Early Childhood and Child Care Study, Nutritional Assessment of the CACFP: Final Report, Vol. II

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USDA
Unrtsd States
Departmi it ot
Agriculture
Food and
Consumer
Service
Office of
Analysis and
Evaluation
Early Childhood and Child
Care Study
Nutritional Assessment of the
CACFP: Final Report
Volume II
July 1997
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-bOC^<\
BEST COPY AVAILABL
USDA United States
Department of
Agriculture
Food and
Consumer
Sen ice
Office of
Anal\ sis and
Evaluation
Early Childhood and Child Care
Study: Nutritional Assessment of
the CACFP
Volume II Final Report
Julv 199*
Authors:
Mary Kay Fox
Frederic B. Giant/
Lynn Geitz
Nancy Burstein
Submitted In: Submitted to:
Abt Associates Inc.
55 Wheeler Street
Cambridge. MA 02138-1168
Office of Analysis and Evaluation
USPA Food and Consumer Service
3101 Park Center Drive. Room 214
Alexandria. VA 22302
Project Director: Frederic B. Glantz Project Officer: John Endahl
This stud) was conducted under Contract No. 53-3198-3-018 with the Food and Consumer Service, United States Department of
Agriculture. I'oints ofview or opinions staled in this report do not necessarih represent the official position of the Food and
Consumer Service.
/
TABLE OF CONTENTS
Page
List of Exhibits "i
Acknowledgments x'n
Executive Summary' xv
Chapter One: Introduction 11
Study Background i-1
Overview of the CACFP 1-1
Organization and Structure of Child Care Sites 1-2
Study Objectives 1-5
Organization of This Report 1-7
Chapter Two: Study Methodology 2-1
Study Design and Data Collection 2-1
Nutrients and Nutrient Standards 2-4
Overview of the Analyses 2-9
Chapter Three: Meals and Snacks Offered by CACFP Providers 3-1
Breakfasts Offered 3-3
Lunches Offered 3-17
Snacks Offered 3-36
All Meals and Snacks Offered 3-43
Chapter Four: Meals and Snacks Consumed by CACFP Participants 4-1
Breakfasts Consumed 4-3
Lunches Consumed 4-13
Snacks Consumed 4-23
All Meals and Snacks Consumed 4-29
Chapter Five: Nutrition Knowledge and Food Service Practices 5-1
Data Sources 5-1
Nutrition Knowledge of CACFP Food Preparers 5-2
Food Service Practices 5-10
Appendix A Methodology Used in Determining the Nutrient Content of
Meals and Snacks Offered and Consumed A-1
Meals and Snacks Offered A-l
Meals and Snacks Consumed A-18
Table of Contents
//
Appendix B
Appendix C
Appendix D
Appendix E
Appendix F
Appendix G
Appendix H
TABLE OF CONTENTS
(continued)
Detailed Tables on Meals and Snacks Offered by
CACFP Providers
Detailed Tables on Meals and Snacks Consumed by
CACFP Participants
Page
B-l
C-l
Study Design D-l
Stage 1
Stage 2
Stage 3
Stage 4
Selection of States D-3
Selection of Sponsors D-4
Selection of Child Care Providers D-4
Selection of Children and Families D-5
Weighting Methodology E-l
Sponsor Weights E-2
Provider and Menu Weights E-3
Weights for On-site Observations E-4
Study Implementation F-l
Summary F-l
Instrumentation F-4
Study Implementation F-6
Disposition of the Study Sample F-12
Followup Survey of Nonresponders F-21
Reference Tables for Approximate Confidence Intervals G-l
Reliability of Visual Estimation of Food Intake H-l
Methodology H-l
Results H-4
Conclusions H-l 2
Table of Contents it
///
LIST OF EXHIBITS
Page
Exhibit 1 Nutrient Standards Used in the Early Childhood and Child
Care Study xxi
Exhibit 1.1 CACFP Meal Pattern Requirements for Children 1-3
Exhibit 2.1 Research Objective. Data Collection Strategy, and
Sample 2-2
Exhibit 2.2 Nutrient Standards Used in the Early Childhood and
Child Care Study 2-7
Exhibit 3.1 CACFP Providers Tend to Offer a Fixed Breakfast Menu Each
Day but Do Vary Menu Items Over the Course of a Week 3-5
Exhibit 3.2 Foods Most Commonly Offered in CACFP Breakfasts 3-6
Exhibit 3.3 Breakfasts Offered by CACFP Providers Supply More Than
One-fourth of the RDA, Except for Energy 3-9
Exhibit 3.4 With the Exception of Energy. Most Providers Offer Breakfasts
That Provide at Least One-fourth or More of the RDA 3-10
Exhibit 3.5 Breakfasts Offered by CACFP Providers An- Largely Consistent
with Dietary Guidelines and NRC Recommendations 3-12
Exhibit 3.6 With the Exception of Saturated Fat. Most Providers Offer
Breakfasts That Meet Dietary Guidelines and NRC
Recommendations 3-14
Exhibit 3.7 Sources of Energy and Nutrients in CACFP Breakfasts:
Relative Contribution of CACFP Meal Components 3-15
Exhibit 3.8 CACFP Providers Tend to Offer a Fixed Lunch Menu Each
Day but Do Vary Menu Items Over the Course of a Week 3-18
Exhibit 3.9 Foods Most Commonly Offered in CACi ? 1 inches 3-20
Exhibit 3.10 Lunches Offered by CACFP Providers Supply More Than
One-third of the RDA. Except for Energy and Iron 3-23
List of Exhibits Hi
/•
LIST OF EXHIBITS
(continued)
Page
Exhibit 3.11 With the Exception of Energy and Iron. Most Providers Offer
Lunches That Provide at Least One-third of the RDA 3-25
Exhibit 3.12 Lunches Offered by CACFP Providers Are Not Consistent
with Dietary Guidelines and NRC Recommendations 3-26
Exhibit 3.13 With the Exception of Cholesterol. Few Providers Offer Lunches
That Meet Dietary Guidelines and NRC Recommendations 3-28
Exhibit 3.14 Low-Fat Lunches Are Somewhat Lower in Total Energy Than
Other Lunches but Provide Comparable Amounts of Key
Nutrients 3-30
Exhibit 3.15 Providers That Offer Low-Fat Lunches Tend to Offer Certain
Foods More Often Than Providers That Offer Higher-Fat
Lunches 3-32
Exhibit 3.16 Sources of Energy and Nutrients in CACFP Lunches: Relative
Contribution of CACFP Meal Components 3-35
Exhibit 3.17 The Afternoon Snack is, by Far. the Most Commonly Offered
CACFP Snack 3-37
Exhibit 3.18 Foods Most Commonly Offered in CACFP Morning Snacks 3-39
Exhibit 3.19 Foods Most Commonly Offered in CACFP Afternoon Snacks .... 3-40
Exhibit 3.20 Snacks Offered by CACFP Providers Supply More Than 10 Percent
of the RDA for Energy and Comparable or Greater Percentages
of the RDA for Key Nutrients 3-42
Exhibit 3.21 Most CACFP Providers Offer Breakfast and Lunch with
One or Two Snacks 3-45
Exhibit 3.22 The Full Complement of Meals and Snacks Offered by Most
CACFP Providers Supplies More Than One-half of the RDA
for Energy and Substantially More Than Two-thirds of the RDA
for Key Nutrients 3-47
Exhibit 3.23 The Meal and Snack Combinations Offered by Most CACFP
Providers Meet or Approximate Dietary Guidelines and NRC
Recommendations, with the Exception of the Percentage of
Energy from Saturated Fat 3-49
List of Exhibits iv
LIST OF EXHIBITS
(continued)
Page
Exhibit 4.1 More Than 80 Percent of CACFP Participants Take Breakfasts That
Include All Required Meal Components 4-4
Exhibit 4.2 CACFP Participants Consume About Three-quarters of the Portions
of Food Taken at Breakfast 4-6
Exhibit 4.3 CACFP Participants Actually Consume About Three-quarters of the
Energy and Nutrients Available in the Breakfasts They Take 4-7
Exhibit 4.4 Breakfasts Consumed by CACFP Participants provide More Than
One-fourth of the RDA, Except for Energy and Iron 4-8
Exhibit 4.5 Breakfasts Consumed by CACFP Participants Five Years of Age
and Older Are Largely Cons-stem with Dietary Guidelines and NRC
Recommendations 4-10
Exhibit 4.6 More Than 80 Percent of CACFP Panicipants Take Lunches That
Include All Required Meal Components 4-14
Exhibit 4.7 With the Exception of Vegetables. CACFP Participants Consume
More Than 70 Percent of the Portions of Food Taken at Lunch ... 4-15
Exhibit 4.8 CACFP Participants Actually Consume About Three-quarters of
the Energy and Nutrients Available in the Lunches They Take .... 4-17
Exhibit 4.9 Lunches Consumed by CACFP Participants Provide One-third or
More of the RDA. Except for Energy and Iron 4-18
Exhibit 4.10 Lunches Consumed by CACFP Participants Five Years of Age and
Older Meet Recommendations for Cholesterol and Sodium
Intake but Do Not Meet Recommendations for the Percentage of
Energy From Fat. Saturated Fat. or Carbohydrate 4-20
Exhibit 4.11 More Than 80 Percent of CACFP Participants Take Snacks That
Include All Required Components 4-24
Exhibit 4.12 CACFP Participants Consume 80 Percent or More of the Portions
of Food Taken at Snack 4-26
Exhibit 4.13 CACFP Participants Actually Consume More Than 80 Percent of the
Energy and Nutrients Available in the Snacks They Take 4-27
List of Exhibits »
VI
LIST OF EXHIBITS
(continued)
Page
Exhibit 4.14 Snacks Consumed by CACFP Participants Provide About 10 Percent
of the RDA for Energy and Comparable or Greater Percentages of
the RDA for All Key Nutrients 4-28
Exhibit 4.15 Most Children in Care Four to Eight Hours per Day Consume at
Least Two CACFP Meals and/or Snacks 4-30
Exhibit 4.16 CACFP Meals and Snacks Consumed by Children in Care Four
to Eight Hours per Day Make Substantial Contributions to Daily
Nutrient Needs 4-31
Exhibit 4.17 CACFP Meals and Snacks Consumed by Five-Year-Old Children
in Care Four to Eight Hours per Day Meet Recommendations for
Total Fat. Carbohydrate, and Cholesterol but Not for Saturated Fat.
Protein, or Sodium 4-33
Exhibit 4.18 Most Children in Care Eight or More Hours per Day Receive
Breakfast. Lunch, and One or Two Snacks 4-34
Exhibit 4.19 CACFP Meals and Snacks Consumed by Children in Care Eight or
More Hours per Day Provide 50 to 100 Percent of Children's
Energy and Nutrient Needs 4-36
Exhibit 4.20 With the Exception of Choles'erol. CACFP Meals and Snacks
Consumed by Five-Year-Old Children in Care Eight or More
Hours per Day Do Not Meet Recommendations 4-37
Exhibit 5.1 CACFP Food Preparers Have a Reasonably High Level of
Nutrition Knowledge 5-4
Exhibit 5.2 CACFP Food Preparers Are Familiar with the Food Guide
Pyramid But Have Some Misconceptions About the Nutrient
Content of Foods 5-5
Exhibit 5.3 CACFP Food Preparers Know a Lot About How to Implement the
Dietary Guidelines 5-8
Exhibit 5.4 According to Food Preparers. CACFP Providers are Implementing
Many Food Service Practices That Are Consistent with the
Dietan Guidelines 5-12
List of Exhibits vi
LIST OF EXHIBITS
(continued)
Page
Exhibit 5.5 Food Preparers with Food Purchasing Responsibility Make Good
Use of Nutrition Labels 5-15
Exhibit 5.6 Food Preparers Give Paramount Consideration to Needs of Children.
Sugar Content of Foods, and Sanitation Considerations When
Making Food Purchasing Decisions 5-16
Exhibit A. 1 Food Groups Used in Determining Average Portions Offered A-4
Exhibit A.2 Meal-Specific Adjustment Ratios for Each Age Group A-5
Exhibit A.3 Average Portions Offered by Age Group and Meal A-7
Exhibit A.4 Food Codes Used for Food Group Analyses A-20
Exhibit B. 1 Percentage of Providers Offering CACFP Breakfast
by Hours of Operation B-1
Exhibit B.2 Mean Energy and Nutrient Content of CACFP Breakfasts
Offered by Age Group B-2
Exhibit B.3 Mean Percentage of RDAs Provided in CACFP Breakfasts
Offered by Age Group B-4
Exhibit B.4 Percentage of Providers Offering CACFP Breakfasts That
Provide One-forth or More of the RDA for Energy and
Key Nutrients by Age Group B 6
Exhibit B.5 Mean Macronutrient. Cholesterol, and Sodium Content of
CACFP Breakfasts Offered by Age Group B-7
Exhibit B.6 Distribution of Macronutrients. Cholesterol, and Sodium
in Breakfasts Offered to Five- to Ten-Year-Olds B-9
Exhibit B 7 Sources of Energy and Nutrients in CACFP Breakfasts B-10
Exhibit B.8 Mean Energy and Nutrient Content of CACFP Lunches
Offered by Age Group B-11
Exhibit B.9 Mean Percentages of RDAs Provided in CACFP Lunches
Offered by Age Group B-13
List of Exhibits vu
y/lll
LIST OF EXHIBITS
(continued)
Page
Exhibit B. 10 Percentage of Providers Offering CACFP Lunches Thai Provide
One-third or More of the RDA for Energy and Key Nutrients
by Age Group B-15
Exhibit B. 11 Mean Macronutrient, Cholesterol, and Sodium Content
of CACFP Lunches Offered by Age Group B-16
Exhibit B. 12 Distribution of Macronutrients. Cholesterol, and Sodium
in Lunches Offered to Five- to Ten-Year-Olds B-18
Exhibit B. 13 Mean Energy and Nutrient Content of CACFP Lunches with
Varying Levels of Energy from Fat B-19
Exhibit B.14 Sources of Energy and Nutrients in CACFP Lunches B-20
Exhibit B. 15 Mean Energy and Nutrient Content of CACFP Morning
Snacks Offered by Age Group B-22
Exhibit B. 16 Mean Percentage of RDAs Provided in CACFP Morning
Snacks Offered by Age Group B-23
Exhibit B.17 Mean Energy and Nutrient Content of CACFP Afternoon
Snacks Offered by Age Group B-25
Exhibit B. 18 Mean Percentage of RDAs Provided in CACFP Afternoon
Snacks Offered by Age Group B-26
Exhibit B 19 Mean Energy and Nutrient Content of Most Common
Meal Combinations Offered by Age Group: All Providers B-28
Exhibit B.20 Mean Energy and Nutrient Content of Most Common
Meal Combinations Offered by Age Group Family Da>
Care Homes B-30
Exhibit B 21 Mean Energy ard Nutrient Content of Most Common Meal
Combinations Offered by Age Group Head Start Centers B-32
Exhibit B 22 Mean Energy and Nutrient Content of Most Common Meal
Combinations Offered by Age Group: Child Care Centers B-34
Exhibit B 23 Mean Energy and Nutrient Content of Most Common
Meal Combinations Offered by Age Group: All Centers B-36
Lut of Exhibits nu
It
LIST OF EXHIBITS
(continued)
Exhibit B.24 Mean Percentage of RDAs Provided in Most Common Meal
and Snack Combinations Offered by Age Group: All Providers
Page
B-38
Exhibit B 25 Mean Percentage of RDAs Provided in Most Common Meal
and Snack Combinations Offered by Age Group:
Family Day Care Homes B-40
Exhibit B.26 Mean Percentage of RDAs Provided in Most Common Meal and
Snack Combinations Offered by Age Group: Head Start Centers . B-42
Exhibit B.27 Mean Percentage of RDAs Provided in Most Common Meal and
Snack Combinations Offered by Age Group Child Care Centers . B-44
Exhibit B 28 Mean Percentage of RDAs Provided in Most Common Meal and
Snack Combinations Offered by Age Group: All Centers B-46
Exhibit B.29 Mean Macronutrient. Cholesterol, and Sodium Content of Most
Common Meal Combinations Offered by Age Group:
All Providers B-48
Exhibit B.30 Mean Macronutrient. Cholesterol, and Sodium Content of MOM
Common Meal Combinations Offered by Age Group:
Family Day Care Homes B 50
Exhibit B 31 Mean Macronutrient. Cholesterol, and Sodium Content of Mod
Common Meal Combinations Offered by Age Group:
Head Start Centers B-52
Exhibit B.32 Mean Macronutrient. Cholesterol, and Sodium Content of Most
Common Meal Combinations Offered by Age Group
Child Care Centers B-54
Exhibit B 33 Mean Macronutrient. Cholesterol, and Sodium Content of Most
Common Meal Combinations Offered by Age Group:
All Centers B 56
Exhibit C 1 Mean Portion Sizes of CACFP Breakfast Foods Taken
by Children C-l
Exhibit C.2 Mean Percentage of Breakfast Portions Consumed by Age Group C 2
Liu of EiAifcfi u
LIST OF EXHIBITS
(continued)
Page
Exhibi! C.3 Mean Percentage of Available Breakfast Nutrients Actuall)
Consumed C-3
Exhibit C4 Mean Energy and Nutrient Intake from CACFP Breakfasts
Consumed by Age Group C-5
Exhibit C.5 Mean Percentage of RDAs Provided m CACFP Breakfasts
Consumed by Age Group ... C-7
Exhibit C.6 Mean Macronutnent. Cholesterol, and Sodium Content of
CACFP Breakfasts Consumed by Age Group C-9
Exhibit C 7 Mean Portion Sizes of CACFP Lunch Foods Taken by Children C-ll
Exhibit C 8 Mean Percentage of Lunch Portions Consumed by Age Group .... C-12
Exhibit C 9 Mean Percentage of Available Lunch Nutrients Actual!)
Consumed C-14
Exhibit C 10 Mean Energ) and Nutrient Intake from CACFP Lunches
Consumed by Age Group C-16
Exhibit C 11 Mean Percentage of RDAs Provided in CACFP Lunches
Consumed by Age Group C-I8
Exhibit C 12 Mean Macronutnent. Cholesterol, and Sodium Content of
CACFP Lunches Consumed by Age Group C-20
Exhibit C 13 Mean Percentage of Available Morning Snack Nutrients
Actual!) Consumed C-22
Exhibit C 14 Mean Percentage of Available Afternoon Snack Nutrients
Actually Consumed . . C-23
Exhibit C. 15 Mean Energy and Nutrient Intake from CACFP Morning Snacks
by Age Group C 24
Exhibit C 16 Mean Percentages of RDAs Provided in CACFP Morning Snacks
Consumed by Age Group C-25
Exhibit C. 17 Mean Energ) and Nutrient Intake from CACFP Afternoon
Snacks by Age Group C-27
Ltatf Ex*+m <
*/
LIST OF EXHIBITS
(continued)
Exhibit C. 18 Mean Percentage of RDAs Provided in CACFP Afternoon
Snacks Consumed by Age Group C-28
Exhibit C 19 Mean Energ> and Nutrient Intake from All CACFP .Heal*
and Snacks Consumed by Children in Care Four to Eight
Hours per Day b> Age Group C-30
Exhibit C 20 Mean Percentages of RDAs Provided in All Meals and Snacks
Consumed by Children in Care Four to Eight Hours per
Day by Age Group C ?2
Exhibit C 21 Mean Macronuthent. Cholesterol and Sodium Content of
All CACFP Meals and Snacks Consumed by Children m Care
Four to Eight Hours per Day by Age Group . . C-34
Exhibit C 22 Mean Energy and Nutrient Intake from All CACFP Meals and
Snacks Consumed by Children in Care Eight or More Hours
per Day by Age Group . . . . . C-36
Exhibit C .23 Mean Percentage of the RDA Provided m All Meads and
Snacks Consumed by Children in Care Eight or More Hours
per Day by Age Group . , r
Exhibit C.24 Mean Macronutnent. Cholesterol, and Sodium Comem of
All Meals and Snacks Consumed by CMdreo in Care Fjght
or More Hours per Day by Age Group C-W
Exhibit D 1 Overview of Study Design D-2
Exhibh D 2 Stales Included in Study Sample by FCS Region D-?
Exhibit F 1 Data Collection Strategy by Study'Objective F2
ExhibuF2 Sample Duposnion Famih Dan Care Home Sponsors. Provider*.
and Children F-14
Fjdubit F 3 Sample Disposition: Head Start Center Sponsors. Providers.
and Children F-IT
ExmbnF4 Sample Disposition Child Care Censer Sponsors, Providers.
and Children F-20
Exmbu F 5 Response Rales for Sponsors. Providers, and Children F 22
Uavf LxhMm: at
X/l
LIST OF EXHIBITS
(continued)
Page
Exhibit F.6 Sample Size. Number of Completed Interviews.
and Response Rates F-25
Exhibit G. la Confidence Intervals for Proportions Based on a Simple
from Children in FDCHs G-3
Exhibit Gib Confidence Intervals for Proportions Based on a Sample
from Children in Head Start Centers G-4
Exhibit G.lc Confidence Intervals for Proportions Based on a Sample
from Children in Child Care Centers G-5
Exhibit G.2a Confidence Intervals for Proportions Based on a Sample
from FDCH Providers G-6
Exhibit G.2b Confidence Intervals for Proportions Based on a Sample
from Head Stan Centers G-7
Exhibit G.2c Confidence Intervals for Proportions Based on a Sample
from Child Care Centers G-8
Exhibit G.3a Confidence Intervals for.Proportions Based on a Sample
from FDCH Sponsors G-9
Exhibit G.3b Confidence Intervals for Proportions Based on a Sample
from Head Start Sponsors G-10
Exhibit G.3c Confidence Intervals for Proportions Based on a Sample
from Child Care Center Sponsors G-l 1
Exhibit H.l "Gold Standard" and Validators' Estimates of the Nutrient
Content of Foods H-5
Exhibit H.2 Correlations Between "Gold Standard" and Validators*
Observations of Nutrient Content of Foods H-7
Exhibit H.3 Differences Between Field Observers' and Validators'
Estimates of Nutrient Intake H-9
Exhibit H.4 Correlations Between Validator and Field Observer
Estimates of Nutrient Intake H-10
Exhibit H.5 Regression Results Predicting Overall Absolute Differences
Between Validator and Observer Estimates of Nutrient Intake H-ll
List of Exhibits xii
XI u
Acknowledgments
The Early Childhood and Child Care Study represents the culmination of more than three years
of effort by many persons in several organizations. While it is not possible to thank every
person who contributed to the study, we want to acknowledge the support and contributions of
several individuals.
Special thanks are due to the family day care providers and the staff of the Head Stan and child
care centers that participated in the study. The results of this study are useful largely because
these individuals opened their doors to study staff and found the time in their busy days to
complete the lengthy questionnaires. Thanks are also due to State Child Nutrition Directors who
helped assemhle listings of family day care homes and child care centers that were used in
selecting national samples for the study. The cooperation of sponsoring institutions was also
invaluable in ensuring the success of the study. In particular, the support of the Child Care
Food Program Sponsors' Forum helped us gain the cooperation of family day care homes.
Staff of the Office of Analysis and Evaluation. Food and Consumer Service. U.S. Department
of Agriculture had responsibility for overseeing the project. Jeffrey Wilde served as the Project
Officer for the first three years of the study. John Endahl served as the Project Officer for the
final year of the study. Both provided valuable insights and direction throughout the project and
in the preparation of the final report.
Early Childhood Associates. Inc.. of Natick. Massachusetts served as Abt Associates*
subcontractor and was responsible for a portion of the work involved in compiling lists of
participating family day care homes and centers. Their staff conducted many of the telephone
calls to sponsoring agencies to obtain provider lists. Linda Warren was responsible for the
subcontract.
Several staff members at Abt Associates played important roles in the project. Mary Jo Cutler.
Deputy Project Director, provided valuable assistance in managing this large and complex
Acknowledgments xiu
/
Early Childhood and Child Care Study: Vol. II
project. Gary Shapiro developed the sampling design. Kurt Veith directed the survey and field
operations. Susan Palter. Jenny Golay. and Mary Jo Cutler developed the Menu Surveys and
meal observation protocols, developed training materials, and helped train field staff. David
Rodda directed the analyses reported in Volume I. Mary Kay Fox and Nancy Burstein oversaw
analyses for Volume II. Analysts who assisted with one or both volumes include Marian
Wrobel. Dylan Conger. William Rhodes, and Don Laliberty. Joan McLaughlin. Mike Puma,
and Nancy Burstein reviewed and critiqued all reports.
Special thanks are due to Mary Kay Fox who directed the nutrition analyses and is the principal
author of Volume II. Ellen Lee who managed the study's large and complex database and
provided invaluable assistance in all analyses, and Eileen Fahey who coordinated production of
all deliverables and reports. I am indented to them for their tireless efforts on this project.
Frederic B. Glantz
Project Director
Abt Associates Inc.
Acknowledgments xiv
Executive Summary
This repon presents findings from the Early Childhood and Child Care Study, a study carried
out by Abt Associates Inc. of Cambridge, Massachusetts, under contract to the Food and
Consumer Service (FCS) of the United States Department of Agriculture (USDA). The study
describes the institutions and children that participate in the Child and Adult Care Food Program
(CACFP). It also describes the nutrient content of meals and snacks offered under the program
and the contribution of CACFP meals and snacks to the daily energy and nutrient needs of
participating children. Information for the study was collected from nationally representative
samples of sponsoring agencies, participating child care sites, and children. Data for the study
were collected between January and June, 1995.
This is the second of two volumes of the final study report. This volume focuses on the nutrient
content of meals and snacks offered by participating child care sites, the meals and snacks
consumed by children receiving child care in those sites. Volume I (a separate document)
provides a descriptive profile of child care sites participating in the CACFP and the children
receiving care in those sites.
THE CHILD AND ADULT CARE FOOD PROGRAM
The Child and Adult Care Food Program (CACFP) is a Federal program that provides meals
and snacks in child and adult day care facilities. The child care component of the CACFP
provides Federal funds for meals and snacks served to children in nonresidential day care
facilities. These include family and group day care homes (homes). Head Start centers, and
some child care centers. In fiscal year 1995. the program served an average of 2.4 million
children daily at a cost of $1.5 billion. Forty-two percent of these children were served through
homes; 58 percent through centers.
This report describes meals and snacks offered by child care sites participating in the CACFP
(CACFP providers) as well as meals and snacks consumed by children receiving care in those
sites (CACFP participants). Information on the average nutrient content of CACFP meals are
compared to the Recommended Dietary Allowances (RDAs), which establish benchmarks for
average daily intake of energy and key nutrients by age group and gender, and to
recommendations incluued in the Dietary Guidelines for Americans and the National Research
Council's (NRC) Diet and Health report. The Dietary Guidelines and NRC recommcndttions
address intake of fats, carbohydrate, and protein, as well as sodium and cholesterol, and are
applied only to older children (five- to ten-year-olds). It must be emphasized that these
standards are used only to facilitate interpretation of the data, CACFPproviders are not required
to meet these or any other nutrient standards.
Executive Summary xv
Early Childhood and Child Cart Study: Vol. II
MEALS AND SNACKS OFFERED BY CACFP PROVIDERS
Breakfasts and Lunches
• The average nutrient content of CACFP breakfasts and lunches, as offered, meets or
exceeds all of the RDA standards used in this study (one-fourth of the RDA for
breakfasts and one-third for lunches), except for energy (breakfasts and lunches) and iron
(lunches).
• Breakfasts offered to children five years of age and older supply 23 percent of total
energy as fat. a level that is consistent with recommendations that no more than 30
percent of total energy come from fat. The average proportion of energy from
carbohydrate (64%) is also consistent with recommendations, as are average amounts of
cholesterol (51 mg) and sodium (445 mg).
• Breakfasts are not consistent with the recommendation for the percentage of energy from
saturated fat (11% percent compared to the recommendation of less than 10%). The
actual amount of saturated fat in CACFP breakfasts is not excessive, however, compared
to the amount of saturated fat allowable in a meal that provides one-fourth of the RDA
for energy and less than 10 percent of the energy as saturated fat. The reason CACFP
breakfasts do not meet the saturated fat recommendation has more to do with the limited
amount of energy provided than with an excessive amount of saturated fat. In fact, if
the average energy content of CACFP breakfasts were increased by about 70 calories for
five-year-olds and 55 calories for six- to ten-year-olds, by offering more carbohydrate-rich
foods such as juices, fruit, and low-fat breads and bread alternates, there would be
no need to reduce actual saturated fat content.
• Lunches offered to children five years of age and older do not meet recommendations
for the percentage of energy from fat, saturated fat. or carbohydrate. The average
percentage of energy from fat is 35 percent; the recommended level is no more than 30
percent. The average percentage of energy from saturated fat is 14 percent, a level
which exceeds the recommendation of less than 10 percent, and the average percentage
of energy from carbohydrate is 47 percent, compared to the recommendation of 55
percent or more.
• The average cholesterol content of CACFP lunches is consistent with the recommended
level (65 mg compared to the recommended range of 100 mg or less). The average
sodium content, however, does not meet the recommendation (919 mg compared to the
recommended range of 800 mg or less).
Snacks
Both morning and afternoon snacks offered in the CACFP supply more than 10 percent
of the RDA for energy and comparable or greater percentages of the RDA for key
Executive Summary xvi
4
Early Childhood and Child Cart Study: Vol. II
nutrients. Snacks are especially rich in vitamin C. providing one-third (afternoon snacks)
to 40 percent (morning snacks) of the RDA.
All Meals and Snacks Offered
• The full complement of meals and snacks offered by most CACFP providers supplies
more than one-half of the RDA for energy and substantially more than two-thirds of the
RDA for all key nutrients.
• The combinations of meals and snacks most commonly offered in the CACFP provide
an average of 30 to 31 percent of energy from fat. levels which approximate the
recommendation of 30 percent or less. Likewise, the percentage of energy from
carbohydrate. 55 to 56 percent, is consistent with recommendations.
• The percentage of energy from saturated fat in the most common meal and snack
combinations (13%) is not consistent with the recommended level of less than 10 percent
• To be consistent with recommendations for cholesterol and sodium intake, meals and
snacks should make equivalent contributions to recommended intakes of energy,
cholesterol, and sodium. The most common meal and snack combinations offered in the
CACFP meet this standard for cholesterol but not for sodium.
MEALS AND SNACKS CONSUMED BY PARTICIPATING CHILDREN
The nutrient profile of meals and snacks actually consumed by participating children may differ
from the meals and snacks offered by providers. For example, children may decline one or more
of the foods offered; children may select portions that differ from the average portion; or
children may waste (not consume) some of the food they take. Thus to gain a full understanding
of the contributions CACFP meals and snacks actually make to children's daily energy and
nutrient needs, it is important to examine CACFP meals and snacks as actually consumed by
children.
Breakfasts and Lunches
• Children generally select portions of food that are equivalent to. or greater than, the
minimum portion sizes specified in CACFP meal pattern requirements. Children
generally consume between 70 and 75 percent of the portions of food taken at hreakfast
and lunch. Different types of food are consumed in approximately equal proportions at
breakfast. At lunch, the average proportion of milk consumed is substantially higher
(83%) and the average proportion of vegetables consumed is substantially lower (59%)
than other foods.
Executive Summary xvii
Earh Childhood and Chdd Care Study: Vol. II
Children's average nutrient intake from CACFP breakfasts and lunches meets or exceeds
all of the RDA standards used in this study (one-fourth of the RDA for breakfast and
one-third of the RDA for lunch), except for energy and iron.
On average, 24 percent of the energy in breakfasts consumed by CACFP participants
five years of age and older comes from fat. a level that is consistent with
recommendation of no more than 30 percent. Carbohydrate intake is also consistent with
recommendations, as are intakes of cholesterol and sodium.
The average percentage of energy from saturated fat in CACFP breakfasts consumed by
children (l\7c) does not meet the recommendation of less than 10 percent. This finding
is not surprising because, as discussed above, breakfasts offered by CACFP providers
do not meet the recommendation for energy from saturated fat. As noted above,
however, the reason that CACFP breakfasts, both as offered to and consumed by children
five and older, do not meet recommendations for the percentage of energy from saturated
fat has more to do with the limited energy contribution of CACFP breakfasts than with
excessive amounts of saturated fat. per se.
The average percentage of energy from fat (35%) and carbohydrate (46%) in lunches
consumed by CACFP participants Five years of age and older is not consistent with
recommendations (no more than 307c and 55% or more, respectively). It is important to
note that the reason CACFP lunches, as consumed, do not meet the recommendation for
the percentage of energy from fat has more to do with the fact that lunches provide a
limited amount of energy, specifically energy from carbohydrate, than with excessive
amounts of fat.
The average percentage of energy from saturated fat in CACFP lunches consumed by
children five years and older does not meet the recommendation (157c compared to the
recommendation of less than \07c). The limited energy contribution of CACFP lunches
does not explain this finding. Lunches consumed by children, like the lunches offered
by providers, supply more saturated fat (total amount as well as a percentage of total
energy) than recommended.
Achieving the desired balance in sources of food energy in CACFP lunches, that is.
increasing consumption of energy from carbohydrate while, at the same time, decreasing
consumption of saturated fat may be difficult in light of the fact that children do not
consume all of the foods presently taken at lunch. Because young children's appetites
are self-limiting, it may be more reasonable to offset calories from fat consumed at lunch
with carbohydrate calories in a snack that precedes or follows lunch.
Lunches consumed by CACFP participants five years of age and older meet
recommendations for cholesterol and sodium intake.
Executive Summary xviii
Early Childhood and Child Cart Study: Vol. II
Snacks
• On average, children consume approximately 80 percent or more of the portions of food
taken at snack. The mean rate of consumption is consistently higher for monting snacks.
Snacks consumed by CACFP participants provide, on average, about 10 percent or more
of the RDA for energy and comparable or greater percentages of the RDA for ke\
nutrients.
All Meals and Snacks Consumed
Because the number of CACFP meals and snacks available to children is influenced by the
amount of time spent in care, findings are summarized separately for children in care at least
four but less than eight hours per day (children in part-day care) and for children in care eight
or more hours per day (children in full-day care).1
Children in Care Four to Eight Hours per Day
• Most children in part-day care consume at least two CACFP meals and/or snacks while
in care. The most common meal and snack combinations are: lunch and one snack (24%
of all children), breakfast, lunch, and one snack (25% of children), and breakfast and
lunch (23% of children). About 18 percent of pan-day children receive only one meal
or snack. This is particularly true among part-day children attending child care centers,
where 36 percent of part-day children receive only one meal or snack.
• On a typical day. children in care at least four but less than eight hours per day consume,
from CACFP meals and snacks, an average of about one-third of the RDA for energ\
and iron and about one-half of the RDA for calcium. Intakes of other nutrients are
substantially higher, averaging 108 percent of the RDA for protein. 80 percent of the
RDA for vitamin A. and 86 percent of the RDA for vitamin C
• Mean intakes among children receiving part-day care in child care centers are lower than
children receiving part-day care in homes and Head Start centers This is consistent with
the fact that 23 percent of part-day children in centers receive only one snack and another
13 percent receive only breakfast or lunch.
• The average nutrient intake of five-year-olds in part-day care meets recommendations for
the percentage of energy from fat (29% compared to the recommendation of no more
than 30%) and carbohydrate (56% compared to the recommendation of at least 55% ). but
does not meet the recommendation for the percentage of energy from saturated fat (12%
compared to the recommendation of less than 10%).
School-age-children (six-to-ten year oldsl are eickl Wd from these tabulations because most ot the>.c children are
in care before and or after school and their patterns of consumption differ substantially from other children in L jre
Executive Summon IU
7
Earlv Childhood and Child Cart Study: Vol. II
• Cumulative intake of sodium and cholesterol from all CACFP meals and snacks is
evaluated with respect to the cumulative contribution to the RDA for energy. Ideally,
relative contributions to recommended daily intakes of energy, cholesterol, and sodium
should be comparable. Five-year-olds in part-day care consume, on average. 31 percent
of the RDA for energy from CACFP meals and snacks. These meals and snacks also
contribute 22 percent of the suggested daily limit of cholesterol, an acceptable level in
light of the mean contribution to recommended energy intake. Mean contribution to the
suggested daily limit for sodium intake is 35 percent, a level which is somewhat high
because it exceeds the contribution to recommended daily energy intake.
Children in Care Eight or More Hours per Day
• Three-quarters of children in care eight or more hours per day (full-day care) consume
breakfast, lunch, and one or two snacks while in care. Another 19 percent of children
consume lunch and one or two snacks, while another four percent consume breakfast and
lunch. None of the children in full-day care receive only one meal or snack
• The total complement of meals and snacks consumed by children in care eight or more
hours per day provides an average of about one-half of the RDA for energy and iron.
Intake of calcium from CACFP meals and snacks approximates, on average, three-quarters
of the RDA. Average intakes of protein, vitamin A. and vitamin C exceed 100
percent of the RDA.
• On average, the total complement of meals and snacks consumed by five-year-old
children in full-day care provides 32 percent of energy from fat (recommendation is no
more than 30%). 14 percent of energy from saturated fat (recommendation is less than
10%). and 53 percent of energy for carbohydrate (recommendation is at least 55c/<).
• I ive-year-old children in full-day care consume an average of 49 percent of the RDA for
energ> and 33 percent of the suggested daily limit for cholesterol By contrast, sodium
intake from CACFP meals and snacks contributes 52 percent of the suggested daily limit
for sodium, a level which is somewhat high in comparison to the contribution lo
recommended dailv enernv intake
Extcutivt Summon sx
2
Early Childhood and Child Cart Study: Vol. II
Exhibit 1
Nutrient Standards Used in the Karlv Childhood and Child Care Study
National School Lunch Program and School Breakfast Program
• One-fourth of the RDA for breakfast
• One-third of the RDA for lunch
Dietary Guidelines for Americans'
• Limit intake of total fat to no more than 30 percent of total calories
• Limit intake of saturated fat to less than 10 percent of total calories
National Research Council's Diet and Health Report1
• Increase intake of carbohydrate to at least 55 percent of total calories
• Limit cholesterol intake to 2.400 mg or less per day
• Limit sodium intake to 300 mg or less per day
Applied onl\ to TieaN ottered lo and consumed b\ children five >ear«. ot avx and older
Executive Summary xxi
Chapter One
Introduction
STUDY BACKGROUND
The Earl> Childhood and Child Care Study was carried out by Abt Associates Inc of
Cambridge. Massachusetts, under contract to the Food and Consumer Service (FCS» of the
'.'nited States Department of Agriculture (USDA). The study describes the institutions and
children that participate in the Child and Adult Care Food Program (CACFP) It also describes
the nutrient content of meals and snacks offered under the program and the contribution of
CACFP meals and snacks to the daily energy and nutrient needs of participating children
Information for the study was collected from nationally representative samples of sponsoring
agencies, participating child care sites, and children Data for the study were collected between
January and June. 1995.
This is the second of two volumes of the final study report This volume focuses on the nutrient
content of meals and snacks offered by participating child care sites and the meals and snacks
consumed b\ children receiving child care in those sites Volume I (a separate document •
provides a descriptive profile of child care sites participating in the CACFP and the children
receiving care in those sites
OVERVIEW OF THE CACFP
The CACFP is a Federal program that provides meals and snacks in child and adult da> care
facilities The Earl) Childhood and Child Care Stud) focused on the child care component of
the CACFP tthich provides Federal funds for meals and snacks served to children in non-residential
day care facilities Eligibility is limned to children age '2 and under. however, an
exception is made for children of migrant workers and children with disabilities, who ma>
participate through ages 15 and 18. respectively Participating sites, which include famil> and
group da> care homes (homes), some child care centers, and all Head Stan centers, may receive
reimbursement for breakfasts, lunches, suppers, and snacks served to children in care
Reimbursement is limited to a maximum of two meals and one snack or one meal and two
Charier I I I-I
/C
Emrh CUdm—d and Chid Cmrt Smtdy t W //
snacks. During the period of time dm study was conducted, centers could receive
reimbursement for an additional meal or snack for children in care eight or more hours per
day On an average day in 1995. 2 3 million children received CACFP meals and/or snacks
CACFP Meal Pattern Requirements
The goal of the CACFP is to provide nutritious meals and snacks 10 children in child caie
programs To this end. L'SDA has established minimum requirements for the meals and snacks
offered by participating child care providers (CACFP providers) These meal pattern
requirements are designed to ensure that meals and snacks are nutritionally well-balanced,
supplying the kinds and amounts of food required to meet childrens' dads *nergy and nutneiii
needs The mtut pane*-. specif.es foods (meal components) to be offered at each meal and snack
as well as mu inr^u portion sizes for children of different ages | infants (less than 12 months).
one and two 1 ^ars. three to five years: and six to twelve years) Meal component requirements
are summarized in Exhibit 11
In addition 10 the meal pattern. L'SDA provides CACFP providers with a sanely of guidance
materials 10 assist menu planners in using meal pattern requirements to plan meals that are
appealing and age appropriate as well as nutritious
ORGANIZATION AND STRICTVRE OF CHILD CARE SITES
The CACFP is administered in two fundamentally different child care settings homes and child
care centers (including Head Stan centers) Homes are small They usually consist of one
provider caring for six to eight children in his or her own home : The typical center, on the
c*hcr hand, enrolls between 50 and 100 children. Homes arc shorter lived than centers In
addition, homes tend to offer more hours of care and are more likely than centers to be cipen
on weekends Because of the differences between homes and centers, the CACFP applies
Ihc pr- • •-.£ '<■- ■ i-i. » -I >:'-• '.-1 '.:. '-I .. I'- Sa *i '■>'< M ■- I mmWmWei ■••- • 1 ■■ tmwmpa
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liiuil anil IK jitmiiilf IIT tmeti jlmiijietl
Vhufitet J imruttu-.iuni #-4
/A
Earlv Childhood and Child Care Study: Vol. II
different rules for reimbursement and administration, as well as different criteria for
participation, to the two types of providers. These differences are described in the following
sections.
Centers
Licensed centers, both public and private, are eligible t< tarticipate in the CACFP if they are
nonprofit institutions. For-profit institutions are also eligible to participate if they receive
compensation for child care under Title XX of the Social Security Act for at least 25 percent of
the children enrolled or 25 percent of their licensed capacity, whichever is less. Centers may
participate in the CACFP independently or under the aegis of a nonprofit agency that assumes
administrative responsibility for the centers it sponsors (sponsored centers).
Centers receive three different categories of reimbursement for the meals and snacks they serve,
depending on children's family income. Meals and snacks served to children from families with
income at or below 130 percent of poverty are reimbursed at the "free" (highest) rate; meals and
snacks served to children from families with income between 130 percent and 185 percent of
poverty are reimbursed at the "reduced-price" (somewhat lower) rate; and meals served to
children from families with income above 185 percent of poverty are reimbursed at the "paid"
< lowest) rate.3
Differences Between Child Care Centers and Head Start Centers
Although child care centers and Head Start centers are equivalent with regard to CACFP
eligibility and administration, the two types of centers differ in several other important
characteristics. Child care centers typically operate year round, provide full-day care to working
parents, and serve several different age groups. Head Start centers, on the other hand, typically
follow school calendars and offer pan-day programs for low-income preschool children.
Moreover. Head Start programs do not provide child care per se. Rather, these programs are
best viewed as preschool programs intended to promote social competence and improve the
This nomenclature is adapted from the National School Lunch Program which uses a comparable three-level reimbursement
structure
Chapter I: Introduction 1-4
/3
Early Childhood and Child Care Study: Vol. II
emotional and cognitive development of low-income children. While most Head Start centers
provide only part-day programs of this nature, some centers may combine traditional pan-day
Head Start programs with full-day and/or before- and after-school child care programs. Head
Start centers are required by their grantor agency, the U.S. Department of Health and Human
Services, to participate in the CACFP.
Homes
To participate in the CACFP, homes must meet State licensing requirements, where these are
imposed, or be approved by a Federal. State, or local agency. In addition, homes must be
sponsored by an organization that assumes responsibility for ensuring compliance with Federal
and State regulations and that acts as a conduit for meal reimbursements.
Organizations thai sponsor homes for the CACFP are reimbursed separately for their
administrative costs, based on the number of homes sponsored each month. During the time
period that this study was conducted, family day care providers were reimbursed at a flat rate
for each meal or snack served. No income eligibility criteria were applied to children receiving
meals, however, such a criterion was applied to the provider's own children. Meals served to
the provider's own children were reimbursable only if the provider's income did not exceed !S5
percent of the poverty threshold.4
STUDY OBJECTIVES
Program participation and costs have increased markedly since the last national study of the
CACFP was conducted in 1986. The number of Federally subsidized meals and snacks served
'The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) changed the reimbursement
structure lor homes, effective July 1. 1997. A two-tiered structure was established with a higher level of reimbursement (tier
I) lor meals and snacks served 10 children enrolled in day care homes looted in low-income areas, i.e.. areas identified, through
the use of census or elementary school data, as areas in which at least 50 percent of children come from households with income
at or below 185 percent of the poverty threshold. Tier I rates are also paid for meals and snacks served by low-income
providers, i.e.. providers whose personal household income is at or below 185 percent of poverty. Homes that do not meet tier
I area- or provider-eligibility criteria are classified as tier II homes and receive a lower (tier II) level of reimbursement. Tier
II homes may elect to have their sponsor perform means tests to identify individual children whose household income is at or
below 185 percent of poverty; meals and snacks served to these children would be reimbursable at tier I rates. Meals and snacks
served to a providers own children continue to be reimbursable (at tier I rates) only if the providers income is at or below 185
percent of poverty.
Chapter I: Introduction 1-5
;¥
Earls- Childhood and Child Care Studs Vol. II
in the program has increased from 678 million in Fiscal Year (FY) 1986 to 1.5 billion in FY
1995 Most of this growth has occurred in the family day care component of the program.
During this same time period, the cost of the program has increased from S689 million (FY
1986; in constant 1995 dollars)' to $1.5 billion (FY 1995). an increase of 117 percent The
dramatic increase in the size and cost of the program over the past decade dictates a need for
updated information on program operations, providers, and participants
The 1986 study of the CACFP did not include an in-depth assessment of the nutrient content of
meals and snacks offered by CACFP providers or consumed by CACFP participants (children).
Nor did it include an assessment of food service practices used in implementing the CACFP
Indeed, these aspects of the CACFP have not been studied in depth since the early 1980s Given
the increased public health focus on the relationship between dietary intake and health status,
there is an obvious need for updated information on the nutritional characteristics of CACFP
meals and snacks. There is also a need for information on the level of nutrition knowledge
possessed by the individuals responsible for preparing meals and snacks in the CACFP. as well
as the practices used in planning, preparing, and serving CACFP meals and snacks Such
information can be useful in identifying and addressing technical assistance and training needs.
The Earl> Childhood and Child Care Study was designed to fill these information gaps The
study has the following specific objectives:
• to describe the food and nutrient content of meals and snacks offered by
CACFP providers (child care sites);
• to describe the nutrient content of meals and snacks consumed by CACFP
participants (children) while in care;
• to assess the nutrition knowledge of individuals with primary responsibility
for preparing CACFP meals and snacks (food preparers);
• to assess the extent to which desirable food service practices arc used in
implementing the CACFP;
'The Consumer Price Index (CPI) was used 10 inflaie 1986 costs 10 1995 dollars Program cosis were S496 million in 1986
dollars
Chapter I: Introduction 1-6
45-
Earlv Childhood and Child Cart Study: Vol. II
• to describe the characteristics of participating children and their families;
and
• to describe CACFP program characteristics.
The first four objectives are addressed in this volume of the report; the two remaining objectives
are addressed in Volume I.
ORGANIZATION OF THIS REPORT
The remainder of this volume is organized as follows:
• Chapter Two presents an overview of the study design and the methodology
used to address research objectives related to the characteristics of CACFP
meals and snacks;
• Chapter Three describes meals and snacks offered by CACFP providers;
• Chapter Four describes meals and snacks consumed by participating
children; and
• Chapter Five describes the nutrition knowledge of CACFP food preparers
as well as the extent to which desirable food service practices are used in
procuring and preparing foods for CACFP meals and snacks.
Detailed appendices provide additional information on the methodology used in collecting and
analyzing information on meals and snacks offered and consumed as well as supplementary
exhibits. Also included are appendices that summarize study design, development of sample
weights, and study implementation.
Chapter I: Introduction 1-7
/£>
Chapter Two
Study Methodology
This chapter provides an overview of the methodology used to assess the food and nutrient
content of meals and snacks offered by CACFP providers and the nutrient content of meals and
snacks consumed by CACFP participants (children). The first section provides a brief
description of study design and data collection methods. The second section identifies the
nutrients examined in the study and the standards used to assess nutritional quality. The final
section provides an overview of the two major analyses discussed in this report: analyses of
meals and snacks offered and meals and snacks consumed.
STUDY DESIGN AND DATA COLLECTION
Data were collected from CACFPproviders (child care sites participating in the CACFP) as well
as from CACFP participants (children receiving care and consuming meals and snacks in
participating child care sites). Data collected from providers were used to describe the food and
nutrient content of meals and snacks offered in the CACFP; data collected from children were
used to describe the nutrient contributions of CACFP meals and snacks actually consumed by
children in care.' The following sections describe the types of data collected, the data collection
methodologies used, and the analytic samples. This information is summarized in Exhibit 2.1.
Data from CACFP Providers
All sampled CACFP providers were asked to complete a Menu Survey which requested detailed
information on the foods included in meals and snacks offered during a specified five-day period
(referred to as the target week).: Respondents were asked to list all foods offered, including
foods that may not have contributed to satisfying the CACFP meal pattern (e.g.. cakes.
'Data were also collected from parents to assess children's nutrient intake outside of child care. However, because response
rates lor this portion ot the study were unacceptanK low isee Appendix F). these data are not presented in this report
To obtain a reasonable assessment ot nutrient content, it is necessary to examine .neals offered over a period of time rather
than a single meal or a single day's offerings. The National Research Council (NRC) recommends that group feeding programs
plan menus so that nutrient standards are met over a five- to ten-day period. A sample five-day period, equivalent to one school
week, is routinely used in assessing USDA's Child Nutrition programs.
Chapter 2: Study Methodology 2-1
17
Earl\ Childhood and Chdd Cart Study: Vol. II
Exhibit 2.1
Research Objective, Data Collection
Strategy, and Sample
Research Objective Data Collection Strategy Sample
Describe the food and
nuineni conteni of meals and
snacks offered by CACFP
providers
Mail survey of CACFP providers to collect
information on foods included in all meals
and snacks offered during a specified five-day
period
1.962 CACFP providers
Describe the nutrient content
of meals and snacks
consumed by participating
children
Observation of all meals and snacks
consumed by sampled children while in child
care on two nonconsecutive davs
1.347 children receiving
child care in CACFP
sites-'
Sample sue varies lor different rivals and snacks because all provider! do not offer all meals and snacks
The number of children observed varies tor each meal and snack because children do nol necessarily consume all meals and
snacks and because sampled children ma> have been observed on one das or two days.
sweetened beverages, or snack chips), and to record the following information for each food
item: food name; a detailed description (a brochure that outlined the types of descriptive
information required for different types of food was included in the survey packet); brand name;
preparation; and recipes (when applicable and readi'y available). Respondents were also asked
to indicate the age groups of children to whom each food was offered, recognizing that some
foods may not be offered to some groups of children, for example, peanuts or whole grapes may
not be offered to toddlers because these foods present an increased risk of choking. The
standard CACFP age groups (one- and two-year-olds; three- to five-year-olds; and six- to
twelve-year-olds) were used in reporting this information.
The Menu Survey did not request information on the ^ize of portions offered because a pretest
revealed that most respondents had difficulty describing portions in sufficient detail. Most
respondents in the pretest either left the portion-size column blank or recorded very general
Chapter 2: Study Methodology 2-2
/S
Early Childhood and Child Can Study: Vol. II
descriptions such as "one glass" (rather than six fluid ounces) or "one bowl" (rather than one
cup).
The Menu Survey was prepared in an easy-to-use booklet format with a separate section for each
day and subsections for each potential meal and snack Detailed instructions were included for
each form. Survey materials were mailed to respondents several weeks prior to the specified
target week A toll-free "help" number was provided and respondents were encouraged to call
with any questions or problems. Several followup calls were made to each respondent to ensure
receipt and completion of survey materials and to provide assistance as needed A total of 1.962
providers submitted complete Menu Surveys (response rate of 87 percent).' All surveys were
completed between January and June. 1995.
Data from Children
On-site observations of CACFP meal service were conducted in a subsample of homes and
centers. Trained field staff conducted two separate observations two days apart (Monday and
Thursday or Tuesday and Friday). Observations were conducted during the target week (i.e..
the same week covered in the Menu Survey) Each day. staff observed all meals and snacks
offered to and consumed by sampled children (maximum of six children per site) To facilitate
observations, all children observed in a center or home were seated together
Before each meal and snack, observers weighed and measured five reference portions of each
food to be offered. Then, using visual estimation techniques, observers recorded the total
amount of each food received by each sampled child, including second helpings, as well as the
total amount of each food that was left over (i.e., not consumed by the child). Observations
were completed for a total of 1.347 children between the ages of one and ten years.4
'Includes five days of data tor most Mies. However, because some ceniers and homes do not operate five days per week
or were closed tor one or more days during the target week. 26 percent of sues provided data for only tour davs and 3 perceni
of sites provided data tor three days. Most ot these sites are Head Sun centers that operate tour davs per week
'Observations were actually completed for a total ot 1.388 infants and children. Twenty-nine intants (less than one year ot
agei are excluded from the ana'yses presented in this report, however, because they do not consume discrete meals and snacks
(Data were summarized in an internal memo). Likewise, four children over the age of ten are excluded because of the limited
size of this group sample Finally, eight children between the ages of one and ten are excluded because ot incomplete
information on tood intake and n, missing age information
Chapter 2: Study Methodology 2-3
19
harts Childhood and Child Care Study Vol. II
(Additional information on the visual estimation technique used and the reliability of visual
estimate*, is provided in appendices A and H)
Response rates for this portion of the studv were relatively low The primary problem was not
being able to reach parents prior to the target week in order to obtain permission to observe their
children Although permission was received and observations were scheduled for 80 percent of
the eligible sample o\ children in homes, the same was true for only 58 percent of the eligible
sample o\ children in Head Stan centers and 60 percent of the eligible sample in child care
centers The difficult) encountered in successfully connecting with parents during the recruiting
phase of the study effectively capped the overall response rate for the child observations.
Completion o\ the planned two days of observation for sampled children was further
compromised b\ absenteeism Some children scheduled to be observed were not in care on one
or both observation days In homes. 91 percent of the children scheduled for observations were
observed on one of the scheduled days; only 67 percent, however, were observed on both
scheduled days In Head Stan centers the figures were 95 percent and 72 percent, respectively,
and in child care centers. 90 percent and 73 percent, respectively.
It is imponant to point out. however, that the rate of absenteeism does not influence the effective
response rates for the child observations Since the analysis of data on meals and snacks
consumed while in care is intended to describe children in care on a typical day. not all children
enrolled in care, children who were selected into the sample but absent on one or both
observation da\s were not considered nonrespondents for purposes of constructing sample
weights for this analysis Rather, they were considered outside of scope
NUTRIENTS AND NUTRIENT STANDARDS
Nutrients and food components examined in this study include those identified as priorities for
public health monitoring by the Joint Nutrition Monitoring Evaluation Committee (JNMEC) of
the U.S. Departments of Health and Human Services and Agriculture (1995) and/or targeted by
USDA in ongoing efforts to improve the nutritional quality of meals offered in the National
Chapter 2: Study Methodology 2-4
6C
Early Childhood and Chdd Care Study: Vol. II
School Lunch Program and the School Breakfast Program (7CFR. parts 210 and 220)/ These
include
• Food energy *► Vitamin C
• Total fat *► Calcium
• Saturated fat '► Iron
• Carbohydrate *► Cholesterol
• Protein «» Sodium
• Vitamin A
Defining Sutrient Standards
CACFP regulations and guidance materials provide broad standards for meals and snack*, ottered
under the program, however, specific nutrient-based standards have not been established for
CACFP meals and snacks. Therefore, for the purposes o:~ this study, it was necessan. to define
a set of nutrient standards that could be used in evaluating the relative nutritional quality of
meals and snacks offered and consumed. Such standards were identified for breakfast and lunch,
drawing from three sources:
• standards used for other Child Nutrition programs (7CFR. Pans 210 and
220);
• the Dietary Guidelines for Americans (U.S. Department1, of Health and
Human Services and Agriculture. 1995): and
• the National Research Council's (1989b) Diet and Health report
Standards were not defined for snacks because snacks are considered to be supplemental
feedings that, on an individual basis, are not expected to make major contributions to children's
daily nutrient intake. Likewise, standards were not defined for the total complement of meals
and snacks offered or consumed. Without specific expectations regarding the contribution of
snacks, it was not possible to define standards for the cumulative contribution of all meals and
snacks consumed."
'Tabulations were also prepared lor thiamin. nhoflavin. nut in. vitamin B„. folate. vitamin B .. phospfvrus magnesium
zinc, arid dietar> fiber These data were summarized tor FCS staff in an internal memo
*Head Stan performance standard' require that children in pan-da> programs receive a iota! of at least one-third of the RDA
from all meals and snacks and that children in full-dav programs receive one-half to two-thirds of the RDA. depending -n thr
length of the program Thtse are not USDA-endorsed standards, however, and therefore do not applv to non-Head Sun CACFP
providers
Chapter 2 Study Methodology 2-5
£/
Earh Childhood and Child Cart Siudx Vol. II
The standards used in this study are summarized in Exhibit 2 2 and the rationale for their
election is discussed in the following sections The reader is cautioned to bear in mind the fact
that all standards are used strictly to facilitate interpretation of the data presented in this report.
CACFP meals and snacks are not required to meet these, nor any other, nutrient-based
standards.
Recommended Dietary Allowances The Recommended Dietan Allowances <RDAs). developed
h> the Food and Nutrition Board (FNBi of the National Research Council (NRCi (1989a). are
the accepted standards for assessing the adequacv of nutrient intake among population groups.
RDAs are defined as:
the levels of intake of essential nutrients that, on the basis of scientific
knowledge, are judged by the FNB to be adequate to meet the known nutrient
needs of practically all healthy persons (National Research Council. 1989b)
Separate RDAs are established for a variety of population groups based on age and or 'ender
The RDAs are traditionally used to both plan for and assess the relative nutrient contribution of
meaK provided in I'SDA Child Nutrition programs Indeed. Federal regulations stipulate that
lurches offered in the National School Lunch Program (NSLP) must provide, on average, one-third
of the RDA (7CFR. Pan 210» Breakfasts offered in the School Breakfast Program (SBPi
must prov ide an average of one-fourth of the RDA (7CFR. Part 2201 Head Start programs are
also required lo follow these standards (45CFR. Pan 1304* These standards have been applied
in this studv to assess food energv. as well as protein, vitamin A. vitamin C. calcium, and iron
tall examined nutrients that have established RDA<o
The Dietary Guidelines for Americans and \RC Diet and Health Recommendations. Several
important nutrients and dietary components are not addressed by the RDAs. SpecificaHv. the
RDAs do not provide retommendations for intake of fat. carbohydrate, cholesterol, or sodium
Recommendations for these nutrients and dietan. components are provided in the Dietan
Guidelines for Americans, issued jointly by the U.S. Departments of Health and Human Services
and Agriculture (1995). and or in the NRC's Diet and Health report <1989b) The Dietary
Chapter 2: Study Methodology 2-4
£1
Emrh OMCmSm* \* II
Exhibit 2.2
Nmhcni Standards Lsed in the Earh CWdfaood and Child Care Stwh
NuLrtCflt Standard In
Nutrients with established
Recommended Dietary
Allowances fRDAs)1
Breakfast: One-fourth of
thcRDA
National School Lunch Program
Food energy-, protein, vitamin A.
vitamin C. calcium, and iron
Lunch: One-third of
theRDA
School Breakfast Program
Other nutrients and dietary
components
Only for children fire yean
of age and older:
Total fat
Breakfast and Lunch:
< 30*? of total energy Dietary Guidelines for Americans*
National Research Council*
Saturated fat < 10** of lots! energy Dietary Guideiinei for Americans'
National Res-arch Council*
Carbohydrate > $$% of total energy National Research Council*
Protein < \5*Z of total energy National Research Council'*
Cholesterol Breakfast: < 75 mg'
Lunch: < 100 mg*
National Research Council*
Sodium Breakfast: < 600 mg
Lunch: < WO mg'
National Research Council*
National Research Council dVKfta' RrammndtJDieiar\ lit'- •* tdaxm TmaMjiina P T Vatiwuutl .4c*dle*»n
Pre**
7CFR. Pan 210
7CFR. Pan 220
T S Department* <<f Healn md II—if Service* md \(u.utt.wt .JW$«. MMrMtuiWYour Heat* Dmam Gmdeb*
Ameruant fourth cd*»a WataMartua. DC IS Gtnrtnmm frau^; Office
*NaiwBaJ Research CoKBci ■(!*§»< Dirt and Heath Impbcaumt for KfOuamt Ovtmu Dtume KtU m'asfaNu^cw DC
National Acadenn Pre**
'The Nauonal Research Cimmi4\ Dirt and Health report reuMMcait*a m—ipastern MUaLr tupiittaitea t» lev* fun twice
ne RDA. Ta achieve rrrn—riii iff level* of caforie* fax— tai at) carborn dratt. the perceattfic ■<»* tout! cakme* *r«« pritmeMi
■eats uhca tht* ran;e
OK-mnk ot trnggmta da*> Ima* of 3W »| of cfccrfenerol aad 2.400 a* at «*■■
"One-Aird of vu^cested da*V hw of 300 a* of caofcurrol aad 2..4O0 *f of M«diuir>
Cuper2 Stub Mrthaaafer* 2-7
<33
Lmrh CkUkni amd CUM Cwn SttAv »* II
Guidelines provide specific recommendations for fat and saturated fan intake, expressed as a
percentage of total energ) intake The NRC />«* and Heath report mirror* the Dietan
Guidelines recommendations and also includes specific recommendations, for intake of
carbohydrate and protein, a* a percentage of total energy intake, a* well as suggestions for
cholesterol and sodium intake
While the dietary recommendations included in both the Dietan Guidelines and the NRC* Duet
and Health report are general!} considered appropriate for all health} persons two years of age
and older, the most recent edition of the Dietan Guidelines indicates that the specific
ICCI ■modalions for '.ht ptr-.tr.iazt of energ} from fat and saturated fai apph onh to children
fire years ofage and older (U.S. Departments of Health and Hunan Service* and Agriculture..
1995* It is recommended that children between the ages of tun and five be offered gradualJ}
diminishing amounts of fat so that, as about fire years ofage. children are consuming a diet that
contains no more than 30 peicent of calories <energy) from fat and less than 10 percent from
saturated fat The Diet and Heath report describes a similar phased-in approach no dietary
modification culminating at about si^t five.. In keeping with these recommendations. .quantified
standard* for the percentage .of energy from me various energy'Htuppty'ing nutrient*., or
macronutnent* (fat. saturated fat. protein, and carbohydrate), are applied in thus study oamly to
nerib ffered to ^riJ c< nsumed h} children five years of age and older F indingi for \oungei
children are summarized in detailed appendix exhibits The text includes comment on tread*
aero** age group*, lev example, the extent to which there » evidence of a gradual deciluae urn the
amount of energy from fat offered to increasingly older children
NeMher the Dietary Guidelines nor the Diet and'WcalrA report suggest resiriciao)©* .on application
of recommendations, for sodium Md -t>< lestero! intake to young children In theory therrfoK
these recommendatjon* are applicable to all healthy' children two year* of age and older. There
is some debate, however, about whether recommendation* for cholesterol and *odaum intake
should bt adj.'sted for use *rtb .en young children to account fal IKM MhAantiall} decreased
White ttit jriiint-iHumiimed ummitmrs om TnuornimanltaiiiciiN. uppmpruttr Mr uhllorwi do Ml N|Hsuitollb itfiikwhs. Hit
pOBMBft '' ""•I ' ■*■ '-'•>■" '■'"''•'■' '■■'• ''""•" :'"'^ ■ I* panMM '■'' BMW '"'"' '•"' 1UBMBM&1 uttw: ;•!.;••;■.. him
cafe fej km MI pnaea
2 SW. M«*«*<i«;.> 2-f
<^
Lmriy CmMMmvd and CkiU Cart Study Yul It
energy make. ftoeDiaan' GmkSmes assume a reference adult diet of 2..tQQ0 calories per da*
the energy RDA* for the majority i«f children termed Iby flfloeCACFP me 1.390 calumet. '.one- and
fwo-year-oiids and three-year-olds) and 3.800 calories ((four-- to six-year-olds )J Although the
rationale for age- adjusted standard:, makes, intuitive sense there it no scientific consensus .on the
issue and specific ape-adjusted standard* have not been established There* we. a ucimpromise
approach ha* been used m Urn study. Quantified standards for cholesterol and sodium, like
flhose for the percentage of energy Irom the various naacronutnents. have been applied .onih IP
tlte oldest children, mat is. to meals offered to and consumed toy ctoddren Age fine and abov e
The interested reader will find resuih* for younger children in detained appendix exltibi
OVERVIEW OF THE ANALYSES
Tftut section provides an .overview .of tlie nutrient analyses: now they .were conducted and hff*
the results are presented in Unas report. The anallyta* .of uneails and snacks <e0emtl is presented
first, followed toy a discussion .of the anailysa* *rf mneate and snacks comsmmitl. In both cases., the
discussion is limited to a general description >of dthe analytic lajflnnoadh.; tine reader its referred no
Appendk A for more eoniprdhenaiwe ddtaite. The section concludes wiiflh a descr.ipiion .of too*
data are presented in the regnant.
Meal* ami Smmk* Offer** fry CACFT frvnden
Analyses erf the nutrient content .of mnealls .and smack* .ofitered in the CACFPme based oro average
portion) suae estimate* determined titom tflhe .obserwjtion .erf' xlhilldnfin ltieceuwmg CACFP meat* and
smack* manner than assuming tlbe nmw^wnwrn portion suites specified in uneail pattern re^uirements
Thus approach provides a monte accurate pwransyall iof flrthat is aoiualMy toeing (Olitatied tto ilhildrten
inthe CACFP, particular!} in a famafly-ttdytle meal service setting. Data suggest thai the a\ wage
portions taken at CACFP meals and smacks are generality euutvalent ;to .or greater 'than itthe
1 portion suzes specified in dthe CACFP meal pattern (ExMwts CA .and C '
The imrnimuni daily maeal pattern rejpinainemts and flhe associated portion sines for mteats and
snack* .orffered toy CACFP providers Are designed to ensure that meals and snacks .are well
balanced and thus supply the kind* and amounts .of food reipircd to ihe%> children meet their
Chapter 2 bmd\ Methudulugy 2-4>
Earl\ Childhood and Child Care Study: Vol. II
energy and nutrient needs. Because the observed portion sizes were generally at least as large,
and sometimes much greater, than the minimum required portion sizes, the nutrient profile of
CACFP meals and snacks presented in this report will generally exceed the nutrient profile that
would result if minimum portion sizes were assumed.
The methodology used to determine the average nutrient content of meals and snacks offered by
CACFP providers involved six distinct steps. First, because providers were not asked to report
information on the size of portions offered (see preceding description of the Menu Survey), data
from the observations of children receiving CACFP meals and snacks (discussed above) were
used to develop estimates of average portions offered for 74 different types of food reported in
the Menu Surveys. Separate estimates were developed for each of five age groups (one- and
two-year-olds, three-year-olds, four-year-olds, five-year-olds, and six- to ten-year-olds) and.
depending on the meals and snacks in which a food was offered, for up to three different meal
types (breakfast, lunch/supper, and snacks).8
Once the portion size estimates had been developed, the second step in the process was to assign
a portion size, by age group and meal/snack, to every food reported in the Menu Survey. The
methodology used in estimating average portions and assigning portion sizes to menus is
described in detail in Appendix A.
The third step in trie process was to compute the nutrient (and energy) content of each portion
ol food and then tabulate the total for each daily meal or snack by adding together nutrients for
all foods and beverage;; offered.y
Next, a weekly average was computed for each provider by adding together the energy and
nutrients for each day and then dividing by five (or. for the sites that operated fewer than five
'Age groups used in (his report differ from the standard CACFP age groups (one- and two-year-olds, three- to five-year-olds,
and six-10 twelve-year-olds) lor two reasons. First, because the RDAs differ lor three-year-olds and tour- and five-year-olds.
separate estimates were developed lor each of the age groups in this range. Second, because the sample size ol children over
the age of ten (who have different RDAsi was too small to support a separate analysis (n=4). the oldest age group considered
in this report is six- to ten-year-olds.
■The Food Intake Analysis System (FIAS). version 2.3. was used for all nutrient analyses.
Chapter 2: Study Methodology 2-10
<*£>
Early Childhood and Child Care Study: Vol. II
days, by four or three). Separate tabulations were completed—for each age group served—for
CACFP breakfasts, lunches, morning snacks, and afternoon snacks, as well as for the total
complement of meals and snacks offered.10
The fifth step in the process vas to determine, for each nutrient with an established RDA. the
percentage of the RDA supplied in meals and snacks offered to each age group. Age-specific
standards were used for all age groups except six- to ten-year-olds. Because this group spans
two different RDA age groups (four- to six-year-olds and seven- to ten-year-olds), a weighted
average RDA was used." Comparable calculations were carried out for breakfasts and lunches
offered to five-year-olds and six- to ten-year-olds to determine the percentage of energy provided
by fat. saturated fat. carbohydrate, and protein.
Because findings for the analyses described in step five (above) were qualitatively similar across
age groups, the sixth and final step in the analysis was to compute an overall average for each
provider based on the age groups served (each age group was weighted evenly). Thus, the
average percentage of the RDA for energy supplied in breakfasts offered by a provider who
serves one- and two-year-olds, three-year-olds, and four-year-olds retlects the overall average
for the three age groups served. These overall averages were used in estimating means and
percentages presented and discussed in the main body of this report. Age-group-specific results
for all major analyses are reported in detailed appendix exhibits.
Meals and Snacks Consumed by CACFP Participants
Results of this analysis reflects CACFP participant's (children's) energy and nutrient intake on
a typical day in care. The methodology used in the analysis parallels the approach used in the
analysis of meals and snacks offered.
"Because very lew providers oiler supper or an evening snack (see Volume I), separate tabulations tor these CACTI'
offerings are not presented in this report Contribution-- ol evening snacks are included, when offered, in tabulations ol energ>
and nutrients in all meals and snacks ottered.
"Weighted average RDAs were developed lor each nutrient by applying a weight of .20 to the lour-10 six-year-old RDA
and a weight of .80 to the seven-10 ten-year-old RDA This approach is consistent with the methodology used in the nuirient-based
menu planning system (NuMenusi used in the NSLP and SBP
Chapter 2: Study Methodology 2-11
<37
Early Childhood and Child Care Study: Vol. II
First, data from the child observations were used to determine the total amount of food
consumed by each observed child. A separate tabulation was done for each food, subtracting
the estimate of the amount left over from the estimate of the total amount taken (amount
consumed = amount taken - amount left over).
Next, the nutrient equivalent of each consumed portion was computed and added together, within
a given meal or snack, to estimate the total amount of energy and nutrients consumed at each
meal and snack. Meal- and snack-specific totals were also tallied to calculate total energy and
nutrient intake from all CACFP meals and snacks consumed. Each child's energy and nutrient
intake, for discrete meals and snacks as well as for the combination of all meals and snacks, was
then compared to age-appropriate RDA standards. Comparable calculations were carried out
to determine the percentage of energy provided by fat. saturated fat. carbohydrate, and protein
in meals consumed by children five years of age and older.
Finally, because, as was true for the analysis of meals offered, the various age-group-specific
results were, in large part, qualitatively similar, an overall average was computed for all
children consuming CACFP meals and snacks, as well as for children served by each type of
provider. Thus, the average percentage of the RDA provided in the meals and snacks consumed
by all CACFP participants (children) reflects the average for all children consuming CACFP
meals and snacks, based on comparison of individual intakes to age-appropriate RDAs. These
overall averages were used in estimating means and percentages presented and discussed in the
main body of this report. Age-group-specific results for all major analyses are reported in
detailed appendix exhibits.
The analysis of meals and snacks consumed by CACFP participants also includes several
additional lines of inquiry. For each meal anc. snack, children's mean rates of food consumption
are examined, as well as the extent to which available energy and nutrients (i.e.. the energy and
nutrients in meals and snacks taken) are actually consumed. Rates of food consumption,
expressed as percentages, were derived by dividing the total amount of food left over (i.e., not
consumed) from the total amount of food taken, including second helpings (for example, children
Chapter 2: Study Methodology 2-12
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Early Childhood and Child Cart Study: Vol. II
consumed an average of 85 percent of the milk portion taken). Similarly, the percentage of
available energy and nutrients actually consumed was determined by dividing the amount of
energy and nutrients in the total amount of food consumed by the energy and nutrients available
in the total amount of food taken.
Data Presentation
As noted in preceding discussions, exhibits included in the body of the report present findings
based on overall averages for all groups of children. The interested reader will find age-group-specific
results in appendices B (meals and snacks offered) and C (meals and snacks consumed).
All reported statistics are based on weighted analyses (see Appendix E for a description of the
methodologies used in developing sample weights) Exhibits report unweighted sample sizes
(number of providers and number of child observations).
Exhibits present results for all types of providers (Chapter Three) and for all children
participating in the CACFP (Chapter Four). Results are also stratified by type of provider (i.e..
homes. Head Start centers, child care centers, and all centers combined). However, because
preliminary analyses, which compared homes versus all centers and Head Stan centers versus
child care centers, revealed no meaningful pattern of differences among providers, differences
among providers are not emphasized in the discussion of findings :: Rather, discussions focus
primarily on findings for all providers and all children. Discussion of differences between
providers (using the same between-group comparisons noted above) are limited to situations
where conclusions about major research questions differ appreciably for the two groups, for
example, a situation where the mean intake of a specific nutrient at breakfast is equivalent to or
more than one-fourth of the RDA for one provider group and substantially less than one-fourth
of the RDA for the other group.
'-'Differences thai proved to be statistically significant had little substantive importance. For example, a minor difference
in the percentage of the RDA for energy offered at lunch was significant, but the average for both provider groups was
substantially less than the one-third RDA standard used in this study.
Chapter 2: Study Methodology 2-13
-2?
Chapter Three
Meals and Snacks Offered by CACFP Providers
This chapter presents information on the meals and snacks offered by child care providers
participating in the CACFP. The analysis is based on foods included in menus offered during
a specified five-day period, as reported by CACFP providers, and estimates of the average
portions served to children of different ages, based on observations of children receiving meals
and snacks in CACFP facilities.1 Findings are therefore indicative of the potential contribution
of CACFP meals and snacks to children's daily nutrient needs (assuming that all foods are
consumed in specified portions), rather than meals and snacks actually consumed by children
Data on children's intake of energy and nutrients from CACFP meals and snacks actually
consumed are presented in Chapter Four.
This chapter addresses the following research questions:
• Which meals and snacks do providers offer?
•
•
•
•
Do meals and snacks offered by CACFP providers comply with meal
component requirements?
Which specific foods are offered most often? Do providers offer options
within CACFP meal component categories on a given day? Do providers
offer a variety of items within CACFP meal component categories over
the course of a week?
What is the potential contribution to children's daily nutrient needs of
individual CACFP meals and snacks?
How do CACFP breakfasts and lunches offered to children compare with
Dietary Guidelines and NRC recommendations?
Which food groups and/or specific foods are major contributors of energy
and key nutrients in CACFP breakfasts and lunches?
'An overview of the methodologies used in collecting and analyzing data is provided in Chapter Two a detailed description
is provided in Appendix A.
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-1
<30
Early Childhood and Child Can Study: Vol. II
What percentage of CACFP providers offer lunches that meet the Dietary
Guidelines recommendation for the percentage of energy from total fat?
How do lunches offered by these providers compare with other lunches
offered by other providers, with regard to both nutrient content and
specific food items offered?
What is the potential contribution to children's daily nutrient needs of the
total complement of CACFP meals and snacks offered? How does the
total complement of meals and snacks offered compare with Dietary
Guidelines and NRC recommendations?
Separate sections present detailed findings for CACFP breakfasts, lunches, and snacks : The
final section of the chapter presents data on the nutrient content of the total complement of
CACFP meals and snacks offered. Results presented reflect the nutrient profile of meals and
snacks offered ox typical (average) CACFP providers.
As noted in Chapter Two. the data presented in this chapter are based on provider-level averages
for meals and snacks offered to all age groups.'-4 Results of age-group-specific analyses are
provided in Appendix B; standard errors are also provided for all nutrient estimates.* Instances
where a conclusion for a specific age group differs appreciably from the conclusion for all
children are noted in the discussion (e.g.. the overall mean for a specific nutrient in breakfasts
offered is equivalent to or more than one-fourth of the RDA. but substantially less than one-fourth
of the RDA for one specific age group) Unweighted sample sizes (number of providers)
are reported in each exhibit.
'Few homes or centers otter -.upper or an evening snack Data tor these CACFP meal ser\ ices are therefore not presented
in this report
'For example, the mean percentage RDA tor breakfasts offered by a provider who serves or.e- and iwo-\ear-olds. and threc-
10 five-> ear-olds was determined by first calculating the percentage of the RDA provided in the average breakfast offered to each
age group lone- and two-year olds, three-year-olds, four-year-olds, and five-year-olds» Next, the overall mean percentage RDA
was computed tor breakfasts offered by the provider by averaging across the four age-group-specific RDA values Preliminary
analyses found that results were not affected by treating menus offered to the three- to five-year-old age group as three different
menus rather than using an average for the age group
'There is very little variation in the actual toods offered Mi different age groups in a particular child care sue
'As noted in Chapter Two. preliminary analyses indicated that findings for each age group were, tor the most part,
qualitatively similar with regard to the nutrient standards used in this study.
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-2
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Early Childhood and Child Cart Study: Vol. II
While data presentations are stratified by type of provider, for the interested reader, the
discussion focuses primarily on findings for all CACFP providers (see Chapter Two).
Discussions about differences between provider groups (family day care homes versus all centers
or Head Stan centers versus child care centers) are limited to situations where conclusions about
major research questions differ appreciably for the two groups."
All reported statistics are based on weighted analyses (see Appendix E). The reader will notice
that findings for all providers resemble most closely findings for family day care homes The
reason for this is that family day care homes account for the majority of all CACFP providers
nationwide Consequently, results for family day care homes have a strong influence on
overall results for all types of CACFP providers combined.
Finally, for ease in interpretation, all food-level analyses presented in this chapter are based on
meals and snacks offered to three- to five-year-olds, unless otherwise noted Since there is ver>
little variation in foods offered to children of different ages within a child care site, tindings for
meals and snacks oftered to one- and two-year olds and six- to ten-year-olds are virtually
identical
BREAKFASTS OFFERED
More than eight out of ten CACFP providers offer breakfast (Exhibit B. 1) Breakfast is most
common among CACFP providers that operate Head Start programs and among homes and child
care centers that operate eight or more hours per day (fu'l-day care) The increased prevalence
of breakfast in Head Start centers, even among those that operate pan-day pr>grams. is
consistent with Head Stan performance standards which explicitly require programs to offer
breakfast to anv child who has not received breakfast at home.
"As noted in Chapter Two. prchminarv analyses tound no meaningful pattern of difference* between home*, and centers or
berween Mead Start tenters and child care centers This is not unexpected since all providers follow the same meal patterns and.
as will he discuss«-d in this chapter, exhibit a high degree of compliance with CACFP meal component requirements
"In FY 1993. when the sample for this study was drawn, homes comprised 87 percent of all CACFP providers (Source
FCS administrative data. December 1996)
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-3
Eart\ Childhood and Child Cart Study: Vol. II
Foods Offered in CACFP Breakfasts
The CACFP meal pattern stipulates that, to receive Federal reimbursement, breakfasts must
include at least one serving of three different meal components: fluid milk; fruit, vegetables,
or full-strength fruit or vegetable juice; and bread or an acceptable bread alternate (e.g. ready-to-eat
cereal) On an average day. more than nine out of ten CACFP breakfast menus comply with
all component requirements
CACFP providers rarely offer children options within a meal component category, for example,
a choice between two types of fruit or two types of cereal. Most CArFP breakfasts include only
one item within each CACFP meal component (Exhibit 3.1). Moreover, observations of CACFP
meal service (MC Chapter Two and Appendix A) indicate that, when more than one item is
offered, for example, cereal and toast (two bread/bread alternate foods), children are generally
served both items
While daily menus tend to be fixed. CACFP providers do offer children a variety of different
foods at breakfast over the course of a typical week. An average of four different types of
truuv vegetables, or juices are offered (Fxhibit 3.1) II well as three to four different types of
breads or acceptable bread alternates Milk is an exception, providers tend to offer only one
type of milk consistently from one day to the next.
The specific foods most frequently offered in CACFP breakfasts are listed in Fxhibit 3.2 " For
this analysis, daily CACFP breakfast menus, as reported in the Menu Survev. were analyzed and
the relative frequency of specific 'xxls and food groups was tabulated Figures presented in
Exhibit 3 2 reflect the percentage of daily CACFP menus, or the percentage of CACFP
breakfasts ottered nationwide on any given day, that include specific foods (or food groups)."
Highlights are summarized by meal component in the following sections
'The list i- limited in foods included in s percent or more o( th- breakfasts offered b> any provider group
The percentage of dail> menus, as reported in exhibits 3 I and 3.2. is not directly equivalent to the percentage of providers
because the number of days of operation varies from three to five days for each provider
Chapter 3: Mealt and Smacks Offered by CACFP Provider! 3-4
33
Earls Childhood and Child Care Study: Vol II
Exhibit 3.1
CACFP Providers Tend to Offer a Fixed Breakfast Menu Each Day
but Do Van' Menu Items Over the Course of a Week
Component/Number of Items
Offered per Day/Week
Center-Based Care
All Family Day 'lead Start ChiW Care All
Providers Care Homes Centers Centers Centers
Percentage of Daily Breakfast Menus
Milk
0 2". 25 25 25 251
1 97 97 % % %
2 1 1 : 2 -»
Mean items per das 1 1 i 1 1
Mean number of different
items per week 1 1 i 1 1
r ruit. Vegetable, or Juke
0 35 3* 25 it 4%
1 89 89 91 86 88
2 or 3 8 8 7 9 8
Mean items per da\
Mean number of different
items per week
Bread or Bread Alternate
0 15 15 IT 15 1"-
1 17 87 91 90 90
: or 3 i: i: 8 8 8
Mean items per da\
Mean number of different
items per week
Number of Daily Breakfast Menus
11 nwcightedi
7427 1882 3fVr 1938 5545
Sule* BJMTJ on breakfast1, offered ID three- i<» five-vear-olds
Detol ma> not sum U> 100 percent due in rounding
Chapter 3 Meali mud Smacks Offered by CACFP Providert 3-5
<&
',...-....'
t.arh Childhood and Child Care Stud\ Vol. II
Exhibit 3.2
Foods Most Commonlv Offered in ("ACFP Breakfasts
AM Farit7lta.tr
C rater-Bated Care
Head Stan GUM Care
Breakfart Component F ood tTioraWri Care Home* Ceater* Carter* Al Carters
Percentage of Itaih Breakfast Majaj in Which Hem 1* Offered
IMk n% 9*«5 9|f ■/--■ W<
While 1% 54 52 65 to 62
While uhole 23 24 15 23 20
White, nfv 13 13 J4 II 12
White. \". \3% 5 5 5 4 5
Whae. <kmt 5 5 1 1 1
fruit*.. \e2etable-. and Juices 97 97 M 95 96
June, orange 22 22 23 22 23
Kiiuiu 20 22 ■ 10 9
June apple 10 10 II 12 12
Apple. Jfc4i 7 7 4 6
Orange. Irc»h ' 6 6 *
Apple •auce 6 6 " 6
June, gtape 4 » 9 *
i .anned 4 4 5 5
June, pineapple 1 1 6 4
la. v,,.,■ •. i.• 42 46 22 27 25
Breads and Bread \hernales 99 99 99 99 99
RcaO .-real 39 39 31 40 36
White bread KKM 24 24 22 21 21
Pamalev »afrtc.. French t««a<4 18 19 12 12 12
11 i cereal 12 12 II 12 11
Mutfinv »»cel bread 3 3 " 5 6
BI^UH ..f"'»\am 3 2 6 5 5
Noncredilable rood* 56 57 57 49 52
High lat .•udimcm^ 30 31 28 2* 26
Swup hone) 16 17 10 10 10
1 . * 10 I 6
Jell* 6 6 5 6
Vugai 6 6 3 4
J 5 6 4
f'hccMr itm l<<* in 2 1 5 3
Numhef •>! I>ail> Bfealla-4 Menu-
1 n»eighicd>
7427 IfjB 3607 RM 5545
Baxrd on Ncakia-4- offered to three- K« foc-tear-aldv Onh acim included at 5 percent m matt of daiH mean* lor
am prouder group are listed
Note
No further specification Menu Sur»c> did nm include informal**) on fal content of mdk >h*n purpose* of nuuiera anahstv
the daiahacc assumes a nutrient profile thai approximates 2 < mdk/
roan thai d« nm contribute u< sashing the CACFP meal pattern
Butter, margarine, cream thee**. gra»>
Sau-agc» are creditable d the} ate less than 30 percent fal In aeight Most sausages verted h) providers m this viud> «cre
piwk hr»»nard-sene sit fe sausages that did not meet this cracria Vauvagrs that did meet the cracrta »ere mcludcd »ah meal*
Chmpur 3: Meal* and Smmeki Offered by CACFT /Vmrirn i-4
EsHy CkmHumd mm OuU Cm* Samy IW II
Milk. Two-percent milk is the most common type of milk offered in CACFP breakfasts, by a
wide margin. Two-percent milk is offered in more than one-half of all CACFP breakfast menus
Skim milk is rarely offered: only 5 percent of all CACFP breakfast menus include skim milk
Flavored milk is even less common in CACFP breakfasts, offered in less than one-half of one
percent of all daily menus (data not shown).
Fruits, Vegetables, and Juices. Orange juice, offered in nearly one out of four daily breakfast
menus, is the food most often offered to satisfy the fruit, vegetable, juice requirement Bananas.
apple juice, fresh apples, and fresh oranges round out the list of the five most common fruits
and juices offered Overall, fresh fruit is included in 42 percent of all daily CACFP breakfast
menus Vegetables of any type are rareh offered in CACFP breakfasts
Breads and Bread Alternates Ready-to-eat cereal is the bread alternate most frequently offered
in CACFP breakfasts More than one-third of all daily CACFP breakfast menus includes a
read) -to-eat cereal White bread or toast, offered in roughi. one-quarter of all dail) breakfast
menus, is the next most frequently offered food in this category Pancakev waffles and French
toast, as a group, and hot cereal are next on the list, offered in 18 and 12 percent of daih
breakfast menus. respect i\ el \
Soncreditable Foods Providers are encouraged to supplement the CACFP meal pattern * rth
other foods that may increase the overall appeal vt the meal as well as its food energt More
than one-half of all daily CACFP breakfast menus include one or more none redliable foods (j c .
foods that do not contribute to satisfying the CACFP meal pattern* Butler, margarine, cream
cheese, and gravy arc the most common noncreditahlc items offered at breakfast, included m
almost one-third of all breakfast menus S> rup and honey arc the next most frequently offered
noncreditable foods, followed hv eggs, jelly sugar, and bacon or sausage
TV < AC rV t*eakta*t meat pmaerm A«c» «« r<
hoc* vepprf oral pamen g r rff* tJKTM
mamctemmame at meakta* BetMttr m *r> km mtstem
hieakta** uwngrv k>kc« tucpuMr K
mat meat m m *txtfUNt me* mxiiumc a* mAmud m me
be ttHett4 » *-eakt*« Ciiiprti egg* me umimete4
«w me* iat i.>mmm. me CACffmne+w* wmnmei 'Taummmv*
too** ait mm.trmvMr im aM meat*
Charter I mtmt mm Smmk> Offered tt ( AC ff rr*»men S-7
Urty ChMkmi mmd CrnOd Can Smd* \U II
\ucnent Content of CACFP Break/am Offered Relative to KDAf
Breakfasts offered in roe CACFP provide more duo one-fourth at roe RDA. except for energy
iExiabti J 3» ThjA general pattern » constttem across provider type* at »«Jll A* JIPTGH* Age
group1 [fc*h'*-ii B ?i On atecqp taatfM I HMBI b) CACWfWWder* supph more than
one-half of the RDA for protein and vitamin A. about tlMee-^parters of the RDA for vitanain C
and moire than one-third of the RDA for calcium and iron % comparison breakfast* are km
m energ}. providing, on average. 39 percent of the RDA.
Percentage of Protiden Offering at Least One-fourth of the KUA at Breakfast
With the exception of energ> and iron. nearly aJJ provider* offer breakfast* dm provide., .on
average, one-fourth m more of'me RDA ^ExbJbn 3.4}.,: Only 3 percent of ai provider* .offer
breakfasts thai supply one-fourth or more of die RDA for energy. And. despite an overall mean
of 35 percent at the RDA for iron (Exhibit 3..3). about oae^porter of aJJ pro\ iders offer
breakfast* that provide an average of less than one-fourth of the RDA for iron.
A greater percentage of home* offer breakfast* dm provide one-fourth of the RDA for ma than
either Head Stan center* or child care center*.. Tint difference i» large h atiritoutabk no
difference*- in the number and or type* of bread* and bread ahentafle* offered. Home* .are more
likely than etfhcr Head Start center* or child care center* to offer WHO or more serving* of bread*
and or bread alternate* at breakfast .(Exhibit 3.1». A* mill be ditscussed lafler in thus section,
bread* and bread aftetnaies provide S3 percent of the iron in CACFP breakfast* Mowetower..
Head Stan center* offer ready-to~eat cereal* k** often than either h< ■••.•;■ • child care center*
(Exhibit 3,2» Because raua ready-to-eat cereal* are fortified mith iron, their inclusion can
dramatically affect iron content
Dau «m wnuinl memi enrr^k mdtiMt^WBMMrfCACFr'incak.Uiiii-i'HcrvOw- •■ ■ .-u . MhtftJ
SiUaMtad«IIMTS 1ci ti»t csimmu- presented ti; t Mirt>ri ? ? art pnn ided uUmf with ajit j ■ >.r »> 1 xnthii if ?
Kpt-pnup••,;.- , - .uh.s art prehenttd iti tKhibii 8.4.
tkqpttrj Ue***a4 Smmcki Offered to cut* ?<*•■*<■•: .<..*
^
burl} ChUdhou* ant CMU Cm* **&: fW. M
MflftJU
feMfctwai Otkmi •-'.• lACfT Pnnuten S.uyy«. Mun Thai
One-1vurtfc *f «** KD4, Ewxy* for Lnergi
f-WJt*-SWMitl f-Wl
fp^Kiiuw C*m BUMS CM***
ttMM Cart
Cealoi* 4» <*■*«*
Mew Penem*.^ of KIM m t *OY »re«towrt>. a*. OHOTHH
Tutal founigy
Protein
Vmamm A
• ilamm €
Calcium
Irani
iM>* 0* iwv, 3SMK
S* 54 M $2 At
54 0 $11 59 *2
n Hi 74 T7
M % v » M
3$ u . M 1
OUnwBiUhtetl)
i<»V 41KI XT. 421) J.22V
C*i»ner 3 M«u/.< imrf inoflte G#fewtf/ fc» CACW fnwtOers M)
3g
Earlv Childhcod and Child Care Study: Vol. II
Exhibit 3.4
With the Exception of Energy', Most Providers Offer Breakfasts That
Provide at Least One-fourth or More of the RDA
Center-Based Care
All
Providers
Family Day
Care Homes
Head Start
Centers
Child Care
Centers All Centers
Percentage of Providers Offering One-fourth of the RDA
Toial Energy
Protein
Vitamin A
Vitamin C
Calcium
Iron
3* 37, 5* sv< 5';
100 100 100 100 100
97 97 98 98 98
93 94 93 91 92
98 98 99 98 99
74 76 62 68 65
Number of Providers
(Unweighted)
1659 430 809 420 122l>
Chapter 3: Meals and Snacks Offered by CAChT Providers 3-10
&?
Early Childhood and Child Cart Study: Vol. 11
Nutrient Content of CACFP Breakfasts Offered Relative to Dietary Guidelines and SRC
Recommendations
CACFP breakfasts offered to five- to ten-year-olds are largely consistent with Dietary Guidelines
and NRC recommendations (Exhibit 3.5).B This is true for all providers as well as for the two
age groups (five-year-olds and six- to ten-year-olds). On average. CACFP breakfasts derive 23
percent of total energy from fat, a level that is consistent with the Dietary Guidelines
recommendation of no more than 30 percent of total energy from fat. The proportion of energy
derived from carbohydrate and protein is also consistent with recommendations, as are levels
of cholesterol and sod'um.
Breakfasts offered by CACFP providers do not, however, meet the Dietary Guidelines
recommendation for the percentage of energy from saturated fat. This is true for all providers
and for breakfasts offered to both five-year-olds and six- to ten-year-olds. On average. 11
percent of the energy in breakfasts offered to children five years of age and older comes from
saturated fat: the recommended level is less than 10 percent. In addition, there is little evidence
of decreasing amounts of saturated fat in breakfasts offered to children between the ages of two
and five, as recommended by the Dietary Guidelines (Exhibits B.2 and B.5).
While on average CACFP breakfasts offered to five- to ten-year-olds provide more energy from
saturated fat than recommended, the average amount of saturated fat in CACFP breakfasts is not
really excessive. The average amount of saturated fat in breakfasts offered to five- to ten-year-olds
does not exceed the amount of saturated fat allowable in an "ideal" breakfast, that is. a
breakfast that supplies one-third of the RDA for energy and derives less than 10 percent of its
energy from saturated fat. An "ideal" breakfast for this age group could include up to 5.0 gm
of saturated fat.14 CACFP breakfasts offered to five- to ten-year-olds provide an average of
4.1 gm of saturated fat. or about 80 percent of the allowable maximum
"Data on actual mean energy and nutrient content "I CACFP breakfasts offered are presented, by age group, in Exhibit B.2
Standard errors lor the estimates presented in Exhibit 3.5 are provided, along with age-group-specilk estimates, in Exhibit B.5.
"Based on one-fourth of the RDA tor energy [ 1933 calories (weighted average of RDA for tour- to six-year-olds and RDA
for seven- to ten-year-olds)| and 9.4 percent of food energy (operational definition of "less than 10 percent") from saturated tat
Chapter 3: Meals and Snacks Offered by CACFP Frnviders 3-11
~&
Early Childhood and Child Care Study: Vol. II
Exhibit 3.5
Breakfasts Offered by CACFP Providers Are Largely Consistent with
Dietary Guidelines and NRC Recommendations
Recommendation
Center-Based Care
All
Providers
Family Day
Cart Homes
Head Start
Centers
Child Care All
Centers Centers
Percent ol Hnergy from l-ai (%)
Percent of hnergy from Saturated
Fat (% t
Perceni ol Hnergy from
Carbohydrate!^ |
■S. 30%
< 10%
* 55%
Mean Nutrient Content of CACFP Breakfasts As Offered
23 23 24 2? 23
II 11 12 II II
64 64 63 65 64
Percent ot Lnergy from Protein (%) S 15% 14 14 14 14 14
Cholesterol <mg) £ 75 mg 51 53 48 43 45
Sodium impi <, 600 mg 445 445 456 431 441
Number ol Providers (Unweighted) 1631 413 808 410 1218
Note Based on breaklasts ottered to five-year-olds and six to ten-year-olds See Chapter Two tor a discussion ot Dietary Guidelines
and NRC recommendations and the rationale tor ape groups used in this analysis
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-12
°tf
Early Childhood and Child Cart Study: Vol. II
Thus, the reason CACFP breakfasts do not satisfy the recommendation for the percentage of
energy from saturated fat has more to do with the amount of energy provided (relatively low)
than with an excessive amount of saturated fat. In fact, if the average energy content of CACFP
breakfasts were increased by about 70 calories for five-year-olds and 55 calories lor six- to ten-year-
olds, by offering more carbohydrate-rich foods such as juices, fruit, and low-fat breads and
bread alternates, there would be no need to lower actual saturated fat content.
If increasing the energy content of CACFP breakfasts is not feasible, the saturated fat content
would need to be reduced in order to meet the recommendation for the percentage of energy
from saturated fat. To avoid further reductions in the contribution of CACFP breakfasts to
children's daily energy needs, however, energy lost as a result of reductions in saturated fat will
need to be replaced with energy from carbohydrate-rich foods. One way in which the saturated
fat content of CACFP breakfasts might be decreased is through increased use of 17c and skim
milks and decreased use of 2% and whole milks. Milk contributes 61 percent of the saturated
fat in CACFP breakfasts (Exhibit 3.7) and 2% and whole milks are the types of milk most often
offered in CACFP breakfasts (Exhibit 3.2).
Percentage ofProviders Meeting Dietary Guidelines and NRC Recommendations at Breakfast
More than 80 percent of all providers offer breakfasts to five- to ten-year-olds that meet
recommendations for the percentage of energy from fat (Exhibit 3.6).'* The same is true for
recommendations related to the percentage of energy from carbohydrate and protein and to
sodium content. A somewhat smaller percentage of providers (127c) offer breakfasts that meet
the recommendation for cholesterol content. Mean cholesterol content is strongly influenced by
the frequency with which eggs, or products containing eggs. e.g.. French toast, pancakes, and
waffles, are offered.
'Detailed distributions are shown in Exhibit B.6.
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-13
•4
Early Childhood and Child Cart Study: Vol. II
Exhibit 3.6
With the Exception of Saturated Fat, Most Providers Offer Breakfasts
That Meet Dietary Guidelines and NRC Recommendations
Center-Based Care
Recommendation
All
Providers
Family Day
Care Homes
Head Start
Centers
Child Care
Centers
All
Centers
Percent of Energy from Fai
Perceni of Energy from Saturated Fat
Percent of Energy from Carbohydrate
Percent of Energy from Protein
Cholesterol
Sodium
Percentage of Providers Meeting Recommendation
89% 89% 867, 91 7c 89^
27 28 16 27 23
93 93 91 96 94
82 82 76 85 81
72 71 78 81 80
93 93 87 95 92
Number of Providers (Unweighted) 1631 413 808 410 1218
Note: Based Oil break*asts ottered to five year-olds and six- to ten-year-olds See Chapter Two tor a disiussioi of Dietary
Guidelines jnd NRC recommendations and the rationale tor age groups used in this analysis
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-14
V3
Early Childhood and Child Cart Study: Vol. II
Exhibit 3.7
Sources of Energy and Nutrients in CACFP Breakfasts:
Relative Contribution of CACFP Meal Components
CACFP Breakfast Component
Fruits/ Breads/Bread Nonet-editable
Milk Vegetables/Jukes Alternates Foods
Percentage Contribution to Average Amount Offered
Total Energy
Protein
Vitamin A
Vitamin C
Calcium
Iron
Total Fat
Saturated Fat
Carbohydrate
Cholesterol
Sodium
287c 2151 37$ 137c
54 6 31 10
37 6 46 !2
7 71 21 1
74 4 19 3
3 10 83 4
42 3 29 26
61 2 17 20
17 33 42 9
47 0 24 30
1*1 1 64 13
Notes Based on breakfast-, ottered 10 three- 10 five-year-olds
A more detailed breakout is provided in Exhibit B.8.
Rows ma\ not total to 100 percent due to rounding
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-15
-0
Earlv Childhood and Child Cart Study: Vol. II
Sources of Nutrients in CACFP Breakfasts
To assess how the various CACFP meal components, as well as specific foods offered within
meal component categories, contribute to the energy and nutrient content of CACFP breakfasts,
the percentage contribution of 16 differtn' foods and food groups was calculated for energy and
for each of the key nutrients examined in this study. Findings from this analysis may be useful
in identifying foods which may be contributing to undesirable characteristics (e.g.. high levels
of saturated fat) and/or foods which may help boost levels of energy, iron, or other nutrients.
Results are summarized, by CACFP breakfast component, in Exhibit 3.7. A more detailed
tabulation is provided in Exhibit B.7. Figures reported in both exhibits represent the percentage
contribution of the specific food or food group to the average energy or nutrient content of
breakfasts offered in the CACFP
Important findings from this analysis are summarized below:
• Breads and bread alternates provide more than one-third of the energy in
CACFP breakfasts Noncreditable foods contribute 13 percent of the
energy in CACFP breakfasts.
• Milk provides more than one-half of the protein in CACFP breakfasts
Breads and bread alternates are the second major contributor of this
nutrient
• Breads and bread alternates, primarily in the form of ready-to-eat cereals
(see Exhibit B.7). contribute 46 percent of the vitamin A in CACFP
breakfasts Milk provides another 37 percent of the vitamin A.
• The vast majority of vitamin C (717c) is contributed by fruits, vegetables,
and juices. Ready-to-eat cereals, most of which are fortified with
vitamins and minerals, provide 21 percent of the vitamin C in CACFP
breakfasts. Other foods and food groups contribute relatively minor
amounts of vitamin C.
• The principal source of calcium in CACFP breakfasts is fluid milk
• The major source of iron in CACFP breakfasts is breads and bread
alternates, specifically ready-to-eat cereals. Breads and bread alternates
as a group provide 83 percent of the iron in CACFP breakfasts; ready-to-eat
cereals alone contribute 55 percent.
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-16
<*>
Early Childhood and Child Can Study: Vol. II
This finding supports the previous conclusion that differences among
providers in the percentage that offer breakfasts supplying one-fourth of
the RDA for iron is largely attributable to differences in the number and
type of breads and bread alternates provided, particularly ready-to-eat
cereals.
Milk is the primary source of both fat and saturated fat in CACFP
breakfasts, providing 42 percent and 61 percent, respectively, of the fat
and saturated fat in CACFP breakfasts. This is consistent with the fact
that most providers offer 2% or whole milk (Exhibit 3.2). Noncreditable
foods, specifically meats and meat alternates and butter, margarine, cream
cheese, and gravy (see exhibits 3.2 and B 7) also contribute substantially
to fat and saturated fat content
Milk and noncreditable foods, primarily meat and meat alternates such as
eggs, bacon, sausage, and cheese, are also the leading sources of
cholesterol in CACFP breakfasts.
Breads and bread alternates provide close to two-thirds of the sodium in
CACFP breakfasts.
LUNCHES OFFERED
Foods Offered in CACFP Lunches
Almost 90 percent of all CACFP providers offer lunch; providers that do not offer lunch
generally operate during before- and/or after-school hours. CACFP lunches must include five
specific components: fluid milk; two (or more) different types of fruit, vegetables, or full-strength
fruit juice; bread or an acceptable bread alternate; and meat or an acceptable meat
alternate On an average day in the CACFP about 87 percent of lunches offered include all five
required components; the specific component most often missing in noncompliant lunches is the
second type of fruit, vegetable, or juice (Exhibit 3.8).
As noted for CACFP breaktasts. most CACFP lunches include only one food within each
CACFP meal component. When more than one food is offered, children are generally served
both foods; examples include spaghetti with garlic bread (a bread and bread alternate) and a ham
and cheese sandwich (a meat and a meat alternate).
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-17
<*
Early Childhood and Child Care Study Vol. II
Exhibit 3.8
CACFP Providers Tend to Offer a Fixed Lunch Menu Each Day but Do
Vary Menu Items Over the Course of a Week
Component/Number of Items All
Offered per Day/Week Providers
Center-Based Care
Family Day Head Start Child Care
Care Homes Centers Centers All Centers
Percentage of Daily Lunch Menus
Milk
0 34 J* 4% 2% 3%
1 % % 94 95 95
: 1 1 2 2 2
Mean items per day 1 1 1 1 1
Mean number of different
items per week 1 1 1 1 1
Fruit, Vegetable, or Juice
0 0* 0% 0% 07c 0%
1 7 8 5 4 4
2 or 3 92 92 95 % 95
Mean items per das
Mean number of different
items per week 9
1
9
3
10
->
li
i
10
tread or Bread Alternate
0 3% 3% 4% 3% 3*
I 79 80 73 70 71
2 or 3 18 17 ft 25 24
Mean utms per das
Mean number of different
items per week 3
I
i
Meal or Meat Alternate
0 2% 2% 2% 2% 2%
1 84 84 84 86 85
2 or 3 13 13 13 12 12
Mean items per day
Mean number of different
items per week
1
5
Number of Daily Lunch Menus
(Unweighted)
8207 2178 3892 2137 6029
N Met Based on lunches ottered to three- to five-year-olds
Detjil may not sum to 100 percent due to rounding.
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-18
^7
Earty Childhood and Child Care Study Vol II
Over the course of a week. CACFP providers offer children a considerable variety of foods at
lunch The type of milk offered tends to be consistent from one da> to the next (indeed, from
one meal to the next) However, on average, providers offer 9 to 10 different types of fruit,
vegetables, and full-strength juices over the course of a typical week, as well as 3 different type*,
of breads or acceptable bread alternates: and 5 different meats or meat alternates The decreased
variety of foods offered in the bread/bread alternate component, relative to other components,
is attributable to a preponderance of sandwiches and a reliance on white bread and sandwich
rolls
The specific foods most frequently offered ir- CACFP lunches are listed in Exhibi; 3 9
Figures reflect the percentage of daily CACFP lunch menus, or the percentage of CACFP
lunches offered nationwide on any given day. that include specific foods or food groups
Highlights are summarized below
Milk. As noted in the preceding analysis of breakfasts offered. 2^ milk is the most common
type of milk offered in the CACFP Skim milk and flavored milks are much les> common.
'••Tered in less than 5 percent of daily lunch menus (data not showni
Fruits and Juices Eight out of ten daily CACFP lunch menu> include fruit or juice The five
specific items offered most frequentl) include fresh apples, applesauce, canned peaches, fruit
cocktail, and canned pears Thirty-seven percent of all daily CACFP lunch menus include fresh
fruit
Vegetables. Vegetables are offered in CACFP lunches somewhat more frequentl) than fruit.
appearing in more than nine out of ten daily CACFP lunch menus The specific vegetable*,
offered most frequently include cooked green beans, raw carrots, corn, fried potatoes, and
canned tomatoes or tomato sauce (occurring primarily in mixed dishes such as spaghetti, pizza,
etc.)
The IIM is limned i.< food-, included in S percent M more of the lunches offered t>> an> provider group
Chapter * -Weali •** Smmeki Offered by CACFP Pnmden 3-19
<A
Early Childhood and Chdd Cart Study: Vol II
Exhibit 3.9
Foods Most Commonlv Offered in CATP Lunches
Al FaMh-Iter
rater »**d Cart
He»d Start CUM Care
Lracfc Cwp«n»i/f**< w\ 9% MVT% CareHaaef Craters Crater* AS Crater*
Per. enuge of Daih lunch Menus in Which Item Is Offered
Ml mi Mfl 9S% fl%
Mitt.:~ 52 51 62 56 5S
Whae. n.h»lc :: 22 !« 23 20
Whae. n»s 14 14 13 12 12
What. 1^ 1 5*! 5 5 5 6 6
rrum and Juice* 10 "9 SO S3 S2
Apple fresh 13 13 12 10 II
Applesauce II 12 6 S 7
Peach, .armed II II II 13 :
rru* cocktail, (.armed S 7 II 12 12
f-j- . jrined 7 7 7 10 9
IMM - 7 4 4 4
'Kjn^e frcdi i 6 10 s 9
PmcappWr canned 5 4 s 9 S
Grapes 4 5 2 1 1
1 • . >re i/i /rju/ " 31 33 29 30
ftpMlfci 92 9! 97 N r
Green hearts conked 13 II 15 13
Carrots ra» 13 II s
' Ml 12 10 10 10
PiHjutv fried 12 11 11 II
Tomatoes cooked 9 13 15 14
Hot • - 10
Lettuce salad urn - IS 13 15
Lefumct - s S
P"(jHc> mashed scalloped 6 10 II 10
Br«ccoli. cooked 5 - 6
Potatoes, baked roasted 5 6 6
Carrot*, cooked 5 4 5
Vegetables m mi ted dishes 4 6 5
Tomatoes ra» 4 6 4
Mued vegetables 3 *> 7
Cabbage, ra* •unhiding .o*csla«; 1 6 4
'a» \ezeuibie\ 30 29 42 33 36
Breads and Bread Mternates 97 97 96 97 97
While bread rolls 40 M 5f 59 59
PJVU 20 19 IS 21 20
Tortillas, taco shells pizza crust 9 12 10 II
Breading on nuggets slicks S * s 7
Rice 6 S s S
Corneread 4 7 7 7
Chapter ) Uealt and Smackt Offered by CACFT r'rtmdtn i-20
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Bread* and Bread AUtnutlet While bread and roil* are the mam. frtaptafflk ott^-ed -bread*.
a-, noted above, appearing in 60 percent of daalh lunch menu* Pasta- Abe oral nnoKt commaon
food in thi*. group i\> ottered rnuih lev freyuemh (19f* of daih menu**. Other ibread alk-rnate*
offcred m 5 percent or more ol luuratb menu* are lonmlila*. lam daelllte. «w pizza tinwa; breading
on ucm* with a*, thicken nugget* or fifh «iick*; and rite
*/ea/j am/ Meat Alternate* Ground beef and cheete. eodber alone or m nmed dtifce*.. ate fbe
■O ' frequent I> uttered meal and meal alternate In the aggregate ground beef and cheew: art
> 'f 1cred in about < >ne-half of all daih' CACFP lunch menu* It a* worm noting thai both ground
beef and theew: arc reI*i!Vehr high in fat and saturated faJ compared Jo .other rneai alternate*
«uch a* chicken. iurke>. and fitch. Chicken and turkey are the next most commonly ottered
thi* group Roasted or baked chicken and turkey N. ottered s.omew ha; more oiiem i
breaded, fried, or procc%wad chicken or turke>
Soncredttabl* Food* One-hall of all CACFP iliunch menu* include* one .or more noncredatabse
ufe. thai «*, load* Jhai do nod cojsjralbujc JO *a4a*fyiing Jtoe CACFP meail paraern Higb-iafl
tondjmeni* with a* butter, margarine, salad dirr**inf;.. mayoraraaiwr. grav> . and whipped cream
are ihe mow common noneredirtable food* offered at lunch, included m more than one-flhiird of
aJ1 daih Junth menu*
Sutrient Content of CACFP Uuuhe* Offered Relative to MDA*
On average. CACFP tunche* provide more than one-third of the PDA. except tor energ> and
• • :,--i'- ](), 7'hji general patttin ' consistent acroa pnwrider type M Mdisn MTOM *t,;;
group* < wse Fxhibii B,9).: The one exception i» Ihunche* .ottered Jo «a«- Jo Jem-year-olld* which
.::'- aatti) one third of the PDA fen IttM
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*52l
Early Childhood and Child Care Study: Vol. II
On average, lunches offered by CACFP providers supply about 100 percent of the RDA for
protein and vitamin A; 50 percent of the RDA for vitamin C; and about 40 percent of the RDA
for calcium (Exhibit 3.10)." CACFP lunches provide lesser amounts of energy and iron,
averaging about one-fourth (rather than one-third) of the RDA for each.
Percentage of Providers Offering at Least One-third of the RDA at Lunch
Most providers offer lunches that supply, on average, one-third (or more) of the RDA for
protein, vitamin A, calcium, and vitamin C (Exhibit 3.11)." Few providers, however, offer
one-third or more of the RDA for energy or iron. Only eight percent of providers offer lunches
that provide, on average one-third of the RDA for energy; and only 14 percent meet this
standard for iron.
Sutrient Conter.l of Lunches Offered Relative to Dietary Guidelines and NRC
Recommendations
With the exception of cholesterol, lunches offered by CACFP providers do not meet Dietary
Guidelines and NRC recommendations (Exhibit 3.12).:" Lunches offered to children five years
of age and older do not meet Dietary Guidelines and NRC recommendations for fat. saturated
fat. protein, and carbohydrate.
i his pattern is generally consistent across providers and for lunches offered to both five-year-olds
and six- to ten-year-olds. Moreover, there is no evidence of a gradual decline in the
percentage ol calories from fat or saturated fat in lunches offered to children between the ages
of two and five, as recommended by the Dietary Guidelines (see Exhibits B.8 and Bill
"Data "ii actual mean energy and nutrieni conieni arc presented m Exhibit H H Aye yroup specifit results and standard
errors lor estimates presented in Exhibit 3 10 are provided in Exhibit H s>
'Age-group-specifk results are presented in Exhibit B 10.
"Data <>n actual mean energy and nutrient content are presented in Exhibit B.8. Age-group-specifiC results and standaid
errors lor the estimates presented m Exhibit 3 12 ate provided in Exhibit B.I I.
Chapter 3: Meals and Snacks Offered by CACFP Providers 3-24
33
Early Childhood and Child Cart Study: Vol. II
Exhibit 3.11
With the Exception of Energy and Iron, Mast Providers Offer Lunches
That Provide at Least One-third of the RDA
"
All Family Day
Center-Based Care
Head Start Child Care
Providers Care Homes Centers Centers All Centers
Percentage of Providers Offering One-third of the RDA
Total Energy 8% 7% 16% 16% 16%
Protein 100 100 100 100 100
Vitamin A 96 95 100 98 99
Vitamin C 76 74 92 89 90
Calcium 94 93 95 96 95
Iron 14 12 27 23 24
Number of Providers 1820 486 878 456 1334
(Unweighted)
Chapter 3: Meals and Snacks Offered