Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children's lunches in England and Scotland: a natural experiment.
Children
Policy evaluation
School food
Ultra-processed food
Universal free school meals
Journal
The international journal of behavioral nutrition and physical activity
ISSN: 1479-5868
Titre abrégé: Int J Behav Nutr Phys Act
Pays: England
ID NLM: 101217089
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
received:
23
05
2024
accepted:
12
09
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
epublish
Résumé
The Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4-7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren. Data from the UK National Diet and Nutrition Survey (2008-2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4-7 years, n = 835) was compared to the change in an unexposed control group (8-11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups. Before UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions. This study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet.
Sections du résumé
BACKGROUND
BACKGROUND
The Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4-7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren.
METHODS
METHODS
Data from the UK National Diet and Nutrition Survey (2008-2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4-7 years, n = 835) was compared to the change in an unexposed control group (8-11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups.
RESULTS
RESULTS
Before UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions.
CONCLUSIONS
CONCLUSIONS
This study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet.
Identifiants
pubmed: 39482639
doi: 10.1186/s12966-024-01656-w
pii: 10.1186/s12966-024-01656-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
124Subventions
Organisme : School for Public Health Research
ID : Grant Reference Number PD-SPH-2015
Informations de copyright
© 2024. The Author(s).
Références
Onita BM, Azeredo CM, Jaime PC, Levy RB, Rauber F. Eating context and its association with ultra-processed food consumption by British children. Appetite. 2021;157:105007.
doi: 10.1016/j.appet.2020.105007
pubmed: 33075442
Rauber F, Louzada ML, da Martinez Steele C, Rezende E, de Millett LFM, Monteiro C. Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open. 2019;9:e027546.
doi: 10.1136/bmjopen-2018-027546
pubmed: 31662351
pmcid: 6830631
Monteiro CA, Moubarac J-C, Levy RB, Canella DS, Louzada ML da C, Cannon G. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr. 2018;21:18–26.
doi: 10.1017/S1368980017001379
pubmed: 28714422
Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Méjean C, Andrianasolo RM, et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ. 2019;365:l1451.
doi: 10.1136/bmj.l1451
pubmed: 31142457
pmcid: 6538975
Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21:5–17.
doi: 10.1017/S1368980017000234
pubmed: 28322183
de Oliveira PG, de Sousa JM, Assunção DGF, de Araujo EKS, Bezerra DS, Dametto JFDS, et al. Impacts of consumption of ultra-processed foods on the maternal-child health: a systematic review. Front Nutr. 2022;9:821657.
doi: 10.3389/fnut.2022.821657
pubmed: 35634416
pmcid: 9136982
Srour B, Kordahi MC, Bonazzi E, Deschasaux-Tanguy M, Touvier M, Chassaing B. Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol. 2022;7:1128–40.
doi: 10.1016/S2468-1253(22)00169-8
pubmed: 35952706
Chang K, Khandpur N, Neri D, Touvier M, Huybrechts I, Millett C, et al. Association between childhood consumption of ultraprocessed food and adiposity trajectories in the Avon longitudinal study of parents and children birth cohort. JAMA Pediatr. 2021;175:e211573.
doi: 10.1001/jamapediatrics.2021.1573
pubmed: 34125152
pmcid: 8424476
Levy RB, Rauber F, Chang K, Louzada ML, da Monteiro C, Millett CA. Ultra-processed food consumption and type 2 diabetes incidence: a prospective cohort study. Clin Nutr. 2021;40:3608–14.
doi: 10.1016/j.clnu.2020.12.018
pubmed: 33388205
Chang K, Gunter MJ, Rauber F, Levy RB, Huybrechts I, Kliemann N et al. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. eClinicalMedicine. 2023;56:101840
Bonaccio M, Castelnuovo AD, Ruggiero E, Costanzo S, Grosso G, Curtis AD, et al. Joint association of food nutritional profile by nutri-score front-of-pack label and ultra-processed food intake with mortality: Moli-Sani prospective cohort study. BMJ. 2022;378:e070688.
doi: 10.1136/bmj-2022-070688
pubmed: 36450651
pmcid: 9430377
Parnham JC, Chang K, Rauber F, Levy RB, Millett C, Laverty AA, et al. The ultra-processed food content of school meals and packed lunches in the United Kingdom. Nutrients. 2022;14:2961.
doi: 10.3390/nu14142961
pubmed: 35889918
pmcid: 9318725
Harrison F, Jennings A, Jones A, Welch A, van Sluijs E, Griffin S, et al. Food and drink consumption at school lunchtime: the impact of lunch type and contribution to overall intake in British 9–10-year-old children. Public Health Nutr. 2013;16:1132–9.
doi: 10.1017/S1368980011002321
pubmed: 21936970
Evans CEL, Mandl V, Christian MS, Cade JE. Impact of school lunch type on nutritional quality of English children’s diets. Public Health Nutr. 2016;19:36–45.
doi: 10.1017/S1368980015000853
pubmed: 25936356
Haney E, Parnham JC, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J et al. Dietary quality of school meals and packed lunches: a national study of primary and secondary school children in the UK. Public Health Nutr. 2023;26(2):425-436.
Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell NRC, Johnston BC. Influence of unhealthy food and beverage marketing on children’s dietary intake and preference: a systematic review and meta-analysis of randomized trials. Obes Rev off J Int Assoc Study Obes. 2016;17:945–59.
doi: 10.1111/obr.12445
Ensaff H, Bunting E, O’Mahony S. That’s his choice not mine! Parents’ perspectives on providing a packed lunch for their children in primary school. J Nutr Educ Behav. 2018;50:357–e3641.
doi: 10.1016/j.jneb.2017.12.008
pubmed: 29631705
Sellen P, Huda N, Gibson S, Oliver LL, Huda Z, Gibson S et al. Evaluation of universal infant free school meals. London, UK: Education Policy Institue; 2018. p. 1–42. https://epi.org.uk/publications-and-research/evaluation-universal-infant-free-school-meals/
Holford A, Rabe B. Going universal. The impact of free school lunches on child body weight outcomes. J Public Econ Plus. 2022;3:100016.
doi: 10.1016/j.pubecp.2022.100016
Parnham JC, Chang K, Millett C, Laverty AA, von Hinke S, Pearson-Stuttard J, et al. The impact of the universal infant free school meal policy on dietary quality in English and Scottish Primary School children: evaluation of a natural experiment. Nutrients. 2022;14:1602.
doi: 10.3390/nu14081602
pubmed: 35458164
pmcid: 9029848
Sustain. Healthy school food for all. Sustain. 2023 [cited 2023 Dec 22]. https://www.sustainweb.org/childrens-food-campaign/healthy-school-food-for-all/
NatCen Social Research, MRC Elsie Widdowson Laboratory. National diet and nutrition survey years 1–9, 2008/09-2016/17. UK Data Service. SN: 6533. 2019. https://doi.org/10.5255/UKDA-SN-6533-15
Public Health England. Appendix B methodology for years 10 and 11 of the NDNS RP. Natl Diet Nutr Surv Years 9 11 Roll Programme 20162017–20182019. 2020. https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019
Lennox A, Fitt E, Whitton C, Roberts C, Prynne C, Appendix A. Dietary data collection and editing. Natl Diet Nutr Surv Years 9 11 Roll Programme 20162017–20182019. 2011. pp. 1–16. https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019
Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada MLC, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22:936–41.
doi: 10.1017/S1368980018003762
pubmed: 30744710
pmcid: 10260459
Anyaegbu G. Using the OECD equivalence scale in taxes and benefits analysis. Econ Labour Mark Rev. 2010;4:49–54.
doi: 10.1057/elmr.2010.9
Ministry of Housing, Communities & Local Government. English indices of deprivation 2019. Natl. Stat. 2019 [cited 2021 Feb 19]. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019
van Buuren S. Classification and regression trees. Flex Imput Missing Data. Bookdown; 2018. https://stefvanbuuren.name/fimd/sec-cart.html
McCaffrey DF, Griffin BA, Almirall D, Slaughter ME, Ramchand R, Burgette LF. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med. 2013;32:3388–414.
doi: 10.1002/sim.5753
pubmed: 23508673
pmcid: 3710547
Börnhorst C, Huybrechts I, Hebestreit A, Vanaelst B, Molnár D, Bel-Serrat S, et al. Diet–obesity associations in children: approaches to counteract attenuation caused by misreporting. Public Health Nutr. 2013;16:256–66.
doi: 10.1017/S1368980012004491
pubmed: 23046605
Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes. 2000;24:1119–30.
doi: 10.1038/sj.ijo.0801376
Spence S, Matthews JNS, McSweeney L, Rowland MK, Orango P, Adamson AJ. Implementation of universal infant free school meals: a pilot study in NE England exploring the impact on key stage 1 pupil’s dietary intake. Public Health Nutr. 2020;24:3167–75.
doi: 10.1017/S1368980020004875
pubmed: 33261703
Cohen JFW, Hecht AA, McLoughlin GM, Turner L, Schwartz MB. Universal school meals and associations with student participation, attendance, academic performance, diet quality, food security, and body mass index: a systematic review. Nutrients. 2021;13:911.
doi: 10.3390/nu13030911
pubmed: 33799780
pmcid: 8000006
Grammatikaki E, Wollgast J, Caldeira S. High levels of nutrients of concern in baby foods available in Europe that contain sugar-contributing ingredients or are ultra-processed. Nutrients. 2021;13:3105.
doi: 10.3390/nu13093105
pubmed: 34578982
pmcid: 8466462
Goudie S. Broken Plate 2023., London UK. Food Foundation; 2023. https://foodfoundation.org.uk/publication/broken-plate-2023
O’Rourke B, Shwed A, Bruner B, Ferguson K. What’s for lunch? Investigating the experiences, perceptions, and habits of parents and School lunches: a scoping review. J Sch Health. 2020;90:812–9.
doi: 10.1111/josh.12944
pubmed: 32820557
Dimbleby H, Vincent J. The school food plan. 2013 [cited 2021 Mar 24]. https://www.schoolfoodmatters.org/campaigns/school-food-plan
Jonathan Cribb C, Farquharson A, McKendrick, Tom Waters. The policy menu for school lunches: options and trade-offs in expanding free school meals in England. Institute for Fiscal Studies; 2023. https://ifs.org.uk/publications/policy-menu-school-lunches-options-and-trade-offs-expanding-free-school-meals-england
Child Poverty Action Group. 800,000 children in poverty not getting free school meals. Child Poverty Action Group. 2022 [cited 2022 Aug 17]. https://cpag.org.uk/news-blogs/news-listings/800000-children-poverty-not-getting-free-school-meals
Food for Life. Food for life served here. Food Life. 2023 [cited 2023 Apr 13]. https://www.foodforlife.org.uk/catering/food-for-life-served-here
Canella D, Azevedo AB, Bandoni D. Feasibility of the requirements and recommendations of the Brazilian school feeding program. Popul Med. 2023;5(Supplement):A1778
Impact on Urban Health. Investing in children’s future: a cost benefit analysis of free school meal provision expansion. Impact on Urban Health. 2022 Oct. https://urbanhealth.org.uk/insights/reports/expanding-free-school-meals-a-cost-benefit-analysis
Parnham JC, Millett C, Vamos EP. School meals in the UK: ultra-processed, unequal and inadequate. Public Health Nutr. 2023;26:297–301.
doi: 10.1017/S1368980022002336
pubmed: 36274638
HM Government. The requirements for school food regulations 2014. Lond. House Commons. 2014. pp. 1–9.
Wang L, Martínez Steele E, Du M, Pomeranz JL, O’Connor LE, Herrick KA, et al. Trends in consumption of ultraprocessed foods among US youths aged 2–19 years, 1999–2018. JAMA. 2021;326:519–30.
doi: 10.1001/jama.2021.10238
pubmed: 34374722
pmcid: 8356071
Department of Education. Schools, pupils and their characteristics: January 2021. 2021 [cited 2021 Jul 20]. https://explore-education-statistics.service.gov.uk/find-statistics/school-pupils-and-their-characteristics