Nutritional Quality Of School Meals Research Articles

Trends in the school lunch program: Changes in selection, nutrition & health

There has been significant national attention to the issue of childhood obesity, leading policymakers to reform the National School Lunch Program (NSLP) to include stricter nutritional requirements. We use data on school lunch menus to document improvements in the nutritional quality of school meals between 1991 and 2010. We then evaluate how this change in nutritional content maps into obesity outcomes, using panel data on a nationally representative cohort of children, tracking them from kindergarten entry in fall 2010 through the end of fifth grade in spring 2016. We find little evidence that participation in the school lunch program leads to weight gain, as measured by changes in obesity, overweight, and BMI. These results suggest that improvements in the nutritional content of school lunches have been largely successful in reversing the previously negative relationship between school lunches and childhood obesity.

An appraisal of the implementation of the national school feeding programme and its effect on enrolment and attendance in public primary schools in Southeast, Nigeria: perception of heads of schools

IntroductionThe National Home Grown School Feeding Programme (NHGSFP) was re-launched in Nigeria in 2016, eleven years after it was first introduced in the country, with Enugu as one of the beneficiary States. The objectives of the programme are to improve the health of school children and aid in the realization of Universal Basic Education (UBE) goals. This study explored the opinions of heads of public primary schools on the implementation and policy benefits of NHGSFP in Enugu, southeast Nigeria.MethodsThis was a cross-sectional study conducted among 24 headmasters and headmistresses purposively selected from public primary schools in the Enugu metropolis. Qualitative data were collected through the use of a pretested Key Informant Interview (KII) guide, and analyzed using a thematic approach.ResultsAll the participants were aware of the NHGSFP, which involved the provision of one mid-day meal per child per school day to the pupils, and all their schools were part of the programme. Most of the participants complained about the nutritional quality and quantity of the school meals which they felt were poor. None of the schools had a kitchen within the school premises, and all the participants admitted that deworming was not regularly carried out, as part of the programme. Most of the participants believed that the objectives of the feeding programme, including, reduced hunger among learners, increased school enrolment, attendance and enhanced participatory learning, were being met.ConclusionAlthough the NHGSFP was implemented in every school in Enugu metropolis, Enugu State, Nigeria, regular deworming of pupils was not carried out, and there were concerns about certain aspects of the implementation, such as inadequate funding and poor quality of school meals. Thus, there is a need for the introduction of deworming and more allocation of funds to the programme to improve the quantity and nutritional quality of school meals.

Dietary quality of school meals and packed lunches: a national study of primary and secondary schoolchildren in the UK.

School lunches represent a key opportunity to improve diets and health of schoolchildren. No recent nationally representative studies have examined the nutritional differences between school meals and packed lunches in the UK. This study aimed to characterise and compare the nutritional quality of school meals and packed lunches among primary and secondary school-age children. A pooled cross-sectional analysis of the UK's National Diet and Nutrition Survey (2008-2017). United Kingdom. 3001 children (aged 4-16 years) who completed a 3/4-d food diary which recorded meal type (school meal/packed lunch). Multivariable logistic regression models assessed associations of meeting food and nutrient recommendations by meal type. Analyses were stratified by academic key stages (KS). KS-1 (4-7 years) and 2 (8-11 years) children consuming school meals were more likely to meet minimum recommendations for vegetables, protein-rich foods and fibre, and not exceed maximum recommendations for salt, savoury and sweet snacks compared with pupils consuming packed lunches. However, in KS-3 (12-14 years) and 4 (14-16 years), these effects were reduced. As children aged, the median weight of fruits, vegetables, protein-rich foods and dairy products consumed typically decreased for both school meals and packed lunches, and generally an increasing proportion of school meals contained sweet and savoury snacks. These findings suggest school meals are nutritionally superior to packed lunches but are not yet optimal. Quality declined at higher KS. Actions to improve lunches of primary and secondary schoolchildren across the UK are needed, with attention to KS-3 and 4 in secondary schools.

Do Parental Perceptions of the Nutritional Quality of School Meals Reflect the Food Environment in Public Schools?

(1) Background: It is unknown whether parents’ perception of school meals, a determinant of student meal participation, align with the nutritional quality of meals served in schools. This study compares the healthfulness of foods offered in schools with parental perception of school meals at those same schools. (2) Method: Parents were asked to rate the healthfulness of school meals at their child’s school. Data on the types of foods offered were collected from public schools in four cities in New Jersey and matched with parent-reported data. Measures were developed to capture the presence of healthy and unhealthy items in the National School Lunch Program and the presence of a la carte offerings as well as vending machines. Multivariable analysis examined the association between parental perceptions of school meals and the school food measures after adjusting for covariates. (3) Results: Measures of the school food environment and parental perceptions were available for 890 pre-K to 12th grade students. No significant associations were observed between parental perceptions and food environment measures when examined one by one or in a comprehensive model. (4) Conclusions: Parents’ perception of the healthfulness of meals served do not align with the nutritional quality of foods offered at schools.

Parental Perceptions of the Nutritional Quality of School Meals and Student Meal Participation: Before and After the Healthy Hunger-Free Kids Act

To examine (1) parental perceptions of school meals and (2) student meal participation before and after the implementation of the Healthy Hunger-Free Kids Act (HHFKA). Data were collected from telephone surveys of 2 independent cross-sectional panels in New Jersey (2009-2010 and 2016-2017). Households with children aged 7-18 years (pre-HHFKA: n = 1,027; post-HHFKA: n = 324). Parental perception of school meals and parental reports of student participation in school meals. Multivariable logistic regression models were developed to examine outcome variables. For school meal participation, nested models were analyzed first controlling for sociodemographic variables, followed by parental perception, and then the interaction between perception and time. Parental perceptions of school meals did not change significantly after the HHFKA. At both time points, school meal participation rates were significantly higher for children of parents who perceived school meals as healthy compared with children whose parents perceived meals to be unhealthy (pre-HHFKA: 89.9% vs 75.1%, P < 0.001; post-HHFKA: 87.3% vs 64.9%, P = 0.02). Because higher perception of school meal quality is associated with higher participation, it is important for school food programs to inform parents about the improved nutritional quality of school meals.

Updated Nutrition Standards for School Meals Associated With Improved Weight Outcomes for Boys in Elementary School.

In response to the Healthy, Hunger-Free Kids Act of 2010, the US Department Agriculture updated the nutrition standards for school meals to improve nutrition-related health outcomes for children. This study assesses the association between implementation of the updated nutrition standards and child weight. A quasi-experimental design and multivariate regression analysis is used to compare longitudinal changes in BMI z-scores for school lunch participants and nonparticipants across 2 nationally representative third grade cohorts of children-those exposed to the updated standards (N=5480) and those not exposed (N=9240). Boys who ate school lunches after implementation of the updated standards experienced slower BMI z-score growth than did nonparticipants; participants' BMI z-scores increased by 0.10 compared with 0.18 for nonparticipants. We find no relationship between school lunch participation and BMI z-scores for girls. This study provides evidence that the updated nutrition standards for school meals are associated with improved weight outcome for boys, but have no effect for girls, 1 year after implementation. These findings are encouraging and provide support for continued focus on improving the nutritional quality of school meals.

How a Public Health Goal Became a National Law: The Healthy, Hunger-Free Kids Act of 2010.

This case study provides insights into policy strategy and advocacy best practices that resulted in passage of the Healthy, Hunger-Free Kids Act of 2010, a public health law that resulted in improvements to school foods and beverages across the country. Congress reauthorizes child nutrition programs such as the National School Lunch Program and School Breakfast Program every 5 years. The Healthy, Hunger-Free Kids Act of 2010 is the legislation that reauthorized the child nutrition programs through September 30, 2015, and continues in effect today. We conducted stakeholder interviews and reviewed the legislative and regulatory history of the Healthy, Hunger-Free Kids Act of 2010 and advocates’ files. We formed an external advisory committee which helped to develop the interview questions and list of interviewees and reviewed the content of the case study. This case study focuses on the provisions that address the nutritional quality of school meals, snacks, and beverages and covers the period from 2004 to 2016. Overall, the case study demonstrates a number of key lessons to help inform other nutrition and public health policy initiatives, as well as continued implementation and defense of school nutrition. For instance, how advocates used research to develop and advocate for policy change, compromises that were needed to advance the policies, changes in attitudes about school food policy over time, framing and messaging, the role of state and local policy that contributed to national change, and how challenges were resolved between stakeholders.

School Lunch Entrées Before and After Implementation of the Healthy, Hunger-Free Kids Act of 2010

BackgroundThe Healthy, Hunger-Free Kids Act (HHFKA) 2010 updated standards to increase the nutritional quality of school meals. Studies of HHFKA outcomes have focused primarily on fruit and vegetables, nutrient quality of whole meals, and plate waste. ObjectiveTo examine changes in school lunch entrée nutrient quality and student selections after HHFKA implementation. DesignDescriptive, longitudinal study analyzing 1.7 million student-selected lunch entrées in eight entrée categories. Participants/settingThree middle schools and three high schools in an urban school district in Washington State, from January 2011 to January 2014 (16 months before and 15 months after HHFKA implementation). Main outcome measuresNutritional quality of each entrée category was assessed by analyzing mean adequacy ratio, energy density, and energy per serving. Selection was determined by analyzing number of entrées in each category selected by students. Statistical analyses performedComparison of indices of pre- and postimplementation nutritional quality using a combination of Wilcoxon two-sample test with t approximation and a two-sided alternative t test assuming equal variances and t test assuming unequal variances using Satterthwaite approximation. Quantity of entrée categories selected was also determined by Satterthwaite approximation. ResultsAfter implementation, there was significant improvement in mean adequacy ratio and energy per serving overall for all entrées combined. There were significant improvements in both mean adequacy ratio and energy per serving for salads, burritos, and pizza in middle schools and for hot sandwiches and burritos in high schools. For energy density, middle schools also had significant decreases for casseroles and salads, with no significant changes found in high schools. The variety of entrées decreased by 44%, and there were significant changes in the proportions of entrées selected from specific food categories. ConclusionNutritional quality of lunch entrées, variety of entrées available, and student entrée selections changed after implementation of HHFKA policy in one urban school district in Washington State.

Nutritional Quality of School Meals in France: Impact of Guidelines and the Role of Protein Dishes.

In France, school meals must comply with 15 frequency criteria (FC) expressed as nutritional requirements (e.g., “starters containing more than 15% fat served no more than four times out of 20”) in a series of 20 consecutive meals. The objective was to assess, for the first time, the nutritional impact of complying with French school food FC. Based on 40 series of meals actually served in primary schools (“observed series”), several scenarios (1600 series per scenario) of compliance or non-compliance with FC were simulated, and nutritional quality was assessed via the mean adequacy ratio (MAR/2000 kcal). In the observed series, only 9.7 FC on average (range 4–14) were fulfilled. In the simulated series: (i) MAR was positively associated with FC compliance level, with the highest MAR obtained with complete compliance; (ii) MAR decreased when meat or fish-based dishes were replaced by dishes without meat or fish; and (iii) removing the protein dish without replacement led to the lowest MAR. This study demonstrates that French school food guidelines ensure good nutritional quality of food services. It also shows that generalizing the service of meals without meat or fish would deteriorate overall nutritional quality, highlighting the need to define the composition of vegetarian dishes and their frequency of service to children.

Evaluation of Cooking for Kids: Culinary Training Program for Oklahoma School Child Nutrition Professionals on Students’ Consumption of School Meals

Determine if Cooking for Kids culinary training affected availability of freshly prepared foods in school meals, the extent to which marketing strategies were implemented and students’ meal component consumption before and after training. The 2010 Healthy Hunger-Free Kids Act improved the nutritional quality of school meals; but created implementation strategies for schools including lack of kitchen infrastructure, staffs’ time and culinary skills to prepare meals, and concerns that students would not be accepting of new foods. Cooking for Kids, developed under the principles of the Community Readiness Model, utilizes professional chefs to teach essential culinary skills and on-site consultations to address menu planning related practices specific to a school district. A meal component consumption analysis was conducted in spring 2014 (681 matched trays) and fall 2016 (537 matched trays) in three pilot schools. Personal interviews were conducted with the Child Nutrition Director (CND) at each school to evaluate changes in use of convenience foods and marketing strategies from pre- to post-intervention. Schools used less convenience foods for entrees and offered more salad bars. There was no negative impact on entree consumption (P= 0.878), an increase in grain (P= 0.011) and fruit (P= 0.000) meal components and a decrease in vegetable consumption (P= 0.000). If schools focus on preparing food from scratch and incorporate marketing strategies, students’ consumption of school meals may improve. Further use of marketing strategies, especially for vegetables, may be beneficial.

Development of the theory-based Chinese primary school children physical activity and dietary behaviour changes intervention (CHIRPY DRAGON): development of a cluster-randomised controlled trial

BackgroundThe rate of increase in prevalence of childhood obesity in mainland China exceeds the trends observed in other countries. Effective, culturally appropriate prevention interventions are urgently needed to control the epidemic. However, previous programmes lacked rigorous development and evaluation. Using the framework set out by the UK Medical Research Council (MRC), we developed a complex childhood obesity prevention intervention for Chinese primary school children. MethodsSeveral different methodologies were employed and iteratively combined in the development process. The theoretical and modelling phases (2009–12) included a mixed-methods study that integrated focus groups and interviews with key stakeholders (n=99) to explore perceived causes of childhood obesity and perceptions of effective and feasible intervention ideas as well as delivery preferences, and a cross-sectional study (n=497) that identified several modifiable environmental risk factors. This phase resulted in six potential intervention targets that were evidenced in both studies. A further qualitative study (2012–14, n=148) gathered key stakeholders' opinions on the potential interventions with a focus on contextual barriers and facilitators. A systematic review of international and Chinese literature in modifiable risk factors for obesity in Chinese children was also conducted. These investigations led to the development of an initial programme that was then tested for feasibility in three Chinese primary schools in 2015. The feasibility trial justified an evaluation of the programme in a definitive trial and helped to optimise the implementation and acceptability of the programme. Ethical approval was obtained from the Life and Health Sciences Ethical Review Committee at the University of Birmingham (ERN_14-1440) and the Ethical Committee of Guangzhou Centre for Disease Control and Prevention. The feasibility and randomised control trials were registered with ISRCTN, numbers ISRCTN13619480 (feasibility) and ISRCTN11867516 (randomised controlled trial). FindingsThe finalised programme consists of four components: 1) improving health knowledge and behaviours among grandparents/parents and children through interactive learning activities; 2) improving the nutritional quality of school meals through regular supportive evaluation and feedback; 3) increasing the level of physical activity outside campus through family friendly games and challenges; and 4) improving the implementation of the national requirement for “one-hour physical activity on campus each day” through joint monthly goal settings, evaluation, and feedback. InterpretationOur study is the first demonstration of application of the MRC framework to develop and evaluate obesity prevention interventions in a Chinese setting. The rigorous and phased development process resulted in a culturally relevant prevention programme for urban Chinese children. The programme is ready for effectiveness and cost effectiveness evaluations through a definitive trial. We also generated contextual knowledge that could support implementation of similar intervention activities in other settings. FundingUniversity of Birmingham, Zhejiang Yong Ning Pharmaceutical.

Let's Go! School Nutrition Workgroups: Regional Partnerships for Improving School Meals

This report describes a regional approach for improving the nutritional quality of school meals and increasing the selection of healthier foods. Let's Go! is a childhood obesity prevention program that establishes regional workgroups to develop innovative solutions to improve school meal programs. Let's Go! fosters collaborative decision making, specifically addressing the feasibility of proposed strategies, differences in school environments, and level of readiness for change. This approach led to 77 schools achieving the HealthierUS School Challenge and 130 schools implementing Smarter Lunchrooms techniques in school year 2011–2012. Communities nationwide could use a similar approach to improve school meals.

The Role of School Foodservice Personnel in Nutrition Education: Challenges and Opportunities at U.S. Elementary Schools

The food environment at school plays an important role in promoting healthy food choices in students. In our previous study, classroom teachers were concerned about some of the meal options offered at their school cafeteria and wanted a school cafeteria component as part of a successful nutrition education program. In response, our first objective was to evaluate the nutritional quality of school meals at Oregon elementary schools. We learned that unless students ate the recommended amount of fruits and vegetables from the salad bar, school menus did not meet the nutrition standards for fruits (99%) and vegetables (100%). As the second objective, we asked Oregon elementary school foodservice personnel (SFP) in a cross-sectional, anonymous mail survey if and how they should be involved in nutrition education programs. Of the 59 SFP who responded, all perceived that nutrition education in elementary schools is somewhat to very important and 76% perceived that they should be involved in a successful nutrition education program. They were interested in nutrition education training (75%) but noted multiple barriers for incorporating the school cafeteria into nutrition education programs, the primary were cost (66%), time (58%), and potential teaching commitments. SFP wanted to be involved in nutrition education through nutrition posters in the cafeteria (58%) and new recipes and food items (56%). In conclusion, SFP are highly motivated to participate in nutrition education programs through activities in the school cafeteria that do not involve teaching. Renewed focus should be on developing and implementing nutrition education programs that provide SFP with training and new recipes and food items that are nutritious, affordable, easy and quick to prepare, and appealing to students so that nutrition information delivered in the classroom can be reinforced in the school cafeteria.

Design and implementation of a questionnaire to evaluate the dietary quality of school meals

The school canteen provides a substantial proportion of the daily nutritional intake for many children. There are nutritional standards for school meals, however, it is still difficult to assess the dietary quality. To design a questionnaire for assessing the dietary quality of school meals, quickly and easily. A dietary questionnaire (COMES) was designed on the basis of the current recommendations. COMES consist of 15 items related to the food-frequency and to other characteristics of school meals. Then, a longitudinal prospective study was performed in order to analyze, with COMES, 36 school meals of 4 catering companies from Castilla y León during the academic years 2006-2007 to 2010-2011. Differences in dietary quality menus according to the management system of catering companies (in situ vs. transported) were analyzed by using the Mann-Whitney and the Kruskal-Wallis tests. The significance was reached at p <0,05. The frequency intake of meat, dairy and prepared products was higher to the recommended in 97,2%, 94,4% and 27,8% of the analyzed menus, respectively. By contrast, the frequency intake of fish, fruit, legume, and vegetable garnishes were lower to the recommended in 83,3%, 94,4%, 91,7% and 75% of menus, respectively. Nevertheless, recommendations established by our consensus document for school meals are complied for all food groups, except for dairy and fruits. The variety of foods and culinary techniques were appropriate. No significant differences were found in the COMES score according to the management system (p=0,87), although catering system provides higher dietary quality. A new tool to assess quickly and easily the nutritional quality of school meals has been proposed. The assessment of the frequency intake of the most problematic foods for schoolchildren with this scale is much more demanding than the current recommendations. Even so, menus analyzed showed an acceptable quality in terms of variety of foods and culinary techniques, although milk frequency in the menus was excessive at the expense of fresh fruit. On the other hand, the transported system (i.e. catering, both hot and cold-holding) provides menus more consistent with the dietary recommendations.

Parental perception of the nutritional quality of school meals and its association with students’ school lunch participation

This study explores the association between parental perception of the nutritional quality of school meals and whether students eat lunch served at school. We use data from five low-income cities in New Jersey that have high minority populations. Students whose parents perceive the quality of school meals to be healthy have greater odds of eating meals served at school. Recent changes in guidelines for the United States Department of Agriculture’s National School Lunch Program met with resistance from several fronts. Advocates for and implementers of improved school meals may benefit from partnering with parents to increase the acceptance and utilization of improved school offerings.

School Lunches and Lunches Brought from Home: A Comparative Analysis

Considerable effort has been put forth to improve the nutritional quality of school meals by the National School Lunch Program (NSLP). However, a large percentage of children do not obtain their meals from school and instead bring lunch from home. Little research has focused on the content of these lunches. The purpose of the current study was to examine differences between school lunch and lunch brought from home. Children in the 2nd grade from seven schools in a large suburban school district were observed on three separate days. A total of 2107 observations were made, with 38.5% of these being lunches brought from home. Chi-squared analyses evaluated differences in the presence of specific food items between school lunch and lunch brought from home. Compared to children with a school lunch, children with a lunch brought from home were significantly less likely to have fruits (75.9% vs. 45.3%), vegetables (29.1% vs. 13.2%), and dairy (70.0% vs. 41.8%) (p < 0.001). Children with a lunch from home were more likely to have snacks high in sugar and/or fat (17.5% vs. 60.0%) and non 100% fruit juice/fruit drink (0.3% vs. 47.2%) (p < 0.001) than children with a school lunch. The NSLP has been widely criticized; however, conducting a comparison in this manner demonstrates advantages to children obtaining school lunches. Although it was beyond the scope of this study to examine diet quality (e.g., actual intake and nutrient/caloric density), these results provide compelling evidence that lunches brought from home should be an area of emphasis for research and intervention.

Nutritional Quality Assessment of Elementary School Lunches of South Korea and the United States

Nutritional quality of school meals is important to provide a balanced nutritional meal for children in many countries. However, few attempts have been made to examine and compare the nutritional quality of school meals between countries. This article analyzes the nutritional quality of school lunches in elementary schools in South Korea and the United States and compares the nutritional quality and adequacy of the school lunches between the two countries. Daily school lunch reports were collected from South Korea and the United States to evaluate and compare the quality and adequacy of school lunches. Dietary quality was assessed using the nutrition adequacy ratio, mean adequacy ratio, and index of nutritional quality. The calcium, vitamin B2, and vitamin C content of school lunches in South Korea were significantly different between schools. School lunches in South Korea and the United States provided sufficient energy, protein, iron, and vitamin C. The results indicated that both countries can increase the provision of micronutrients. Recognition of insufficient nutrient provision in school lunches can help to improve lunch programs to improve children's health. Enhanced school lunches will place a greater emphasis on fruits and vegetables, which would lead to more nutritionally balanced lunches.

Present status and issues of school nutrition programs in Korea.

School nutrition programs are essential for children's long-term nutrition and health promotion. The last decade has been the most dramatic years in the history of school nutrition programs in Korea. The percentage of schools serving school lunches reached almost 100% in 2003. In 2006, School Meals Act was significantly revised after serial outbreaks of food-borne illness among students having eaten school lunches. The safety and nutritional quality of school meals had remained as the biggest issue until the middle of 2000s, and then eco-friendly and universal free school lunches have become the main issues related to school meal service and are still under debate. Implementation of the Nutrition Teacher System in 2006 was the turning point of school-based nutrition education in Korea. In addition, two new laws, Special Act on Children's Dietary Life Safety Management of 2008 and Dietary Life Education Support Act of 2009, started to make meaningful changes in school nutrition environment and practices. The next decade is expected to be very critical in the development of school nutrition programs in Korea as the new systems and laws are to be settled. Significant effort is needed from both the academia and the field to make the related issues to be debated and answered to progressive direction for the school nutrition programs in Korea.

An Empirical Analysis of and Policy Recommendations to Improve the Nutritional Quality of School Meals

The National School Lunch Program is not meeting its nutritional goals. Data for 330 Minnesota school districts are analyzed to derive recommendations for improving the nutritional quality of school lunches. This study finds, contrary to widely held views, that lunch sales do not decline when healthier meals with less fat, for example, are served and that more nutritious lunches do not necessarily cost more. Healthier meals have higher labor costs, but lower costs for processed foods. Indirect costs, paid by the food service to the school district, negatively affect meal quality by decreasing funds to upgrade kitchens and train staff to prepare more nutritious meals.