A school-based nutrition education program involving children and their guardians in Japan: facilitation of guardian-child communication and reduction of nutrition knowledge disparity

Background: Since the risk of noncommunicable diseases is closely associated with dietary intake, it is important to establish healthy dietary habits in childhood. Although several dietary education programs for children have been attempted, their implementation at school was often difficult due to overcrowded study curricula. We developed a new program which included homework for children and guardians, and evaluated its effect. Determinants of the effect were also investigated. Methods: The school-based nutrition education program including a 45-min lecture, a series of homework assignments involving children and guardians, and two handouts was implemented in 14 public primary schools in Japan. Seven schools each underwent the intervention in an alternating manner. Nutrition knowledge (percentage (%) of correct answers in the nutrition knowledge questionnaire) and attitude/behavior toward diet was evaluated three times (May (baseline), October, February) as outcomes. These factors and their changes following the intervention were assessed by linear mixed models to adjust for individual factors, with consideration to clustering of the participants and repeated measurements. Results: In total, 2227 children aged 10-12 years and their guardians participated. All schools completed the program. Children's nutrition knowledge level was significantly increased (8.7%, 95% confidence interval [7.7-9.7]) following the intervention. Communication between children and their guardians, which was positively related with nutrition knowledge, was facilitated by the intervention. The increase in nutrition knowledge was greater among children with a lower knowledge level at baseline. Conclusions: This school-based nutrition education program was effective and feasible. Appropriate teaching materials for homework can reduce the burden on schools and facilitate communication between children and guardians. Public schools can be crucial venues for decreasing disparities in nutrition knowledge.