Abstract| Volume 53, ISSUE 7, SUPPLEMENT , S66, July 2021

P91 Menu Quality and Food Substitution in Early Care and Education (ECE) Programs: The FRESH Study


      Preschool children consume two thirds of their dietary requirements at Early Care and Education (ECE) programs. Programs in tribal communities face unique challenges like rural location and reduced food access. Evaluation of ECE menus is an efficient method to examine dietary quality of foods and find opportunity to enhance nutrition quality through training and interventions for programs including those serving Native American children.


      Determine nutrient content, Child and Adult Care Food Program (CACFP) compliance, food substitution to assess menu quality in tribally affiliated ECE programs.

      Study Design, Setting, Participants

      Cross-sectional analysis was conducted as the baseline assessment in FRESH, a community-based participatory research study. Menus and recipes were collected from 9 sites and foods served to children were photographed.

      Measurable Outcome/Analysis

      Food Processor was used for nutrient analyses of fiber, saturated fat, and energy content. A quantitative index assessed the revised 2017 CACFP requirement, best practice, and combined compliance (possible score of zero to 100 percent for each). Food substitutions were classified as nutritionally equivalent, nutritionally superior (higher nutrient quality), or nutritionally inferior (poorer nutrient quality), and summed. Means, standard deviation, medians, and interquartile ranges were calculated for all variables.


      Mean fiber, saturated fat, and energy content of menus were 3.5g ± 0.5g, 10.5g ± 3.4g, and 643.7 ± 106.6 kcals, respectively. Menus were 74.4%, 61.4%, and 88.1% compliant with the total CACFP guidelines, best practices, and requirements, respectively. In 1 week, 54.8% of the foods were substituted; 44.3% were equivalent quality substitutions, 32.6% superior, and 23.1% inferior.


      Menus need to provide two thirds of the daily requirement of fiber (12-16g) to match the CACFP guidelines. More than 10% of total calories came from saturated fat and menus did not provide two thirds of total energy requirement (666-1067 kcals). Menus were fairly compliant with the CACFP guidelines however, there is a room for improvement. Foodservice personnel training may enhance nutritional quality of meals and substitutions.
      Funding National Institute on Minority Health and Health Disparities (R01MD011266).

      Appendix. Supplementary data