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.

IF 5.6 1区 医学 Q1 NUTRITION & DIETETICS
Jennie C Parnham, Kiara Chang, Fernanda Rauber, Renata B Levy, Anthony A Laverty, Jonathan Pearson-Stuttard, Martin White, Stephanie von Hinke, Christopher Millett, Eszter P Vamos
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Abstract

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: 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: 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: 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.

评估婴儿免费校餐普及政策对英格兰和苏格兰儿童午餐中超加工食品含量的影响:自然实验。
背景:2014/15 年,英格兰和苏格兰为 4-7 岁的学龄儿童推出了 "全民婴儿免费校餐"(UIFSM)政策,从而提高了校餐的摄入量。众所周知,与从家里带来的食物(盒饭)相比,英国的学校膳食更健康、工业加工更少。然而,UIFSM政策对午餐时间在学校消费的超加工食品(UPF)数量的影响尚不清楚。本研究旨在评估英国和苏格兰学童在午餐时间摄入超加工食品(UPF)的情况:方法:利用英国国家膳食与营养调查(2008-2019 年)的数据进行差异自然实验。实验结果包括学校午餐摄入量和学校午餐时间UPF平均摄入量(以克为单位的午餐总量百分比(%g)和以千卡为单位的午餐总量百分比(%Kcal))。采用线性回归法比较了干预组(4-7 岁,n = 835)与未干预对照组(8-11 岁,n = 783)在引入 "UIFSM"(英格兰为 2014 年 9 月,苏格兰为 2015 年 1 月)前后的结果变化。采用反概率加权法平衡干预组和对照组的特征:结果:在 "超级学校 "之前,干预组和对照组的学校膳食摄入量和 UPFs 消费量相似。DID模型显示,在 "UIFSM "之后,学校膳食摄入量增加了25%个百分点(pp)(95% CI 14.2,35.9),UPFs消耗量(%g)减少了6.8个百分点(95% CI -12.5,-1.0)。分析表明,这是由于微加工乳制品、蛋类和淀粉类食品的增加,以及超加工咸味零食、面包和饮料的减少。与中高收入儿童相比,最低收入儿童的差异更大(-19.3 UPF(%g);95% CI -30.4,-8.2)。使用 UPF %Kcal 进行的分析也得出了类似的结论:这项研究以之前的证据为基础,表明 "全民免费午餐 "对膳食模式产生了积极影响,减少了学校午餐时间的 UPF 消费量,对最低收入家庭的儿童影响最大。普及免费校餐可以成为长期公平改善儿童饮食的一项重要政策。
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来源期刊
CiteScore
13.80
自引率
3.40%
发文量
138
审稿时长
4-8 weeks
期刊介绍: International Journal of Behavioral Nutrition and Physical Activity (IJBNPA) is an open access, peer-reviewed journal offering high quality articles, rapid publication and wide diffusion in the public domain. IJBNPA is devoted to furthering the understanding of the behavioral aspects of diet and physical activity and is unique in its inclusion of multiple levels of analysis, including populations, groups and individuals and its inclusion of epidemiology, and behavioral, theoretical and measurement research areas.
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