Promotion of Functional Foods in a School Context: Evaluation of Food Education Sessions Involving Cooking Skills

ABSTRACT

Food education through cooking programs have been identified to promote healthy eating among individuals, especially among the youngest. It was intended to evaluate the impact of a set of food education sessions in students of the 3rd cycle of basic education (from the 7th to the 9th grade) to promote the consumption of functional foods and improve their cooking skills. A pre- and post-session questionnaire and a global assessment of the sessions were applied. Twenty-three students aged between 13 and 14 participated in the activity, mostly male (60.9%). About 95% of the students had a normal weight and 4.8% were overweight. There was an improvement in the cooking skills of the students, especially in their confidence in making sauces and soup. About 70% of students are very/very willing to increase the frequency of meals prepared by themselves and consider it important to introduce themes related to functional foods in the syllabus in the 3rd cycle of basic education.

KEYWORDS:

• Students
• cooking skills
• children
• food education
• school

Introduction

The term functional foods was first used in Japan in the 1980s, yet its definition is often misunderstood as despite being subject to regulation, it is not legally recognized in most countries (Alongi & Anese, 2021). Thus, across the world there are many definitions for functional foods (Temple, 2022). We can find simple definitions for functional foods such as food or components that have health benefits by reducing the risk of specific diseases or other health problems (Thomas & Earl, 1994) or more complex definitions such as those that beneficially affect one or more functions of the body, in addition to producing their basic nutritional effects, in such a way that there is an improvement in health and well-being and/or a reduction in the risk of disease (Diplock et al., 1999).

More recently, a new definition of functional foods has been proposed, which argues that these are new foods that have been formulated to contain live substances or microorganisms with the potential to improve health or prevent disease, and that they are present in a concentration that is safe and sufficiently high to produce the intended benefit. This definition further emphasizes that the added ingredients can be nutrients, dietary fiber, phytochemicals, other substances or probiotics (Temple, 2022).

Functional foods should be consumed within a normal dietary pattern, not pills or capsules or food supplements (Diplock et al., 1999). We can consider functional foods: an unaltered natural food (for example, fatty fish with a high content of omega-3 polyunsaturated fatty acids); a food in which a component has been increased, decreased, added, or removed by the production process or other technologies (e.g., antioxidant-enhanced fruit juice, phytosterol-added spreads, fat-reduced yogurt); a food with a component whose bioavailability has been modified (e.g. rice genetically modified to increase the bioavailability of iron); or, a combination of the above (European Commission, 2010).

The ability of functional foods to have beneficial effects on health (e.g., cancer prevention, gastrointestinal health, cardiovascular health, cognition and neurodegenerative diseases, and cardiometabolic syndrome (Aguiar, Geraldi, Betim Cazarin, & Maróstica Junior, 2019)) is due to the fact that they contain bioactive compounds, that is, food components that can affect biological processes or substrates and, therefore, have an impact on the functions or conditions of the organism and, finally, in the health status (Konstantinidi & Koutelidakis, 2019; Luna-Castillo et al., 2021). These bioactive compounds are present in foods of animal or plant origin that are traditionally consumed in the Mediterranean dietary pattern (Battino et al., 2019; Elmaliklis et al., 2020), plant-based diets (Jiang et al., 2020), including algae (Boukid & Castellari, 2023).

Studies report the difficulty in assessing the consumption of functional foods due to the great variability of methods used to collect this information, as well as the selection of foods classified or not as functional. However, they report that the consumption of functional foods is high (varying between different countries) (Ozen, Pons, & Tur, 2012; Özen, Bibiloni Mdel, Pons, & Tur, 2014).

Interventions in children and adolescents have aroused the interest of policy makers as there is evidence that eating habits created in childhood tend to be maintained into adulthood (Kelder, Perry, Klepp, & Lytle, 1994; Perez-Rodrigo & Aranceta, 2001; Prado, Fortes, Lopes, & Guimarães, 2016), therefore, it is essential to promote the adoption of healthy lifestyles and the consumption of health-promoting foods at an early age (Prado, Fortes, Lopes, & Guimarães, 2016).

Intervention programs aimed at increasing cooking skills have been shown to be effective in improving eating habits not only in adults (Garcia et al., 2020), but also in children (Bennett, Mockler, Cunningham, Glennon-Slattery, & Johnston Molloy, 2021; Muzaffar, Metcalfe, & Fiese, 2018; Ng, Kaur, Koo, Mukhtar, & Yim, 2022; Reicks, Trofholz, Stang, & Laska, 2014), not only because they provide an opportunity to put the acquired knowledge into practice, but also because it is something useful in everyday life and strengthens relationships between peers through being an activity carried out in a team (Thomas & Irwin, 2011).

For adults, it has been proposed that the lack of cooking skills can be an obstacle to the preparation of healthy meals (Tani, Fujiwara, & Kondo, 2020). A study involving 120 adults who participated in an intervention program with a cooking component (for 7 weeks, with a weekly session), reported an increase in the consumption of fruits and vegetables, without differences in the frequency of meal preparation, although it is mentioned a change in eating behavior, namely an increase in food variety, cooking self-efficacy and family’s participation in cooking (Metcalfe, Prescott, Schumacher, Kownacki, & McCaffrey, 2022).

However, the study of cooking skills in children is still limited, not knowing much about how cooking skills influence their diet (Ganann, Fitzpatrick-Lewis, Ciliska, & Peirson, 2012). A more recent study, in which 83 children participated in a 5-module food education program, with a culinary component over 12 weeks, demonstrated that the intervention group increased their knowledge, improved their attitudes, practices, and self-efficacy in relation to the preparation of healthy meals, in addition, improvements in the availability of fruits, vegetables, healthy foods, and a reduction in the availability of less healthy foods were reported (Ng, Kaur, Koo, Mukhtar, & Yim, 2022). It should also be noted that this food education program also included a module with the parents of these children on the availability of food at home, which was held every 2 weeks.

Therefore, the objective of this work was to evaluate a set of food education sessions in students of the 3rd cycle of basic education (from the 7th to the 9th grade) whose purpose was to promote the consumption of functional foods and improve their cooking skills. More specifically, we intend to find out whether the implemented education sessions have an impact on knowledge and perceived attitudes toward functional foods, as well as on the cooking skills of students in the 3rd cycle of basic education.

Materials and methods

We selected a school, with basic education located in the municipality of Angra do Heroísmo, for convenience (receptivity for implementation of the food education sessions and proximity to the University). After an 8th grade class was selected by its school health coordinator to participate in the sessions. This choice was based on the ease of integration of the sessions into the timetable of the Education for Health discipline and the availability of the kitchen where the sessions were held.

A questionnaire was applied with the aim of carrying out the sociodemographic characterization of the students and verifying their satisfaction with the food education sessions, as well as their perception of the impact of these on their culinary skills and on their knowledge about functional foods. It consisted of 4 groups (1 ─ sociodemographic and anthropometric characterization; 2 ─ Food consumption habits; 3 ─ Perception, attitudes and beliefs about functional foods; 4 ─ Cooking skills). In this work, only groups 1, 3, and 4 of the aforementioned questionnaire will be analyzed. Therefore, for the sociodemographic characterization, questions were asked about gender, date of birth, nationality, place of residence, household composition, etc., data relating to anthropometric characterization (weight and height) were self-reported. Weight status was assessed by calculating the body mass index (BMI) and compared with the World Health Organization criteria using the z-score curves referring to BMI for age (de Onis et al., 2007) using the WHO AnthroPlus software v1.0.4 (World Health Organization, 2009).

The assessment of students’ cooking skills was carried out using the adapted scale by Hartmann and colleagues (Hartmann, Dohle, & Siegrist, 2013). This scale had 7 statements related to the ability to prepare different foods on which students assigned a score on a 6-point scale (1—strongly disagree; 6—strongly agree). The aforementioned questionnaire served as an intervention evaluation tool, being filled out before and after it. A questionnaire was also applied regarding the global assessment of the sessions by the students. The first questionnaire before the intervention was applied to the class on April 22, 2016. The second application of the questionnaire was carried out on May 6, 2016 after the last session, and the global assessment questionnaire of the sessions was applied a week later.

Implementation of the sessions

Three sessions were held between April 22nd and May 6th, 2016. All sessions were implemented by a researcher (with a degree in nutrition sciences) and in the presence of the teachers who accompanied the class at that time, since the sessions took place during school hours. The sessions started with an interactive introduction lasting 30 minutes. The first session consisted of an initial approach to the topic of functional foods, explaining the concept and providing examples of the same. Subsequently, the introduction of these foods to breakfast and snacks in the context of a healthy diet was discussed, giving basic notions of hygiene and food safety for food handling.

The second session started with a short review of the previous session followed by providing examples of functional foods that could be introduced in lunch/dinner preparation, as well as their beneficial health properties.

Finally, in the third session, functional foods produced in the Autonomous Region of the Azores were discussed and the aromatic herbs and spices used in regional cuisine, as well as their cultivation method, were emphasized. Therefore, we tried to create a sequence: functional food, health benefits, consumption and cultivation.

In the second part of the sessions, the practical part of the same was carried out, being dynamized in the experimental kitchen of the school with a duration of 120 minutes, reinforcing the theoretical contents of the first part in a work context. The recipes prepared were adapted from the website http://www.superhealthykids.com also translated into Portuguese) and from a book on regional gastronomy (Gomes, 2002) in order to introduce or increase the presence of functional foods, as well as to have a healthier nutritional composition (reducing the amounts of sugar and fat in them, with the concern of not mischaracterizing the recipes).

At the end of the third session, students were given an informative booklet on the main contents covered in the sessions, which contained all the recipes prepared, and they were also encouraged to repeat the recipes at home and disseminate what they learned with their families.

Ethical considerations

The present study was carried out in accordance with the ethical standards set out in the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards (World Medical Association., 2013). The board of the evaluated school approved the realization of the present study and the food education sessions. The students’ participation in the sessions took place after authorization from the guardians through an informed consent form. Students were also asked if they wanted to participate in the study, and after an affirmative answer from both, they were allowed to participate in it and in the sessions.

Statistical analysis

The statistical analysis of the present study was performed using the IBM SPSS software version 26.0. Descriptive statistics consisted of calculating frequencies in the case of ordinals and nominals. The normality of the variables was evaluated by the Shapiro-Wilk test. Pre- and post-sessions cooking skills were analyzed by Wilcoxon’s test for two dependent samples. In all analyses, a significance level (p) of 5% was considered.

Results

From a total of 23 students in the 8th grade class, a participation rate of 87.0%, 100.0% and 78.3% was obtained in relation to the 1st, 2nd and 3rd session, respectively. Twenty pre-sessions questionnaires and 21 post-sessions questionnaires were collected. Thus, the class consisted of students between the ages of 13 and 14, 60.9% of whom were male, living in Angra do Heroísmo. Most students lived in a household with four individuals (43.5%) and 2 of them were under 18 years old (52.3%), in addition they had a vegetable garden at home (78.3%) of which half used to help maintain it. Regarding the students’ weight status, it was found that 95.2% were normal weight and 4.8% were overweight. Table 1 presents the results on the evaluation of the session by the students. Most of them really enjoyed participating in the sessions in general (46.7%), with session 1 on breakfast and snacks being the one in which they most enjoyed participating. More than 50% of the students said they really enjoyed making: “pasta and cheese with pumpkin and tuna;” “banana pancake with oatmeal;” “sparkling water flavored with wild berries;” and “colorful chicken salad.” On the other hand, the recipes that the students liked the least were “sweet potato puree” and “water flavored with apple, orange and cinnamon” (Table 2).

Table 1. Classification attributed by the students to the cooking sessions.

How did you enjoy participating in:	n	Not at all	A little	Somewhat	Quite	Very much
		n (%)	n (%)	n (%)	n (%)	n (%)
Session 1 – Breakfasts and snacks	18	0 (0.0)	1 (5.6)	4 (22.2)	3 (16.7)	10 (55.6)
Session 2 – Lunches and dinners	22	0 (0.0)	1 (4.5)	3 (13.6)	8 (36.4)	10 (45.5)
Session 3 – Regional dishes	15	0 (0.0)	2 (13.3)	2 (13.3)	7 (46.7)	4 (26.7)
Sessions in general	15	0 (0.0)	0 (0.0)	1 (6.7)	7 (46.7)	7 (46.7)

Table 2. Classification attributed by the students to the recipes prepared in the cooking sessions.

How much did you like the recipes made?	n	Not at all	A little	Somewhat	Quite	Very much
		n (%)	n (%)	n (%)	n (%)	n (%)
Session 1 – Breakfasts and snacks
Apple Pie Parfait	19	1 (5.3)	3 (15.8)	6 (31.6)	5 (26.3)	4 (21.1)
Banana pancake with oatmeal	20	0 (0.0)	0 (0.0)	0 (0.0)	4 (20.0)	16 (80.0)
Carrot, Apple, and Oat Cookies	15	1 (6.7)	5 (33.3)	6 (40.0)	1 (6.7)	2 (13.3)
Granola with fatty fruits	18	1 (5.6)	5 (27.8)	6 (33.3)	3 (16.7)	3 (16.7)
Lemonade with mint	20	2 (10.0)	7 (35.0)	5 (25.0)	4 (20.0)	2 (10.0)
Tricolor banana smoothy	19	0 (0.0)	1 (5.3)	2 (10.5)	7 (36.8)	9 (47.4)
Session 2 – Lunches and dinners
Colorful chicken salad	22	0 (0.0)	2 (9.1)	1 (4.5)	8 (36.4)	11 (50.0)
Pasta and cheese with pumpkin and tuna	21	0 (0.0)	2 (9.5)	1 (4.8)	7 (33.3)	11 (52.4)
Pizza with spinach	21	0 (0.0)	0 (0.0)	3 (14.3)	9 (42.9)	9 (42.9)
Salmon burritos	23	0 (0.0)	2 (8.7)	4 (17.4)	6 (26.1)	11 (47.8)
Sparkling water flavored with wild berries	23	0 (0.0)	3 (13.0)	3 (13.0)	5 (21.7)	12 (52.2)
Water flavored with apple, orange and Cinnamon	21	3 (14.3)	6 (28.6)	6 (28.6)	4 (19.0)	2 (9.5)
Session 3 – Regional dishes
Aromatic rice with spices	17	0 (0.0)	4 (23.5)	10 (58.8)	2 (11.8)	1 (5.9)
Dona Amelia Cake	17	1 (5.9)	3 (17.6)	3 (17.6)	7 (41.2)	3 (17.6)
Tuna steaks with villain sauce	17	0 (0.0)	1 (5.9)	8 (47.1)	4 (23.5)	4 (23.5)
Species of São Jorge	17	2 (11.8)	3 (17.6)	3 (17.6)	4 (23.5)	5 (29.4)
Stewed meat	14	0 (0.0)	0 (0.0)	3 (17.4)	5 (26.1)	6 (34.8)
Sweet potato puree	18	5 (27.8)	3 (16.7)	4 (22.2)	2 (11.1)	4 (22.2)
Fennel soup	18	2 (12.5)	3 (18.8)	8 (37.5)	3 (18.8)	2 (12.5)

Most students reported having greatly increased their knowledge about functional foods, greatly improving their attitudes toward them, considering the introduction of topics related to functional foods in the syllabus in the 3rd cycle of basic education very/very important, as well as very important to carry out extracurricular activities related to these.

In addition, students considered that they greatly increased their consumption of functional foods and were very willing to increase the frequency of meals prepared by themselves (or to help prepare them) — Table 3.

Table 3. Students’ perception of food education sessions (n = 22).

	Not at all	A little	Somewhat	Quite	Very much
	n (%)	n (%)	n (%)	n (%)	n (%)
1. Do you think you’ve increased your knowledge of functional foods?	0 (0.0)	1 (4.5)	7 (31.8)	9 (40.9)	5 (22.7)
2. Do you think you’ve improved your attitudes toward functional foods?	0 (0.0)	1 (4.5)	10 (45.5)	7 (31.8)	4 (18.2)
3. You think it is important to introduce topics related to functional foods in the syllabus in the 3rd cycle of basic education?	0 (0.0)	1 (4.5)	5 (22.7)	8 (36.4)	8 (36.4)
4. Do you think it is important to carry out extracurricular activities related to functional foods?	0 (0.0)	1 (4.5)	4 (18.2)	10 (45.5)	7 (31.8)
5. Have you increased your consumption of functional foods?	1 (4.5)	7 (31.8)	7 (31.8)	5 (22.7)	2 (9.1)
6. Do you think you’ve improved your cooking skills?	0 (0.0)	2 (9.1)	7 (31.8)	10 (45.5)	3 (13.6)
7. Are you willing to increase the frequency of meals you prepare (or help prepare them)?	0 (0.0)	3 (13.6)	4 (18.2)	9 (40.9)	6 (27.3)

The impact of participating in sessions on students’ cooking skills is shown in Table 4. There was an improvement in students’ cooking skills, especially confidence in making sauces and soup.

Table 4. Culinary skills of students before and after food education sessions.

		I totally disagree	I strongly disagree	I disagree	I agree	I strongly agree	I totally agree	p*
		n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
1. I think my cooking skills are sufficient.	T1 (n = 20)	4 (20.0)	6 (30.0)	1 (5.0)	2 (10.0)	4 (20.0)	3 (15.0)	0.284
	T2 (n = 21)	1 (4.8)	1 (4.8)	8 (38.1)	6 (28.6)	2 (9.5)	3 (14.3)
2. I can prepare a hot meal without a recipe.	T1 (n = 20)	6 (30.0)	4 (20.0)	4 (20.0)	2 (10.0)	2 (10.0)	2 (10.0)	0.315
	T2 (n = 21)	3 (14.3)	3 (14.3)	7 (33.3)	3 (14.3	2 (9.5)	3 (14.3)
3. I can make gratins.	T1 (n = 19)	8 (42.1)	2 (10.5)	3 (15.8)	1 (5.3)	2 (10.5)	3 (15.8)	0.454
	T2 (n = 21)	3 (14.3)	4 (19.0)	9 (42.9)	1 (4.8)	0 (0.0)	4 (19.0)
4. I can make soup.	T1 (n = 20)	6 (30.0)	4 (20.0)	5 (25.0)	2 (10.0)	1 (5.0)	2 (10.0)	0.027*
	T2 (n = 21)	1 (4.8)	3 (14.3)	9 (42.9)	2 (9.5)	2 (9.5)	4 (19.0)
5. I can make a sauce.	T1 (n = 20)	7 (35.0)	5 (25.0)	2 (10.0)	3 (15.0)	0 (0.0)	3 (15.0)	0.015*
	T2 (n = 21)	1 (4.8)	5 (23.8)	2 (9.5)	5 (23.8)	5 (23.8)	3 (14.3)
6. I can make a cake.	T1 (n = 20)	3 (15.0)	4 (20.0)	3 (15.0)	5 (15.0)	1 (5.0)	6 (30.0)	0.093
	T2 (n = 21)	1 (4.8)	0 (0.0)	4 (19.0)	8 (38.1)	3 (14.3)	5 (23.8)
7. I can make bread.	T1 (n = 20)	5 (25.0)	7 (35.0)	5 (25.0)	2 (10.0)	0 (0.0)	1 (5.0)	0.052
	T2 (n = 21)	4 (19.0)	3 (14.3)	6 (28.6)	2 (9.5)	4 (19.0)	2 (9.5)

Note: p: Wilcoxon’s test; *p < 0.05.

T1 – Before the session; T2 – After the sessions.

Finally, it was left to each student to comment on the sessions attended. Eight comments were left, the three most relevant are highlighted below:

1. “I found the idea of the sessions very interesting, our class was able to work in the kitchen and together it was good for those who don’t cook much and for those who already cook they were able to improve their cooking skills.” (student, 13 years old);

2. “I think these sessions should be done more often, as we learned a lot and improved our cooking techniques. I loved it and it was a good way for us to work as a team. Thank you for this experience.” (student, 13 years old);

3. “I really enjoyed the cooking sessions, although some recipes I didn’t like, but in general they were good. I would like to be able to repeat this experience next year” (student, 14 years old).

Discussion

With this study, we intended to evaluate the food education sessions implemented with the aim of promoting the consumption of functional foods. Specially to assess its impact on knowledge and perceived attitudes toward functional foods, as well as to assess students’ cooking skills.

Cooking sessions can be carried out in isolation or as part of an intervention that may include: gardening classes, tasting sessions, food shopping, visits to producer markets, visits to restaurants and food education sessions. Interventions that involve more than one component tend to have better results, as opposed to interventions that focus on just one (Muzaffar, Metcalfe, & Fiese, 2018). In this study, the food education sessions were divided into two parts, one more theoretical and the other more practical, in line with other intervention studies carried out in schools (Isoldi & Dolar, 2020; Ng, Kaur, Koo, Mukhtar, & Yim, 2022).

The participation rate was quite high, and in general the students really enjoyed the sessions and the recipes prepared. In these sessions, the changes made to the original recipes did not have a technological objective, but a functional (health-based) one, as the intention was to modify the recipes so that they became healthier (by reducing sugar, fat, and salt) but also health promoters, with more fiber, proteins, and bioactive compounds (e.g., antioxidants). We also intend to promote food sustainability by promoting locally sourced functional foods, including them in recipes, such as: pineapple, tea (Liang, Huang, & Kwok, 1999), regionally produced fruit and vegetables (Dias, 2010), cheese, milk (Rego et al., 2008), and meat (Duarte, 2011; Rosa et al., 2014; Silva, Rego, Simoes, & Rosa, 2010).

The sessions had a positive impact on attitudes toward functional foods, as well as increasing their consumption, as reported by students. As in another study (Oliveira, 2016) students think it is important to introduce topics related to functional foods in the syllabus in the 3rd cycle of basic education, as well as to carry out extracurricular activities related to these. During the sessions, the students (and the teachers who accompanied them) were very enthusiastic and willing to repeat the experience. The integration of cooking sessions and food education sessions with a practical component in the school curriculum are relevant elements for the development of a successful intervention program and justify the continuity of its implementation (Isoldi & Dolar, 2020; Lukas & Cunningham-Sabo, 2011; Ng, Kaur, Koo, Mukhtar, & Yim, 2022; Vio Del Río, Olaya, Fuentes-Garcia, & Lera, 2020).

The increase in cooking skills on the part of students is quite positive as it is associated with adherence to a healthier diet (McGowan et al., 2015; Muzaffar, Metcalfe, & Fiese, 2018; Ng, Kaur, Koo, Mukhtar, & Yim, 2022; Overcash et al., 2018; Zahr & Sibeko, 2017). In addition, having seen an increase in the improvement of the ability to make soup, it could be an incentive to consume it, which is important since soup is a good way to consume vegetables whose regular consumption is associated with the reduction of certain chronic diseases (Cavallo, Horino, & McCarthy, 2016; Wang, Fang, Gao, Zhang, & Xie, 2016) and body weight control (Pem & Jeewon, 2015).

It is also important to discuss some limitations of the study, such as the small number of participants and the short period of time in which the food intervention took place, which may explain the fact that no significant associations were found between the variables under study, such as the reduced impact on increase in cooking skills. It would also be important to include a control group to compare the results. In addition, our study included 8th grade students, so their perception and knowledge of functional foods may have been influenced by their understanding of the questions asked (even if these were adapted to their schooling), so the results should be interpreted with caution.

We suggest the inclusion of this type of interventions in the school context in a structured way and with a longer duration, with the aim of promoting healthy eating habits, as well as the consumption of health-promoting foods (Muzaffar, Metcalfe, & Fiese, 2018; Zahr & Sibeko, 2017). Including parents in cooking sessions can also be an interesting strategy for promoting healthy eating habits. A Brazilian study (Martins, Machado, Louzada, Levy, & Monteiro, 2020) with students and their parents from 9 private schools in São Paulo, reported that the increase in parents’ confidence in their cooking skills was directly associated with a decrease in the consumption of ultra-processed foods (associated with poor nutritional quality, obesity and other chronic non-communicable diseases (Rauber et al., 2018)) by the students.

Conclusion

The food education sessions carried out had a positive impact on the perception of functional foods, as well as on the perceived improvement of their cooking skills. The importance of this type of interventions in a school context is highlighted so that knowledge related to healthy eating and lifestyles is acquired.

Authors contributions statement

LO, FS and MGS, conceptualization and study design; LO, experimental implementation; LO, data analysis; LO, drafting, editing and reviewing; LO, tables; LO, FS and MGS, supervision and final writing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by the Calouste Gulbenkian Foundation, under the contest “Literacy in Health 2014 — Citizens and Health: improving information, improving decision-making” within the scope of the project “Health-promoting foods in a school context - more knowledge, better growth”.