Nutrient composition of children's lunches: The association between the school food environment, dietary intake and weight status of elementary school children

There is increased interest in the role of schools in improving children's eating habits and reducing childhood obesity through the implementation of healthy eating policies. In this study, I assessed the nutritional quality of lunchtime food consumption among Grade 5 and 6 English speaking children on Prince Edward Island, and the level of school adherence to the policy (defined as the proportion of foods offered at lunch which were prohibited by the policy expressed as tertiles). Differences in nutritional quality according to level of school nutrition policy (SNP) adherence were also assessed.;The survey of principals indicated that elementary schools are making some progress in adhering to the policy, with some components being easier to implement than others. Most principals reported that they were using healthy foods or non-food items for fundraising purposes but fewer indicated that they were involving students in planning foods offered at school. Objective assessments of foods offered at school indicated that 74% of all foods and beverages served at lunch were considered "allowed" by the PEI SNP indicating that principal's perceptions were in good accord with the actual pattern. However, 68.3% of schools still offered at least one prohibited food. There was support for the study hypothesis that students attending schools with lower levels of adherence to the SNP will report higher fat intakes at lunch. However, the hypothesis that students attending schools with lower levels of adherence to the SNP will report higher sugar and sodium intakes was not supported.;Children attending schools with closer adherence to the SNP were more likely to consume fat intakes within the recommended range compared to those from schools who adhered to the SNP less closely (p<0.002). Two thirds of the food consumed by the students came from home sources, so home sources must be taken into account when assessing school nutrition programs. The overall nutritional quality of lunches was poor, regardless of food source.;This is the first study in Canada, and one of the first worldwide, to evaluate the dietary quality of lunch-time foods consumed by elementary students which considers the source of the food (home versus school) and the level of adherence to a SNP. Comparing the dietary quality of children's lunch's items purchased from school versus items brought from home can help us understand the role of schools in enabling children to consume school lunches which are high in nutrient quality.;A descriptive survey was used to assess principal's perceived adherence to key SNP components and food availability. Adherence to the SNP food list was assessed objectively by comparing specific foods offered in the school lunch programs, vending machines, and canteens to those allowed by the SNP. Students (n=1966) completed a lunchtime food record during an in-class survey. Nutrient intakes were generated using the Canadian Nutrient File. Dietary adequacy was assessed by comparing micronutrient intakes with one third of the EAR; macronutrient intakes were compared to the Acceptable Macronutrient Distribution Ranges. Descriptive statistics (medians and percentiles) for calories and all nutrients assessed were generated for each child according to sex and grade. Chi-square tests of association were used to assess the association between the level of adherence of the SNP and the proportion of children meeting recommended nutrient intakes. The Wilcoxon Rank Sum Test was used to assess differences in nutrient intakes according to grade, sex, source and day of recording.