Effectiveness of food and nutritional education activities in children under the age of two: a systematic review

Candido, Aline Carare; Oliveira, Fabiana de Cássia Carvalho

doi:10.1590/1806-9304202400000240-en

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REVIEW • Rev. Bras. Saude Mater. Infant. 24 • 2024 • https://doi.org/10.1590/1806-9304202400000240-en copy

Effectiveness of food and nutritional education activities in children under the age of two: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate the effectiveness of food and nutritional education on children up to the age of two.

Methods:

the systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The research was carried out in 2022 in the Virtual Health Library/Lilacs, Pubmed/Medline and Science Direct databases. The articles were selected independently using the Microsoft Excel® program. Articles that evaluated food and nutritional education applied on children up to the age of two were included. The risk of bias was assessed using the Joanna Briggs Institute tool.

Results:

the research resulted in 1,523 studies and nine were included in the review. The articles presented a low risk of bias and good methodological quality. Food and nutritional education strategies were developed especially with the children’s parents. Workshops, lectures, and teaching materials were developed. In most of the studies, the activities developed helped to improve children’s health and eating patterns.

Conclusion:

food and nutritional education activities have therefore been effective in building healthy eating habits at childhood. Prospero registration: CRD42022325608.

Key words
Food and nutritional education; Child health; Healthy eating; Child

Authors/Year	Location/ Design	Population	FNE Strategy	Intervention duration	Main outcomes	Conclusions
Bhandari et al.,¹²12 Bhandari N, Mazumder S, Bahl R, Martines J, Black RE, Bhan MK, et al. An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. J Nutr. 2004 Sep; 134 (9): 2342-8. 2004	India/ Randomized Clinical	1,025 children aged 6 to 18 months Intervention: 552 Control: 473	Home visits, cooking workshops, debates about complementary feeding, street plays, posters, flipbooks, and folders with guidelines about feeding.	The children were followed up every 3 months until the age of 18 months.	The boys in the intervention group showed greater length at 12 months (p=0.035) and a greater increment in length between 6 and 12 months of age (p=0.035). Better eating habits were also observed in this group.	Although FNE strategies improved feeding practices, the effect on physical growth varied. Therefore, interventions need to take into account gender differences.
Fahmida et al.,¹³13 Fahmida U, Htet MK, Ferguson E, Do TT, Buanasita A, Titaley C, et al. Effect of an Integrated Package of Nutrition Behavior Change Interventions on Infant and Young Child Feeding Practices and Child Growth from Birth to 18 Months: Cohort Evaluation of the Baduta Cluster Randomized Controlled Trial in East Java, Indonesia. Nutrients. 2020 Dec; 12 (12): 3851. 2020	Indonesia/ Randomized cohort	691 children from 0 to 18 months Intervention: 346 Control: 345	Media campaigns and activities were carried out on nutrition during pregnancy, breastfeeding, complementary feeding and hand washing.	The pregnant women were followed up during the third trimester until 18 months postpartum.	Among breastfed children, the percentage of children who achieved the minimum DDS and MAD was higher for the intervention group. The odds ratios were 3.49 and 2.79 for DDS and 3.49 and 2.74 for MAD in the 9 -11 month and 16 -18 month groups, respectively.	The intervention was effective in improving children’s eating practices, but not in improving their linear growth.
Roy et al.,¹⁴14 Roy SK, Jolly SP, Shafique S, Fuchs GJ, Mahmud Z, Chakraborty B, et al. Prevention of malnutrition among young children in rural Bangladesh by a food-health-care educational intervention: a randomized, controlled trial. Food Nutr Bull. 2007 Dec; 28 (4): 375-83. 2007	Bangladesh/ Randomized Clinical	576 children aged 6 to 9 months Intervention: 294 Control: 282	FNE activities based on the UNICEF nutritional triangle concept.	Once a week for the first 3 months and once every 2 weeks for the other 3 months.	83.8% of the mothers started to offer the food at least three times a day to their children, compared to 19.4% in the control group (p<001). Weight gain was greater in the intervention group, with improved nutritional status (1.81 vs. 1.39 kg, p<0.001).	FNE strategies, when appropriate to the regions and based on the nutritional triangle model, prevent stunting and malnutrition among children.
Shi et al.,¹⁵15 Shi L, Zhang J, Wang Y, Caulfield LE, Guyer B. Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial. Public Health Nutr. 2010 Apr; 13 (4): 556-65. 2010	China/ Randomized Clinical	599 children aged 2 to 12 months Intervention: 294 Control: 305	Workshops were held to teach healthy recipes and food hygiene, booklets on infant feeding were prepared, and home visits were made.	1 year. The visits occurred at 6, 9, and 12 months of age of the children.	Dietary diversity, meal frequency and hygiene practices improved in the intervention group. Infants in the intervention group gained 0.22 kg more (p=0.047) and gained 0.66 cm more (p=0.04) than in the controls.	FNE strategies provided by local health professionals can lead to behavioral changes in caregivers and improve child growth.
BortolinI and Vitolo,¹⁶16 Bortolini GA, Vitolo MR. The impact of systematic dietary counseling during the first year of life on anemia and iron deficiency prevalence rates at 12-16 months. J Pediatr. 2012; 88: 33-9. 2012	Brazil/ Randomized clinical	397 children between 0 and 12 months Intervention: 163 Control: 234	Dietary Guidelines for the Ten Steps to Healthy Eating for Children Under two years of age.	10 home visits conducted in the first 10 days after birth, monthly until 6 months and at 8, 10 and 12 months.	In the intervention group there was improved eating pattern, higher consumption of meat, lower consumption of cow’s milk than the children in the control group.	The intervention did not result in a reduction in the prevalence of anemia and iron deficiency. But dietary changes were observed in the intervention group.
Daniels et al.,¹⁷17 Daniels LA, Mallan KM, Battistutta D, Nicholson JM, Meedeniya JE, Bayer JK, et al. Child eating behavior outcomes of an early feeding intervention to reduce risk indicators for child obesity: the NOURISH RCT. Obesity (Silver Spring). 2014 May; 22 (5): E104-11. 2014	Australia/ Randomized Clinical	397 children aged 0-12 months Intervention: 163 Control: 234	Exposure activities to unfamiliar and unhealthy foods, feeding responsive to hunger and satiety signals, and activities to encourage autonomy.	The intervention started with children aged 4-7 months. The second module started 6 months after the completion of the first with children aged 13-16 months.	Children in the intervention group were rated with higher scores for satiety responsiveness (p=0.03) and lower scores for emotional excess (p=0.009) and restlessness (p=0.01). The children also liked fruit more (p=0.008) and were exposed to a greater variety of vegetables (p=0.008).		The application of FNE on eating practices impacts aspects of the child’s “obesogenic” eating behavior, food preferences, and diet quality.
Fangupo et al.,¹⁸18 Fangupo LJ, Heath AL, Williams SM, Somerville MR, Lawrence JA, Gray AR, et al. Impact of an early-life intervention on the nutrition behaviors of 2-y-old children: a randomized controlled trial. Am J Clin Nutr. 2015 Sep; 102 (3): 704-12. 2015	New Zealand/ Randomized Clinical	666 children aged 0 to 18 months Intervention: 325 Control: 341	Interactive workshops with healthy snacks and drink ideas, healthy food shopping, and label reading.	Home visits at 4, 7, 13 and 18 months of age.	The children in the intervention group had more control over their eating and less pressure to eat at 18 months, as well as more encouragement to consume healthy food at 24 months.		Interventions that focus on education and feeding support do not seem to be sufficient to change the parents and children’s diet.
Roche et al.,¹⁹19 Roche ML, Marquis GS, Gyorkos TW, Blouin B, Sarsoza J, Kuhnlein HV, et al. A community-based positive deviance/hearth infant and young child nutrition intervention in Ecuador improved diet and reduced underweight. J Nutr Educ Behav. 2017 Mar; 49 (3): 196-203.e1. 2016	Ecuador/ Randomized Clinical	264 children aged 0 to 24 months Intervention: 80 Control: 184	Workshops on healthy recipes using local food, food hygiene, responsive eating, and organization.	Home visit every 2 weeks for 4 months. And FNE activities for 12 days.	In the intervention, children consumed more iron, zinc, vitamin A, protein and energy (p<0.05). The prevalence of low weight decreased from 30.4% to 23.7% and the prevalence of very low weight decreased from 10.0% to 1.3%.		The FNE strategies helped mothers to improve nutritional practices and reduced the incidence of low weight in children.
Cândido et al.,²⁰20 Cândido NA, Sousa TM, Santos LC. Effectiveness of different interventions in public nurseries based on food and nutrition education: promoting breast-feeding and healthy complementary feeding. Public Health Nutr. 2018 Sep; 21 (13): 2454-61. 2018	Brazil/ Randomized clinical	169 children from 4 to 24 months Intervention: 72 Control: 97	Activities on consistency of baby food, offering rejected food, healthy eating, and food to be avoided.	For the children, the average time of the interventions was 50 minutes, for the professionals there were 4 meetings of 8 hours, and for the parents and guardians there were meetings with a total duration of 5 hours.	The consistency of food offered to infants evolved from ‘pureed’ to ‘like the rest of the family’ after the 8-month interval. There were improvements among parents regarding beliefs (soups and broths do not nourish my child: p=0.012), and intentions (not offering soups and broths: p=0.003; offering vegetables: p=0.018; offering meat: p<0.001).		The intervention using FNE strategies impacted on the parameters evaluated, denoting the importance of its application in child care to improve the introduction of food.

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[1] Associated Editor: Nathália Souza