Abbreviations: BMI, body mass index; CG, control group; CMH, Color Me Healthy; FV, fruit and vegetable; IG, intervention group; NE, nutrition education; PA, physical activity; RCT, randomized controlled trial; SCT, Social Cognitive Theory; SLT, Social Learning Theory; tbsp, tablespoon; tsp, teaspoon. Unlike nutrition education, nutrition counselling is a two-way process during which the mother is actively involved . The objective is to enable academics to develop and apply strategies, techniques and teaching methods in nutrition education programs in a qualified manner. As a result, there was a significant increase between baseline and the 3-month follow-up in the consumption of fruit snacks (by approximately 20.8%; P<0.001) and vegetables snacks (by approximately 33.1%; P<0.01). This review has 2 limitations. They reported improved knowledge of fiber (P<0.001) and vitamins and minerals (P<0.05), but they did not find a significant change in consumption of fruit and vegetables. Nutrition education is the process of teaching the science of nutrition to an individual or group. . Only fruit consumption rose temporarily between baseline and follow-up 2, though not significantly, To measure the effects of a garden-based NE program on FV knowledge, willingness to taste, food preferences, and perceived quality of school life in upper primary school children vs in a control group, Three 1-h NE sessions over 10 wk and one 45-min session 4 times per week, To introduce the CATCH nutrition curriculum and Farm to School program to assess nutrition knowledge of 3rd-grade students, and increase their FV consumption behavior, Two 30-min NE lessons and a 2-h farm tour over a 4-wk period, Significant differences in knowledge of fiber were found (, To investigate the effects of 4 experimental conditions and 1 CG on health-related parameters, such as the lipid, physiological, and anthropometric profiles of children, 6-mo intervention, with 60-min sessions of PA twice a week, 2 1-h NE classes for children, and 6 2-h NE classes for parents, Students in groups receiving PA reduced their fat percentage (, To examine the effects of a school garden on childrens FV knowledge, preference, and consumption, 28 wk, with a biweekly 1-h sessions of NE and biweekly 1-h sessions of gardening, Participants in NE&G and NE groups exhibited significantly greater improvements in nutrition knowledge and taste ratings than those in CG (, To assess the impact of a multicomponent NE program on student knowledge, attitudes, and behaviors related to consumption of FVs, One school year. Health-related behavior change is a complex process that includes new behaviors to learn and undesired behaviors to reduce. Farm to school and nutrition education: positively affecting elementary school-aged childrens nutrition knowledge and consumption behavior. Effective nutrition education is a complex undertaking that calls for a systematic and comprehensive assessment of the determinants ofas well as the barriers tothe desired outcome to inform the intervention.64 This review found that nutrition education interventions with a comprehensive, multicomponent, and multilevel approach were more likely to achieve their stated objectives in all age groups. Funding/support. Nutrition education interventions that succeeded had clear alignment between the stated objectives, the desired outcome, and the implemented activities. Seven overarching factors emerged as critical to successful nutrition education among children: (1) a multicomponent (involving teachers and parents), multilevel (including the schools and the home) approach; (2) adequate duration of intervention and frequency of exposure; (3) parental engagement; (4) age-appropriate, hands-on experiences; (5) fidelity as ensured by training of the implementers and standardization of the protocol among all groups; (6) environmental change to impact knowledge (upstream outcome) and then behavior (midstream outcome); and (7) proper alignment between the stated objectives, the intervention, and the desired outcome, which is needed to affect weight or BMI (downstream outcome). Keywords entered in varying combinations included nutrition education, nutrition education intervention, children, and dietary behavior.. You should always employ nutrition counselling as a tool to help you achieve this objective. This review followed the recommendations and criteria established in the PRISMA statement (see Appendix S1 in the Supporting Information online).21 Articles published between 2009 and 2016 were obtained from electronic searches of 4 databases, namely PubMed, Web of Science, Science Direct, and ERIC (Education Resources Information Center) from 2009 to 2016. Other systematic reviews found similar findings. Abbreviations: BMI, body mass index; CATCH, Coordinated Approach to Child Health; CG, control group; CWK, Cooking with Kids; DDS, dietary diversity score; HBM, Health Belief Model; HK, Healthy Kick; HPM, Health Promotion Model; IG, intervention group; FV, fruit and vegetable; MUFAs, monounsaturated fatty acids; MVPA, moderate to vigorous physical activity; NE, nutrition education; NE&G, nutrition education and gardening; OR, odds ratio; PA, physical activity; PE, physical education; PT, physical training; RCT, randomized control trial; SAKG, Stephanie Alexander Kitchen Garden; SCT, Social Cognitive Theory; SEM, Socio-Ecological Model; TPB, Theory of Planned Behavior; TRA, Theory of Reasoned Action. No external funds supported this work. Another environmental strategy, the Delicious and Nutritious Garden intervention, included cooking and taste testing reported a significant increase in the number of fruits and vegetables ever eaten, in vegetable preferences, and in fruit and vegetable asking behavior at home. To account for the wide range in the age (219 years) and cognitive development of children, the review and the subsequent analysis were based on developmental stages categorized into preschool, elementary, and secondary school children in order to identify key strategies associated with successful interventions in the context of each age category. Medford, Mass: Tufts University School of Nutrition; 1995. and S.S. wrote the introduction. Finally, successful interventions targeting elementary school children used age-appropriate activities.25,26,28,31,37,38,40,42,44,47 Age-appropriate activities at the elementary school level included cooking and/or tasting sessions25,28,47; a learning-through-playing approach based on age or grade40,44,47; gardening sessions28,38; training classes in physical activity37,42; the use of posters, masks, and songs31,44; and the use of vocabulary and mathematics questions based on nutrition-related issues.26,31 In particular, the intervention carried out by Keihner et al31 designed different activities based on grade level. The majority (n=21) of the studies did not engage parents, and other studies engaged parents by passive methods (n=6) such as providing them with written information or directing them to a website.24,27,31,32,35,62 Successful studies were more likely to engage parents actively, ie on a face-to-face basis, by offering them nutrition classes33,37,49,59,60 or health fairs42,50,53,61; requiring them to accompany their children during cooking, tasting, or nutrition education sessions43,48,56,57; or allowing them to be part of the programs staff.28,44 This was especially critical in the interventions that targeted preschool students.56,57,5961 These findings are congruent with the results of a meta-analysis performed by Ling et al,68 who concluded that interventions providing skills training and behavioral change strategies aimed at parents were associated with improvement of childrens BMI in preschool. Although age-appropriate interventions were important in all age groups, they were critical in the preschooler age group.5660,62 Age-appropriate activities in preschool included learning through a story book57,59; using role models through play acting, posters, or videos56,58; exploring with the senses62; and playing games or coloring sheets with peers.60 For instance, the intervention conducted by Witt and Dunn62 consisted of hands-on, 30-minute weekly lessons. The following were excluded: (1) review articles, abstracts, or qualitative or cross-sectional studies, (2) studies targeting populations with special nutritional needs (eg, hospitalized children), (3) nutrition education interventions targeting caregivers or parents exclusively, and (4) publications based on the same data set used in an already-included study, in which case only the most recently published study was included. At the 6-month follow-up assessment, a significant reduction was found in the proportion of children who consumed soft drinks (from 26.3% to 11.2%; P<0.001) and energy-dense unhealthy foods (from 16.1% to 7.2%; P=0.03). Similar to the interventions conducted among elementary school children, interventions that used age-appropriate activities among secondary school children were more likely to achieve their objectives. This study significantly increased students knowledge of fruits and vegetables (P<0.05) and self-efficacy toward eating fruits and vegetables (P<0.001), while interventions that implemented a single intervention within a wide age range without discriminating according to age were not successful in achieving their objectives.3,8,24,27,29,30,34,39,46 For example, Herbert et al29 evaluated the effectiveness of their intervention in changing behavior and physical activity habits among children aged 7 to 11 years. For example, an intervention by Campos Pastor et al48 provided a daily balanced breakfast composed of a dairy product, fruits, cereals, nuts, and a sandwich with protein content; a prescribed well-balanced diet; and lessons on dietary and lifestyle recommendations for students, family members, and teachers. , . The findings of the current systematic review are based on critical analysis of these factors. , . Colquitt JL, Loveman E, OMalley Cet al. Many nutrition education programs target not only the child, but also the parents and/or nutritional gatekeepers. Rosi A, Brighenti F, Finistrella Vet al. For example, the objectives of the identified school feeding programs include addressing short-term hunger, reducing nutrient deficiency, improving attendance and school performance, encouraging healthy eating habits, and supporting local agriculture and economy. The study promoted healthy lifestyles among the adolescents by engaging them in activities such as planning their own lunch, planning healthy diets daily by themselves, and listing healthy alternatives to high-calorie foods. Targeting specific behaviors to modify was one of the characteristics commonly observed among the successful interventions.5658,62 For example, Hoffman et al58 planned a 2.5-year intervention that included knowledge, preference, and consumption of fruits and vegetables. The long-term knowledge score in IG was 12.35, which was lower than the score immediately after the intervention (P<0.01) but higher than the baseline score (P<0.01) and higher than the baseline and long-term scores in CG (P<0.01), There was a statistically significant difference between scores immediately after interventions and long-term scores in terms of having unhealthy food preferences and picky eating habits (P<0.05), Food safety scores of the IG post intervention were higher (P<0.01) than those of the CG both preintervention and at 9-mo follow-up. , . Other activities included strategies to overcome the perceived barriers to eating a healthy breakfast. In addition, all authors discussed each article as a group and either confirmed or added to the findings of the 2 reviewing authors. Similarly, Meiklejohn et al72 found significant changes in anthropometric measures among adolescents when parents were engaged. Use school as a platform for nutrition education and other nutrition-related services. Nutrition, including the combination of processes by which the body receives substances necessary for maintenance of its functions and for growth and renewal of its components, i.e., ingestion, digestion, absorption, metabolism, and elimination. Although the use of theory did not determine the success of the interventions analyzed in this review, it is important to note that most of the interventions were only informed by a theory but were not designed and driven by theory. Changes in eating and other nutrition-related behaviours that could be measured by the following: dietary recalls, records, or food frequency questionnaires;intakes of specific foods, some composite index of food intake or food score; actual behaviours such as eating 5 portions of fruit and vegetables dailyy, having fruits available and visible at home, salting . A total of 46% met their primary objectives of nutrition education intervention, while the rest either partially achieved or did not achieve their stated objectives. As observed among successful interventions in elementary and secondary schools, 5 of 7 studies that targeted preschoolers in this review included parental engagement on face-to-face basis, with hands-on activities in addition to lectures.56,57,5961 For example, De Bock et al56 created hands-on activities in which parents and children interacted in activities such as preparing fruit and vegetable snacks. Published by Oxford University Press on behalf of the International Life Sciences Institute. Similarly, the current review found that nutritional interventions in elementary schools were more likely to meet their objectives when they were multifaceted, had a high frequency of exposure, were delivered by nutritionists or trained teachers, and engaged parents. Nutrition education interventions at the preschool level, At end of intervention, significant difference between IG and CG in frequency of eating breakfast (P=0.02), At end of study, children in IG chose more nutrient-dense foods for breakfast compared with children in CG, who chose more energy-dense foods according to the nutrition label on the food (P<0.001), Quantity of food consumed at breakfast increased significantly in IG but decreased in CG (P<0.001), In year 1, children in IG consumed 22 more grams (1.5 tbsp) of fruit and 7 more grams (1.5 tsp) of vegetable per lunch (P<0.0001 and P<0.005, respectively) compared with children in CG, In year 2, IG consumed 15 more grams (1 tbsp) of fruit and 3 more grams (0.5 tsp) of vegetables per lunch (P<0.0005 and P<0.05, respectively) compared with children in CG, In year 3 and follow-up, IG did not consume more fruit than CG (P<0.05), In year 3, IG consumed 3 more grams of vegetables than CG (P<0.05), Children in IG scored about 0.5 to 0.66 of a point higher for knowledge than children in CG at each point of data collection. Despite these limitations, the strength of the current review lies in its analysis of several factors that contributed to the success of various types of interventions. Search for other works by this author on: Institute of Nutrition and Food Science, Dhaka University, Dhaka, Bangladesh, Yale-Griffin Prevention Research Center, Derby, Connecticut, USA. Among the secondary school interventions, all 8 interventions were implemented by trained nutritionists, researchers, or teachers and reported using a standardized format.4855. After 6 months of the intervention, the results showed a significant improvement in the childrens nutrition knowledge, physical activity, food habits, and BMI z score in the intervention group compared with the control group (P<0.001). Building on the work of a prior systematic review on factors that contribute to successful intervention in nutrition education for adults,22 this review aims to identify factors associated with successful nutrition education interventions among children. Version 3.0. Instead, fruit and vegetable intake showed a significant decline between baseline and the 2 follow-up assessments. These factors were identified through systematic review of the 41 published nutrition education interventions. conceptualized the systematic review. PICOS criteria for inclusion and exclusion of studiesa, Randomized controlled trials, pre-post design quasi-experimental studies, Elaborated according to the description of PICOS criteria as provided by Liberati et al (2009).21. Accessed July 20, 2017. NE administrated once per month. , . Change of environment was a factor in 3 of the 8 successful interventions in this category.48,50,53 It was effective in increasing healthy food choices, changing attitudes, or reducing weight as measured by body mass index (BMI). Forty-one studies were included: 7 targeted preschool children, 26 targeted elementary school children, and 8 targeted secondary school children. The lead investigator systematically trained the research team about the methods of systematic review, step by step. Objectives: At least 80% of program students complete program requirements within 1.2 years (150% of the program length). Four authors screened and determined the quality of the studies using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system and extracted the data from the articles. The purpose of this systematic review was to identify factors associated with successful nutrition education interventions conducted in children and published between 2009 and 2016. Similarly, a systematic review by Silveira et al75 concluded that interventions using structured activities aligned with specific objectives to provide knowledge about the benefits of maintaining a healthy diet were more likely to be successful. There was no significant change in the BMI of IG, while the percentage of obese school children in CG increased significantly, from 4.5% to 6.9% (P<0.001). and V.N. Similar to successful interventions in the other age groups, effective preschool interventions included age-appropriate activities, ensured fidelity by providing training to teachers, and offered short but frequent sessions to accommodate the short concentration span of preschoolers. , . Efficacy of a school-based healthy life program in Turkey, Nutrition education intervention improves vegetablerelated attitude, selfefficacy, preference, and knowledge of fourthgrade students, Impact of a school-based nutrition intervention on anthropometric parameters and the metabolic syndrome in Spanish adolescents, Effect of nutrition education intervention based on Penders Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students, School-based intervention as a component of a comprehensive community program for overweight and obesity prevention, Sousse, Tunisia, 20092014, Effects of school-based point-of-testing counselling on health status variables among rural adolescents. At the 6-month follow-up assessment, significantly more students from the intervention group brought lunch from home that included fruit (P<0.001) as compared with the control group. Our program's objective is to improve the health of our students by providing palatable and nutritious foods while enhancing their nutrition education Goals To offer each child an opportunity to purchase foods that will add to his/her physical well being. This process often requires time to learn new skills, identify resources, practice the new behavior, and identify support to sustain the new behavior.67 In addition to including multiple levels and multiple components, this current review found that reviewed interventions were more likely to meet their stated objectives when they were implemented for more than 6 months and offered frequent exposures, such as weekly or biweekly. To identify the objectives and competencies sought by the discipline of food and nutrition education (FNE) in the training of nutritionists. A.F.M-C. edited the manuscript. Moreover, in intervention schools, there was a >10% increase in children who consumed potato crisps, processed meat, sweets, and carbonated beverages between 2009 and 2011. Successful interventions either trained existing teachers or engaged nutrition experts in the implementation of the intervention.26,28,33,37,38,40,4244,47 For example, in the study by Cunningham-Sabo and Lohse,25 food educators received for 30hours of training to teach cooking and tasting lessons for the intervention. The successful nutrition education interventions that targeted secondary school children added policy and environmental changes to the intervention, used age-appropriate activities that included technology, identified specific behaviors, aligned activities with their stated objectives, offered the intervention frequently (such as weekly or biweekly), engaged parents on a face-to-face basis, and trained implementers to ensure fidelity. Children will follow a food from origin to table. The Evolving Model of Medical Nutrition Education Then and Now: Historical Perspectives and Lessons Learned. Additional content in nutrition education was identified for 4/16 (25%) of these courses through follow-up faculty interviews. , . Material and Methods. Effectiveness of a school-based nutrition and food safety education program among primary and junior high school students in Chongqing, China, Nutrition Education: Linking Research, Theory, and Practice, Health inequalities in Lithuania: education and nutrition habits, State-wide dissemination of a school-based nutrition education programmme: a RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) analysis, Eating habits and behaviors, physical activity, nutritional and food safety knowledge and beliefs in an adolescent Italian population, Evaluation of a school-based multicomponent nutrition education program to improve young childrens fruit and vegetable consumption, Nutrition education intervention improves nutrition knowledge, attitude and practices of primary school children: a pilot study, Pilot study: EatFit impacts sixth graders academic performance on achievement of mathematics and English education standards, Systematic Review: School health promotion interventions targeting physical activity and nutrition can improve academic performance in primary- and middle-school children, How effective are family-based and institutional nutrition interventions in improving childrens diet and health?
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