title: Schoolchildren's consumption of competitive foods and beverages, excluding à la carte.
abstract: BACKGROUND
  Competitive foods/beverages are those in school vending machines, school stores, snack bars, special sales, and items sold à la carte in the school cafeteria that compete with United States Department of Agriculture (USDA) meal program offerings. Grouping à la carte items with less nutritious items allowed in less regulated venues may obfuscate analysis of the school competitive food environment. Excluding à la carte items from competitive foods, the objectives were to: (1) assess competitive food use by gender, ethnicity, eligibility for free or reduced-price meals, and participation in school meals programs, (2) determine differences between grade levels in energy intakes obtained from food sources, (3) determine the nutrient intake derived from competitive foods for students who consumed them, and (4) determine energy-adjusted differences in 24-hour nutrient intakes of protein, calcium, iron, and other selected nutrients between competitive food consumer and nonconsumers.
  
  
  METHODS
  Competitive foods/beverages use, excluding à la carte items, was examined using the third School Nutrition Dietary Assessment Study (SNDA III), a nationally representative sample of 2309 schoolchildren in grades 1 to 12. Mean nutrient intakes were adjusted for energy intake and other covariates, and differences between consumers and nonconsumers of competitive items were determined using analysis of variance and sudaan.
  
  
  RESULTS
  Excluding à la carte items, 22% of schoolchildren consumed competitive items in a representative school day and use was highest in high school. Consumers of competitive items other than à la carte had significantly higher mean energy, sugar intakes, and lower sodium, dietary fiber, B vitamins, and iron intakes than nonconsumers.
  
  
  CONCLUSIONS
  Use of competitive foods/beverages, excluding à la carte, was detrimental to children's diet quality.
authors.affiliation: Division of Hematology/Oncology; VA Staff Medical Oncologist, Department of Internal Medicine, University of Michigan, 2150 Cancer Center, Ann Arbor, MI 48105, USA. mkakaral@umich.edu
authors.forename: Madhuri
authors.initials: M
authors.lastname: Kakarala
authors.forename: Debra R
authors.initials: DR
authors.lastname: Keast
authors.forename: Sharon
authors.initials: S
authors.lastname: Hoerr
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004032:Diet / Q000706:statistics & numerical data*; D004034:Diet Surveys; D002149:Energy Intake; D005260:Female; D005509:Food Dispensers, Automatic / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012574:Schools / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors