title: Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students.
abstract: Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans.
  
  
  
  The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source).
  
  
  
  An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year.
  
  
  
  Fourth- and fifth-grade students (N=3,944) completed a diary-assisted 24-hour food recall.
  
  
  
  The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home.
  
  
  
  Analysis of variance, χ2test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed.
  
  
  
  School lunch eaters had a higher mean±standard deviation overall diet quality score (HEI-2010=49.0±11.3) compared with students who ate a lunch obtained from home (46.1±12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch).
  
  
  
  Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on children's diet quality.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Au
authors.forename: Nila J
authors.initials: NJ
authors.lastname: Rosen
authors.forename: Keenan
authors.initials: K
authors.lastname: Fenton
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hecht
authors.forename: Lorrene D
authors.initials: LD
authors.lastname: Ritchie
mesh_terms: D002648:Child; D004032:Diet / Q000592:standards*; D015930:Diet Records; D004034:Diet Surveys; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D005522:Food Services / Q000592:standards; D006801:Humans; D062409:Lunch; D008297:Male; D009753:Nutritive Value; D012574:Schools; D013334:Students
keywords: Children; Diet quality; Healthy Eating Index-2010 (HEI-2010); School breakfast; School lunch