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Associations between school meal attendance, dietary intake and nutritional status in Spanish school-aged children: a
María Del Mar Uclés-Torrente1,2,3, Gema Esperanza Ruiz-Gamarra2,3,4, José Manuel Alcalde-Llergo5
1Nursing, Pharmacology and Physiotherapy Department, University of Cordoba, Cordoba, Menéndez Pidal Avenue, 7, 14004, Spain.
Introduction:
Childhood obesity and poor diet quality remain major public health challenges, highlighting the importance of school food environments. This study examined whether regular school cafeteria attendance is associated with healthier nutritional status and greater adherence to balanced dietary patterns among schoolchildren.
Methods:
A cross-sectional study of 171 children from five primary schools was conducted between January and March 2025. Anthropometric measurements, dietary quality, cafeteria attendance, menu nutritional composition and daily menu cost were assessed.
Results:
Children attending the school cafeteria showed slightly higher adherence to the Mediterranean diet than non-attendees (5.55 ± 3.32 vs. 4.80 ± 3.69). No significant differences were observed in BMI-for-age z scores or blood pressure (p > 0.05), although weight percentiles differed significantly (p < 0.001). Non-attendees reported higher energy intake (108.3% vs. 94.4%), lipid intake (128.5% vs. 105.9%; p = 0.006) and higher intake of several micronutrients (p < 0.05). Menu cost and school type were significantly associated with nutrient intake, anthropometric percentiles and Mediterranean diet adherence (p < 0.001).
Conclusions:
School cafeteria attendance was associated with modest differences in dietary quality but not anthropometric or blood pressure measures. Menu cost and school type may influence children's dietary patterns and nutritional outcomes.
Impact:
International research supports the potential benefits of school meal programmes for children, especially among food-insecure children. Children who eat at home had higher energy, lipid and micronutrient intake, suggesting a more energy-dense dietary pattern. School menu costs were significantly associated with multiple nutrient indicators, indicating a socioeconomic gradient in nutritional quality. School type (public, state-funded, or private) was linked to menu cost, anthropometric percentiles and diet quality. Findings support the role of school meal programmes as potential equity tools while highlighting the need to standardise minimum cost per child.
