Research is limited on added sugars in school meals and children’s dietary intakes after the 2015–2020 Dietary Guidelines for Americans (DGA) recommended that added sugars be limited to less than 10% of total calories. This analysis uses data from the School Nutrition and Meal Cost Study (SNMCS) to examine levels of added sugars in: (1) school meals and (2) children’s dietary intakes at breakfast, lunch, and over 24 h on school days. SNMCS data were collected in the 2014–2015 school year after updated nutrition standards for school meals were implemented. Most schools exceeded the DGA limit for added sugars at breakfast (92%), while 69% exceeded the limit at lunch. The leading source of added sugars in school meals (both breakfasts and lunches) was flavored skim milk. More than 62% of children consumed breakfasts that exceeded the DGA limit, and almost half (47%) consumed lunches that exceeded the limit. Leading sources of added sugars in the breakfasts consumed by children were sweetened cold cereals and condiments and toppings; leading sources of added sugars in children’s lunches were flavored skim milk and cake. Over 24 h, 63% of children exceeded the DGA limit. These findings show that school meals and children’s dietary intakes are high in added sugars relative to the DGA limit and provide insights into the types of foods that should be targeted in order to decrease levels of added sugars.

Prior research has shown that participation in the United States’ National School Lunch Program (NSLP) is associated with consuming higher-quality lunches and diets overall, but little is known about differences by income and race/ethnicity. This analysis used 24 h dietary recall data from the School Nutrition and Meal Cost Study to examine how NSLP participation affects the diet quality of students in different income and racial/ethnic subgroups. Diet quality at lunch and over 24 h was assessed using the Healthy Eating Index (HEI)-2010, where higher scores indicate higher-quality intakes. HEI-2010 scores for NSLP participants and nonparticipants in each subgroup were estimated, and two-tailed t-tests were conducted to determine whether participant–nonparticipant differences in scores within each subgroup were statistically significant. NSLP participants’ lunches received significantly higher total HEI-2010 scores than those of nonparticipants for lower-income, higher-income, non-Hispanic White, and non-Hispanic Black students, suggesting that participating in the NSLP helps most students consume healthier lunches. These significantly higher total scores for participants’ lunch intakes persisted over 24 h for higher-income students and non-Hispanic White students but not for lower-income students or students of other races/ethnicities. For NSLP participants in all subgroups, the nutritional quality of their 24 h intakes was much lower than at lunch, suggesting that the positive influence of the NSLP on their overall diet quality was negatively influenced by foods consumed the rest of the day (outside of lunch).

BACKGROUND:Implementation of updated nutrition standards for school meals began during school year (SY) 2012-2013. The standards were designed to improve the nutritional quality of the meals and their consistency with the Dietary Guidelines for Americans.OBJECTIVE:To assess the nutritional quality of school lunches and breakfasts after the updated standards were in place and compare it with the nutritional quality of the meals before the updated standards.DESIGN:School menu data were used from two cross-sectional, nationally representative studies of schools participating in the National School Lunch Program during SY 2014-2015 (School Nutrition and Meal Cost Study) and SY 2009-2010 (fourth School Nutrition Dietary Assessment Study).PARTICIPANTS/SETTING:The analysis used 1 week of school menu data from 1,206 schools at lunch and 1,110 schools at breakfast for SY 2014-2015, and 884 schools at lunch and 802 schools at breakfast for SY 2009-2010.OUTCOME MEASURES:Healthy Eating Index 2010 scores were estimated.STATISTICAL ANALYSES:Descriptive analyses were conducted to estimate mean Healthy Eating Index 2010 total and component scores for school meals. Scores are expressed as a percentage of maximum possible scores. Two-tailed t tests were used to assess differences in scores before and after updated standards were in place.RESULTS:Total Healthy Eating Index 2010 scores for school lunches and breakfasts increased significantly after the updated standards. Between SY 2009-2010 and SY 2014-2015, the total score for school lunches increased from 58% of the maximum score to 82%, and the total score for school breakfasts increased from 50% to 71% (P<0.05). For both meals, component scores increased by more than 20 percentage points for whole grains, refined grains, and empty calories, as well as for greens and beans for lunches and whole fruit and sodium for breakfasts.CONCLUSIONS:The updated nutrition standards for schools meals significantly improved the nutritional quality of the meals and their consistency with the Dietary Guidelines for Americans.

Background: Although the increases in overweight and obesity observed for several decades have appeared to have leveled off, the prevalence of overweight and obesity remains exceptionally high among children of color. This article estimates the effect of Healthy Harlem's Get Fit-a 12-week after-school program aimed at helping students improve physical activity and eating habits-on BMI and weight status of adolescents. Methods: Participants were 436 students who had overweight or obesity in 12 Harlem Children's Zone after-school programs in New York. The evaluation was a randomized controlled trial where students were assigned to an intervention group that received Get Fit plus Prevention services or a control group that only received Prevention services in 2013 or 2014. Impacts were assessed on BMI z-score, percentage with overweight or obesity, and percentage with obesity using regression analysis. Results: Relative to the control group, students randomized to Get Fit experienced a decrease in BMI z-score (mean difference = -0.04; p = 0.02). The percentage of students with overweight or obesity was also lower (mean difference = -5.3; p = 0.02), but there was no effect on the percentage of students with obesity. Get Fit had an impact on BMI for girls, but not boys. Conclusions: Get Fit improved middle- and high-school students' BMI outcomes and weight status. Schools continue to face pressure to allocate time for physical education and activity while meeting their academic demands, underscoring the importance of after-school student-level interventions like Get Fit.

BACKGROUND:Proper nutrition during infancy and toddlerhood is crucial for supporting healthy growth and development, including bone health. Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during late infancy and continuing to 24 mo of age. OBJECTIVES:This article aims to describe systematic reviews (SRs) conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer these questions: what is the relationship between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and bone health? Methods: The literature was searched with the use of 4 databases (CINAHL, Cochrane, Embase, and PubMed) to identify articles published from January 1980 to July 2016 that addressed these topics and met predetermined criteria for inclusion. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS:Three articles addressed the timing of introduction of CFBs and bone health during childhood (through 18 y of age), and 2 addressed the types and/or amounts of CFBs consumed relative to bone health. CONCLUSIONS:Insufficient evidence was available to draw conclusions about the relationships between the timing of CFB introduction and types and/or amounts of CFBs consumed and bone health. Therefore, a grade was not assignable for these SRs. The ability to draw conclusions was limited by an overall lack of research, failure to adjust for several key confounding factors, and heterogeneity in studies with regard to methodology, subject populations, and results. Additional research is needed that addresses these gaps and limitations.

Background: Systematic reviews were conducted as part of the USDA and the US Department of Health and Human Services Pregnancy and Birth to 24 Months Project to examine the relation between complementary feeding and developmental milestones. Objectives: The aim of this study was to describe systematic reviews examining the relationship between timing of introduction of complementary foods and beverages (CFB), and the types and amounts of CFB consumed, and developmental milestones. Methods: The literature was searched using 4 databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that met predetermined criteria for inclusion. Data extraction and risk of bias assessment were conducted for each included study. The body of evidence for each systematic review was qualitatively synthesized to develop a conclusion statement, and the strength of evidence was graded. Results: Three included articles (1 randomized controlled trial; 2 observational studies) examined timing of introduction of CFB. Eight included articles (3 randomized controlled trials; 5 observational studies) examined types and amounts of CFB. There was insufficient evidence to draw conclusions about the relation between either timing of CFB introduction or types and amounts of CFB, and developmental milestones. Conclusions: The ability to draw conclusions about the relationship between complementary feeding and developmental milestones was restricted by an inadequate amount of evidence with potential for issues with reverse causality and wide variation in design, type/age of outcome assessment, exposure assessment, and reported results. Additional research to address these gaps and limitations would be useful.

BACKGROUND:Proper nutrition during early life is critical for growth and development. OBJECTIVES:The aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)? METHODS:A literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS:Nine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status. CONCLUSIONS:Several conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed.

BACKGROUND Systematic reviews (SRs) were conducted by the Nutrition Evidence Systematic Review (NESR) team for the USDA's and the Department of Health and Human Services' Pregnancy and Birth to 24 Months Project. OBJECTIVES The aim was to describe the SRs examining the relationship between types and amounts of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes. METHODS The NESR team collaborated with subject matter experts to conduct this SR. The literature was searched and screened using predetermined criteria. For each included study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of evidence was graded. RESULTS This SR includes 49 articles that examined type, amount, or both of CFBs consumed and growth, size, and body-composition outcomes. Moderate evidence suggests that consuming either different amounts of meat, meat instead of iron-fortified cereal, or types of CFBs with different fats or fatty acids does not favorably or unfavorably influence growth, size, or body composition. In relation to overweight/obesity, insufficient evidence is available with regard to the intake of meat or CFBs with different fats or fatty acids. Limited evidence suggests that type and amount of fortified infant cereal does not favorably or unfavorably influence growth, size, body composition, or overweight/obesity. Limited evidence suggests that sugar-sweetened beverage consumption during the complementary feeding period is associated with increased obesity risk in childhood but is not associated with other measures of growth, size, or body composition. Limited evidence showed a positive association between juice intake and infant weight-for-length and child body mass index z scores. Insufficient evidence is available on other CFBs or dietary patterns in relation to outcomes. CONCLUSIONS Although several conclusions were drawn, additional research is needed that includes randomized controlled trials, examines a wider range of CFBs, considers issues of reverse causality, and adjusts for potential confounders to address gaps and limitations in the evidence.

All TEC and NESR team members, Project leads, and FEG-TEC liaisons participated in establishing the research questions, analytic framework, and study inclusion and exclusion criteria.LKE, JEO, YPW, TLP, PN, KJ, and NT developed and conducted the literature search, screened search results, and identified studies for inclusion.LKE and JEO extracted data and assessed risk of bias

Julie E. Obbagy, PhD, RD,a Laural K. English, PhD,b Tricia L. Psota, PhD, RD,a Perrine Nadaud,b MS, Kirsten Johns, MS,b Yat Ping Wong, MLS, MPH,c Nancy Terry, MLS,d Nancy F. Butte, PhD, RD,e Kathryn G. Dewey, PhD,f David M. Fleischer, MD,g Mary Kay Fox, MEd,h Frank R. Greer, MD,i Nancy F. Krebs, MD, MS,j Kelley S. Scanlon, PhD, RD,k Kellie O. Casavale, PhD, RD,l Joanne M. Spahn, MS, RDN,m Eve Stoody, PhDm

BACKGROUND:Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo.OBJECTIVES:The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis?METHODS:The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded.RESULTS:Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed.CONCLUSIONS:Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.

Early dietary patterns are critical to growth and development and play an important role in development of food preferences and habits. The objective of this paper is to describe when different foods enter the diet and how food consumption changes over the period of complementary feeding.

Abstract Objective To explore eating patterns and snacking among US infants, toddlers and pre-school children. Design The Feeding Infants and Toddlers Study (FITS) 2008 was a cross-sectional national survey of children aged 6–47 months, weighted to reflect US age and racial/ethnic distributions. Dietary data were collected using one multiple-pass 24h recall. Eating occasions were categorized as meals, snacks or other (comprised of all feedings of breast milk and/or infant formula). The percentage of children consuming meals and snacks and their contribution to total energy, the number of snacks consumed per day, energy and nutrients coming from snacks and the most commonly consumed snacks were evaluated by age. Setting A national sample of US infants, toddlers and pre-school children. Subjects A total of 2891 children in five age groups: 6–8 months (n 249), 9–11 months (n 256), 12–23 months (n 925), 24–35 months (n 736) and 36–47 months (n 725). Results Snacks were already consumed by 37 % of infants beginning at 6 months; by 12 months of age, nearly 95 % were consuming at least one snack per day. Snacks provided 25 % of daily energy from the age of 12 months. Approximately 40 % of toddlers and pre-school children consumed fruit and cow’s milk during snacks; about 25 % consumed 100 % fruit juice. Cookies were introduced early; by 24 months, 57 % consumed cookies or candy in a given day. Conclusions Snacking is common, contributing significantly to daily energy and nutrient needs of toddlers and pre-school children. There is room for improvement, however, with many popular snacking choices contributing to excess sugar.

The primary purpose of this paper is to assess how well food consumption patterns of young children in the U.S. conform to the 2015 Dietary Guidelines for Americans. A secondary purpose is to gain insight into food choices that contribute to over- or under-consumption of key food groups and dietary constituents.