Promoting Childhood and Adolescent Cardiovascular Health: Analyzing School Meal Nutrition

Background: Schools play a vital role in childhood nutrition. Months into the COVID-19 pandemic, 21 million free meals were distributed by Chicago Public Schools (CPS). Cardiovascular (CV) risk factors begin in childhood and school meals establish healthy eating patterns. To our knowledge, school meal nutrition has not been studied from a CV disease prevention perspective. Guidelines published by the National Heart, Lung, and Blood Institute (NHLBI) in 2012 strongly recommend that 2-21-year-olds consume <30% of calories/day from fat, <10% of calories/day from saturated fat, and <300 mg of cholesterol/day to promote CV health in adolescence. As CPS currently follows USDA nutrition guidelines, we sought to determine the alignment of school meals for K-8th graders with NHLBI recommendations.

Methods: May and June 2021 CPS breakfasts and lunches were analyzed. Menus were obtained from the CPS website and nutrition information from a school nutritionist. Total breakfast and lunch calories, calories from fat, calories from saturated fat, and mg of cholesterol were recorded. The percent of daily caloric intake from fat and saturated fat was calculated. Days that cholesterol content exceeded 200 mg (⅔ of daily recommended) were analyzed as we examined ⅔ of daily meals. The effect of milk (skim, chocolate skim, or 1%) was considered. The number of meals meeting NHLBI guidelines were counted, and the percentage of meals meeting standards were calculated with 95% confidence intervals.

Results: CPS meals met the standards for total fat, saturated fat, and cholesterol on 62%, 60%, and 78% of days, respectively with median values meeting NHLBI standards. When factoring milk consumption, skim and chocolate milk respectively add 85 and 115 calories with no fat and 5 mg cholesterol. Both of these milk choices improve compliance with total and saturated fat standards while having a negligible impact on the cholesterol standard. 1% milk adds 105 calories at the expense of 27 calories of fat, 18 calories of saturated fat, and 15 mg of cholesterol. This milk has minimal impact on the total fat standard and total cholesterol standards but a negative impact on the saturated fat standard. Cholesterol results are greatly impacted by eggs. On all the days where total cholesterol exceeded 200 mg, hard-boiled eggs were served at breakfast.

Conclusion: Over the last several decades, the nutritional quality of school meals has vastly improved. Specifically, CPS is a leader in nutrition standards and has made monumental strides to improve school meals. As a program federally funded by the National School Lunch Program, CPS represents many other qualifying schools. While CPS currently exceeds the USDA guidelines it is expected to comply with, the rates of compliance with NHLBI guidelines suggest there is room for improvement. Current guidelines may want to consider implementing standards specific to CV health promotion.