School-based Nutrition Intervention Research Articles

Unveiling school community perceptions of nutrition-friendly school initiatives in preschool settings in rural Sindh province, Pakistan: an exploratory study

IntroductionIn 1995, the World Health Organization launched its Global School Health Initiative to expand the Health Promoting School (HPS). The objective of this study was to explore the perception of the school community in implementing nutrition-friendly school initiatives in preschool settings.MethodsThis paper delineates the exploratory phase of a mixed-method study, which broadly aims to assess the adoption of the Nutrition Friendly School Initiative (NFSI) through a preschool preparedness intervention package in rural Sindh province, Pakistan. The study sites include three campuses of the Aga Khan School (Mirpur Sakro, Junior Campus Vur, and a community-based school in Sujawal). Participants were selected purposively from these campuses and constituted a committee named ‘school community,’ which was responsible for implementing all activities outlined in the intervention package. Data was gathered through in-depth interviews and consultative meeting with the school community. Thematic analysis was employed for data analysis.ResultsThe analysis established five major themes that represent the participants’ perception of school-based nutrition interventions in preschool settings. These five themes include (i) Challenges in health and nutrition for pre-school age children, (ii) Clarity in roles and responsibilities for school-based nutrition intervention, (iii) Advancing school-based nutrition activities and interventions, (iv) Recognizing resources requirements, (v) Opportunities and challenges for the way forward in school-based nutrition. Findings also suggest sustainability and scalability measures that include the aligning School Nutrition Policy with the school handbook, ways to engage with parents, a nutrition theme corner, the inclusion of a parenting component in the nutrition manual, and capacity building of the school community.ConclusionQualitative findings have guided the refinement of the intervention package, proposing additional measures for sustainability and scalability across AKES, P. The school community is hopeful that the implementation of the refined intervention package will enhance preschool preparedness toward achieving nutrition-friendly school checklist items. This study holds strong potential for replication in a public school setting and presents an opportunity to launch a school accreditation program to certify schools as Nutrition-friendly.

Response to Commentary: Effect evaluation of Sahtak bi Sahnak, a Lebanese secondary school-based nutrition intervention: a cluster randomised trial.

Response to Commentary: Effect evaluation of Sahtak bi Sahnak, a Lebanese secondary school-based nutrition intervention: a cluster randomised trial.

An Evaluation of Usage of Effective Recommendations in School-Based Nutrition Interventions Conducted in India Between 2010-2021: A Review Paper

Objective: India is currently in early phases of using School-based Nutrition Interventions (SNIs) as a strategy to address Childhood Obesity. Therefore, this study aims to evaluate the effectiveness of SNIs conducted in India, analyse the use of established recommendations for successful SNIs, and identify the minimally used recommendations which may have more impactful results. Material and Methods: Extensive literature search for SNIs was done using pre-established inclusion criteria through online databases. Eleven recommendations for effective SNIs were also compiled by literature search. The effectiveness of the included SNIs was evaluated as per their significant results. The application of recommendations was then analysed and minimally used recommendations were identified. Results: None of the SNIs had a significant effect on Body Mass Index. Other outcomes like waist circumference and physical activity were improved. Only four of the eleven recommendations were highly employed by more than 70% of interventions. Rest were minimally used (avg.<35%). Conclusion: There are currently very few recommendations being used to influence the health behaviors of Indian children. More interventions need to be planned, using these underutilized efficient strategies. Keywords: Childhood, Obesity, Overweight, School, Nutrition, Intervention.

Efforts Undertaken by Several ASEAN Countries to Address Childhood and Adolescent Obesity in School-Based Programs: A Systematic Review

Background: Childhood and adolescent obesity is on the rise in Southeast Asia. Necessitating stronger actions from ASEAN governments to address this issue, because the significant financial and social welfare implications. Schools provide an effective platform for targeted interventions among children and adolescent groups. Objectives: This study provides an overview of school-based nutrition interventions implemented in ASEAN countries to address childhood and adolescent obesity. Methods: A literature review was conducted by searching multiple databases (Google Scholar, PubMed, ProQuest, ScienceDirect, and Web of Science) between April 1 and May 1, 2023. The search included computer-based searches and manual search in relevant journals. The articles considered were limited to publications from the past 10 years. Discussion: School-based nutrition interventions in ASEAN countries require further development, with attention to key factors such as intervention duration, sample size, and family involvement. Conclusions: Urgent large-scale research is needed to evaluate the effectiveness of existing school-based nutrition programs. Integrated and effective programs require support and collaboration from families, the private sector, and the government.

A Systematic Review of School-Based Nutrition Interventions for Promoting Healthy Dietary Practices and Lifestyle Among School Children and Adolescents.

Childhood malnutrition is one of the foremost community health problems in the world, particularly in developing countries like India. This current review was conducted to evaluate the effectiveness of various school-centered nutrition interventions/intervention programs developed in recent years, and their impact on the nutritional status, dietary habits, food preferences, lifestyle, and dietary behaviors in relation to diet, as well as physical activities for school children, especially adolescents. This review included studies found in the PubMed/Medline, SCOPUS, and Web of Science (WOS) databases, published from July 2017 to 2023. They were analyzed for eligibility criteria defined for this study, including school children and adolescents, school-based nutrition interventions/strategies/policies/initiatives, nutritional status, physical activity, dietary habits, and lifestyle. The Risk of Bias assessment was conducted using Review Manager version 5.4. Among 1776 potentially related studies, 108 met the eligibility criteria. Following this review, 62 studies were identified as eligible for this study, in which 38 intervention programs were discussed. A total of 13 studies were considered comprehensive and multi-component, 15 were nutrition education interventions, six were identified as physical activity interventions, and four focused on lifestyle and dietary behavior-related interventions. Another 24 of the 62 studies reviewed (approximately 39%) were either original articles, review articles, or articles pertaining to nutritional program guidelines, protocols, and/or reports. These studies uncovered a possible relationship between a decrease in BMI and school children's engagement in diet and/or physical activity. Results also suggest that these programs can be effective, although evidence for the long-term sustainability of changes in BMI was less evident and not fully substantiated/supported. Most of these findings are based on self-reported program data and may consist of biases linked to recall, selection of participants, and the desire to report favorable final measures (physical activity, lifestyle, and dietary habits). This study has the potential for use in public health programs devoted to healthy nutrition behavior and lifestyle practices. This research was primarily conducted by clinical researchers and did not receive any standardized institutional or organization-derived grant funding and support.

An Increase in Food Insecurity Correlated with an Increase in Plasma Triglycerides among Latinx Children

BackgroundFood insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity. ObjectiveThe objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 academic year. MethodsThis secondary analysis used data from TX Sprouts, a cluster-randomized school-based gardening, cooking, and nutrition trial. The study enrolled 3rd–5th-grade students from 16 schools that served primarily (>50%) Hispanic families with low income in Austin, TX. Participants (n = 619) provided household food insecurity data and fasting lipid panels at both baseline and postintervention, ∼9 mo following. ResultsThere was no intervention effect on household food insecurity. Independent of the intervention, a 1-point increase in food insecurity, indicative of becoming more food insecure, was associated with a 2.61 mg/dL increase in triglycerides (P = 0.001; 95% CI: 1.04, 4.19) at follow-up. Children who were food insecure at baseline and became food secure at follow-up had a mean 5.05 mg/dL decrease in triglycerides compared with a 7.50 mg/dL increase in triglycerides in children who remained food insecure throughout (95% CI: −23.40, −1.71, P = 0.023). There were no other associations between changes in food insecurity and cardiometabolic markers. ConclusionAlthough the intervention did not improve food insecurity, reductions in food insecurity over 9 mo were associated with improved cardiometabolic markers in high-risk children, emphasizing the need for interventions targeting food insecurity.The study is registered at clinicaltrials.gov under NCT02668744 (https://classic.clinicaltrials.gov/ct2/show/NCT02668744).

Feeding for a brighter future: The long-term labor market consequences of school meals in rural China

This study examines the impacts of childhood exposure to the Nutrition Improvement Program (NIP), which provides free school meals to eligible students in rural China, on adult labor market outcomes. Using data from the China Family Panel Studies, we employ a cohort difference-in-differences (DID) design to identify the NIP’s long-term effects. The results show that early-life exposure to the NIP has increased adulthood employment probability by 6.5 percentage points. Childhood exposure to the NIP has also resulted in an average increase of 12.4% in adult hourly wages and 10.3% in annual income. These findings remain robust to a battery of validity checks. Our heterogeneous analysis demonstrates that these effects are more pronounced among those who are females and from households with low socioeconomic status. Further, we find that exposure to the NIP yields lasting beneficial effects on adult education attainment, cognitive and non-cognitive skills, as well as health and health behaviors. This suggests that improvements in human capital accumulation and health behaviors are potential mechanisms contributing to the long-term labor market consequences of the NIP. Our study sheds light on the enduring impacts of school-based nutrition intervention on individuals’ economic well-being in developing countries.

Commentary: Effect evaluation of Sahtak bi Sahnak, a Lebanese secondary school-based nutrition intervention: a cluster randomised trial.

Commentary: Effect evaluation of Sahtak bi Sahnak, a Lebanese secondary school-based nutrition intervention: a cluster randomised trial.

Development and initial qualitative evaluation of a novel school-based nutrition intervention – COOKKIT (Cooking Kit for Kids)

BackgroundExcess weight and an unhealthy diet are risk factors for many cancers, and in high income countries, both are more prevalent among low income families. Dietary interventions targeting primary-school aged children (under 11) can improve healthy eating behaviours, but most are not designed to support the translation of skills learnt in the classroom to the home setting. This paper assessed attitudes and approaches to cooking and eating at home, and the potential to enhance engagement in healthy eating through the COOKKIT intervention.MethodsCOOKKIT is an intervention to deliver weekly cooking classes and supportive materials for low-income families to maintain healthy eating at home. Preliminary qualitative interviews were conducted with teachers and parent–child dyads from a range of primary schools in the UK to explore attitudes, barriers and facilitators for healthy eating and inform the development of COOKKIT. Following implementation, ten children (8–9 y/o) participated in post-intervention focus groups, alongside interviews with teaching staff and parents.ResultsThematic analysis identified five themes under which to discuss the children’s experience of food, cooking and the impact of COOKKIT: Involving children in planning and buying food for the family; Engaging children in preparing meals at home; Trying to eat healthy meals together in the midst of busy lives; Role-modelling; and Balancing practicalities, information and engagement when delivering cooking classes.ConclusionsResults suggest COOKKIT provides engaging and easy to follow in-school resources for children and school staff with take-home kits facilitating continued engagement and reinforcing lessons learned in the home environment. Importantly, participants highlighted the combination of healthy eating information, applied practical skills and low costs could support families to continue following the COOKKIT advice beyond the intervention, suggesting further evaluation of COOKKIT is warranted.

Effect of school-based nutrition interventions among primary school children in sub-Saharan Africa: a systematic review protocol

IntroductionPreadolescents are passing through an intensive growth and development period that will benefit from healthy eating practices. For those attending school, school environments offer several potential benefits and have been...

Effects of a School-Based Nutrition, Gardening, and Cooking Intervention on Metabolic Parameters in High-risk Youth

Although school-based gardening programs for children have consistently been shown to improve dietary behaviors, no cluster randomized clinical trial (RCT) has evaluated the effects of a school-based gardening intervention on metabolic outcomes. To evaluate the effects of a school-based gardening, nutrition, and cooking intervention (Texas Sprouts) on changes in metabolic outcomes in elementary schoolchildren. This study was a secondary analysis of a cluster RCT, conducted over 3 years from 2016 to 2019, at low-income elementary schools with majority Hispanic students in the greater Austin, Texas, area. Data were analyzed from January to August 2022. Texas Sprouts was 1 school year long (9 months) and consisted of (1) Garden Leadership Committee formation; (2) a 0.25-acre outdoor teaching garden; (3) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school year; and (4) 9 monthly parent lessons. The delayed intervention was implemented the following academic year and received an identical intervention. The following measures were obtained at baseline and postintervention (9 months): demographics via survey; measured height, weight, and body mass index parameters; and glucose, insulin, homeostatic model assessment of insulin resistance, and a lipid panel via an optional fasting blood draw. Sixteen elementary schools were randomly assigned to either Texas Sprouts intervention (8 schools) or to delayed intervention (control, 8 schools). A total of 3302 children (aged 7-12 years) were enrolled in Texas Sprouts, and fasting blood samples were obtained from 1104 children (or 33% of those enrolled) at baseline. The final analytic sample included 695 children (307 boys [44.17%]; mean [SE] age, 9.28 [0.04] years; 480 Hispanic children [69.02%]; 452 [65.03%] eligible for free or reduced lunch) with complete demographic data and baseline and postintervention (9-month) fasting blood draws. Compared with control schools, children from Texas Sprouts schools had a 0.02% reduction in mean hemoglobin A1c (95% CI, 0.03%-0.14%; P = .005) and a 6.40 mg/dL reduction in mean low-density lipoprotein cholesterol (95% CI, 3.82-8.97 mg/dL; P = .048). There were no intervention effects on glucose, insulin, homeostatic model assessment of insulin resistance, or other lipid parameters. In this cluster RCT, Texas Sprouts improved glucose control and reduced low-density lipoprotein cholesterol in high-risk youth. These findings suggest that elementary schools should incorporate garden-based interventions as a way to improve metabolic parameters in children. ClinicalTrials.gov Identifier: NCT02668744.

A systematic review of the effects of nutrition programmes in high schools

Introduction/Objective: Obesity rates are reaching alarming levels. Adolescence is a critical period for the prevention of nutritional problems, as it is a time of development of one’s own eating habits. These habits will persist into adulthood, so showing adolescents healthy lifestyle patterns is important. The ideal option would be through school-based nutrition intervention programmes. The main objective of this article is to investigate the effectiveness of intervention programmes based on nutritional knowledge and the behaviour of adolescents aged 11-19 years. Method: To carry out this systematic review we employed Scopus, PubMed, and Web of Science as databases and a search period that spanned the last 10 years, following the PRISMA statement. Subsequent to the search, 110 articles were found. Finally, 19 articles were selected for in-depth analysis after a thorough screening. Results: The results show that, in general, intervention programmes have improved the nutritional knowledge of high school students, which means an improvement in their eating behaviours. In addition, these programmes increase their levels of physical activity. However, gender differences are observed, with girls being more concerned about maintaining a balanced diet. Conclusion: In conclusion, schools are an ideal environment for developing programmes that interfere in adolescent eating behaviour.

Ajyal Salima a novel public-private partnership model for childhood obesity prevention in the Arab countries.

The prevalence of childhood overweight and obesity among children is on the rise around the world. Meanwhile, comprehensive multi-sectorial approaches have been found to be effective in improving nutritional status among children. Ajyal Salima is a public-private partnership (PPP) school-based nutrition and physical activity intervention program implemented in six Arab countries. Its objective is to promote healthy eating and physical activity habits among 9-11-year-old students. The stakeholders, involved with the implementation of the program, comprised (1) local authorities, ministries of Education and Health, and non-governmental organizations (NGOs) as public partners, (2) The American University of Beirut (AUB) as the academic/regional scientific partner, and (3) Nestlé as the private partner. The Ajyal Salima program encompasses four coordinated educational components: classroom sessions, family involvement, food service intervention, and training of trainers. The program's educational material has been culturally adapted to each country's needs, as well as pilot tested. This paper describes the strategies used to build the PPP framework of Ajyal Salima, and the role of each stakeholder. The Ajyal Salima program is an example of a promising and sustainable comprehensive PPP program to address childhood obesity, that can be exported to other countries in the region and globally.

Impact of a School-Based Nutrition Intervention in Preventing Overweight and Obesity in Children in Thailand.

This study evaluated the impact of a school-based nutrition program on preventing overweight and obesity in children in Thailand from 2014 to 2019. We used difference-in-differences with matched comparison group to evaluate program impact. Treatment schools were categorized into those that participated in phase 1 only, and those that participated in phase 1 and 2. We matched 311 treatment schools in phase 1 only with 1504 comparison schools, and 75 treatment schools in both phases with 216 comparison schools. Administrative data from Thailand Office of Basic Education Commission were used from 2014 (baseline), 2016 (first follow-up), and 2019 (second follow-up). Program resulted in a 0.6-1.1 percentage point reduction in the students' probability of overweight by the end of phase 1, and 1.7 percentage points by the end of phase 2. Impact on obesity was found only for schools participating in both phases (0.4 and 0.9 percentage points by the end of phase 1 and 2, respectively). Program continuity and intensity are key to achieve a reduction in overweight and obesity in schoolchildren. The program was successful in reducing overweight and/or obesity given appropriate level of continuity and intensity.

Effectiveness of school-based nutrition intervention components on fruit and vegetable intake and nutrition knowledge in children aged 4-12 years old: an umbrella review.

School-based nutrition interventions can support healthy eating in children. To identify components of school-based nutrition interventions and synthesize the impact on consumption of fruits and vegetables (FV) and nutrition knowledge (NK) in children aged 4-12 y. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and PICOS inclusion criteria, relevant systematic reviews and/or meta-analyses, written in English, published between 2010 and August 2020, across 6 databases were identified. Two reviewers independently performed data extraction and assessed the study quality. The JBI Critical Appraisal Instrument for Systematic Reviews and Research Syntheses was used to assess review quality, and the Grading of Recommendations Assessment, Development, and Evaluation approach was used to rate strength of evidence. From 8 included reviews, 7 intervention components were identified: FV provision, gaming/computer-delivered, curriculum, experiential learning, reward/incentives, nudging, and caregiver involvement. FV provision had the greatest effect on F intake, gaming/computer-delivered on V intake, and curriculum on NK. FV provision and gaming/computer-delivered components showed, overall, some positive effect on FV intake, as did the curriculum component on NK. More evidence evaluating single-component effectiveness that considers the setting and context of nutrition interventions is required to strengthen the evidence base. PROSPERO, registration no.: CRD42020152394.

Meals, Education, and Gardens for In-School Adolescents (MEGA): study protocol for a cluster randomised trial of an integrated adolescent nutrition intervention in Dodoma, Tanzania

IntroductionSecondary schools have the transformative potential to advance adolescent nutrition and provide a unique entry point for nutrition interventions to reach adolescents and their families and communities. Integrated school nutrition...

The Impact of School-Based Nutrition Interventions on Parents and Other Family Members: A Systematic Literature Review.

Little is known about the impact of school-based nutrition interventions on parents and other family members. This systematic review aims to explore the impact of school-based nutrition interventions on different parental/family outcomes, mainly dietary intake, nutrition knowledge, and health outcomes. PubMed, Web of Science, PsycINFO, EconLit, Cochrane Reviews, and Google Scholar were systematically searched for controlled trials or natural experiments measuring the impact of school-based nutrition interventions, with or without parental involvement, on parents/families of school children. Twenty-two studies met the inclusion criteria. Of which, 15 studies assessed the impact of school-based nutrition interventions on parental/family dietary intake, 10 on parental/family nutrition knowledge, and 2 on parental/family health outcomes. Inconsistent results were found for parental dietary intake with six studies reporting favorable effects. Most studies found improved parental nutrition knowledge. Positive impacts were seen by both studies that assessed the impact on a parental health outcome. Overall, we found that there is potential for school-based nutrition interventions to result in positive effects for parents, in particular for nutrition knowledge. More research is needed to assess the impacts of school-based nutrition interventions on parents and other family members and to assess important intervention characteristics in creating a positive impact.

School-Based Nutrition Interventions Had Impacts on Dietary Diversity and Meal Frequency of Adolescent Girls in Ethiopia

ObjectivesAdolescence is a critical period of physical and psychological development, especially for girls as poor nutrition can affect their well-being as well as the well-being of their children. In Ethiopia, where the population is very young, evidence on the nutrition of adolescent girls and their determinants is scant. We tested the impact of a package of nutrition interventions delivered primarily through schools and implemented by Alive & Thrive (A&T) on the diet of adolescent girls. MethodsA cluster-randomized trial design compared 27 primary school clusters in A&T areas to 27 clusters in non-A&T areas in the SNNP and Somali regions. We surveyed adolescent girls (n = 536) aged 10–14 years and enrolled in primary school grades 4–8, following at least one school semester (approximately 4 months) of implementation in March-April 2021. Using linear regression models, we tested for differences between program groups on dietary diversity, meal frequency, and consumption of unhealthy foods. In adjusted models, we controlled for age, household food security and wealth, and region. ResultsWe observed significant impacts on dietary diversity score (1.4 food groups) and minimum dietary diversity (OR: 5.2). Among the food groups, there was significantly higher consumption of 5 groups in A&T areas: pulses, meats, eggs, vitamin A-rich fruits and vegetables, and other fruits. There was also a significant impact on meal frequency of 0.9 meals/snacks in the previous 24 hours, with girls in A&T areas consuming 4.0 meals/snacks out of 6 eating times compared to 3.2 in control areas. There was no significant impact on consumption sweets, baked sweets, sweetened beverages, and fried and salty foods among girls, but there was lower consumption of sweets in the previous 24 hours in A&T (14%) versus control areas (23%). ConclusionsIntegrating nutrition interventions into primary schools in Ethiopia was feasible and achieved a significant impact on girls’ dietary diversity and meal frequency. Reinforcing messages about eating better and more often resulted in incremental behavior change related to dietary diversity and meal frequency; however, telling adolescents not to eat junk foods that they crave or enjoy without changing their food environments may be less successful in curbing consumption. Funding SourcesBill & Melinda Gates Foundation, through A&T, managed by FHI Solutions.

A randomized control trial of a Canadian-based school food program on the home food environment.

Research provides evidence of take-home effects in school-based nutrition interventions, citing children as important influencers of family nutrition, acting as agents of change in the household and potentially influencing family food consumption. Therefore, the purpose of this randomized control trial was to examine whether implementation of a centrally procured school food program would produce changes in children's home food environment, including fruit and/or vegetable availability and parental modelling of fruit and/or vegetable consumption. A secondary objective was to investigate whether children's fruit and/or vegetable intake predicted their parent's fruit and/or vegetable intake. A total of 60 schools participated in the evaluation, including 2443 students (and their parents) in grades 5-8. Findings indicated that the intervention did not produce take-home effects on children's home availability of fruit (p = 0.52) and vegetables (p = 0.67) or parental modelling of fruit (p = 0.26) and vegetable consumption (p = 0.78), which may be related to the fact that only food provisions were given. However, children's fruit and vegetable consumption predicted parents' fruit and vegetable consumption (p < 0.001), thereby indicating that children may possess the capacity to influence home nutrition. Future school-based nutrition interventions are recommended to be multi-component (e.g. experiential learning, parent involvement) and that encourage nutrition leadership opportunities for children in the home context.

Using predicted marginal effects to assess the impact of rurality and free and reduced lunch eligibility on a school-based nutrition intervention

PurposeTo estimate the impact of a school-based nutrition education intervention in rural schools and schools with high free and reduced lunch (FRL) eligibility rates. MethodsAs part of the evaluation of the Healthy Schools Healthy Students intervention, 20 schools were randomized to control and intervention conditions. Pre (October 2017) and posttest (April 2018) data were analyzed using multi-level linear regression models to estimate the intervention effect for multiple outcomes controlling for school-level demographic characteristics. We report the predicted marginal effect overall and specifically for rural; high FRL; and rural, high-FRL schools. ResultsWe observed at least one significant intervention effect for food group knowledge, liking to eat fruit, beliefs about how healthy fruits are, non-taste test fruit preferences, liking to eat vegetables, beliefs about how healthy vegetables are, and taste test vegetable preferences. We observed differential intervention effects for all outcomes except taste test vegetable preferences based on rural and high-FRL status. ConclusionsInterventions do not necessarily have the same impact on all participants. Sub-analyses can reveal these important differential effects, as they have important implications for policymakers, program implementers, and evaluators. Resources and interventions should be allocated where they will have the greatest impact.