Improvements in school meal quality in Sweden after the introduction of new legislation-a 2-year follow-up.
BACKGROUND
Sweden provides a free school lunch to every child in the compulsory (9-year) school system. It consists of a hot meal, a salad buffet, bread and a beverage. The Education Act states it must be free of charge (since 1997) and 'nutritious' (since 2011). No standards/limits are specified but voluntary guidelines for serving of the school meal exist. We describe how school meal quality has changed since 2011.


METHODS
A random sample of schools were contacted in spring 2011 and invited to use a novel web-based instrument to evaluate school meal quality. In spring 2013, the participating schools (N = 191) were encouraged to use it again and 97 did. The outcomes were measures of quality including food provision/choice, adherence to serving guidelines and, using validated food-based criteria, nutritional quality.


RESULTS
No change was seen in the proportion offering alternative options daily, but a vegetarian option was significantly more widely available in 2013. Adherence to all but one of the studied serving guidelines improved, although this reached significance for only a small number. Adherence to two of the four nutrient criteria improved significantly.


CONCLUSIONS
Two years after the introduction of new legislation, school meal quality in Sweden has improved modestly. The effect of the law itself is difficult to separate from other influences, including the effect of monitoring. Extended follow-up of schools will allow us to evaluate the longer-term changes and effects on health, learning and equality in health.
1 Center for Epidemiology and Social Medicine, Stockholm County Council, Sweden 2 Deparment of Public Health Sciences, Karolinska Institutet, Sweden emma.patterson@ki.se.
Emma
E
Patterson
1 Center for Epidemiology and Social Medicine, Stockholm County Council, Sweden 2 Deparment of Public Health Sciences, Karolinska Institutet, Sweden.
Liselotte Schäfer
LS
Elinder
D005522:Food Services / Q000331:legislation & jurisprudence* / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006801:Humans; D018673:Nutrition Policy; D012111:Residence Characteristics; D012574:Schools / Q000706:statistics & numerical data*; D013548:Sweden