(P12-22-26) The Association Between Beef Consumption as Part of the National School Lunch Program and Diet Quality: A National Health and Nutrition Examination Survey 2003-2018 Analysis

Objectives: The aim was to examine the diet quality of students consuming beef as part of the National School Lunch Program (NSLP) compared to students consuming an NSLP meal without beef, overall and by age, gender, and food security category.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2003–2018 first 24-hour dietary recall were used for analysis. Previously defined methods were used to assess NSLP participation, and the Healthy Eating Index-2020 (HEI-2020) was used to determine diet quality. Regression analyses were used to examine differences in the HEI-2020 between NSLP participants who were beef consumers vs. non-beef consumers adjusted for age, sex, and race/ethnicity.

Results: The analytical sample included 3,046 (weighted n=18,787,280) NSLP participants, including 1,153 (n=7,024,904) beef consumers and 1,893 (n=11,762,376) non-beef consumers at school lunch. Beef consumers at school lunch (median beef intake 14 g; IQR 5, 41) had a lower overall HEI-2020 score compared to beef non-consumers (mean difference -2.05 ± 0.60 points; p< 0.001). Compared to beef non-consumers at school lunch, beef-consumers had lower scores for the sodium (-0.38 ± 0.16 points; p=0.017), saturated fat (-0.89 ± 0.21 points; p< 0.001), seafood and plant proteins (-0.33 ± 0.10 points; p=0.001), and fatty acid ratio (-0.95 ± 0.17 points; p< 0.001), and higher scores for the total vegetables (0.20 ± 0.08 points; p=0.019) and dairy (0.40 ± 0.15 points; p< 0.007) HEI-2020 components. Effect estimates were generally consistent across gender groups. When examining age categories, no differences in the HEI-2020 total score were observed between school lunch beef consumers vs. non-consumers for ages 5-8 years. For those 9-13 (-2.06 ± 1.00 points; p=0.04) and 14-18 (-4.67 ± 1.01 points; p< 0.001) years beef-consumers at school lunch had a lower HEI-2020 score compared to non-beef consumers. Food secure beef consumers at school lunch had a lower HEI-2020 total score compared to non-beef consumers (-1.95 ± 0.62 points; p=0.002).

Conclusions: In NSLP participants, intake of beef as part of school lunch was associated with modestly lower diet quality.

Funding Sources: National Cattlemen’s Beef Association, a contractor to the Beef Checkoff