Importance The Healthy, Hunger-Free Kids Act of 2010, implemented nationwide in 2012, was intended to improve the nutritional quality of meals served in the National School Lunch Program (NSLP). Objective To assess whether there was an association between the Healthy, Hunger-Free Kids Act of 2010 and dietary quality of lunch for students participating in the NSLP, stratified by income. Design, Setting, Participants Serial cross-sectional study design, using National Health and Nutrition Examination Survey (NHANES) data from 2007-2008, 2009-2010, 2013-2014, and 2015-2016, of students who were surveyed in the NHANES and were attending schools participating in the NSLP. Individuals who were aged 5 to 18 years, in kindergarten through 12th grade, enrolled in a school that served school lunch, and had a reliable weekday dietary recall were included. Exposures The Healthy, Hunger-Free Kids Act of 2010 (prepolicy period: 2007-2010; postpolicy period: 2013-2016), with participation in the NSLP estimated based on an algorithm. Main Outcomes and Measures The primary outcome was dietary quality of intake for lunch, measured by the Healthy Eating Index-2010 (HEI-2010) score (range, 0-100; 0 indicates a diet with no adherence to the 2010 Dietary Guidelines for Americans and 100 indicates a diet with complete adherence to the guidelines). Results Among 6389 students included in the surveys (mean age, 11.7 [95% CI, 11.6-11.9] years; 3145 [50%] female students; 1880 [56%] were non-Hispanic white), 32% were low-income, 12% were low-middle-income, and 56% were middle-high-income students. A total of 2472 (39%) were participants in the NSLP. Among low-income students, the adjusted mean prepolicy HEI-2010 score was 42.7 and the postpolicy score was 54.6 among NSLP participants and the adjusted mean prepolicy score was 34.8 and postpolicy score was 34.1 among NSLP nonparticipants (difference in differences, 12.6 [95% CI, 8.9-16.3]). Among low-middle-income students, the adjusted mean prepolicy HEI-2010 score was 40.4 and postpolicy score was 54.8 among NSLP participants and the adjusted mean prepolicy score was 34.2 and postpolicy score was 36.1 among NSLP nonparticipants (difference in differences, 12.4 [95% CI, 4.9-19.9]). Among middle-high-income students, the adjusted mean HEI-2010 prepolicy score was 42.7 and postpolicy score 55.5 for NSLP participants and the adjusted mean prepolicy score was 38.9 and prepolicy score was 43.6 for NSLP nonparticipants (difference in differences, 8.1 [95% CI, 4.2-12.0]). Conclusions and Relevance In a serial cross-sectional study of students, the Healthy, Hunger-Free Kids Act of 2010 was associated with better changes in dietary quality for lunch among presumed low-income, low-middle-income, and middle-high-income participants in the NSLP compared with nonparticipants.

中文翻译：

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健康、无饥饿儿童协会在美国全国学校午餐计划中的儿童饮食质量方面采取行动

重要性 2010 年《健康、无饥饿儿童法案》于 2012 年在全国范围内实施，旨在提高国家学校午餐计划 (NSLP) 中膳食的营养质量。目的 评估 2010 年《健康、无饥饿儿童法案》与参加 NSLP 的学生的午餐膳食质量（按收入分层）之间是否存在关联。设计、设置、参与者 连续横断面研究设计，使用 2007-2008 年、2009-2010 年、2013-2014 年和 2015-2016 年国家健康和营养检查调查 (NHANES) 数据，对象为接受 NHANES 调查的学生，以及正在参加 NSLP 的学校就读。年龄在 5 岁至 18 岁之间、从幼儿园到 12 年级、就读于提供学校午餐的学校、并具有可靠的工作日饮食回忆的个人均被纳入其中。曝光 2010 年《健康、无饥饿儿童法案》（政策前时期：2007-2010 年；政策后时期：2013-2016 年），以及根据算法估计的 NSLP 参与情况。主要结果和措施 主要结果是午餐摄入量的膳食质量，通过 2010 年健康饮食指数 (HEI-2010) 评分（范围 0-100；0 表示饮食不符合 2010 年美国人膳食指南100表示​​完全遵守指南的饮食）。结果 在参与调查的 6389 名学生中（平均年龄，11.7 [95% CI，11.6-11.9] 岁；3145 名 [50%] 女学生；1880 名 [56%] 为非西班牙裔白人），32% 为低收入家庭，12%为中低收入学生，56%为中高收入学生。NSLP 的参与者共有 2472 人（39%）。在低收入学生中，NSLP 参与者的调整后平均保单前 HEI-2010 分数为 42.7，保单后分数为 54.6，NSLP 非参与者中调整后平均保单前分数为 34.8，保单后分数为 34.1（差异中的差异，12.6 [95%] CI，8.9-16.3]）。在中低收入学生中，NSLP 参与者的调整后平均保单前 HEI-2010 分数为 40.4，保单后分数为 54.8；NSLP 非参与者中调整后平均保单前分数为 34.2，保单后分数为 36.1（差异中的差异，12.4 [95] % CI，4.9-19.9]）。在中高收入学生中，NSLP 参与者的调整后平均 HEI-2010 政策前得分为 42.7，政策后得分为 55.5，NSLP 未参与者调整后平均政策前得分为 38.9，政策前得分为 43.6（差异中的差异，8.1 [95%] CI，4.2-12.0]）。结论和相关性 在一项针对学生的系列横断面研究中，2010 年《健康、无饥饿儿童法案》与假定的低收入、中低收入和中高收入人群午餐膳食质量的更好变化相关。 NSLP 参与者与非参与者的收入比较。