(P29-046-23) Evaluation of Health and Economic Effects of U.S. School Meal Standards Consistent With the 2020-2025 Dietary Guidelines for Americans

Objectives: The current school meal nutrition standards, established in 2010, are not fully aligned with the 2020-2025 DGA. This study evaluates the potential short-term and long-term health and economic benefits of strengthening the school meal standards on added sugars, sodium, and whole grains to be aligned with current guidelines.

Methods: We used comparative risk assessment (CRA) frameworks based on nationally representative data incorporating current demographics, dietary habits, and risk factors of US children aged 5-18 years from three cycles of NHANES (2013-2018). To estimate short-term impact, the model incorporated estimated dietary changes due to DGA-aligned school meal nutrition standards, and the effect of these changes on childhood body mass index (BMI) and blood pressure (BP). To estimate the long-term impact, the model further incorporated data on the sustainability of childhood dietary changes to adulthood, demographics and risk factors of US adults, diet-disease associations, and disease-specific national mortality.

Results: In a best-case scenario (full compliance), the DGA-aligned standards were estimated to reduce US children’s consumption of added sugars by a mean (SE) of 1.6 (0.09) g/day and sodium, by 101 (3) mg/day. Whole grain consumption increased by 5.6 (0.2) g/day. In the short term, these dietary changes would reduce children’s BMI by a mean of 0.06 kg/m² (95% UI: 0.03-0.09), and BP by 0.10 mm Hg (0.04-0.16). Assuming 35% of childhood dietary changes were sustained to adulthood, the 2020 DGA-aligned school meal standards were associated with 8,430 (2,730-14,500) fewer annual deaths due to CVD, diabetes, and cancer, saving 217,000 DALYs and $15.5 billion in direct and indirect medical costs annually in adulthood. Accounting for incomplete school compliance, implementation would save an estimated 6,690 (1,280-12,600) deaths, 231,000 (70,000-42,000) DALYs, and $12.6 (2.59-23.6) billion in healthcare-related costs per year.

Conclusions: Stronger school meal standards on added sugars, sodium, and whole grains aligned with the quantitative recommendations of the 2020-2025 DGA may improve diet, childhood health outcomes, and adulthood burdens of CVD, diabetes, cancer, and associated economic costs.

Funding Sources: The Center for Science in the Public Interest