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Meta-Analysis
. 2021 Apr 18;13(4):1350.
doi: 10.3390/nu13041350.

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis

Floriana Mandracchia  1 , Lucia Tarro  1   2 , Elisabet Llauradó  1 , Rosa Maria Valls  1 , Rosa Solà  1   2   3
Affiliations
Meta-Analysis

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis

Floriana Mandracchia et al. Nutrients. .

Abstract

Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

Keywords: family; food behavior; food-service; menu choice; out-of-home eating; restaurant; restaurant-based interventions.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 flow diagram for the systematic review of the article selection process.
Figure 2
Figure 2
Forest plot of the effectiveness of increasing the dietary intake of healthy food items (servings/day), according to the included intervention studies (RCTs and non-RCTs).
Figure 3
Figure 3
Forest plot of the effectiveness of decreasing the dietary intake of saturated fat, fat and added sugar nutrients (g/day) according to the included intervention studies (RCTs and non-RCTs).
Figure 4
Figure 4
Forest plot of the relationship between the effectiveness of the included interventions (RCTs) and the risk for schools to offer unhealthy items on canteen menus.
See this image and copyright information in PMC

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