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      Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis

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          Abstract

          Background

          Healthy eating by primary school-aged children is important for good health and development. Schools can play an important role in the education and promotion of healthy eating among children. The aim of this review was to: 1) perform a systematic review of randomised controlled, quasi-experimental and cluster controlled trials examining the school-based teaching interventions that improve the eating habits of primary school children; and 2) perform a meta-analysis to determine the effect of those interventions.

          Methods

          The systematic review was limited to four healthy eating outcomes: reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; reduced sugar consumption or preference (not from whole fruit); increased nutritional knowledge. In March 2014, we searched seven electronic databases using predefined keywords for intervention studies that were conducted in primary schools which focused on the four healthy eating outcomes. Targeted internet searching using Google Scholar was also used. In excess of 200,000 possible citations were identified. Abstracts and full text of articles of potentially relevant papers were screened to determine eligibility. Data pertaining to teaching strategies that reported on healthy eating outcomes for primary school children was extracted from the 49 eligible papers.

          Results

          Experiential learning strategies were associated with the largest effects across the reduced food consumption or energy intake; increased fruit and vegetable consumption or preference; and increased nutritional knowledge outcomes. Reducing sugar consumption and preference was most influenced by cross-curricular approaches embedded in the interventions.

          Conclusions

          As with most educational interventions, most of the teaching strategies extracted from the intervention studies led to positive changes in primary school children’s healthy eating behaviours. However, given the finite resources, increased overcrowding of school curriculum and capacity of teachers in primary schools, a meta-analysis of this scope is able to provide stakeholders with the best evidence of where these resources should be focused.

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          Most cited references 80

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          Quantitative methods in psychology: a power primer.

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            The nutrition transition: worldwide obesity dynamics and their determinants.

            This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity. Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children. Youth and adults from a range of countries around the world. The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults. The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor.
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              Hypothesis: could excessive fructose intake and uric acid cause type 2 diabetes?

              We propose that excessive fructose intake (>50 g/d) may be one of the underlying etiologies of metabolic syndrome and type 2 diabetes. The primary sources of fructose are sugar (sucrose) and high fructose corn syrup. First, fructose intake correlates closely with the rate of diabetes worldwide. Second, unlike other sugars, the ingestion of excessive fructose induces features of metabolic syndrome in both laboratory animals and humans. Third, fructose appears to mediate the metabolic syndrome in part by raising uric acid, and there are now extensive experimental and clinical data supporting uric acid in the pathogenesis of metabolic syndrome. Fourth, environmental and genetic considerations provide a potential explanation of why certain groups might be more susceptible to developing diabetes. Finally, we discuss the counterarguments associated with the hypothesis and a potential explanation for these findings. If diabetes might result from excessive intake of fructose, then simple public health measures could have a major impact on improving the overall health of our populace.
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                Author and article information

                Contributors
                dean.dudley@mq.edu.au
                wayne.cotton@usyd.edu.au
                louisa.peralta@usyd.edu.au
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                25 February 2015
                25 February 2015
                2015
                : 12
                Affiliations
                [ ]School of Education, Faculty of Human Sciences, Macquarie University, Sydney, NSW Australia
                [ ]Faculty of Education and Social Work, University of Sydney, Sydney, NSW Australia
                Article
                182
                10.1186/s12966-015-0182-8
                4416340
                25889098
                © Dudley et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2015

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