RUDD ARTICLES Comparing Current Practice to Recommendations for the Child and Adult Care Food Program Marlene B. Schwartz, PhD, 1 Kathryn E. Henderson, PhD, 2 Gabrielle Grode, MPH, 3 Maia Hyary, 1 Erica L. Kenney, PhD, ScD, MPH, 4 Meghan O’Connell, MPH, 1 and Ann E. Middleton, MPH 5 Abstract Background: The federal Child and Adult Care Food Program (CACFP) assists child care centers serving low-income pre- schoolers and regulates the quality and quantity of food served. The aim of this study was to assess the nutritional quality of lunches served at 38 child care centers and examine how current practices compare to proposed meal pattern recommendations. Methods: Preschool-aged children (n = 204) were observed eating lunch in 38 CACFP-participating preschools. All foods served and consumed were measured and compared to the 2011 Institute of Medicine (IOM) recommendations to improve CACFP and the 2015 Proposed Rule issued by the USDA. Results: All centers provided access to all required lunch components, but not all components were served (i.e., placed on the child’s plate). Vegetables were significantly less likely to be served than meat or grains. Compared with CACFP recommended portion sizes, servings of meat and grain were high, whereas milk was low. Compared with IOM recommendations, average calorie consumption was appropriate, but saturated fat, protein, and sodium intake were high and dietary fiber was low. Meals that offered children both a fruit and a vegetable led to significantly higher produce consumption than meals that offered only one fruit or one vegetable. Conclusions: Child care centers generally comply with current CACFP regulations, but do not provide lunches consistent with the 2011 IOM recommendations for saturated fat, protein, fiber, and sodium. Decreased use of beef and cheese and increased provision of whole grains, fruits, and vegetables are recommended. Introduction T he national Child and Adult Care Food Program (CACFP) supports food service in child care centers that serve low-income families. 1 Participating cen- ters must serve meals and snacks that meet specific nutri- tion standards, and there is evidence that this program positively influences children’s diets. 2 Centers that partic- ipate in CACFP report serving more fruit, vegetables, milk, and meat/meat alternates and fewer snacks and sweetened beverages than non-CACFP sites, 3 and studies have found that children who attend CACFP participating child care centers are more likely to consume fruits and vegetables than children attending non-CACFP centers or at home under parental care. 4–6 Although current CACFP standards ensure some degree of nutritional quality, research comparing these meals to national recommendations have found that they are still high in saturated fat 7 and sodium, 8 highlighting potential areas for improvement. In 2008, the USDA asked the In- stitute of Medicine (IOM) how to bring CACFP meals into alignment with the Dietary Guidelines for Americans, 9 and these recommendations were published in 2011. 10 The 2010 Healthy Hunger-Free Kids Act required the USDA to revise the nutrition standards of the CACFP, and new USDA recommendations were released in January 2015. 11 1 Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT. 2 Henderson Consulting, Guilford, CT. 3 Public Health Management Corporation, Philadelphia, PA. 4 Prevention Research Center, Harvard University, Cambridge, MA. 5 IMPAQ International, LLC, Oakland, CA. CHILDHOOD OBESITY October 2015 j Volume 11, Number 5 ª Mary Ann Liebert, Inc. DOI: 10.1089/chi.2015.0041 491