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A repeat cross-sectional study examining the equitable impact of nutritional standards for school lunches in England in 2008 on the diets of 4-7y olds across the socio-economic spectrum.

Spence S, Matthews JN, White M, Adamson AJ - Int J Behav Nutr Phys Act (2014)

Bottom Line: Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008-9 compared with 2003-4.The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation.A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain.

View Article: PubMed Central - PubMed

Affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. suzanne.spence@ncl.ac.uk.

ABSTRACT

Background: The 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children's nutrient intake at lunchtime and in total diet by level of deprivation.

Methods: We conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children's diets.

Results: 368 and 624 children participated in 2003-4 and 2008-9 respectively. At lunchtime, between 2003-4 and 2008-9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008-9 compared with 2003-4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation.

Conclusions: By 2008-9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain. Additional interventions to promote equitable nutrition in children are needed to support legislative measures and maximise their impact.

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Flowchart for number of children consenting, reasons for exclusion and final number included in analysis.
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Fig1: Flowchart for number of children consenting, reasons for exclusion and final number included in analysis.

Mentions: The analyses included 368 children in 2003–4 (63% of those consenting) and 624 (81% of those consenting) in 2008–9; reasons for exclusion are shown in Figure 1. There were similar numbers of boys and girls participating in 2003–4 (male n = 181 (49%); female n = 187 (51%)) and 2008–9 (male n = 317 (51%); female n = 307 (49%)), mean age was 5.8y in 2003–4 and 6.1y in 2008–9. We found no statistically significant difference in the level of deprivation for children included in the analysis in 2003–4 and 2008–9 (mean IMD 27.0 and 26.1 respectively, p = 0.50) (Table 1).Figure 1


A repeat cross-sectional study examining the equitable impact of nutritional standards for school lunches in England in 2008 on the diets of 4-7y olds across the socio-economic spectrum.

Spence S, Matthews JN, White M, Adamson AJ - Int J Behav Nutr Phys Act (2014)

Flowchart for number of children consenting, reasons for exclusion and final number included in analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4228190&req=5

Fig1: Flowchart for number of children consenting, reasons for exclusion and final number included in analysis.
Mentions: The analyses included 368 children in 2003–4 (63% of those consenting) and 624 (81% of those consenting) in 2008–9; reasons for exclusion are shown in Figure 1. There were similar numbers of boys and girls participating in 2003–4 (male n = 181 (49%); female n = 187 (51%)) and 2008–9 (male n = 317 (51%); female n = 307 (49%)), mean age was 5.8y in 2003–4 and 6.1y in 2008–9. We found no statistically significant difference in the level of deprivation for children included in the analysis in 2003–4 and 2008–9 (mean IMD 27.0 and 26.1 respectively, p = 0.50) (Table 1).Figure 1

Bottom Line: Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008-9 compared with 2003-4.The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation.A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain.

View Article: PubMed Central - PubMed

Affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. suzanne.spence@ncl.ac.uk.

ABSTRACT

Background: The 2008 nutritional standards for primary school lunch in England improved nutritional content. The impact on socio-economic inequalities is unknown. We examine the impact of the nutritional standards on children's nutrient intake at lunchtime and in total diet by level of deprivation.

Methods: We conducted cross-sectional studies in 12 English primary schools before and after legislation. Dietary intake was recorded for 4-7y olds using a validated, prospective four-day food diary. Socio-economic status was estimated using the Index of Multiple Deprivation; three groups of approximately equal sizes were created. Linear, mixed-effect models explored the effect of year, lunch type (school or home-packed lunch), level of deprivation and the interaction(s) between these factors on children's diets.

Results: 368 and 624 children participated in 2003-4 and 2008-9 respectively. At lunchtime, between 2003-4 and 2008-9, the increase in non-starch polysaccharide (NSP) intake was larger in the least compared to the most deprived group (difference in mean change 0.8 mg; 95% CI 0.4, 1.3). There were similar differences in mean changes for iron (0.3 mg; 0.2, 0.4) and zinc (0.3 mg; 0.1, 0.5). In total diet, differential effects were observed for NSP, iron and zinc; we found no evidence these changes were associated with lunch type. Lunch type was associated with changes in per cent energy from non-milk-extrinsic sugars (NMES) and vitamin C. Per cent energy from NMES was lower and vitamin C intake higher in school lunches in 2008-9 compared with 2003-4. The corresponding differences in home-packed lunches were not as marked and there were subtle but statistically significant effects of the level of deprivation.

Conclusions: By 2008-9, NMES at lunchtime and in total diet was lower for children consuming a school lunch; this change was equitable across the deprivation groups. Vitamin C intake increased more for children in the most deprived group, narrowing the socio-economic inequality. A range of significant differential effects of the nutritional standards were observed and important socio-economic inequalities in dietary intake remain. Additional interventions to promote equitable nutrition in children are needed to support legislative measures and maximise their impact.

Show MeSH
Related in: MedlinePlus