title: School meal provision, health, and cognitive function in a Nordic setting - the ProMeal-study: description of methodology and the Nordic context.
abstract: BACKGROUND
  School meals, if both nutritious and attractive, provide a unique opportunity to improve health equality and public health.
  
  
  OBJECTIVE
  To describe the study rationale, data collection, and background of participants in the study 'Prospects for promoting health and performance by school meals in Nordic countries' (ProMeal). The general aim was to determine whether overall healthiness of the diet and learning conditions in children can be improved by school lunches, and to capture the main concerns regarding school lunches among children in a Nordic context.
  
  
  METHODS
  A cross-sectional, multidisciplinary study was performed in Finland, Iceland, Norway, and Sweden on pupils (n=837) born in 2003.
  
  
  RESULTS
  In total 3,928 pictures of school lunches were taken to capture pupils' school lunch intake. A mean of 85% of all parents responded to a questionnaire about socioeconomic background, dietary intake, and habitual physical activity at home. Cognitive function was measured on one occasion on 93% of the pupils during optimal conditions with a Stroop and a Child Operation Span test. A mean of 169 pupils also did an Integrated Visual and Auditory Continuous Performance Test after lunch over 3 days. In total, 37,413 10-sec observations of classroom learning behavior were performed. In addition, 753 empathy-based stories were written and 78 focus groups were conducted. The pupils had high socioeconomic status.
  
  
  CONCLUSIONS
  This study will give new insights into which future interventions are needed to improve pupils' school lunch intake and learning. The study will provide valuable information for policy making, not least in countries where the history of school meals is shorter than in some of the Nordic countries.
authors: Department of Food and Nutrition, Umeå University, Umeå, Sweden; maria.waling@umu.se.
authors: Maria
authors: M
authors: Waling
authors: School of Education, University of Iceland, Reykjavik, Iceland.
authors: Anna S
authors: AS
authors: Olafsdottir
authors: Turku Institute of Child and Youth Research, University of Turku, Turku, Finland.
authors: Hanna
authors: H
authors: Lagström
authors: Faculty of Education, Bergen University College, Bergen, Norway.
authors: Hege
authors: H
authors: Wergedahl
authors: Department of Psychology, Umeå University, Umeå, Sweden.
authors: Bert
authors: B
authors: Jonsson
authors: Department of Food and Nutrition, Umeå University, Umeå, Sweden.
authors: Cecilia
authors: C
authors: Olsson
authors: Faculty of Education, Bergen University College, Bergen, Norway.
authors: Eldbjørg
authors: E
authors: Fossgard
authors: Faculty of Education, Bergen University College, Bergen, Norway.
authors: Asle
authors: A
authors: Holthe
authors: Turku Institute of Child and Youth Research, University of Turku, Turku, Finland.
authors: Sanna
authors: S
authors: Talvia
authors: Unit for Nutrition Research, Landspitali - The National University Hospital of Iceland and Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
authors: Ingibjorg
authors: I
authors: Gunnarsdottir
authors: Department of Food and Nutrition, Umeå University, Umeå, Sweden.
authors: Agneta
authors: A
authors: Hörnell
keywords: Nordic countries; cognitive function; dietary intake; education; school meals