Abstract
OBJECTIVES: To conduct a rapid review addressing the question: What is the effect of school-based strategies that aim to improve acceptance of healthier foods and dietary patterns in children and adolescents on dietary intake and dietary intake-related behaviors? Results are presented for middle and junior high school (MS) only. METHODS: We conducted a literature search (2000–2020) and dual-screened the results using pre-defined inclusion criteria. We extracted data, assessed risk of bias, qualitatively synthesized evidence to develop conclusion statements, and graded the strength of evidence. RESULTS: Fifty-seven articles (54 randomized controlled trials [RCTs]) were included, examining teaching/educational interventions (32 articles), behavioral/environmental interventions (14 articles), and interventions combining education with behavioral/environmental strategies (“combined”; 14 articles). Curriculum-based nutrition education tended to improve dietary intake (particularly overall diet quality and vegetables), but evidence was insufficient for other educational interventions. Behavioral/environmental interventions tended to improve in-school food choices, but evidence on intake was limited due to inconsistency. Combined interventions tended to improve food choices and intake, particularly fruit, vegetables, and lower nutritional quality foods/beverages. Few studies directly compared combined interventions to use of either strategy alone but suggested a benefit of combined interventions. CONCLUSIONS: Moderate evidence from this rapid review indicates that in MS students: curriculum-based nutrition education improves dietary intake (particularly overall dietary quality and vegetable intake); school-based behavioral and environmental interventions beneficially affect in-school food and beverage selection; and school-based interventions that combine educational and environmental strategies targeting promotion and increased availability of nutrient dense foods and beverages improve food purchasing behaviors and dietary intake, particularly for fruit, vegetables, and foods and beverages of lower nutritional quality. FUNDING SOURCES: USDA, Food and Nutrition Service, Office of Policy Support, Special Nutrition Research and Analysis Division.