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The Impact of 2017 CACFP Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The FRESH Study

Susan B Sisson, Kaysha Sleet, Rachel Rickman, Charlotte Love, Alexandria Bledsoe, Mary Williams, Valarie Blue Bird Jernigan
Current Developments in Nutrition ; doi:10.1093/cdn/nzz094

Abstract: Background Native American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the United States Department of Agriculture enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs who serve food that uphold the program's nutrition requirements. Objective 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3-to-5 year old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in nine NA ECE programs before and after enforcement of the revised CACFP requirements. Methods This longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for one week at each of nine programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. Trial registry: NCT03251950 Results Total grams of fiber (5.0 ± 1.2 vs. 5.9 ± 0.8, p = 0.04) and total grams of sugar (53.8 ± 12.6 vs. 48.4 ± 7.9, p = 0.024) improved, although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 vs. 10.5 ± 3.4, p = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this was not statistically significant. No significant changes in substitution quality occurred. Conclusions This study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.
Keywords: Children / obesity / Compliance / adult / revised / Meal pattern / Grams / CACFP requirement

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