Effect of Food Environment Interventions on Anthropometric Outcomes in School-Aged Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

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Abstract
Food environments may promote access to unhealthy foods, contributing to non-communicable diseases in low- and middle- income countries (LMICs). This review assessed published evidence on the effects of food environment interventions on anthropometric (BMI and weight-status) outcomes in school-aged children (5–9 years) and adolescents (10–19 years) (SACA) in LMICs. We summarized randomized controlled trials (RCTs) and quasi-experimental studies (QES) published since 2000 to August 2019 in the peer-reviewed and grey literature that assessed the effects of food-related behavioural and environmental interventions on diet-related health outcomes in SACA in LMICs. Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched using appropriate keywords, MeSH, and free text terms. Eleven RCTs and six QES met the inclusion criteria, testing multicomponent behavioural and environmental interventions in schools. Analysis of six RCTs (n = 17,054) suggested an overall effect on change in BMI (mean difference (MD): -0·11, 95 per cent confidence interval (95 per cent CI) -0·19, -0·03), whereas there was no observed effect in five studies using endline BMI (n = 17,371) (MD: 0·05, 95 per cent CI: -0·32, 0·21). There was no significant pooled effect among the three QES (n = 5,023) that reported differences in change in BMI or endline (MD: -0·37, (95 per cent CI: -0·95, 0·22). There is limited evidence to support the modification of diet-related health outcomes through school-based food environment interventions in SACA in LMICs. Further studies are needed to understand the impact of school and community-based food environment interventions on nutritional status in this population.
Funding Information
  • University of Toronto (0001/2017/471141)

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