Nutrient Intakes and Diet Quality of Children Participating in the U.S. School Meals Program

Objectives: We examined nutrient intakes and diet quality of U.S. children who consume school meals (SM), and the contributions of SM to whole grain (WG) intake, and of ready-to-eat cereal (RTEC) plus milk eaten during SM, to nutrient intakes. Methods: Analyses were based on 24h diet recalls from participants aged 5-18yr in NHANES 2017-March 2020 (n=3,187). SM eaters (n=729; 22.9% of total) were defined as eating ≥50 kcal at breakfast and/or lunch on weekdays, and reporting "Cafeteria in a K-12 school" when asked "Where did you get (this/most of the ingredients for this) **Foodname**?" Nutrient adequacy was estimated via the NCI method with 2 days of diet recalls. Diet quality was assessed using HEI-2015 scores. Results: Based on Day 1 data, SM eaters had significantly higher intakes of nutrients of public health concern (i.e., fiber, calcium, potassium, vitamin D) and others, yet consumed similar calories, sodium, saturated fat, and added sugars as non-eaters. A lower proportion of SM eaters were below the EAR for calcium, vitamin D, vitamin A and vitamin C, and a higher percentage were above the AI for fiber, compared to non-eaters. However, gaps in adequacy existed for most nutrients/food groups regardless of SM intake (e.g., less than 5% and 10% of all children consumed adequate WG and vitamin D, respectively). Diet quality was significantly higher in SM eaters than non-eaters (HEI-2015 scores: 56.1+1 in SM eaters; 50.5+1.3 in non-eaters; p=0.001). Individual HEI component scores suggested significantly better adherence to the Dietary Guidelines for Americans among SM eaters for WG, fruit, dairy, and added sugars. Top WG sources in SM at breakfast and lunch were RTEC (contributing 48.9% of WG eaten) and pizza (contributing 37.6% of WG), respectively. Among SM eaters who ate RTEC, RTEC plus milk contributed substantially to key under-consumed nutrients and WG (e.g., 45.1% of vitamin D, 26.6% of calcium, 16.6% of potassium, 15.3% of fiber, 34.3% of WG), and accounted for 13% of calories, 9.7% of sodium, 9.2% of saturated fat, and 20.5% of added sugars. Conclusions: These findings suggest that SM are an important way for American children to meet dietary recommendations. However, opportunities for improvement in nutrient/food group intakes remain across all children. Funding Sources: Bell Institute of Health and Nutrition, General Mills, Inc.