National School Lunch Program (NSLP) standards recently changed significantly. Healthy Hunger-Free Kids Act (HHFKA) presumably improved dietary quality (DQ) of meals, while Child Nutrition Program (CNP) Flexibilities appear to decrease DQ. This variability has not been quantified. Objective: To determine differences in DQ between elementary school lunch menus meeting NSLP standards – School Meal Initiative (SMI), HHFKA, CNP Flexibilities, evidence-based best practices (BP). A base menu was portioned per NSLP standards and analyzed for nutrient content and DQ. Statistical analyses included one-way ANOVA, Kruskal-Wallis, and Dunnett's test. BP menu had higher whole fruit and whole grain Healthy Eating Index scores than SMI (ps < 0.0083). BP and HHFKA menus had higher refined grain and added sugar scores than SMI (ps < 0.0083). SMI menu had lower total vegetable and saturated fat scores than all menus (ps < 0.0083). This study informs policy towards improving standards, positively impacting child health and academic performance through higher DQ lunches.

Objectives There have been numerous changes to the National School Lunch Program (NSLP) nutrition standards over the past 10 years. The Healthy Hunger-Free Kids Act (HHFKA, 2010) presumably improved dietary quality (DQ) of reimbursable school meals from previous standards, while Child Nutrition Program Flexibilities (CNP Flexibilities, 2017) appear to decrease DQ. However, this variability in DQ has not been quantified. Thus, the purpose of this study was to determine differences in nutrient content and DQ between elementary school lunch menus meeting recent NSLP nutrition standards, School Meal Initiatives (SMI, 1995), HHFKA (2012), and CNP Flexibilities (2017), as well as with evidence-based school lunch best practices implemented (BP). Methods A base menu, deemed typical by expert opinion, was portioned per three versions of NSLP nutrition standards (SMI, HHFKA, CNP Flexibilities) and BP for elementary schoolchildren, and analyzed for nutrient content and DQ using ESHA Food Processor and The Healthy Eating Index (HEI) 2015. Statistical analyses included one-way ANOVA, Kruskal-Wallis, and Dunnett's test. The level of significance was set at P < 0.0083. Results The BP menu had significantly higher whole fruit (317%) and whole grain (669%) HEI scores than the SMI menu. The BP and HHFKA menus had higher refined grain (156%) and added sugar (2%) HEI scores than the SMI menu. The SMI menu had lower total vegetable (49-50%) and saturated fat (43-51%) HEI scores compared to all other menus. Results were significant (ps < 0.0083). Conclusions This study provides important information for guiding future policy towards further improving NSLP nutrition standards in their mission to provide healthy food to children, combatting malnutrition and obesity. Continuing to improve NSLP policy has the potential to impact the health, academic performance, and future of US children through higher DQ school lunches. Funding Sources None.

Objectives The objective of this systematic review was to summarize the literature on non-occupational cardiovascular disease (CVD) risk factors experienced by firefighters, specifically those related to nutrition, physical fitness, and physical activity. Methods Two electronic databases (PubMed and Scopus) were used for this review. Search terms included those related to CVD, nutrition, physical fitness, and physical activity among firefighters. The PRISMA checklist was followed to ensure a rigorous review. The Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research was also used for critical appraisal of the included studies. The review process was performed by one researcher and is in the process for a second independent researcher to reduce bias. Results Twenty-six (n = 26) articles were included in the final qualitative synthesis (4 nutrition, 4 nutrition and physical fitness/activity, and 18 physical fitness/activity). The outcomes were that firefighters do not engage in regular physical activity, tend to have substandard fitness levels and poor dietary habits, and work in a poor food environment. These factors have been shown to relate with higher prevalence of CVD and its indicators. These studies also suggest that firefighters want information, programs, and resources related to improving nutrition and physical activity to reduce CVD. Conclusions Among firefighters, numerous studies exist regarding increased CVD risk related to inadequate physical fitness and activity levels, however, few studies address the role of a healthy diet in the development of CVD risk. This review is beneficial for public health practitioners, researchers, and fire service leaders, as it provides insight into the need to further investigate how diet affects CVD risk among the firefighting population. Funding Sources None.