Primary school interventions to promote fruit and vegetable consumption: A systematic review and meta-analysis

Objective. The consumption of fruits and vegetables (FV) may contribute to the prevention of many diseases. However, children at school age do not cat an enough amount of those foods. We have systematically reviewed the literature to assess the effectiveness of school interventions for promoting the consumption of FV. Methods. We performed a search in MEDLINE, EMBASE, CINAHL and CENTRAL We pooled results and stratified the analysis according to type of intervention and study design. Results. Nineteen cluster studies were included. Most studies did not describe randomization method and did not take the cluster's effect into account. Pooled results of two randomized controlled trials (RCTs) of computer-based interventions showed effectiveness in improving consumption of FV [Standardized Mean Difference (SMD) 0.33 (95% CI 0.16. 0.50)]. No significant differences were found in pooled analysis of seven RCTs of multicomponent interventions or pooling results of two RCTs evaluating free/subsidized FV interventions. Conclusions. Meta-analysis shows that computer-based interventions were effective in increasing FV consumption. Multicomponent interventions and free/subsidized FV interventions were not effective. Improvements in methodology are needed in future cluster studies. Although these results are preliminary, computer-based interventions could be considered in schools, given that they are effective and cheaper than other alternatives. (C) 2011 Elsevier Inc. All rights reserved.