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Systematic Reviews
Published in: Systematic Reviews 1/2021

Open Access 01-12-2021 | Obesity | Protocol

Effects of nutrition intervention strategies in the primary prevention of overweight and obesity in school settings: a protocol for a systematic review and network meta-analysis

Authors: Edris Nury, Jakub Morze, Kathrin Grummich, Gerta Rücker, Georg Hoffmann, Claudia M. Angele, Jürgen M. Steinacker, Johanna Conrad, Daniela Schmid, Jörg J. Meerpohl, Lukas Schwingshackl

Published in: Systematic Reviews | Issue 1/2021

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Abstract

Background

Overweight and obesity in children and adolescents are major public health challenges affecting quality of life and representing important risk factors in the development of non-communicable diseases. School environments provide great possibilities for the primary prevention of overweight and obesity and different school-based nutrition interventions are available. However, existing research on school-based nutrition interventions has important limitations and no network meta-analysis (NMA) has been performed yet to compare all available interventions. Therefore, the present research project aims to investigate the impact of different nutrition interventions in the school setting by comparing and ranking them using NMA methodology.

Methods/design

A systematic literature search will be performed in 11 electronic databases (PubMed, the Cochrane Library, Web of Science, ERIC, PsycINFO, CAB Abstracts, Campbell Library, BiblioMap EPPI, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice Database and Practice-based Evidence in Nutrition Database). Parallel or cluster randomized controlled trials (RCTs) meeting the following criteria will be included: (1) generally healthy school students aged 4–18 years, (2) school-based intervention with ≥ 1 nutrition component, and (3) assessed anthropometric (overweight/obesity risk, body weight change, weight Z-score, [standardized] body mass index, body fat, waist circumference) and/or diet-quality measures (daily intake of fruits and vegetables, fat, and sugar-sweetened beverages). Random effects pairwise and NMA will be performed for these outcomes and surface under the cumulative ranking curve (SUCRA) estimated (P-score). Where possible, component NMA (CNMA) will be used additionally. Subgroup analyses are carried out for intervention duration, gender, age of school students, socioeconomic status, and geographical location, and sensitivity analyses by excluding high risk of bias RCTs.

Discussion

This systematic review and NMA will be the first to both directly and indirectly compare and rank different school-based nutrition interventions for the primary prevention of overweight and obesity in childhood and adolescence. Our analyses will provide important insights about the effects of the different interventions and show which are the most promising. The results of our study can help inform the design of new studies and will be of value to anyone interested in developing successful, evidence-based nutrition interventions in school settings.

Systematic review registration

PROSPERO: CRD42020220451.
Appendix
Available only for authorised users
Literature
1.
Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ. 2012;345:e4759.PubMedPubMedCentralCrossRef
2.
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736–88.CrossRef
3.
Lobstein T, Jackson-Leach R. Planning for the worst: estimates of obesity and comorbidities in school-age children in 2025. Pediatr Obes. 2016;11(5):321–5.PubMedCrossRef
4.
Llewellyn A, Simmonds M, Owen CG, Woolacott N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev. 2016;17(1):56–67.PubMedCrossRef
5.
6.
7.
Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.CrossRef
8.
9.
10.
Leech RM, McNaughton SA, Timperio A. The clustering of diet, physical activity and sedentary behavior in children and adolescents: a review. Int J Behav Nutri Phys Act. 2014;11:4.CrossRef
11.
12.
Francis DK, Van den Broeck J, Younger N, McFarlane S, Rudder K, Gordon-Strachan G, et al. Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents. Public Health Nutr. 2009;12(8):1106–14.PubMedCrossRef
13.
James J, Kerr D. Prevention of childhood obesity by reducing soft drinks. Int J Obes (2005). 2005;29 Suppl 2:S54–7.CrossRef
14.
Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ (Clinical research ed). 2012;346:e7492.
15.
Keller A. Bucher Della Torre S. Sugar-sweetened beverages and obesity among children and adolescents: a review of systematic literature reviews. Child Obes. 2015;11(4):338–46.PubMedPubMedCentralCrossRef
16.
Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(4):1084–102.PubMedPubMedCentralCrossRef
17.
Della Corte K, Fife J, Gardner A, Murphy BL, Kleis L, Della Corte D, et al. World trends in sugar-sweetened beverage and dietary sugar intakes in children and adolescents: a systematic review. Nutr Rev. 2020;79(3):274–88.
18.
Cecchini M, Warin L. Impact of food labelling systems on food choices and eating behaviours: a systematic review and meta-analysis of randomized studies. Obes Rev. 2016;17(3):201–10.PubMedCrossRef
19.
Currie C, Roberts C, Settertobulte W, Morgan A, Smith R, Samdal O, et al. Young people’s health in context : Health Behaviour in School-aged Children (HBSC) study : international report from the 2001/2002 survey / edited by Candace Currie ... [et al.]. Copenhagen: WHO Regional Office for Europe; 2004.
20.
Pomerleau J, Lock K, McKee M, Altmann DR. The challenge of measuring global fruit and vegetable intake. J Nutr. 2004;134(5):1175–80.PubMedCrossRef
21.
World Health Organization. Diet, nutrition, and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. WHO Technical Report Series 916. Geneva: World Health Organization; 2003.
22.
Kovács E, Siani A, Konstabel K, Hadjigeorgiou C, de Bourdeaudhuij I, Eiben G, et al. Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study. Int J Obes. 2014;38(2):S144–S51.CrossRef
23.
24.
Newens KJ, Walton J. A review of sugar consumption from nationally representative dietary surveys across the world. J Hum Nutr Diet. 2016;29(2):225–40.PubMedCrossRef
25.
26.
Qin Z, Xu F, Ye Q, Zhou H, Li C, He J, et al. Sugar-sweetened beverages and school students' hypertension in urban areas of Nanjing, China. J Hum Hypertens. 2018;32(6):392–6.PubMedCrossRef
27.
Chan TF, Lin WT, Huang HL, Lee CY, Wu PW, Chiu YW, et al. Consumption of sugar-sweetened beverages is associated with components of the metabolic syndrome in adolescents. Nutrients. 2014;6(5):2088–103.PubMedPubMedCentralCrossRef
28.
Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010. Am J Clin Nutr. 2013;98(1):180–8.PubMedCrossRef
29.
Brand-Miller JC, Barclay AW. Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention. Am J Clin Nutr. 2017;105(4):854–63.PubMedCrossRef
30.
Aburto TC, Pedraza LS, Sánchez-Pimienta TG, Batis C, Rivera JA. Discretionary foods have a high contribution and fruit, vegetables, and legumes have a low contribution to the total energy intake of the Mexican population. J Nutr. 2016;146(9):1881s–7s.PubMedCrossRef
31.
Varnaccia G, Zeiher J, Lange C, Jordan S. Adipositasrelevante Einflussfaktoren im Kindesalter – Aufbau eines bevölkerungsweiten Monitorings in Deutschland. J Health Monit. 2017;2(2):90–102.
32.
Dudley DA, Cotton WG, Peralta LR. Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2015;12:28.PubMedPubMedCentralCrossRef
33.
Evans CE, Christian MS, Cleghorn CL, Greenwood DC, Cade JE. Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y. Am J Clin Nutr. 2012;96(4):889–901.PubMedCrossRef
34.
Jaime PC, Lock K. Do school based food and nutrition policies improve diet and reduce obesity? Prev Med. 2009;48(1):45–53.PubMedCrossRef
35.
Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, et al. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev. 2014;(4):Cd008958.
36.
Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Public Health (Oxford, England). 2012;34(3):360–9.CrossRef
37.
Katz DL, O'Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (2005). 2008;32(12):1780–9.CrossRef
38.
Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton-McHarg T, Tzelepis F, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2018;5:Cd008552.PubMed
39.
Nekitsing C, Blundell-Birtill P, Cockroft JE, Hetherington MM. Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years. Appetite. 2018;127:138–54.PubMedCrossRef
40.
Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. Effectiveness of school food environment policies on children’s dietary behaviors: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0194555.PubMedPubMedCentralCrossRef
41.
Feng L, Wei DM, Lin ST, Maddison R, Ni Mhurchu C, Jiang Y, et al. Systematic review and meta-analysis of school-based obesity interventions in mainland China. PLoS One. 2017;12(9):e0184704.PubMedPubMedCentralCrossRef
42.
Gori D, Guaraldi F, Cinocca S, Moser G, Rucci P, Fantini MP. Effectiveness of educational and lifestyle interventions to prevent paediatric obesity: systematic review and meta-analyses of randomized and non-randomized controlled trials. Obes Sci Pract. 2017;3(3):235–48.PubMedPubMedCentralCrossRef
43.
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777–84.PubMedCrossRef
44.
St Leger L, Young I, Perry M. Achieving health promoting schools: Guidelines for promoting health in schools. In: Version 2 of the document formerly known as "Protocols and guidelines for health promoting schools"; 2008.
45.
Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008;121(4):e794–802.PubMedCrossRef
46.
Hoppu U, Lehtisalo J, Kujala J, Keso T, Garam S, Tapanainen H, et al. The diet of adolescents can be improved by school intervention. Public Health Nutr. 2010;13(6a):973–9.PubMedCrossRef
47.
Lytle LA, Murray DM, Perry CL, Story M, Birnbaum AS, Kubik MY, et al. School-based approaches to affect adolescents’ diets: results from the TEENS study. Health Educ Behav. 2004;31(2):270–87.PubMedCrossRef
48.
Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ (Clinical research ed). 2001;323(7320):1029–32.CrossRef
49.
Ensaff H, Crawford R, Russell JM, Barker ME. Preparing and sharing food: a quantitative analysis of a primary school-based food intervention. J Public Health (Oxford, England). 2017;39(3):567–73.
50.
Evans A, Ranjit N, Hoelscher D, Jovanovic C, Lopez M, McIntosh A, et al. Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial. BMC Public Health. 2016;16:973.PubMedPubMedCentralCrossRef
51.
Nicklas TA, Johnson CC, Myers L, Farris RP, Cunningham A. Outcomes of a high school program to increase fruit and vegetable consumption: Gimme 5--a fresh nutrition concept for students. J School Health. 1998;68(6):248–53.PubMedCrossRef
52.
Williamson DA, Champagne CM, Harsha DW, Han H, Martin CK, Newton RL Jr, et al. Effect of an environmental school-based obesity prevention program on changes in body fat and body weight: a randomized trial. Obesity (Silver Spring, Md). 2012;20(8):1653–61.CrossRef
53.
Ask AS, Hernes S, Aarek I, Vik F, Brodahl C, Haugen M. Serving of free school lunch to secondary-school pupils - a pilot study with health implications. Public Health Nutr. 2010;13(2):238–44.PubMedCrossRef
54.
Bartholomew JB, Jowers EM. Increasing frequency of lower-fat entrees offered at school lunch: an environmental change strategy to increase healthful selections. J Am Diet Assoc. 2006;106(2):248–52.PubMedCrossRef
55.
Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, et al. Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003;78(5):1030–8.PubMedCrossRef
56.
Colin-Ramirez E, Castillo-Martinez L, Orea-Tejeda A, Vergara-Castaneda A, Keirns-Davis C, Villa-Romero A. Outcomes of a school-based intervention (RESCATE) to improve physical activity patterns in Mexican children aged 8-10 years. Health Educ Res. 2010;25(6):1042–9.PubMedCrossRef
57.
Brandstetter S, Klenk J, Berg S, Galm C, Fritz M, Peter R, et al. Overweight prevention implemented by primary school teachers: a randomised controlled trial. Obes Facts. 2012;5(1):1–11.PubMedCrossRef
58.
Kobel S, Wirt T, Schreiber A, Kesztyüs D, Kettner S, Erkelenz N, et al. Intervention effects of a school-based health promotion programme on obesity related behavioural outcomes. J Obes. 2014;2014:476230.PubMedPubMedCentralCrossRef
59.
Greene KN, Gabrielyan G, Just DR, Wansink B. Fruit-promoting smarter lunchrooms interventions: results from a cluster RCT. Am J Prev Med. 2017;52(4):451–8.PubMedCrossRef
60.
Anderson AS, Porteous LE, Foster E, Higgins C, Stead M, Hetherington M, et al. The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables. Public Health Nutr. 2005;8(6):650–6.PubMedCrossRef
61.
Bere E, Veierod MB, Klepp KI. The Norwegian School Fruit Programme: evaluating paid vs. no-cost subscriptions. Prev Med. 2005;41(2):463–70.PubMedCrossRef
62.
Te Velde SJ, Brug J, Wind M, Hildonen C, Bjelland M, Perez-Rodrigo C, et al. Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study. Br J Nutr. 2008;99(4):893–903.CrossRef
63.
Muckelbauer R, Libuda L, Clausen K, Toschke AM, Reinehr T, Kersting M. Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics. 2009;123(4):e661–7.PubMedCrossRef
64.
Kocken PL, Eeuwijk J, Van Kesteren NM, Dusseldorp E, Buijs G, Bassa-Dafesh Z, et al. Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study. J School Health. 2012;82(3):115–22.PubMedCrossRef
65.
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–7.PubMedPubMedCentralCrossRef
66.
67.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ (Clinical research ed). 2000;320(7244):1240–3.CrossRef
68.
Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT, et al. Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr. 1994;72(4):619–43.PubMedCrossRef
69.
The EndNote Team. EndNote. EndNote X9 ed. Philadelphia: Clarivate Analytics; 2013.
70.
71.
Uhlmann L, Jensen K, Kieser M. Bayesian network meta-analysis for cluster randomized trials with binary outcomes. Res Synth Methods. 2017;8(2):236–50.PubMedCrossRef
72.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2019;366:l4898.
73.
Eldridge S, Campbell M, Campbell MJ, Drahota-Towns A, Giraudeau B, Higgins J, et al., editors. Revised Cochrane risk of bias tool for randomized trials (RoB 2.0): additional considerations for cluster-randomized trials 2016.
74.
75.
Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Methods. 2012;3(2):80–97.CrossRefPubMed
76.
Chaimani A, Higgins JPT, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network meta-analysis in STATA. PLoS One. 2013;8(10):e76654-e.CrossRef
77.
Chaimani A, Caldwell DM, Li T, Higgins JPT, Salanti G. Undertaking network meta-analyses. In: Cochrane Handbook for Systematic Reviews of Interventions; 2019. p. 285–320.CrossRef
78.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed). 2003;327(7414):557.CrossRef
79.
80.
Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.PubMedCrossRef
81.
82.
Welton NJ, Caldwell DM, Adamopoulos E, Vedhara K. Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. Am J Epidemiol. 2009;169(9):1158–65.PubMedCrossRef
83.
84.
Schwingshackl L, Schwarzer G, Rucker G, Meerpohl JJ. Perspective: Network Meta-analysis Reaches Nutrition Research: Current Status, Scientific Concepts, and Future Directions. Adv Nutr (Bethesda, Md). 2019;10(5):739–54.CrossRef
85.
Kobel S, Lämmle C, Wartha O, Kesztyüs D, Wirt T, Steinacker JM. Effects of a randomised controlled school-based health promotion intervention on obesity related behavioural outcomes of children with migration background. J Immigr Minor Health. 2017;19(2):254–62.PubMedCrossRef
86.
Chaimani A, Salanti G. Using network meta-analysis to evaluate the existence of small-study effects in a network of interventions. Res Synth Methods. 2012;3(2):161–76.PubMedCrossRef
87.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed). 1997;315(7109):629–34.CrossRef
88.
Brignardello-Petersen R, Bonner A, Alexander PE, Siemieniuk RA, Furukawa TA, Rochwerg B, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol. 2018;93:36–44.PubMedCrossRef
89.
Nikolakopoulou A, Mavridis D, Salanti G. Planning future studies based on the precision of network meta-analysis results. Stat Med. 2016;35(7):978–1000.PubMedCrossRef
90.
Salanti G, Nikolakopoulou A, Sutton AJ, Reichenbach S, Trelle S, Naci H, et al. Planning a future randomized clinical trial based on a network of relevant past trials. Trials. 2018;19(1):365.PubMedPubMedCentralCrossRef
91.
Nikolakopoulou A, Mavridis D, Salanti G. Using conditional power of network meta-analysis (NMA) to inform the design of future clinical trials. Biom J. 2014;56(6):973–90.PubMedCrossRef
92.
Nikolakopoulou A, Mavridis D, Egger M, Salanti G. Continuously updated network meta-analysis and statistical monitoring for timely decision-making. Stat Methods Med Res. 2018;27(5):1312–30.PubMedCrossRef
Metadata
Title
Effects of nutrition intervention strategies in the primary prevention of overweight and obesity in school settings: a protocol for a systematic review and network meta-analysis
Authors
Edris Nury
Jakub Morze
Kathrin Grummich
Gerta Rücker
Georg Hoffmann
Claudia M. Angele
Jürgen M. Steinacker
Johanna Conrad
Daniela Schmid
Jörg J. Meerpohl
Lukas Schwingshackl
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2021
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-021-01661-1

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