School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews
Open accessAbstract
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.
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The existing literature has not adequately explored the effectiveness of specific intervention strategies within each component of the HPS framework.
“The existing literature has not adequately explored the effectiveness of specific intervention strategies within each component of HPS.”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
The Discussion (§4.5, page unavailable) says variability among studies limits the ability to determine which approaches work within multistrategy interventions. The review does not specifically establish that strategies within each HPS component have been inadequately explored; it reports effectiveness findings for nutrition education and food-environment interventions (§3.4). (LLM, conf=0.83)
Experimental — accuracy not yet measuredFindings on the effectiveness of eating knowledge and behaviour outcomes were reported according to a framework previously employed in a Cochrane overview of reviews.
“We reported findings on the effectiveness of eating knowledge and behaviour outcomes according to a framework previously employed in a Cochrane overview of reviews framework [19, 27].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
The Data Synthesis section (2.6) says the review categorised findings for each dietary intake outcome using a framework previously applied in a Cochrane overview of reviews. But the Strengths and Limitations section (4.5) says reviews reporting only nutrition-related knowledge were excluded, so this source does not support the claim about eating knowledge outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDespite a plethora of school-based interventions, including many reviews, there is a lack of synthesised evidence on the diverse components and contents of these interventions and their impact on adolescents' eating behaviour.
“However, despite there being a plethora of school-based intervention, including many reviews, there is a lack of synthesised evidence on the diverse components and contents of these interventions and their impact on adolescents’ eating behaviour.”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
The Introduction (page unavailable) says that several reviews exist, but their mixed study designs and intervention types make it difficult to identify the most effective approach. That supports a gap in clear, intervention-specific evidence, not a general lack of synthesised evidence: this paper itself synthesises 13 reviews of children aged 6–18, rather than adolescents alone (Abstract, page unavailable). (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe combination of effective components within the collaborative individual- and system-level approach for adolescents aged 10 to 19 years involved shaping knowledge through educational instructions and experiments, creating associations with stimuli that cue healthy behaviours, and establishing antecedents to facilitate healthy food choices.
“However, our review found that the combination of effective components within the collaborative individual- and system-level approach for adolescents aged 10 to 19 years involved shaping knowledge through educational instructions and experiments, creating associations with stimuli that cue healthy behaviours, and establishing antecedents to facilitate healthy food choices [17, 19, 53, 54].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
The Results (§3.4) report some benefits from school-based nutrition education and changes to the school food environment, which broadly support combining individual- and system-level strategies. They do not identify educational experiments, behavioural cues, and antecedents as an effective combination. The Methods (§2.1) cover ages 6–18, not the claimed 10–19 range. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCombining system and individual-level interventions can create supportive environments that underpin and perpetuate changes in individual behaviour.
“Combining system and individual-level interventions can create supportive environments that underpin and perpetuate changes in individual behaviour [17, 19, 53, 54].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
The Introduction describes a whole-school approach combining curriculum, environment, and partnerships to support healthy choices. The Discussion (§4.1) reports that interventions using this framework likely improve combined fruit and vegetable intake. The paper does not establish that these environments perpetuate individual behaviour changes over time. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Although previous reviews have examined school-based nutrition interventions in children, most have focused on dietary intake, healthy eating behavior, or general nutrition outcomes rather than nutrition literacy as the primary target.
“Although previous reviews have examined school-based nutrition interventions in children, most have focused on dietary intake, healthy eating behavior, or general nutrition outcomes rather than nutrition literacy as the primary target.”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [39]
Results §3.2 reports that 10 of the 13 included reviews examined more than one dietary-intake outcome. But Discussion §4.5 says reviews reporting only nutrition-related knowledge were excluded. The paper therefore supports the dietary-intake focus of its included reviews, not the broader claim that most previous reviews did not make nutrition literacy their primary target. (LLM, conf=0.83)
Experimental — accuracy not yet measuredExisting reviews have provided limited detail on how these interventions were designed and delivered, including their strategies, activity components, curriculum content, and implementation methods.
“Existing reviews have also provided limited detail on how these interventions were designed and delivered, including their strategies, activity components, curriculum content, and implementation methods.”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [39]
Section 3.2 reports that only three reviews identified who delivered the interventions, and Section 2.6 says seven reviews did not classify or report results by a particular intervention type. These findings support limited detail about delivery and strategies, but the paper does not specifically establish that reviews lacked activity components, curriculum content, or implementation methods. (LLM, conf=0.79)
Experimental — accuracy not yet measuredThese findings are broadly consistent with earlier reviews of school-based nutrition interventions, which have generally shown clearer effects on knowledge and selected dietary outcomes than on BMI or other anthropometric measures.
“These findings are broadly consistent with earlier reviews of school-based nutrition interventions, which have generally shown clearer effects on knowledge and selected dietary outcomes than on BMI or other anthropometric measures [38, 39].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [39]
The Summary of Main Results (section 4.1; page not supplied) reports positive effects on some dietary intake outcomes. But the Study Inclusion and Exclusion section (2.1) excludes knowledge measures, and the review does not compare dietary effects with effects on BMI or other anthropometric measures. It therefore supports the selected-dietary-outcomes part, not the claimed pattern across all three outcome types. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrograms based mainly on information delivery were less likely to produce lasting behavioral change than those that also included skills practice, family involvement, or environmental support.
“For this reason, programs based mainly on information delivery were less likely to produce lasting behavioral change than those that also included skills practice, family involvement, or environmental support [22, 39, 65, 67].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [39]
The Results (§3.4, page unavailable) report benefits for some school food-environment interventions and mixed findings for educational and multistrategy interventions. The Discussion (§4.1, page unavailable) also reports benefits for nutrition education, so the review does not establish that information-focused programs are generally less effective. It does not compare lasting change between the stated program types or establish a benefit from skills practice or family involvement. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe umbrella review's omission of a synthesis of the interventions' specific components and their respective contents constitutes a notable evidence gap that merits further exploration.
“Moreover, the umbrella review’s omission of a synthesis of the interventions’ specific components and their respective contents constitutes a notable evidence gap that merits further exploration [19].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
One umbrella review assessed school-based healthy eating interventions focusing on behaviour changes in children aged 6 to 18 years, but did not present results separately for adolescents.
“One umbrella review assessed school-based healthy eating interventions focusing on behaviour changes in children aged 6 to 18 years, it did not present results separately for adolescents [19].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [19]
Previous reviews have mainly examined school-based nutrition programs in relation to dietary intake, healthy eating behavior, or general nutrition outcomes, rather than nutrition literacy as the main target.
“Previous reviews have mainly examined school-based nutrition programs in relation to dietary intake, healthy eating behavior, or general nutrition outcomes, rather than nutrition literacy as the main target [22, 39].”
From Effects of school-based nutrition literacy Intervention on obesity prevention in school-age students: a systematic review and meta-analysis (2026) · cites this paper as [39]
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Cites
The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n71 · Cited by 108,283 · see citing works
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
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“Author Year Quality Assessment Tool Primary Study QualityAssessment Synthesis Method for Dietary Intake Outcomes Summary of Findings School-based nutrition interventions based on the HPS framework ** Langford 2014 [22,49] GRADE Nutrition outcomes = low quality MA Nutrition only • FV = SMD 0.15 95%: CI 0.02 to 0.29, I2…”
MethodInfluentialShea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., et al. (2017) · BMJ · doi:10.1136/bmj.j4008 · Cited by 10,636 · see citing works
GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)
Guyatt, G. H., Oxman, A. D., Vist, G., Kunz, R., Brozek, J., Alonso-Coello, P., Montori, V., Akl, E. A., Djulbegovic, B., & Falck-Ytter, Y. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.017 · Cited by 2,798 · see citing works
Langford, R., Bonell, C. P., Jones, H. E., Pouliou, T., Murphy, S. M., Waters, E., Komro, K. A., Gibbs, L. F., Magnus, D., & Campbell, R. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008958.pub2 · Cited by 768 · see citing works
Langford, R., Bonell, C., Jones, H., Pouliou, T., Murphy, S., Waters, E., Komro, K., Gibbs, L., Magnus, D., & Campbell, R. (2015) · BMC Public Health · doi:10.1186/s12889-015-1360-y · Cited by 578 · cited 3× · see citing works
“Langford 2014 [22,49] Country: Any Age: 4 to 18 Setting: School, college Design: CRCTs Intervention: School interventions based on the HPS framework, with active components in school education, environment, and partnerships for improving health and wellbeing (range: 5 months to 3 years) Comparator: No intervention, us…”
BackgroundMethodBonell, C., Jamal, F., Harden, A., Wells, H., Parry, W., Fletcher, A., Petticrew, M., Thomas, J., Whitehead, M., Campbell, R., et al. (2013) · Public Health Research · doi:10.3310/phr01010 · Cited by 192 · see citing works
Assisted reproductive technology: an overview of Cochrane Reviews
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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
“One umbrella review assessed school-based healthy eating interventions focusing on behaviour changes in children aged 6 to 18 years, it did not present results separately for adolescents [19].”
BackgroundMethodInfluentialPosri, S., Powwattana, A., Lagampan, S., Chongsuwat, R., Boonmanunt, S. W., & Wongkampun, S. (2026) · BMC Public Health · doi:10.1186/s12889-026-27909-w
“These findings are broadly consistent with earlier reviews of school-based nutrition interventions, which have generally shown clearer effects on knowledge and selected dietary outcomes than on BMI or other anthropometric measures [38, 39].”
- Authors
- O’Brien, K. M., Barnes, C., Yoong, S., Campbell, E., Wyse, R., Delaney, T., Brown, A., Stacey, F., Davies, L., Lorien, S., & Hodder, R. K.
- Affiliations
- Hunter Medical Research Institute (AU)
- Hunter New England Local Health District (AU)
- Corresponding author
- O’Brien, Kate M.
- ORCID
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2021-11-17
- Volume
- 13
- Issue
- 11
- Pages
- 4113
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC8618558
- OpenAlex
- W3213455183
- Cited by
- 100
- References
- 10
- Citations by year
- 2026: 22 · 2025: 27 · 2024: 30 · 2023: 15 · 2022: 6
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- National Health and Medical Research Council (APP1153479)
- RKH NHMRC Early Career Fellowship (APP1160419)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- school-based nutrition intervention, children and adolescents, dietary intake, nutrition education, food environment, digital health interventions, fruit and vegetable intake, dietary fat intake, healthy eating
- MeSH terms
- Systematic Reviews as Topic, Adolescent, Adolescent Behavior, Child, Child Behavior, Diet, Eating, Environment, Feeding Behavior, Health Education, Health Promotion, Humans, School Health Services, Health Behavior, Telemedicine
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