title: Do healthy school meals affect illness, allergies and school attendance in 8- to 11-year-old children? A cluster-randomised controlled study.
abstract: OBJECTIVE
  A nutritionally adequate diet in childhood is important for health and resistance of allergies and infections. This study explored the effects of school meals rich in fish, vegetables and fibre on school attendance, asthma, allergies and illness in 797 Danish 8- to 11-year-old children. No comparable studies conducted in high-income settings have been identified.
  
  
  METHODS
  The OPUS School Meal Study was a cluster-randomised cross-over trial. Children from third and fourth grades at nine Danish schools received school meals or usual packed lunch (control) for two 3-month periods. Occurrence and duration of illnesses, asthma and allergies during the last 14 days were recorded by parental questionnaires at baseline and after each 3-month period. Self-reported well-being was assessed by visual analogue scales.
  
  
  RESULTS
  The school meals did not affect school attendance, parent-reported occurrence or duration of asthma and allergies or self-reported well-being. The most common symptoms of illness were stomach pain (24%), headache (28%) and cold (24%). A slightly higher number of children experienced headaches in the school meal (27%) compared with the control period (22%) (P=0.02). However, subgroup analyses showed that this effect was only seen in children eating school meals in the classroom (P=0.007), and not in common dining areas (P=0.2). No effect was found on other symptoms of illness.
  
  
  CONCLUSIONS
  Provision of nutritionally balanced school meals did not affect school attendance, asthma, allergies, illness or well-being in 8- to 11-year-old children. The slight increase in occurrence of headaches seems to be related to the physical eating environment.
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: R P
authors.initials: RP
authors.lastname: Laursen
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Lauritzen
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Ritz
authors.affiliation: Centre for Strategic Research in Education and Competence, Aarhus University, Aarhus C, Denmark.
authors.forename: C B
authors.initials: CB
authors.lastname: Dyssegaard
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Astrup
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: K F
authors.initials: KF
authors.lastname: Michaelsen
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: C T
authors.initials: CT
authors.lastname: Damsgaard
mesh_terms: D001249:Asthma / Q000453:epidemiology; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002669:Child Welfare / Q000706:statistics & numerical data*; D016000:Cluster Analysis; D018592:Cross-Over Studies; D003718:Denmark / Q000453:epidemiology; D004032:Diet / Q000592:standards*; D005260:Female; D005522:Food Services / Q000592:standards*; D006261:Headache / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology; D062409:Lunch; D008297:Male; D062407:Meals; D012572:School Health Services; D012574:Schools; D011795:Surveys and Questionnaires