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Citation: Rosi, A.; Biasini, B.; Monica,
E.; Rapetti, V.; Deon, V.; Scazzina, F.
Nutritional Composition and
Environmental Impact of Meals
Selected in Workplace Canteens
before and after an Intervention
Promoting the Adherence to the
Mediterranean Diet. Nutrients 2022,
14, 4456. https://doi.org/
10.3390/nu14214456
Academic Editors: Emilia
Vassilopoulou, Ioannis Pagkalos,
Maria Hassapidou and
Athanasios Papadopoulos
Received: 21 September 2022
Accepted: 20 October 2022
Published: 23 October 2022
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4.0/).
nutrients
Article
Nutritional Composition and Environmental Impact of Meals
Selected in Workplace Canteens before and after an
Intervention Promoting the Adherence to the
Mediterranean Diet
Alice Rosi 1, *,† , Beatrice Biasini 1 ,† , Elisa Monica 1, Valeria Rapetti 2, Valeria Deon 2and Francesca Scazzina 1
1Human Nutrition Unit, Department of Food and Drugs, University of Parma, 43125 Parma, Italy
2Global Nutrition & Wellbeing Unit, Research, Development & Quality Group, Barilla G. e R. Fratelli,
43122 Parma, Italy
*Correspondence: alice.rosi@unipr.it; Tel.: +39-0521-903913
† These authors contributed equally to this work.
Abstract:
Enhancing healthy and sustainable food systems is one of the key goals of the current
European Commission policy. In this light, the creation of a food environment where people are
properly informed about the healthiness and sustainability of food choices is essential. This study
aimed to evaluate the nutritional profile and the environmental impact of meals consumed in a
workplace canteen in Italy in the presence of a nudge (i.e., the Double Pyramid logo) combined with
a web-based application promoting the Mediterranean Diet. Energy and nutrient contents and the
carbon, water, and ecological footprints of 29,776 meals were compared across three subsequent
periods (from June to April) through one-way ANOVA. Although the choice of dishes labelled with
the Double Pyramid logo was comparable across periods, the selection of fish- and plant-based dishes
increased from +2% (fish, vegetables) up to +17% (whole-grain cereals), with a concurrent reduction
of meat-based options (
−
2%). Although the consumption of healthy items increased (p< 0.001),
they were not added as a replacement for alternative options, leading to a higher content in energy
(p< 0.001) and nutrients (p< 0.001) and worse environmental footprints, contrarily to what was
observed when data were adjusted for energy. The intervention significantly improved food choices;
however, as the higher selection of desired dishes was not adequately compensated for, it was not
fully effective.
Keywords:
sustainable menus; Mediterranean Diet; environmental burden; educational intervention;
choice architecture; worksite cafeteria; blue collars; office workers; caterer
1. Introduction
Providing workers with nutritious, safe, and affordable food is considered a public
health strategy [
1
]. As reported by the Italian National Institute for Insurance against
Accidents at Work (INAIL), a proper diet for workers must take into account both energy
and nutrient contents of the meals consumed during the day, the type of work performed
(i.e., sedentary, varied, light, heavy) and the number of working hours, the physical
conditions of the environment in which the work is carried out (e.g., temperature, humidity,
etc.), the food habits (i.e., cultural background), and extra work activities (e.g., sports,
second job, hobbies) [
2
]. To avoid a decrease in attention span and other cognitive functions,
it is also important to minimise the risk of hypoglycaemia that can occur when meals
are skipped [
3
]. On the other hand, meals eaten at work should not exceed the proper
energy and nutrient amount, mainly in the case of sedentary work, during which energy
expenditure is limited. Moreover, they should be easily digestible, mainly consisting of
whole grains, legumes, fruit and vegetables, and should provide adequate hydration [
2
,
4
].
Nutrients 2022,14, 4456. https://doi.org/10.3390/nu14214456 https://www.mdpi.com/journal/nutrients
Nutrients 2022,14, 4456 2 of 14
Such food composition reflects the planetary health plate suggested by the EAT-
Lancet Commission, which identifies a flexitarian dietary model as globally healthy and
environmentally sustainable, taking into account a multitude of scientific targets affected
by food production activities [
5
]. Plant-based meals, with eventual small quantities of
meat, fish, and dairy products, are healthy and eco-friendly options, and their habitual
consumption within a balanced energy diet contributes to reducing the mortality and
disease risk as well as mitigating negative externalities caused by food systems, such
as resource exploitation, terrestrial acidification, water pollution, deforestation, climate
change and biodiversity loss [
5
,
6
]. Therefore, following a sustainable diet is an objective
and an essential means to achieve a sustainable food system [7].
To quantify food system and diet pressure on the environment, several indicators have
been used. Among these, the carbon footprint (which accounts for greenhouse gas (GHG)
emissions) = and the use of water, land or energy have been extensively investigated in
relation to the production of single food products [
6
], their consumption within meals [
8
],
and actual and alternative dietary patterns, including the Mediterranean Diet (MD) [
9
,
10
].
The MD is an example of a flexitarian diet, referring to the traditional dietary pattern
adopted in the southern Italy population in the 1960s [
11
]; it has widely emerged as a
dietary model linked to both health and environmental benefits. Specifically, the evidence
of positive health outcomes has been found to be convincing in reducing the risk for
cardiovascular diseases, diabetes and metabolic syndrome, highly suggestive in relation to
breast cancer and cognitive function, and suggestive for total mortality, overweight and
obesity, and certain types of cancers [
12
]. From the environmental perspective, the MD has
been associated with reduced resource use and lower GHG emissions compared to current
population diets [
9
]. Furthermore, the inextricable interaction fostered by the new MD
pyramid between food and diet, conviviality, gastronomic culture, agriculture, traditions,
and other lifestyle dimensions (such as physical activity and rest) has contributed to the
evolution of the MD concept from a healthy to a sustainable eating pattern [13].
Despite the increasing awareness from the political and scientific perspective about
the importance of the food environment in determining food intake, little work has been
conducted on analyzing the availability of healthy food in specific scenarios, especially in
worksite settings [14].
Given that moving towards more healthy and sustainable food systems is one of
the key goals of the European Green Deal, promoting a food environment where people
are properly informed about the healthiness and sustainability of their food choices is
paramount [
15
]. People are more inclined to change their eating behaviors if they are
gently guided in their decision-making process. Although healthy eating nudges have been
extensively used [
16
], a few studies have analyzed the effectiveness of nudges in increasing
healthy and sustainable food chosen and consumed out of the home [
17
,
18
]. As defined
by Thaler and Sunstein [
19
], a nudge is “any aspect of the choice architecture that alters
people’s behavior in a predictable way without forbidding any options or significantly
changing their economic incentives”. Strictly speaking, when applied in food services,
nudges refer to the menu redesign, the alteration of placement or portion size of dishes, or
the use of signs, symbols, labels, or claims aimed at moving food choice.
To foster more conscious food choices, the Barilla Centre for Food and Nutrition
(BCFN) developed the “Double Pyramid”, an intuitive educational tool that combines
the food pyramid, inspired by the Mediterranean Diet, and the environmental pyramid
models [
20
]. The model demonstrates a very close relationship between the nutritional
value of a food and the environmental impact generated during its production and con-
sumption, measured as the ecological footprint. This graphic tool suggests that, in principle,
foods that should be consumed more frequently (i.e., plant-based foods) present a lower
ecological footprint compared to the products whose intake should be moderate (i.e.,
animal-based food).
Therefore, the objective of the present study was to evaluate the nutritional profile
and the environmental impact of meals served and consumed in a worksite canteen setting
Nutrients 2022,14, 4456 3 of 14
by the company employees in the presence of the “Double Pyramid” nudge combined with
a web-based application designed to promote the adherence to the Mediterranean Diet.
Specifically, the nutritional analysis of the menus aims to evaluate energy and nutrient
contents, whereas carbon, water, and ecological footprints are assessed to determine the
environmental impacts of menus.
The project follows a previous nutritional intervention programme enhancing the MD,
which was implemented in the same setting a few years earlier but without the inclusion of
the web-based tool associated with a rewards program [
21
]. The former intervention was
able to effectively improve the dietary choices of employees in the canteens, but during the
intervention phase, both nutritionists and the canteen staff were actively involved, making
the intervention not fully bearable over time, contrary to the web-based application that
could be used for a prolonged period.
2. Materials and Methods
2.1. Study Design
A longitudinal study design was applied. The study took place in the two worksite
canteens of the Barilla G & R. F.lli S.p.A. food company, based in Pedrignano (Parma, Italy),
from June 2018 to April 2019. All canteen users (both genders, 19–67 years old, blue-collar
or office workers) were invited to take part in the study by means of information sent to
employees through the administration’s profiling database and by exhibiting specific flyers
in the worksite canteens.
Since 2011, the sì.mediterraneo healthy eating education project has been carried out at
the company headquarters in Pedrignano (Parma, Italy), where more than 1500 employees
work. The primary aims of the sì.mediterraneo project are (i) increasing the awareness of
employees about the benefits of the Mediterranean Diet and the relationship between
proper nutrition and environmental sustainability through nutritional information and
education in line with the principles of the Double Pyramid promoted by the BCFN, and
(ii) improving the eating habits through a wider, more varied, healthy and sustainable offer
of Mediterranean dishes available in the company’s canteens.
Access to the canteens at the time of the study was open to all the employees from 12.00
to 14.30 for lunch. One of the two cafeterias was also open for dinner from 18.30 to 20.00.
The company employees were offered a complete lunch menu, free of charge, composed
of three dishes such that the employee can choose between a selection of first courses
(i.e., dishes composed mainly of starchy foods, such as pasta, rice, etc.) and/or second
courses (i.e., dishes mainly composed of protein-based foods, such as meat, fish, eggs, dairy
products, legumes) or main dishes (i.e., dishes composed of both starchy and protein-based
foods, such as mixed salads), side dishes (i.e., vegetables) and fruit. Additional servings
and beverages or desserts were instead paid for by the employees. However, no price
promotion for specific recipes was applied, as all dishes in each category (i.e., first course,
second course, main dish, side dish, dessert, beverage) were offered at the same (relatively
low) price. The menus are based on a 4-week rotation and are differentiated across the
four seasons to guarantee the offer of seasonal fresh fruit and vegetables. Most of the
meals offered at the worksite canteens were freshly prepared every day using mostly fresh
ingredients (e.g., seasonal fruits and vegetables). A few dishes were instead prepared using
canned or frozen ingredients (e.g., fish, pulses, vegetable burgers).
A nudge technique was applied beginning in 2011 and throughout the whole study
duration, as the healthy and sustainable dishes within the list of the canteen menus were
marked every day with the Double Pyramid logo showing the recommended ones. In
2011, to improve the availabilities of some foods, new legume-based dishes were added
to menus, and some existing recipes were adjusted to improve both the nutritional profile
and the environmental impact. Furthermore, the weekly frequency of specific dishes (e.g.,
French fries, ham, etc.) was also reduced to offer healthier choices. During the observation
period (from June 2018 to April 2019), the menus did not undergo any additional changes.
The logo was applied to the first courses, second courses and main dishes, which were
Nutrients 2022,14, 4456 4 of 14
compliant with specific energy, nutritional and environmental sustainability criteria. The
nutritional criteria were defined as follows: energy
≤
500 kcal/serving, fibre
≥
6 g/serving,
and saturated fatty acids < 3 g/serving for first courses; energy
≤
600 kcal/serving and
saturated fats
≤
2.5 g/serving for main courses and saturated fats
≤
2.5 g/serving for
second courses. As an environmental criterion, the ecological footprint threshold applied
to all courses was < 5 global m2/serving.
In addition, the canteen environment was set up with posters reporting information
about: (1) the Mediterranean Diet; (2) the recommended consumption frequencies of food
groups; (3) the food’s environmental impact and the indicators used to measure it.
The new sì.mediterraneo project started in September 2018 with the aim to improve
the dietary habits of employees using new educational materials also delivered through a
specifically designed web application. The canteen users had the option to freely register
to the web-based application promoting healthy food choices based on the Mediterranean
dietary model. The digital tool provided employees with educational resources on the
Mediterranean Diet and the nutritional and environmental impacts of dietary choices.
The tool was integrated with employees’ cafeteria cards, tracking their food choices at
the worksite canteens, converting them into nutritional and carbon footprint values and
providing feedback on participants’ choices. In addition, the tool was integrated with a
chatbot that suggested the best menu of the day considering the offer of the canteen and the
choices made by the user in the previous days to promote a varied diet and the frequency
of consumption of food groups based on the Mediterranean dietary pattern. The web app
also had a rewards scheme based on the actual choices made in the canteen that gave points
if adherent to the nutritional and environmental recommendations.
2.2. Data Collection
All meals bought and consumed at the canteen site for lunch and/or dinner were
recorded at baseline (time 0, from June to September 2018), time 1 (from September to De-
cember 2018), and time 2 (from January to April 2019). Specifically, the analysis considered
a total of 50 working days (from Monday to Friday) for each 3-month time period and ex-
cluded days around holidays (e.g., Christmas and Easter) due to the non-representativeness
of the menus served at the canteen and the limited number of users. Only subjects regis-
tered to the web-based program who purchased at least three menus in at least one period
were included in the data collection. All subjects were exposed to the Double Pyramid
nudge starting from t0. During the intervention period, some employees left, others joined
the company, and some were temporally absent during certain days due to working travel
and personal or holiday leaves.
Data were collected automatically by using the personal employee’s badge connected
to the cash register, where cashiers typed the purchased products. Through the electronic
system, the food selected by the canteen users was recorded in terms of quality (which
food items) and quantity (number of portions) consumed for each digital transaction.
Only menus representative of the participants’ meal consumption pattern and provid-
ing at least 300 kcal were considered. This minimum energy threshold was set based on the
definition according to which a meal is represented by any food intake occasion providing
at least 15% of the total energy (with 2000 kcal/day taken as reference for the average adult
energy requirement), regardless of the quality of consumed food [
22
]. Multiple consecutive
transactions associated with one user on the same day were merged if it was clear they
corresponded to a unique meal (e.g., if one transaction included only fruit or beverages, it
was merged with the previous one on the same day).
2.3. Nutritional and Environmental Evaluation
Actual food consumption was estimated, assuming that the selected meal was entirely
consumed by the subject. On this basis, the amount (i.e., grams/millilitres) of food items
consumed for each meal was estimated from each digital transaction based on the dish
Nutrients 2022,14, 4456 5 of 14
recipes, without any ex post recipe modifications due to the discretionary use of seasonings
to the dishes (i.e., extra-virgin olive oil, vinegar, salt, etc.).
The Tool Chef software, a digital tool of the company used only for internal analysis,
linked to the sì.mediterraneo one, was used to calculate the number of portions of each
food group and the number of items with the Double Pyramid logo selected per menu,
as well as the nutritional composition and the environmental footprints of the meals.
In particular, each recipe was linked to a specific number of portions of food groups
based on its ingredients. The standard portions considered were: 1 plate of a first course
(corresponding to an average of 80 g of raw pasta or cereals), 50 g of bread and 30 g of
bread substitutes, 1 plate of a second course (e.g., 150 g of fish, 100 g of meat, 50 g of cured
meat, 100 g of fresh cheese, 50 g of dried legumes), 200 g of vegetables (80 g for salad),
150 g of fruit, 330 mL of beverages (e.g., sugared or sugar-free beverages), and 125 mL of
fruit juices [23].
The Tool Chef software contains data from the Food Composition Database for Epidemi-
ological Studies in Italy [
24
], used to evaluate the mean energy and nutrient composition
of the meals. In particular, the content of energy, proteins, fats, saturated fatty acids, total
carbohydrates, sugars, fibre, and salt was calculated for each consumed meal by summing
the values of each ingredient used to prepare the recipes of each food item.
Similarly, the Tool Chef software includes the BCFN’s environmental impact database [
20
]
used to assess the environmental impact of each meal consumed. Three indicators were
retrieved from the environmental database: carbon (g of CO
2
equivalent emissions), water
(L) and ecological (m
2
of biologically productive land and water needed to regenerate
the consumed resources and to absorb the emissions/waste) footprints. Environmental
values took into account the cooking methods (e.g., boiling, baking) applied during meal
preparation. For each meal, the three environmental footprints were estimated by summing
the relative performance of single ingredients of each dish.
2.4. Statistical Analysis
The statistical analyses were performed by the SPSS software (IBM Corp. Released
2020. IBM SPSS Statistics for Macintosh, Version 27.0. Armonk, NY: IBM Corp), setting the
significance at p< 0.05. Data are presented as mean
±
standard deviation or as numbers
and percentages. Percentages of dishes labelled with the Double Pyramid logo and of food
groups consumed in the canteens were obtained by dividing the number of dishes/portions
by the number of total meals recorded for each period, multiplied by 100.
The chi-squared test was used to explore associations among time periods for dish
percentages, whereas differences in the number of dishes labelled with the Double Pyramid
logo and of portions consumed for each food group were investigated by applying a non-
parametric Kruskal–Wallis test with pairwise comparisons. Similarly, a parametric one-way
ANOVA with the Tamhane post hoc test was applied to assess differences in the energy,
nutritional and environmental composition of meals.
3. Results
A total of 401 employees took part in the study (47% females, 44.2 ±10.9 years).
The choice of dishes labelled with the Double Pyramid logo was similar among the
three time periods (p= 0.107), with a median of 1 (25–75th percentile: 1–2) labelled dish
per meal in all periods, and with 99% of meals having at least one labelled dish during the
whole study duration (data not shown).
Changes in the frequencies of selection of each food group among time periods are
shown in Figure 1. The frequencies of choice of a portion of fruit (78%), vegetables (92%)
and cereals (76%) were high at baseline. However, an increased selection of +7% at Time 1
and +8% at Time 2 for fruit, +2% for vegetable portions at both periods, and +1% at Time
1 and +9% at Time 2 for cereals was registered. The numbers of portions of whole-grain
cereals were the most increased, with +16% and +17% at Time 1 and Time 2, respectively,
compared to baseline. Additionally, portions of pulses increased at Time 1 (+4%) and
Nutrients 2022,14, 4456 6 of 14
Time 2 (+5%), fish portions reached +2%, while meat decrease accounted for
−
2% at both
time periods.
Nutrients 2022, 14, x FOR PEER REVIEW 6 of 15
and cereals (76%) were high at baseline. However, an increased selection of +7% at Time
1 and +8% at Time 2 for fruit, +2% for vegetable portions at both periods, and +1% at Time
1 and +9% at Time 2 for cereals was registered. The numbers of portions of whole-grain
cereals were the most increased, with +16% and +17% at Time 1 and Time 2, respectively,
compared to baseline. Additionally, portions of pulses increased at Time 1 (+4%) and Time
2 (+5%), fish portions reached +2%, while meat decrease accounted for −2% at both time
periods.
Figure 1. Frequencies of choice of each food group by time periods (T0: baseline from June to Sep-
tember; T1: time period 1 from September to December; T2: time period 2 from January to April).
Similarly, considering the composition of meals in terms of the portion of food
groups (Supplementary Table S1), an increase in portion per tray of fruit, whole grain
cereals, and pulses but also desserts was observed from baseline to Time 1 and Time 2 (p
< 0.001). The portions per tray of refined cereals and dairy products were higher at Time
2 with respect to baseline and Time 1 (p < 0.001), whereas the selection of fish, eggs and
tubers was greater at Time 1 than baseline and Time 2 (p < 0.001). A decrease in portions
per meal of meat was observed from baseline to Time 1 and Time 2 (p = 0.020). The number
of portions per tray of vegetables, beverages, and juice was similar among time periods.
In line with the previous results, when the number of selected portions was trans-
formed into categorical variables (Table 1), significant associations were found between
the amount of food groups consumed per meal and the three time periods, except for
beverages and juice, the intake of which was extremely low across the time periods. Inter-
estingly, the share of trays containing at least one portion of fruit increased from 68%
(baseline) to 75% (at both Time 1 and Time 2), while the proportion of meals containing at
least one portion of whole grain cereals increased from 18% (baseline) to 31% at Time 1
and 32% at Time 2. The percentage of trays containing at least one portion of pulses
switched from 17% (baseline) to 20% and 21% at Time 1 and Time 2, respectively, with a
concurrent decrease (from 79% to 72% and 74%) in the share of legume-free transactions.
Similarly, a small increase in the percentage of meals with at least a portion of fish (from
20% at baseline to 23% at Time 1 and 21% at Time 2) and a portion of vegetables (66% at
baseline and 75% at both Time 1 and Time 2) was observed, whereas around 38% of trays
with at least a portion of meat were selected in each time period.
Figure 1.
Frequencies of choice of each food group by time periods (T0: baseline from June to
September; T1: time period 1 from September to December; T2: time period 2 from January to April).
Similarly, considering the composition of meals in terms of the portion of food groups
(Supplementary Table S1), an increase in portion per tray of fruit, whole grain cereals, and
pulses but also desserts was observed from baseline to Time 1 and Time 2 (p< 0.001). The
portions per tray of refined cereals and dairy products were higher at Time 2 with respect
to baseline and Time 1 (p< 0.001), whereas the selection of fish, eggs and tubers was greater
at Time 1 than baseline and Time 2 (p< 0.001). A decrease in portions per meal of meat was
observed from baseline to Time 1 and Time 2 (p= 0.020). The number of portions per tray
of vegetables, beverages, and juice was similar among time periods.
In line with the previous results, when the number of selected portions was trans-
formed into categorical variables (Table 1), significant associations were found between the
amount of food groups consumed per meal and the three time periods, except for beverages
and juice, the intake of which was extremely low across the time periods. Interestingly, the
share of trays containing at least one portion of fruit increased from 68% (baseline) to 75%
(at both Time 1 and Time 2), while the proportion of meals containing at least one portion of
whole grain cereals increased from 18% (baseline) to 31% at Time 1 and 32% at Time 2. The
percentage of trays containing at least one portion of pulses switched from 17% (baseline)
to 20% and 21% at Time 1 and Time 2, respectively, with a concurrent decrease (from 79%
to 72% and 74%) in the share of legume-free transactions. Similarly, a small increase in the
percentage of meals with at least a portion of fish (from 20% at baseline to 23% at Time 1
and 21% at Time 2) and a portion of vegetables (66% at baseline and 75% at both Time 1
and Time 2) was observed, whereas around 38% of trays with at least a portion of meat
were selected in each time period.
The increased number of portions per tray observed for some food groups was also
reflected in a generally higher intake of energy and nutrients during the intervention phases
compared to baseline (Table 2). The highest energy, protein, fat, carbohydrate, fiber, and
salt intakes were registered at Time 2, while the lowest was observed at baseline. However,
energy contribution from proteins was higher at baseline than at Time 1 and Time 2; the
percentage of energy from fat remained similar among time periods, whereas energy from
carbohydrates and fiber increased during the intervention phases compared to baseline.
The saturated fat intake was lower at baseline and similar between Time 1 and Time 2,
but energy contribution from this nutrient was similar among the three time periods. The
highest sugar intake and the highest energy contribution from sugars were observed at
Time 1, while the lowest ones were observed Sat baseline.
Nutrients 2022,14, 4456 7 of 14
Table 1.
Number of portions (%) of food groups per tray consumed at the worksite canteens across
the study and by time periods.
Portions
(n)/tray
Total
n= 29,776
T0 (Jun–Sept)
n= 7142
T1 (Sept–Dec)
n= 10,834
T2 (Jan–Apr)
n= 11,800 p-Value 1
Fruit
0 7719 (25.9) 2195 (30.7) 2601 (24.0) 2923 (24.8)
0.5 246 (0.8) 76 (1.1) 108 (1.0) 62 (0.5)
<0.001
1 19,043 (64.0) 4225 (59.2) 7191 (66.4) 7627 (64.6)
1.5 87 (0.3) 54 (0.8) 27 (0.2) 6 (0.1)
≥2 2681 (9.0) 592 (8.3) 907 (8.4) 1182 (10.0)
Vegetables
0 8034 (27.0) 1982(27.8) 2915 (26.9) 3137 (26.6)
<0.001
0.5 1703 (5.7) 464 (6.5) 595 (5.5) 644 (5.5)
1 13,010 (43.7) 3018 (42.5) 4741 (43.8) 5251 (44.5)
1.5 1665 (5.6) 463 (6.5) 603 (5.6) 599 (5.1)
≥2 5364 (18.0) 1215 (17.0) 1980 (18.3) 2169 (18.4)
Tubers
0 26,339 (88.5) 6357 (89.0) 9474(87.4) 10,508 (89.1)
<0.001
1 3366 (11.3) 766 (10.7) 1348 (12.4) 1252 (10.6)
≥2 71 (0.2) 19 (0.3) 12 (0.1) 40 (0.3)
Cereals
0 10,473 (35.2) 2358 (33.0) 4051 (37.4) 4064 (34.4)
<0.001
0.5 513 (1.7) 182 (2.5) 184 (1.7) 147 (1.2)
1 14,200 (47.7) 3825 (53.6) 4970 (45.9) 5405 (45.8)
1.5 498 (1.7) 113 (1.6) 176 (1.6) 209 (1.8)
≥2 4092 (13.7) 664 (9.3) 1453 (13.4) 1975 (16.7)
Whole-grain
cereals
0 20,999 (70.5) 5734 (80.3) 7307 (67.4) 7958 (67.4)
<0.001
0.5 285 (1.0) 89(1.2) 125 (1.2) 71 (0.6)
1 7359 (24.7) 1224 (17.1) 2942 (27.2) 3193 (27.1)
1.5 77 (0.3) 14 (0.2) 36 (0.3) 27 (0.2)
≥2 1056 (3.5) 81 (1.1) 424 (3.9) 551 (4.7)
Pulses
0 22,088 (74.2) 5588 (78.2) 7828 (72.3) 8672 (73.5)
<0.001
0.5 1888 (6.3) 353 (4.9) 859 (7.9) 676 (5.7)
1 5158 (17.3) 1064 (14.9) 1922 (17.7) 2172 (18.4)
1.5 248 (0.8) 45 (0.6) 99 (0.9) 104 (0.9)
≥2 394 (1.3) 92 (1.3) 126 (1.2) 176 (1.5)
Dairies
0 23,748 (80.2) 5730 (80.2) 8813 (81.3) 9205 (78.0)
<0.001
0.5 3709 (12.5) 802 (11.2) 1165 (10.8) 1742 (14.8)
1 2017 (6.8) 533 (7.5) 746 (6.9) 738 (6.3)
1.5 223 (0.7) 61 (0.9) 74 (0.7) 88 (0.7)
≥2 79 (0.3) 16 (0.2) 36 (0.3) 27 (0.2)
Eggs
0 28,492 (95.7) 6783 (95.0) 10,454 (96.5) 11,255 (95.4)
<0.001
0.5 335 (1.1) 97 (1.4) 67 (0.6) 171 (1.4)
1 942 (3.2) 260(3.6) 309 (2.9) 373 (3.2)
1.5 4 (0.0) 0 (0.0) 3 (0.0) 1 (0.0)
≥2 3 (0.0) 2 (0.0) 1 (0.0) 0 (0.0)
Fish
0 22,346 (75.0) 5443 (76.2) 8059 (74.4) 8844 (74.9)
<0.001
0.5 989 (3.3) 299 (4.2) 236 (2.2) 454 (3.8)
1 5900 (19.8) 1268 (17.8) 2376 (21.9) 2256 (19.1)
1.5 273 (0.9) 51 (0.7) 124 (1.1) 98 (0.8)
≥2 268 (0.9) 81 (1.1) 39 (0.4) 148 (1.3)
Meat
0 15,756 (52.9) 3659 (51.2) 5757 (53.1) 6340 (53.7)
<0.001
0.5 2780 (9.3) 783 (11.0) 1010 (9.3) 987 (8.4)
1 9905 (33.3) 2310 (32.2) 3622 (33.4) 3982 (33.7)
1.5 936 (3.1) 273 (3.8) 299 (2.8) 364 (3.1)
≥2 399 (1.3) 126 (1.8) 146 (1.3) 127 (1.1)
Dessert 0 29,694 (99.7) 7142 (100) 10,834 (100) 11,718 (99.7) <0.001
1 82 (0.3) 0 (0.0) 0 (0.0) 82 (0.7)
Beverages
0 28,696 (96.4) 6869 (96.2) 10,437 (96.3) 11,390 (96.5)
0.679
1 1078 (3.6) 273 (3.8) 396 (3.7) 409 (3.5)
≥2 2 (0.0) 0 (0.0) 1 (0.0) 1 (0.0)
Juices 0 29,767 (100) 7140 (100) 10,832 (100) 11,795 (100) 0.582
1 9 (0.0) 2 (0.0) 2 (0.0) 5 (0.0)
1Chi-squared test.
Nutrients 2022,14, 4456 8 of 14
Table 2.
Energy and nutrient content (mean
±
SD) per tray consumed at the worksite canteens across
the study and by time periods.
Total
n= 29,776
T0 (Jun–Sept)
N= 7142
T1 (Sept–Dec)
n= 10,834
T2 (Jan–Apr)
n= 11,800 p-Value 1
Energy (kcal/tray) 699 ±208 649 ±194 c707 ±208 b723 ±211 a<0.001
Proteins (g/tray) 36.3 ±13.0 35.1 ±12.4 c36.3 ±12.4 b37.0 ±13.8 a<0.001
(%Energy) 21.3 ±7.1 22.2 ±7.4 a21.1 ±6.9 b20.9 ±7.0 b<0.001
Fat (g/tray) 21.3 ±11.7 19.6 ±11.1 c21.6 ±11.9 b22.1 ±11.8 a<0.001
(%Energy) 26.7 ±10.4 26.5 ±10.8 26.8 ±10.3 26.9 ±10.3 0.052
Saturated fat (g/tray) 6.0 ±4.9 5.6 ±4.9 b6.1 ±5.1 a6.1 ±4.7 a<0.001
(%Energy) 7.3 ±4.9 7.3 ±5.3 7.3 ±4.9 7.3 ±4.6 0.762
Carbohydrates (g/tray) 88.4 ±32.6 80.1 ±31.1 c89.5 ±32.3 b91.8 ±33.0 a<0.001
(%Energy) 50.5 ±12.7 49.7 ±13.6 b50.7 ±12.5 a50.8 ±12.4 a<0.001
Sugars (g/tray) 23.3 ±11.9 20.5 ±11.2 c24.7 ±12.1 a23.8 ±11.8 b<0.001
(%Energy) 14.1 ±7.7 13.3 ±7.6 c14.8 ±7.9 a13.9 ±7.4 b<0.001
Fiber (g/tray) 11.3 ±4.7 10.3 ±4.4 c11.4 ±4.7 b11.7 ±4.9 a<0.001
(%Energy) 3.4 ±1.7 3.4 ±1.7 b3.4 ±1.6 ab 3.5 ±1.7 a0.002
Salt (g/tray) 3.6 ±1.6 3.3 ±1.3 c3.6 ±1.7 b3.8 ±1.7 a<0.001
1
Main effect from one-way ANOVA test with Tamhane post hoc test. Different letters in the same row indicate
significantly different values (p< 0.05).
The increased selection of some food groups during the intervention phases also
influenced the environmental impacts of selected meals (Table 3). Carbon and water
footprints increased over time, with the highest impacts registered at Time 2 and the lowest
ones registered at baseline. The lowest ecological footprint was also observed at baseline,
but values were similar between Time 1 and Time 2. In contrast to these results, when
environmental data were expressed per 1000 kcal, the highest footprints were observed for
all three environmental indicators at baseline, while they were similar between intervention
phases (Time 1 and Time 2).
Table 3.
Carbon, water, and ecological footprints (mean
±
SD) per tray consumed at the worksite
canteens and per 1000 kcal across the study and by time period.
Total
n= 29,776
T0 (Jun–Sept)
n= 7142
T1 (Sept–Dec)
n= 10,834
T2 (Jan–Apr)
n= 11,800 p-Value 1
Carbon Footprint
(g CO2eq/tray) 1112 ±867 1061 ±823 c1108 ±874 b1146 ±883 a< 0.001
Water Footprint
(L/tray) 1083 ±858 1028 ±814 c1082 ±879 b1117 ±863 a< 0.001
Ecological Footprint
(m2/tray) 8.9 ±5.7 8.5 ±5.4 b9.0 ±5.7 a9.1 ±5.8 a< 0.001
Carbon Footprint
(g CO2eq/1000 kcal) 1649 ±1444 1699 ±1474 a1626 ±1445 b1639 ±1423 b0.002
Water Footprint
(L/1000 kcal) 1593 ±1293 1631 ±1324 a1575 ±1310 b1586 ±1256 b0.012
Ecological Footprint
(m2/1000 kcal) 13.4 ±9.6 13.8 ±9.9 a13.3 ±9.6 b13.2 ±9.4 b< 0.001
1
Main effect from one-way ANOVA test with Tamhane post hoc test. Different letters in the same row indicate
significantly different values (p< 0.05).
4. Discussion
This longitudinal study described the effect of an educational intervention based on
a nudge technique coupled with a web-based program aimed at promoting healthy and
environmentally sustainable food choices in two worksite canteens. The intervention was
offered at no cost to all employees of the Barilla G & R. F.lli S.p.A. food company who had
access to the canteens.
Nutrients 2022,14, 4456 9 of 14
Due to the very high proportion of trays containing at least one dish marked with the
Double Pyramid logo at the baseline, the nudge tool showed no added effect in improving
the food choices when combined with additional educational materials. This could also be
due to the high quality of served meals that are focused on the promotion of healthy and
sustainable food choices. A similar nudge showing only the MD pyramid was applied in
a previous study by Vitale and colleagues [
21
] to highlight the healthy plates resembling
the traditional MD. However, similarly to the present study, the effectiveness of the MD
Pyramid logo was not tested as a separate intervention compared to the baseline condition.
Thus, the evaluation of a direct association between the food choice improvement and the
sole logo application was not possible. Different choice architectures suggested for the
food services can be found in the literature, such as modifying portion sizes, increasing
the prominence of healthy options, and including and positioning symbols/labels to
highlight healthy and/or sustainable options (e.g., vegetarian offers). When the approaches
showed some ability to shift decisions, consumers were often found to be unaware about
the influence exerted on their choices [
25
]. However, specifically referring to the use of
symbols/labels, no univocal results in terms of efficacy have been observed. Stressing
the fact that a dish is “vegetarian” or “free from meat” has proven to be less effective
compared to the use of other framing options [
26
]. Specifically, the use of the “V” symbol
placed before or after the titles of vegetarian dishes did not exert a significant influence
on food choice in an online study involving UK consumers [
27
]. On the other hand,
descriptive name labels referring to sustainability have proven to effectively influence
decisions in a university canteen setting [
17
], suggesting a higher level of attractiveness for
such descriptions compared to the healthy/nutritional dimension.
Positive results related to the choice of plant-based products were observed across
the study, as the selection of fruit, pulses, and whole-grain cereals, followed by vegetables,
increased over time, underlining the effectiveness of the sì.mediterraneo educational inter-
vention. On the other hand, more heterogeneous results can be observed for animal-based
food groups. Indeed, although the choice of fish seemed to slightly increase and a small
reduction in the selection of meals containing meat was observed, the share of meat-based
dishes constantly remained almost double, three times and more than ten times the share
of meals containing, respectively, one portion of plant-protein sources (i.e., pulses), dairies,
and eggs.
Our results appear to be consistent with what was observed in an online randomised
controlled trial [
27
], suggesting that, to allow the large-scale selection of vegetarian dishes,
the offer of these dishes should widely overcome that of meat options (75% vs. 25%).
However, mixed findings have emerged from the literature, as a prior study [
28
] proved
that a perfect balance between meat and vegetarian (50% vs. 50%) options was enough to
entail a relevant shift in vegetarian options in four dish menus. In this light, it would be
important to increase the offer of plant-based protein alternatives in the canteens since it
was lower than the animal-based options.
From the nutritional perspective, the average energy content of the meals was com-
prised between 32% at baseline and 35–36% (during the intervention periods) of the adult
energy requirement used as reference (2000 kcal/die). The energy intake observed at
baseline was slightly lower compared to the share of energy the lunch should provide daily
(i.e., 35–40%) [
4
]. Therefore, the increase in energy intake observed during the intervention
phases should be considered a positive change in participants’ diet composition. The
carbohydrate content of lunch meals was adequate as it provided 51–52% of energy intake.
Indeed, according to the Italian dietary guidelines [
23
], the daily share of energy due to
carbohydrates should equal 45–60%. The energy contribution to the meals of fat, which
was around 26–27%, was consistent with the proportion of energy (20–35%) that should
derive from fat daily [
23
]. Nevertheless, the actual fat intake, mainly derived from extra
virgin olive oil, could be higher due to the possible dressings made directly by users at
the table, especially for side dishes. Last, the proportion of energy from proteins, which
corresponded to 21–22%, appears to be slightly high.
Nutrients 2022,14, 4456 10 of 14
The significant increase in the energy content of the selected meals seems to be par-
ticularly driven by sugars, proving that, on average, a higher fruit selection was not
compensated for by a reduction in the choice of other food groups. Even if the higher
selection of desired dishes did not adequately replace the choice of other options, the
average sugar content of the chosen meals remained below the recommended 15% of the
meal energy content [
23
] during the three time periods. In addition, the fiber content was
satisfying, accounting for 40–48% of the recommended daily fiber intake (i.e., 25 g) for
the Italian adult population [23]. Promisingly, even better achievements were reported by
Lassen and colleagues [
29
] in a study carried out in 15 Danish worksite canteens. Indeed,
after a 10-year period, in parallel to an increase in the estimated mean intake of fruit and
vegetables from lunch meals, the authors observed a reduction in the energy density, with
no concurrent reduction in the portion size of the meals.
An important finding of the study relates to the remarkably and increasingly high level
of salt in the dishes offered at the canteens across the time periods. As shown, on average,
the amount of salt in each tray was approximately equal to one-third of the daily average
salt consumption in the Italian population (about 9 g) [
30
] and more than two-thirds of
the maximum daily recommended amount (5 g) [
4
]. It is worth noting that the actual
salt intake derived from the canteen dishes could be even higher due to the discretionary
salt possibly added by canteen users at the table. This observation confirms previous
considerations on the need to simultaneously develop consumer-based and establishment-
based strategies [
31
] addressed to the different figures acting in the food services, ranging
from the canteen staff to the final consumers, to maximise beneficial outcomes.
As practical implications of the present study, tailored training sessions dedicated to
cooks can be suggested to improve the nutritional quality of dishes, as already reported in
the same setting by Vitale and colleagues (2017). Furthermore, it is worth noting that, to
effectively improve the dietary intake in workplace canteens, even if further evidence is
needed, a multitude of actions should be applied, ranging from the application of consumer-
based strategies to the modification of the meal offering to enhancing the proposal of
healthier options while limiting the counterparts [31].
From the environmental perspective, for all three considered indicators, the interven-
tion did not lead to a reduction in the environmental burden associated with the chosen
meals. This finding is consistent with the increased food consumption across time. How-
ever, when data were adjusted by energy, the carbon, water, and ecological footprints were
lower compared to the baseline levels, suggesting that the higher absolute values could
have been due to a higher amount of food selected across the three time periods, but the
food choices were slightly shifted towards more sustainable dietary patterns. On average,
the selected meals were characterised by a relatively high carbon emission intensity and
water consumption, accounting, respectively, for more than 1000 g of CO
2
eq and more than
1000 L of water per meal. Indeed, such ideal cut-offs have been suggested in the framework
of the SU-Eatable project led by the BCFN [
32
] as a scenario in line with a 1.5
◦
C–2
◦
C
increase by 2100 [
5
], applying impact values of food items selected from Petersson and
colleagues (2021) [33].
The lunch meals’ GHG emissions seem to be consistent with the calculation made
for the Italian diet, as estimated from the national consumption survey (INRAN-SCAI
2005–2006), accounting for 3.6 kg CO
2
eq, calculated as the average impact of females’
(3.2 kg CO
2
eq) and males’ (4.0 kg CO
2
eq) food intake [
34
]. Similarly, in a more recent
study involving an omnivorous Italian sample, the estimated carbon footprint was 3.9 kg
CO
2
eq [
35
]. Thus, GHG emissions of served meals in the present study covered around
28–30% of the average daily Italian values. Consistently, meals contributed to around 35%
of both water and ecological footprints compared to the Italian population values reported
in the literature [34,35].
Furthermore, if compared to the results obtained from an LCA study carried out on
about 20 million meals served in 240 Swiss canteens in 2011, the mean carbon footprint calcu-
lated per lunch meal is about one-fourth (1.1 CO
2
eq in our study vs. 4.1 kg CO
2
eq) [
36
]. Such
Nutrients 2022,14, 4456 11 of 14
discrepancies may be explained, however, from a different data specificity characterizing
the two studies. Our environmental impact analysis took into account the food production
phase and the contribution estimated for different cooking typologies and duration. The
Swiss study [
36
] instead considered all stages from farm to the transport to the canteen,
including the estimated contribution derived from packaging, transportation, refrigeration,
waste disposal, as well as the resource use linked to the activities in the canteen.
The environmental database used, even if regularly updated and based on informa-
tion from the scientific literature, cannot be considered complete, representing one of the
limitations of the present analysis. In addition, the lack of a baseline scenario where the
nudge was not present can be considered a study limitation, as it prevented the possibility
of investigating the single effect of the applied nudge compared to a control condition.
Furthermore, the food selection was considered a proxy of actual food consumption, which
was not more directly estimated as no waste records were collected. Despite the prospective
study design, the same subject was not specifically followed over time, hindering the as-
sessment of intra-subject variability during the 10 months of observation. Moreover, as only
the sex and age of participants were recorded during data collection, in-depth assessments
of choice determinants cannot be carried out. Additional socio-demographic information,
such as education and income levels, could be relevant as a heterogeneous population is
considered in this study, with both white and blue collars being involved. However, the
experimental conditions, such as the relatively low price at which the meals are offered at
the company canteens, contributed to minimising the influence of economic factors.
Last, it should be taken into consideration that these results may not be totally gen-
eralizable to the general working population, as all participants are employees of a food
company where the double logo pyramid has been created, and they may have more
knowledge on these topics than the general population. The adoption of a certain food
behaviour (e.g., healthy and sustainable food choice) results from a combination of intrin-
sic (e.g., food preferences, personal attitude and/or motivation and/or knowledge) and
extrinsic factors (i.e., the food environment, food policy framework) that singularly can
variably affect food intake [
7
,
37
]. Therefore, the inclusion of additional outcome variables
would be beneficial to investigate the so-called “attitude-behaviour gap”, which reflects the
discrepancy between a favourable attitude toward a certain behaviour and the behaviour
itself [38].
Despite these considerations, to the best of our knowledge, this is the first explorative
analysis of the dietary and environmental contents of meals served in worksite canteens in
Italy. The main strengths of the study relate to the high number of transactions that were
qualitatively and quantitatively assessed during the study, which allowed us to capture a
reliable overview of the food choice made at the worksite canteens over an extended period
(10 months).
5. Conclusions
This study shows the positive effect of an education program applying a nudge inter-
vention represented by the Double Pyramid logo and an online application in promoting
healthy and environmentally sustainable food choices based on the MD in a worksite
canteen setting during a 10-month period. Although the choice of dishes labelled with the
Double Pyramid logo did not differ across the time due to a very high baseline selection,
the choice of plant-based dishes, mostly those based on whole-grain cereals and legumes,
and fish increased over time, while meat-based options decreased. Although the selection
of healthy items increased, they were added to menus, not in replacement of other dishes,
accounting for a higher level of energy and macronutrients and worse environmental
footprints per meal. However, the nutritional composition of meals improved during the
intervention phases. In addition, when data were adjusted for energy, no higher environ-
mental impacts were observed, demonstrating a small improvement in the environmental
sustainability of selecting menus. Therefore, the intervention was not fully effective, even
though it significantly improved food choices.
Nutrients 2022,14, 4456 12 of 14
Well-designed catering initiatives may offer an effective opportunity to promote
healthy and sustainable food choices. However, targeted public health policy and actions
are needed to support and motivate caterers to develop interventions in the desired direc-
tion. Furthermore, the study promisingly highlights the interest of consumers in receiving
information in eating out scenarios about the health and environmental impact of food and
demonstrates the value of using a digital application as a proper solution for users’ needs.
Supplementary Materials:
The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/nu14214456/s1, Table S1: Number of portions (median (25–75th
percentile)) of food groups per tray consumed at the worksite canteens across the study and by
time period.
Author Contributions:
Conceptualization, V.R., A.R. and F.S.; methodology, V.R., A.R.; formal
analysis, A.R.; investigation, V.R., A.R.; data curation, A.R., B.B. and E.M.; writing—original draft
preparation, B.B, A.R. and E.M.; writing—review and editing, F.S., V.R. and V.D.; supervision, F.S.,
V.R., V.D.; funding acquisition, V.R. All authors have read and agreed to the published version of
the manuscript.
Funding:
This research was partially funded by the Emilia-Romagna region–Piano Regionale Tri-
ennale Alte Competenze per la Ricerca, il Trasferimento Tecnologico e l’imprenditorialità–CUP
D99I17000250009 (“Sicurezza, qualitàe integrazione delle filiere agroalimentari regionali per aumen-
tarne la competitività”). The project was also supported by institutional funds from the Barilla Company.
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement:
Data are available on request due to restrictions. The data presented in
this study are available on request from the corresponding author. The data are not publicly available
due to privacy and company policy.
Acknowledgments:
Authors would like to thank Antonio Rossano, coordinator of the IT unit in
charge of the technological development of the web application.
Conflicts of Interest:
Valeria Rapetti and Valeria Deon are Barilla employees involved in the nutri-
tional activities performed in the company. The funders had no role in the design of the study; in the
collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to
publish the results.
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