title: Nutrient content of school meals before and after implementation of nutrition recommendations in five school districts across two U.S. counties.
abstract: OBJECTIVE
  To compare changes in nutrient levels of school meals before and after implementation of nutrition interventions at five school districts in two, large U.S. counties. School menu changes were compared against national school meal recommendations.
  
  
  METHODS
  A large urban school district in Los Angeles County (LAC), California and four school districts in suburban Cook County (SCC), Illinois implemented school meal nutrition interventions. Nutrition analyses were conducted for school breakfast and lunch before and after changes were made to the meal programs. Means, % change, and net calories (kilocalories or kcal) offered as a result of the nutrition interventions were calculated.
  
  
  RESULTS
  School districts in both counties made district-wide changes in their school breakfast and lunch menus. Menu changes resulted in a net reduction of calories, sugar, and sodium content offered in the meals. Net fewer calories offered as a result of the nutrition interventions were estimated to be about 64,075kcal per student per year for LAC and 22,887kcal per student per year for SCC.
  
  
  CONCLUSIONS
  Nutrition interventions can have broad reach through changes in menu offerings to school-aged children and adolescents. However, further research is needed to examine how these changes affect student food selection and consumption.
authors.affiliation: Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, 71-254 CHS, Los Angeles, CA 90024-1772, USA; Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA 90010, USA. Electronic address: pcummings@ph.lacounty.gov.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Cummings
authors.affiliation: Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Consortium to Lower Obesity in Chicago Children, 225 E. Chicago Avenue, Box 205, Chicago, IL 60611, USA. Electronic address: swelch@luriechildrens.org.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Welch
authors.affiliation: Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Consortium to Lower Obesity in Chicago Children, 225 E. Chicago Avenue, Box 205, Chicago, IL 60611, USA; Department of Pediatrics and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 157, Chicago, IL 60611, USA. Electronic address: mmason@luriechildrens.org.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mason
authors.affiliation: Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA 90010, USA. Electronic address: lburbage@ph.lacounty.gov.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Burbage
authors.affiliation: Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Consortium to Lower Obesity in Chicago Children, 225 E. Chicago Avenue, Box 205, Chicago, IL 60611, USA. Electronic address: skwon@luriechildrens.org.
authors.forename: Soyang
authors.initials: S
authors.lastname: Kwon
authors.affiliation: Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., 8th Floor, Los Angeles, CA 90010, USA; Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024-4142, USA. Electronic address: tkuo@ph.lacounty.gov.
authors.forename: Tony
authors.initials: T
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D002151:Calorimetry; D002648:Child; D002675:Child, Preschool; D005260:Female; D005522:Food Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D062407:Meals; D008612:Menu Planning; D015596:Nutrition Assessment; D018673:Nutrition Policy; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D012574:Schools; D014481:United States; D016885:United States Department of Agriculture
keywords: Child nutrition; Nutrition assessment; Nutrition policy; Obesity