Implementation Of Universal Infant Free School Meals: A Pilot Study In Ne England Exploring The Impact On Key Stage 1 Pupil'S Dietary Intake

Objective: To consider the principal effect of an interaction between year (pre- and post-Universal Infant Free School Meals (UIFSM)) and school on pupil's dietary intakes. Design: A repeated cross-sectional survey using dietary data from 2008 to 2009 (pre-) and 2017 to 2018 (post-UIFSM) Setting: Two primary schools, NE England. Participants: Pupils aged 4-7 years (2008-2009 n 121; 2017-2018 n 87). Results: At lunchtime, there was a statistically significant decrease in pupils non-milk extrinsic sugars intake (%E NMEs) pre- to post-UIFSM (mean change -4.6%; 95% CI -6.3, -2.9); thiswas reflected in total diet (-3.8%; -5.2, -2.7%). A year and school interaction was found for mean Ca intakes: post-UIFSM pupils in School 2 had a similar mean intake as pre; in School 1 intakes had increased (difference of difference: -120mg; 95% CI -179, -62); no reflection in total diet. Post-UIFSM mean portions of yogurt decreased in School 2 and remained similar in School 1 (-0.25; -0.46, -0.04); this was similar for `cake/pudding' and fruit. Conclusions: Within the limitations, these findings highlight positives and limitations following UIFSM implementation and demonstrate the role of school-level food practices on pupil's choices. To facilitate maximum potential of UIFSM, national levers, such as discussions on updating school food standards, including sugars, could consider removing the daily `pudding' option and advocate `fruit only' options 1 d/week, as some schools do currently. Small school-level changes could maximise positive health impacts by decreasing NMEs intake. A more robust evaluation is imperative to consider dietary impacts, equitability and wider effects on schools and families.