School‐based health and nutrition interventions addressing double burden of malnutrition and educational outcomes of adolescents in low‐ and middle‐income countries: A systematic review
Open accessAbstract
School system is a promising platform for addressing all forms of malnutrition in adolescents. However, little is known about the impact of integrated school health and nutrition programmes on adolescent nutrition and educational outcomes in low‐ and middle‐income countries (LMICs). This systematic review sought to characterize school‐based health and nutrition interventions among adolescents in LMICs and analyze their effects on nutritional status and educational outcomes. Four databases were searched for studies evaluating school‐based health and nutrition interventions for adolescents in LMICs, reporting changes in either nutritional status or educational outcomes. A narrative synthesis was used to analyze and describe the evidence. Our review included 68 articles evaluating 58 interventions, of which a third had moderate to strong methodological quality. Forty‐two studies evaluated single‐domain interventions, while 26 evaluated multi‐component interventions. A third of all interventions were based on a theoretical framework. Three‐fourths of the interventions were shorter than 11 months, which may make identifying their effect difficult. The results of the effectiveness of these interventions were mixed and inconsistent across intervention types. Sixteen out of 21 studies evaluating multi‐component interventions and 12 out of 23 studies evaluating nutrition education reported improving nutritional or diet‐related outcomes. One out of six studies reported positive effects on educational outcomes. Our review has identified that research needs include: a greater inclusion of theory‐based approaches to guide the implementation of interventions; more studies of integrated interventions that involve parents and the wider community in LMICs; and extension of outcomes beyond nutritional status to include educational outcomes.
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These reviews mostly included studies based in HICs; eight reviews among these 14 included primary studies based in five LMICs.
“These reviews mostly included studies based in HICs. Eight reviews among these 14 included primary studies based in five LMICs [30, 35–38, 42, 43, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
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Experimental — accuracy not yet measuredAll the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs.
“All the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs [30, 35–38, 42, 43, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (‘Description of studies’; page not provided) say this review excluded studies from high-income countries, contrary to the claim that all the cited reviews included them. The Results (‘Study design, setting and population’; page not provided) report 58 intervention evaluations in 20 countries, not a few studies in five LMICs. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe intervention duration ranged from two to 10 weeks and the timing of follow-up assessments ranged from immediately after intervention to three years after the intervention.
“The intervention duration, ranged from two to 10 weeks [30, 38] and the timing of follow up assessments ranged from immediately after intervention to three years after the intervention [30, 38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Intervention characteristics; page unavailable) report durations from one week to three years, not two to 10 weeks. The Results (Description of studies; page unavailable) also list follow-up at 54 months after intervention, beyond the claimed three-year limit. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThese reviews mainly focused on interventions in HICs, with only 11 primary studies from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia).
“These reviews mainly focused on interventions in HICs - only 11 primary studies were from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia) [30, 35–38, 42, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Description of studies; Study design, setting and population; page unavailable) say this review excluded high-income-country studies and included 58 interventions across 20 countries. It therefore does not support describing this review as mainly focused on HICs or as containing only 11 LMIC primary studies. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe intervention duration ranged from 15 min to 10 years, and follow-up assessments ranged from immediately to four years after the intervention.
“The intervention duration ranged from 15 min to 10 years [30, 36–38, 42, 45] and time of the follow up assessments ranged from immediately to four years after the intervention [30, 32, 36, 37, 42].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Intervention characteristics; page unavailable) report intervention durations from one week to three years, not 15 minutes to 10 years. The Results (Description of studies; page unavailable) list a follow-up at 54 months after intervention—four and a half years—rather than a maximum of four years. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
Primary outcomes for these reviews were healthy eating knowledge and behaviour such as consumption of FV, dairy, meat and fibre, tendency to skip meals and intake of processed snacks and SSBs.
“Primary outcomes for these reviews were healthy eating knowledge and behaviour such as consumption of FV, dairy, meat and fibre, tendency to skip meals and intake of processed snacks and SSBs [26, 30, 38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Main findings of interventions; page unavailable) report nutritional knowledge, fruit and vegetable intake, breakfast intake, soft-drink consumption, and fried-food consumption as outcomes. The review does not establish dairy, meat, or fibre intake as outcomes in the cited passages, and it also assesses anthropometric and educational outcomes; the claim's description of these diet measures as the reviews' primary outcomes is therefore too broad for this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSeven high-quality and one moderate-quality reviews (including 192 unique studies) reported promising effects of multi-component interventions on healthy eating behaviour.
“There were promising effects of multi-component interventions on healthy eating behaviour reported in seven high-quality [30, 32, 35–38, 45] and one moderate-quality reviews [42] (including 192 unique studies) [30, 32, 35–38, 42, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Main findings of interventions; page unavailable) report improvement in at least one nutrition- or diet-related outcome in 16 of 21 studies of integrated multi-component interventions, supporting the general point about promising effects. But this paper reviews intervention studies, not seven high-quality and one moderate-quality reviews, and it does not report 192 unique studies; its Discussion (Synthesis of findings; page unavailable) says it included 68 articles describing 58 interventions. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe healthy eating education components at the individual level included lectures, quizzes and games, media shows, plays, electronic messages, rewards, peer-leading activities and training for teachers.
“The healthy eating education components at the individual level, included lectures [30, 32, 36, 38, 42, 45], quizzes and games [30, 36, 38], media shows [37], plays, electronic messages, rewards, peer-leading activities and training for teachers [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results, Intervention characteristics section (page unavailable) lists lectures, quizzes, games, role-plays, puppet shows, movies and peer-led education. The Description of studies section (page unavailable) also describes text messages for adolescents and a teacher workshop. Our copy does not identify rewards as a healthy-eating education component; its monetary incentives relate to a separate nutrition-subsidy intervention. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe school environment change components at the system level involved FV gardening, school food marketing, canteen modifications, vending machine modifications, postering, workshops with kitchen staff, and loyalty programs.
“The school environment change components at the system level, involved FV gardening [32, 36], school food marketing [38, 45], canteen modifications [30, 36], vending machine modifications [35], postering [45], workshops with kitchen staff [36], and loyalty programs [32].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results sections on intervention characteristics and study descriptions report school gardens, promotion of healthier foods, changes to school shops and menus, posters, and training with school employees. They do not describe vending-machine modifications or loyalty programs; the reported staff training also does not specifically identify kitchen staff. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe primary outcomes for the reviews reporting promising effects were intake of FV, processed snacks, SSB, fat, protein, fibre and vitamins, frequency of regular meals, recommended calorie intake, healthy eating knowledge, and staying in school for having healthy lunch.
“The primary outcomes for these reviews were intake of FV [30, 32, 36–38, 42, 45], processed snacks [30, 36–38, 45], SSB [30, 35, 37], fat [37, 42], protein, fibre and vitamins [37], frequency of regular meals [30, 37, 38], recommended calorie intake [37, 42], healthy eating knowledge [30, 36], and staying in school for having healthy lunch [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Main findings of interventions; page unavailable) report fruit and vegetable intake, soft-drink consumption, fried-food intake, and nutritional knowledge as outcomes, supporting part of the list. The review does not identify staying in school to have a healthy lunch as an outcome; its Discussion (Synthesis of findings; page unavailable) instead reports a finding from another review about school feeding and days spent in school. The claimed full set of primary outcomes is therefore not supported by this source. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe contents of healthy eating education components involved lessons on healthy eating, food labelling, healthy cooking, consequences of SSB intake, nutrition, food safety farmers' visits on healthy food cultivation, menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting.
“The contents involved lessons on healthy eating [32, 37, 38, 42, 45], food labelling, healthy cooking [30, 36], consequences of SSB intake [35], nutrition, food safety farmers’ visits on healthy food cultivation [36], menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results, under Intervention characteristics (page not provided), describe nutrition lessons, goal setting, food diaries and monitoring progress, food-label reading, recipe demonstrations, and food tasting. These support several components attributed to this review, but the passages do not establish menu planning or using healthy food as rewards. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe contents of school environment change components involved increased availability of milk and protein and fresh fruits, free or subsidised FV, replacing SSB with healthier alternatives in vending machines, chef and staff consultations on healthy culinary lessons, and healthy eating posters around school.
“The contents involved increased availability of milk and protein [32, 35–38, 45] and fresh fruits [30], free or subsidised FV [35], replacing SSB with healthier alternatives (milk, water, juice) in vending machines [35], chef, staff consultations on healthy culinary lessons [36], and healthy eating posters around school [45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Description of studies; page not provided) describe weekly fruit distribution, posters, staff training, milk at breakfast, and the sale of fruits, vegetables and water at school. The review does not describe increased protein availability, free or subsidised fruit and vegetables, replacing vending-machine drinks, or chef consultations on culinary lessons. Its support for the listed components is therefore partial. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe family involvement components at the system level included communicating with families via newsletters, leaflets, emails, booklets, brochures and texts, organising parents' meetings, in-school learning sessions, food coupons and social support groups, and providing parents recipe guides.
“The family involvement components at the system level included communicating with families via newsletters [30, 32, 35, 37, 38], leaflets [30, 45], emails [35, 37], booklets [30], brochures [30] and texts [37], organising parents’ meetings [35, 45], in-school learning sessions, food coupons [37] and social support groups [35], and providing parents recipe guides [30].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (‘Intervention characteristics’; page not provided) describe engaging parents through educational materials and distributing booklets, brochures and recipe guides. The ‘Description of studies’ reports newsletters, but does not establish that they were sent to families; the passages found do not mention leaflets. The other listed components are cited to different sources in the citing sentence, so they are not judged against this paper. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe contents of family involvement components involved information on healthy eating knowledge, healthy cooking, feeding healthy foods to children at home, nutritional guidelines, coupons to purchase healthy foods, offering FV and free healthy foods.
“The contents involved information on healthy eating knowledge [30, 32, 35, 38, 42, 45], healthy cooking, feeding healthy foods to children at home [37], nutritional guidelines [38], coupons to purchase healthy foods [37], offering FV and free healthy foods [45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
The Results (Intervention characteristics; page unavailable) describe nutrition education about healthy diets and report that parents received educational materials, supporting the healthy-eating-information part attributed to this source. The review mentions dietary guidelines in a study description but does not say nutritional guidelines were provided to families. The cooking, coupons, and free-food items are attached to other citations in the printed sentence. (LLM, conf=0.83)
Experimental — accuracy not yet measuredFifteen of the reviews used narrative synthesis and two included both meta-analysis and narrative synthesis.
“Fifteen of the reviews used narrative synthesis [29–43] and two included both meta-analysis and narrative synthesis [44, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
According to the JBI critical appraisal tool, 14 reviews scored high, two reviews scored moderate, and only one review scored low in terms of methodological quality.
“According to the JBI critical appraisal tool, 14 reviews scored high [30–32, 34–41, 43–45], two reviews scored moderate [33, 42], and only one review scored low [29] in terms of methodological quality (Table 2).”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
Majority of the reviews (n = 14) evaluated multi-component interventions while three reviews evaluated only health education interventions.
“Majority of the reviews (n = 14) evaluated multi-component interventions [30–32, 34–40, 42–45] while three reviews evaluated only health education interventions [29, 33, 41].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
Two reviews used the food frequency questionnaire (FFQ) to measure outcomes and the third review did not report such tools.
“Two reviews [26, 38] used the food frequency questionnaire (FFQ) to measure outcomes and the third review did not report such tools [30].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [30]
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Cited by
Sorted by citations
School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review
Samad, N., Bearne, L., Noor, F. M., Akter, F., & Parmar, D. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01668-6 · Cited by 41 · see citing works
“Majority of the reviews ( n = 14) evaluated multi-component interventions [30–32, 34–40, 42–45] while three reviews evaluated only health education interventions [29, 33, 41].”
BackgroundMethodInfluential
- Authors
- Shinde, S., Wang, D., Moulton, G. E., & Fawzi, W. W.
- Affiliations
- Harvard University (US)
- Corresponding author
- Shinde, Sachin
- Fawzi, Wafaie W.
- Venue
- Maternal & Child Nutrition
- Publisher
- Wiley
- Published
- 2023-03-30
- Volume
- 21
- Issue
- S1
- Pages
- e13437-e13437
- ISSN
- 1740-8695 (ISSN-L)
- 1740-8709
- PMC
- PMC12208896
- OpenAlex
- W4361272329
- Cited by
- 34
- References
- 10
- Citations by year
- 2026: 14 · 2025: 12 · 2024: 8
- FWCI
- 1.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Maternal and Child Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- UNICEF
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- school-based intervention, adolescent nutrition, double burden of malnutrition, educational outcomes, school health programmes, nutrition education, multicomponent intervention, nutritional status, low- and middle-income countries, theory-based intervention, parent and community involvement
- MeSH terms
- Adolescent, Developing Countries, Educational Status, Female, Health Education, Humans, Nutritional Status, School Health Services, Schools, Malnutrition
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