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Evaluating Changes to Sodium Content in School Meals at a Large, Urban School District in Los Angeles County, California

Cummings, Patricia L. MPH; Burbage, Lindsey MPH; Wood, Michelle MPP; Butler, Rebecca K.; Kuo, Tony MD, MSHS

Journal of Public Health Management & Practice: January/February 2014 - Volume 20 - Issue - p S43–S49
doi: 10.1097/PHH.0b013e31829f2e50
Original Articles

Context: Children consume more than one-third of their daily food intake in schools, suggesting that these environments are ideal places for intervening on poor dietary behaviors.

Objective: To assess the impact of strategy-focused menu planning on the sodium content of student meals served in the Los Angeles Unified School District (LAUSD).

Design: Pre- and post-LAUSD menu change analyses for school years (SY) 2010-2011 and 2011-2012 were performed using nutritional analysis data and food production records. The analyses assessed changes in sodium content by meal categories.

Setting: 900+ schools, grades K-12, operated by the LAUSD.

Participants: The LAUSD Food Services Branch, which serves about 650 000 meals per day.

Intervention: A multistage menu planning approach that focused on implementing evidence-based strategies to improve the nutritional content of school breakfast and lunch menus. Engagement and formation of multisectoral partnerships, including public health and parent/student groups, were vital elements of the intervention process.

Main Outcome Measure(s): Sodium content changes in the LAUSD menu, SY 2010-2011 versus SY 2011-2012; other measures include documentation of program reach.

Results: From SY 2010-2011 to SY 2011-2012, the mean unweighted sodium levels for elementary (K-5) breakfast and for secondary (6-12) breakfast and lunch decreased. These changes met or exceeded the 2014-2015 US Department of Agriculture sodium targets for school meals and for secondary breakfast, the 2022-2023 target(s). These results, however, were not as notable once student food selection patterns (weighted data) and condiments were considered in the analysis.

Conclusions: Use of strategy-focused menu planning as a mechanism to reduce sodium in school meals appeared to be promising, demonstrating favorable declines in mean sodium levels for at least 3 of 4 meal categories in the LAUSD. Student food selection patterns and condiments use, however, can affect the strength of the intervention.

This article provides an assessment of the impact of strategy-focused menu planning on the sodium content of student meals served in the Los Angeles Unified School District for school years 2010–2011 and 2011–2012.

Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California (Mss Cummings, Burbage, Wood, and Butler and Dr Kuo); and Department of Epidemiology, Jonathan & Karin Fielding School of Public Health (Ms Cummings), and Department of Family Medicine, David Geffen School of Medicine (Dr Kuo), University of California, Los Angeles.

Correspondence: Patricia L. Cummings, MPH, Los Angeles County Sodium Reduction Initiative, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010 (pcummings@ph.lacounty.gov).

This work was supported in part by a cooperative agreement from the Centers for Disease Control and Prevention (U50 DP003061). The findings and conclusions in this article are those of the authors and do not necessarily represent the views or the official position(s) of the Los Angeles County Department of Public Health, the Los Angeles Unified School District, or the Centers for Disease Control and Prevention. The authors report no conflicts of interest and have no financial disclosures.

The authors thank the staff at the Los Angeles Unified School District for their technical support of the nutritional analyses and the analysis of the food production records.

© 2014 Lippincott Williams & Wilkins, Inc.