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

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.

SUBMITTER: O'Brien KM

PROVIDER: S-EPMC8618558 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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

O'Brien Kate M KM Barnes Courtney C Yoong Serene S Campbell Elizabeth E Wyse Rebecca R Delaney Tessa T Brown Alison A Stacey Fiona F Davies Lynda L Lorien Sasha S Hodder Rebecca K RK

Nutrients 20211117 11

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 accord ...[more]

PMID: 34836368

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Project description:Children and adolescents spend a large proportion of the after-school period in sedentary behaviors (SB). Identifying context-specific correlates is important for informing strategies to reduce these behaviors. This paper systematically reviews the correlates of children's and adolescents' after-school SB.A computerized literature search was performed in October 2015 for peer-reviewed original research journal articles published in English before October 2015. Eligibility criteria included: 1) sample aged 5-18 years; 2) quantified the amount of SB or component of this that the children/adolescents were performing after school; 3) a measure of SB as the dependent outcome; and 4) the association between potential correlates and after-school SB.Data were synthesized in October 2015. Thirty-one studies met the eligibility criteria: 22 studies among children (≤ 12 years), six among adolescents (>12 years), two had a combined sample of children and adolescents and one cohort followed children from childhood to adolescence. Findings were separated by after-school location i.e. after-school programs (n = 4 studies) and unidentified locations (n = 27). There was insufficient evidence to draw conclusions on all but two of the 58 potential correlates: sex and age. Among children at unidentified locations there was a null association between sex (male) and overall after-school SB, a null association between sex (male) and after-school TV viewing, a positive association between age and overall after-school SB and an inconsistent association between age and after-school TV viewing. No correlates of after-school sedentary behaviour while at after-school programs were identified.Only two correlates have been investigated frequently enough to determine an overall association; neither correlate is modifiable. Due to the lack of consistent investigation of potential correlates, further evidence is required to accurately identify potential intervention targets.CRD42014009180.

Project description:BackgroundThe benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear.AimThis umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10-19 years old).MethodsUsing Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation's Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement.ResultsSeventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents' knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap.ConclusionSchool-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries.

Project description:BackgroundChildhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised.MethodsAn update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect.FindingsMeta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness.InterpretationThis updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning.FundingThis research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).

Project description:ObjectiveTo systematically evaluate and synthesize quantitative evidence regarding the effects of pediatric massage in infants and children under five years.Review methodsWe conducted searches in databases including MEDLINE, Embase, Health Technology Assessment Database, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Allied and Complementary Medicine, Embase, the China National Knowledge Infrastructure, Wanfang Data, SinoMed, and CQVIP up to February 2024. Two reviewers independently screened articles, extracted data, and conducted quality appraisals on the included studies. We focused on systematic reviews with meta-analyses comparing pediatric tuina with a waitlist control, placebo, medication, massage combined with other interventions, and usual care. Outcomes analyzed included physical, psychological, developmental, and safety-related measures for children and their caregivers. Methodological quality was assessed using AMSTAR 2, and evidence quality was evaluated using the GRADE approach. Pooled effect estimates and heterogeneity were extracted for each meta-analyzed outcome. Evidence evaluated as 'high' and 'moderate' quality by GRADEpro with low heterogeneity are presented in the result section.ResultsTwenty-two systematic reviews with meta-analysis of 81 outcomes were included. Seven studies (31.8 %) were high quality, and the evidence of 6 (7.4 %) outcomes were evaluated as high quality. The meta-analysis results demonstrate significant benefits of pediatric massage for infants compared to routine care, with increased weight gain (MD 455.07 g; 95 % CI 86.33 to 823.8; I2 = 0 %) based on 2 studies with 157 cases, length growth (MD 1.58 cm; 95 % CI 1.42 to 1.74; I2 = 25 %) from 9 studies with 1294 cases, reduced fussing (MD -0.37 time; 95 % CI -0.53 to -0.21; I2 = 30 %) according to 3 studies with 271 cases, and lower post-intervention bilirubin levels (3 studies/345 cases; MD -31.75 mmol/L; 95 % CI -40.05 to -23.46; I2 = 0 %). Pediatric massage was associated with reduced diarrhea incidence compared to waitlist controls (2 RCTs/310 cases; RR 0.39; 95 % CI 0.2 to 0.76; I2 = 0 %) and improved psychomotor development indices (4 RCTs/466 cases; SMD -0.35; 95 % CI -0.54 to -0.15; I2 = 1.06 %). Additionally, pediatric massage significantly enhanced blood oxygen saturation variation post-procedure for pain management (5 RCTs/355 cases; MD 1.05; 95 % CI 0.51 to 1.58; I2 = 0 %).ConclusionsPediatric massage significantly enhances mother-child attachment, promotes physical growth, reduces fussing, lowers bilirubin levels, improves motor and psychomotor development, as well as manages digestive conditions and pain in children under 5 years. Future research should improve study quality and comprehensively report adverse events.

Project description:BackgroundFood and nutrition literacy is a newly emerged concept to connect food-related knowledge and skills to healthy diets. Its promotion is important to protect children as they eat too many low-nutrient, high-energy foods. Food and nutrition literacy promotion needs multi-dimensional interventions. In the process of developing an intervention to promote food and nutrition literacy, the present review protocol aims to critically examine the evidence in the area of school-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children.MethodsWe will search PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest (from inception onwards). Additional studies will be identified through manual searching of reference lists. Quantitative studies (e.g., randomized controlled trial, quasi-randomized trials, and cluster randomized trials) evaluating the effect of interventions to promote food and nutrition literacy in elementary school children (5-12 years old) will be included. Main outcomes will be food and nutrition literacy at functional, interactive, and critical levels. Secondary outcomes will be dietary intake indicators (e.g., healthy eating index, DDS) and health outcome measures (e.g., reduction in BMI and less weight gain). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. The quality of the included studies will separately evaluate using the validated Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project (EPHPP). Data will be extracted by two reviewers from the identified relevant literature. Standard data synthesis and analysis will be used for the review.DiscussionThis systematic review will summarize the evidence regarding the components, implementation methods, and effectiveness of the interventions of food and nutrition literacy promotion in elementary school children. The results of this review will provide a useful reference for policymakers and curriculum developers to assess education curricula and develop practical learning and teaching strategies to improve students' food and nutrition literacy.Systematic review registrationPROSPERO (CRD42019135118).

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

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

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