VCU news

By Brian McNeill

The National School Lunch Program provides free or reduced-price lunches to more than 30 million children each day. But just how nutritious are these meals, which the students — mostly from lower-income families and predominantly racial and ethnic minoritized populations — often rely on for the majority of their dietary intake?

A new study led by Virginia Commonwealth University and Children’s Hospital of Richmond at VCU researchers examined 1,102 lunches chosen and consumed by children at six Title I elementary schools that serve free meals to all students to better understand the nutrient composition of what they chose and what they actually ate.

It found that meals selected by the students met most federal nutrient recommendations for the majority of children. But it also found, based on overall consumption, that fewer children met recommendations for intake of total calories (5%), calcium (8%), iron (11%), vitamin A (18%), vitamin C (16%) and fiber (7%).

“Based on children's lunch consumption, we found suboptimal intake of several nutrients at lunch,” said lead author Elizabeth Adams, Ph.D., a postdoctoral fellow at VCU Massey Cancer Center who is working at Children’s Hospital of Richmond at VCU’s Healthy Lifestyles Center. “This suggests that, although children are provided with the opportunity to consume sufficient amounts of important nutrients, there is a need for evidence-based strategies to promote children's intake of nutrient-rich meal items selected.”

The new research arrives as Congress is considering a reauthorization of child nutrition and school meal standards for the first time since 2010, when the Healthy, Hunger-Free Kids Act, which required schools to provide more fruits, vegetables and whole grains, among other reforms, was signed into law.

The researchers said the study’s findings speak to the need to maintain, if not improve, the current National School Lunch Program nutrient standards in order to continue providing children with access to a healthful diet.

“We hope this research informs the current legislative decisions around the Nutrition Reauthorization Act,” said study co-author Melanie K. Bean, Ph.D., an associate professor of pediatrics and psychiatry at VCU and co-director of the Healthy Lifestyles Center at Children's Hospital of Richmond at VCU, as well as a member of VCU Massey Cancer Center's Cancer Prevention and Control research program. “Congress has an important opportunity to maintain — or better yet, improve — the [National School Lunch Program] nutrient standards that this research, and research from others, supports.”

In March, the Senate Committee on Agriculture, Nutrition and Forestry held a hearing to reauthorize the child nutrition programs, which includes the National School Lunch Program. During the pandemic, the U.S. Department of Agriculture granted school districts waivers for certain nutritional standards to provide flexibility. There are calls among some in Congress to continue allowing school districts to loosen nutrition standards, particularly requirements regarding sodium and whole grains, saying they are too difficult to maintain.

“This study showed that these schools were able to provide meals that meet most nutrient recommendations, which counters the assumptions that current nutrient recommendations are too challenging to meet,” Adams said. “Rather than roll back these meal standards that provide children with healthy meal offerings, our study showed that current nutrient guidelines should (at minimum) be maintained, and ideally improved. For example, we would argue that there should be an added sugar limit in the new standards.”

The researchers said they support the implementation intervention strategies that focus on increasing children’s consumption of healthy food selected as part of the school lunch program. And they also called for support for school districts, particularly for schools with high levels of poverty, to ensure they can offer meals that align with nutrient standards.

The researchers said their research supports three key takeaways for policymakers: prioritize children's nutritional health, make evidence-based decisions to maintain or improve the National School Lunch Program nutrient standards, and invest in strategies that optimize policy impact by providing support to schools for achieving healthy meal standards and promoting children's consumption of healthy nutrients offered.

“Rolling back the current nutrient standards — especially now after the dramatic increases in food insecurity due to COVID-19 — would only be detrimental to children's health and provide them with even fewer opportunities to obtain critical nutrients,” Adams said.

Any changes to the National School Lunch Program would have tremendous public health implications, Bean said.

“We have a real opportunity to advocate for healthy meals in schools, ensure that science-based nutrition standards are set, and support schools in reaching these standards,” she said. “School lunch has been demonstrated to be healthier on average compared to meals brought from home, and children who participate in school lunch — particularly children from lower-income families — have demonstrated health benefits, including projected reductions in obesity.

“Our study demonstrates that we still have work to do to help ensure children are consuming these healthy meals and that we need to continue to build on the successes of the Healthy, Hunger-Free Kids Act to optimize school meals,” she added.

“Rolling back the current nutrient standards — especially now after the dramatic increases in food insecurity due to COVID-19 — would only be detrimental to children's health and provide them with even fewer opportunities to obtain critical nutrients.”

Elizabeth Adams, Ph.D.

The study, “Nutrient Intake During School Lunch in Title I Elementary Schools with Universal Free Meals,” was published in the journal Health Education & Behavior. The paper was a secondary analysis of data collected as part of a study funded by a National Institutes of Health grant awarded to Bean.

The researchers collected the study’s data by using “digital imagery plate waste methods.” At the start of lunch, children's lunch trays were labeled, and a pre-consumption image was taken as students exited the lunch line. At the end of lunch, a post-consumption image was taken of each lunch tray, before any waste was discarded. The pre- and post-consumption images for each child were matched based on the tray labels.

In the lab, trained raters would examine matched images and rate how much of each food and beverage were left on the tray in the post-consumption image. Standardized measurements of the initial serving size for each food and beverage offered were obtained, and the amount wasted for each child was subtracted from this value, allowing the researchers to identify how much of each item was consumed. Nutritional information was obtained for each food and beverage item to identify the nutrients in all foods selected (from the pre-consumption image) and then consumed (the difference between lunch selection and waste).

In addition to Adams and Bean, the study’s authors included Hollie A. Raynor, Ph.D., associate dean and professor in the Department of Nutrition at the College of Education, Health and Human Services at the University of Tennessee; Laura M. Thornton, Ph.D., research professor at University of North Carolina at Chapel Hill; and Suzanne E. Mazzeo, Ph.D., professor in the Department of Psychology in the College of Humanities and Sciences at VCU.