Effect of Food Environment Interventions on Anthropometric Outcomes in School-Aged Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract

<jats:title>ABSTRACT</jats:title> <jats:p>Food environments may promote access to unhealthy foods, contributing to noncommunicable diseases in low- and middle- income countries (LMICs). This review assessed published evidence on the effects of food environment interventions on anthropometric (BMI and weight status) outcomes in school-aged children (5–9 y) and adolescents (10–19 y) (SACA) in LMICs. We summarized randomized controlled trials (RCTs) and quasi-experimental studies (QES) published since 2000 to August 2019 in the peer-reviewed and gray literature that assessed the effects of food-related behavioral and environmental interventions on diet-related health outcomes in SACA in LMICs. Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched using appropriate keywords, Medical Subject Headings, and free text terms. Eleven RCTs and 6 QES met the inclusion criteria, testing multicomponent behavioral and environmental interventions in schools. Analysis of 6 RCTs (n = 17,054) suggested an overall effect on change in BMI [mean difference (MD): −0.11, 95% CI: −0.19 , −0.03], whereas there was no observed effect in 5 studies using endline BMI (n = 17,371) (MD: 0.05, 95% CI: −0.32, 0.21). There was no significant pooled effect among the 3 QES (n = 5,023) that reported differences in change in BMI or endline (MD: −0.37, 95% CI: −0.95, 0.22). There is limited evidence to support the modification of diet-related health outcomes through school-based food environment interventions in SACA in LMICs. Further studies are needed to understand the impact of school and community-based food environment interventions on nutritional status in this population.</jats:p>

The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review

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Long-Term Dietary and Physical Activity Interventions in the School Setting and Their Effects on BMI in Children Aged 6–12 Years: Meta-Analysis of Randomized Controlled Clinical Trials

“…When interpreting the results of studies that evaluate interventions on physical activity and dietary habits, one of the main problems we face is the lack of control over what children do beyond the school setting [ 44 ]. The effort made in the school environment may be adversely affected by the influence of the social environment, consumerism, and the media so that the effort undertaken in the school setting becomes diluted [ 45 ].…”

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