ABSTRACT: BACKGROUND:Research on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited. OBJECTIVE:This study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children's dietary intakes. DESIGN:The Healthy Communities Study was a cross-sectional observational study conducted between 2013 and 2015. PARTICIPANTS AND SETTING:US children aged 4 to 15 years (n=5,106) were included. MAIN OUTCOME MEASURES:Dietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit and vegetables, fiber, whole grains, dairy, calcium, total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value. STATISTICAL ANALYSIS:Multivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs not every day) and dietary intake, adjusting for child- and community-level covariates. RESULTS:Children who ate school breakfast every day compared with children who ate 0 to 4 days/wk, reported consuming more fruits and vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day, compared with those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6). No significant associations were observed between school meal consumption and energy-dense nutrient-poor foods or added sugars. CONCLUSIONS:Eating school breakfast and school lunch every day by US schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.
