A repeat cross-sectional study examining the equitable impact of nutritional standards for school lunches in England in 2008 on the diets of 4-7y olds across the socio-economic spectrum.

Suzanne Spence,Martin White,Ashley J Adamson,John Ns Matthews

doi:10.1186/s12966-014-0128-6

Abstract

BackgroundThe 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children’s nutrient intake at lunchtime and in total diet by level of deprivation.MethodsWe conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children’s diets.Results368 and 624 children participated in 2003–4 and 2008–9 respectively. At lunchtime, between 2003–4 and 2008–9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008–9 compared with 2003–4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation.ConclusionsBy 2008–9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain. Additional interventions to promote equitable nutrition in children are needed to support legislative measures and maximise their impact.

Highlights

The 2008 nutritional standards for primary school lunch in England improved nutritional content
It is not known if the changes to school lunch impact equitably across the socio-economic spectrum, for example, does improving food provision at school lunch inadvertently increase the difference in children’s mean nutrient intake due to individual food choice? As the standards focus only on school lunch, what is the impact of home-packed lunch on nutrient intake across the socio-economic spectrum? With the recent UK Government announcement that all children aged 4–7 years in England will be entitled to a free school lunch from September 2014 [25], understanding further the impact of school lunch on children’s diets across the socio-economic spectrum is important
The primary aim of this paper is to examine the impact of the 2008 food and nutrient-based standards on socio-economic inequalities in food consumed at lunchtime and in total diet in children aged 4-7years

Summary

Introduction

The 2008 nutritional standards for primary school lunch in England improved nutritional content. Primary schools in England have been required to comply with legislation detailing specific food- and nutrientbased standards for school food since September 2008 [17,18] This was in response to a number of factors; for example, national surveys of school lunch in primary and secondary schools [19,20] and a media broadcast in April 2005 “Jamie’s School Dinners” [21] highlighted the poor nutritional content of school lunch. Improvements were found for children consuming a school lunch in their mean total dietary intake [24] It is not known if the changes to school lunch impact equitably across the socio-economic spectrum, for example, does improving food provision at school lunch inadvertently increase the difference in children’s mean nutrient intake due to individual food choice? It is not known if the changes to school lunch impact equitably across the socio-economic spectrum, for example, does improving food provision at school lunch inadvertently increase the difference in children’s mean nutrient intake due to individual food choice? As the standards focus only on school lunch, what is the impact of home-packed lunch on nutrient intake across the socio-economic spectrum? With the recent UK Government announcement that all children aged 4–7 years in England will be entitled to a free school lunch from September 2014 [25], understanding further the impact of school lunch on children’s diets across the socio-economic spectrum is important

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