Abstract 01: The Impact of School Food Environment Policies on Child Dietary Intake and BMI and Future Cardiometabolic Outcomes in the United States

Introduction: Promising school food environment policies include providing fresh fruits and vegetables (F&V provision) and competitive food restrictions on sugar-sweetened beverages (SSB restriction). Yet, the impact of these policies on diet and BMI in children and future cardiometabolic disease (CMD) outcomes is not established. Methods: We used a comparative risk assessment model to estimate the effects of F&V provision and SSB restriction on diet and BMI in US children age 5-18 yrs. We used national data from NHANES 2009-12 on baseline BMI and intakes of fruits, vegetables, and SSBs; impacts of these policies on diet from meta-analyses of interventions; and estimated effects of dietary changes on BMI from trials and cohorts. We also estimated the effects of these school policies on CMD in current US adults if such policies had been implemented in their childhood, based on meta-analysis of long-term within-person correlations of childhood and adult diets, meta-analyses of diet and CMD, and data on national CMD deaths. Model inputs were stratified by age, sex, and race, where appropriate. Point estimates and 95% uncertainty intervals were derived from probabilistic sensitivity analyses using 1000 Monte Carlo simulations. Results: F&V provision would increase overall fruit intake in children by ~ 14-21% and would not significantly increase vegetable intake ( Table ). SSB restriction would decrease overall SSB intake by ~ 6-11% and BMI (kg/m 2 ) by 0.2-0.3%. Among these dietary factors, reducing SSBs had the largest estimated impact on CMD (2418 deaths averted/year), followed by providing fruits (2121) and vegetables (165). If US adults had been exposed to both policies, an estimated 4703 CMD deaths/year would be averted, representing 0.67% of all CMD deaths. Conclusions: Specific US school food environment policies involving F&V provision and SSB restriction would modestly improve diet and BMI in children, and could prevent up to 0.7% of all CMD deaths.