Schoolchildren's Consumption of Competitive Foods and Beverages,Excluding à la Carte*

BACKGROUND: Competitive foods/beverages are those in school vending machines, school stores, snack bars, special sales, and items sold à la carte in the school cafeteria that compete with United States Department of Agriculture (USDA) meal program offerings. Grouping à la carte items with less nutritious items allowed in less regulated venues may obfuscate analysis of the school competitive food environment. Excluding à la carte items from competitive foods, the objectives were to: (1) assess competitive food use by gender, ethnicity, eligibility for free or reduced-price meals, and participation in school meals programs, (2) determine differences between grade levels in energy intakes obtained from food sources, (3) determine the nutrient intake derived from competitive foods for students who consumed them, and (4) determine energy-adjusted differences in 24-hour nutrient intakes of protein, calcium, iron, and other selected nutrients between competitive food consumer and nonconsumers. METHODS: Competitive foods/beverages use, excluding à la carte items, was examined using the third School Nutrition Dietary Assessment Study (SNDA III), a nationally representative sample of 2309 schoolchildren in grades 1 to 12. Mean nutrient intakes were adjusted for energy intake and other covariates, and differences between consumers and nonconsumers of competitive items were determined using analysis of variance and sudaan . RESULTS: Excluding à la carte items, 22% of schoolchildren consumed competitive items in a representative school day and use was highest in high school. Consumers of competitive items other than à la carte had significantly higher mean energy, sugar intakes, and lower sodium, dietary fiber, B vitamins, and iron intakes than nonconsumers. CONCLUSIONS: Use of competitive foods/beverages, excluding à la carte, was detrimental to children's diet quality.     

Nutrient intake of children consuming breakfast at school clubs in London

Introduction: Research into the effectiveness of breakfast clubs has most commonly focused on social benefits to the child and school, such as improved attendance at school, punctuality and improved concentration levels in the classroom ( UEA, 2002 ). Limited research has been undertaken to investigate the nutritional value of the breakfast foods on offer, or the nutritional content of foods consumed by the child. The aim of this study was to find out what children eat and drink at school breakfast clubs in London. Method: The sample population consisted of 98 children (39 boys and 59 girls) aged 5–11 years attending four primary schools in London. Data were collected about the food on offer and the pricing of different food items, demographic data about the children attending the school club, qualitative data on food preferences and a weighed food intake on two different occasions for each child. Statistical tests (anova and chi‐squared tests) and nutrient analysis using Comp‐Eat were carried out. Results: The average nutrient content of the breakfast meal consumed was 330 kcal, 12 g protein, 11 g fat and 49 g carbohydrate. Variation was seen between schools. Generally intakes of vitamin C, calcium and sodium were high and intakes of iron were average. anova between schools showed statistically significant results for a number of nutrients – protein, fat, saturated fat, carbohydrate, sugar, calcium and sodium. Boys were consuming statistically significantly more fat, saturated fat and calcium than girls. One in five children did not have a drink at breakfast. Menu options and pricing of food items varied between the schools and it was noted to influence children's food choice and consumption. Mean energy intakes equated to 18% of the estimated average requirement for boys and 20% for girls, with girls consuming more carbohydrate and sugar, and boys consumed more fat and protein. Discussion: The findings suggest that careful planning of menus should be undertaken with cereal‐based options being offered daily and cooked options only occasionally, and that healthier eating messages can be incorporated effectively into school clubs when supported by the whole school approach to healthy eating. Conclusion: Food offered at school breakfast clubs can contribute substantial nutrients to a child's daily intake and therefore a varied menu, and guided food choices, should be developed incorporating healthier nutrient rich options. This work was supported by Brooke Bond working in partnership with the BDA Community Nutrition Group.     

Children's nutritional intake as part of the Eat Well Do Well scheme in Kingston‐upon‐Hull – a pilot study

In April 2004 Hull City Council introduced free healthy school meals for all primary and special schools in an attempt to reduce health inequalities. This pilot study aimed to compare nutritional intake between those children consuming a free healthy school meal and those consuming a packed lunch brought from home. The study compared two schools from different socio‐economic areas and considered the impact of lunch on total daily food and nutrient intakes in these children. Fieldwork was undertaken over five consecutive days in each school. Seven hundred and thirty‐five lunches were weighed and photographed before and after consumption to assess actual food intake vs. wastage. One hundred and forty‐seven children aged 8‐to‐11‐years participated from two primary schools. Five‐day food diaries were completed by a small number of participants (n = 20) receiving school meals (n = 10) and packed lunches (n = 10) from the two schools selected. While the lunches provided at the two schools met the majority of the nutritional guidelines for school meals, children ate only a small amount, often leaving the potatoes and vegetables behind; therefore, their intakes were below recommended levels. Children from both schools who opted for packed lunch consumed significantly more energy, fat, sugar and sodium but with this more micronutrients than children who had a free healthy school meal. Statistical differences (P < 0.01) were found between the two schools, with children from the less affluent school consuming less food from the school meal and therefore obtaining a lower nutrient intake from lunch than children from the more affluent school. Findings from a small number of food diaries suggest that the differences in intakes between those having a school meal and those having a packed lunch were compensated for by other food consumed during the day, such that daily nutrient intakes were not significantly different. This study suggests that many children may not be consuming sufficient amounts of the food provided in schools. Therefore, it cannot be assumed that the provision of school meals that conform to the School Food Trust guidelines will be of nutritional benefit to all children concerned. Bearing this in mind, more needs to be done to provide menus that are both healthy and enjoyable for children, so that they will want to consume the foods provided. Parents also need more advice regarding how they can provide their children with a healthy packed lunch, possibly via the introduction of a government‐led packed lunch policy, particularly in schools from areas of lower socio‐economic status. Although there was only a small sample of food diaries in this study, the findings suggest that socio‐economic demographics may exert more of an influence on the total daily nutrient intake of children than the type of lunch consumed.     

Nutrient Intakes among Children and Adolescents Eating Usual Pizza Products in School Lunch Compared with Pizza Meeting HealthierUS School Challenge Criteria

Pizza is a popular food that can contribute to high intakes of saturated fat and sodium among children and adolescents. The objective of this study was to compare daily nutrient intakes when a pizza product meeting the US Department of Agriculture's criteria for competitive food entrées under the HealthierUS School Challenge (HUSSC) was substituted for usual pizza products consumed during foodservice-prepared school lunch. The study used National Health and Nutrition Examination Survey (2005-2008) dietary recall data from a cross-sectional sample of US children and adolescents (age 5 to 18 years, n=337) who ate pizza during school lunch on 1 day of dietary recall. Daily nutrient intakes based on the consumption of usual pizza products for school lunch (pre-modeled) were compared with intakes modeled by substituting nutrient values from an HUSSC whole-grain pizza product (post-modeled). Paired t tests were used to make the comparison. Post-modeled intakes were lower in daily energy, carbohydrate, total fat, saturated fat, cholesterol, and sodium compared with pre-modeled intakes among children and adolescents (P<0.01). Protein, dietary fiber, vitamin A, and potassium intakes were higher in the post-modeled intake condition compared with the pre-modeled condition (P<0.01). Substituting the healthier pizza product for usual pizza products may significantly improve dietary quality of children and adolescents eating pizza for school lunch, indicating that it could be an effective approach to improve the nutritional quality of school lunch programs.     

Change in Dietary Energy Density after Implementation of the Texas Public School Nutrition Policy

Consumption of energy-dense foods has been associated with rising obesity rates and the metabolic syndrome. Reducing dietary energy density is an important strategy to address obesity, but few studies have examined the effect of nutrition policies on children's energy density. The study's objective was to assess the impact of the Texas Public School Nutrition Policy on children's energy density by using a pre- and post-policy evaluation. Analysis of variance/covariance and nonparametric tests compared energy density after the Texas policy change to intakes at baseline. Two years of lunch food records were collected from middle school students in Southeast Texas at three public middle schools: baseline (2001-2002) and 1 year after implementation of the Texas Policy (2005-2006). Students recorded the amount and source of foods consumed. The Texas Public School Nutrition Policy was designed to promote a healthy school environment by restricting portion sizes of high-fat and high-sugar snacks and sweetened beverages, fat content of foods, and serving of high-fat vegetables like french fries. Energy density (kcal/g): energy density−1 was the energy of foods only (no beverages) divided by the gram weight and has been previously associated with obesity and insulin resistance; energy density−2 included all food and beverages to give a complete assessment of all sources of calories. Following implementation of the Texas policy, students' energy density−1 significantly decreased from 2.80±1.08 kcal/g to 2.17±0.78 kcal/g (P<0.0001). Similarly, energy density−2 significantly decreased from 1.38±0.76 kcal/g to 1.29±0.53 kcal/g (P<0.0001). In conclusion, the Texas Public School Nutrition Policy was associated with desirable reductions in energy density, which suggests improved nutrient intake as a result of student school lunch consumption.     

New Zealand children's dietary intakes during school hours

Aim:  To describe the dietary habits of New Zealand schoolchildren during school hours.
Methods:  The present study was a secondary analysis of New Zealand's national nutrition survey of schoolchildren (2002 National Children's Nutrition Survey). It includes a subset of 2247 children aged 5–14 years, surveyed to recall a school day. A 24-hour dietary recall was collected in the home of the child. Food or beverage consumption during the morning (9:00 a.m.−11:59 a.m.) and at lunch time (12:00 noon−2:00 p.m.) was based on whether energy intake during these times was above zero. Foods consumed and nutrient intakes during these two time periods were ascertained.
Results:  Approximately 80% of children consumed some food or beverage during the morning and over 90% during lunch time. Older children were less likely than younger children to consume foods or beverages during lunch time. Snack foods, fruit and biscuits were the food groups most consumed during the morning, while sandwiches and fruit were the most popular foods during lunch time. Children obtained approximately one-third of their daily nutrient intakes during school hours. Food and nutrient intakes differed by ethnicity both during the morning and at lunch time.
Conclusions:  Children's food consumption at school could be improved—particularly morning snack quality. Encouraging healthier selections sourced from home is vital as well as ensuring that healthy options are available for purchase, and Pacific children need the most encouragement to choose wisely.     

Increased Energy Density of the Home-Delivered Lunch Meal Improves 24-Hour Nutrient Intakes in Older Adults

As food intake declines with aging, older adults develop energy and nutrient inadequacies. It is important to design practical approaches to combat insufficient dietary intakes to decrease risk for acute and chronic diseases, illness, and injury. Manipulating the energy density of meals has improved energy intakes in institutional settings, but the effects on community-residing older adults who are at nutrition risk have not been investigated. The aim of this study was to determine whether enhancing the energy density of food items regularly served in a home-delivered meals program would increase lunch and 24-hour energy and nutrient intakes. In a randomized crossover counterbalanced design, 45 older adult Older American Act Nutrition Program participants received a regular and enhanced version of a lunch meal on alternate weeks. The types of foods, portion sizes (gram weight), and appearance of the lunch meal was held constant. Consumption of the enhanced meal increased average lunch energy intakes by 86% (P<0.001) and 24-hour energy intakes by 453 kcal (from 1,423.1±62.2 to 1,876.2±78.3 kcal, P<0.001). The 24-hour intakes of several key macronutrients and micronutrients also improved. These data suggest that altering the energy density of regularly served menu items is an effective strategy to improve dietary intakes of free-living older adults.     

Soy-enhanced lunch acceptance by preschoolers

OBJECTIVE: To evaluate acceptance of soy-enhanced compared with traditional menus by preschool children. Soy-enhanced foods were substituted on a traditional cycle menu, and the amount eaten, energy, and nutrient values for traditional and soy-enhanced lunches were compared. DESIGN: A traditional three-week cycle menu, using the Child and Adult Care Food Program (CACFP) meal pattern guidelines, was used to develop a comparable soy-enhanced menu. Traditional and soy-enhanced lunches were randomly assigned to respective days. Foods were portioned onto individual plates using standardized measuring utensils. Individual plate waste techniques were used to collect food waste. Subjects/setting Participants were preschool children, three to six years of age and of white and Hispanic origin, attending a part-day Head Start program. Statistical analyses performed Analysis of covariance was used to adjust lunch and food intakes for differences in average amounts of foods served. The Nutrient Data System was used to calculate energy and nutrient content of lunches. Analysis of variance was used to calculate differences in amounts eaten, energy values, and nutrient values of traditional and soy-enhanced lunches and foods. Data analyses were performed with the Statistical Analysis Software (version 8.0, 1999, SAS Institute, Cary, NC). RESULTS: Soy-enhanced foods were successfully substituted for 23 traditional foods included in the cycle menus. Soy-enhanced foods tended to be higher in energy, protein, and iron. Traditional lunches tended to be higher in fat, saturated fat, and vitamin A. Consumption was significantly less for energy, protein, fiber, and iron from foods eaten from traditional compared with soy-enhanced lunch menus. Applications/conclusions Acceptance of soy-enhanced lunches was shown because there were no significant differences in the average amount eaten (grams per meal) between traditional and soy-enhanced lunches. Preschool programs can substitute soy-enhanced for traditional foods, which will add variety to the diet without sacrificing taste, energy, or nutrient value. The fat and energy content of the lunches was higher than recommended, and soy-enhanced foods were not always lower in fat. There is a need for the food industry and foodservice personnel to address the energy and fat content of all foods served in lunches to preschool children because a few extra calories added to the daily intakes can contribute to weight gain.     

Effect of the energy density and volume of high carbohydrate meals on short term satiety in preschool children.

OBJECTIVE: To investigate the effect of energy density and food volume intakes in one meal (lunch-time) on food and energy intakes in the subsequent meal (tea-time). DESIGN: During lunch, two meals with different energy densities (1.26 and 0.69 kcal/g) were offered to preschool children using normal foods and maintaining a similar energy, carbohydrate, and fat intakes. In the subsequent meal a varied type of high acceptability foods were served in higher amounts than those that children usually consume. SETTING: A day care center where the children were fed during lunch-time and tea-time. SUBJECTS: Two hundred and thirty-four normal preschool children, 108 males and 126 females, according to the weight for height index using the NCHS standards. METHODS: Chemical analysis of the meals served using the AOAC methods and determination of food and energy intakes by differential weighing of the foods. RESULTS: The preschool children had a similar energy intake at lunch but a significantly higher food intake when they consumed the meal with the lower energy density (313 vs. 290.7 kcal) (P = 0.001). There were no differences in the food intakes at the subsequent meal times. CONCLUSIONS: The results of this present work demonstrate that under the conditions of the study, there is an inverse relationship between the energy density of the meals consumed at the first meal-time and the energy intakes at the subsequent meal in normal preschool children; and a direct relationship with the short-term satiety. It is possible that differences in satiety reflect, in part, effects from the characteristics of the normal food used in the dietary treatments. These conclusions suggest that future research must be carried out in order to investigate the separate effects of food and the dietary variables commonly used in the studies of food and energy regulations in humans.     

Peer Reviewed: School Lunch Source and Adolescent Dietary Behavior

Introduction

As rates of childhood obesity rise, the nutritional content of lunches eaten at school is more heavily scrutinized. We examined the association between dietary behaviors and the number of days that adolescents bring lunch to school.

Methods

We analyzed cross-sectional data for 2,774 adolescents who responded to the 2005 California Health Interview Survey and reported dietary behaviors for a weekday.

Results

In bivariate analyses, adolescents who typically brought their lunch from home 5 days per week ate fast food on fewer occasions; consumed fewer servings of soda, fried potatoes, and high-sugar foods; and ate more fruit and vegetables compared with adolescents who never brought their lunch to school. In linear regressions controlling for demographics, body mass index, desire to change weight, parent education, and adult presence after school, students who typically brought their lunch to school 5 days per week ate fast food 0.35 fewer times and consumed 0.35 fewer servings of soda, 0.10 fewer servings of fried potatoes, 0.25 fewer servings of high-sugar foods, and 0.95 more servings of fruit and vegetables per day compared with students who never brought their lunch to school.

Conclusion

These findings suggest that adolescents who bring lunch to school from home have more positive dietary behaviors than do adolescents who get their lunches from other sources. Improving the nutritional quality of foods offered from other sources, such as the National School Lunch Program and competitive foods, could help improve adolescent dietary behaviors.     

Validation of the school lunch recall questionnaire to capture school lunch intake of third- to fifth-grade students

Children's dietary intake is a key variable in evaluations of school-based interventions. Current methods for assessing children's intake, such as 24-hour recalls and meal observations, are time- and resource-intensive. As part of a study to evaluate the impact of farm-to-school programs, the school lunch recall was developed from a need for a valid and efficient tool to assess school lunch intake among large samples of children. A self-administered paper-and-pencil questionnaire, the school lunch recall prompts for school lunch items by asking children whether they chose a menu item, how much of it they ate, how much they liked it, and whether they would choose it again. The school lunch recall was validated during summer school in 2008 with 18 third- to fifth-grade students (8 to 11 years old) in a North Carolina elementary school. For 4 consecutive days, trained observers recorded foods and amounts students ate during school lunch. Students completed the school lunch recall immediately after lunch. Thirty-seven total observation school lunch recall sets were analyzed. Comparison of school lunch recalls against observations indicated high accuracy, with means of 6% for omission rate (items observed but unreported), 10% for intrusion rate (items unobserved but reported), and 0.63 servings for total inaccuracy (a measure that combines errors for reporting items and amounts). For amounts, accuracy was high for matches (0.06 and 0.01 servings for absolute and arithmetic differences, respectively) but lower for omissions (0.47 servings) and intrusions (0.54 servings). In this pilot study, the school lunch recall was a valid, efficient tool for assessing school lunch intake for a small sample of third- to fifth-grade students.     

Enhancement of Select Foods at Breakfast and Lunch Increases Energy Intakes of Nursing Home Residents with Low Meal Intakes

Objective

Nursing facilities often provide enhanced or fortified foods as part of a “food-first” approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss. The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal (breakfast, lunch, and supper) calorie and protein intakes in long-term care residents.

Design

A randomized cross-over design was used to compare investigator-weighed food intakes under three menu conditions: control (no meals enhanced); lunch only enhanced; and both breakfast and lunch enhanced. Two breakfast foods (juice and hot cereal) and two lunch foods (soup and potato side dish) were chosen for enhancement.

Subjects/setting

Participants were 33 nursing home residents from a facility in South Florida (average age=87.3 years).

Statistical analysis

Repeated-measures analysis of variance was used to test the effects of the within-subjects factor (control, lunch enhanced, breakfast and lunch enhanced conditions), the between-subjects factor (smaller vs bigger eater), and the interaction on intakes (gram, kilocalories, and protein).

Results

Results revealed that bigger eaters consumed considerably more calories when breakfast foods, but not lunch foods, were enhanced. Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced. Overall daily protein intakes were not substantially increased by food enhancement. These data suggest that for an enhanced food program to be most effective for smaller eaters, who are at greatest risk for undernutrition and weight loss, it should include several enhanced foods at more than one meal.     

The Impact of School Socioeconomic Status on Student Lunch Consumption after Implementation of the Texas Public School Nutrition Policy*

BACKGROUND: This study compares the impact of the Texas Public School Nutrition Policy on lunch consumption of low‐ and middle‐income students in sixth through eighth grades. METHODS: Students in 1 middle socioeconomic status (SES) and 1 low SES school completed lunch food records before (2001/2002) and after (2005/2006) implementation of the Texas policy. Students recorded amount and source of foods/beverages consumed. Two‐way analyses of variance with year and school SES as factors were performed to compare consumption by school SES before and after implementation of the Texas policy. RESULTS: Regardless of year, the low SES group consumed less fat, sweetened beverages, and candy and more vitamin C and calcium than the middle SES group. There were more significant improvements in dietary patterns for the middle SES school students post‐policy, particularly from the National School Lunch Program (NSLP) meal. The middle SES school students reported significantly higher percentages of less healthy items from home post‐policy. CONCLUSIONS: Overall, low SES school students consumed more healthy lunches at school compared with middle SES school students, and the Texas policy improved middle SES school student dietary intakes. Whether the dietary behaviors in school influence dietary intake for the entire day is unknown.     

Appalachian adolescents' eating patterns and nutrient intakes

Meal and snack patterns of 114 male and 111 female adolescents in a southern Appalachian state were examined from 24-hour food records kept on a school day. Breakfast was skipped by 34% of the respondents, and 27% either skipped lunch or ate a snack-type lunch. The evening meal and snacks, each of which contributed about one-third of the daily energy intake, were eaten by 94% and 89%, respectively. Girls' mean intakes of vitamin A, calcium, and iron were low at all eating occasions throughout the day. Boys' mean intakes of iron were low at breakfast, lunch, and snacks; their vitamin A intakes were low at lunch and snacks. Adolescents who prepared their own breakfasts consumed less energy, protein, fat, and niacin at that meal than did adolescents who ate breakfasts prepared by their mothers. However, adolescent-prepared breakfasts were higher in nutrient density for calcium, riboflavin, and thiamin. Evening meals prepared by adolescents were similar in total nutrient content to meals prepared by their mothers but lower in nutrient density for iron and thiamin. Evening meals prepared by adolescents were more likely to include a sandwich and less likely to include a vegetable than were meals prepared by mothers.     

Pacific parents' rationale for purchased school lunches and implications for obesity prevention

Pacific children and adolescents are burdened with higher prevalences of obesity compared to other groups in New Zealand. Previous research shows Pacific young people purchase their lunch food items significantly more than other groups. The aim of this study is to describe school lunch food consumption patterns and the influences on these among low-income Pacific adolescents and their parents. Using mixed-methodology design; a self-completion questionnaire was administered to 4216 students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project. Thirty Pacific households (33 adolescents and 35 parents) were interviewed in the qualitative phase of the study. Results found a greater proportion of Pacific students purchased school food items compared to other ethnic groups. Purchasing school food was related to having higher amounts of daily food money (>=NZD 6-15) and this was associated with increased quantities of soft drink consumption and after-school food purchasing of high-fat, high-sugar snack foods. There were no differences in school food purchasing behaviour by Pacific weight status (n=2485), with both Healthy weight (67.6%) and Obese students (66.9%) sourcing lunch from school canteens or shops outside of school rather than from home. Time-constrained parents confirmed convenience, poverty compensation and valuing students' independence as three reasons for choosing to make money available for students to purchase lunch food items. The social effects of poverty affect the health-promoting behaviours of Pacific communities in New Zealand. Social policies that decrease social inequities should be the intervention priority.     

Nutrient intakes and foods selected by college students: comparisons among subgroups divided by energy intake

Food consumption patterns of college students, divided into subgroups of men (no. = 58), women with mean energy intakes greater than 1,200 kcal (no. = 192), and women consuming less than 1,200 kcal (no. = 53), were studied using 3-day food records. Patterns of nutrient intakes, eating frequency, and types of food eaten differed among subgroups. Women with less than 1,200 kcal had lower intakes of protein, carbohydrate, fat, calcium, iron, thiamin, riboflavin, and niacin; they ate less frequently; and they ate less meat and eggs, legumes, bread, cooked starchy vegetables, milk products, desserts, added fat, and added sugar than did men and women whose mean energy intakes exceeded 1,200 kcal. There were differences between the latter two groups for 10 nutrients and for intakes of fluid milk, meat and eggs, legumes, bread, cooked starchy vegetables, alcoholic beverages, and noncarbonated, sweetened beverages. Diets of men met the RDAs for all nutrients calculated, and diets of women whose intakes exceeded 1,200 kcal met all RDAs except that for iron. Group mean intakes of women with less than 1,200 kcal did not meet the RDAs for calcium, iron, thiamin, riboflavin, and niacin. However, the subgroup with intakes less than 1,200 kcal consumed food of greater nutrient density than did other college students.     

Increasing the portion size of a sandwich increases energy intake

OBJECTIVE: This study investigated the effect on energy intake of increasing the portion size of a food served as a discrete unit. DESIGN: A within-subject design with repeated measures was used. SUBJECTS/SETTING: The sample comprised 75 young adults (37 females and 38 males) from a university community. INTERVENTION: Individuals ate lunch in the lab once a week for 4 weeks. Each week, they were served one of four sizes of a deli-style sandwich (6, 8, 10, or 12 inches), of which they could eat as much as they wanted. MAIN OUTCOME MEASURES: Energy intakes were determined for each meal, as were ratings of hunger and satiety before and after each meal. STATISTICAL ANALYSES PERFORMED: A linear mixed model with repeated measures was used. The influence of subject characteristics was examined using analysis of covariance. RESULTS: The portion size of the sandwich significantly influenced lunch intake for both males and females (P<.0001). The majority of individuals consumed the entire 6-inch sandwich. When served the 12-inch sandwich, compared with the 8-inch sandwich, females consumed 12% more energy (74 kcal) and males consumed 23% more energy (186 kcal). Despite these differences, ratings of hunger and fullness were not significantly different after eating the 12-inch and 8-inch sandwiches. APPLICATIONS/CONCLUSIONS: These results suggest that increasing the portion size of a food served as a discrete unit leads to increased energy intake at a single meal without differentially influencing ratings of hunger and satiety. Dietitians should educate their clients about strategies to moderate the effect on intake of increased portions of high-calorie foods.     

Improvements in middle school student dietary intake after implementation of the Texas Public School Nutrition Policy

Objectives. We assessed the effect of the Texas Public School Nutrition Policy on middle school student lunchtime food consumption.Methods. Three years of lunch food records were collected from middle school students in southeast Texas: baseline (2001–2002), after local district changes (2002–2003), and 1 year after implementation of the Texas Public School Nutrition Policy (2005–2006). Students recorded amount and source of foods and beverages they consumed. Analysis of variance and covariance and nonparametric tests were used to compare intake after the policy change with intake during the 2 previous years.Results. After implementation of the nutrition policy, student lunch consumption of vegetables, milk, and several nutrients increased (protein, fiber, vitamins A and C, calcium, and sodium), and consumption of less desirable items (sweetened beverages, snack chips) decreased, as did percentage of energy from fat. Most of the desired nutrients and foods (vegetables and milk) were obtained from the National School Lunch Program meal. Fewer sweetened beverages, candy, chips, and dessert foods were purchased and consumed, but more of these items were brought from home and purchased from the snack bar.Conclusions. Overall, state school nutrition policies can improve the healthfulness of foods consumed by students at lunch.Public health efforts to reduce the increasing rates of childhood obesity1 have recently focused on school food environments.2 Although regulations exist for National School Lunch Program (NSLP) meals, there are no federal rules for competitive foods sold elsewhere in the school such as in snack bars and vending machines, except for foods of minimal nutritional value (e.g., soda).3 This has become an issue because the school environment influences dietary behavior.4 For example, middle school students with access to snack bar and a la carte foods consumed more sweetened beverages and french fries, and fewer fruit and vegetables compared with elementary school students without snack bars.5^,6 The number of snack vending machines was negatively related to daily fruit consumption among middle school youth.7 In high schools where soft drink machines were turned off during lunch, students purchased fewer soft drinks compared with students in schools where these machines were on during lunch.8 Improving types and portion sizes of foods available in school snack bars and a la carte could reduce the source of kilojoules available for student purchase and possibly improve energy balance.9States, school districts, and individual schools have enacted laws and policies regarding foods and beverages available in school food environments.10 The beverage industry also developed a voluntary beverage vending policy for schools.11 Such changes are controversial, and barriers to improving school food environments exist. These include the revenue generated from vending and snack bar and a la carte sales,12 school staff, student and parent attitudes toward types of foods expected in schools,13 and the concern that limiting access to these foods at school will not improve overall student dietary intake.14 Critics suggest that if these items are not available in schools, students will compensate by increasing consumption of desired foods in out-of-school environments.14Few data exist for the effect of policy changes on actual food consumption by students at school. One recent study documented significant improvements in food consumption by Texas middle school students (more milk, calcium, and vitamin A; fewer sweetened beverages) after a local school district enacted a snack bar food policy change.15 Consumption of chips purchased from the snack bar declined, but consumption of chips from vending machines increased, because the school administration, which was responsible for vending machines, made no changes. These results suggest that all school food sources have to make similar changes to favorably influence consumption.The Texas Public School Nutrition Policy, an unfunded mandate to promote a healthy school environment for Texas students, was implemented statewide in the fall of 2004. The guidelines apply to all school food sources, including vending machines.16 For middle schools, the policy restricts the portion sizes of high-fat and sugar snacks (limits vary by food group), sweetened beverages (≤ 12 oz), and the fat content of all foods served (≤ 28 grams of fat per serving no more than 2 times per week). It also sets limits on the frequency of serving high-fat vegetables such as french fries (3 oz per serving no more than 3 times per week). We report the results of a naturalistic study that assessed the effect of the Texas Public School Nutrition Policy on lunch consumption of middle school students in southeast Texas. Student lunch consumption data for 2 previous years were available for comparison.15     

Dietary Studies of Children: The Bogalusa Heart Study Experience

For more than 20 years the Bogalusa Heart Study has been collecting data on children's dietary intakes in a biracial community. The macronutrient contribution of children's diets is similar to that in diets of adolescents: 13% of energy from protein, 49% from carbohydrate, and 38% from fat. As children get older, mean intakes of vitamins and minerals per 1,000 kcal decrease. Ten-year-old children in 1987-1988 were 3 lb heavier than 10-year-olds in 1973-1974. Yet total energy intakes remained virtually the same from 1973 to 1988. The composition of macronutrients shifted over the 15-year period, with an increase in the percentage of energy from protein and carbohydrate and a decrease in the percentage of energy from total fat, particularly saturated fat. Dietary cholesterol intake also decreased as a result of a decrease in egg consumption. Although the diets of children changed positively from 1973 to 1988, more than 75% of children consumed more total fat, saturated fat, and cholesterol than the recommended amounts. School meals had a major impact on the diets of children. School breakfast and lunch, together, contributed approximately 50% of the day's total intake of energy, protein, cholesterol, carbohydrate, and sodium. About 40% of daily total fat intake came from school breakfast and lunch. The diets of children in the Bogalusa study are similar to those reported in national studies of children. What might be different, however, are the types of foods consumed and their contribution to intakes of specific nutrients. An understanding of the diet and nutrition habits of children is critical to the planning of intervention strategies that will assist us in meeting our dietary goals for Healthy People 2000. J Am Diet Assoc. 1995; 95:1127-1133.