Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
Population Health Research Institute, St George's, University of London, London, UK.
Int J Behav Nutr Phys Act. 2024 Oct 14;21(1):117. doi: 10.1186/s12966-024-01668-6.
The benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear.
This umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10-19 years old).
Using Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation's Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement.
Seventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents' knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap.
School-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries.
健康饮食的益处众所周知，但青少年的饮食往往不佳。基于学校的干预措施为促进健康饮食提供了一个有希望的选择，然而，证据并不明确。
本伞式综述综合了目前关于促进青少年（10-19 岁）健康饮食的基于学校的干预措施的证据。
使用 Joanna Briggs 研究所（JBI）伞式综述指南，对 11 个电子数据库（PubMed、CINHAL、EMBASE、Science Direct、PsycINFO、MEDLINE、Scopus、ERIC、Web of Science、Cochrane 系统评价登记册和 JBI 证据综合）进行了系统检索，以确定 2000 年 1 月至 2023 年 12 月期间发表的综述。使用 JBI 批判性评价工具评估方法学质量。根据世界卫生组织健康促进学校（HPS）框架对综述进行叙述性综合，该框架将基于学校的干预措施分为三个组成部分，即健康教育、学校环境变化以及家庭和社区参与。
确定了 17 篇综述（包括 347 项独特的初级研究），这些综述发表于 2008 年至 2023 年期间。87%的综述基于高收入国家的干预措施，限制了其在低收入和中等收入国家的适用性。14 篇综述被评为高质量，2 篇为中等质量，1 篇为低质量。71%的综述（n=14 篇，13 篇为高质量）的证据表明，多组分干预措施（即纳入 HPS 框架两个以上组成部分的干预措施）提高了青少年对健康饮食的知识和行为。在个体层面上，基于技术的健康饮食课程有效地改善了青少年的饮食习惯。当这些基于个体层面的干预措施得到系统层面的改变支持时，如改变学校环境，包括增加健康食品的供应，并让家长参与进来，以促进青少年健康饮食，这些干预措施就会变得更加有效和可持续。然而，只有三篇综述提供的有限证据表明，基于技术的干预措施的可行性存在差异，而多组分干预措施的可行性较低。另一个关键证据差距是缺乏关于利益相关者参与干预设计的信息。
基于学校的多组分健康饮食干预措施，将个体层面的干预措施与系统层面的改变相结合，可有效促进青少年的健康饮食行为。未来的综述应评估参与式方法在干预设计、可行性和扩大规模研究中的有效性，并分析来自低收入和中等收入国家的证据。
