Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis
Open accessAbstract
The school is a favorable environment for the development of interventions to prevent obesity. The objective of this systematic review is to evaluate the effects of school-based food and nutrition education interventions on adolescent food consumption. The literature search was conducted on databases: MEDLINE/PubMed, Embase, Scopus, ERIC, Science Direct, Web of Science, Cochrane, LILACS, and ADOLEC. The following research strategies were focused on: population (adolescents), intervention (food and nutrition education), outcome (food consumption), and study design (clinical trial). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines were followed and all stages of this review were performed by two researchers and, when necessary, a third researcher resolved discrepancies. Included studies are randomized clinical trials (RCT). A total of 24 articles were included for review and 11 articles in meta-analysis. In the evaluation of the general effects, there was a significant effect (mean difference (MD) for fruit consumption (MD = 0.09, CI 0.05, 0.14) in serving/day; and for vegetables (MD = 0.59, IC 0.15, 1.03) at times/week. In the consumption of FV (fruits and vegetables), there was no significant effect (standardized mean difference (SMD) of interventions in their consumption (SMD = 0.00, 95% C1 −0.11, 0.11). The evidence available in this review and meta-analysis concludes that food and nutrition education interventions in schools presented favorable results in the food consumption of adolescents. Registered on the PROSPERO database (CRD42019116520).
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All 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 [45]
Section 3.3 (Study Characteristics; page unavailable) lists trials in the USA and European countries alongside trials in Iran, Brazil, Ecuador and China, supporting that this review includes studies from both higher- and lower-income settings. The paper does not establish the citing sentence’s aggregate count of eight reviews or five LMICs across those reviews. (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 [45]
Section 3.4 (page unavailable) identifies school-environment changes including meals, educational posters, and offering fruits and vegetables. Section 3.5 describes greater availability of fruits and vegetables and posters near vending machines. Our copy does not substantiate the more specific claims about milk and protein, free or subsidised produce, replacing vending-machine drinks, or chef and staff consultations. (LLM, conf=0.86)
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 [45]
The Discussion reports teacher training or support in reviewed interventions, including study [38], and the Results describe peer leaders, a board game, and prize raffles. But the copy does not substantiate the cited list of plays, electronic messages, lectures, quizzes, or media shows; it also treats teacher development as a separate component rather than an individual-level activity. Page numbers were not provided in the indexed passages. (LLM, conf=0.83)
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 [45]
Section 3.5 (page unavailable) describes food tasting, hands-on fruit-and-vegetable snack preparation, and planning when and where to eat fruit and vegetables. It does not establish the full list attributed to this source, particularly menu planning, self-monitoring, or healthy food given as rewards; its prize raffles rewarded students for choosing produce. (LLM, conf=0.84)
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 [45]
The Discussion reports favorable food-consumption results for adolescents receiving multicomponent interventions, so this paper supports its inclusion as a review reporting promising effects. It includes 24 studies, however, and does not establish the citing sentence’s quality rating or its aggregate count of 192 unique studies across eight reviews. (LLM, conf=0.84)
Experimental — accuracy not yet measured
These 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 [45]
The Introduction says an earlier adolescent nutrition review included randomized studies from developed countries, and Results §3.3 lists many studies from those countries. But this paper does not substantiate the cited sentence’s total of 11 LMIC studies or its list of Ethiopia, India, Iran, Kenya, and Tunisia; its own country list includes Iran alongside Brazil, Ecuador, China, and Trinidad Tobago. No page numbers are available in our copy. (LLM, conf=0.88)
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 [45]
The Results (§3.4–3.5; page unavailable) describe school-environment changes involving fruit and vegetable availability, lunch and à la carte offerings, and posters near vending machines. They do not substantiate the full list: gardening, kitchen-staff workshops, loyalty programs, and modifications to vending machines are not described in the matching passages. (LLM, conf=0.84)
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 [45]
Section 3.5 (page not provided) reports fruit and vegetable consumption as a major outcome and also discusses cookies, soft drinks, and breakfast, which overlap with several listed outcomes. The passages do not establish protein, fibre, vitamin, fat, or recommended-calorie intake as outcomes of this review. Section 3.6 also reports no significant overall effect on combined fruit-and-vegetable consumption, so describing that result as promising needs qualification. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe outcomes in the studies were measured by FFQ, 24 h dietary recalls, food diary, KAP survey, cognitive and attitudinal assessments, FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale, and 7-day recall, or 5-day food recall.
“The outcomes were measured by FFQ [32, 35–38, 42, 45], 24 h dietary recalls [32, 35–38, 45], food diary [38, 42], knowledge attitude practice (KAP) survey [32, 45], cognitive and attitudinal assessments [38], FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale [38], and 7-day recall [45], or 5-day food recall [42].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [45]
Section 3.5 (Food Consumption; page unavailable) says the reviewed studies used food-frequency questionnaires and 24-hour recalls to assess food consumption. It does not substantiate the other listed instruments or measures, including food diaries, KAP surveys, cognitive and attitudinal assessments, snack scales, and 5- or 7-day recalls. (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 [45]
The Results section (3.4; page unavailable) describes sending messages and leaflets to parents and holding school events with family participation. It does not specify newsletters, booklets, brochures or recipe guides, which the citing sentence also attributes to this source. (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 [45]
The Intervention Characteristics section (3.4) reports family components involving messages and leaflets to parents, family participation at school, and offering fruits and vegetables. It does not specify that these components provided nutritional guidelines or healthy-eating knowledge—the details to which this source's citation is attached. The cooking, coupons, and free-food details are attached to other citations in the citing sentence. (LLM, conf=0.79)
Experimental — accuracy not yet measuredThese 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 [45]
The 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 [45]
The Results (§3.5) describe 15–30-minute game sessions held weekly for 24 weeks, not an intervention lasting just 15 minutes. The Discussion (§4) groups interventions as shorter or longer than one year, and the Methods (§2.5) mention the first post-intervention assessment. Our copy does not establish a 10-year intervention or follow-up extending from immediately after intervention to four years. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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- Authors
- Medeiros, G. C. B. S. D., Azevedo, K. P. M. D., Garcia, D., Oliveira Segundo, V. H., Mata, Á. N. D. S., Fernandes, A. K. P., Santos, R. P. D., Trindade, D. D. B. D. B., Moreno, I. M., Guillén Martínez, D., & Piuvezam, G.
- Affiliations
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (BR)
- Universidade Federal do Rio Grande do Norte (BR)
- Department of Physiotherapy, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, Brazil
- Universidad Católica de Murcia (ES)
- Department of Nursing, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
- Corresponding author
- Medeiros, Gidyenne Christine Bandeira Silva de
- ORCID
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2022-08-24
- Volume
- 19
- Issue
- 17
- Pages
- 10522
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC9518323
- OpenAlex
- W4292998376
- Cited by
- 94
- References
- 44
- Citations by year
- 2026: 24 · 2025: 29 · 2024: 27 · 2023: 12 · 2022: 2
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, cc-by)
- RIUCAM (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES) (001)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- school-based intervention, food and nutrition education, fruit consumption, vegetable consumption, obesity prevention, school nutrition programs
- MeSH terms
- Adolescent, Educational Status, Fruit, Health Education, Humans, Schools, Vegetables
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