Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

Abstract

Objective: Fruit and vegetables (FVs) distribution interventions have been implemented as a public health strategy to increase children’s intake of FVs at school settings. The purpose of this review was to examine whether snack-based FVs distribution interventions can improve school-aged children’s consumption of FVs. Design: Systematic Review and meta-analysis of articles published in English, in a peer-review journals were identified by searching six databases up to August 2020. Standardized Mean Differences (SMDs) and 95% Confidence Interval (CI) were calculated using a random effects model. Heterogeneity was quantified using I2 statistics. Setting: Population-based studies of interventions where the main focus was the effectiveness of distributed FVs as snacks to schoolchildren in North America, Europe and Pacific were included. Results: Forty-seven studies, reporting on 15 different interventions, were identified; 10 studies were included in the meta-analysis. All interventions were effective in increasing children’s consumption of FVs, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children’s consumption of FVs, particularly for multi-component interventions at post-intervention (SMD 0.20, CI 0.13, 0.27) and free distribution interventions at follow-up (SMD 0.19, CI 0.12, 0.27). Conclusions: Findings suggest that utilizing FV distribution interventions provide a promising avenue by which children’s consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration, and follow-up evaluation are needed to improve comparability across studies.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study

“…School food programs can include breakfast, lunch, and snacks, with or without integration into the curricula, and can contribute to child, family, and community health and well-being [ 16 ]. School food programs that are available to all children, regardless of a family’s ability to pay, can support the development of healthy eating patterns across groups of varying socioeconomic status (SES) [ 16 , 17 ].…”

“…The 160 members of the Canadian Coalition for Healthy School Food (CHSF), the largest Canadian organization advocating for school food programs, advocates for a universal school food program that is key to positively evaluated programs [ 17 ]. Universality means that all children have access to a school lunch program, and in the case of the intervention discussed here, at no cost, regardless of income.…”

Mapping of Outdoor Food and Beverage Advertising around Spanish Schools

“…Given the effect of marketing on children, we believe that it is reasonable to think that fruit advertisements near schools may promote intake. The benefits are evident, which have been resulted in school interventions to promote fruit intake [ 36 ].…”

Association between Adequate Fruit and Vegetable Intake and CVDs-Associated Risk Factors among the Malaysian Adults: Findings from a Nationally Representative Cross-Sectional Study

“…This could be also the underlying reason for the observed low prevalence of adequate fruit and vegetable intake among the respondents in this study and is pending further investigation. On the other hand, the inadequate daily intake of fruit and vegetables was shown to be due to poor dietary practices usually established in childhood and that tended to carry into later adulthood [ 33 , 35 ], which suggested childhood was an opportune time for health-promoting interventions that incorporate the role of parents/caregivers as positive role models to instill good dietary practices among children [ 35 , 36 , 37 ].…”