4. Discussion
MAY
In this study, and after a 12-month intervention, improvements similar to or higher than 25% in four items of the AMed criteria in the intervention group were observed. In the control group, there was an increase from baseline data in the offerings of dairy desserts without added sugar (40%), with a decrease (40%) in the first course offerings as vegetables and/or legumes. Improvements of ≥40% in several SMAP criteria, as well as in the average of all SMAP criteria, were observed in the intervention group but not in the control group. Additionally, in the intervention group, but not in the control group, improvements in traffic light ratings, nutrients, and allergens were observed for desserts. Between-group differences were observed in energy reduction and allergen-free parameters in the intervention group desserts versus the control desserts. Thus, overall, the intervention showed beneficial effects that improved the quality of the menus.In the intervention group, the main increases for AMed criteria were observed in relation to two items. The first item was “olive oil for dressing, and olive oil or high oleic sunflower for cooking”. A large body of knowledge exists on the advantages of olive oil consumption compared with other types of fats [Concerning SMAP criteria, the item “place on the tables bottles of oil, vinegar, sauces and baskets for exclusive use, or single-dose portions” significantly increased in both groups. This item was one of the mandatory conditions established for the partial reopening of restaurants in Spain in May 2020 after the COVID-19 pandemic lockdown [It is interesting that improvements in traffic light ratings, nutrients, and allergens occurred only in desserts in the intervention group, without changes in starters or main dishes. Despite having a small sample size, we were able to detect differences between groups for dessert energy regarding traffic light and allergen-free parameters. Regarding the traffic light ratings, there was an increase in green, a moderate decrease in orange, and a decrease in red for both energy and carbohydrates in the intervention group. Concerning sugar, however, the improvement in the intervention group was related to changes from red to orange, without modifications toward the green. Desserts are among the top five sources of fats and sugar [Strengths and LimitationsThe present study has several strengths. First of all, this study’s design is robust enough to increase the available high-quality information on the effectiveness of this type of intervention. Additionally, focusing on the poor Mediterranean offerings on restaurant menus and difficulties preparing dishes without food allergens or with controlled food allergens is an original approach, considering the training of the restaurant staff and the provision of tools. This helps to increase their autonomy in improving the nutritional quality of the menu and food allergen detection, instead of teaching consumers about their selection when they visit restaurants.One particular limitation of this study must be highlighted to explain the moderate success of the intervention and the timing of the intervention: from September 2019 to March 2021, the COVID-19 pandemic was particularly prevalent in Spain [