Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis.
Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0194555
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Mozaffarian D
中科院分区：
文献类型：
--
作者：
Micha R;Karageorgou D;Bakogianni I;Trichia E;Whitsel LP;Story M;Peñalvo JL;Mozaffarian D
学校食品环境政策可能是促进儿童健康饮食的重要工具，但其有效性尚不清楚。系统地回顾和量化学校食品环境政策对儿童饮食习惯、肥胖和代谢风险的影响。我们系统地检索了在线数据库，以评估学校食品环境政策对儿童饮食习惯、肥胖或代谢危险因素的影响的随机或准实验干预措施。数据分别独立提取和重复提取，并使用反方差随机效应荟萃分析进行汇总。习惯性（校内+校外）饮食摄入是主要结果。采用元回归和亚组分析探讨异质性。漏斗图，Begg 's和Egger 's检验评估了潜在的发表偏倚。从6,636个摘要中，包括91个干预措施（55个在美国/加拿大，36个在欧洲/新西兰），直接提供健康食品/饮料（N = 39项研究），竞争性食品/饮料标准（N = 29）和学校膳食标准（N = 39）（一些干预措施评估多种政策）。直接供应政策主要针对水果和蔬菜，使水果的消费量增加了0.27份/天（n = 15估算值（95%CI: 0.17, 0.36）），水果和蔬菜的消费量增加了0.28份/天（n = 16 (0.17, 0.40)）；对蔬菜有轻微影响（n = 11; 0.04(0.01, 0.08)），对总热量没有影响（n = 6; -56 kcal/d(-174, 62)）。在以水为目标的干预措施中，习惯性摄入量保持不变（n = 3； 0.33杯/天（-0.27,0.93））。竞争性食品/饮料标准将含糖饮料的摄入量减少了0.18份/天（n = 3 (-0.31, -0.05)）；不健康的零食减少0.17份/天（n = 2(-0.22, -0.13)），对总热量没有影响（n = 5； -79千卡/天（- 179,21））。学校膳食标准（主要是午餐）增加了水果摄入量（n = 2； 0.76份/天（0.37,1.16份）），减少了总脂肪（-1.49%能量；n = 6(-2.42, -0.57)）、饱和脂肪（n = 4; -0.93%能量（-1.15,-0.70））和钠（n = 4； -170毫克/天（-242,-98））；但不是总热量（n = 8； -38千卡/天（- 137,62））。在17项评估肥胖的研究中，通常没有发现显著的减少；很少有研究评估代谢因素（血脂/血糖/血压），结果好坏参半。未发现异质性或发表偏倚的重要来源。具体的学校食品环境政策可以改善有针对性的饮食行为；对肥胖和代谢风险的影响需要进一步研究。这些发现为正在进行的关于改善儿童饮食习惯和健康的最佳做法的政策讨论和辩论提供了信息。
School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children’s dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg’s and Egger’s test evaluated potential publication bias. From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health.
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影响因子：
3.2
作者：
Ask, Anne Selvik;Hernes, Sigrunn;Haugen, Margaretha
通讯作者：
Haugen, Margaretha
影响因子：
--
作者：
Bartholomew, JB;Jowers, EM
通讯作者：
Jowers, EM
影响因子：
3.2
作者：
Anderson, AS;Porteous, LEG;Adamson, AJ
通讯作者：
Adamson, AJ
DOI：
10.3961/jpmph.2012.45.1.47
发表时间：
2012-01-01
期刊：
Journal of preventive medicine and public health = Yebang Uihakhoe chi
影响因子：
--
作者：
Bae, Sang Geun;Kim, Jong Yeon;Lee, Won Kee
通讯作者：
Lee, Won Kee
影响因子：
3.6
作者：
Bere, Elling;Hilsen, Marit;Klepp, Knut-Inge
通讯作者：
Klepp, Knut-Inge