Implementation of Universal Infant Free School Meals: a pilot study in NE England exploring the impact on Key Stage 1 pupil's dietary intake.

Objective: To consider the principal effect of an interaction between year (pre- and post-Universal Infant Free School Meals (UIFSM)) and school on pupil's dietary intakes.

Design: A repeated cross-sectional survey using dietary data from 2008 to 2009 (pre-) and 2017 to 2018 (post-UIFSM).

Setting: Two primary schools, NE England.

Participants: Pupils aged 4-7 years (2008-2009 n 121; 2017-2018 n 87).

Results: At lunchtime, there was a statistically significant decrease in pupils non-milk extrinsic sugars intake (%E NMEs) pre- to post-UIFSM (mean change -4·6 %; 95 % CI -6·3, -2·9); this was reflected in total diet (-3·8 %; -5·2, -2·7 %). A year and school interaction was found for mean Ca intakes: post-UIFSM pupils in School 2 had a similar mean intake as pre; in School 1 intakes had increased (difference of difference: -120 mg; 95 % CI -179, -62); no reflection in total diet. Post-UIFSM mean portions of yogurt decreased in School 2 and remained similar in School 1 (-0·25; -0·46, -0·04); this was similar for 'cake/pudding' and fruit.

Conclusions: Within the limitations, these findings highlight positives and limitations following UIFSM implementation and demonstrate the role of school-level food practices on pupil's choices. To facilitate maximum potential of UIFSM, national levers, such as discussions on updating school food standards, including sugars, could consider removing the daily 'pudding' option and advocate 'fruit only' options 1 d/week, as some schools do currently. Small school-level changes could maximise positive health impacts by decreasing NMEs intake. A more robust evaluation is imperative to consider dietary impacts, equitability and wider effects on schools and families.