Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013-2014?

Tzuan A Chen,Lorraine R Reitzel,Jayna M Dave,Ezemenari M Obasi

doi:10.3390/nu13103574

Abstract

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)–2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.

Highlights

Diet plays an important part in health [1,2]
This study examined the association of nutrition assistance program participation with diet quality (as assessed by the Healthy Eating Index (HEI– 2015)) among United States (US) children ages 5–18, using the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) data
These findings are partially consistent with previous research in a low-income sample of children focusing on single nutrition assistance program participation, where significant differences by Supplemental Nutrition Assistance Program (SNAP) participation were not found in total energy, HEI–2005 and macronutrients for children aged 4 to 19 [27] or in adults [26]

Summary

Introduction

Poor diet quality (e.g., high fats, added sugars, and low fiber) is a leading cause for chronic diseases like type 2 diabetes, cardiovascular disease, and some cancers such as breast cancer and colorectal cancer [3,4,5]. Poor diet quality ranks among the top risk factors for chronic disease and mortality in the United States (US) [6]. Evidence showed that poor diet quality contributed to elevated disease risk among children such as hormonerelated cancers and insulin resistance [8,9], and worse school performance [10]. Children having poor diet quality are more susceptible to adverse health outcomes throughout life, as dietary behaviors developed in early life often carry into adulthood [9,11,12]

Methods

Results

Discussion

Conclusion