion The municipal school breakfast project seems suitable for providing children with low-threshold access to a healthy breakfast, as the project schools generally selected foods in line with the OMD and were therefore able to tackle the problem of inadequate breakfast provision at home.