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Summary

Ensuring that the foods1 provided to children in schools are consistent with current dietary recommendations is an important national focus. The National School Lunch Program (NSLP) and the School Breakfast Program (SBP) hold the potential to provide nearly all the nation’s schoolchildren with access to nutritious, low-cost meals to support their growth, development, and health. The NSLP alone is available in 99 percent of U.S. public schools and in 83 percent of private and public schools. In fiscal year 2007, the participating schools served about 5.1 billion lunches at a federal cost of approximately $8.7 billion. If a school participates in one or both of the school meal programs, any child who attends the school may have access to the school meal.

Various laws and regulations govern the operation of the school meal programs. In 1995, new Nutrition Standards and Meal Requirements were put in place to ensure that the meals offered will be of high nutritional quality. The eight recommendations in this report update those Nutrition Standards and Meal Requirements, shift the focus toward meeting recommendations in Dietary Guidelines for Americans, emphasize the need for effective implementation, and identify key research topics.

Numerous school-based factors, such as other foods offered and nutrition education efforts, ultimately have an impact on the foods that children eat at school. Many are not related to Nutrition Standards and Meal Requirements and, therefore, are beyond the scope of this report. Nonetheless, these standards and requirements provide the starting point for the complex

1

The word foods is meant to encompass both foods and beverages.



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Summary Ensuring that the foods1 provided to children in schools are consistent with current dietary recommendations is an important national focus. The National School Lunch Program (NSLP) and the School Breakfast Program (SBP) hold the potential to provide nearly all the nation’s schoolchildren with access to nutritious, low-cost meals to support their growth, develop- ment, and health. The NSLP alone is available in 99 percent of U.S. public schools and in 83 percent of private and public schools. In fiscal year 2007, the participating schools served about 5.1 billion lunches at a federal cost of approximately $8.7 billion. If a school participates in one or both of the school meal programs, any child who attends the school may have access to the school meal. Various laws and regulations govern the operation of the school meal programs. In 1995, new Nutrition Standards and Meal Requirements were put in place to ensure that the meals offered will be of high nutritional quality. The eight recommendations in this report update those Nutrition Standards and Meal Requirements, shift the focus toward meeting recom- mendations in Dietary Guidelines for Americans, emphasize the need for effective implementation, and identify key research topics. Numerous school-based factors, such as other foods offered and nutri- tion education efforts, ultimately have an impact on the foods that children eat at school. Many are not related to Nutrition Standards and Meal Re- quirements and, therefore, are beyond the scope of this report. Nonetheless, these standards and requirements provide the starting point for the complex 1 The word foods is meant to encompass both foods and beverages. 

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 SCHOOL MEALS journey to improving the diets of a vulnerable and important population group, our children. THE TASK The U.S. Department of Agriculture (USDA) requested that the Institute of Medicine (IOM) provide recommendations to revise the nutrition- and food-related standards and requirements for the NSLP and the SBP. This request relates to the congressional requirement that USDA issue new guid- ance and regulations for the Nutrition Standards and Meal Requirements of the school meal programs. In particular, the committee was asked to review and assess the food and nutritional needs of school-aged children in the United States using the 2005 Dietary Guidelines for Americans and the IOM’s Dietary Reference Intakes (DRIs) and to use that review as a basis for recommended revisions to the NSLP and SBP Nutrition Standards and Meal Requirements. The goal was the development of a set of well-conceived, practical, and eco- nomical recommendations for standards that reflect current nutritional sci- ence, increase the availability of key food groups as appropriate, and allow these two meal programs to better meet the nutritional needs of children, foster healthy eating habits, and safeguard children’s health. Both a Phase I report and a final report were to be prepared. Figure S-1 depicts the current relationships among major elements of the task, focusing on the Nutrition Standards and Meal Requirements. The figure uses a number of the terms that are specific to school meal pro- grams and depicts the two existing approaches to menu planning, one that relies on a food-based approach and one that relies on a nutrient-based approach. In the course of its work, the committee made recommendations that require a change in terminology and a revised approach to menu planning that leads to a less complex set of elements for the planning of school meals (see Figure S-2, and compare it with Figure S-1). In particular, the committee provides recommendations for (1) Nutrient Targets rather than Nutrition Standards and (2) only one method of menu planning rather than several. It uses the phrase as selected by the student rather than as sered to provide clarity. The recommended Nutrient Targets provide the foundation for setting revised Meal Requirements. The recommended Meal Require- ments encompass meal patterns and other specifications for menu planning (the standards for menu planning) and specifications for the number and types of food that the student must select for a reimbursable meal (the standards for meals as selected by the student).

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 SUMMARY NUTRITION STANDARDS • Nutrition Standards —Goals for School Meals— —Foundation of school meals —Established by USDA and “Nutrient Standards” for specified in regulation age-grade groups —“Nutrient Standards” currently reflect required nutrients in calculated quantities for age-grade groups • Meal Requirements implement the Nutrition Standards —Established by USDA and MEAL REQUIREMENTS specified in regulation • Meal Requirements consist of standards for two types of menu Meal Requirements Meal Requirements planning approaches For For Food-Based Nutrient-Based • Menu planning approach is Menu Planning Menu Planning selected by the school food authority and menus are developed at the local level • Meal “as offered” to the student Standards for Standards for must meet the as offered standard Food-Based Nutrient-Based for the menu planning approach Menu Planning Menu Planning • Meal selected by student — “as served” — must meet the as served standard for the menu planning approach Food-Based Nutrient-Based Standards for Standards for Meals as Served Meals as Served by the Student by the Student • Components of child's meal checked by cashier Reimbursability of Meal Established FIGURE S-1 Relationships among current Nutrition Standards, Meal Require- ments, and eligibility for federal reimbursement. THE APPROACH During Phase I of the Figuresthe committee developed four criteria project, S-1 and 1-1 R01592 to guide the development and testing of its recommendations, proposed a vector editable process for addressing its tasks, and prepared the Phase I report for public comment. The final version of the criteria appears in Box S-1.

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 SCHOOL MEALS NUTRIENT TARGETS —Goals for School Meals— MEAL REQUIREMENTS Standards for Menu Standards for Meals as Planning Selected by the Student FIGURE S-2 Depiction of the recommended elements in the path to nutritious school meals. In this figure and throughout the remainder of the report, the com- mittee uses the term as selected by the student (or simply as selected) rather than as sered to apply to standards for reimbursable meals. Figures S-2 and 2-1 R01592 vector editable BOX S-1 Criteria for the Nutrient Targets and Meal Requirements for the National School Lunch Program and the School Breakfast Program Criterion 1. The Nutrient Targets and Meal Requirements will be consistent with current dietary guidance and nutrition recommendations to promote health—as exemplified by the Dietary Guidelines for Americans and the Dietary Reference Intakes—with the ultimate goals of improving children’s diets by reducing the prevalence of inadequate and excessive intakes of food, nutrients, and calories. Criterion 2. The Nutrient Targets and Meal Requirements will be considered on the basis of age-grade groups that are consistent with the current age-gender categories used for specifying reference values and with widely used school grade configurations. Criterion 3. The Nutrient Targets and Meal Requirements will result in the sim- plification of the menu planning and monitoring processes, and they will be com- patible with the development of menus that are practical to prepare and serve and that offer nutritious foods and beverages that appeal to students of diverse cultural backgrounds. Criterion 4. The Nutrient Targets and Meal Requirements will be sensitive to program costs and school administrative concerns.

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 SUMMARY During this second phase of the work, the approach used to develop the recommended Nutrient Targets and Meal Requirements involved • setting age-grade groups, • conducting a new review of schoolchildren’s dietary intakes us- ing data from the third School Nutrition Dietary Assessment study (SNDA-III), • testing methods of setting the Nutrient Targets, • using preliminary targets in developing Meal Requirements, and • checking possible requirements against the four criteria. Extensive analyses provided the foundation for the recommended Nu- trient Targets and Meal Requirements. The process of developing the rec- ommendations was iterative. For example, initial proposals for the Meal Requirements were tested to determine how well they aligned with the committee’s criteria, and the results were used to modify the proposals to achieve a better fit. The final products—the recommended Nutrient Targets and Meal Requirements—are described in detail in the report. NUTRIENT TARGETS Currently, Nutrition Standards provide the basis for nutrient-based menu planning and the monitoring of meal quality every 5 years, but the committee decided that this approach does not necessarily lead to meals that are consistent with the Dietary Guidelines. Furthermore, nutrient- based menu planning is unnecessarily complex if a broad array of nutri- ents is to be considered. Therefore, the committee developed the concept of Nutrient Targets to replace Nutrition Standards. The Nutrient Targets would provide the scientific basis of the standards for menu planning, but they would be only one of the elements considered when developing these standards. Recommended Nutrient Targets Recommendation 1. The Food and Nutrition Service of USDA should adopt the Nutrient Targets as the scientific basis for setting standards for menu planning for school meals but should not adopt a nutrient- based standard for school meal planning and monitoring. To ensure that all nutrient recommendations were considered, the com- mittee set targets for 24 nutrients and other dietary components. Because the Nutrient Targets are intended for developing standards for menu plan- ning that are consistent with the DRIs and not for planning actual menus,

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 SCHOOL MEALS it was desirable to set Nutrient Targets for most nutrients with a DRI. Key aspects of the Nutrient Targets appear below. Calories In contrast to the current standard for calories, which specifies only a minimum calorie level, both minimum and maximum calorie levels for breakfast and lunch are recommended for each age group (5–10 years, kindergarten through grade 5; 11–13 years, grades 6 through 8; and 14–18 years, grades 9 through 12). The recommendations are based on refer- ence growth chart data for healthy weights and heights, objective data on physical activity, and data on how calories are distributed among meals and snacks consumed by schoolchildren. Maximum calorie levels are introduced in part because of concern about the high prevalence of childhood over- weight and obesity in the United States. The recommended calorie levels are either lower or comparable to the existing minimum calorie standard. The meals offer adequate amounts of nutrients, and the level of calories is appropriate for the level of physical activity of most children. Fats and Cholesterol One change was made in setting the targets for fats and cholesterol: the recommended upper limit for total fat was increased from 30 to 35 percent of the calories. This aligns the target with Dietary Guidelines. Although the goal is to eliminate trans fat from school meals, it was not possible to set a specific Nutrient Target for this fat. However, the standards for menu planning set zero grams of trans fat as the amount declared on the label of foods used in school meals. The target for saturated fat, which is less than 10 percent of calories, is unchanged. Protein, Vitamins, and Minerals To set recommended Nutrient Targets for protein and selected vitamins and minerals, the committee used an adaptation of the Target Median In- take (TMI) method. This method, recommended by the IOM, is designed to identify the change in intake of each nutrient that would be likely to reduce the predicted prevalence of inadequacy to a specific level. Because school meals are consumed by subgroups of children with differing calorie and nutrient needs within an age-grade group, the committee considered the ratio of nutrient needs (based on the Estimated Average Requirement or Adequate Intake) relative to the calorie requirements (based on the Esti- mated Energy Requirement) for each subgroup within a school meals age-

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 SUMMARY BOX S-2 Key Aspects of Recommended Nutrient Targets • Nutrient Targets are recommended for use in the development of the stan- dards for menu planning, not for menu planning or for monitoring of the nutritional quality of the meals. • Recommended targets cover both minimum and maximum calorie levels. • The number of specifications increased from 8 requirements to 24 targets for nutrients and other dietary components. grade group. For example, because females ages 14–18 years have higher nutrient requirements relative to their calorie needs than do males of the same age, the School Meal-TMIs for this age group were set based on the needs of the females. This approach results in Nutrient Targets that will meet the needs of more children than would past approaches based on Recommended Dietary Allowances. Even though the targets are relatively high, analyses of pro- jected intakes indicate a low prevalence of intakes that exceed the Tolerable Upper Intake Level for most nutrients. Furthermore, analyses showed that almost all the Nutrient Targets would be met if MyPyramid food patterns, which correspond to the Dietary Guidelines for Americans, are used as the basis of standards for menu planning (see next section). For protein, vitamins, and minerals at lunch, the recommended Nutri- ent Targets are set at 32 percent of the School Meal-TMI. At breakfast, they are set at 21.5 percent of the School Meal-TMI. (For sodium, the target is the corresponding percentage of the Tolerable Upper Intake Level.) Al- though a Nutrient Target has not been set for vitamin D, the standards for menu planning described below ensure that children are offered at least 8 fluid ounces of milk at each meal, which provides one-half of the Adequate Intake for vitamin D at each meal. Key aspects of the recommended Nutrient Targets appear in Box S-2. RECOMMENDED MEAL REQUIREMENTS The Meal Requirements encompass two types of standards: (1) stan- dards for menu planning and (2) standards for meals as selected by the student.

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 SCHOOL MEALS Standards for Menu Planning Recommendation 2. To align school meals with the Dietary Guide- lines for Americans and improve the healthfulness of school meals, the Food and Nutrition Service should adopt standards for menu planning that increase the amounts of fruits, vegetables, and whole grains; in- crease the focus on reducing the amounts of saturated fat and sodium provided; and set a minimum and maximum level of calories—as pre- sented in Table S-1. The recommendation is for a single approach to menu planning that is largely food based but that also includes specifications for minimum and maximum calorie levels, maximum saturated fat content, and maximum sodium content. Without those specifications, there would be no practical way to achieve alignment with Dietary Guidelines. The recommended standards for planning menus for school breakfasts (see Table S-2) cover the weekly amounts of food from five of the food groups and subgroups listed under “Meal Pattern” in the table (including both whole grain-rich and refined grains) and specifications expressed as a 5-day average for three dietary components: calories, saturated fat, and sodium. The recommended standards for school lunches cover the weekly amounts of food from all 10 food groups and subgroups listed under “Meal Pattern” and specifications for the same three dietary components. As designed, these standards lead to menus that meet or are very close to the Nutrient Targets for all but four or five nutrients (depending on the meal and the age-grade group) when the nutrient content is averaged over a 5-day school week. The exceptions were expected, as explained in Chapter 9 of the report. Standards for Meals as Selected by the Student Recommendation 3. To achieve a reasonable balance between the goals of reducing waste and preserving the nutritional integrity of school meals, the Food and Nutrition Service, in conjunction with state and local educational agencies and students, should weigh the strengths and limitations of the committee’s two options (see Table S-2) when setting standards for the meals as selected by the student. Noting that Congress has specified the various types of stakeholders that are to be involved in the initial design phase for administrative pro- cedures for meals as sered, the committee developed two options for the standards for meals as selected by the student and identified strengths and limitations of each. The options differ in the number of food items that may be declined, but they both include a new requirement related to the

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 SUMMARY TABLE S-1 Recommended as Offered Meal Standards Breakfast Lunch Grades Grades Grades Grades Grades Grades K–5 6–8 9–12 K–5 6–8 9–12 Amount of Foodsa Per Week Meal Pattern Fruits (cups)b 5 5 5 2.5 2.5 5 Vegetables (cups)b 0 0 0 3.75 3.75 5 0.5c 0.5c 0.5c Dark green 0 0 0 0.5c 0.5c 0.5c Orange 0 0 0 0.5c 0.5c 0.5c Legumes 0 0 0 Starchy 0 0 0 1 1 1 1.25c 1.25c 2.5c Other 0 0 0 Grains, at least half of which 7–10 8–10 9–10 9–10 9–10 12–13 must be whole grain-richd (oz eq) Meats, beans, cheese, yogurt 5 5 7–10 8–10 9–10 10–12 (oz eq) Fat-free milk (plain or 5 5 5 5 5 5 flavored) or low-fat milk (1% milk fat or less) (cups) Other Specifications: Daily Amount Based on the Average for a 5-Day Week Other Specifications Min-max calories (kcal)e,f 350–500 400–550 450–600 550–650 600–700 750–850 < 10 < 10 < 10 < 10 < 10 < 10 Saturated fat (% of total calories)g [≤ 430] [≤ 470] [≤ 500] [≤ 640] [≤ 710] [≤ 740] Sodium (mg) Sodium targets are to be reached by the year 00.h Nutrition label must specify zero grams of trans fat per serving.i trans fat NOTES: K = kindergarten; kcal = calories; max = maximum; mg = milligrams; min = minimum; oz eq = ounce equivalent. Although the recommended weekly meal intake patterns do not specify amounts of unsaturated oils, their use is to be encouraged within calorie limits. aFood items included in each group and subgroup and amount equivalents. Appendix Table H-1 gives a listing of foods by food group and subgroup. Minimum daily requirements apply: 1⁄5 of the weekly re- quirement for fruits, total vegetables, and milk and at least 1oz equivalent each of grains and meat or meat alternate (2 oz of each for grades 9–12 lunch). bOne cup of fruits and vegetables usually provides two servings; ¼ cup of dried fruit counts as ½ cup of fruit; 1 cup of leafy greens counts as ½ cup of vegetables. No more than half of the fruit offerings may be in the form of juice. cLarger amounts of these vegetables may be served. dBased on at least half of the grain content as whole grain. Aiming for a higher proportion of whole grain-rich foods is encouraged. See Box 7-1 for Temporary Criterion for Whole-Grain Rich Foods. Also note that in Chapter 10 the committee recommends that the Food Buying Guide serving sizes be updated to be consistent with MyPyramid Equivalent serving sizes. eThe average daily amount for a 5-day school week is not to be less than the minimum or exceed the maximum. fDiscretionary sources of calories (for example, solid fats and added sugars) may be added to the meal pattern if within the specifications for calories, saturated fat, trans fat, and sodium. gThe average daily amount for a 5-day school week is not to exceed the maximum. hTo ensure that action is taken to reduce the sodium content of school meals over the 10-year period in a manner that maintains student participation rates, the committee suggests the setting of intermediate targets for each 2-year interval. (See the section “Achieving Long-Term Goals” in Chapter 10.) iBecause the nutrition facts panel is not required for foods with Child Nutrition labeling, the commit- tee suggests that only products with 0 grams of trans fat per serving be eligible for consideration for such labeling.

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0 SCHOOL MEALS TABLE S-2 Options for Standards for Meals as Selected by the Student under the Offer Versus Sere Provision of P.L. 94-105a Number of Items the Student May Decline and Required Items Breakfast Lunch itemb 1. Preferred One may be declined, must Two items may be declined, must take at least one fruit or juice take at least one fruit or vegetable 2. Alternative Two items may be declined, must Three items may be declined, must take at least one fruit or juice take at least one fruit or vegetable NOTE: Options are provided for consideration by the U.S. Department of Agriculture, work- ing cooperatively with state educational agencies and with participation by local educational agencies and student to develop new regulations. aUnder current traditional food-based menu planning standards, high school students are required to take 3 out of 4 (or 5) food items at breakfast and 3 out of 5 food items at lunch. Offer ersus sere is optional for elementary and middle schools. bA specific food offered in the specified portion sizes that will meet the recommended as offered Meal Standards. selection of a fruit or vegetable. A rule that allows more options to decline foods clearly could reduce waste, but it would increase the chance that the nutritional integrity of the children’s meals would not be maintained, and vice versa. Foods need to be appealing to students to encourage selection and consumption. Summary of Changes in the Meal Requirements Major changes in the Meal Requirements are summarized in Box S-3. RECOMMENDATIONS FOR IMPLEMENTATION AND MONITORING The Meal Requirements will be beneficial only to the extent that pro- gram participation is maintained or increased and the participants’ food consumption improves. The effectiveness of revised Meal Requirements will be determined in a large part by the manner in which they are implemented. Strategies that can be used to promote change include engaging the school community; involving students, parents, and the community; providing nutrition education; training and mentoring of food service workers; and providing technical assistance. An essential element of the implementation processes will be industry involvement to develop appealing foods that are lower in sodium and saturated fat and that have a higher ratio of whole grain to refined grain. Effective monitoring can lead to improvements in implementation efforts.

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 SUMMARY BOX S-3 Major Recommended Changes in the Meal Requirements Meal Planning Approaches • The recommended approach to meal planning is food-based with the ad- ditions of quantitative specifications for minimum and maximum calorie levels, maximum saturated fat content, and maximum sodium content. • Only one approach to menu planning is recommended. • Computer analysis of nutrient content could be used to assist in planning menus that meet the recommended standards for menu planning but would not be needed to analyze the vitamin and mineral content of meals. Standards for Menu Planning • The standards for all age-grade groups include more food groups and introduce food subgroups. More fruit is specified. Fruits and vegetables are not interchangeable. • Specifications for types of food to be included are more precise. • Over a 5-day school week, – The average daily calorie content of the meal offerings must be within the specified minimum and maximum levels and the average satu- rated fat content must be less than 10 percent of calories. – Vegetable offerings at lunch must include at least one-half cup equivalent of each of the following: dark green vegetables, bright orange vegetables, and legumes. – No more than half of the fruit offerings may be in the form of juice. – At least half of the bread/grain offerings must meet the criterion for a whole grain-rich food (based on at least half of the grain content as whole grain, see Box 7-1 in Chapter 7). • On a daily basis, – The milk must be fat-free (plain or flavored) or plain low-fat (1 per- cent milk fat or less). – If purchased commercially, the nutrition labeling or manufacturer’s specification must indicate that the product contains zero grams of trans fat per serving. – The inclusion of unsaturated vegetable oils is encouraged within calorie limits. Standards for Foods That Are Selected by the Student • Two options are presented, and the strengths and limitations of each are described in the text. Both options specify that the student must select a fruit at breakfast and either a fruit or vegetable at lunch for the meal to be reimbursable. Recommendation 4. The Food and Nutrition Service, working together with state agencies, professional organizations, and industry, should provide extensive support to enable food service operators to adapt to the many changes required by revised Meal Requirements. The types of support required include the following:

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 SCHOOL MEALS a. Technical assistance for developing and continuously improving menus, ordering appropriate foods (including the writing of specifica- tions), and controlling costs while maintaining quality. b. New procedures for monitoring the quality of school meals that (1) focus on meeting relevant Dietary Guidelines and (2) provide in- formation for continuous quality improvement and for mentoring food service workers to assist in performance improvement. It is essential that USDA collaborate with school food service directors to revise related menu planning guidance materials, including the Food Buying Guide for Child Nutrition Programs. The committee encourages the simplification of procedures for selecting specific foods in amounts that will meet the standards. The committee suggests that, at least for the next few years, monitoring guidance be directed toward facilitating the transition to the new Meal Re- quirements. Such guidance would place an emphasis on examining progress in meeting the standards, especially those related to fruits, vegetables, whole grain-rich foods, calories, saturated fat, and sodium; identifying training needs for school food service operators; and providing needed technical assistance to improve the school meals. Recommendation 5. USDA should work cooperatively with Health and Human Services, the food industry, professional organizations, state agencies, advocacy groups, and parents to develop strategies and incentives to reduce the sodium content of prepared foods and to in- crease the availability of whole grain-rich products while maintaining acceptable palatability, cost, and safety. The specification for sodium merits special attention. The committee recognizes that there are barriers to reducing the sodium content of meals to the recommended levels without having long-term adverse effects on student acceptance and participation, safety, practicality, and cost. For this reason, the committee set the year 2020 as the date to achieve full imple- mentation; and it suggests that intermediate targets be set at 2-year intervals and be periodically re-evaluated to promote stepwise reductions in sodium content over the decade beginning in 2010. Recommendation 6. The Food and Drug Administration should take ac- tion to require labeling for the whole grain content of food products. The lack of such labeling is a major barrier to menu planners who are striving to achieve at least a one-to-one ratio of whole grains to refined grains, as recommended by Dietary Guidelines.

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 SUMMARY CONSISTENCY OF RECOMMENDATIONS WITH THE COMMITTEE’S CRITERIA The recommendations for Nutrient Targets and Meal Requirements and for implementing and monitoring them are consistent with the committee’s criteria, as summarized below. Criterion 1. Consistent with Current Dietary Guidance The Nutrient Targets were based on the Dietary Reference Intakes, us- ing methods recommended for this purpose. The Meal Requirements were designed to come as close as possible to Dietary Guidelines and to the Nutrient Targets while still being practical. Sample menus were reviewed to confirm their consistency with Dietary Guidelines (see Box S-4) and were analyzed to confirm reasonable consistency with the recommended Nutrient Targets. Chapter 10 addresses strategies to reduce the sodium content and to increase whole grains in school meals to bring them into closer alignment with Dietary Guidelines. Dietary Guidelines emphasize meeting nutrient needs without exceed- ing energy needs. The ranges for the calorie content of school meals reflect the best judgment of the committee based on current evidence for the en- ergy requirements of schoolchildren. The committee recognizes that there is a wider range of actual requirements, but it set the ranges with the objective of avoiding the provision of excessive calories while ensuring the offering of amounts of vitamins, minerals, and protein that would be appropriate BOX S-4 Recommended Changes in Standards for Menu Planning Improve Alignment with Dietary Guidelines for Americans • Both a minimum and a maximum calorie level • More fruit at breakfast, including whole fruit • A greater amount and variety of vegetables at lunch • Both fruit and vegetables required on the lunch menu • More whole grain-rich foods, fewer refined grain foods • Milk choices limited to fat-free (unflavored or flavored) and plain low-fat (1 percent milk fat or less) • Increased emphasis on limiting saturated fat • Encouragement to include unsaturated oils within the calorie limits • Minimized content of trans fat • Major reduction in sodium content to be achieved fully by the year 2020, with stepwise reductions

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 SCHOOL MEALS for essentially all children in the age-grade group. The high nutrient qual- ity of the meals supports the role that school meals play as a safety net in meeting the nutrient needs of children who may be at risk for inadequate food intake and food insecurity. Criterion 2. Appropriate Age-Grade Groups The age-grade groups established by the committee consider the cur- rent age-gender categories used in the DRIs to the extent that they are compatible with widely used school grade configurations. The committee made adjustments to account for differences between the Dietary Reference Intake age groupings and school grade configurations—for the kindergarten through grade 5 group in particular. Because differences are small between the standards for meal planning for the elementary and middle school groupings, food service operators may plan identical menus for children in kindergarten through grade 8 if applicable to the local food service operation. Criterion 3. Simplified Menu Planning and Monitoring and Student Acceptance of School Meals Simplification of Menu Planning The committee worked to develop the least complex approach to menu planning that would be consistent with Dietary Guidelines. Although the recommended standards for menu planning are not as simple as the current food-based standards, it was essential to introduce new elements to con- form to Dietary Guidelines. The committee ruled out making recommenda- tions for nutrient-based menu planning because there was not a practical way to do so that would cover the full array of nutrients and also ensure consistency with Dietary Guidelines. High-quality menu planning for school meals is always a complex task, and application of the standards for menu planning will present challenges for many school food service directors. However, meeting the Meal Requirements is only one of many aspects of the process. Chapter 10 addresses a number of approaches that would help menu planners to gradually implement the new standards for menu planning. Recommenda- tion 4a in the previous section emphasizes how important it will be for food service operators to receive technical support and other forms of assistance to implement the new Meal Requirements. From a broader programmatic perspective, the standards have been simplified (for example, compare Figure S-2 with Figure S-1). Recom- mendations provide for a single, primarily food-based approach to menu

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 SUMMARY planning and three consistent age-grade groups for breakfast and lunch. They provide the means to meet Dietary Guidelines rather than focusing on meeting all the Nutrient Targets. Required food composition data are limited to calories, saturated fat, trans fat, and sodium—each of which is readily available on nutrition facts panels or from manufacturers. Simplification of Monitoring the Nutritional Quality of Meals Recommendation 4b concerning the monitoring of the quality of school meals does not call for analysis of the broad array of nutrients for which Nutrient Targets were set. Instead, the monitoring process would be de- signed to help schools improve their menus and food service operation in ways that produce appealing meals that meet the recommended Meal Requirements and control overall costs. Basis for Practical and Appealing Nutritious Meals The committee used the meal patterns to develop 4 weeks of practical and appealing nutritious menus for breakfast and lunch for each of the three age-grade groups. Criterion 4. Sensitive to Costs and Administrative Concerns Measures to help school food programs meet Dietary Guidelines will increase costs and the need for administrative support. Largely because of increases in the recommended amounts of fruits, vegetables, and whole grain-rich foods, menu costs are expected to increase, especially for the school breakfast. By estimating the costs of representative baseline menus and comparing them with those of baseline menus modified by the commit- tee to meet the recommendations, the committee found that the foods costs for breakfast (as selected by the student) increased by 18 percent, largely because of the increase in fruit, and those for lunch (as selected) increased by 4 percent. These estimates are representative of the expected increase in food costs that are due to the recommended changes in menus, but they should be viewed with some caution, especially because students’ food se- lections under the new Meal Requirements cannot be known in advance. If even higher percentages of students select the maximum amount of fruits and vegetables, the food costs for breakfast and lunch may increase up to 23 percent and 9 percent, respectively. Furthermore, price changes that reflect changes in the market for food products important in the school meal programs (such as dairy and fruits) can have a significant effect on the cost of meals. The committee recognizes that, at current federal reimbursement levels,

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 SCHOOL MEALS most school food authorities will be unable to absorb these increased costs completely, even with better management. Implementation of the recom- mended Meal Requirements likely will require some combination of higher federal meal reimbursement, a source of capital investment to cover costs of equipment, and additional money to train operators to prepare more food from basic ingredients. Other school administrative concerns relate to potential changes in student participation, the menu planning process, purchasing, preparation and meal service, routine monitoring, the staffing pattern, staff training, equipment, and kitchen and storeroom space. The committee considered all these elements in the development of the Meal Requirements. With the adoption of appropriate implementation strategies, the changes in student participation rates are expected to be temporary and relatively small and, thus, to have limited administrative impact. The committee recognizes that some administrative changes will be necessary. For a smooth transition, technical assistance must cover analysis of and strategies for the most ef- fective approaches to implementing menu changes. RECOMMENDATIONS FOR EVALUATION AND RESEARCH The committee considered needs for the overall evaluation of the Nutri- ent Targets and Meal Requirements and for related research. Key recom- mendations follow: Recommendation 7. Relevant agencies in USDA and other federal de- partments should provide support for the conduct of studies to evaluate the revised Meal Requirements for the School Breakfast Program and the National School Lunch Program. a. USDA should continue funding for periodic School Nutrition Dietary Assessment studies, with the intermittent addition of a cost component. b. USDA should take the lead in providing funding to conduct well-designed short-term studies in varied school settings to better un- derstand how the new Meal Requirements change children’s total and school meal dietary intakes, student participation, food service opera- tions, and cost. Recommendation 8. The committee recommends that agencies of USDA, of other federal departments, and relevant foundations fund re- search studies on topics related to the implementation of the new Meal Requirements, children’s acceptance of and participation in school meals, and children’s health—especially the following:

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 SUMMARY a. Effects of the recommended range of calorie levels on the ad- equacy of energy intakes for individual children within each of the age-grade categories. b. Impacts of various approaches to reducing the sodium content of school meals and student acceptance of reduced-sodium foods. c. Impacts of various approaches to increase the acceptance of whole grain-rich products. d. Fruit and vegetable options and preparation methods that will increase consumption and decrease waste. e. Effects on cost, waste, and food and nutrient intakes of various options to govern the number and types of foods students must accept for a reimbursable meal under the offer versus serve provision of the law. f. Targeted approaches to decreasing the prevalence of nutrient inadequacy that do not require increasing the intakes of all children. g. Changes in child health as a result of the new standards. CLOSING REMARKS The recommendations for Nutrient Targets and Meal Requirements lay the foundation for healthy school meals that are consistent with current dietary recommendations. The ultimate effect of improvements in program regulations that are based on these recommendations will depend on the effectiveness of a broad array of implementation strategies. These strategies will require the participation of stakeholders at the local, state, and national levels, including those in food production. Well-designed evaluation and re- search can guide future program improvements. The goal is a school meals environment in which students may choose from a variety of appealing and healthful options, leading to the consumption of foods that will promote their health and well-being.

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