Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program
Association of the Healthy, Hunger-Free Kids Act With Dietary Quality Among Children in the US National School Lunch Program
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DOI：
10.1001/jama.2020.9517
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发表时间：
2020-07-28
影响因子：
120.7
通讯作者：
Jones-Smith, Jessica
中科院分区：
文献类型：
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作者：
Kinderknecht, Kelsey;Harris, Cristen;Jones-Smith, Jessica
重要性：2012年在全国实施的《2010年健康、无饥饿儿童法》旨在改善国家学校午餐方案提供的膳食的营养质量。目的：评估2010年《健康、无饥饿儿童法案》（Healthy, Hunger-Free Kids Act of 2010）与按收入分层的参加NSLP的学生午餐膳食质量之间是否存在关联。设计、环境、参与者采用全国健康与营养调查（NHANES） 2007-2008年、2009-2010年、2013-2014年和2015-2016年的数据进行连续横断面研究设计，研究对象为参加NSLP的学校的NHANES调查学生。年龄在5到18岁之间，从幼儿园到12年级，在提供学校午餐的学校注册，并且有可靠的工作日饮食回忆的个体被包括在内。2010年《健康、无饥饿儿童法案》（政策前时期：2007-2010年；政策后时期：2013-2016年），根据算法估计参与国家儿童福利计划。主要结局和测量主要结局是午餐摄入的饮食质量，通过健康饮食指数-2010 （HEI-2010）评分来衡量（范围0-100；0表示饮食没有遵守2010年美国人饮食指南，100表示饮食完全遵守指南）。结果在调查的6389名学生中（平均年龄11.7 [95% CI, 11.6-11.9]岁，女学生3145名[50%]，非西班牙裔白人1880名[56%]），32%为低收入学生，12%为中低收入学生，56%为中高收入学生。NSLP共纳入2472例（39%）。在低收入家庭学生中，NSLP参与者的政策前调整平均HEI-2010得分为42.7分，政策后得分为54.6分；非NSLP参与者的政策前调整平均得分为34.8分，政策后得分为34.1分（差异中的差异为12.6 [95% CI, 8.9-16.3]）。在低收入中等收入学生中，NSLP参与者的政策前调整平均HEI-2010得分为40.4分，政策后得分为54.8分；非NSLP参与者的政策前调整平均得分为34.2分，政策后得分为36.1分（差异中的差异为12.4 [95% CI, 4.9-19.9]）。在中等收入学生中，NSLP参与者的调整后平均HEI-2010政策前得分为42.7分，政策后得分为55.5分；非NSLP参与者的调整后平均政策前得分为38.9分，政策前得分为43.6分（差异中的差异为8.1[95% CI, 4.2-12.0]）。结论和相关性在一项针对学生的连续横断面研究中，与非参与者相比，在NSLP中假定的低收入、中低收入和中高收入参与者中，《2010年健康无饥饿儿童法案》与午餐饮食质量的更好变化有关。
IMPORTANCE The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP).OBJECTIVE To assess whether there was an assoc at on between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income.DESIGN, SETTING, PARTICIPANTS Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data from 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students who were surveyed in the NHANES and were attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included.EXPOSURES The Healthy, Hunger-Free Kids Act of 2010 (prepolicy period: 2007-2010; postpolicy period: 2013-2016), with participation in the NSLP estimated based on an algorithm.MAIN OUTCOMES AND MEASURES The primary outcome was dietary quality of intake for lunch, measured by the Healthy Eating Index-2010 (HEI-2010) score (range, 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines).RESULTS Among 6389 students included in the surveys (mean age, 11.7 [95% CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32% were low-income, 12% were low-middle-income, and 56% were middle-high-income students. A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1among NSLP nonparticipants (difference in differences, 12.6 [95% CI, 8.9-16.3]). Among low-middle-income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1among NSLP nonparticipants (difference in differences, 12.4 [95% CI, 4.9-19.9]). Among middle-high-income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1[95% CI, 4.2-12.0]).CONCLUSIONS AND RELEVANCE In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low-income, low-middle-income, and middle-high-income participants in the NSLP compared with nonparticipants.