© 2019 Society for Nutrition Education and Behavior Objective: Assess if diet quality (DQ) differs among 3 lunch measures commonly used to assess DQ in early care and education (ECE) centers, which include what is listed on the menu, served, and consumed. Design: This quantitative observational study measured DQ of food and beverage items listed on the menu, what children were served, and what they consumed during one lunch meal. Setting: Alabama ECE centers. Participants: ECE centers (n = 28) with attendance of ≥10 children ages 3 to 5 years and provided lunch daily. Main Outcome Measure(s): DQ measured through Healthy Eating Index–2015 (HEI) scores, which were calculated for the menu, served, and consumed lunch measures. Analysis: Menu, served, and consumed HEI scores compared using either Kruskal-Wallis or ANOVA. Dunn Bonferroni or Duncan post hoc tests identified which group differed. Results: Total HEI scores were significantly higher among menus, compared with served and consumed (P =.001). Served and consumed total HEI scores were not different. Conclusions and Implications: Menu DQ differed from both the served and consumed lunch measures. These findings support the need for nutrition education on the importance of menu adherence in ECE centers.