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Meta-Analysis
. 2019 Apr 29;16(1):38.
doi: 10.1186/s12966-019-0798-1.

The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis

Nicole Nathan  1   2   3   4   5 , Lisa Janssen  6 , Rachel Sutherland  6   7   8   9 , Rebecca Kate Hodder  6   7   8   9 , Charlotte E L Evans  10 , Debbie Booth  11 , Sze Lin Yoong  6   7   8   9 , Kathryn Reilly  6   7   8   9 , Meghan Finch  6   7   8   9 , Luke Wolfenden  6   7   8   9
Affiliations
Meta-Analysis

The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis

Nicole Nathan et al. Int J Behav Nutr Phys Act. .

Abstract

Objective: To assess the effectiveness of lunchbox interventions aiming to improve the foods and beverages packed and consumed by children at centre-based care or school; and subsequent impact on children's adiposity.

Methods: Systematic search of nine databases for controlled trials published in English between 1995-January 2017. Where appropriate, data were pooled in a random effects meta-analysis.

Results: Of the 1601 articles identified, ten studies (centre-based care n = 4, school n = 6) were included of which eight were RCTs. The impact of interventions on the packing of discretionary foods, sugar-sweetened drinks and other core foods was inconsistent. Meta-analysis of four RCTs trials found a moderate increase in provision of vegetables (SMD = 0.40 95% CI 0.16 to 0.64, p = 0.001, I2 = 82%; equivalent to a mean difference of 0.28 serves) but not fruit. Four studies reported impact on children's dietary intake, one reported no significant effect on consumption of discretionary foods, one reported improvements in the consumption of sugar-sweetened drinks and water, and two reported improvements in consumption of vegetables and fruit. Two studies, that were broader obesity prevention interventions, reported no significant impact on adiposity.

Conclusions: There is some evidence that lunchbox interventions are effective in improving the packing of vegetables in children's lunchboxes, however more robust research is required to determine the impact on children's dietary intake and adiposity.

Trial registration: PROSPERO 2016: CRD42016035646 .

Keywords: Children; Diet behaviour; Lunchbox; Packed lunch; Systematic review.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable

Consent for publication

This manuscript has not been published – either in print or electronic form – or is being considered for publication elsewhere. All authors approved the final version for submission.

Competing interests

Author CE has received funding from Unilever UK to repeat a survey of children’s packed lunches in England in 2016.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA diagram
Fig. 2
Fig. 2
Risk of bias graph
Fig. 3
Fig. 3
Risk of bias summary
Fig. 4
Fig. 4
Forest plot – provision of vegetables
Fig. 5
Fig. 5
Forest plot – provision of fruit
See this image and copyright information in PMC

References

    1. Hardy L, et al. NSW schools physical activity and nutrition survey (SPANS) 2010: full report. Sydney: Ministry of Health; 2011.
    1. Commonwealth Scientific Industrial Research Organisation (CSIRO), 2007 Australian National Children’s Nutrition and Physical Activity Survey - Main Findings, Department of Health and Ageing, Editor. 2008, Commonwealth of Australia: Canberra.
    1. Nicklas T, Johnson R. Position of the American dietetic association: dietary guidance for healthy children ages 2 to 11 years. J Am Diet Assoc. 2004;104(4):660–677. doi: 10.1016/j.jada.2004.01.030. - DOI - PubMed
    1. Whitrow MJ, et al. Core food intakes of Australian children aged 9-10 years: nutrients, daily servings and diet quality in a community cross-sectional sample. J Hum Nutr Diet. 2016;29(4):449–457. doi: 10.1111/jhn.12358. - DOI - PubMed
    1. Krebs-Smith SM, et al. Americans do not meet federal dietary recommendations. J Nutr. 2010;140(10):1832–1838. doi: 10.3945/jn.110.124826. - DOI - PMC - PubMed

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