Nutr Res Pract.  2022 Apr;16(2):217-232. 10.4162/nrp.2022.16.2.217.

Do school-based nutrition interventions improve the eating behavior of school-age children?

• Buyco NG
• Dorado JB
• Azaña GP
• Viajar RV
• Aguila DV
• Capanzana MV

• KMID: 2527812
• DOI: http://doi.org/10.4162/nrp.2022.16.2.217

Abstract

BACKGROUND/OBJECTIVES
Filipino children aged 6–10 yrs are consuming poor quantities and quality of food based on the 2013 Philippine National Nutrition Survey. During these years healthy eating habits must be formed through family influence. Within this background, a complete package of nutrition intervention—feeding and nutrition classes, was pilot tested in selected schools to determine 1) changes in nutrition attitude and behavior and 2) food intake of schoolchildren after the intervention.
SUBJECTS/METHODS
A quasi-experimental design was used in the study. School children aged 7–9 yrs enrolled in selected Philippine public elementary schools and their mothers/ caregivers were the study participants. Profile and socio-demographic data were collected from each participant at baseline. The nutrition behavior and food intake of children were determined using the modified Child and Diet Evaluation Tool (CADET) and the 24-h food recall form, respectively. Data were analyzed using Stata version 15.
RESULTS
No significant differences in characteristics were found among the 339 childmother pairs in the 4 study groups. The modified CADET recorded improved mean attitude scores of children ranging from 22 to 24 points at endline in the group receiving both lunch feeding and nutrition education classes (group 3). The perceived better behavior of children was reported by their mothers in terms of increased intake of milk and vegetables and decreased consumption of sugar. These improvements were supported by the actual food intake of children obtained from the 24-h food recall.
CONCLUSIONS
Family involvement, particularly of mothers/caregivers, appeared to be an important factor in shaping the children's eating behavior. An intervention package with lunch feeding and nutrition classes resulted in a substantial improvement in children's behavior and actual food intake with increased levels of vegetables and milk while lowering sugar consumption. The adoption of the intervention package in public elementary schools should therefore be pursued.

Keyword

Children; child malnutrition; eating behavior

Reference

1. Christian MS, Evans CEL, Hancock N, Nykjaer C, Cade JE. Family meals can help children reach their 5 a day: a cross-sectional survey of children's dietary intake from London primary schools. J Epidemiol Community Health. 2013; 67:332–338. PMID: 23254183.

2. Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI). Philippine Nutrition Facts and Figures 2013: Food Consumption Survey. Taguig: Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI);2015.

3. Angeles-Agdeppa I, Denney L, Toledo MB, Obligar VA, Jacquier EF, Carriquiry AL, Capanzana MV. Inadequate nutrient intakes in Filipino schoolchildren and adolescents are common among those from rural areas and poor families. Food Nutr Res. 2019; 63:3435.

4. Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI). Philippine Nutrition Facts and Figures 2015: Updating of Nutritional Status of Filipino Children and Other Population Groups Anthropometric Survey. Taguig: Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI);2016.

5. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. International Child Development Steering Group. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007; 369:60–70. PMID: 17208643.

6. Moxley RL, Jicha KA, Thompson GH. Testing the importance of family solidarity, community structure, information access, and social capital in predicting nutrition health knowledge and food choices in the Philippines. Ecol Food Nutr. 2011; 50:215–239. PMID: 21888580.

7. Scaglioni S, Arrizza C, Vecchi F, Tedeschi S. Determinants of children's eating behavior. Am J Clin Nutr. 2011; 94:2006S–2011S. PMID: 22089441.

8. Fisk CM, Crozier SR, Inskip HM, Godfrey KM, Cooper C, Robinson SM. Southampton Women's Survey Study Group. Influences on the quality of young children's diets: the importance of maternal food choices. Br J Nutr. 2011; 105:287–296. PMID: 20807465.

9. World Health Organization. Healthy diet [Internet]. Geneva: World Health Organization;2020. cited 2020 April 2. Available from: https://www.who.int/behealthy/healthy-diet.

10. Department of Education. DO 13, S. 2017 Policy and guideline on healthy food and beverage choices in schools and in Deped offices [Internet]. Pasig: Department of Education;2017. cited 2020 March 2. Available from: https://www.deped.gov.ph/wp-content/uploads/2017/03/DO_s2017_013.pdf.

11. Department of Education. DO 39, S. 2017 Operational guidelines on the implementation of school-based feeding program for school years 2017–2022 [Internet]. Pasig: Department of Education;2017. cited 2020 March 2. Available from: https://www.deped.gov.ph/2017/08/07/do-39-s-2017-operational-guidelines-on-the-implementation-of-school-based-feeding-program-for-school-years-2017-2022/.

12. Albert JRG, Tabunda AML, Angeles-Agdeppa I. Policy note 2015-01 feeding severely wasted children in school: examining processes in DepEd's school feeding program [Internet]. Philippine Institute for Development Studies;2015. cited 2020 March 31. Available from: https://pidswebs.pids.gov.ph/webportal/CDN/PUBLICATIONS/pidspn1501.pdf.

13. Department of Education. DM 293, S. 2007 Gulayan sa Paaralan [Internet]. Pasig: Department of Education;2007. cited 2020 March 31. Available from: https://www.deped.gov.ph/wp-content/uploads/2018/10/DM_s2007_293.pdf.

14. Scaglioni S, Salvioni M, Galimberti C. Influence of parental attitudes in the development of children eating behaviour. Br J Nutr. 2008; 99(Suppl 1):S22–S25. PMID: 18257948.

15. Cooke L. The importance of exposure for healthy eating in childhood: a review. J Hum Nutr Diet. 2007; 20:294–301. PMID: 17635306.

16. Lakkakula A, Geaghan J, Zanovec M, Pierce S, Tuuri G. Repeated taste exposure increases liking for vegetables by low-income elementary school children. Appetite. 2010; 55:226–231. PMID: 20541572.

17. Asakura K, Todoriki H, Sasaki S. Relationship between nutrition knowledge and dietary intake among primary school children in Japan: combined effect of children's and their guardians' knowledge. J Epidemiol. 2017; 27:483–491. PMID: 28576447.

18. Cade JE, Frear L, Greenwood DC. Assessment of diet in young children with an emphasis on fruit and vegetable intake: using CADET--Child and Diet Evaluation Tool. Public Health Nutr. 2006; 9:501–508. PMID: 16870023.

19. Christian MS, Evans CEL, Nykjaer C, Hancock N, Cade JE. Evaluation of the impact of a school gardening intervention on children's fruit and vegetable intake: a randomised controlled trial. Int J Behav Nutr Phys Act. 2014; 11:99. PMID: 25128211.

20. Evans C, Hutchinson J, Christian MS, Hancock N, Cade JE. Measures of low food variety and poor dietary quality in a cross-sectional study of London school children. Eur J Clin Nutr. 2018; 72:1497–1505. PMID: 29391590.

21. Christian MS, Evans CEL, Nykjaer C, Hancock N, Cade JE. Measuring diet in primary school children aged 8–11 years: validation of the Child and Diet Evaluation Tool (CADET) with an emphasis on fruit and vegetable intake. Eur J Clin Nutr. 2015; 69:234–241. PMID: 25139558.

22. Nekitsing C, Blundell-Birtill P, Cockroft JE, Hetherington MM. Taste exposure increases intake and nutrition education increased willingness to try an unfamiliar vegetable in preschool children: a cluster randomized trial. J Acad Nutr Diet. 2019; 119:2004–2013. PMID: 31378647.

23. Appleton KM, Hemingway A, Rajska J, Hartwell H. Repeated exposure and conditioning strategies for increasing vegetable liking and intake: systematic review and meta-analyses of the published literature. Am J Clin Nutr. 2018; 108:842–856. PMID: 30321277.

24. Zeinstra GG, Vrijhof M, Kremer S. Is repeated exposure the holy grail for increasing children's vegetable intake? Lessons learned from a Dutch childcare intervention using various vegetable preparations. Appetite. 2018; 121:316–325. PMID: 29158150.

25. Wardle J, Herrera ML, Cooke L, Gibson EL. Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable. Eur J Clin Nutr. 2003; 57:341–348. PMID: 12571670.

26. Fildes A, van Jaarsveld CHM, Wardle J, Cooke L. Parent-administered exposure to increase children's vegetable acceptance: a randomized controlled trial. J Acad Nutr Diet. 2014; 114:881–888. PMID: 24091061.

27. Poelman AAM, Delahunty CM, de Graaf C. Vegetables and other core food groups: a comparison of key flavour and texture properties. Food Qual Prefer. 2017; 56:1–7.

28. Cervato-Mancuso AM, Westphal MF, Araki EL, Bógus CM. School feeding programs' role in forming eating habits. Rev Paul Pediatr. 2013; 31:324–330. PMID: 24142314.

29. Cooke L. The importance of exposure for healthy eating in childhood: a review. J Hum Nutr Diet. 2007; 20:294–301. PMID: 17635306.

30. Aguilar FV. Rice in the Filipino diet and culture. PIDS discussion paper series, No. 2005–15 [Internet]. Makati: Philippine Institute for Development Studies (PIDS);2005. cited 2020 April 2. Available from: http://hdl.handle.net/10419/127896.

31. Caragay RN. Dietary pattern in a Philippine village: its determinants and improvement. Jpn J Health Hum Ecol. 1985; 51:224–238.

32. Gonzales JT, Raaij JV, Narciso ZV. Consumption pattern for fruits and vegetables of some Filipino adolescents in selected public schools in the city of Manila. J Nutr Disord Ther. 2016; 6:1000202.

33. Ransley JK, Taylor EF, Radwan Y, Kitchen MS, Greenwood DC, Cade JE. Does nutrition education in primary schools make a difference to children's fruit and vegetable consumption? Public Health Nutr. 2010; 13:1898–1904. PMID: 20338089.

34. Pem D, Jeewon R. Fruit and vegetable intake: benefits and progress of nutrition education interventions- narrative review article. Iran J Public Health. 2015; 44:1309–1321. PMID: 26576343.

35. Yeom MY, Cho YO. Nutrition education discouraging sugar intake results in higher nutrient density in diets of pre-school children. Nutr Res Pract. 2019; 13:434–443. PMID: 31583063.

36. Choi ES, Shin NR, Jung EI, Park HR, Lee HM, Song KH. A study on nutrition knowledge and dietary behavior of elementary school children in Seoul. Nutr Res Pract. 2008; 2:308–316. PMID: 20016735.

37. Pérez-Rodrigo C, Aranceta J. School-based nutrition education: lessons learned and new perspectives. Public Health Nutr. 2001; 4:131–139. PMID: 11255503.

38. Alamri E. Factors affecting food intake and the role of nutrition education in the understanding and implementation of healthy dietary habits in Saudi adolescent girls [doctoral thesis]. Plymouth: University of Plymouth;2017.

39. Moxley RL, Jicha KA, Thompson GH. Testing the importance of family solidarity, community structure, information access, and social capital in predicting nutrition health knowledge and food choices in the Philippines. Ecol Food Nutr. 2011; 50:215–239. PMID: 21888580.

40. Celik Ates H, Ceylan M. Effects of socio-economic factors on the consumption of milk, yoghurt, and cheese: insights from Turkey. Br Food J. 2010; 112:234–250.

41. Jenco M. AHA: limit children's sugar consumption to 6 teaspoons per day [Internet]. Itasca (IL): American Academy of Pediatrics;2016. cited 2020 March 2. Available from: https://www.aappublications.org/news/2016/08/23/Sugar082316.

42. Adamo KB, Brett KE. Parental perceptions and childhood dietary quality. Matern Child Health J. 2014; 18:978–995. PMID: 23817727.