An Umbrella Review of Systematic Reviews of School-Based Nutrition Interventions to Determine Outcomes Used and Their Measurement Tools

Abstract

Context: School-based nutrition interventions have the potential to promote dietary behaviors and other outcomes among children and adolescents. However, inconsistent reporting of outcomes and measurement tools limits evidence synthesis and the identification of effective intervention strategies.

Objective: This umbrella review aimed to synthesize the range of outcomes related to diet, health, well-being, and education reported in systematic reviews of school-based nutrition interventions, along with the measurement tools used. The findings will be used to inform the development of a Core Outcome Set (COS) to guide future evaluations in this field.

Data sources: We conducted a systematic search across 7 databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, Web of Science, and Scopus) to identify systematic reviews published from January 2018 to December 2023.

Data extraction: Data on outcomes related to diet, health, well-being, and education were extracted from eligible systematic reviews. When available, information on outcome measurement tools was also extracted. Additional details were retrieved from primary studies referenced within systematic reviews as needed.

Data analysis: Ninety-eight systematic reviews, comprising 965 unique studies, were included. Outcomes were categorized into 4 domains: (1) "diet" (68.8%), subdivided into "dietary intake" and "diet-related cognitive/attitudinal behaviors"; (2) "physical health" (44.8%), subdivided into "body composition" and "clinical/biochemical measures"; (3) "social and emotional well-being and behavior" (9.2%); and (4) "education" (6.4%). Substantial heterogeneity was observed across outcome domains, subdomains, and measurement tools, which presents challenges for evidence synthesis and limits comparability across studies.

Conclusions: The findings of this review underscore the need for a stakeholder-informed, context-aware COS to standardize outcome reporting in school-based nutrition interventions. Such standardization is essential to improve the comparability of research findings, enhance evidence synthesis, and facilitate the translation of evidence into policy and practice. Subsequent phases of this work will involve diverse stakeholder engagement to finalize the COS and recommend appropriate tools for outcome measurement for evaluating school-based nutrition interventions.

Systematic review registration: PROSPERO registration No. CRD42022378746.

Keywords: adolescents; children; nutrition intervention; outcomes; school.