title: Comparing Current Practice to Recommendations for the Child and Adult Care Food Program.
abstract: BACKGROUND
  The federal Child and Adult Care Food Program (CACFP) assists child care centers serving low-income preschoolers and regulates the quality and quantity of food served. The aim of this study was to assess the nutritional quality of lunches served at 38 child care centers and examine how current practices compare to proposed meal pattern recommendations.
  
  
  METHODS
  Preschool-aged children (n = 204) were observed eating lunch in 38 CACFP-participating preschools. All foods served and consumed were measured and compared to the 2011 Institute of Medicine (IOM) recommendations to improve CACFP and the 2015 Proposed Rule issued by the USDA.
  
  
  RESULTS
  All centers provided access to all required lunch components, but not all components were served (i.e., placed on the child's plate). Vegetables were significantly less likely to be served than meat or grains. Compared with CACFP recommended portion sizes, servings of meat and grain were high, whereas milk was low. Compared with IOM recommendations, average calorie consumption was appropriate, but saturated fat, protein, and sodium intake were high and dietary fiber was low. Meals that offered children both a fruit and a vegetable led to significantly higher produce consumption than meals that offered only one fruit or one vegetable.
  
  
  CONCLUSIONS
  Child care centers generally comply with current CACFP regulations, but do not provide lunches consistent with the 2011 IOM recommendations for saturated fat, protein, fiber, and sodium. Decreased use of beef and cheese and increased provision of whole grains, fruits, and vegetables are recommended.
authors.affiliation: 1 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT.
authors.forename: Marlene B
authors.initials: MB
authors.lastname: Schwartz
authors.affiliation: 2 Henderson Consulting , Guilford, CT.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Henderson
authors.affiliation: 3 Public Health Management Corporation, Philadelphia, PA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Grode
authors.affiliation: 1 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT.
authors.forename: Maia
authors.initials: M
authors.lastname: Hyary
authors.affiliation: 4 Prevention Research Center, Harvard University , Cambridge, MA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Kenney
authors.affiliation: 1 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT.
authors.forename: Meghan
authors.initials: M
authors.lastname: O'Connell
authors.affiliation: 5 IMPAQ International, LLC, Oakland, CA.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Middleton
mesh_terms: D000328:Adult; D002656:Child Day Care Centers / Q000458:organization & administration / Q000592:standards*; D053198:Child Nutrition Sciences / Q000193:education; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D003611:Dairy Products; D004034:Diet Surveys; D004043:Dietary Fiber; D002523:Edible Grain; D002149:Energy Intake; D005260:Female; D005522:Food Services / Q000458:organization & administration / Q000592:standards*; D005638:Fruit; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D062409:Lunch; D008297:Male; D018673:Nutrition Policy; D009751:Nutritional Requirements; D009753:Nutritive Value; D015397:Program Evaluation; D014481:United States / Q000453:epidemiology; D014675:Vegetables