Table 1.
Summary of Studies Published in the Peer-Reviewed Literature Assessing the Nutritional Adequacy of the USDA National School Lunch Program (NSLP) and School Breakfast Program (SBP) Meals and Dietary Intakes and Nutritional Outcomes of NSLP and SBP Participants in Correspondence with Historical Events (Enactments and Nutrition Standard Revisions) of the NSLP and SBP 1.
| Study | Design | Setting | Participants | Purpose | Outcomes Assessed | Findings |
|---|---|---|---|---|---|---|
| Enactment of the National School Lunch Act (1946) and Child Nutrition Act (1966, 1975) | ||||||
| Paige, 1972 | Observational; Prospective | • 4 elementary schools • Baltimore City, MD |
• n = 742 1st, 2nd and 6th graders | • To assess nutritional impact on biomarkers and anthropometrics of NSLP participants compared to non-participants | • Height • Weight • Hematocrit |
• NSLP participants were not nutritionally better off compared to non-participants |
| Hanes, 1984 | Observational; Cross-sectional | • Nationally representative sample (NESNP 5) | • n = 1089 second graders | • Assess differences in caloric and nutrient intakes of NSLP participants and non-participants • Assess whether differences are due to food quality or quantity |
• Dietary intake (24-h dietary recall) | • NSLP participants vs. non-participants consumed greater calories and amounts of all nutrients except vitamin C and iron • SBP participants vs. non-participants consumed more calcium, phosphorus, protein, and magnesium, but less iron, vitamin A, and vitamin B6 |
| Vermersch, 1984 | Observational; Cross-sectional | • Nationally representative sample (NESNP 5) | • n = 6556 | • Assess differences anthropometrics between NSLP and SBP participants and non-participants | • Height • Weight • Triceps skinfold |
• NSLP participants’ weight-for-age and body fat were significantly greater compared to non-participants • Participant in the SBP may move students away from the extremes to normal for weight and fat (triceps skinfold) distributions |
| Wolfe, 1994 2 | Observational; Cross-sectional | • New York State, excluding New York City • Schools randomly chosen |
• n = 1797 2nd and 5th graders | • Determine weight distribution of children in New York State • Determine factors associated with child fatness |
• Height • Weight • Triceps skinfold • Midarm circumference |
• Higher BMI-percentile and arm fat area (midarm circumference) were significantly higher among NSLP participants compared to non-participants |
| Burghardt, 1995 2 | Observational; Cross-sectional | • Nationally representative sample (SNDA 4 I) | • n = 524 schools • n = 3350 students grades 1–12 from 329 schools |
• Summarize key findings of the SNDA 4 I study • Assess dietary intake of NSLP/SBP participants compared to non-participants |
• Nutrient analysis of meals offered • Dietary intake (24-h dietary recall) |
• 1% of schools reached the target of <30% calories from fat for lunch • One of 544 reached the target of <10% of calories from saturated fat for lunch • Average calories from fat in the SBP meals was 14% • Both breakfasts and lunches exceeded sodium target |
| Melnick, 1998 2 | Observational; Cross-sectional | • New York City Schools | • n = 1396 2nd and 5th graders | • Assess the prevalence of overweight and obesity • Assess the relationship between weight status and household characteristics, including participation in NSLP/SBP |
• Height • Weight • Household characteristics |
• No association between free- or reduced-cost school lunch participation and weight status |
| 1994 Revisions to NSLP and SBP Nutritional Standards 9 | ||||||
| Gleason, 2003 | Observational; Cross-sectional | • Nationally representative sample (CSFII 6) | • n = 1021 children 6–18 years old | • Assess the relationship between NSLP participation and dietary intake | • NSLP participation • Dietary intake (24-h recall) |
• NSLP participants consumed significant more calories, total fat, saturated fat, cholesterol, and sodium compared to non-participants • NSLP participants consumed significantly more than non-participants for several vitamins and minerals as well as less added sugar and total carbohydrate |
| Jones, 2003 | Observational; Cross-sectional | • Nationally representative sample (PSID 8) | • n = 722 children aged 5–12 years old | • Assess the relationship between NSLP and SBP participation and weight status while considering food security status | • Household food security • School meal participation • Height • Weight |
• Food insecure girls who participate in NSLP or combined NSLP and SBP have reduced odds of being overweight |
| Hofferth, 2005 | Observational; Cross-sectional | • Nationally representative sample (PSID CDA 8) | • n = 1268 children aged 6–12 years old | • Assess the relationship between NSLP and SBP participation and weight status | • School meal participation • Height • Weight |
• No significant relationships demonstrated between school meals participation and BMI-percentile or weight status |
| Addison, 2006 | Observational; Cross-sectional | • 2 Mississippi school districts—one suburban and one urban | • n/a | • Examine diet quality compared to nutritional standards | • Nutrient analysis of menus | • Calories, fat, protein, and sodium were served in excess of recommended amounts |
| Clark, 2009 | Observational; Cross-sectional | • n = 287 public schools • Nationally representative sample (SNDA 4 III) |
• n = 2314 1st–12th graders | • Summarize meal analysis and dietary analysis results from SNDA 4 III | • Dietary intake (24-h dietary recall) | • More than three-quarters of school-aged children consume excessive amounts of saturated fat and sodium • NSLP and SBP participants consume significantly more calories than non-participants • A significantly greater percent of participants consume excessive amounts of sodium |
| Crepinsek, 2009 | Observational; Cross-sectional | • n = 398 schools (130 school districts) • Nationally representative sample (SNDA 4 III) |
• n/a | • Assess the nutrient content of NSLP and SBP meals | • Nutrient analysis of meals offered and served | • NSLP lunches were high in fat and saturated fat compared to standards • Both NSLP and SBP meals were high in sodium and low in fiber compared to standards |
| Gleason, 2009 | Observational; Cross-sectional | • Nationally representative sample (SNDA 4 III) | • n = 2228 1st–12th graders | • Assess the relationship between school meal participation and weight status | • School meal participation • Height • Weight |
• There was a significant, inverse relationship between SBP participation and BMI z score |
| Baxter, 2010 3 | Observational; Cross-sectional | • 17 schools in South Carolina | • n = 1780; 4th graders | • Investigate a potential relationship between BMI and participation in the NSLP and SBP | • Height • Weight • Observed meal intake |
• No significant relationship between BMI-percentile and participation in NSLP and SBP • Average BMI-percentile was larger for children who ate breakfast in the classroom vs. the cafeteria |
| Paxton-Aiken, 2012 a 3 | Observational; Cross-sectional (compilation of 4 studies) | • 6 to 11 elementary schools • Augusta, Georgia |
• n = 1535 (meal participation data) 4th graders • n = 342 (dietary intake data) 4th graders |
• Assess the relationship between NSLP and SBP participation and weight status • Assess the relationship between BSP and NSLP participation and dietary intake |
• School meal participation (reported by researchers) • Height • Weight • Dietary intake (meal observation) |
• Significant, positive relationship between SBP and NSLP participation and caloric intake was seen |
| Paxton, 2012 b 3 | Observational; Cross-sectional (compilation of 4 studies) | • 13 elementary schools • Augusta, Georgia |
• n = 1496 4th graders | • Assess the relationship between NSLP and SBP participation and weight status | • School meal participation (reported by parents) • Height • Weight |
• Significant, positive relationship between SBP and BMI-percentile was seen • Significant, negative relationship between NSLP participation and BMI-percentile was seen |
| Hanson, 2013 3 | Observational; Cross-sectional | • Nationally Representative Sample (NHANES 7 2003–2008) | • n = 2376 children aged 6–17 years old | • Assess the relationship between SBP and NSLP participation and weekday caloric intake and diet quality | • School meal participation • Dietary intake (24-h dietary recall) • Healthy Eating Index scores |
• Total vegetable and milk component scores were significantly higher for participants • Whole grains, saturated fat, and sodium component scores were significantly lower for participants |
| 2010 Revisions to NSLP and SBP Nutritional Standards 10 | ||||||
| Cohen, 2014 | Observational; Prospective | • Urban district of Massachusetts | • n = 1030 elementary- and middle school-aged children | • Compare food selection, consumption, and waste prior to and after the implementation of new NSLP and SBP meal standards | • Tray plate waste methodologies to determine food selected, consumed, and wasted | • Fruit selection increased and milk selection decreased significantly • Entrée and vegetable consumption increased and milk consumption decreased significantly |
| Ohri, 2014 | Observational; Cross-sectional | • New Jersey • Schools randomly chosen |
• n = 1220 parents of school-going children | • Assess parental perceptions of NSLP lunches • To determine relationships between parents’ perceptions of NSLP lunches and their children’s consumption of NSLP lunches |
• NSLP participation rate • Parental perceptions of the healthiness of NSLP lunches |
• The students’ odds of consuming NSLP lunches was significantly lower if parents’ perceived the meals to be somewhat unhealthy or very unhealthy compared to parents who perceived the meals to be very healthy |
1 Quality of meals and dietary intake and nutritional quality of SFSP participants are not included in this review due to a complete lack of peer-reviewed literature; 2 Dates of data collection for study were prior to 1994 meal requirement changes; 3 Dates of data collection for study were prior to 2010 meal requirement changes; 4 SNDA = School Nutrition Dietary Assessment; 5 NESNP = National Evaluation of School Nutrition Programs; 6 CSFII = Continuing Survey of Food Intakes by Individuals; 7 NHANES = National Health and Nutrition Examination Survey; 8 PSID = Panel Study of Income Dynamics; CDS = Child Development Supplement; 9 1994 Changes: (1) Averaged over the course of a one-week period, provision of lunches meeting: (a) one-third of the Recommended Dietary Allowance (RDA) for calories; (b) one-third of the RDA for key nutrients including protein, calcium, iron, vitamin A, and vitamin C; (c) ≤30% of calories from fat; and (d) ≤10% of calories from saturated fat; (2) Reduction in sodium and cholesterol; however, quantifiable targets were not established; (3) Increase in dietary fiber; however, no quantifiable targets were established; and (4) inclusion of fluid milk, an entrée, and at least one other item to qualify as a meal [23]; 10 2010 Changes: (1) Requirement of fruits to be a separate meal component; (2) Requirement of vegetables to be a separate meal component; (3) Offer vegetables daily at lunch with subgroups (dark green, red/orange, legumes, starchy, other); (4) Limit starchy vegetables; (5) Requirement of grains to be whole grains half of the time and progressing to an all of the time after two years; (6) Serve fat-free (flavored and unflavored) and low-fat (unflavored) milk only; (7) Meet specific calorie ranges for age and grade groups; (8) Reduce sodium incrementally over a 10-year period; (9) Eliminate trans-fat; and (10) Narrow the ranges of age and grade groups [16].