BACKGROUND In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. OBJECTIVES This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. In addition, this study examines the impact of these standards on nutrients consumed. DESIGN The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Study was an observational cohort study conducted among students from spring 2012 to spring 2013. PARTICIPANTS/SETTING One hundred sixty students in 12 middle schools and high schools in Massachusetts completed two 24-hour recalls before (spring 2012) and after implementation (spring 2013) of the updated standards. MAIN OUTCOME MEASURES Changes in school meals, competitive food, and after-school snack selection, as well as nutrients consumed outside of school were examined. STATISTICAL ANALYSES PERFORMED Logistic regression and mixed-model analysis of variance were used to examine food selection and consumption. RESULTS After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08] vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar daily after implementation compared with before implementation (86 g vs 108 g; P=0.002). CONCLUSIONS With the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school. This provides important new evidence that both national school meal and snack policies may improve daily diet quality and should remain strong.

中文翻译：

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1 年更健康的学校食品政策对学生在校期间和校外饮食的影响

背景 2012 年，马萨诸塞州同时实施了更新的国家学校膳食标准和综合竞争性食品/饮料标准，与当前国家对学校零食的要求密切相关。目标 本研究考察了这些综合标准对学校膳食和休闲食品选择以及校外食品选择的影响。此外，这项研究检查了这些标准对消耗的营养素的影响。设计 NOURISH（了解涉及学生健康的改革的营养机会）研究是一项观察性队列研究，于 2012 年春季至 2013 年春季在学生中进行。参与者/设置 马萨诸塞州 12 所中学和高中的 160 名学生在更新标准实施之前（2012 年春季）和实施后（2013 年春季）完成了两次 24 小时召回。主要结果测量 学校膳食、竞争性食物和课后零食选择的变化，以及在校外消耗的营养素进行了检查。执行的统计分析 Logistic 回归和混合模型方差分析用于检查食物选择和消费。结果 实施后，选择校餐的学生增加了 13.6%（70.1% 对 56.5%；P=0.02）。竞争性食品购买没有差异，但课后不健康零食的消费数量显着减少（0.69 [标准误差 = 0.08] vs 1.02 [标准误差 = 0.10]；P = 0.009）。一整天下来，与实施前相比，实施后学生平均每天消耗的糖减少 22 克（86 克对 108 克；P=0.002）。结论 随着不健康的学校零食数量的减少，明显更多的学生选择了学校膳食。学生并没有通过增加校外不健康零食的消费来弥补校内不健康零食的不足。这提供了重要的新证据，表明国家学校膳食和零食政策可能会改善日常饮食质量，并且应该保持强劲。学生并没有通过增加校外不健康零食的消费来弥补学校不健康零食的不足。这提供了重要的新证据，表明国家学校膳食和零食政策可能会改善日常饮食质量，并且应该保持强劲。学生并没有通过增加校外不健康零食的消费来弥补校内不健康零食的不足。这提供了重要的新证据，表明国家学校膳食和零食政策可能会改善日常饮食质量，并且应该保持强劲。