Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students

Background Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans. Objective The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source). Design An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year. Participants/setting Fourth- and fifth-grade students (N=3,944) completed a diary assisted 24-hour food recall. Main outcome measures The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home. Statistical analysis Analysis of variance, chi(2) test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed. Results School lunch eaters had a higher mean standard deviation overall diet quality score (HEI-2010=49.0 +/- 11.3) compared with students who ate a lunch obtained from home. (46.1 +/- 12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch). Conclusions Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on children's diet quality.