Abstract
Background
During 2010, the US Department of Agriculture updated the school meals standards,
including three progressively decreasing sodium targets. The Target 1 standards went
into effect in 2014, but during 2018, the US Department of Agriculture delayed the
Target 2 standards until 2024 and eliminated the Target 3 standards citing concerns
regarding the availability and acceptability of lower-sodium foods. In addition, there
are currently no sugar standards, and it is unknown whether sugar is substituted for
salt in lower-sodium school foods.
Objective
To examine the availability, selection, and consumption of school lunches already
in alignment with the Target 2 and 3 sodium levels and the association between sodium
and sugar.
Design
An observational cafeteria-based study conducted during fall 2018.
Participants and setting
Students (n = 1985) in grades three through eight attending 13 elementary/kindergarten
through eighth-grade schools in a large, urban school district in New England.
Main outcome measures
Availability, selection, and consumption were examined using plate waste methodology.
Statistical analyses performed
Mixed-model analysis of variance accounting for student demographic characteristics
with schools/students as a random effect (students nested within schools) were used
to examine differences in availability, selection, and consumption. Linear regression
was used to examine the association between sodium and sugar in the school foods.
Results
The majority of meals selected (87%) and consumed (98%) were already in alignment
with the Target 2 standards. There were significant inverse associations between sodium
levels and consumption; each 100-mg increase in sodium was associated with a decrease
in consumption by 2% for entrées (P = 0.002) and 5% for vegetables (P = 0.01). When examining the association between sodium and sugar, each 10-mg reduction
in sodium was associated with 1-g increase in sugar among entrées (P < 0.0001), whereas there was a significant positive association between sodium and
sugar with vegetables and condiments.
Conclusions
This study provides some evidence that schools may already have the ability to provide
lower-sodium meals that are acceptable to students, and therefore the recent rollbacks
to the sodium standards may be unwarranted. Study findings suggest that the US Department
of Agriculture should take under consideration policies that would limit added sugar
for school meals as sugar may be substituted for salt.
Keywords
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Biography
J. F. W. Cohen is an associate professor, Department of Health Sciences, Merrimack College, North Andover, MA, and adjunct associate professor,Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
Biography
S. Richardson is a doctoral degree student, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.
Biography
C. A. Roberto is an associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Biography
E. B. Rimm is a professor, Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University; and Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
Article info
Publication history
Published online: October 21, 2020
Accepted:
July 21,
2020
Received:
January 14,
2020
Footnotes
Supplementary materials: The Figure is available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was funded by a grant from the Boston Centers for Youth & Families and the Shah Family Foundation. J. F. W. Cohen is supported by grant 1K01DK107810-01A1 from the National Institutes of Health.
AUTHOR CONTRIBUTIONS J. F. W. Cohen, S. Richardson, C. Roberto, and E. Rimm conceived the study. J. F. W. Cohen and S. Richardson supervised the study. J. F. W. Cohen completed the analyses and led the writing. S. Richardson, C. Roberto, and E. Rimm provided critical feedback on the manuscript.
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© 2021 by the Academy of Nutrition and Dietetics.
