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Research Article

The Bear upon of Nutrient and Nutrient-Based Standards on Principal Schoolhouse Children's Tiffin and Total Dietary Intake: A Natural Experimental Evaluation of Government Policy in England

• Suzanne Spence,
• Jennifer Delve,
• Elaine Stamp,
• John Due north. South. Matthews,
• Martin White,
• Ashley J. Adamson

x

• Published: October 30, 2013
• https://doi.org/ten.1371/journal.pone.0078298

Figures

Abstract

In 2005, the nutritional content of children'south school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring master schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children'south total nutrition. We undertook a natural experimental evaluation, analysing data from cantankerous-exclusive surveys in 12 master schools in North East England, pre and postal service policy. Dietary data were collected on iv consecutive days from children aged 4–7 years (north = 385 in 2003–4; n = 632 in 2008–9). Nosotros used linear mixed effect models to analyse the effects of gender, year, and tiffin blazon on children'south mean total daily intake. Both pre- and mail-implementation, children who ate a school dejeuner consumed less sodium (mean alter −128 mg, 95% CI: −183 to −73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fatty (−ane.viii%, −2.8 to −0.ix) and saturated fat (−1.0%; −1.vi to −0.5) than children eating packed lunches. Children eating school lunches mail implementation consumed significantly more than saccharide (xvi.4 grand, 5.3 to 27.6), protein (3.half-dozen g, 1.1 to 6.0), non-starch polysaccharides (1.v g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.iv) in their full diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children's total diet. School food- and nutrient-based standards can play an of import role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children'south diet.

Commendation: Spence S, Delve J, Postage E, Matthews JNS, White K, Adamson AJ (2013) The Affect of Food and Nutrient-Based Standards on Primary Schoolhouse Children's Dejeuner and Full Dietary Intake: A Natural Experimental Evaluation of Government Policy in England. PLoS I 8(10): e78298. https://doi.org/10.1371/journal.pone.0078298

Editor: Lorraine Brennan, University Higher Dublin, Republic of ireland

Received: June 21, 2013; Accepted: September 19, 2013; Published: October thirty, 2013

Copyright: © 2013 Spence et al. This is an open-access article distributed under the terms of the Artistic Eatables Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This piece of work was undertaken as part of the research plan of the Public Health Research Consortium. The Public Health Inquiry Consortium is funded by the Department of Health (DH) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of DH. Data about the wider program of the PHRC is available from http://phrc.lshtm.ac.united kingdom/. The funders had no role in the study design, data drove or analysis, interpretation of findings, writing of, or the decision to submit for publication. All authors had access to information, and accept responsibility for the integrity of the data and the accurateness of the data analysis. MW and AJA are partly funded as members of Fuse, the Centre for Translational Research in Public Health, a United kingdom of great britain and northern ireland Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding for Fuse from the British Heart Foundation, Cancer Research UK, Economical and Social Enquiry Council, Medical Research Council, and the National Institute for Wellness Research, under the auspices of the UKCRC, is gratefully acknowledged. AJA is funded by the National Institute of Health Enquiry. Opinions expressed are not necessarily those of the funders.

Competing interests: The authors have alleged that no competing interests exist.

Introduction

The causes, complexities and adverse wellness effects of obesity are well documented [1]–[5]. Diet has played a meaning function in contributing to childhood obesity levels in the United kingdom [four]. The National Child Measurement Plan identified 23% of reception (4–5 year olds) and 33% of year 6 (ten–eleven year olds) children in England equally overweight or obese in 2011 [6]. National Diet and Nutrition Surveys report children's diets exceed recommended intakes of per cent energy from saturated fat and non-milk extrinsic sugars (NMES), and incorporate low levels of some micronutrients, such as iron [7], [8]. Central to improving children's diets is the demand to reduce intakes of fat, saturated fat, and NMES, while increasing nutrient density.

Although the food children consume at home is of great importance, up to a third of children's daily energy and micronutrient intake is provided by school tiffin [9]. Over the last four decades, policy changes accept had a significant impact on the nutritional quality of school lunches in England. The 1980 Didactics Act removed nutritional standards, kickoff introduced in 1941. Despite government introducing nutrient-based standards for schoolhouse lunches in 2001, [10] findings from a national survey of principal and secondary schoolhouse lunches reported they contained besides much fat and sugar, and lacked key micronutrients [9], [11]. In Feb 2005, Tv chef Jamie Oliver's media broadcast "Jamie's School Dinners" attracted both public and Authorities attention and led to intensive lobbying by parents and pressure groups [12], [13]. In March 2005, a national School Repast Review Panel was established to advise on schoolhouse nutrient, [14] and in April of the aforementioned year the School Nutrient Trust was established to "transform schoolhouse food" [15]. A major policy change ensued in England, which received legislative support in 2006 [16]. New food- and food-based standards were introduced and primary schools were expected to comply by September 2008 [17]. Nutrient-based standards specify which foods can and cannot exist served, and how frequently. Nutrient-based standards utilize to the average nutritional content of schoolhouse lunches over three-weeks, and specify minimum and maximum levels [18]. Both food- and food-based standards focus on planned provision, not consumption.

To date, enquiry has focused on changes to school and packed tiffin [xix]–[22]. There is a lack of research in the United kingdom examining the wider effects of this important policy modify, i.e. on the impact of school food standards on children's total dietary intake. In this paper, we report a natural experimental evaluation [23] to appraise whether the introduction of food- and nutrient-based standards in primary schools had an bear on on children'due south lunchtime dietary intake and their total nutrition.

Methods

Ethics Statement

Ethical approving was granted by Newcastle University ethics committee (reference 000011/2007). Parents provided written informed consent prior to children'south participation.

Study Design, Setting and Participants

Nosotros undertook cantankerous-sectional surveys during two bookish years: 2003–iv (pre-) and 2008–ix (postal service-implementation) in 12 primary schools, North East England. The pre-implementation survey had been completed as part of a prior study [24]. The post-implementation survey used the same methods, which are described briefly hither.

A letter with study details was posted to head teachers of the 16 primary schools that had participated in 2003–4. The results presented in this study are based on 12 schools for which comparable information were available from the 2 surveys. These schools had been identified to represent a comprehensive range of socio-economical circumstances, determined using the costless school repast alphabetize at school level [25].

All children in Reception, Year 1 and Twelvemonth ii (aged iv–vii years) were eligible to participate. Each child received a letter with study details and a form requesting parental permission to participate in the study: consent forms were collected from schools past the study nutritionist.

Data Collection

We used a prospective, 24-hour food diary method (the Food Assessment in Schools Tool (FAST)), validated to tape young children'due south dietary intake [24]. FAST assesses foods within half-dozen defined daily time slots, along with age- and sex activity-specific portion sizes, derived from the National Diet and Diet Surveys (NDNS) [7].

Four sequent days of dietary consumption were assessed: three week days and one weekend twenty-four hour period. Total written instructions on how to complete the diary were provided to parents. At each school, a team of trained observers and the study nutritionist recorded dietary intake, including, breakfast and afterschool clubs. The diary design enabled categorisation of foods into 'school luncheon', 'packed lunch', and 'food eaten at home'. All dietary coding for nutritional composition was based on McCance and Widdowson'southward Integrated Composition of Food Dataset [26]. School recipes and menus were obtained to allow for coding of school food and assessing compliance with food- and nutrient-based standards.

All nutrients reported were checked for completeness in McCance and Widdowson's Integrated Composition of Food Database [26]. To ensure consistency of dietary coding, all food codes, weights and nutrient groups allocated were exported and interrogated, allowing identification and correction of inconsistencies.

Main Outcome Measures

Main outcome measures were changes in hateful daily intakes of macro- and micro-nutrients in schoolhouse tiffin, packed tiffin and total diet. The values for vitamins A and C had skewed distributions and were log-transformed earlier analysis.

Statistical Analysis

The sample size of the study was pragmatic and determined by the number of children studied in the earlier survey of the participating schools, and by the number of these schools prepared to participate in the more recent survey. Similar studies with smaller numbers of children aged eleven–12 years have identified important and statistically significant changes in selected macro and micronutrients [27]–[29].

The starting time analysis assessed the direct upshot of changes in school tiffin standards, and considered just children who ate school lunches. The hateful intake of macro- or micro-nutrients of each child from this source solitary were compared between the 2003–4 and 2008–9 surveys. A more detailed analysis considered the intake of macro- and micro-nutrients from the total diet: this analysis explored the importance of year of the survey, whether the child ate a school or packed dejeuner, and the interaction between these factors. All analyses adjusted for the upshot of gender and used a linear mixed effect model, with year (of survey), gender and packed/school luncheon taken as fixed furnishings: potential correlation between responses inside the same schoolhouse and child were accommodated by plumbing fixtures random effects for school and kid. The models were fitted using xtmixed in Stata (version 10) and lme in R (version ii.14.0).

Results

Beyond all 12 schools, 586 (45% of those eligible) and 775 (55%) children consented in 2003–4, and 2008–9 respectively. Children eligible, consenting and completing, and reasons for exclusion are shown in Figure ane. The analyses included observed dietary intake from 407 children (boys north = 198; girls n = 209) in 2003–four, and 641 children (boys n = 322; girls northward = 319) in 2008–9. In 2003–04, 233 children ate school lunch (boys n = 106; girls n = 127); in 2008–09, 323 children ate schoolhouse lunch (boys n = 164; girls n = 159).

Lunchtime Intake: Alter in Mean Daily Nutrients from School Lunches between 2003–iv and 2008–9

Table one shows the change in children'south mean daily macro- and micro-food intake from school lunches. Between 2003–iv to 2008–nine there was a statistically significant fall in children'south mean daily per cent energy intake of fat (mean change −11.2%, 95% confidence interval −12.i to −ten.iv), saturated fat (−5.3%, −5.8 to −four.seven), and NMES (−1.3%, −1.9 to −0.7), despite a small increment in mean free energy intake (44 kcals, 26.six to 62.0). Post-implementation children'southward mean daily intake of sodium brutal; intakes of calcium, vitamin C, iron, zinc, vitamin A, and folate intake all increased; these were also statistically meaning (Table 1). In relation to the planned food-based standards children'due south mean intake from calcium, iron, zinc and vitamin A remain below the minimum standard.

Full Dietary Intake: the Effect of Year and Lunch Blazon on Mean Daily Nutrient Intake

The results of the assay of total diet are tabulated in Tables 2–4. Table 2 presents the results showing the effect of year, Table three the effect of dejeuner type, and Tabular array 4 presents those variables for which at that place was a meaning interaction betwixt year and lunch blazon.

In children's total dietary intake between 2003–4 and 2008–9, there was a statistically significant reduction in mean daily intake of per cent energy from NMES (mean change −2.iv%, 95% conviction interval −iii.0 to −1.7), and in absolute intakes of fat (−9.5 g, −xi.0 to −eight.0), saturated fat (−4 g, −four.8 to −iii.iii), NMES (−16.9 m, −xx.3 to −13.7), and sodium (−148 mg, −202 to −93). At that place was no evidence of a change in children's mean daily intake of vitamin A, calcium, iron, or zinc (Table 2). In 2008–9 children'due south mean daily intake of per cent energy from NMES and accented amounts of sodium (mg) remain above the dietary reference value. Mean daily intakes of vitamin A (µg) and zinc (mg) remain below the dietary reference value.

Table three shows the result of children'southward lunch blazon (school or dwelling house-packed lunch) on their mean total dietary intake adjusted for year (pre- and post-implementation). Children who ate schoolhouse lunch consumed a lower mean per cent energy from NMES (mean change −two.6%, 95% confidence interval, −3.2 to −ane.ix) and lower accented intakes of saturated fat (−1.5 g, −0.8 to −2.2), NMES (−10.3 g, −xiii.6 to −7.0), and sodium (−128 mg, −183 to −73) than children eating a packed lunch. Mean daily intakes of vitamin A and zinc were higher in the full diets of children who ate a schoolhouse dejeuner (Tabular array 3). Although full fat intake was slightly lower and fe slightly higher in children who ate a school tiffin, there was no statistically significant change. Children who ate a schoolhouse lunch had a statistically significant lower intake of calcium (−29 mg, −54 to −four) in their mean total daily intake.

For a number of macro- and micro-nutrients examined, there was a significant interaction between yr (pre- and post-implementation), and lunch blazon (school or home-packed luncheon), and the consequent event on total dietary intakes (Table iv). In 2003–iv, children who ate a school lunch had a lower hateful daily free energy intake compared with children consuming a packed dejeuner (−57 kcals); by 2008–ix, children who had a school tiffin had a slightly higher hateful daily energy intake, though this difference was very small (29 kcals). In 2003–four, children who ate a school tiffin had a higher per cent energy from fat (0.half dozen%); past 2008–ix children who ate a school lunch had a lower per cent energy from fat in their full diets than those who ate a packed dejeuner (−1.ii%). Mean total daily per cent energy intake from saturated fat was lower in children who ate a school dejeuner in 2003–4 and remained lower in 2008–9 (Table iv). Carbohydrate and vitamin C intakes were lower in 2003–four in those consuming schoolhouse lunches; by 2008–9 children who ate a school lunch had a higher intake. In 2008–9 children who ate a school tiffin had significantly higher mean daily total intakes of protein, NSP, and folate than children who ate packed lunches (Table four). In that location was no statistically pregnant interaction between year and luncheon type and children's mean daily total intake of per cent energy from NMES and absolute amounts of fat, saturated fat, NMES, sodium, vitamin A, calcium, fe, or zinc.

Discussion

Summary of Primary Findings

This natural experimental evaluation of the nutrient standards for master schools in England identified important reductions in both per cent energy and absolute intakes of fat, saturated fat, and NMES in schoolhouse and packed lunches post-implementation. While nosotros observed a small increase in the energy content of a child's average school tiffin mail service-implementation, the boilerplate energy content provided past either a school or packed lunch was similar post-implementation (494 and 504 kcals respectively) and remained below the target stated in the requirements of 530 kcals/day. Post-implementation the average level of all micro-nutrients except calcium were higher in school lunches than packed lunches.

A number of these key changes in children's mean daily intake from school lunch were reflected in children's total nutrition. Mail service-implementation a child who ate a school lunch had a lower per cent energy derived from fat and saturated fatty, but more carbohydrate, protein, NSP, vitamin C and folate in their total diet than children who ate a packed lunch. Findings show that children mean daily intake of % energy from saturated fatty and NMES, and absolute amounts of sodium remain above Dietary Reference Values. Children's mean daily intake of Vitamin A and Zinc continue to remain below the Reference Nutrient Intake.

Strengths and Weaknesses of the Written report

This natural experimental evaluation was dependent on repeated cross-sectional surveys, and as such, we were limited in the extent to which changes in nutrient intakes could be attributed to the implementation of the school food policy. Externally imposed time constraints for the implementation of the new standards precluded a stronger, prospective report design. Notwithstanding, the study offers a unique evaluation of national policy, enabled by the availability of pre-implementation data, nerveless for an earlier written report [24]. To avert introducing measurement bias, the aforementioned methods were employed post-implementation. The written report was restricted to a sample of primary schools in i city in North East England, which potentially limits generalisability.

Food and food-based standards for primary schools are based on the average school lunch over a three-week menu bike. Some foods on which standards are based, such as oily fish, only have to exist served once in this three calendar week cycle. A potential limitation to assessing the touch of food and nutrient-based standards on children's total diet is that our data collection did not cover a total 3 week cycle in primary schools. However, in that location is a selection of food items available at school lunch each 24-hour interval. Children make choices both at the counter and, in one case seated, they may or may non choose to consume particular food items served. Our findings are based on children's actual food consumption.

Human relationship to Previous Piece of work

This study has shown changes in the food content of both schoolhouse and packed lunches, just also provides show of a widening gap betwixt school and packed lunches. The finding that packed lunches contained more than fat, saturated fatty, sodium and NMES than schoolhouse lunch confirms the findings of previous studies [20],[thirty]–[33]. This report, along with others, [19], [32], [33] provides some evidence of the potential advantages of planned, nutrient-based lunch provision compared with home-prepared packed lunches. Our findings on total diet are similar to those of the NDNS [34] and show some improvements in children's food intake over recent years. This study provides evidence that at least part of this improvement is associated with the change in school food policy. Although this study has not reported on children'due south weight gain following the implementation of the standards, a recent written report in the United states of america examined the bear upon of stricter nutritional standards and student weight gain [35]. Their findings bear witness that, in states with stringent regulation of school food, children eating school lunches improved their weight status. This adds further support for regulation of foods offered at schoolhouse tiffin and the potential impact of such legislation on child health.

Time to come Research

Both the Salubrious Lives, Healthy People (2010) [36] and Foresight [4] reports take highlighted the consequence of social inequalities in children's diets. Schools offer a unique opportunity to influence the nutrient choices of all children with the potential to reduce inequalities [37]. Farther research is needed to assess whether the introduction of new school food- and nutrient-based standards has had a comparable result on children's total diet beyond the socio-economical spectrum.

Conclusions and Implications

Although our findings show reductions in children's average daily intake of per cent energy from saturated fat and NMES, and absolute intakes of NMES and sodium, intakes remain in a higher place the Dietary Reference Values [38]. These remain key areas for public health action, necessitating a focus on children's food choice at school and beyond. At school, more encouragement and supervision of children at lunchtime with selection of foods, more fourth dimension to eat, and more kid friendly dining environments accept been advocated [39]. Following implementation of the nutritional standards, school lunches appeared to have a positive impact on children's total diet, but this can but be realised fully in children who eat school lunch. School lunch competes against packed lunch where children bring their choice of foods. Although it was observed some schools do impose rules (e.g. no sweets, chocolate, or crisps), there are more than often no regulations as to what tin can and cannot exist brought from home in a packed lunch.

Information technology has been advocated that to address the complexity of obesity there is a need for political will [1], [5], [40], [41]. In 2011, Swinburn et al [39] commented that to enable 'healthy choices', policy interventions are required at the environment level. After a highly publicised campaign on the state of school lunches, regime provided legislative and financial back up for this modify in policy, thereby creating an environment to enable healthier food choices in schools. Within the limitations of the natural experimental design, we constitute that children'south full diet has improved since the reintroduction of food- and nutrient-based standards. Our findings of a positive event on both lunchtime and total diet intake provide prove to support this level of intervention in primary schools. Similar policy approaches should be considered for other schools and academies, and other environments influencing children's diet outside school. Prospective evaluation of public health policy interventions would add considerably to the evidence base of operations.

Acknowledgments

We thank: the schools, parents, and children who provided the states with all-encompassing data; all members of the research steering group which included representatives from the Department of Wellness, Newcastle City and Northumbria Canton Councils, Newcastle Primary Care Trust and the School Nutrient Trust; and Professor Andrew Rugg-Gunn (Professor Emeritus Newcastle Academy) for his invaluable expertise and guidance from the inception of the Newcastle and Northumberland dietary surveys.

Author Contributions

Conceived and designed the experiments: AJA MW JM. Performed the experiments: SS JD. Analyzed the information: SS ES JM. Wrote the paper: SS JD ES JM MW AJA.

References

1. 1. Ebbeling C, Pawlak D, Ludwig D (2002) Babyhood obesity: public health crisis, common sense cure. Lancet 360: 473–582.
   • View Article
   • Google Scholar
2. 2. WHO (2003) Diet, Nutrition and the Prevention of Chronic Disease: Report of a Articulation WHO/FAO Skillful Consultation. Geneva: WHO.
3. 3. Lobstein T, Baur Fifty, Uauy R (2004) Obesity in children and immature people: a crisis in public wellness. Obes Rev 5 (Suppl (1)) 4–85.
   • View Article
   • Google Scholar
4. 4. Foresight (2007) Tackling obesities: Futurity Choices- Project Report.
5. five. Han J, Lawlor D, Kimm Due south (2010) Childhood obesity. Lancet 375: 1737–1748.
   • View Commodity
   • Google Scholar
6. six. Department of Health (2011) National Child Measurement Plan: England, 2010/11 schoolhouse yr. London: Department of Health.
7. 7. Gregory J, Lowe South (2000) National Diet and Diet Survey: immature people aged four to 18 years. London: HMSO.
8. 8. Bates B, Lennox A, Bates C, Swan G (2011) National Diet and Diet Survey: Headline results from years i and 2 (combined) of the Rolling Program 2008/9–2009/10. London:Section of Health.
9. 9. Nelson M, Nicholas J, Suleiman Southward, Davies O, Prior G, et al.. (2006) School meals in primary schools in England. London: Department for Education and Skills.
10. 10. The Pedagogy (Nutritional Standards for School Lunches) (England) Regulations 2000. Available: http://world wide web.legislation.gov.uk/uksi/2000/1777/contents/made Accessed 2012 Sep 20.
11. 11. Nelson M, Bradbury J, Poulter J, McGee A, Msebele Southward, et al.. (2004) Schoolhouse Meals in Secondary Schools in England. London: Department for Education and Skills.
12. 12. Spence D (2005) Jamie'southward School Dinners. British Medical Periodical 330.doi: Available: http://dx.doi.org/10.1136/bmj.330.7492.678 Accessed 2013 Apr 17.
13. 13. BBC NEWS Oliver's school meal crusade goes on. Available: http://news.bbc.co.uk/go/pr/fr/-/1/hello/uk/5313882.stm Accessed 2013 April 17.
14. xiv. Schoolhouse Meals Review Console (2005) Turning the Tables. Transforming School Food: A report on the development and implementation of nutritional standards for schoolhouse lunches.
15. 15. School Nutrient Trust Nutrient-based and nutrient-based standards for school lunches and food other than lunches. Available: www.schoolfoodtrust.org.united kingdom of great britain and northern ireland/the-standards Accessed 2012 Mar 28.
16. 16. The Education (Nutritional Standards and Requirements for School Food) (England) (Amendment) Regulations 2008. Bachelor: http://www.opsi.gov.uk/si/si2008/pdf/uksi_20081800_en.pdf Accessed 2012 Mar 28.
17. 17. Department for Pedagogy and Skills (2006) Nutritional Standards for school lunches and other school food. London: Department for Education and Skills.
18. 18. Schoolhouse Food Trust A Guide to introducing the Government's food-based and nutrient-based standards for school lunches Available: www.childrensfoodtrust.org.great britain/resources/guide-to-the-food-based-standards Accessed 2013 Jun 13.
19. 19. Rogers IS, Ness AR, Hebditch G, Jones LR, Emmett PM (2007) Quality of nutrient eaten in English principal schools: school dinners vs packed lunches. Eur J Clin Nutr 61: 856–864.
    • View Article
    • Google Scholar
20. twenty. Rees GA, Richards CJ, Gregory J (2008) Food and nutrient intakes of primary school children: a comparing of school meals and packed lunches. J Hum Nutr Diet 21: 420–427.
    • View Article
    • Google Scholar
21. 21. Haroun D, Harper C, Wood L, Nelson M (2010) The bear upon of the food-based and food-based standards on lunchtime food and potable provision and consumption in chief schools in England. Public Health Nutr fourteen: 209–218.
    • View Article
    • Google Scholar
22. 22. Golley R, Pearce J, Nelson M (2010) Children's lunchtime food choices following the introduction of food-based standards for school meals: observations from 6 primary schools in Sheffield. Public Health Nutr 14: 271–278.
    • View Article
    • Google Scholar
23. 23. Craig P, Cooper C, Gunnell D, Haw South, lawson K, et al.. (2012) Using natural experiments to evaluate population health interventions: new Medical Inquiry Council guidance. J Epidemiol Community Wellness.doi:https://doi.org/10.1136/jech-2011-200375.
24. 24. Adamson AJ, Griffiths JM, Carlin LE, Barton KL, Wrieden WL, et al. (2003) FAST: Food Assessment in Schools Tool. Proc Nutr Soc 62: 84A.
    • View Article
    • Google Scholar
25. 25. Directgov.co.united kingdom. Available: www.directly.gov.uk/en/Parents/Schoolslearninganddevelopment/SchoolLife/DG_4016089. Accessed 2012 Aug 29.
26. 26. Food Standards Agency (2002) McCance and Widdowson'south the Composition of Foods,Sixth Summary Edition. Cambridge: The Purple Guild of Chemistry.
27. 27. Adamson AJ, Rugg-Gunn AJ, Butler TJ, Appleton DR, Hackett AF (1992) Nutritional intake, height and weight of xi–12-year-old Northumbrian children in 1990 compared with information obtained in 1980. Br J Nutr 68: 543–563.
    • View Article
    • Google Scholar
28. 28. Rugg-Gunn AJ, Fletcher ES, Matthews JNS, Hackett AF, Moynihan PJ, et al. (2007) Changes in consumption of sugars by English adolescents over xx years. Public Health Nutr 10: 354–363.
    • View Article
    • Google Scholar
29. 29. Fletcher ES, Rugg-Gunn AJ, Matthews JNS, Hackett A, Moynihan PJ, et al. (2004) Changes over 20 years in macronutrient intake and body mass index in eleven- to 12-year old adolescents living in Northumberland. Br J Nutr 92: 321–333.
    • View Commodity
    • Google Scholar
30. 30. Evans CEL, Greenwood DC, Thomas JD, Cade JE (2010) A cross-exclusive survey ofchildren'due south packed lunches in the Great britain: food-and food-based results. J Epidemiol Community Health 64: 977–983.
    • View Article
    • Google Scholar
31. 31. Evans CEL, Greenwood DC, Thomas JD, Cleghorn CL, Kitchen MS, et al. (2010) SMART lunch box intervention to amend the food and nutrient content of children's packed lunches: UK wide cluster randomised controlled trial. J Epidemiol Community Health 64: 970–976.
    • View Article
    • Google Scholar
32. 32. Gatenby L (2011) Children's nutritional intake as part of the Eat Well Do Well scheme inKingston-upon-Hull-a pilot study. Nutr Bull 36: 87–94.
    • View Commodity
    • Google Scholar
33. 33. Pearce J, Harper C, Haroun D, Woods 50, Nelson Yard (2011) Key differences between school lunches and packed lunches in master schools in England in 2009. Public HealthNutr 14: 1507–1510.
    • View Article
    • Google Scholar
34. 34. Bates B, Lennox A, Swan M (2010) National Diet and Nutrition Survey- headline results from twelvemonth one (2008–2009). London: Section of Wellness.
35. 35. Taber D, Chriqui J, Powell Fifty, Chaloupka F (2013) Association between country laws governing schoolhouse meal diet content and student weight condition. JAMA Pediatr.doi:https://doi.org/10.1001/jamapediatrics.2013.399.
36. 36. HM Regime (2010) Salubrious Lives, Healthy People: Our strategy for public health in England. London: HMSO.
37. 37. The Marmot Review (2010) Fair Society, Healthy Lives. London: The Marmot Review.
38. 38. Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London: HMSO.
39. 39. Adamson A, White One thousand, Stead Thou, Delve J, Stamp East, et al.. (2011) The process and bear on of change in the school nutrient policy on food and nutrient intake of children aged 4–vii and 11–12 years both in and out of schoolhouse; a mixed methods arroyo. Available: http://phrc.lshtm.ac.uk/papers/PHRC_B5-07_Final_Report.pdf.
40. forty. Gortmaker SL, Swinburn BA, Levy D, Carter R, Mabry PL, et al. (2011) Changing the time to come of obesity: scientific discipline, policy and action. Lancet 378: 838–846.
    • View Article
    • Google Scholar
41. 41. Swinburn BA, Sacks Yard, Hall KD, McPherson K, Finegood DT, et al. (2011) The global obesity epidemic: shaped by drivers and local environments. Lancet 378: 804–814.
    • View Article
    • Google Scholar

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