Food and Nutrition: Interventions

Moderate postive impact based on low quality evidence with moderate resource implications

Impact

Resources

Evidence

Studies

5

Description

Description

Nutritional interventions are a set of actions intended to improve the nutritional status of an individual or population [Martínez-López 2022]. They are utilised to increase knowledge, change beliefs and attitudes about healthy eating, increase skills, and promote healthy eating [Brace 2018]. Over the last few years, there has been increased interest in understanding how to promote healthy nutrition in different population groups (especially in disadvantaged populations) [Gillies 2021] and how location and socio-economic status influence nutritional attitudes and behaviour [Wardle 2003; Alkerwi 2015].

Impact

Impact 

Nutritional interventions are an effective way to promote healthy dietary habits and thus promote better health outcomes. Interventions that are effective in high-income countries may not be effective in deprived settings or in low-income countries (LMICs) because of design issues.

Results

Results

A total of six reviews comprising over 100 primary studies were included. In general, these reviews examined strategies to promote healthier dietary behaviour. One review examined the impact of environmental interventions on eating behaviours at the workplace [Allan 2017]. A second review assessed the impact of interventions in small food stores on the food environment [Gittelsohn 2012]. The common intervention strategies included increasing the availability of healthier foods, point-of-purchase promotions (shelf labels, posters), and community engagement. 

A third review investigated the effect of community-based interventions on prepared-food sources [Gittelson 2013]. The fourth review assessed the effect of nutritional interventions on stunted growth in children aged 0-5 years living in urban slums in low- and middle-income countries (LMICs) [Goudet 2019]. The fifth review assessed nutritional interventions that could enhance nutritional status among urban poor children in sub-Saharan Africa [Mutisya 2021] and also involved a Delphi-based consultation. A sixth review evaluated the effectiveness of nutritional interventions aimed at improving access to fresh food in vulnerable communities [Smith 2013].

Food Promotion

  • Over half of the included studies (13/22) in the environmental workplace reported significant changes in primary measures of eating behaviour (increased consumption of fruit/veg, reduction in total calories purchased, and increased sales of healthy options) [Allan 2017].
  • In urban settings, cost-effective methods (e.g., labelling foods as healthful) may have a significant impact on prepared-food source sales and customer behaviour [Gittelson 2013].
  • Increased availability of healthy foods, improved sales of healthy foods, and improved consumer knowledge and dietary behaviours were associated with significant improvements in dietary behaviour [Gittelsohn 2012].
  • Nutritional interventions that had the potential to decrease stunting, based on evidence from outside of slum contexts, did not show significant results in slums in LMICs [Goudet 2019; Mutisya 2021].
  • There was a positive impact on low birth weight (LBW) of education interventions in pregnant women in slums in LMICs [Goudet 2019].
  • Food policy advocacy and supermarket tax incentives are effective ways to promote healthy community development [Smith 2013].

Strength of the evidence

Strength of the evidence

Five reviews provided information on the reporting quality. In [Allan 2017], eight studies had a high risk of bias, and no study had a low risk of bias. In [Gittelsohn 2012; Gittelson 2013], many of the interventions included in both reviews were not formal studies. In [Goudet 2019], the overall certainty of the evidence was very low to moderate. The overall risk of bias in [Mutisya 2021] was reported as moderate.

Recommendations

Recommendations

  • More rigorous, comprehensively reported studies that account for compensatory behaviours are required to fully understand the impact of environmental interventions on diet and, especially, on body weight indices.
  • Further research is required to determine the best combination of interventions for small-store trials.
  • Future research should investigate how to increase consumer demand for healthy foods through price manipulation.
  • Further exploration of strategies to increase more healthful food options in community-based prepared-food sources should be undertaken.
  • There is a need to standardize the outcome measures used by various interventions. 
  • Systematic inclusion of urban slums in nutrition‐sensitive and ‐specific interventions, as well as in national nutrition monitoring systems such as demographic and health surveys, should be a priority.
  • Urban poor community members should be engaged in identifying research gaps and potential solutions.

Related Resources

Related Resources

Reference to reviews

Reference to Reviews

Allan 2017. “Environmental interventions for altering eating behaviours of employees in the workplace: a systematic review.” Obesity reviews : an official journal of the International Association for the Study of Obesity vol. 18,2 (2017): 214-226. doi:10.1111/obr.12470.

Gittelsohn 2012 “Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease.” Preventing chronic disease vol. 9 (2012): E59.

Gittelsohn 2013. “Community-based interventions in prepared-food sources: a systematic review.” Preventing chronic disease vol. 10 E180. 31 Oct. 2013, doi:10.5888/pcd10.130073.

Goudet 2019. “Nutritional interventions for preventing stunting in children (birth to 59 months) living in urban slums in low- and middle-income countries (LMIC).” The Cochrane database of systematic reviews vol. 6,6 CD011695. 17 Jun. 2019, doi:10.1002/14651858.CD011695.pub2.

Mutisya 2013. “Improving nutritional status among urban poor children in sub-Saharan Africa: An evidence-informed Delphi-based consultation.” Maternal & child nutrition vol. 17,2 (2021): e13099. doi:10.1111/mcn.13099

Smith 2013. “Interventions to improve access to fresh food in vulnerable communities: A review of the literature.” Int J Disabil Hum Dev. 12(4); 2013:409-417. DOI: 10.1515/ijdhd-2013-0203