Associations among Food Security, School Meal Participation, and Students’ Diet Quality in the First School Nutrition and Meal Cost Study

The Healthy, Hunger-Free Kids Act of 2010 updated the nutrition standards in the National School Lunch and School Breakfast Programs (NSLP and SBP) and expanded universal free meals’ availability in low-income schools. Past studies have shown that school meals are an important resource for children in food-insecure households. This analysis used data from the School Nutrition and Meal Cost Study to classify students as food insecure (FI), marginally secure (MS), or food secure (FS). Diet quality from school and nonschool foods that students consumed was assessed using Healthy Eating Index (HEI)-2010 scores. Chi-squared and two-tailed t-tests were conducted to compare school meal participation, students’ energy intakes, and diet quality across food security groups. FI and MS students were significantly more likely to participate in NSLP than FS students (79%, 71%, and 49%, respectively). SBP participation followed a similar pattern but was lower (38% FI, 33% MS, and 16% FS). Compared to FS students, FI and MS students more likely attended schools offering SBP, universal free meals, or afterschool snacks and suppers. School meals contributed significantly more energy to FI and MS students’ diets than to FS students (22%, 20%, and 13%, respectively). All groups’ dietary intakes from school foods were of higher quality than non-school foods. These findings highlight the role of school meals in meeting the energy and diet quality needs of FI and MS students.

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Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013–2014?

Nutrients ◽

10.3390/nu13103574 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3574

Author(s):

Tzuan A. Chen ◽

Lorraine R. Reitzel ◽

Ezemenari M. Obasi ◽

Jayna M. Dave

Keyword(s):

Diet Quality ◽

Low Income ◽

Safety Net ◽

Healthy Eating Index ◽

School Meals ◽

Assistance Program ◽

School Meal ◽

Nutrition Assistance ◽

Low Income Households

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)–2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.

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Differences in Diet Quality between School Lunch Participants and Nonparticipants in the United States by Income and Race

Nutrients ◽

10.3390/nu12123891 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3891

Author(s):

Elizabeth C. Gearan ◽

Kelley Monzella ◽

Leah Jennings ◽

Mary Kay Fox

Keyword(s):

United States ◽

Diet Quality ◽

School Lunch ◽

The United States ◽

School Nutrition ◽

Healthy Eating Index ◽

Lower Income ◽

Cost Study ◽

Hispanic White

Prior research has shown that participation in the United States’ National School Lunch Program (NSLP) is associated with consuming higher-quality lunches and diets overall, but little is known about differences by income and race/ethnicity. This analysis used 24 h dietary recall data from the School Nutrition and Meal Cost Study to examine how NSLP participation affects the diet quality of students in different income and racial/ethnic subgroups. Diet quality at lunch and over 24 h was assessed using the Healthy Eating Index (HEI)-2010, where higher scores indicate higher-quality intakes. HEI-2010 scores for NSLP participants and nonparticipants in each subgroup were estimated, and two-tailed t-tests were conducted to determine whether participant–nonparticipant differences in scores within each subgroup were statistically significant. NSLP participants’ lunches received significantly higher total HEI-2010 scores than those of nonparticipants for lower-income, higher-income, non-Hispanic White, and non-Hispanic Black students, suggesting that participating in the NSLP helps most students consume healthier lunches. These significantly higher total scores for participants’ lunch intakes persisted over 24 h for higher-income students and non-Hispanic White students but not for lower-income students or students of other races/ethnicities. For NSLP participants in all subgroups, the nutritional quality of their 24 h intakes was much lower than at lunch, suggesting that the positive influence of the NSLP on their overall diet quality was negatively influenced by foods consumed the rest of the day (outside of lunch).

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Added Sugars in School Meals and the Diets of School-Age Children

Nutrients ◽

10.3390/nu13020471 ◽

2021 ◽

Vol 13 (2) ◽

pp. 471

Author(s):

Mary Kay Fox ◽

Elizabeth C. Gearan ◽

Colin Schwartz

Keyword(s):

Skim Milk ◽

School Nutrition ◽

Dietary Guidelines ◽

School Age Children ◽

Dietary Intakes ◽

School Meals ◽

Cost Study ◽

Added Sugars ◽

School Year ◽

Dietary Guidelines For Americans

Research is limited on added sugars in school meals and children’s dietary intakes after the 2015–2020 Dietary Guidelines for Americans (DGA) recommended that added sugars be limited to less than 10% of total calories. This analysis uses data from the School Nutrition and Meal Cost Study (SNMCS) to examine levels of added sugars in: (1) school meals and (2) children’s dietary intakes at breakfast, lunch, and over 24 h on school days. SNMCS data were collected in the 2014–2015 school year after updated nutrition standards for school meals were implemented. Most schools exceeded the DGA limit for added sugars at breakfast (92%), while 69% exceeded the limit at lunch. The leading source of added sugars in school meals (both breakfasts and lunches) was flavored skim milk. More than 62% of children consumed breakfasts that exceeded the DGA limit, and almost half (47%) consumed lunches that exceeded the limit. Leading sources of added sugars in the breakfasts consumed by children were sweetened cold cereals and condiments and toppings; leading sources of added sugars in children’s lunches were flavored skim milk and cake. Over 24 h, 63% of children exceeded the DGA limit. These findings show that school meals and children’s dietary intakes are high in added sugars relative to the DGA limit and provide insights into the types of foods that should be targeted in order to decrease levels of added sugars.

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Skipping Breakfast Is Associated with Diet Quality and the Distribution of Food Intake Throughout the Day: NHANES 2005–20016

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_034 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 534-534

Author(s):

Owen Kelly ◽

Stephanie Fanelli ◽

Sara Thomas ◽

Jessica Krok-Schoen ◽

Satya Jonnalagadda ◽

...

Keyword(s):

Food Intake ◽

Healthy Eating ◽

Diet Quality ◽

Diabetes Management ◽

Population Based ◽

Healthy Eating Index ◽

Dietary Intakes ◽

Nutrient Intakes ◽

Diabetes Status ◽

Skipping Breakfast

Abstract Objectives Distribution of carbohydrate intakes (carb choices) throughout the day are an important aspect to diabetes management and reducing blood glucose spikes. Skipping breakfast represents a behavior of concern, providing an extension of the overnight fast and may result in elevated sugar levels later in the day. Therefore, the purpose of this study was to evaluate dietary intake differences, including carbohydrates, based on consuming breakfast or not, and by diabetes status. Methods Adults over 30 years from NHANES 2005–2016 were classified into nondiabetes (HbA1c <5.7%, n = 14,701), prediabetes (HbA1c 5.7–6.4%, n = 5855) and diabetes (HbA1c (≥6.5%, n = 2881). Dietary intakes were assessed using a multiple pass 24-hour recall to estimate intakes from the foods and beverages reported as consumed on the day prior to the NHANES visit. Breakfast was self-defined by participants. Total population-based means (95% CI) of nutrient intakes, MyPlate equivalents, and Healthy Eating Index 2015 scores from the day of intake were calculated across levels of glycemic control and skipping breakfast status. Results Across all groups, adults who reported breakfast consumption had a significantly better overall diet quality, while total intakes of whole grains and fiber were significantly lower in those who skipped breakfast. Intakes of added sugars were not significantly different between those who skipped versus consumed breakfast. Conclusions The absence of breakfast on the day of intake was related to differential intakes of several nutrients related to healthy eating and glycemic management, resulting in a poorer overall diet quality. Healthcare professionals could evaluate meal skipping patterns and its impact on overall nutrient intakes, and the distribution of food intake throughout the day, in people with diabetes, to help improve disease management. Funding Sources Abbott Nutrition.

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Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program–Education) eligible households across California

Public Health Nutrition ◽

10.1017/s1368980019003197 ◽

2019 ◽

Vol 23 (1) ◽

pp. 3-12 ◽

Cited By ~ 1

Author(s):

Fred Molitor ◽

Celeste Doerr ◽

John Pugliese ◽

Lauren Whetstone

Keyword(s):

Diet Quality ◽

Low Income ◽

Vegetable Intake ◽

Age Groups ◽

Healthy Eating Index ◽

Poverty Level ◽

Cross Sectional ◽

Assistance Program ◽

Dietary Behaviours ◽

Nutrition Assistance

AbstractObjective:To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.Design:Cross-sectional telephone surveys using a validated 24 h dietary assessment.Setting:Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.Participants:Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.Results:Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.Conclusions:The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

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Quality of diet related to food insecurity and food stamps use among older people

Ageing Research ◽

10.4081/ar.2011.e3 ◽

2011 ◽

Vol 2 (1) ◽

pp. 3 ◽

Cited By ~ 3

Author(s):

Maria F Montoya ◽

Andre W Hite ◽

Patricia Rohrbeck ◽

Binky Bawa ◽

Oladayo O Akinwolemiwa ◽

...

Keyword(s):

Food Security ◽

Food Insecurity ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Food Stamps ◽

Older Individuals ◽

Cross Sectional Survey ◽

Food Security Status

We explore the association between quality of diet and food security status among older persons. Cross-sectional survey of large national samples, from the National Health & Nutrition Examination Surveys (1988-1994 & 2001-2002), in the United States. A total of 5,039 and 2,040 men and women aged 60 and older, respectively. The dependent variable was the healthy eating index (HEI; 2000 and 2005) as a measure of diet quality. The independent variable of interest was food security status and was categorized as food secure, food insecurity receiving food stamps and food insecurity not receiving food stamps. In multivariate analyses, food insecure individuals not receiving food stamps had lower total HEI-2000 scores compared to food secure individuals (b=-3.91, SE=1.81, P=0.0310). Factors independently associated with high HEI (2000 or 2005) scores were female gender, being married, highly educated or wealthy, with very good/ excellent perceived health, or without functional limitations. Food secure individuals had better quality of diet than food insecure individuals. Among food insecure individuals, receiving food stamps was not associated with diet quality. Food insecure families with older individuals may need new methods of dissemination of food and nutrition programs – methods that yield positive and promising changes in the health status of this special population group.

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Racial/Ethnic Differences in Diet Quality and Eating Habits Among WIC Pregnant Women: Implications for Policy and Practice

American Journal of Health Promotion ◽

10.1177/0890117119883584 ◽

2019 ◽

Vol 34 (2) ◽

pp. 169-176 ◽

Cited By ~ 2

Author(s):

Alla M. Hill ◽

Danielle L. Nunnery ◽

Alice Ammerman ◽

Jigna M. Dharod

Keyword(s):

African American ◽

Pregnant Women ◽

African American Women ◽

Healthy Eating ◽

Diet Quality ◽

Low Income ◽

Eating Behaviors ◽

Dietary Habits ◽

Healthy Eating Index ◽

American Women

Purpose: One of the major federal food assistance programs, the Special Supplemental Program for Women, Infants, and Children (WIC), serves approximately 1.5 million low-income pregnant women per year; however, limited information is available on their dietary habits. This is critical because low-income women are at higher risk of gaining excess weight during pregnancy. Thus, the study objectives were to (1) determine the overall diet quality of WIC pregnant women and (2) examine diet quality and eating behaviors by race/ethnicity and other sociodemographics. Design: This was a cross-sectional study. Setting: One of the 3 WIC offices in a north-central county in North Carolina, USA. Sample: Pregnant women (n = 198) in the second trimester. Measures: Interviews included sociodemographics, food security, diet, and eating behaviors. Diet quality was assessed by the Healthy Eating Index (HEI) 2010 scores. Analysis: Descriptives, bivariate analysis, and multivariate analysis. Results: Average participant age was 26 years, and the mean HEI-2010 score was 56 of maximum score of 100. Specifically, African American women consumed significantly lower servings of whole grains (β = −1.71; 95% CI: −3.10 to −0.32; P < .05) and dairy (β = −1.42; 95% CI: −2.51 to −0.33; P < .05) compared with non-Hispanic white women. Hispanic women scored higher in daily intake of fruits (β = 0.98; 95% CI: 0.17-1.79; P < .05) and for consuming empty calories in moderation (β = 1.57; 95% CI: 0.06-3.09; P < .05). Frequency of intake of fast foods/outside meals was higher among African American women (57%, P = .025). Conclusion: Efforts are warranted to promote optimal nutrition among WIC pregnant women. Specifically, African American women are highly vulnerable to poor dietary habits during pregnancy. Further investigation of barriers/facilitators for healthy eating is necessary to address nutrition disparities among WIC pregnant women.

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Diet Quality as Measured by the Healthy Eating Index and the Association with Lipid Profile in Low-Income Women in Early Postpartum

Journal of the American Dietetic Association ◽

10.1016/j.jada.2009.10.038 ◽

2010 ◽

Vol 110 (2) ◽

pp. 274-279 ◽

Cited By ~ 32

Author(s):

Bijal S. Shah ◽

Jeanne H. Freeland-Graves ◽

Jodi M. Cahill ◽

Hongxing Lu ◽

Glenn R. Graves

Keyword(s):

Lipid Profile ◽

Healthy Eating ◽

Diet Quality ◽

Low Income ◽

Healthy Eating Index ◽

Early Postpartum ◽

Low Income Women

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Diet quality, assessed by the Healthy Eating Index-2010, and exercise associated factors of obesity: a cross-sectional study

Revista Española de Nutrición Humana y Dietética ◽

10.14306/renhyd.25.2.1109 ◽

2020 ◽

Vol 25 (2) ◽

pp. 189-198

Author(s):

Ismael San Mauro Martin ◽

Elena Garicano Vilar ◽

Paula Mendive Dubourdieu ◽

Victor Paredes Barato ◽

Cristina Garagarza ◽

...

Keyword(s):

Diet Quality ◽

Cross Sectional Study ◽

Healthy Eating Index ◽

Overweight And Obesity ◽

Quality Data ◽

Dietary Intakes ◽

Anthropometric Measures ◽

Cross Sectional ◽

The Mean

Introduction: Certain weight management methods may be associated with unhealthy dietary intakes, skewing toward certain dietary components and lacking others. Management of weight should not ignore the quality of the diet, as both obesity and poor diet are associated with higher risk of chronic disease. Objective: To conduct a diet quality and exercise scan and observe their repercussion on BMI, in adults from Spain, Portugal, Uruguay and Mexico. Material and methods:An observational retrospective cohort study was designed, with 1181 adults aged 18-65 years. HEI-2010 score was used to assess diet quality. Data on type, days a week and hours/day of exercise, and participant’s anthropometric measures were collected.Results: The mean HEI-2010 score was 65.21. There were no statistically significant differences between HEI-2010 score and BMI [p=0.706], BMI and days of exercise per week [p=0.151], BMI and hours/day of exercise [p=0.590] and BMI and being active [>3 days/week] [p=0.106]. On the contrary, overall exercise influenced BMI significantly [p<0.001]. Conclusions: Dietary patterns may help to prevent weight gain and fight overweight and obesity. This study, however, did not observe associations between the quality of the diet nor specifics of exercise with lower BMIs. The quality of the diet of adults in Spain, Portugal, Uruguay and Mexico fell short of recommendations.

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Serum Metabolites Associated with Healthy Diets in African Americans and European Americans

Journal of Nutrition ◽

10.1093/jn/nxaa338 ◽

2020 ◽

Vol 151 (1) ◽

pp. 40-49 ◽

Cited By ~ 1

Author(s):

Hyunju Kim ◽

Emily A Hu ◽

Kari E Wong ◽

Bing Yu ◽

Lyn M Steffen ◽

...

Keyword(s):

African Americans ◽

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index ◽

P Value ◽

Dietary Intakes ◽

Serum Metabolites ◽

European Americans ◽

Healthy Diets ◽

Participant Characteristics

ABSTRACT Background High diet quality is associated with a lower risk of chronic diseases. Metabolomics can be used to identify objective biomarkers of diet quality. Objectives We used metabolomics to identify serum metabolites associated with 4 diet indices and the components within these indices in 2 samples from African Americans and European Americans. Methods We studied cross-sectional associations between known metabolites and Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension Trial (DASH) diet, alternate Mediterranean diet (aMED), and their components using untargeted metabolomics in 2 samples (n1 = 1,806, n2 = 2,056) of the Atherosclerosis Risk in Communities study (aged 45–64 y at baseline). Dietary intakes were assessed using an FFQ. We used multivariable linear regression models to examine associations between diet indices and serum metabolites in each sample, adjusting for participant characteristics. Metabolites significantly associated with diet indices were meta-analyzed across 2 samples. C-statistics were calculated to examine if these candidate biomarkers improved prediction of individuals in the highest compared with lowest quintile of diet scores beyond participant characteristics. Results Seventeen unique metabolites (HEI: n = 6; AHEI: n = 5; DASH: n = 14; aMED: n = 2) were significantly associated with higher diet scores after Bonferroni correction in sample 1 and sample 2. Six of 17 significant metabolites [glycerate, N-methylproline, stachydrine, threonate, pyridoxate, 3-(4-hydroxyphenyl)lactate)] were associated with ≥1 dietary pattern. Candidate biomarkers of HEI, AHEI, and DASH distinguished individuals with highest compared with lowest quintile of diet scores beyond participant characteristics in samples 1 and 2 (P value for difference in C-statistics <0.02 for all 3 diet indices). Candidate biomarkers of aMED did not improve C-statistics beyond participant characteristics (P value = 0.930). Conclusions A considerable overlap of metabolites associated with HEI, AHEI, DASH, and aMED reflects the similar food components and similar metabolic pathways involved in the metabolism of healthy diets in African Americans and European Americans.

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