Intervention Review

School feeding for improving the physical and psychosocial health of disadvantaged students

  1. Betsy Kristjansson1,*,
  2. Mark Petticrew2,
  3. Barbara MacDonald3,
  4. Julia Krasevec3,
  5. Laura Janzen4,
  6. Trish Greenhalgh5,
  7. George A Wells6,
  8. Jessie MacGowan7,
  9. Anna P Farmer8,
  10. Beverley Shea7,
  11. Alain Mayhew7,
  12. Peter Tugwell9,
  13. Vivian Welch9

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 30 APR 2006

DOI: 10.1002/14651858.CD004676.pub2

How to Cite

Kristjansson B, Petticrew M, MacDonald B, Krasevec J, Janzen L, Greenhalgh T, Wells GA, MacGowan J, Farmer AP, Shea B, Mayhew A, Tugwell P, Welch V. School feeding for improving the physical and psychosocial health of disadvantaged students. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004676. DOI: 10.1002/14651858.CD004676.pub2.

Author Information

  1. 1

    University of Ottawa, School of Psychology, Faculty of Social Sciences, Ottawa, Ontario, Canada

  2. 2

    London School of Hygiene and Tropical Medicine, PEHRU, London, UK

  3. 3

    C/O Cochrane Developmental, Psychosocial and Learning Problems Group, Bristol, UK

  4. 4

    The Hospital for Sick Children, Department of Psychology & Division of Haematology/Oncology, Toronto, Ontario, Canada

  5. 5

    University College London, Primary Care and Population Sciences, London, UK

  6. 6

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

  7. 7

    University of Ottawa, Institute of Population Health, Ottawa, Canada

  8. 8

    University of Alberta, Department of Agricultural, Food and Nutritional Science and The Centre for Health Promotion Studies, Edmonton, Alberta, Canada

  9. 9

    University of Ottawa, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

*Betsy Kristjansson, School of Psychology, Faculty of Social Sciences, University of Ottawa, Room 407C, Montpetit Hall, 125 University, Ottawa, Ontario, K1N 6N5, Canada. kristjan@uottawa.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Background

Early malnutrition and/or micronutrient deficiencies can adversely affect physical, mental, and social aspects of child health. School feeding programs are designed to improve attendance, achievement, growth, and other health outcomes.

Objectives

The main objective was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils .

Search methods

We searched a number of databases including CENTRAL (2006 Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), PsycINFO (1980 to May 2006) and CINAHL (1982 to May 2006). Grey literature sources were also searched. Reference lists of included studies and key journals were handsearched and we also contacted selected experts in the field.

Selection criteria

Data from randomized controlled trials (RCTs), non-randomised controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series studies (ITSs) were included. Feeding had to be done in school; the majority of participants had to be socio-economically disadvantaged.

Data collection and analysis

Two reviewers assessed all searches and retrieved studies. Data extraction was done by one of four reviewers and reviewed by a second. Two reviewers independently rated quality. If sufficient data were available, they were synthesized using random effects meta-analysis, adjusting for clustering if needed. Analyses were performed separately for RCTs and CBAs and for higher and lower income countries.

Main results

We included 18 studies. For weight, in the RCTs and CBAs from Lower Income Countries, experimental group children gained an average of 0.39 kg (95% C.I: 0.11 to 0.67) over an average of 19 months and 0.71 kg (95% C.I.: 0.48 to 0.95) over 11.3 months respectively. Results for weight were mixed in higher income countries. For height, results were mixed; height gain was greater for younger children. Attendance in lower income countries was higher in experimental groups than in controls; our results show an average increase of 4 to 6 days a year. Math gains were consistently higher for experimental groups in lower income countries; in CBAs, the Standardized Mean Difference was 0.66 (95% C.I. = 0.13 to 1.18). In short-term studies, small improvements in some cognitive tasks were found.

Authors' conclusions

School meals may have some small benefits for disadvantaged children. We recommend further well-designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio-economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

School feeding for improving the physical and psychosocial health of disadvantaged schoolchildren

Early malnutrition and/or micronutrient deficiencies can negatively affect many aspects of child health and development. School feeding programs are designed to provide food to hungry children and to improve their physical, mental and psychosocial health. This is the first systematic review on the topic of school feeding. Eighteen studies were included in this review; nine were performed in higher income countries and nine in lower income countries. In the highest quality studies (randomized controlled trials (RCTs) from low income countries, children who were fed at school gained an average of 0.39 kg more than controls over 19 months; in lower quality studies (controlled before and after trials (CBAs)), the difference in gain was 0.71 kg over 11.3 months. Children who were fed at school attended school more frequently than those in control groups; this finding translated to an average increase of 4 to 6 days a year per child. For educational and cognitive outcomes, children who were fed at school gained more than controls on math achievement, and on some short-term cognitive tasks.Results from higher income countries were mixed, but generally positive. For height, results from lower income countries were mixed; in RCTs, differences in gains were important only for younger children, but results from the CBAs were large and significant overall. Results for height from high Income countries were mixed, but generally positive. School meals may have small physical and psychosocial benefits for disadvantaged pupils. We recommend that further well-designed studies on the effectiveness of school meals be undertaken, that results should be reported according to the socio-economic status of the children who take part in them, and that researchers gather robust data on outcomes that directly reflect effects on physical, social, and psychological health.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

学校供餐是否改善弱势学生群体的身体及社会心理健康?

研究背景

早期的营养不良和/或微量元素缺乏会给儿童生理和社会心理健康带来负面影响。设计学校供餐计划可以促进学生的出勤率、成绩、成长以及其它健康结果。

研究目的

评估学校供餐方案对于改善弱势学生群体的身体和社会心理健康的效果。

检索方法

我们检索了以下数据库,包括CENTRAL(2006年第2期),MEDLINE(1966年至2006年5月),EMBASE(1980年至2006年5月),PsycINFO(1980年至2006年5月)和CINAHL(1982年至2006年5月),另外也检索了灰色文献。我们手工检索相关研究及重要期刊中的参考文献,并联系该领域的专家以全面获得资料。

纳入标准

纳入随机对照试验(RCTs)、非随机对照临床试验(CCTs),前后对照研究(CBAs),以及中断时间序列研究(ITSs)。其中,供餐地点必须是在学校,且大多数受试者必须为社会经济地位较低的弱势群体。

数据收集与分析

两位评价者对文献进行了评估。四位评价者其中之一负责资料提取的工作,再由另外一位核查;另两位研究者分别对研究的质量进行评分。对于数据较多的资料,我们采取随机效应模式的Meta-分析进行评估,必要时用分类归并调整。我们分别对随机对照试验和前后对照试验进行了分析,另外也分别分析来自较高收入和较低收入国家的研究。

主要结果

共纳入了18个研究。在体重方面,在较低收入国家,随机对照试验研究的实验组儿童在平均19个月的时间内,平均增加了0.39公斤(95%CI: 0.11 ∼ 0.67);而前后对照试验研究的实验组儿童在平均11.3个月的时间内,平均增加了0.71公斤的体重(95%CI: 0.48 ∼ 0.95)。在较高收入国家的结果则不一致。在身高方面,结果亦不一致,较年幼的儿童身高增加较多。在较低收入国家的实验组,其上学出勤率明显高于对照组,每年平均增加4至6天。在较低收入国家的实验组,数学成绩均有提高,在前后对照试验研究中,标准化均数差为0.66(95%CI: 0.13 ∼ 1.18)。在短期研究中,也发现在某些认知测验结果上有小幅进步。

作者结论

学校供餐可能对弱势儿童有些益处。我们建议应要进一步开展设计完善的研究来评估学校供餐的效果,并报告对不同社会经济地位儿童的效果,另外,原始研究者应收集详实的过程指标和结局指标。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

学校供餐是否改善弱势学生群体的身体及社会心理健康?

学校供餐是否以改善弱势学生群体的身体及社会心理健康?

早期营养不良和/或微量元素缺乏可能对儿童健康发育产生许多不利影响。学校供餐方案旨在提供食物给饥饿的儿童,以改善他们的身体、精神和社会心理健康。这是第一个以学校供餐为题的系统评价。本研究共纳入18个研究,其中9个是在较高收入的国家,9个在较低收入国家进行。在低收入国家中,高质量的研究(随机对照试验)显示,学校提供餐食的儿童在平均19个月内,相比对照组,平均多增加0.39公斤的体重;而在较低质量的研究(前后对照研究)中,在11.3个月内,两组体重增长的差异为0.71公斤。由学校提供餐食的儿童上学的次数比对照组多,本次研究发现每年每个孩子平均增加4至6天。对教育和认知方面的结果,由学校供餐的儿童,在数学成绩及一些短期的认知测验结果的进步高于对照组。而在较高收入国家,结果不一,但基本是肯定的效果。对于身高来说,较低收入国家的结果不一致,在随机对照试验中,只有较年幼的儿童的身高增加有差异,但前后对照试验的结果整体来说差异较大且显著。关于较高收入国家的儿童身高的影响结果不一,但基本是肯定的效果。综上,学校供餐可能对弱势儿童的身体和心理社会方面有益。我们建议需要进一步设计完善的研究来评估学校供餐的效果,且研究报告应反映对不同社会经济地位的儿童的效果,另外,原始研究人员应要完整收集可以直接反映出身体、社会、以及心理健康效果的数据。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

背景

學校供餐以改善弱勢學生的身體及心理社會健康

早期營養不良和/或缺乏微量營養元素會負面地影響兒童生理,心理,以及社會方面的健康。設計學校供餐計畫以增加出席率、學業、成長以及其他健康預後。

目標

主要目的是要確定學校供餐方案在改善弱勢學童的身體和心理社會健康的成效。

搜尋策略

我們搜尋了以下資料庫,包括CENTRAL(2006年第2期),MEDLINE(1966年至2006年5月),EMBASE(1980年至2006年5月),PsycINFO(1980年至2006年5月)和CINAHL(1982年至2006年5月),另外也搜尋灰色文獻。我們以手工檢索收納的研究及重要期刊中的參考文獻,也和此領域的專家進行聯繫。

選擇標準

資料的來源包括隨機對照試驗(RCTs)、非隨機對照臨床試驗(CCTs),前後對照研究(CBAs),以及中斷時間序列研究(ITSs);其中,供餐必須是在學校,且大多數受試者必須為社經地位弱勢者。

資料收集與分析

兩位審查者評估了所有搜尋和檢索的研究。四位審查者的其中之ㄧ負責資料萃取的工作,之後再由另外一位回顧;兩位審查員分別對品質做評分。如果數據資料足夠,這些數據會以隨機效果模式的統合分析方法 (random effects metaanalysis) 統整,必要的話會依群集 (cluster) 做調整。我們分別對RCT研究和CBA研究進行分析,另外也分別對較高收入和較低收入的國家的研究作分析。

主要結論

我們共收納了18個研究。在體重方面,針對較低收入國家,RCT研究的實驗組兒童在平均19個月的時間內,增加了平均0.39公斤的體重(95%CI :0.11 – 0.67);而CBA研究的實驗組兒童在平均11.3個月的時間內,增加了平均0.71公斤的體重(95%CI :0.48~0.95)。較高收入的國家的體重方面的結果則不一致。在身高方面,結果為不一致; ,在較年幼的兒童身高增加較多。較低收入的國家的實驗組的上學出席明顯高於對照組,我們的結果顯示,每年平均增加4至6天。較低收入的國家的實驗組的數學進步一致較高,在CBA的研究中,平均標準差為0.66(95%CI :0.13~1.18),在短期研究也有發現在某些認知測驗有小幅進步。

作者結論

學校供餐可能對弱勢兒童有些益處。我們建議應要進行進一步完善設計的研究來評估學校供餐的效果,且結果報告應該要呈現出社經地位,另外,研究人員應要收集兩種進程的可靠數據並且仔細地選擇結果預後。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

早期營養不良和/或微量營養素缺乏可能對兒童健康發展的許多方面產生不利影響。學校供餐方案旨在提供食物給飢餓的兒童,以改善他們的身體、精神和心理社會的健康。這是第一個針對學校供餐的議題的系統性回顧。此次回顧收納了18個研究,其中9個是在較高收入的國家,9個在較低收入國家。在低收入國家中,高品質的研究(隨機對照試驗[RCT])顯示,接受學校供餐的孩童在平均19個月內,比對照組平均多增加為0.39公斤的體重,而在較低品質的研究(前後對照研究[CBA])中,在11.3個月內,兩組體重差異為0.71公斤。較高收入國家的結果不一,但普遍較正向。身高的部份,較低收入國家的結果也不一致,在RCT中,只有較年幼的兒童的身高增加有差異,但CBA的結果整體來說差異較大且顯著。較高收入國家的身高的結果不一,但普遍較正向。在低收入國家,有學校供餐的孩童上學的次數比對照組多,此一發現為每年每個孩子平均增加4至6天。對教育和認知方面的結果,有學校供餐的孩童,在數學成就及一些短期的認知測驗比對照組進步較多。學校供餐可能對弱勢孩童的身體和心理社會方面有助益。我們建議應要進行進一步完善設計的研究來評估學校供餐的效果,且結果報告應該要呈現出參與孩童的社經地位,另外,研究人員應要完整收集可以反映出身體、社會以及心理健康的效果預後的數據。