School meals and snacks in Canadian primary schools: assessing diet quality among schoolchildren

Abstract Background School food programs (SFPs) are an effective strategy for improving children's diet. Canada does not have a national SFP but rather a patchwork of school food offerings, and their impact on children's diet is unknown. This study assessed the diet quality of Canadian primary schoolchildren who accessed meals and snacks provided by school. Methods We surveyed 2,366 students aged 9-14 years (49% girls) from 32 schools in socioeconomically disadvantaged communities in two Canadian provinces. Using a 24-hour diet recall, students recorded foods and beverages consumed for meals (breakfast, lunch) and snacks (morning, afternoon) during school hours. Students also indicated whether the meal or snack was provided by their school (yes/no). Diet quality was assessed using the Diet Quality Index - International (DQI-I) score (ranging from 0 to 100, with higher scores indicating higher diet quality) and its components (adequacy, variety, balance, moderation). Multivariable linear regression models were used to examine the association of school-provided meals and snacks with diet quality. Results Only 293 (12%) students consumed at least one school-provided meal or snack during school hours. These students most often consumed school-provided morning snack (43%) and least often breakfast (18%). Consuming at least one meal or snack provided by school was associated with a higher overall DQI-I score (β = 1.8, 95% CI = 0.7 to 3.0), as well as higher component scores for variety (β = 0.5, 95% CI = 0.1 to 0.9) and adequacy (β = 0.9, 95% CI = 0.4 to 1.5). Consuming snacks provided by school was associated with higher overall DQI-I scores (morning snack β = 2.2, 95% CI = 0.5 to 3.8; afternoon snack β = 3.1, 95% CI = 1.1 to 5.1); no significant associations were found for breakfast or lunch provided by school. Conclusions School meals and snacks, though consumed by only one in eight primary schoolchildren, may contribute to better diet quality, with the greatest impact observed for snacks. Key messages • The availability of meals and snacks provided by schools in Canada was low, with only one in eight primary schoolchildren having consumed school meals or snacks. • Diet quality was higher among students who consumed school meals or snacks than those who did not, with the greatest benefit observed for snacks.