Evaluation of Methods to Assess Children's Diets in the School Context: A Systematic Review
Authors: Tugault‐Lafleur Claire , Black Jennifer , Barr Susan I 
Published: November 2023

Background & ObjectivesSchools are a proposed site for public health action to improve children's diet quality, but valid and reliable methods are needed to evaluate what children eat at school and the impact of emerging school‐based nutrition interventions. The objective of this study was to systematically review dietary assessment instruments and dietary measures developed and/or applied to assess the quality of foods and beverages consumed in the school context.MethodsA systematic review of the literature was conducted using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) statement. Three health databases (MEDLINE, CINAHL and PubMed) were searched for full‐text English‐language publications that developed or applied: 1) dietary assessment instruments to collect dietary data in the school context and/or 2) included at least one dietary intake measure evaluating the quality of intake of foods consumed in the school context. Papers were reviewed if they described a method applicable to school‐age children (6–17 years).Evidence synthesisA total of 45 studies met the inclusion criteria. Dietary instruments: 27 studies described self‐report instruments (e.g. 24‐hour recalls, food records, food frequency questionnaires) and 18 described observational dietary instruments (e.g. visual estimation techniques) to evaluate dietary intake in school settings. Each instrument offers trade‐offs between level of detail, accuracy, ease of administration, and costs. Such characteristics affect the type of measurement error which holds implications for assessing diet quality at the population‐level. Dietary outcomes: 36 studies described dietary outcomes for foods and beverage intake in the school context. The majority of studies (n=26) used multiple food groups and/or nutrient intakes to evaluate diet quality at school, but some (n=6) used a single food group as a proxy for overall diet quality. Only one a priori composite diet quality index assessed quality of lunch‐time intakes: the Meal Index of Dietary Quality (Denmark). In addition, one study used the U.S. Healthy Eating Index (HEI)‐2005 to evaluate diet quality during school hours to examine temporal variations in diet quality based on children's participation in the U.S. National School Meal Program. Originally developed to assess diet quality based on a whole day, the U.S. HEI uses scoring standards expressed as amounts per 1,000 kcal consumed. As such, it can be potentially applied to a portion of the school day.ConclusionsAssessing dietary quality is methodologically difficult, both from the perspective of data collection and data analysis. The choice of method depends on the goal of the study and resources available. No analytical method has been developed to specifically assess the quality of foods and beverage consumed by children in the North American school context. However, the U.S. HEI appears to have potential in this regard. Such methods could have many meaningful applications for planning and designing tailored nutrition interventions and assessing the impacts of school‐based nutrition interventions.Support or Funding InformationCanadian Institute for Health Research (CIHR) Food Practices on School Days Study; Leonard S Klinck Memorial Fellowship; Land and Food System Graduate Student Awards