Dining at School

474037137When was the last time you consumed a school lunch?  As Rick and I quip on PodMed this week, we have a collective and not-so-fond memory of 'mystery meat' and the like. Things have changed quite a bit these days, a study on the nutritional value of home-packed versus school-provided lunches as published in JAMA Pediatrics demonstrates, and while we're at it, seems like breakfast at school is another good idea, per a second study in the same issue.

The lunch study examined the nutritional content of lunches from home of 242 elementary and 95 intermediate school students from 12 schools located in the Houston, TX, area. The content of these lunches was compared with the guidelines found in the National School Lunch Program, begun in 2012, based on a 2009 (!) Institute of Medicine report.  I'll leave this huge legislative delay alone for the moment, and note that these were the first updates to nutritional recommendations for children for more than 30 years.

Here's what the study determined, "Compared with the NSLP guidelines, lunches brought from home contained more sodium (1110 vs ≤640 mg for elementary and 1003 vs ≤710 mg for intermediate students) and fewer servings of fruits (0.33 cup for elementary and 0.29 cup for intermediate students vs 0.50 cup per the NSLP guidelines), vegetables (0.07 cup for elementary and 0.11 cup for intermediate students vs 0.75 cup per the NSLP guidelines), whole grains (0.22-oz equivalent for elementary and 0.31-oz equivalent for intermediate students vs 0.50-oz minimum per the NLSP guidelines), and fluid milk (0.08 cup for elementary and 0.02 cup for intermediate students vs 1 cup per the NSLP guidelines). About 90% of lunches from home contained desserts, snack chips, and sweetened beverages, which are not permitted in reimbursable school meals. The cost of lunches from home averaged $1.93 for elementary and $1.76 for intermediate students. Students from lower-income intermediate schools brought significantly higher-priced ($1.94) lunches than did students from middle-income schools ($1.63)." While the authors conclude that efforts should be undertaken to educate parents to pack more nutritional lunches, we take a slightly different tack and opine that perhaps all children should be encouraged to eat school-provided lunches.

Ditto for the breakfast study.  Turns out that while school breakfast programs have been in place for some time in many low income areas, barriers to children actually eating breakfast at school include the need to arrive early as well as stigma associated with the program.  This study looked at 446 public elementary schools and assessed the impact of serving breakfast in the classroom.  While the authors were aiming at whether such a strategy improved academic performance this outcome was not significant, which Rick considers not surprising as the study wasn't long enough. Things that did show immediate improvement were the number of children who benefited, reductions in tardiness and improvements in overall attendance. I suggest in the podcast a sliding scale for all parents, so that all children can have breakfast in the classroom.  There is abundant evidence for the benefits of breakfast on school performance, and such a strategy would reduce stigma.  While we're at it, why not include lunch, too?

Other topics this week include two new agents to reduce potassium levels in people with chronic kidney disease in NEJM, a new agent for treating chronic cough in the Lancet, and two medications for managing Marfan syndrome in NEJM.  Until next week, y'all live well.

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