Research Original Research: Brief| Volume 116, ISSUE 11, P1817-1824, November 2016

Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students



      Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans.


      The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source).


      An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year.


      Fourth- and fifth-grade students (N=3,944) completed a diary-assisted 24-hour food recall.

      Main outcome measures

      The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home.

      Statistical analysis

      Analysis of variance, χ2 test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed.


      School lunch eaters had a higher mean±standard deviation overall diet quality score (HEI-2010=49.0±11.3) compared with students who ate a lunch obtained from home (46.1±12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch).


      Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on children’s diet quality.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. US Department of Agriculture. National School Lunch Program: Participation and lunches served. 2016. Accessed January 20, 2016.

      2. US Department of Agriculture. School Breakfast Program participation and meals served. 2016. Accessed January 20, 2016.

        • Leos-Urbel J.
        • Schwartz A.E.
        • Weinstein M.
        • Corcoran S.
        Not just for poor kids: The impact of universal free school breakfast on meal participation and student outcomes.
        Econ Educ Rev. 2013; 36: 88-107
        • Gordon A.R.
        • Cohen R.
        • Crepinsek M.K.
        • Fox M.K.
        • Hall J.
        • Zeidman E.
        The third School Nutrition Dietary Assessment Study: Background and study design.
        J Am Diet Assoc. 2009; 109: S20-S30
      3. US Department of Agriculture. School meals: Healthy Hunger-Free Kids Act. 2014. Accessed April 2, 2015.

      4. US Departments of Agriculture and Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. 2010. Accessed December 19, 2014.

        • Johnston C.A.
        • Moreno J.P.
        • El-Mubasher A.
        • Woehler D.
        School lunches and lunches brought from home: A comparative analysis.
        Child Obes. 2012; 8: 364-368
        • Hur I.
        • Burgess-Champoux T.
        • Reicks M.
        Higher quality intake from school lunch meals compared with bagged lunches.
        ICAN. 2011; 3: 70-75
        • Caruso M.L.
        • Cullen K.W.
        Quality and cost of student lunches brought from home.
        JAMA Pediatr. 2015; 169: 86-90
        • Farris A.R.
        • Misyak S.
        • Duffey K.J.
        • et al.
        Nutritional comparison of packed and school lunches in pre-kindergarten and kindergarten children following the implementation of the 2012-2013 National School Lunch Program standards.
        J Nutr Educ Behav. 2014; 46: 621-626
        • Briefel R.R.
        • Wilson A.
        • Gleason P.M.
        Consumption of low-nutrient, energy-dense foods and beverages at school, home, and other locations among school lunch participants and nonparticipants.
        J Am Diet Assoc. 2009; 109: S79-S90
      5. Cole N, Fox M. Diet quality of American school-age children by school lunch participation status: Data from the National Health and Nutrition Examination Survey, 1999-2004. 2008. Accessed March 21, 2016.

      6. Condon E, Drilea S, Lichtenstein C, Mabli J, Madden E, Niland K. Diet quality of American school children by National School Lunch participation status: Data from the National Health and Nutrition Examination Survey, 2005-2010. 2015. Accessed March 21, 2016.

        • Campbell B.L.
        • Nayga R.M.
        • Park J.L.
        • Silva A.
        Does the National School Lunch Program improve children’s dietary outcomes?.
        Am J Agric Econ. 2011; 93: 1099-1130
        • Bhattacharya J.
        • Currie J.
        • Haider S.J.
        Breakfast of champions? The School Breakfast Program and the nutrition of children and families.
        J Hum Resource. 2006; 41: 445-466
        • Guenther P.M.
        • Casavale K.O.
        • Reedy J.
        • et al.
        Update of the Healthy Eating Index: HEI-2010.
        J Acad Nutr Diet. 2013; 113: 569-580
      7. Keihner A, Rosen N, Wakimoto P, et al. Impact of California Children's Power Play! campaign on fruit and vegetable intake and physical activity among fourth- and fifth-grade students [published online ahead of print November 15, 2015]. Am J Health Promot.

        • McPherson R.S.
        • Hoelscher D.M.
        • Alexander M.
        • Scanlon K.S.
        • Serdula M.K.
        Dietary assessment methods among school-aged children: Validity and reliability.
        Prev Med. 2000; 31: S11-S33
        • Crawford P.B.
        • Gosliner W.
        • Kayman H.
        The ethical basis for promoting nutritional health in public schools in the United States.
        Prev Chronic Dis. 2011; 8: A98
        • Lytle L.A.
        • Murray D.M.
        • Perry C.L.
        • Eldridge A.L.
        Validating fourth-grade students' self-report of dietary intake.
        J Am Diet Assoc. 1998; 98: 570-572
        • Lytle L.A.
        • Nichaman M.Z.
        • Obarzanek E.
        • et al.
        Validation of 24-hour recalls assisted by food records in third-grade children. The CATCH Collaborative Group.
        J Am Diet Assoc. 1993; 93: 1431-1436
        • Weber J.L.
        • Lytle L.
        • Gittelsohn J.
        • et al.
        Validity of self-reported dietary intake at school meals by American Indian children: The pathways study.
        J Am Diet Assoc. 2004; 104: 746-752
        • Conway J.M.
        • Ingwersen L.A.
        • Moshfegh A.J.
        Accuracy of dietary recall using the USDA five-step multiple-pass method in men: An observational validation study.
        J Am Diet Assoc. 2004; 104: 595-603
      8. Bartlett S, Olsho L, Klerman J, Patland K, Blocklin M, Connor P. Evaluation of the fresh fruit and vegetable program (FFVP): Final evaluation report. 2013. Accessed March 21, 2016.

        • Guenther P.M.
        • Kirkpatrick S.I.
        • Reedy J.
        • et al.
        The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.
        J Nutr. 2014; 144: 399-407
        • Fenton K.
        • Rosen N.J.
        • Wakimoto P.
        • Patterson T.
        • Goldstein L.H.
        • Ritchie L.D.
        Eat lunch first or play first? Inconsistent associations with fruit and vegetable consumption in elementary school.
        J Acad Nutr Diet. 2015; 115: 585-592
        • Ritchie L.D.
        • Rosen N.J.
        • Fenton K.
        • Au L.E.
        • Goldstein L.H.
        • Shimada T.
        School breakfast policy is associated with dietary intake of fourth- and fifth-grade students.
        J Acad Nutr Diet. 2016; 116: 449-457
      9. SAS Institute, Inc. Released 2013. SAS version 9.4. Cary, NC: SAS Institute Inc.

        • Hanson K.L.
        • Olson C.M.
        School meals participation and weekday dietary quality were associated after controlling for weekend eating among U.S. school children aged 6 to 17 years.
        J Nutr. 2013; 143: 714-721
        • Bhattacharya J.
        • Currie J.
        • Haider S.
        Poverty, food insecurity, and nutritional outcomes in children and adults.
        J Health Econ. 2004; 23: 839-862
        • Longacre M.R.
        • Drake K.M.
        • Titus L.J.
        • et al.
        School food reduces household income disparities in adolescents' frequency of fruit and vegetable intake.
        Prev Med. 2014; 69: 202-207
        • Hubbard K.L.
        • Must A.
        • Eliasziw M.
        • Folta S.C.
        • Goldberg J.
        What's in children's backpacks: Foods brought from home.
        J Acad Nutr Diet. 2014; 114: 1424-1431
        • Rees G.A.
        • Richards C.J.
        • Gregory J.
        Food and nutrient intakes of primary school children: A comparison of school meals and packed lunches.
        J Hum Nutr Diet. 2008; 21: 420-427
        • Gleason P.M.
        • Suitor C.W.
        Eating at school: How the National School Lunch Program affects children's diets.
        Am J Agr Econ. 2003; 85: 1047-1061
        • Leung C.W.
        • Blumenthal S.J.
        • Hoffnagle E.E.
        • et al.
        Associations of food stamp participation with dietary quality and obesity in children.
        Pediatrics. 2013; 131: 463-472
        • Leung C.W.
        • Epel E.S.
        • Ritchie L.D.
        • Crawford P.B.
        • Laraia B.A.
        Food insecurity is inversely associated with diet quality of lower-income adults.
        J Acad Nutr Diet. 2014; 114: 1943-1953.e1942


      L. E. Au is an assistant researcher, Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA.


      K. Hecht is director of policy, Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA.


      L. D. Ritchie is director and a cooperative extension specialist, Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA.


      N. J. Rosen is a senior associate, Informing Change, Berkeley, CA.


      K. Fenton is a biostatistician, Seattle Genetics, Bothell, WA.