■白宫关于饥饿的国家战略,营养,健康包括向所有学生提供免费的校餐,无论收入如何,这在美国引发了争论。
■评估美国普遍免费学校餐(UFSM)与学校和学生成绩之间的关联。
■制定了专家小组知情方案,以评估比较UFSM计划的干预或队列研究,例如社区资格规定(CEP),2012年8月(不包括由于COVID-19大流行而导致的2020-2021年)在美国学校开展非UFSM课程。结果包括膳食参与率,出席,饮食摄入量和质量,食物浪费,经济影响,粮食不安全,人体测量学,纪律处分,污名,和羞辱。搜索Medline,Econlit,最终的业务来源,ERIC,Agricola,CabAbstracts,和CINAHL于2024年4月进行。两名研究人员筛选了纳入的文章,提取的数据,并评估了偏见的风险,在非随机干预研究工具中使用偏倚风险,对于每个纳入的研究。建议的分级,评估,发展,评估用于评估每个结果的证据的确定性。
■搜索确定了2784条记录,包括6项研究,代表超过11000个小学,中间,和高中。非随机干预研究进行差异或比率分析以调查CEP参与率,出席,人体测量学,和/或悬架。CEP与增加午餐(3项研究;中等确定性)和早餐(1项研究;非常低的确定性)相关。与没有UFSM的学校相比,有CEP的学校的入学率没有变化或有所改善(2项研究;确定性低)。CEP与较低的肥胖患病率(1项研究;非常低的确定性)和较少的悬浮(1项研究;非常低的确定性)相关。降低确定性评级的原因包括间接性(数据不能完全代表美国)和不一致性(少量研究限制了评估一致性的能力)。尽管有局限性,证据反映了设计良好的纵向干预研究,适合于决策.
■在这篇系统综述中,UFSM与增加的膳食参与有关,出勤率没有或略有改善,肥胖患病率和中止率降低;午餐参与的证据确定性适中,其他结局的证据确定性较低或非常低.研究没有报告几个重要的结果,如饮食质量和粮食安全,这表明需要更多高质量的研究,包括与政策相关的指标。
UNASSIGNED: The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States.
UNASSIGNED: To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States.
UNASSIGNED: An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome.
UNASSIGNED: The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making.
UNASSIGNED: In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.