Children's dietary intake in afterschool programs: Impact of foods and beverages obtained outside of program-provided snacks

INTRODUCTION. Although evidence is growing about the healthfulness of snacks served to children by afterschool programs, little is known about snacks that children bring in from vending machines, home, or other sources. We measured the nutritional quality and consumption of program-provided and non-program snacks in afterschool programs, quantifying the impact of non-program snacks on energy intake during snack time. METHODS. We recorded snack consumption for 306 children over 2 days in 19 afterschool programs participating in the Out of School Nutrition and Physical Activity (OSNAP) trial, using a validated observation measure. All but one participated in a federal meal program that stipulated basic nutrition standards for snacks served to children. Fixed effects regression models estimated the dietary impact of non-program snacks, contrasting within-child dietary intake on days with and without these snacks. RESULTS. Having a non-program snack was associated with significantly higher consumption of total energy (+119.35 kcals per snack period, p<0.001) salty snacks (+0.37 servings, p=0.008), desserts (+0.29 servings, p=0.02) and foods with added sugars (+0.47 servings; p<0.001) during the afterschool program compared to days where a child ate only the program-provided snack. DISCUSSION. The consumption of non-program provided snacks in afterschool settings increased intake of calories and salty or sugary foods during the snack period compared to days where only a program-provided snack was consumed. Children consumed twice the calories compared to days where they only had the program snack. Policies limiting or setting nutritional standards for non-program snacks should be further explored to promote child health.