School-Based Strategies to Improve Acceptance of Healthier Foods and Dietary Patterns in Elementary School Students: A Rapid Review

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 elementary school children only. METHODS: We conducted a literature search (2000–2020) and dual-screened the results using pre-defined inclusion and exclusion criteria. We extracted data, assessed risk of bias, qualitatively synthesized the evidence to develop conclusion statements, and graded the strength of the evidence. RESULTS: One-hundred-six articles (97 randomized controlled trials [RCTs]) were included, examining educational interventions (56 articles [50 RCTs]), behavioral and environmental interventions (32 articles [30 RCTs]), and interventions that combined educational strategies with behavioral and environmental strategies (20 articles [17 RCTs]). Curriculum-based nutrition education tended to improve food and beverage intake, particularly fruit; a few interventions reduced sodium intake. Some studies found that playing educational games for several weeks improved dietary intake, and brief educational books and videos tended to improve immediate food choice. Behavioral and environmental interventions tended to improve in-school food and beverage selection, particularly fruit, vegetables, and milk; many improved in-school food and beverage intake. Interventions that combined educational strategies with behavioral and environmental strategies tended to improve food and beverage intake, particularly fruit. CONCLUSIONS: Moderate evidence from this rapid review indicates that in elementary school children: curriculum-based nutrition education improves food and beverage intake (particularly fruit); school-based behavioral and environmental interventions improve in-school food and beverage selection (including fruit, vegetables, and milk) and in-school vegetable intake; and school-based interventions that combine educational strategies with behavioral and environmental strategies improve intake of food and beverages, particularly fruit. FUNDING SOURCES: USDA, Food and Nutrition Service, Office of Policy Support, Special Nutrition Research and Analysis Division.