Introduction
Methods
Inclusion criteria
Exclusion criteria
Conducting the search
Databases
Setting | Behaviour | Outcome |
---|---|---|
Kindergarten, preschool, day care facilities, nursery
| cooking ability, skill, or competence, food and nutrition literacy, curriculum or syllabus, teaching, taste development, food and meal policies, legislation or regulations or farm to fork or plate, garden farm or visits; food and taste education | BMI, body mass index, diabetes, skinfold, weight and height, and intervention, food neophobia and neophilia, food and meal preferences including liking, willingness to try, knowledge, food consumption or intake |
Data management
Data collection and analysis
Selection of studies
Quality assessment
Rating | Definition | Study description | Design & methods |
---|---|---|---|
* | Weak | Many details missing (three or more of the following: setting, intervention design, duration, intensity, population or statistical analysis) irrelevant design or methods | Methodological flaws (in statistical methods used or design of intervention) or the intervention was in a non-natural environment i.e. food laboratory |
** | Moderate | One or two details missing | Small sample size (<50) or short duration (<one week) |
*** | Strong | One or two details missing | Larger sample size or longer duration |
**** | Very Strong | Clearly presented with all details provided | Larger sample size or longer duration and at least one of the following criteria: population randomly allocated or matched for intervention or control, generalizable results, or validated dietary assessment |
Results
Study | Aim of study | Setting | Age (years) | Ethnicity | Detailed description of the intervention | Theoretical foundation |
---|---|---|---|---|---|---|
Single intervention
| ||||||
Bannon et al.; [16] | The purpose of the study was to develop and test a commercial for apples on kindergarten children’s snack choice. | Kindergarten in Elementary school (USA) | 51
| 92% Caucasian | The children were shown 60 s videos with either 1 positive gain-framed video; 1 negative loss-framed video; 1 control video prior to apple/animal crackers eating. | Not stated |
4% African- American 4% Hispanic | ||||||
Birch et al.; [17] | The influence of peer models’ food selections and eating behaviours on preschoolers’ food preferences was investigated. | Preschool (USA) | 3,11
| 87% Caucasians. | A target child who preferred vegetable A to B was seated with 3 or 4 peers with opposite preference patterns. 17 situations were arranged. Children were served their preferred and non-preferred vegetable pairs at lunch and asked to choose 1. On day 1 the target child chose first, while on days 2, 3, and 4 peers chose first. | Not stated |
8% African American | ||||||
5% Asians, Middleclass families | ||||||
O’Connell et al.; [18] | The trial tested the hypotheses that children who are served unfamiliar vegetables repeatedly in the preschool lunch setting will increase consumption of them, and that consumption will be influenced by peer eating behaviours and parental feeding behaviours. | Preschool (USA) | 4-52
| Caucasians: 69% | Serving of unfamiliar vegetables repeatedly in a preschool lunch setting 10 times during a 6 week period. Influence of between child variability and thus peer influence. | Not stated |
Asian 8% | ||||||
African-American: 5% | ||||||
Hispanic: 6%. | ||||||
Other: 12% | ||||||
From highly educated households. | ||||||
Harnack et al.; [19] | To evaluate the effects on serving vegetables first or together with the meal on fruit, vegetables and energy intake among preschoolers. | Preschool (USA) | Missing | Not stated | Meal service strategy: serving vegetables first, compared with serving all food items at the same time compared with control (no change). Every strategy was implemented in two weeks. | Not stated |
Hendy; [20] | The purpose of the study was to examine the effectiveness of trained peer models to increase food acceptance of preschool children and the test whether the same gender would be the most effective. | Preschool (USA) | 3-62
| 90% Caucasians | Three novel foods presented during the preschool meal. 16 children were trained by their teachers to serve as peer models and given toy reinforcement. | Social cognitive theory. |
8% African American | ||||||
2% Hispanic | ||||||
Leahy et al.; [21] | To test the effect of reducing the energy density of an entrée on children’s ad libitum intake. | Preschools, (USA) | 3,91
| Caucasians: 69% | Children were served two version of a macaroni and cheese dish with the same palatability; one was energy dense and the other calorie-reduced. Each version was served 3 times. | Not stated |
Asian: 27% | ||||||
African-American: 4% | ||||||
90% of the mothers and 85% of fathers reported having at least a 4-year university degree | ||||||
Noradilah; [22] | The objective of this study was to determine the effects of multiple exposures to the acceptance of a targeted vegetable among Malay preschoolers. | Kindergartens (Malaysia) | 5-62
| The majority of the fathers of the subjects (89.2%) had education up to secondary school, were self-employed (59.5%) and had monthly incomes of below RM1500 (91.9%). Meanwhile, the majority of the mothers were housewives (73%) with secondary education level (86.5%). | The children were exposed to three exposures of round cabbage in the kindergarten setting. The test vegetable had been decided upon based on questionnaire data from the parents. The parents served the vegetable at home once in order to determine the child’s liking of round cabbage. | Not stated |
Ramsey; [23] | The objective of this study was to compare kindergarteners’ intake of food from a school lunch meal when they are pre-served a larger entrée portion to when they are allowed t0 choose from three preplated entrée portion sizes. | Kindergartens (USA) | 2-72
| Not stated | A portion size of 4 chicken nuggets was the standard amount offered to the kindergarteners before the study. In the study they were given the choice to self-select smaller entrée portion sizes of 2, 3 and 4 nuggets. | Not stated |
Educational intervention
| ||||||
Baskale et al.; [24] | The purpose was to develop and implement a program based upon Piaget’s theories. It also determined the average levels of knowledge children would have about nutrition following the program would be different in terms of group, group time, whether there would be any differences in food consumption frequencies between the study and the control group and whether there would be changes in anthropometric measurements of the children. | Nursery schools (Turkey) | 52
| Different socio-economic layers, but the groups were not significantly different. | Activities were carried out once a week by a nurse educator in the course of 6 weeks. The sessions were carried out in the children’s classroom and the lengths were 20–30 minutes. The themes were the food pyramid, variation of fruits and vegetables, and healthy bones. | Piaget’s cognitive development theory |
Parents in both intervention and control group were given nutrition education in 1 ½ -2 hours. | ||||||
Cason KL; [25] | The objective of the educational program were to enable preschool children to identify nutritious snack foods, identify and name vegetables, increase willingness to try novel vegetables, help to prepare and consume nutritious foods using developmentally appropriate practices and acquire behaviours that contribute to nutritionally sound food choice and a healthy lifestyle. | Preschool (USA) | 4,41
| 63% African Americans | A theory-based curriculum of 12 lessons of 40 minutes every second week developed for preschool children, the core topics of healthy snacking, fruit and vegetables identification, and the Food Guide Pyramid. | Multiple intelligence theory. |
37% Caucasians | ||||||
Cespedes; [26] | The objective was to implement and evaluate a nutritional and physical activity educational intervention in preschools. | Preschools (Colombia) | 3,71
| Low-income: 58% | Children were provided educational and interactive classroom activities throughout 5 months (1 hour daily). Parents participated in 3 workshops and weekly healthy messages were distributed. Teachers participated in 3 centralised workshops and 2 hourly personalised sessions every 14 days. Teachers also received a guidebook. | Social cognitive theory and the trans-theoretical model |
Middle-income: 42% | ||||||
Gorelick et al.; [27] | To develop a developmentally age appropriate educational curriculum and assess the success of the project curricular objectives. | Preschools (USA) | 3-52
| Primarily Caucasians | A kit with assessment instruments, fifty classroom activities, patterns to make materials for the classrooms lessons, a recipe book and two film strips. The educational curriculum was delivered by teachers. | Piaget’s developmentally theory |
Wide SES range | ||||||
Hu et al.; [28] | To evaluate the impact of nutrition education in kindergartens and to promote healthy dietary habits in preschool children. | Kindergarten (China) | 4-62
| Low-income: 14% | Monthly nutrition education sessions were held over two semesters. The nutrition educational program consisted of a flexible curriculum for children and parents. An illustrated book to all children and pamphlets were delivered to parents. Two series of promotional pictures providing information regarding nutrition were shown to the children. | Not stated |
Middle-income: 57% | ||||||
High income: 29% | ||||||
Johnson SL; [29] | Objective was to investigate whether children could be taught to focus on internal cues of hunger and satiety and consequently improve their self-regulation of energy intake. | Preschool (USA) | 4,71
| Primarily high socio economic population. | Introduction of hunger through video and role-play with adults and dolls. Children were instructed before, during and after eating to attend to cues of hunger and satiation. | Not stated |
To examine the effects of a randomized school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures and fitness in low socioeconomic children. | Kindergarten (Israel) | 3-62
| All kindergartens were situated in a low-socio economic area. | Three all-day seminars for teachers. Parents were invited for two health-day festivals. The nutritional intervention was designed mainly to improve nutritional knowledge and was delivered by preschool teachers. Monthly pamphlets with nutrition information were sent home via the children, who were asked to present the nutritional information to their parents. | Not stated | |
Parcel et al.; [32] | To evaluate the impact of a health curriculum on educational and behavioural outcomes | Preschool (USA) | 2-42
| Not stated | Health education curriculum that was designed to teach selected age-appropriate types of behaviour that enables children to assume greater responsibility for their own health. The classes were taught everyday by a project employee, 1 teacher and 2 aides. The teachers additionally received two-three in-house training. | Social Learning theory |
Piziak V; [33] | The purpose was to test the effectiveness of a bilingual nutrition game to increase the servings of healthful foods particular vegetables, fruit and water offered to children and decrease the servings of sugar sweetened beverages in the Head Start population. | Preschool (USA) | 3-52
| The study took place at Head Start, a governmentally funded locally operated school for low-income families. Mexican-American: 57,3% | A pictorial nutrition education game played at class and during meals, the game lends itself to nutrition education. The cards and boards show colour images of culturally appropriate foods and the reverse side gives the name in English and Spanish which may also be used to improve reading skills. | Not stated |
Sirikulchaya-nonta et al.; [34] | To evaluate the use of food experience, multimedia, and role models for promoting fruit and vegetable consumption. | Kindergarten (Thailand) | 4-52
| Not stated | The program consisted of 11 activities of 30–40 minutes duration that presented information on health benefits of F&V as manner to improve familiarity with and acceptance of the concept. Teachers, peers, and parents were used as role models while eating together. A take-home letter was sent to the parents once. | Social Learning theory |
Witt et al.; [35] | Determine whether an interactive nutrition and physical activity program for preschool children increases fruit and vegetable consumption | Child care centres (USA) | 4-52
| Not stated | The Color me healthy program was implemented for 6 weeks; 2 circle-time lessons and 1 imaginary trip were taught to children each week. The lessons were 15–30 minutes in duration. | Not stated |
Multicomponent
| ||||||
Bayer et al.; [36] | The intervention focused on improving health behaviour on a daily basis in the day care setting, aiming at establishing a health promoting behaviour patterns that might also be maintained outside of the day care setting. | Kindergarten (Germany) | 3-62
| Children: German nationality: | A behavioural intervention programme using a box-set with activities for kindergarten teachers. Included 2 day training session for KG teachers and a hotline for additional advice. Newsletters for parents was provided and availability of fruit, vegetables and water as well. An internet platform with additional information was established. | Not stated |
Intervention: 91,6 | ||||||
Control: 92,4% | ||||||
Parents: Educational level medium – high: | ||||||
Intervention: 73% | ||||||
Control: 71% | ||||||
Brouwer et al.; [37] | The purpose of this study was to assess the feasibility of a garden-based intervention to promote fruit and vegetable intake among children attending childcare. | Childcare centres (USA) | 4,81
| Child care directors: | A garden-based intervention with a structured curriculum for child-care providers, consultations by a gardener, and technical assistance from a health educator. The curriculum included an overview module followed by monthly modules designed around a specific crop. | Not stated |
75% African American | ||||||
50% College degree. | ||||||
Children: | ||||||
All centres had children from low-income families | ||||||
De Bock et al.; [38] | To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children. | Kindergarten (Germany) | 4,21
| Without immigrant background: 65% With immigrant background: 32% Maternal educational level: Low: 16% Middle: 56% High: 21% Missing: 7% | A nutritional intervention, consisting of fifteen 2 hours sessions once weekly over a period of 6 months. Ten modules only targeted children, another five parents and children or parents exclusively. Intervention activities consisted of familiarizing with different food types and preparation methods as well as cooking and eating meals together in groups of children, teachers and parents. Availability of fruit, vegetables and water was increased. | Social Learning theory and Zajonc’ Exposure theory as well as the RE-AIM framework for the process evaluation |
Hammond et al.; [39] | To evaluate the impact of an early childhood nutrition education program on kindergarten students familiarity with and stated willingness-to-try 16 test foods | Kindergarten (CAN) | 52
| Cultural inheritance: | Nutrition Educational Program that includes 4 steps; food introduction activities, cooking, journal keeping activity, and communication between child and parents | Not stated |
Intervention: Canadian/British/English: 59% Other: 41% | ||||||
Control: Canadian/British/English: 81% Other: 19% | ||||||
Hoffman et al.; [40] | The purpose of this study was to examine the impact of a multi-year, multicomponent school-based F&V consumption during school lunch. | Kindergarten (USA) | 62
| Experimental group: African-American: 29% Latino: 41% Asian: 24% Caucasian: 3% Other: 2% Control: | Multi-year, multi-component fruit and vegetable promotion program, that included school-wide, classroom, lunchroom and family components to promote F & V consumption with an emphasis on F&V in the school lunch. Program components were designed to capture students’ attention and to increase retention of nutrition information using influential role models and deliver consistent messages across the setting. | Social Learning theory |
African-American: 36% | ||||||
Latino: 51% | ||||||
Asian: 0% | ||||||
Caucasian: 4% | ||||||
Other: 9% | ||||||
Vereecken et al.; [41] | To develop and assist Belgian preschools in the implementation of a healthy school policy and evaluate the impact of the intervention in children’s food consumption. | Preschools (Belgium) | 3-42
| Intervention: Education low: 60% Education medium: 22% Education high: 18% Control: Education low: 57% Education medium: 26% Education high: 17% | A two-days training was given to school staff. An educational package, including an educational map for the teachers, an educative story and educational material was developed. Food messages and newsletters directed at the school staff and parents were made available. | Intervention Mapping |
Williams et al.; [42] | To evaluate the effects on a preschool nutrition education and food service intervention | Preschools (USA) | 2-52
| Minority, primarily African-American: 67% Latino: 33% The majority lived in families with annual income below poverty lines. | There was two intervention types; 1 with food service modification and nutrition education and 1 with food service modification and safety education. The nutrition education segment included a curriculum. The food service modification consisted of help to decrease the consumption of total and saturated fat. | Not stated |
Populations studied
Ethnicity and socio-demographic characteristics of participants
Interventions
Study | Study design | Sampling | n | Duration | Limitations | Quality1 | Main target behaviour | Primary and secondary outcomes |
---|---|---|---|---|---|---|---|---|
Single intervention | ||||||||
Bannon et al.; [16] | RCT | Convenience | 50 | 3 d | No controlling for internal measurement bias. |
**
| Children: | The children viewing the gain-framed and loss framed videos were significantly more likely to choose apples than controls. Among the children who saw one of the nutrition message videos, 56% chose apples rather than animal crackers; in the control condition only 33% chose apples. |
Food preference questionnaire. | ||||||||
Healthy Food questionnaire (children circled the food they thought were healthy). | ||||||||
Short time between exposure and control conditions. | ||||||||
Snack choice between an apple or a snack | ||||||||
Small sample size | ||||||||
Short duration of intervention (3×60 s.) | ||||||||
Birch LL; [17] | P/P | Convenience | 39 | 4 d | No control |
*
| Children: | Vegetable preference increased significantly from day 1 to 4. |
Food preferences were assessed | ||||||||
No data on allocation short duration of exposure | Food intake of the test vegetables | The total consumption of vegetables decreased during the 4 days, but they still ate the non-preferred food item. Young children were more affected than older children by peer modelling. | ||||||
Small sample size. | ||||||||
O’Connell et al.; [18] | RCT | Randomly | 96 | 6 w |
***
| Children: Willingness to try new vegetables. | Repeated exposure did not increase vegetable consumption. | |
Greater consumption by tablemates was a significant predictor of greater vegetable consumption. 1 gr. of peer intake was associated with roughly 1/5 gr. Intake among the subjects. | ||||||||
Harnack et al.; [19] | Randomized crossover Trial | Not stated | 53 | 6 w | Sampling methodology not stated. Not enough time between exposure/control conditions. |
**
| Children: | Fruit intake was significantly higher with serving style 1 |
Anthropometric measures | ||||||||
Vegetables intake did not appear to increase | ||||||||
Food and nutrient intake during lunch. | ||||||||
Small sample size | ||||||||
Hendy H; [20] | Quasi | Convenience | 38 | Not stated | Duration not stated |
**
| Children: | The study found an effect on food acceptance, but the effect had disappeared after 1 month. |
Number of bites taken of the novel foods | ||||||||
Food preference | The children serving as peer models rated their food preferences for the novel food higher than the observers. | |||||||
Mothers: Information on height, weight, age. | ||||||||
Leahy et al.; [21] | Quasi | Convenience | 77 | 6 d | No control |
**
| Children: | <decreasing the energy density of the entrée by 30% significantly decreased children’s energy intake by 25% and total lunch intake by 18%. Children consumed significantly more of the lower-energy-dense version. |
Preference assessment of the two dishes | ||||||||
Height and weight. | ||||||||
Lunch intake of the two different dishes. | ||||||||
Parents: | ||||||||
Child feeding questionnaire | ||||||||
Socio-demographic variables. | ||||||||
Noradilah; [22] | Quasi | Convenience, but randomly assigned to intervention | 37 | 3 d | The sample size is small and the duration short. Liking was assessed by parents |
**
| Children: | The liking scores were significantly higher after the intervention. Consumption of the test vegetable significantly increased from 21.58 to 28.26 on the 3rd day. The effect was especially evident among girls. |
Food intake of the test vegetable | ||||||||
Parents: Liking of the test vegetable | ||||||||
A questionnaire was developed to obtain information on the usual preparation methods of vegetables, frequency of vegetables served and consumed by children at home | ||||||||
Ramsey; [23] | Quasi | Not stated | 235 | 5 d | No individual data. Short duration No control conditions Sampling conditions are not stated |
*
| Children: Food intake at lunch. The food intake was on canteen level, not at an individual level. | Children’s intake of chicken nuggets was greater when they were not given a choice of nugget portion size. Demonstrating that serving larger portion sizes in preschools increase children’s intake of them. |
Educational intervention | ||||||||
Başkale et al.; [24] | RCT | Convenience | 115 | 6 w | High drop-out rate (50% +). No evaluation of parent part of intervention. |
***
| Children: | Children’s nutritional knowledge increased significantly compared to control group. |
Body Mass Index | ||||||||
Mid-upper arm circumference | ||||||||
Nutrition knowledge. | ||||||||
Healthy food consumption increase significantly in milk, yoghurt, white meat and green leafy vegetables. No anthropometric differences. | ||||||||
Parents: | ||||||||
Demographic data | ||||||||
Food consumption of children | ||||||||
Cason KL; [25] | P/P | Convenience. | 6102 | 24 w | No control or comparison group |
**
| Children: | Subjects showed significant improvement in food identification and recognition, healthy snack identification, willingness to taste food, and frequency of fruit, vegetables, meat and dairy consumption. |
Knowledge and attitude pictorial questionnaire. | ||||||||
Parents: Children’s eating habits and food attitudes. | ||||||||
Food frequency questionnaire and pictorial assessment of food likes. | ||||||||
Cespedes; [26] | Cluster RCT | Randomly | 1216 | 5 m |
****
| Children: Height and weight Knowledge and attitude scores. | Children showed significantly changes in knowledge and attitudes. Parents showed statistically significant, but minor changes in knowledge, attitudes and habits. More children were eutrophic after the intervention. | |
Nutritional status | ||||||||
Parents. | ||||||||
Parental knowledge and attitudes. | ||||||||
Gorelick et al.; [27] | RCT | Convenience | 187 | 6 w |
***
| Children: | The outcomes were fruit identification; vegetable identification; bread identification; vegetables classification; fruit classification; matching; tooth brushing; hand washing; food preparation; food choices and there was a significant improvement over the course of the project. Older children scored higher than the younger ones. | |
Identification of bread, fruits and vegetables | ||||||||
Food classification of bread, fruits and vegetables. | ||||||||
Food preparation | ||||||||
Food choices | ||||||||
Hu et al.; [28] | RCT | Randomly | 2102 | 10 m | Educational intervention not theoretically founded |
****
| Parents: | No significant difference in anthropometrics but difference in children’s unhealthy diet related behaviours and parents attitudes and knowledge between intervention and control. |
Nutrition-related eating behaviours. | ||||||||
Nutrition knowledge | ||||||||
Attitudes to the factors they considered important when arranging their children’s dietary habits. Food frequency questionnaire | ||||||||
Children: Height and weight. | ||||||||
Johnson SL; [29] | Quasi | Convenience | 25 | 6 w | Small sample size No control Short exposure time |
*
| Children: Compensation index based on baseline food intake data. Anthropometric data. | Food intake was measured and showed that children had improved their ability to compensate their energy intake according to the energy density of food offered. The intervention did not have an effect on BMI. |
RCT | Not stated | 725 | 1 y | Sampling methodology not stated |
***
| Children: Weight and height. Nutritional knowledge and preferences using a photo-elicitated questionnaire. | Significant increase in nutritional and physical activity knowledge and preference | |
Frequency of nutritional education not stated. | ||||||||
Significant decrease in number of overweight children. | ||||||||
Intervention not theoretically founded | ||||||||
Significant improvement in fitness | ||||||||
No sign in BMI percentiles, but 32% from overweight to normal weight. | ||||||||
At follow-up after 1 year with 206 children BMI and BMI percentiles were significantly lower in the intervention group compared to control. Nutritional knowledge and preferences remained significantly elevated in the intervention group compared to the control. | ||||||||
Parcel et al.; [32] | Quasi | Convenience | 173 | 4 y | Allocation process is missing. Lack of transparency in changes of the sample throughout the study. | ** | Mothers: Health values, health behaviour in the home. | No evidence of effect on fruit consumption as a replacement for candy according to parent self-reporting. However, there was strong evidence of less candy eating among the health curriculum group compared to the control according to teacher observation. No evidence of increased variety in food for lunch. |
Children: Health locus of control. | ||||||||
Preferences for health and safety behaviour | ||||||||
Lack of information on validation | ||||||||
Teachers: Observation of children regarding health and safety behaviour. | ||||||||
Piziak V; [33] | Quasi | Convenience | 413 | 1 y | No control | ** | Parents: Food frequency questionnaire. | There was a significant increase in vegetables served outside the preschools both on weeks and in weekends. |
Sampling methodology not stated | ||||||||
Intervention not theoretically founded | ||||||||
Lack of information regarding intervention group. | ||||||||
Sirikulchayanonta et al.; [34] | Quasi | Random selected school, but convenient chosen class | 26 | 8 w | Lack of information of intervention group Small sample size. | * | Parents: Demographic variables | The use of food experience, multimedia and role models were effective in increasing F&V consumption |
Family F&V vegetables consumption behaviour. | ||||||||
Changes in the children eating behaviour after the intervention. | ||||||||
Children: F&V behaviour at lunch time in respect to kinds and amounts consumed. | ||||||||
Witt et al.; [35] | RCT | Not stated | 263 | 6 w | Sampling methodology not stated. | *** | Children: Food consumption of F&V snacks. | Strong evidence that the Color Me Healthy program increased F&V snack consumption among the intervention group compared to the control group. There was a significant increase in consumption of fruit with 20,8% and with vegetable snacks with 33,1%. |
The parental data at follow-up was only at 14%, which was insufficient to make substantive conclusions. | Parents: Changes in children’s F&V consumption at home. | |||||||
Food frequency questionnaire | ||||||||
General health survey. | ||||||||
Multi component | intervention | |||||||
Bayer et al.; [36] | Cluster RCT | Randomly | 1609 | 1 y |
****
| Parents: Children eating habits and food frequency data were examined using a questionnaire. | The program led to an increased proportion of children with high fruit and vegetable consumption after 6 months, which was sustainable with adjusted odds ratios of 1.59 (1.26: 2.01) and 1.48 (1.08:2.03) after 18 months. Subgroup analyses by gender, overweight and parental education, performed in order to assess consistency of effects, showed similar results. Prevalence of overweight and obesity as well as motoric testing results were not statistically different between intervention and control groups. | |
Anthropometrics (height, weight) and motoric testing of children were done at the yearly health examination offered to all children in the area of Bavaria. | ||||||||
Brouwer et al.; [37] | RCT | Randomly | 16 | 4 m | The intervention was carried out in 6 preschool, but only 3 children per class were evaluated causing a small sample size, also the children were not the same at pre and post measurement |
**
| Children: Structured dietary observation of food intake during meals and snack time in preschools. | Consumption increased with an additional ¼ serving of vegetables, despite fewer vegetables being served. |
Child care centres: Demographic variables including low-income children and ethnicity of child care directors. | ||||||||
De Bock et al.; [38] | Cluster RCT | Convenience | 348 | 6 m | High dropout rate |
***
| Children: Height, weight, waist circumference, total body fat using skinfold measurement. | Children’s fruit and vegetable intakes increased significantly. |
No significant changes in the consumption of water and sugared drinks were found. | ||||||||
Parents: Questionnaire assessing multiple domains of behaviour including | ||||||||
No anthropometric measurements changes were found. | ||||||||
Children’s’ eating behaviour and physical activity. | ||||||||
Food frequency questionnaire. | ||||||||
Socio-demographic information. | ||||||||
Hammond et al.; [39] | RCT | Convenience | 123 | 7 m |
***
| Children: Interviews with children to test their familiarity. | Familiarity with and stated willingness to eat 16 tested foods increased significantly. | |
Parents: Demographic variables | ||||||||
Children’s willingness-to-eat. | Mentioning of exposure of foods in KG when requesting food at home more than doubled (reported by parents) | |||||||
Changes in the child’s dietary habits over the school year. | ||||||||
Hoffman et al.; [40] | RCT | Convenience | 297 | 1 y | Demographic difference between intervention and control group. |
***
| Children: Awareness of the intervention | No difference in F&V preferences |
F&V preferences | Increase in fruit and vegetable intake at year 1, but at year 2 a difference was only found on fruit intake. | |||||||
Weighed plate waste during 3 lunches in the preschool cafeteria. | ||||||||
Height and weight | ||||||||
Caregiver/parents: Demographic variables | ||||||||
Vereecken et al.; [41] | RCT | Convenience | 476 | 6 m | Response rate is low 33% | *** | Parents: Food frequency questionnaire on their children’s general food consumption. | Increased fresh fruit intake among the intervention children, but the effect was only significant among parental reported fruit consumption. The increase was due to more available fruit at school. |
Socio-demographic information | ||||||||
Questions relating to the school food policy. Teachers: Registration of food available for consumption. | ||||||||
Williams et al.; [42] | Quasi | Convenience | 787 | 6 m | No information about the allocation process. | *** | Children: Dietary intake by observation during school and by interviewing the parents. | Very strong evidence of a decreased relative risk of elevated cholesterol levels among children with elevated cholesterol at baseline in both food service modification groups. Furthermore, strong evidence of a decrease in total cholesterol in the two food service modification groups compared to the control group. |
Weight and height |
The study design of included studies
Sampling methods
Sample size
Main target behaviours
Duration of intervention
Theoretical foundations of interventions
Information missing from articles
Bias
Effects of interventions
Single intervention
Educational intervention
Multicomponent interventions
Discussion and conclusions
Quality of the evidence
Author’s conclusions
Implications for practice
Implications for research
Highlights
-
Healthy eating interventions in preschools were classified by their type.
-
Comprehensive interventions were more likely to succeed in behaviour change, especially when targeting children of low-income families
-
Preschools are a promising venue for increasing fruit and vegetable consumption.
-
Evaluations showed a positive increase in food-related knowledge.
-
Properly designed interventions, with clear indicators and outcomes are scarce.