title: School Breakfast Policy Is Associated with Dietary Intake of Fourth- and Fifth-Grade Students.
abstract: BACKGROUND
  Breakfast skipping has been associated with obesity. Schools have adopted breakfast policies to increase breakfast participation. Recently, there have been concerns that students in schools where breakfast is served in the classroom may be eating two breakfasts--one at home and one at school--thereby increasing their risk of excessive energy intake and weight gain.
  
  
  OBJECTIVE
  The study objective was to compare the prevalence of not eating breakfast, eating breakfast at home or school only, and eating double breakfasts (home and school) by students in schools with distinct breakfast policies and evaluate the relationship of breakfast policy to energy intake and diet quality.
  
  
  METHODS
  Baseline data were collected in 2011-2012 as part of a cluster randomized controlled trial to evaluate the effectiveness of a school-based intervention to promote fruit and vegetable intake and physical activity in low-resource elementary schools in California.
  
  
  METHODS
  Participants were 3,944 fourth and fifth graders from 43 schools, 20 served breakfast in the cafeteria before school, 17 served breakfast in the classroom at the start of school, and 6 served "second chance" breakfast (in the cafeteria before school and again at first recess).
  
  
  METHODS
  As part of a secondary data analysis, differences in school and individual characteristics by school breakfast policy were assessed by χ(2) test of independence or analysis of variance. Associations between school breakfast policy and breakfast eating patterns were assessed. Outcomes included calorie intake at breakfast, total daily calorie intake, and diet quality as measured by the Healthy Eating Index 2010. Control variables included student race/ethnicity, grade, and language spoken at home, and clustering of students by school.
  
  
  RESULTS
  Breakfast in the classroom was associated with fewer students not eating breakfast (P<0.001), but more eating breakfast at both home and school (P<0.001). Students in the breakfast in the classroom group did not have higher mean energy intakes from breakfast or higher daily energy intakes that were higher than other breakfast policy groups. The breakfast in the classroom group had higher overall diet quality (P=0.01).
  
  
  CONCLUSIONS
  No evidence was found to support discontinuation of breakfast in the classroom policy on the basis of concerns that children will eat excess calories.
authors.forename: Lorrene D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: Nila J
authors.initials: NJ
authors.lastname: Rosen
authors.forename: Keenan
authors.initials: K
authors.lastname: Fenton
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Au
authors.forename: Lauren H
authors.initials: LH
authors.lastname: Goldstein
authors.forename: Tia
authors.initials: T
authors.lastname: Shimada
mesh_terms: D062408:Breakfast; D002140:California; D002648:Child; D016000:Cluster Analysis; D005247:Feeding Behavior; D005260:Female; D005522:Food Services; D005638:Fruit; D006801:Humans; D008297:Male; D009043:Motor Activity; D018673:Nutrition Policy; D012574:Schools; D014675:Vegetables
keywords: Dietary intake; Food policy; Nutrition; Obesity; School breakfast