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Nutrition Education Systematic Review

Nutrition Education and Diet Intake Related Behaviors

Eating behaviors established during childhood can track in adulthood, making it particularly important to ensure that children adopt healthy eating practices early in life. However, many children are consuming excess calories, while not meeting nutrient needs, and are facing the same health consequences as adults. The U.S. Department of Agriculture (USDA) supports a wide range of nutrition education policies and programs designed to help Americans, particularly children, consume healthier diets.

The purpose of this project was for the Evidence Analysis Library Division of the Center for Nutrition Policy and Promotion (CNPP), USDA, to conduct a series of systematic reviews for the Food and Nutrition Service (FNS), USDA to ascertain the most effective designs for delivering nutrition education that improves the dietary intakerelated behaviors of children and adolescents.

Over the past few decades, systematic reviews have become the preferred foundation for developing public health guidelines, policies, and programs. Also, systematic reviews can aid compliance with the Consolidated Appropriations Act of 20014 or Data Quality Act, which mandates Federal agencies ensure the quality, objectivity, utility, and integrity of the information used to form federal guidance. Therefore, conducting systematic reviews of nutrition education research can help FNS and other USDA agencies, such as the National Institute of Food and Agriculture (NIFA) to better understand how nutrition education can be used to promote adoption of dietary intakerelated behaviors consistent with Dietary Guidelines for children and adolescents.

The systematic review questions addressed were identified and prioritized to focus the reviews on topics that would enhance current nutrition education practice and programs. In particular, the reviews focus on nutrition education interventions designed for children in preschool, kindergarten, and elementary school and adolescents in middle and high school. In addition, attention was given to effective interventions that are appropriate for the Supplemental Nutrition Assistance Program Nutrition Education (SNAPEd) population and other similar target audiences (e.g., the Expanded Food and Nutrition Education Program (EFNEP); Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Commodity Supplemental Food Program (CSFP)). Therefore, when available, research findings related to specific population sub-groups (e.g., cultural, racial and/or ethnic background, gender, age, and household income) was included.

The evidence reviews encompassed a broad range of child-focused, school-based nutrition education interventions, but also considered other types of interventions, such as those delivered in other community-based settings (e.g., healthcare settings, child care facilities, after-school and extracurricular programs) or directly to families, so long as the intervention targeted children’s dietary intake behaviors. The outcomes of interest for this review were limited to dietary intake-related behaviors. Intermediate outcomes, such as knowledge and attitudes, and health outcomes, such as body weight, were not considered. Interventions that targeted children indirectly by educating their parents, teachers, child care providers, food service staff, and other nutritional gatekeepers were included, as long as there was assessment of behavioral change among children or adolescents. Full systematic reviews were conducted for the following systematic review questions:

Systematic Review Questions

Nutrition Education and Diet Intake Related Behaviors

What is the effect of nutrition education delivered via digital media and/or technology on children’s dietary intake-related behaviors?

What is the effect on nutrition education with parental involvement compared to no parental involvement on children's and adolescents' dietary intake-related behaviors?

Which type of educator who delivers nutrition education is most effective in changing children's and adolescents' dietary intake-related behaviors?

What are the effects of combining changes to the food environment and nutrition education compared to either of these strategies alone on children's and adolescents' dietary intake-related behaviors?

What are the effects of multi-component compared to single-component nutrition education interventions on children's and adolescents's dietary intake-related behaviors?

What factors mediate the effects of nutrition education interventions on children's and adolescent's dietary-intake related behaviors?

What factors moderate the effects of nutrition education interventions on children's and adolescent's dietary-intake related behaviors?

The results of this systematic review project can be used to inform the work of nutrition education practitioners, as well as Federal nutrition education policy and programs. It can also aid in the development of nutrition education guidance and communication strategies and effective nutrition education interventions targeting behavior change, and help identify areas where more research is needed.