A systematic review of interventions to improve the diet of children

Aim The purpose of this systematic review was to evaluate robust interventions across seven eating practice outcomes and to consider potential modifiers, including parental involvement, intervention setting, and quality of food practice evaluation. Methods The search procedure reflected Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Web of Science, PsychInfo, PubMed, and Elton B. Stephens Company (EBSCO) (2004-2019) were searched for studies that aimed to change children's (2 to 12 years old) diet (one or more eating practice components: fruit, vegetables, whole grains, lower saturated fat, lower sugar-sweetened beverages (SSBs), intake of dairy, diet quality). Of 2316 papers, 22 met inclusion criteria. Results Fruits (n = 12) and vegetables (n = 15) were the most frequent outcomes. Half of fruit-targeted, two-thirds of vegetable-targeted, half of fruit/vegetable-targeted, eight of nine SSB-targeted, and one of two whole grain-targeted outcomes showed significant improvements. The actual food intake change was modest in most cases. Eighteen interventions included parents, although the four that did not also reported significant outcomes. Most studies were conducted in schools, early childcare, or after-school programs (n = 13) with significant improvements in most settings. Only about half of the studies involving children < 10 years used proxy reporting/direct observation. Eight studies included no reliability, validity, or citation for the method of dietary measurement. Conclusion Robust studies continue to focus on one or two foods, parental involvement may be beneficial depending on the intervention, and more research is needed to establish best practices across all settings.