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A natural experimental evaluation of the effect of universal infant free school meals on key stage 1 pupil’s dietary intake in northeast England: a pilot study

Lookup NU author(s): Dr Suzanne Spence, Professor John MatthewsORCiD, Dr Lorraine McSweeneyORCiD, Maisie Rowland, Phoebe Orango, Professor Ashley AdamsonORCiD


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Background In 2013, a government-commissioned review of school food recommended that all key stage 1 pupilsin England should receive free school meals. In 2014, Universal Infant Free School Meals (UIFSM) were implemented,costing £450 million. There has been no evaluation of this policy change on pupil’s diets. We assessed the effectof UIFSM on pupil’s lunch and total daily intake.Methods We used cross-sectional surveys in 2008–09 (before) and 2017–18 (after UIFSM) in two primary schoolsin Newcastle (school A in most deprived ward; school B in least deprived ward) and a validated, prospective 4-day fooddiary. All pupils (4–7 years) were eligible to participate with written parental consent (2008–09: n=112; 2017–18 n=84).A linear regression model explored the effect of year, school, level of deprivation (pupil postcode), and the interactionsbetween these factors on mean change in percent energy non-milk extrinsic sugars (%E NMES), calcium, yoghurt,and cake; analyses were adjusted for gender. Ethical approval for this study was granted by Newcastle University.Findings At lunchtime, we found evidence of a decrease in pupils mean ENMES before and after UIFSM (mean change–4·6% [95% CI –6·3 to –2·9]), which was reflected in total daily intake (–3·8% [–5·2 to –2·7]). We found a year andschool interaction on mean calcium: pupils in School B had a similar mean intake before and after UIFSM; in schoolA, calcium intake had increased (difference between schools in calcium change –120 mg [95% CI –179 to –62]);no evidence was found of an effect in total daily intake. After UIFSM, mean portions of yoghurt decreased in school Band increased in school A (–0·25 portions [–0·46 to –0·04]); mean portions of cake increased in School B and remainedsimilar in school A (0·23 [0·43–0·42]).Interpretation Within the limitations of this study (repeat cross-sectional survey; only two schools) there is evidencethat UIFSM contributed to a reduction in ENMES. Schools should consider implementation of healthier policies(eg, removing the daily cake choice).

Publication metadata

Author(s): Spence S, Matthews JNS, McSweeney L, Rowland M, Orango P, Adamson AJ

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Public Health Science

Year of Conference: 2019

Pages: S87-S87

Print publication date: 01/11/2019

Online publication date: 29/11/2019

Acceptance date: 29/11/2019

ISSN: 0140-6736

Publisher: The Lancet Publishing Group


DOI: 10.1016/S0140-6736(19)32884-3

Series Title: The Lancet