A natural experimental evaluation of the effect of universal infant free school meals on key stage 1 pupil′s dietary intake in northeast England: A pilot study


Background: In 2013, a government-commissioned review of school food recommended that all key stage 1 pupils in England should receive free school meals. In 2014, Universal Infant Free School Meals (UIFSM) were implemented, costing £450 million. There has been no evaluation of this policy change on pupil’s diets. We assessed the effect of UIFSM on pupil’s lunch and total daily intake.

Methods: We used cross-sectional surveys in 2008–09 (before) and 2017–18 (after UIFSM) in two primary schools in Newcastle (school A in most deprived ward; school B in least deprived ward) and a validated, prospective 4-day food diary. All pupils (4–7 years) were eligible to participate with written parental consent (2008–09: n=112; 2017–18 n=84). A linear regression model explored the effect of year, school, level of deprivation (pupil postcode), and the interactions between these factors on mean change in percent energy non-milk extrinsic sugars (%E NMES), calcium, yoghurt, and cake; analyses were adjusted for gender. Ethical approval for this study was granted by Newcastle University.

Findings: At lunchtime, we found evidence of a decrease in pupils mean ENMES before and after UIFSM (mean change –4·6% [95% CI –6·3 to –2·9]), which was reflected in total daily intake (–3·8% [–5·2 to –2·7]). We found a year and school interaction on mean calcium: pupils in School B had a similar mean intake before and after UIFSM; in school A, calcium intake had increased (difference between schools in calcium change –120 mg [95% CI –179 to –62]); no evidence was found of an effect in total daily intake. After UIFSM, mean portions of yoghurt decreased in school B and increased in school A (–0·25 portions [–0·46 to –0·04]); mean portions of cake increased in School B and remained similar in school A (0·23 [0·43–0·42]).

Interpretation: Within the limitations of this study (repeat cross-sectional survey; only two schools) there is evidence that UIFSM contributed to a reduction in ENMES. Schools should consider implementation of healthier policies (eg, removing the daily cake choice).

The Lancet 2019; 394:S87