Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Sample and Design
2.2. Measures
2.2.1. Child Care Center-Level Characteristics
2.2.2. Menu Quality
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Appendix A
2016 (Pre-Update) | 2019 (Post-Update) | ||||
---|---|---|---|---|---|
Non-CACFP Centers | CACFP Centers | Non-CACFP Centers | CACFP Centers | ||
N days | 254 | 163 | 247 | 174 | |
N snacks | 449 | 169 | 408 | 189 | |
Morning snack, n (%) | 234 (52.1) | 11 (6.5) | 227 (55.6) | 15 (7.9) | |
Afternoon snack, n (%) | 215 (47.9) | 158 (93.5) | 181 (44.4) | 174 (92.1) | |
N weeks | 51 | 33 | 50 | 35 | |
CACFP meal component requirements, n (%) | |||||
Morning snack | 198 (84.6) | 10 (90.9) | 202 (89.0) | 15 (100) | |
Afternoon snack | 175 (81.4) | 153 (96.8) | 161 (89.0) | 169 (97.1) | |
CACFP minimum nutrition standards, n (%) | |||||
N days | 254 | 163 | 247 | 174 | |
Unflavored skim/low-fat milk to 2–5-year-old children | 253 (99.6) | 162 (99.4) | 242 (98.0) | 172 (98.9) | |
At least one serving of whole grains per day | 76 (29.9) | 27 (16.6) | 67 (27.3) | 58 (33.3) | |
Limit 100% fruit/vegetable juice to one serving per day | 237 (93.3) | 162 (99.4) | 233 (94.3) | 174 (100) | |
No grain-based dessert | 220 (86.6) | 133 (81.6) | 224 (90.7) | 166 (95.4) | |
Mean total number of minimum standards met per day, SD | 3.1 (0.7) | 3.0 (0.6) | 3.1 (0.7) | 3.3 (0.6) | |
CACFP best practices, n (%) | |||||
Morning snacks, n | 234 | 11 | 227 | 15 | |
Fruit or vegetable as 1 of 2 components, n (%) | 139 (59.4) | 7 (63.6) | 140 (61.7) | 11 (73.3) | |
Afternoon snacks, n | 215 | 158 | 181 | 174 | |
Fruit or vegetable as 1 of 2 components, n (%) | 149 (69.3) | 96 (60.8) | 120 (66.3) | 96 (55.2) | |
Day service, n | 254 | 163 | 247 | 174 | |
Whole fruit served more often than juice, n (%) | 106 (41.7) | 59 (36.2) | 118 (47.8) | 72 (41.4) | |
≥2 servings of whole grains per day, n (%) | 7 (2.8) | 2 (1.2) | 6 (2.4) | 1 (0.6) | |
Weeks, n | 51 | 33 | 50 | 35 | |
Dark green vegetables at least once per week, n (%) | 3 (5.9) | 1 (3.0) | 3 (6.0) | 1 (2.9) | |
Red and orange, n (%) vegetables at least once per week, n (%) | 19 (37.3) | 4 (12.1) | 13 (26.0) | 5 (14.3) | |
Bean and peas at least once per week, n (%) | 17 (33.3) | 5 (15.2) | 17 (34.0) | 6 (17.1) | |
Starchy vegetables at least once per week, n (%) | 3 (5.9) | 0 (0.0) | 1 (2.0) | 1 (2.9) | |
Other vegetables at least once per week, n (%) | 20 (39.2) | 10 (30.3) | 25 (50.0) | 14 (40.0) | |
Processed meats one serving per week or less, n (%) | 51 (100) | 33 (100) | 50 (100) | 35 (100) | |
Pre-fried meats one serving per week or less, n (%) | 51 (100) | 33 (100) | 50 (100) | 35 (100) | |
Natural cheese only, n (%) | 4 (11.8) | 5 (21.7) | 13 (44.8) | 13 (50.0) | |
Lean meats, nuts, and legumes only, n (%) | 21 (95.5) | 11 (100) | 21 (95.5) | 10 (100) | |
No non-creditable foods with added sugars, including candy, sugary drinks, n (%) | 30 (58.8) | 32 (97.0) | 38 (76.0) | 33 (94.3) | |
Mean total number of best practices met per week, SD | 4.7 (2.1) | 4.3 (1.5) | 5.1 (1.6) | 4.5 (1.4) |
2016 (Pre-Update) vs. 2019 (Post-Update) | CACFP vs. Non CACFP | Interaction between 2019 to 2016 and CACFP Status | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | |
CACFP minimum nutrition standards | ||||||||||
Unflavored skim/low-fat milk to 2–5-year-old children | 838 | 0.16 | 0.005, 5.2 | 0.30 | 2.40 | 0.0005, 11,895 | 0.84 | 3.06 | 0.11, 86.5 | 0.51 |
At least one serving of whole grains per day | 838 | 0.87 | 0.58, 1.3 | 0.52 | 0.49 | 0.29, 0.85 | 0.01 | 2.62 | 1.2, 5.5 | 0.01 |
No grain-based dessert | 838 | 1.47 | 0.87, 2.5 | 0.15 | 0.69 | 0.43, 1.1 | 0.13 | 3.12 | 1.2, 7.9 | 0.02 |
Best practice standards | ||||||||||
Morning snack: Fruit or vegetable as 1 of 2 components | 487 | 1.11 | 0.72, 1.70 | 0.65 | 1.02 | 0.19, 5.6 | 0.98 | 1.39 | 0.16, 12.1 | 0.76 |
Afternoon snack: Fruit or vegetable as 1 of 2 components | 728 | 0.86 | 0.58, 1.3 | 0.48 | 0.70 | 0.40, 1.2 | 0.20 | 0.91 | 0.50, 1.6 | 0.75 |
Whole fruit served more often than juice | 838 | 1.24 | 0.84, 1.8 | 0.28 | 0.81 | 0.46, 1.4 | 0.46 | 0.91 | 0.49, 1.7 | 0.77 |
At least 2 servings of whole grains per day | 838 | 0.87 | 0.29, 2.6 | 0.80 | 0.38 | 0.07, 2.0 | 0.26 | 0.54 | 0.03, 8.9 | 0.66 |
Dark green vegetables at least once per week | 169 | 1.01 | 0.23, 4.5 | 0.99 | 0.40 | 0.02, 7.4 | 0.54 | 0.97 | 0.22, 4.3 | 0.94 |
Red and orange vegetables at least once per week | 169 | 0.59 | 0.27, 1.3 | 0.18 | 0.23 | 0.07, 0.77 | 0.02 | 2.00 | 0.43, 9.2 | 0.38 |
Bean and peas at least once per week | 169 | 0.98 | 0.51, 1.9 | 0.96 | 0.30 | 0.10, 0.94 | 0.04 | 1.23 | 0.36, 4.2 | 0.74 |
Other vegetables at least once per week | 169 | 1.51 | 0.90, 2.5 | 0.12 | 0.68 | 0.26, 1.7 | 0.42 | 0.93 | 0.29, 3.0 | 0.90 |
Natural cheese only | 169 | 6.10 | 1.6, 22.6 | 0.007 | 2.07 | 0.49, 8.8 | 0.32 | 0.60 | 0.10, 3.6 | 0.58 |
No non-creditable foods with added sugars, including candy, sugary drinks | 169 | 2.13 | 1.0, 4.3 | 0.04 | 30.5 | 2.6, 352.9 | 0.006 | 0.23 | 0.01, 3.9 | 0.31 |
References
- GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016, 388, 1659–1724. [Google Scholar] [CrossRef]
- Savage, J.S.; Fisher, J.O.; Birch, L.L. Parental Influence on Eating Behavior: Conception to Adolescence. J. Law Med. Ethic. 2007, 35, 22–34. [Google Scholar] [CrossRef] [PubMed]
- U.S. Department of Health and Human Services. 2015–2020 Dietary Guidelines for Americans. 2015. Available online: https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015 (accessed on 1 August 2022).
- Welker, E.B.; Jacquier, E.F.; Catellier, D.J.; Anater, A.S.; Story, M.T. Room for Improvement Remains in Food Consumption Patterns of Young Children Aged 2–4 Years. J. Nutr. 2018, 148, 1536S–1546S. [Google Scholar] [CrossRef] [PubMed]
- de Brey, C.; Snyder, T.D.; Zhang, A.; Dillow, S.A. Digest of Education Statistics 2019; NCES 2021-009; National Center for Education Statistics: Washington, DC, USA, 2021.
- American Academy of Pedatrics; American Public Health Association; National Resource Center for Health and Safety in Child Care and Early Education. Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition. 2012. Available online: https://nrckids.org/CFOC/Childhood_Obesity (accessed on 1 August 2022).
- Kaphingst, K.M.; Story, M. Child care as an untapped setting for obesity prevention: State child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States. Prev. Chronic. Dis. 2009, 6, A11. [Google Scholar]
- Reynolds, M.A.; Cotwright, C.J.; Polhamus, B.; Gertel-Rosenberg, A.; Chang, D. Obesity Prevention in the Early Care and Education Setting: Successful Initiatives across a Spectrum of Opportunities. J. Law Med. Ethic. 2013, 41, 8–18. [Google Scholar] [CrossRef]
- United States Department of Agriculture, Food and Nutrition Service. Child and Adult Care Food Program (CACFP), Participation. 2018. Available online: https://fns-prod.azureedge.us/sites/default/files/resource-files/12ccfypart-9.pdf (accessed on 11 August 2022).
- Murphy, S.P.; Yaktine, A.L.; Suitor, W.; Moats, S. Child and Adult Care Food Program: Aligning Dietary Guidance for All; National Academies Press: Washington, DC, USA, 2010. [Google Scholar]
- Ritchie, L.D.; Boyle, M.; Chandran, K.; Spector, P.; Whaley, S.E.; James, P.; Samuels, S.; Hecht, K.; Crawford, P. Participation in the Child and Adult Care Food Program Is Associated with More Nutritious Foods and Beverages in Child Care. Child. Obes. 2012, 8, 224–229. [Google Scholar] [CrossRef]
- Korenman, S.; Abner, K.S.; Kaestner, R.; Gordon, R.A. The Child and Adult Care Food Program and the nutrition of preschoolers. Early Child. Res. Q. 2013, 28, 325–336. [Google Scholar] [CrossRef]
- Andreyeva, T.; Kenney, E.L.; O’Connell, M.; Sun, X.; Henderson, K.E. Predictors of Nutrition Quality in Early Child Education Settings in Connecticut. J. Nutr. Educ. Behav. 2018, 50, 458–467. [Google Scholar] [CrossRef]
- Erinosho, T.; Vaughn, A.; Hales, D.; Mazzucca, S.; Gizlice, Z.; Ward, D. Participation in the Child and Adult Care Food Program Is Associated with Healthier Nutrition Environments at Family Child Care Homes in Mississippi. J. Nutr. Educ. Behav. 2018, 50, 441–450. [Google Scholar] [CrossRef]
- Liu, S.T.; Graffagino, C.L.; Leser, K.A.; Trombetta, A.L.; Pirie, P.L. Obesity Prevention Practices and Policies in Child Care Settings Enrolled and Not Enrolled in the Child and Adult Care Food Program. Matern. Child Health J. 2016, 20, 1933–1939. [Google Scholar] [CrossRef]
- Glenn, M.E.; Patlan, K.; Connor, P.; Stidsen, C.; Ball, S.; Peterson, K.E.; Olsho, L.E.; Gola, A.A.H.; Copeland, K.A. Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days. J. Acad. Nutr. Diet. 2022, 122, 1141–1157.e3. [Google Scholar] [CrossRef] [PubMed]
- United States Department of Agriculture. Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010; United States Department of Agriculture: Washington, DC, USA, 2015.
- Chriqui, J.F.; Leider, J.; Schermbeck, R.M.; Sanghera, A.; Pugach, O. Changes in Child and Adult Care Food Program (CACFP) Practices at Participating Childcare and Education Centers in the United States Following Updated National Standards, 2017–2019. Nutrients 2020, 12, 2818. [Google Scholar]
- Kenney, E.L.; Poole, M.K.; Cory, H.; Cradock, A.L. Impact of changes to the Child and Adult Care Food Program on children’s dietary intake in family child care homes. Public Heal. Nutr. 2020, 23, 2016–2023. [Google Scholar] [CrossRef] [PubMed]
- Sisson, S.B.; Sleet, K.; Rickman, R.; Love, C.; Bledsoe, A.; Williams, M.; Jernigan, V.B.B. Impact of the 2017 Child and Adult Care Food Program Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The Food Resource Equity and Sustainability for Health Study. Curr. Dev. Nutr. 2020, 4, 12–22. [Google Scholar] [CrossRef] [PubMed]
- Andreyeva, T.; Sun, X.; Cannon, M.; Kenney, E.L. Implementation of Minimum Nutrition Standards and Best Practices in Childcare Centers. J. Acad. Nutr. Diet. 2021, 121, 2454–2463. [Google Scholar] [CrossRef]
- Dave, J.M.; Cullen, K.W. Foods Served in Child Care Facilities Participating in the Child and Adult Care Food Program: Menu Match and Agreement with the New Meal Patterns and Best Practices. J. Nutr. Educ. Behav. 2018, 50, 582–588. [Google Scholar] [CrossRef]
- Williams, B.D.; Sisson, S.B.; Stinner, E.L.; Hetrick, H.N.; Dunlap, M.; Graef-Downard, J.; Eliot, K.; Finnell, K.; Salvatore, A.L. Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes. Nutrients 2021, 13, 4483. [Google Scholar] [CrossRef]
- Andreyeva, T.; Henderson, K.E. Center-Reported Adherence to Nutrition Standards of the Child and Adult Care Food Program. Child. Obes. 2018, 14, 421–428. [Google Scholar] [CrossRef]
- United States Census Bureau. 2013–2017 American Community Survey 5-Year Estimates. 2017. Available online: https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2017/5-year.html (accessed on 1 August 2022).
- Poole, M.K.; Cradock, A.L.; Kenney, E.L. Changes in Foods Served and Meal Costs in Boston Family Child Care Homes after One Year of Implementing the New Child and Adult Care Food Program Nutrition Standards. Nutrients 2020, 12, 2817. [Google Scholar] [CrossRef]
- Gurzo, K.; Lee, D.L.; Ritchie, K.; Yoshida, S.; Vitale, E.H.; Hecht, K.; Ritchie, L.D. Child Care Sites Participating in the Federal Child and Adult Care Food Program Provide More Nutritious Foods and Beverages. J. Nutr. Educ. Behav. 2020, 52, 697–704. [Google Scholar] [CrossRef]
- Department of Agriculture, Food and Nutrition Service. National School Lunch Program and School Breakfast Program: Nutrition standards for all foods sold in school as required by the Healthy, Hunger-Free Kids Act of 2010. Fed. Regist. 2016, 81, 50131–50151. [Google Scholar]
- Stallings, V.A.; Suitor, C.W.; Taylor, C.L. School Meals: Building Blocks for Healthy Children; National Academies Press: Washington, DC, USA, 2010. [Google Scholar]
- Schwartz, C.; Wootan, M.G. How a Public Health Goal Became a National Law: The Healthy, Hunger-Free Kids Act of 2010. Nutr. Today 2019, 54, 67–77. [Google Scholar] [CrossRef] [PubMed]
- FACT SHEET: Healthy, Hunger-Free Kids Act School Meals Implementation; United States Department of Agriculture Food and Nutrition Service: Washington, DC, USA, 2014.
- Kinderknecht, K.; Harris, C.; Jones-Smith, J. Association of the Healthy, Hunger-Free Kids Act with Dietary Quality Among Children in the US National School Lunch Program. JAMA 2020, 324, 359–368. [Google Scholar] [CrossRef] [PubMed]
- Johnson, D.B.; Podrabsky, M.; Rocha, A.; Otten, J.J. Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates. JAMA Pediatr. 2016, 170, e153918. [Google Scholar] [CrossRef]
- Kenney, E.L.; Barrett, J.L.; Bleich, S.N.; Ward, Z.J.; Cradock, A.L.; Gortmaker, S.L. Impact of the Healthy, Hunger-Free Kids Act on Obesity Trends. Health Aff. 2020, 39, 1122–1129. [Google Scholar] [CrossRef] [PubMed]
- Richardson, A.S.; Weden, M.M.; Cabreros, I.; Datar, A. Association of the Healthy, Hunger-Free Kids Act of 2010 With Body Mass Trajectories of Children in Low-Income Families. JAMA Netw. Open 2022, 5, e2210480. [Google Scholar] [CrossRef] [PubMed]
Non-CACFP Centers (n = 55) | CACFP Centers (n = 37) | p-value 3 | |
---|---|---|---|
Meal and/or snack served, n (%): | <0.001 | ||
Meal only or meal and snack served | 18 (32.7) | 37 (100) | |
Snack only served | 37 (67.3) | 0 (0.0) | |
Accreditations, n (%): | |||
Center accredited by the National Association for the Education of Young Children (NAEYC) | 30 (54.6) | 37 (100) | <0.001 |
Center has School Readiness program slots available | 8 (15.1) | 30 (81.1) | <0.001 |
Center has a sponsoring organization, n (%) 1 | 12 (21.8) | 13 (39.4) | 0.08 |
Center capacity, mean (SD) | 88.4 (60.1) | 117.9 (94.3) | 0.10 |
Weekly tuition, mean (SD) 2 | USD 262.4 (78.7) | USD 210.2 (57.9) | 0.003 |
Meal preparation, n (%): | <0.001 | ||
Kitchen on site from scratch | 11 (20.0) | 19 (51.4) | |
Kitchen of another center and delivered | 0 (100) | 0 (100) | |
Purchased from a vendor and heat up on site | 5 (9.1) | 5 (13.5) | |
Purchased from a vendor and do not heat up | 8 (14.6) | 7 (18.9) | |
Other | 31 (56.4) | 6 (16.2) | |
Kitchen and equipment, n (%): | 0.003 | ||
Full kitchen on site | 25 (45.5) | 24 (62.2) | |
Partial kitchen on site (fridge/freezer alone) | 21 (38.2) | 10 (27.0) | |
Microwaves in the classroom | 15 (27.3) | 1 (2.7) | |
No cooking equipment on site | 4 (7.3) | 1 (2.7) | |
Sociodemographic characteristics of center’s Census tract, mean (SD): | |||
Median household income | USD 98,717 (USD 43,852) | USD 52,255 (USD 24,791) | <0.001 |
Percent of population with college degree | 47.1 (16.4) | 28.6 (21.4) | <0.001 |
Percent of households below poverty level | 6.4 (6.2) | 21.2 (13.7) | <0.001 |
Percent of population that is non-Hispanic White | 78.8 (12.9) | 47.2 (28.9) | <0.001 |
2016 (Old CACFP Meal Pattern) | 2019 (New CACFP Meal Pattern) | |||
---|---|---|---|---|
Non-CACFP Centers | CACFP Centers | Non-CACFP Centers | CACFP Centers | |
N menu days | 90 | 179 | 89 | 185 |
N meals and snacks | 246 | 492 | 232 | 544 |
Breakfast, n (%) | 35 (14.2) | 159 (32.3) | 54 (23.3) | 175 (32.2) |
Lunch, n (%) | 86 (35.0) | 174 (35.4) | 80 (34.5) | 180 (33.1) |
Snack (a.m./p.m.), n (%) | 125 (50.8) | 159 (32.3) | 98 (42.2) | 189 (34.7) |
Meeting CACFP meal component requirements, n (%) of meals 1 | ||||
Breakfasts | 30 (85.7) | 153 (96.2) | 40 (74.1) | 159 (90.9) |
Lunches | 57 (66.3) | 149 (85.6) | 50 (62.5) | 163 (90.6) |
Snacks | 112 (89.6) | 154 (96.8) | 81 (82.7) | 184 (97.4) |
Meeting CACFP minimum nutrition standards, n (%) of days | ||||
Fruit and vegetables as 2 components at lunch | 66 (76.7) | 161 (92.5) | 64 (80.0) | 164 (91.1) |
Unflavored skim/low-fat milk to 2–5-year-old children | 84 (93.3) | 178 (99.4) | 84 (94.4) | 183 (98.9) |
≥1 serving of whole grains per day | 35 (38.9) | 110 (61.5) | 49 (55.1) | 160 (86.5) |
Limit 100% fruit/vegetable juice to 1 serving per day | 84 (93.3) | 173 (96.7) | 89 (100) | 184 (99.5) |
No grain-based desserts served | 78 (86.7) | 150 (83.8) | 86 (96.6) | 177 (95.7) |
Mean (SD) total number of minimum standards met per day | 4.1 (0.8) | 4.4 (0.7) | 4.4 (0.7) | 4.9 (0.6) |
Following CACFP voluntary best practices, n (%) of snacks, days, and weeks | ||||
Meal-level best practices | ||||
Fruit or vegetable as 1 of 2 components at snack | 93 (74.4) | 95 (61.6) | 61 (62.2) | 107 (56.6) |
Daily best practices | ||||
Whole fruit served more often than juice | 59 (65.6) | 156 (87.2) | 78 (87.6) | 168 (90.8) |
≥2 servings of whole grains per day | 13 (14.4) | 50 (27.9) | 27 (30.3) | 101 (54.6) |
Weekly best practices | ||||
Dark green vegetables ≥ 1 time/week | 11 (61.1) | 25 (69.4) | 10 (55.6) | 27 (73.0) |
Red and orange vegetables ≥ 1 time/week | 14 (77.8) | 33 (91.7) | 15 (83.3) | 32 (86.5) |
Bean and peas ≥ 1 time/week | 11 (61.1) | 13 (36.1) | 10 (55.6) | 20 (54.1) |
Starchy vegetables ≥ 1 time/week | 13 (72.2) | 27 (75.0) | 14 (77.8) | 29 (78.4) |
Other vegetables ≥ 1 time/week | 18 (100) | 34 (94.4) | 17 (94.4) | 36 (97.3) |
Processed meats ≤ 1 time/week | 15 (83.3) | 28 (77.8) | 15 (83.3) | 37 (100) |
Pre-fried meats ≤ 1 time/week | 18 (100) | 28 (77.8) | 15 (83.3) | 36 (97.3) |
Natural cheese only | 0 (0.0) | 0 (0.0) | 1 (5.9) | 3 (8.6) |
Only lean meats, nuts, and legumes served for meat/meat alternates | 4 (22.2) | 3 (8.3) | 3 (17.7) | 3 (8.3) |
No non-creditable foods with added sugars served | 7 (38.9) | 25 (69.4) | 10 (55.6) | 23 (62.2) |
Mean (SD) total number of best practices followed per week | 7.3 (1.6) | 6.9 (1.5) | 7.2 (1.5) | 7.6 (1.5) |
2019 (Post-Update) vs. 2016 (Pre-Update) | CACFP vs. Non CACFP | Interaction between 2019 to 2016 and CACFP Status | |||||||
---|---|---|---|---|---|---|---|---|---|
Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | |
CACFP minimum nutrition standards | |||||||||
Fruit and vegetables as 2 components at lunch | 1.09 | 0.38, 3.1 | 0.88 | 4.42 | 1.25, 15.5 | 0.02 | 0.78 | 0.20, 3.04 | 0.72 |
Unflavored skim/low fat milk to 2–5-year-old children | 0.76 | 0.13, 4.3 | 0.75 | 13.0 | 0.98 172.2 | 0.05 | 0.66 | 0.12, 3.71 | 0.64 |
At least one serving of whole grains per day | 1.97 | 0.98, 4.0 | 0.06 | 2.72 | 1.3, 5.9 | 0.01 | 2.02 | 0.75, 5.4 | 0.17 |
No grain-based dessert | 4.40 | 1.2, 16.2 | 0.03 | 0.80 | 0.42, 1.5 | 0.49 | 0.97 | 0.22, 4.4 | 0.97 |
Best Practice Standards | |||||||||
Fruit or vegetable as 1 of 2 components at snack | 0.41 | 0.12, 1.46 | 0.17 | 0.19 | 0.08, 0.50 | <0.001 | 2.27 | 0.59, 8.82 | 0.23 |
Whole fruit served more often than juice | 4.23 | 1.5, 11.6 | 0.005 | 4.82 | 1.4, 16.2 | 0.01 | 0.34 | 0.10, 1.15 | 0.08 |
At least 2 servings of whole grains per day | 2.77 | 1.0, 7.7 | 0.05 | 2.53 | 0.80, 8.0 | 0.11 | 1.14 | 0.35, 3.71 | 0.82 |
Dark green vegetables at least once per week | 0.79 | 0.27, 2.3 | 0.66 | 1.58 | 0.47, 5.27 | 0.46 | 1.5 | 0.38, 6.0 | 0.56 |
Red and orange vegetables at least once per week | 1.50 | 0.29, 7.9 | 0.63 | 4.33 | 0.82, 22.8 | 0.08 | 0.97 | 0.04, 3.29 | 0.38 |
Bean and peas at least once per week | 0.77 | 0.32, 1.83 | 0.55 | 0.36 | 0.11, 1.2 | 0.10 | 2.97 | 0.92, 9.6 | 0.07 |
Starchy vegetables at least once per week | 1.50 | 0.64, 3.5 | 0.35 | 1.26 | 0.36, 4.4 | 0.72 | 0.80 | 0.21, 3.0 | 0.73 |
Lean meats, nuts, and legumes only | 0.71 | 0.20, 2.5 | 0.60 | 0.31 | 0.06, 1.6 | 0.16 | 1.41 | 0.27, 7.2 | 0.68 |
No non-creditable foods with added sugars, including candy, sugary drinks | 1.99 | 0.61, 6.5 | 0.26 | 3.50 | 1.1, 11.3 | 0.04 | 0.36 | 0.09, 1.4 | 0.14 |
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Andreyeva, T.; Mozaffarian, R.S.; Kenney, E.L. Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study. Nutrients 2022, 14, 3786. https://doi.org/10.3390/nu14183786
Andreyeva T, Mozaffarian RS, Kenney EL. Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study. Nutrients. 2022; 14(18):3786. https://doi.org/10.3390/nu14183786
Chicago/Turabian StyleAndreyeva, Tatiana, Rebecca S. Mozaffarian, and Erica L. Kenney. 2022. "Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study" Nutrients 14, no. 18: 3786. https://doi.org/10.3390/nu14183786