Evaluation of health and economic effects of United States school meal standards consistent with the 2020–2025 dietary guidelines for Americans

BACKGROUND: The current school meal nutrition standards, established in 2010, are not fully aligned with the 2020–2025 Dietary Guideline for Americans (DGA). This study evaluates the potential short-term and long-term health and economic benefits of strengthening the school meal standards on added sugars, sodium, and whole grains to be aligned with current guidelines. METHODS: We used comparative risk assessment frameworks based on nationally representative data incorporating current demographics, dietary habits, and risk factors of United States children aged 5–18 y from 3 cycles of the National Health and Nutrition Examination Survey (2013–2018). To estimate short-term impact, the model incorporated estimated dietary changes owing to potential new DGA-aligned school meal nutrition standards and the effect of these changes on childhood body mass index (in kg/m(2)) and blood pressure. To estimate long-term impact, the model further incorporated data on the sustainability of childhood dietary changes into adulthood, and on demographics and risk factors of United States adults, diet-disease associations, and disease-specific national mortality. RESULTS: In a best-case scenario assuming full school compliance, implementing new DGA-aligned nutritional standards would lower elementary children’s BMI by an average 0.14 (95% UI: 0.08–0.20) kg/m(2) and systolic blood pressure by 0.13 (95% UI: 0.06–0.19) (95% mm Hg. Later in life, the new standards were estimated to prevent 10,600 [95% uncertainty interval (UI): 4820–16,800) annual deaths from cardiovascular disease (CVD), diabetes, and cancer in adulthood; and save 355,000 (95% UI: 175,000–538,000) disability-adjusted life years and $19.3 (95% UI: 9.35–30.3) B in direct and indirect medical costs each year. Accounting for plausible (incomplete) school compliance, implementation would save an estimated 9110 (95% UI: 2740–15,100) deaths, 302,000 (95% UI: 120,000–479,000) disability-adjusted life years, and $15.9 (95% UI: 4.54–27.2) B in healthcare-related costs per year in later adulthood. CONCLUSIONS: Stronger school meal nutrition standards on added sugars, sodium, and whole grains aligned with the 2020–2025 DGA recommendations may improve diet, childhood health, and future adult burdens of CVD, diabetes, cancer, and associated economic costs.