Using digital imagery to quantify students' added sugar intake at lunch in Title I schools with universal free meals.

Abstract

School meals are a major source of dietary intake for low-income students at high obesity risk. Associations between added sugar and obesity are well known, and the National School Lunch Program prohibits added sugar in fruit and juice; yet, no added sugar limits exist for other meal components. This study measured students' added sugar selection and consumption in school lunches and compared % of daily calories consumed from added sugar to the Dietary Guidelines for Americans (DGA) recommendations. In October 2016, this cross-sectional study was conducted in six Virginia Title I elementary schools (>90% racial/ethnic minorities; 100% free meals). Digital imagery plate waste methods assessed lunch consumption in N=1155, 1st-5th graders. Added sugar (g, %kcal) in foods and beverages selected and consumed were quantified, and kcal of added sugar consumed was compared to DGA recommendations. Students consumed an average 6.6g of added sugar from foods (grade differences; q=0.0012), and 3.6g of added sugar from beverages. Added sugar comprised ~10% of school lunch calories consumed from foods and ~35% of school lunch calories consumed from beverages. Added sugar in the total school lunch meal comprised ~2.5% of student's recommended daily calorie needs; thus, ~7.5% of daily calories from added sugar remained before students would have exceeded the DGA. Total added sugar consumption was within daily DGA recommendations. Findings contribute to previous reports that school-provided lunches are low in added sugar. Future research should examine added sugar consumed in school breakfast and lunch separately and combined.