School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews.

Kate M O’Brien,Rebecca K Hodder,Rebecca Wyse,Lynda Davies,Sasha Lorien,Serene Yoong,Fiona Stacey,Courtney Barnes,Tessa Delaney,Alison Brown,Elizabeth Campbell

doi:10.3390/nu13114113

Abstract

Schools are identified as a key setting to influence children’s and adolescents’ healthy eating. This umbrella review synthesised evidence from systematic reviews of school-based nutrition interventions designed to improve dietary intake outcomes in children aged 6 to 18 years. We undertook a systematic search of six electronic databases and grey literature to identify relevant reviews of randomized controlled trials. The review findings were categorised for synthesis by intervention type according to the World Health Organisation Health Promoting Schools (HPS) framework domains: nutrition education; food environment; all three HPS framework domains; or other (not aligned to HPS framework domain). Thirteen systematic reviews were included. Overall, the findings suggest that school-based nutrition interventions, including nutrition education, food environment, those based on all three domains of the HPS framework, and eHealth interventions, can have a positive effect on some dietary outcomes, including fruit, fruit and vegetables combined, and fat intake. These results should be interpreted with caution, however, as the quality of the reviews was poor. Though these results support continued public health investment in school-based nutrition interventions to improve child dietary intake, the limitations of this umbrella review also highlight the need for a comprehensive and high quality systematic review of primary studies.

Highlights

Poor diet is a leading preventable risk factor for the development of noncommunicable diseases (NCDs), such as cardiovascular disease, specific types of cancer, and type 2 diabetes [1]
After applying the effectiveness categorisation framework, we found nutrition-only Health Promoting Schools (HPS) interventions are likely to be effective for improving fruit and vegetable intake combined, but are ineffective for fat intake, and nutrition and physical activity HPS interventions are ineffective for fruit and vegetables combined, and fat intake
After applying the effectiveness categorisation framework, we found evidence that school-based nutrition interventions, including those delivered via electronic health (eHealth), are likely to be effective for increasing fruit and vegetable intake combined [20,21,46], and European food interventions broadly to be effective for sugar sweetened beverages (SSB) [29] and promising for fruit and vegetable intake combined [29]

Summary

Introduction

Poor diet is a leading preventable risk factor for the development of noncommunicable diseases (NCDs), such as cardiovascular disease, specific types of cancer, and type 2 diabetes [1]. As a result, promoting healthy diets at all life stages is a global public health priority [2]. Public health strategies to improve the diets in children are a recommended strategy to reduce the burden from NCDs, as dietary behaviours established in childhood often persist into adulthood [2,3,4]. A healthy diet is essential during childhood and adolescent years for optimal growth, health, and development [5,6,7]. A healthy diet has been shown to enhance children’s cognitive skills such as concentration and memory, and improve mood, energy levels, and academic performance [8,9,10]. Consuming higher levels of unhealthy foods, such as fast food and sugar sweetened beverages (SSB), has been associated with behavioural problems, poor concentration, obesity, and emotional development problems [8,11,12]

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Discussion

Conclusion