Enhancing nutritional environments through access to fruit and vegetables in schools and homes among children and youth: a systematic review

Abstract

BackgroundLow fruit and vegetable (FV) consumption is one of the top 10 global risk factors for mortality, and is related to increased risk for cancer, cardiovascular disease and diabetes. Many environmental, sociodemographic and personal factors affect FV consumption. The purpose of this review is to examine the effects of interventions delivered in the home, school and other nutritional environments designed to increase FV availability for five to 18-year olds.MethodsThe search included: 19 electronic bibliographic databases; grey literature databases; reference lists of key articles; targeted Internet searching of key organization websites; hand searching of key journals and conference proceedings; and consultation with experts for additional references. Articles were included if: in English, French and Spanish; from high-, middle-, and low-income countries; delivered to anyone who could bring about change in FV environment for 5 to 18 year olds; with randomized and non-randomized study designs that provided before-after comparisons, with or without a control group. Primary outcomes of interest were measures of FV availability.ResultsThe search strategy retrieved nearly 23,000 citations and resulted in 23 unique studies. Interventions were primarily policy interventions at the regional or state level, a number of curriculum type interventions in schools and community groups and a garden intervention. The majority of studies were done in high-income countries.The diversity of interventions, populations, outcomes and outcome measurements precluded meta-analysis. The most promising strategies for improving the FV environment for children are through local school food service policies. Access to FV was successfully improved in four of the six studies that evaluated school-based policies, with the other two studies finding no effect. Broader state or federally mandated policies or educational programs for food service providers and decision makers had mixed or small impact. Similarly family interventions had no or small impact on home accessibility, with smaller impact on consumption.ConclusionsThe studies have high risk of bias but more rigorous studies are difficult to impossible to conduct in naturalistic settings and in policy implementation and evaluation. However, there are promising strategies to improve the FV environment, particularly through school food service policies.

Can targeted policies reduce obesity and improve obesity‐related behaviours in socioeconomically disadvantaged populations? A systematic review

“…Policies enacted at organizational and government levels, nearly all of which were implemented within schools, appeared similarly effective amongst disadvantaged children. Other reviews have also found a majority of child-related interventions to be conducted in schools (54,59), with one finding local school food service policies to be more effective in enhancing food environments compared with broader state/federally mandated policies targeting a wider variety of settings (54). It is clear from our results that schools can provide a supportive context for focused intervention in support of relatively highquality controlled studies.…”

“…Many reviews have examined the impact of school‐based interventions on obesity‐related outcomes in children . The current study is the first, to our knowledge, to examine the impact of school‐based policies targeting disadvantaged children.…”

Review of Hypertension in sub-Saharan Africa

“…High-income earning countries have achieved reduction in hypertension through the implementation of robust public health policies aimed at reducing salt in processed food, improving the availability and affordability of fruits and vegetables (38), and creating environments that promote physical activity. In low-and middle income countries however, shortcomings in these public health policies and others have facilitated increasing trends of hypertension (3).…”

Impact of permagarden intervention on improving fruit and vegetable intake among vulnerable groups. A quasi-experimental study conducted in seven cities of Ethiopia

“…FV from home gardens have been documented as an important supplemental sources of nutrients, contribute to food and nutritional security, and allow families to produce their own fruits and vegetables organically (13,15,16). Vegetable gardens introduce more variety into the diets of children (17). Consequently, the intake of various nutrients such as vitamin A and calcium is increased with gardening (14).…”