School Snack Regulation Could Reduce Childhood Type 2 Diabetes Rates

The implementation of the Smart Snacks in School standards (Smart Snacks) in 310 public schools resulted in healthier dietary intakes among students compared with those without the standards, according to a JAMA study published January 15.¹

Smart Snacks is a set of guidelines that US schools participating in federal child nutrition programs were required to follow in 2014. The goal of Smart Snacks was to reduce total energy intake, consumption of solid fats and added sugars, and sodium intake. Smart Snacks is aligned with the Dietary Guidelines for Americans and science-based nutritional recommendations.

Overall, the standards resulted in a mean reduction of 53.9 kilocalories (kcal) from solid fats and sugars per day. Specifically, wrote the authors, “Adjusted mean daily kcal from solid fats and added sugars was significantly lower among students in states with laws (508.7 [95% CI, 463.0-554.4] kcal) than among students in states without laws (562.5 [95% CI, 534.3-590.8] kcal; difference, −53.9 [95% CI, −104.5 to −3.2] kcal; P = .04).”

Researchers believe these findings could support implementation of similar regulations at the national level to combat diet-related illnesses among children.

“Dietary intake is the primary modifiable behavioral risk factor associated with morbidity and mortality among people in the United States, with unhealthful dietary habits associated with cardiovascular disease, stroke, diabetes, and obesity....The 2010 [Dietary Guidelines for Americans] recommend that children, adolescents, and adults limit their intake of empty calories, which are commonly obtained by consumption of foods and beverages that contain solid fats and added sugars,” they wrote.

In recent years, rates of type 2 diabetes have increased in children, due in part to rising obesity levels. According to a study published in The New England Journal of Medicine, “After adjustment for age, sex, and race or ethnic group, the relative annual increase in the incidence of…type 2 diabetes was 4.8% (P <.001)” from 2002 to 2012.²

Improving diet is one way to prevent type 2 diabetes. Outside of school, the CDC recommends that families integrate healthy habits into children’s homelife. They suggest the following tips:

• Drink more water and fewer sugary drinks.
• Eat more fruits and vegetables.
• Make favorite foods healthier.
• Get kids involved in making healthier meals.

The Smart Snacks study collected data from 310 public schools in 30 states and Washington, DC. Seven states included in the study had a Smart Snacks law: Arkansas, DC, Florida, Georgia, Illinois, Mississippi, and Utah. In total, 1959 students between grades 1 and 12 were included in the study. The mean participant age was 11.9 years.

Solid fats and added sugars made up, on average, 25.7% of daily energy intake for students in states with laws and 28.4% of total daily energy intake in those without.

The 2015 to 2020 Dietary Guidelines recommend “no more than 10% of kcal daily from sugar and no more than 10% from saturated fat.” Researchers’ findings “suggest that more than 25% of daily energy intake was derived from solid fats and added sugars, with solid fats and added sugars consumption each over 10%.”

Although this reduction may not seem like a significant amount, researchers argue incremental changes made every day can have long-term effects.

“Studies have shown that over time, small changes in daily dietary intake can substantially improve health outcomes, including weight status and cardiovascular outcomes associated with consumption of solid fats and added sugars,” they said.

References

1. Turner L, Leider J, Piekarz-Porter E. Associations of state laws regarding snacks in US schools with students’ consumption of solid fats and added sugars [published online January 15, 2020]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2019.18436.

2. Mayer AJ, Lawrence JM, Dabelea D, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012. N Engl J Med. 2017;376:1419-1429. doi: 10.1056/NEJMoa1610187.