School Lunch Consumption is Associated with Higher Intakes of Total Fat, Added Sugars, and Sodium in US Children

Abstract

More than 20 million children are served school lunch each day in the United States. It is important to examine how school lunch program participation influences diet quality and markers for chronic disease in children. The objective of this study was to describe diet quality, including dietary energy density and food group intake, of children who participate in the national school lunch program, and evaluate diet quality in children who consume school lunch vs. those who do not in a nationally representative sample of US children. The present study used a nationally representative sample of 6,735 US school‐aged children who participated in the 2009–2012 National Health and Nutrition Examination Surveys (NHANES). Data regarding school lunch participation was provided collected in the NHANES. Children were categorized into school lunch consumers vs. non‐consumers, and also categorized by number of days school lunch is consumed each week. Diet quality was determined using HEI component scores as well as total intake of USDA‐identified food groups (fruits, vegetables, solid fats, etc.). Dietary ED (kcal/gram) was calculated using multiple methods. All data were analyzed using appropriate survey weights and procedures in SAS 9.3. Our results indicate that daily school lunch participation is associated with higher total fat intake and higher added sugar intake after controlling for sex, race, physical activity, socioeconomic status. Children who eat school lunch 5 days/week consume an average of 74.0g of fat, compared to non‐consumers, consuming 68.6 ± 1.1g, p=0.02. This association was seen even in students who infrequently consume school lunch, with children consuming school lunch reporting an average of 65.8 ± 2.1g, p=0.05. Similarly, children who consume school lunch eat school lunch have significantly higher sugar intake than those children who do not (127.5±1.5g vs. 111.8±3.2g respectively; p=0.0003). Additionally, children defined as school lunch eaters displayed significantly higher sodium intake than children who do not each school lunch (3216.2±43.8g vs. 2921.6±96.1g; p=0.0073). Despite these nutrient intake differences, no difference in energy density was observed between consumers and non‐consumers. Since the National School Lunch Program services a substantial proportion of children in the US, the composition of school lunches served in the U.S. should be assessed in terms of additional total fat, sodium, and sugar contribution to daily intake of school‐aged children.