@article{d21971ef1cca41d4be898aa0a6b4414e,
title = "Impact of the 2017 child and adult care food program meal pattern requirement change on menu quality in tribal early care environments: The food resource equity and sustainability for health study",
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 USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements. Objective: This study had the following 2 objectives: 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-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 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 1 wk at each of 9 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. This trial was registered at clinicaltrials.gov as NCT03251950. Results: Total grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions 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. Curr Dev Nutr 2020;4:nzz094.",
keywords = "CACFP, Community-based participatory research, Dietary intake, Early care, Education, Food program, Menu, Native American, Preschool, Tribal, Young children",
author = "Sisson, {Susan B.} and Kaysha Sleet and Rachel Rickman and Charlotte Love and Alexandria Bledsoe and Mary Williams and Jernigan, {Valarie Blue Bird}",
note = "Funding Information: This study was funded by the National Institute on Minority Health and Health Disparities (R01MD011266). The funding agency did not participate in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. We thank the members of the Osage Nation for their participation in and continued support of the FRESH Study. The study was reviewed and approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center. The authors' responsibilities were as follows-VBBJ: conceptualized and supervised the study; VBBJ, MW, KS, RR, AB, and CL: assisted with manuscript writing; SBS: supervised and guided development of the menu review process; SBS: supervised data treatment, processing, and analyses; SBS: led manuscript writing. VBBJ and SBS: had responsibility for final content. MW: guided data treatment and analyses and contributed to data presentation; KS and RR: cleaned and processed all data, conducted data analyses, prepared tables and figures; AB: collected data, contributed to data interpretation; CL: supervised and assisted with data collection, assisted with analytical planning; all authors: read and approved the final manuscript. Funding Information: The FRESH study partnership began in 2013 and comprises a multisector group of representatives from the health (n = 2), education (n = 5), agriculture (n = 3), and government (n = 1) leadership within the Osage Nation, and public health and nutrition staff and faculty (n = 8) from the Oklahoma State University Center for Indigenous Health Research and Policy. The FRESH study was funded in 2016 and is led by the multisector tribal–university study executive committee. Publisher Copyright: {\textcopyright} The Author(s) 2019. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.",
year = "2020",
doi = "10.1093/CDN/NZZ094",
language = "English",
volume = "4",
pages = "12--22",
journal = "Current Developments in Nutrition",
issn = "2475-2991",
publisher = "Oxford University Press",
}