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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions

Virginia A. Stallings and Christine L. Taylor, Editors

Committee on Nutrition Standards for National School Lunch and Breakfast Programs

Food and Nutrition Board

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions Virginia A. Stallings and Christine L. Taylor, Editors Committee on Nutrition Standards for National School Lunch and Breakfast Programs Food and Nutrition Board

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. AG-3198-C-08-0001 between the National Academy of Sciences and the U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-12795-0 International Standard Book Number-10: 0-309-12795-5 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2008 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2008. Nutrition Standards and Meal Requirements for National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending Revisions. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON NUTRITION STANDARDS FOR NATIONAL SCHOOL LUNCH AND BREAKFAST PROGRAMS VIRGINIA A. STALLINGS (Chair), The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia KAREN WEBER CULLEN, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX ROSEMARY DEDERICHS, Minneapolis Public Schools, Special School District No. 1, Minneapolis, MN MARY KAY FOX, Mathematica Policy Research, Inc., Cambridge, MA LISA HARNACK, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis GAIL HARRISON, School of Public Health, Center for Health Policy Research, University of California, Los Angeles MARY ARLINDA HILL, Jackson Public Schools, Jackson, MS HELEN H. JENSEN, Department of Economics, Iowa State University, Ames RONALD E. KLEINMAN, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA GEORGE P. McCABE, College of Science, Purdue University, West Lafayette, IN SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu ANGELA ODOMS-YOUNG, Department of Kinesiology and Nutrition, University of Illinois at Chicago YEONHWA PARK, Department of Food Science, University of Massachusetts, Amherst MARY JO TUCKWELL, inTEAM Associates, Eau Claire, WI Study Staff CHRISTINE TAYLOR, Study Director SHEILA MOATS, Associate Program Officer JULIA HOGLUND, Research Associate SANDRA AMAMOO-KAKRA, Program Associate (until August 2008) HEATHER BREINER, Program Associate (from August 2008) CAROL WEST SUITOR, Consultant Writer LINDA D. MEYERS, Food and Nutrition Board Director v

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FOOD AND NUTRITION BOARD * DENNIS M. BIER (Chair), Children’s Nutrition Research Center, Houston, TX MICHAEL P. DOYLE (Vice Chair), Center for Food Safety, University of Georgia, Griffin DIANE BIRT, Department of Food Science and Human Nutrition, Iowa State University, Ames YVONNE BRONNER, School of Public Health and Policy, Morgan State University, Baltimore, MD FERGUS M. CLYDESDALE, Department of Food Science, University of Massachusetts, Amherst RICHARD J. DECKELBAUM, Institute of Human Nutrition, Columbia University, New York, NY GORDON L. JENSEN, Department of Nutritional Sciences, Pennsylvania State University, University Park REYNALDO MARTORELL, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA SUSAN T. MAYNE, Division of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven, CT SANFORD A. MILLER, Center for Food, Nutrition, and Agriculture Policy, University of Maryland, College Park J. GLENN MORRIS, JR., Emerging Pathogens Institute, University of Florida, Gainesville SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu JOSE M. ORDOVAS, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA MARTIN A. PHILBERT, School of Public Health, University of Michigan, Ann Arbor JIM E. RIVIERE, Center for Chemical Toxicology Research and Pharmacokinetics, North Carolina State University, Raleigh PATRICK J. STOVER, Division of Nutritional Sciences, Cornell University, Ithaca, NY WALTER C. WILLETT, Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA Staff LINDA D. MEYERS, Director GERALDINE KENNEDO, Administrative Assistant ANTON L. BANDY, Financial Associate * IOM Boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the report rests with the authoring committee and the institution. vi

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: George H. Beaton, Department of Nutritional Sciences, University of Toronto Marilyn Briggs, Center for Integrative Nutrition Environments in School Communities, Department of Nutrition, University of California, Davis Roger Clemens, University of Southern California School of Pharmacy Barbara L. Devaney, Human Services Research, Mathematica Policy Research, Inc. Jean Harris, Government Relations, Pierre Foods Penny E. McConnell, Food and Nutrition Services, Fairfax County Public Schools, Fairfax, VA Rodolfo M. Nayga, Jr., Department of Agricultural Economics, Texas A&M University Barry Sackin, B. Sackin & Associates, L.L.C., Alexandria, VA Sandra Schlicker, Wellness and Nutrition Services, Office of the State Superintendent of Education, Government of the District of Columbia Frances H. Seligson, Nutrition Consultant, Hershey, PA Walter Willett, Department of Nutrition, Harvard School of Public Health Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Elaine L. Larson, School of Nursing, Columbia University, and Johanna T. Dwyer, Tufts University School of Medicine & Friedman School of Nutrition Science & Policy, Frances Stern Nutrition Center, Tufts-New England Medical Center. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. vii

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Contents Summary 1 Chapter 1 Introduction 15 Overview: Programs and Participants, 16 Why Is There a Need for Updating and Revisions?, 24 The Committee’s Task, 28 Relevant Findings from Large-Scale Evaluations of School Meal Programs, 30 Implications, 33 Chapter 2 The Nutrition Standards and Meal Requirements: Description and Topics Relevant to Their Revision 35 Current Nutrition Standards and Meal Requirements, 35 Topics Relevant to Revising the Nutrition Standards and Meal Requirements, 47 Summary, 54 Chapter 3 Working Principles and Criteria for the Committee’s Approach to Proposing Revisions 55 Working Principles, 55 Criteria, 57 Overview of the Committee’s Proposed Approach to Developing Recommendations, 59 Chapter 4 Food and Nutrient Needs of Schoolchildren 61 Data Sources, 61 Data Limitations, 63 Assessment of Food Intakes, 65 Assessment of Nutrient Intakes, 72 Summary and Conclusions, 86 Chapter 5 Proposed Planning Model for Establishing Nutrition 89 Standards for School Meals Setting Nutrient Intake Targets for School Meals, 91 Setting Food Intake Targets for School Meals, 101 Summary: Combining the Nutrient Intake and Food Intake Targets, 103 Chapter 6 Proposed Phase II Analyses: Sensitivity Analysis, Cost Implications, and Market Effects 105 Sensitivity Analysis, 105 Addressing Cost Implications, 106 viii

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Estimation of Market Effects, 112 Summary, 113 Chapter 7 References 115 Appendixes A Acronyms, Abbreviations, and Glossary 125 B A Selection of Laws and Regulations Governing the National School Lunch Program and School Breakfast Program 131 C Comparison of 1995 and 2005 Dietary Guidelines for Americans 135 D July 2008 Workshop Agenda 139 E Critical Issues for Consideration by the Committee 143 F Selected Evaluations of School Meal Programs 149 G Current Standards for Food-Based Menu Planning Approach 153 H Current Standards for Nutrient-Based Menu Planning Approach 159 I Data Sources and Study Methodology: SNDA-III and 2008 Diet Quality Report 161 J MyPyramid Calorie Levels and Food Intake Patterns 165 K Dietary Reference Intakes for Individuals Ages 4 Through 18 Years, Including Those Who Are Pregnant or Lactating 167 L MyPyramid Food Intake Pattern Compared with Meal Requirements for the NSLP 175 M Estimation of Cost of Food for One Week’s Menu: Example for Elementary School Level 177 ix

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