Did school food and nutrient-based standards in England impact on 11-12Y olds nutrient intake at lunchtime and in total diet? Repeat cross-sectional study.

INTRODUCTION: In September 2009, middle and secondary schools in England were required to comply with food and nutrient-based standards for school food. We examined the impact of this policy change on children's lunchtime and total dietary intake. METHODS: We undertook repeat cross-sectional surveys in six Northumberland middle schools in 1999-2000 and 2009-10. Dietary data were collected from 11-12 y olds (n = 298 in 1999-2000; n = 215 in 2009-10). Children completed two consecutive 3-day food diaries, each followed by an interview. Linear mixed effect models examined the effect of year, lunch type and level of socio-economic deprivation on children's mean total dietary intake. RESULTS: We found both before and after the introduction of the food and nutrient-based standards children consuming a school lunch, had a lower per cent energy from saturated fat (-0.5%; p = 0.02), and a lower intake of sodium (-143 mg; p = 0.02), and calcium (-81 mg; p = 0.001) in their total diet, compared with children consuming a home-packed lunch. We found no evidence that lunch type was associated with mean energy, or absolute amounts of NSP, vitamin C and iron intake. There was marginal evidence of an association between lunch type and per cent energy NMES (p = 0.06). In 1999-2000, children consuming a school lunch had a higher per cent energy from fat in their total diet compared with children consuming a home-packed lunch (2.8%), whereas by 2009-10, they had slightly less (-0.2%) (year by lunch type interaction p<0.001; change in mean differences -3%). CONCLUSIONS: We found limited evidence of an impact of the school food and nutrient-based standards on total diet among 11-12 year olds. Such policies may need to be supported by additional measures, including guidance on individual food choice, and the development of wider supportive environments in school and beyond the school gates.

The impact of food and nutrient-based standards on primary school children's lunch and total dietary intake: a natural experimental evaluation of government policy in England.

In 2005, the nutritional content of children's school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children's total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4-7 years (n = 385 in 2003-4; n = 632 in 2008-9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children's mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change -128 mg, 95% CI: -183 to -73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (-1.8%, -2.8 to -0.9) and saturated fat (-1.0%; -1.6 to -0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children's total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children's diet.