• Melissa A Clark and Mary Kay Fox.
• Mathematica Policy Research, Inc, PO Box 2393, Princeton, NJ 08543, USA. MClark@Mathematica-mpr.com
• J Am Diet Assoc. 2009 Feb 1;109(2 Suppl):S44-56.

BackgroundGood nutrition is essential to healthy childhood. Because the school meal programs--the National School Lunch Program and the School Breakfast Program--are so widely available, they are in a unique position to influence the nutritional quality of children's diets.ObjectiveThis article assesses the nutritional quality of the diets of US public school children and explores the relationship between children's participation in the school meal programs and the nutritional quality of their diets.DesignData were collected as part of the third School Nutrition Dietary Assessment Study (SNDA-III), a nationally representative study fielded during school year 2004-2005. Data on children's dietary intakes were collected through in-person 24-hour dietary recalls. Nutritional quality of children's diets was assessed by estimating the prevalence of inadequate and excessive intakes of energy and nutrients.Subjects/SettingThe analysis is based on a nationally representative sample of 2,314 children in grades 1 through 12 from 287 public schools.Statistical Analyses PerformedNutrient adequacy and excess were assessed by comparing usual nutrient intake distributions to Dietary Reference Intakes and the Dietary Guidelines for Americans 2005. Propensity score matching was used to examine the relationship between school meal program participation and the prevalence of inadequate and excessive intakes.ResultsThe majority of public school children in the United States had nutritionally adequate diets, but 80% had excessive intakes of saturated fat and 92% had excessive intakes of sodium. School meal program participation was associated with reduced prevalence of nutrient inadequacy but with increased prevalence of excessive sodium intakes.ConclusionsSchool meal programs play an important role in the nutritional adequacy of children's diets. However, the association between program participation and excessive sodium intakes, along with the high prevalence of excessive saturated fat intakes among all students, suggest areas for improvement in the meals these programs provide.

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