Vital signs: sodium intake among U.S. school-aged children - 2009-2010.

BACKGROUND: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. METHODS: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6­18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009­2010. RESULTS: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school­aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14­18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6­10 years or 11­13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%). IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%­50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75­150 mg per day and about 220­440 mg on days children consume school meals.

School food and nutrition policy, monitoring and evaluation in the USA.

OBJECTIVE: To provide an overview of school food and nutrition monitoring from 1980 to the Healthy Hunger-Free Kids Act of 2010 and data on school food availability in the USA. DESIGN: A review of the history of school food and nutrition policy, monitoring and evaluation efforts in the USA over the past three decades. SETTING: USA. SUBJECTS: School food service, school districts and schools nationwide. RESULTS: The school food environment in the USA is governed by a patchwork of federal, state and local laws and policies. The federal government has primary authority over the school meal programmes and has recently issued updated regulations governing the food and nutrient requirements for meals sold or served through the National School Lunch and School Breakfast Programs. Competitive foods (i.e. foods and beverages sold/served outside the meal programmes) are governed primarily by state and district laws and policies, although new federal regulations are expected to set minimum standards in this area. The USA has a long history of data monitoring and evaluation funded by government and private foundations which has enabled decision makers to monitor progress and opportunities to improve the foods and beverages made available to students in school. CONCLUSIONS: School food-related monitoring and evaluation research has been highly influential in influencing legislation and policy, leading to improvements in the foods and beverages available to children at school as part of planned meals and individual items sold outside the meal programmes. The lessons learned from the US experience provide insights that may be valuable for implementation, monitoring and evaluation of school food programmes in other countries.

WIC Infant and Toddler Feeding Practices Study: protocol design and implementation.

The federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which began in the 1970s, has undergone revisions in the past several years, including revision to contents of the supplemental food "packages" in 2009 based on recommendations provided by an Institute of Medicine (IOM) committee of The National Academies. In 2010, the IOM held a workshop to examine and recommend research priorities for the program. The overall purpose of the current (ie, second) WIC Infant and Toddler Feeding Practices Study (ITFPS-2) is to conduct a nationally representative, longitudinal study of contemporary WIC infant and toddler feeding practices. This study will update earlier studies and collect information on variations in WIC program components. The study will also assess ways in which WIC may address obesity in early childhood and examine changes in feeding practices that may stem from the 2009 food package revisions. The sample is drawn from the universe of WIC sites nationally, excluding only those with an insufficient volume of eligible participants. Eligibility for the study includes the ability to be interviewed in English or Spanish. Approximately 8000 women and infants are being sampled, and ∼ 4000 are expected to participate. Eligible women are invited to participate during their WIC enrollment visit, and informed consent is sought. The design includes a core sample to be followed until the infant reaches age 2 y and a supplemental sample to be used in some cross-sectional analyses to ensure adequate representation of groups that might be underrepresented in the core sample. Participants will complete up to 11 interviews (core sample) or 4 interviews (supplemental sample) each except for the prenatal interview, which includes a quantitative 24-h recall of food intake for the infant. Eighty sites have been sampled across 26 states and 1 territory. Instruments have been developed and pretested in both English and Spanish, and interviewers have been rigorously trained. Recruitment and interviewing began in July 2013. This study will provide the only current large-sample longitudinal feeding data available on a nationally representative sample of infants in low-income families, and results will be available to inform the 2020 Dietary Guidelines for Americans for the 0- to 24-mo age group.