USDA Summer Meals Programs: Meeting the Nutritional Needs of Children.

BACKGROUND: Although research shows that children from households with low incomes have diet quality that is better during the school year vs the summer, very little research exists around the nutritional quality of summer meals available to children through the US Department of Agriculture's (USDA) summer meals programs. OBJECTIVE: The objective was to examine the extent to which summer meals contributed to meeting the daily nutritional goals from the 2015-2020 Dietary Guidelines for Americans (DGAs) for 9- to 13-year-olds. The current study also analyzed the types of food offered and the top food sources of energy and nutrients in summer lunches. DESIGN: This cross-sectional study analyzed a nationally representative sample of summer meal sites participating in the Summer Food Service Program (SFSP) or the Seamless Summer Option (SSO). SETTING: Weekly lunch menus were obtained from 731 summer meal sites operating in the summer of 2018 (SFSP sites: n = 578; SSO sites: n = 153). MAIN OUTCOME MEASURES: Outcome measures included the most frequently offered foods in the major food groups. The energy and nutrient content of lunches offered were estimated and compared with the daily nutritional goals provided by the 2015-2020 DGAs for 9- to 13-year-olds. STATISTICAL ANALYSES PERFORMED: Menu data were entered into USDA's SurveyNet and linked to the USDA's Food and Nutrient Database for Dietary Studies 2015-2016. Foods were classified into major and minor food groups from the USDA's School Nutrition and Meal Cost Study. The energy and nutrient values were compared with the daily nutritional goals provided by the DGAs for children ages 9 to 13 years. RESULTS: Summer lunches provided substantial contributions toward the daily goals for energy and nutrients for 9- to 13-year-olds. SSO programs provided significantly more vegetables than SFSP programs (P < 0.05) and contained significantly higher amounts of vitamins A (P < 0.05), C (P < 0.05), and iron (P < 0.05). Sodium amounts were below the daily limit for 9- to 13-year-olds across both program types. CONCLUSIONS: Although SSO lunches offered more vegetables than SFSP lunches, lunches served in both SSO and SFSP contributed substantially toward the daily goals for energy and nutrients.

Duration of WIC Participation and Early Feeding Practices Are Associated With Meeting the Added Sugars Recommendation at Age 3 Years.

OBJECTIVE: To examine whether duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and early feeding practices are associated with the likelihood of meeting the Dietary Guidelines for Americans (DGA) recommendation for added sugars (AS) at age 3 years. METHODS: Using data from the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), logistic regression assessed associations between WIC participation patterns, early feeding practices, and whether 3-year-olds met the AS recommendation. RESULTS: Children introduced to sugar-sweetened beverages (SSBs) in their first year were about half (adjusted odds ratio, 0.65; P < 0.01) as likely to meet the recommendation as those not exposed in their first 2 years. First-year-only WIC participation (adjusted odds ratio, 0.61; P < 0.04) also increased the risk of excessive consumption compared with children who participated in their third year. CONCLUSIONS AND IMPLICATIONS: Duration of WIC participation is inversely associated with young children's AS intakes. Public health efforts to reduce WIC attrition and enhance education efforts focused on delaying sugar-sweetened beverage introduction are supported.

Shifts in Sources of Food but Stable Nutritional Outcomes among Children in the Early Months of the COVID-19 Pandemic.

Early in the COVID-19 pandemic, the U.S. Department of Agriculture (USDA), State governments, and school districts took unprecedented steps to mitigate the pandemic's impact on students' nutrition. To examine the effect of emergency responses on 6-year-old children's nutritional outcomes, this study analyzed longitudinal data from a national study of children's feeding practices, the Special Supplemental Nutrition Program for Women, Infants, and Children-Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2). Findings include no differences in food insecurity prevalence; however, there were shifts in sources of food, with children in the post-COVID-emergency-declaration (post-ED) group consuming more dietary energy from stores and community food programs and less from restaurants and schools than children in the pre-COVID-emergency-declaration (pre-ED) group (p < 0.01 for all comparisons). Examination of within-person mean differences in 2015 Healthy Eating Index scores and nutrient intakes between ages 5 and 6 years revealed few statistically significant differences between the two groups: children in the post-ED group consumed slightly fewer vegetables (p = 0.02) and less sodium (p = 0.01) than their pre-ED peers. Findings suggest emergency efforts to maintain children's nutrition were largely successful in the early months of the pandemic. Research is needed to understand the mechanisms by which emergency efforts contributed to these findings.

Impact of Food Insecurity Nutrition Incentives on Household Fruit and Vegetable Expenditures.

OBJECTIVE: Evaluate the impact of the Food Insecurity Nutrition Incentive (FINI) grant program on self-reported fruit and vegetable (FV) expenditures. DESIGN: Pre-post quasi-experimental study design. SETTING: Farmers markets and grocery stores in states with FINI projects. PARTICIPANTS: A total of 2,471 Supplemental Nutrition Assistance Program (SNAP) households in 4 intervention groups who lived near a FINI retailer (farmers market or grocery store) and 4 matched comparison groups who did not live near a FINI retailer. MAIN OUTCOME MEASURES: Awareness and use of point-of-sale incentives and changes in self-reported monthly household FV expenditures. ANALYSIS: Ordinary least squares intent-to-treat regression model using lagged dependent variable model framework. RESULTS: Awareness of FINI was higher among households who were near a FINI retailer and had shopped there before FINI than those who lived near a FINI retailer but had not shopped there before FINI; the number of information sources from which SNAP participants heard about FINI was positively associated with incentive receipt (P < 0.05). Among those who received incentives, the average amount of incentives received at the last shopping trip ranged from $15 to $23. The FINI program had a positive impact on the average monthly FV expenditures for those in the farmers market shopper, grocery store shopper, and grocery store general intervention groups-increases ranged from $9 to $15 (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Point-of-sale incentives were associated with an increase in FV expenditures among SNAP households. Further research is needed to examine (1) effective messaging strategies to increase incentive awareness and (2) the long-term impact of incentives on FV expenditures.

Comparison of recruitment and retention among demographic subgroups in a large diverse population study of diet.

OBJECTIVE: We examined the feasibility of conducting a longitudinal study of diet among diverse populations by comparing rates of response throughout recruitment and retention phases by demographic and other characteristics. METHODS: Using quota sampling, participants were recruited from 3 geographically and demographically diverse integrated health systems in the United States. Overall, 12,860 adults, ages 20-70, were invited to participate via mail. Participation first required accessing the study's website and later meeting eligibility criteria via telephone interview. Enrollees were asked to provide two 24-hour dietary recalls, either interviewer-administered or self-administered on the web, over 6 weeks. Stepped monetary incentives were provided. RESULTS: Rates for accessing the study website ranged from 6% to 23% (9% overall) across sites. Site differences may reflect differences in recruitment strategy or target samples. Of those accessing the website, enrollment was high (≥ 87%). Of the 1185 enrollees, 42% were non-Hispanic white, 34% were non-Hispanic black, and 24% were Hispanic. Men and minorities had lower enrollment rates than women and non-Hispanic whites, partially due to less successful telephone contact for eligibility screening. Once enrolled, 90% provided 1 recall and 80% provided both. Women had higher retention rates than men, as did older compared to younger participants. Retention rates were similar across race/ethnicity groups. CONCLUSIONS: While study recruitment remains challenging, once recruited most participants, regardless of race/ethnicity, completed two 24-hour dietary recalls, both interviewer-administered and self-administered on the web. This study demonstrates the feasibility of collecting multiple 24-hour recalls including less expensive automated self-administered recalls among diverse populations.

Comparison of Interviewer-Administered and Automated Self-Administered 24-Hour Dietary Recalls in 3 Diverse Integrated Health Systems.

Twenty-four-hour dietary recalls provide high-quality intake data but have been prohibitively expensive for large epidemiologic studies. This study's goal was to assess whether the web-based Automated Self-Administered 24-Hour Recall (ASA24) performs similarly enough to the standard interviewer-administered, Automated Multiple-Pass Method (AMPM) 24-hour dietary recall to be considered a viable alternative. In 2010-2011, 1,081 adults from 3 integrated health systems in Detroit, Michigan; Marshfield, Wisconsin; and Kaiser-Permanente Northern California participated in a field trial. A quota design ensured a diverse sample by sex, age, and race/ethnicity. Each participant was asked to complete 2 recalls and was randomly assigned to 1 of 4 protocols differing by type of recall and administration order. For energy, the mean intakes were 2,425 versus 2,374 kcal for men and 1,876 versus 1,906 kcal for women by AMPM and ASA24, respectively. Of 20 nutrients/food groups analyzed and controlling for false discovery rate, 87% were judged equivalent at the 20% bound. ASA24 was preferred over AMPM by 70% of the respondents. Attrition was lower in the ASA24/AMPM study group than in the AMPM/ASA24 group, and it was lower in the ASA24/ASA24 group than in the AMPM/AMPM group. ASA24 offers the potential to collect high-quality dietary intake information at low cost with less attrition.

Development of a field-friendly automated dietary assessment tool and nutrient database for India.

Studies of diet and disease risk in India and among other Asian-Indian populations are hindered by the need for a comprehensive dietary assessment tool to capture data on the wide variety of food and nutrient intakes across different regions and ethnic groups. The nutritional component of the India Health Study, a multicentre pilot cohort study, included 3908 men and women, aged 35-69 years, residing in three regions of India (New Delhi in the north, Mumbai in the west and Trivandrum in the south). We developed a computer-based, interviewer-administered dietary assessment software known as the 'NINA-DISH (New Interactive Nutrition Assistant - Diet in India Study of Health)', which consisted of four sections: (1) a diet history questionnaire with defined questions on frequency and portion size; (2) an open-ended section for each mealtime; (3) a food-preparer questionnaire; (4) a 24 h dietary recall. Using the preferred meal-based approach, frequency of intake and portion size were recorded and linked to a nutrient database that we developed and modified from a set of existing international databases containing data on Indian foods and recipes. The NINA-DISH software was designed to be easily adaptable and was well accepted by the interviewers and participants in the field. A predominant three-meal eating pattern emerged; however, patterns in the number of foods reported and the primary contributors to macro- and micronutrient intakes differed by region and demographic factors. The newly developed NINA-DISH software provides a much-needed tool for measuring diet and nutrient profiles across the diverse populations of India with the potential for application in other South Asian populations living throughout the world.