Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial

Abstract

Background Previous studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up. Methods The study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data. Results At baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33). Conclusion No evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting. Trial registration ISRCTN, ISRCTN43284296. Registered 28 April 2017 - retrospectively registered.

Improving Obesogenic Dietary Behaviors among Adolescents: A Systematic Review of Randomized Controlled Trials

“…Most of the studies were conducted in North America, [ 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], with the United States as the most frequent country. Few studies were conducted in Asian [ 25 , 26 , 27 , 28 , 29 , 30 ], Oceanic [ 31 , 32 , 33 , 34 , 35 ], South American [ 36 , 37 , 38 ], or European [ 39 , 40 , 41 , 42 , 43 ] countries. The main intervention settings were school [ 12 , 13 , 14 , 17 , 18 , 20 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 34 , 35 ,…”

“…Few studies were conducted in Asian [ 25 , 26 , 27 , 28 , 29 , 30 ], Oceanic [ 31 , 32 , 33 , 34 , 35 ], South American [ 36 , 37 , 38 ], or European [ 39 , 40 , 41 , 42 , 43 ] countries. The main intervention settings were school [ 12 , 13 , 14 , 17 , 18 , 20 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 41 , 42 , 43 ], clinical [ 5 , 10 , 11 , 24 , 30 , 40 ], home [ 9 , 21 , 22 , 23 , 33 , 36 ], and online […”

“…All the studies included in the systematic review were RCTs, and the number of participants from each study varied widely from 31 [ 42 ] to 3110 [ 39 ]. The focus age range was also wide, including children from as early as 5 [ 33 ] to 20 [ 42 ] years old, but all studies included the adolescent age range. Of the 36 included studies, two main intervention approaches were identified: nutrition education interventions and multicomponent interventions.…”

“…The nutrition education intervention approach was defined as the delivery of health programs that included education on nutrition or dieting [ 5 , 11 , 12 , 15 , 16 , 17 , 18 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 37 , 38 , 41 ]. Multicomponent interventions included not only a nutrition education component, but also an additional component such as physical activity [ 9 , 10 , 13 , 14 , 19 , 20 , 24 , 31 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 43 ] or overall wellbeing, stress reduction, and social relationships [ 10 , 42 ]. Over half of the interventions were also multilevel in nature, meaning that multiple levels of the socioecological model, e.g., families or peers, school environments, and home environments, were engaged or manipulated through intervention activities [ 9 , 13 , 14 , 17 , 18 , 21 , 22 , 23 , 24 , …”

“…Multicomponent interventions included not only a nutrition education component, but also an additional component such as physical activity [ 9 , 10 , 13 , 14 , 19 , 20 , 24 , 31 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 43 ] or overall wellbeing, stress reduction, and social relationships [ 10 , 42 ]. Over half of the interventions were also multilevel in nature, meaning that multiple levels of the socioecological model, e.g., families or peers, school environments, and home environments, were engaged or manipulated through intervention activities [ 9 , 13 , 14 , 17 , 18 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 31 , 34 , 35 , 36 , 37 , 38 , 42 , 43 ]. The duration of the included studies ranged from 5 weeks [ 17 , 18 ] to 28 months [ 38 ].…”