A Systematic Review of the Impact of Multi-Strategy Nutrition Education Programs on Health and Nutrition of Adolescents.

OBJECTIVE: To update evidence on the impact of multi-strategy nutrition education interventions on adolescents' health and nutrition outcomes and behaviors.

DESIGN: Systematic review of randomized controlled studies of multi-strategy interventions encompassing nutrition education published from 2000 to 2014 guided by the Preferred Reported Items for Systematic Reviews and Meta-analyses statement.

SETTING: Secondary schools in developed countries.

PARTICIPANTS: Adolescents aged 10-18 years.

MAIN OUTCOME MEASURES: Anthropometric and dietary intake.

ANALYSIS: Systematic search of 7,009 unduplicated articles and review of 11 studies (13 articles) meeting inclusion criteria using qualitative comparison.

RESULTS: Four studies reported significant changes in anthropometric measures and 9 showed significant changes in dietary intake. Type of nutrition education varied. Components of the interventions that showed statistically significant changes in anthropometric and dietary intake included facilitation of the programs by school staff and teachers, parental involvement, and using theoretical models to guide the intervention's development. Changes in canteens, food supply, and vending machines were associated with significant changes in dietary intake.

CONCLUSIONS AND IMPLICATIONS: Multi-strategy interventions can have significant impacts on nutrition of adolescents when the nutrition education is theoretically based and facilitated by school staff in conjunction with parents and families, and includes changes to the school food environment.