Scoping Dietary Interventions for Adolescent Health: Bridging Evidence Gaps

Systematic Scoping Review

The current literature aims to provide the comprehensive existing knowledge overview of scientific evidence on dietary interventions among adolescents to facilitate improvement of effective healthy and sustainable dietary behavior. The scoping literature for the research will identify the connection between aspects of dietary intervention. Moreover, it will explore different studies to prepare the empirical study. The major aim of scoping review is to analyze the map and connect the available evidence to provide the arguments and theoretical background of the topic. Although, there are many studies available on the topic of Nutritional Epidemiology and public health but none of them is offering the in-depth information. Therefore, this scoping review will help to gain a deeper knowledge on the topic areas and connection between different concepts.

Critical appraisal

To maintain the quality of the results and improve the validity of the study, the critical appraisal of the selected articles was important. To assess the quality of the articles “Standard quality assessment criteria for evaluating the primary research papers from a variety of fields” was used. According to the analysis of the studies, the article of Wang et al., (2022) has provided the information relegated to the intervention and diet of the people to maintain the health. This article has also provided the information related to the randomized control in the dietary habits of the primary school children and offering of good food. In addition to this, the article of Black et al., (2015) has provided the data related to the public nutrition at school and assessed the quality of the food that offered to the children. It has focused on healthy and environmentally sustainable food initiatives in schools. Apart from this, the study of Wang et al., (2022) has offered the information related to the meals, education and gardens for in-school adolescents. This study has provided unique intervention of the nutrition to reach the communities and development of sustainable status and food security to maintain the health of the people (Brennan et al., 2021). However, some of the articles were lacking to offer the information related to the sampling methods and data analysis procedure but the literature of these articles was strong to improve the understanding and knowledge about the topic of the study. Moreover, all articles have received more than 72% of total score and therefore all included in scoping review.

Results

The aim of scoping review is to provide the in-depth information and understanding about the existing research on dietary interventions among adolescents to facilitate improvement of effective healthy and sustainable dietary behavior. The results of review has provided the information related to the characteristics that including the geographical orientation as well as study design and population of the study. Moreover, the study has offered the information related to the sensitizing concepts and theoretical aspects of the studies included in the scoping review.

Research characteristics

The scoping review has included 14 articles to provide the information related to the dietary interventions among adolescents to facilitate improvement of effective healthy and sustainable dietary behavior. The major studies that included in scoping review are Oostindjer et al., 2017, Black et al., 2015, Brennan et al., 2021, Colobo et al., 2020, Driessen et al., 2021, Jones et al., 2012, Lane et al., 2018, Llaurado et al., 2018, Mat Jones at al., 2017, Sgambato et al., 2016, Van Dogen et al., 2019, Wang et al., 2022, Williams et al., 2015 and WHO sustainable healthy diet principle 2019.

The majority of articles have qualitative design that ranging from the in-depth interviews to focus-group interviews that has provided the perception of the participants related to the sustainable eating behavior and intervention of dietary process. There were three studies that based on the quantitative data and provided the results of public health and nutrition. The data collection methods that used by the studies have provided the information related to the different nature of people in eating and managing their health (Oostindjer et al., 2017). The quantitative studies have provided the data related to the size and composition of the intervention and improvement in the healthy sustainable dietary behavior. Apart from this, the qualitative studies have offered the information related to people experience and sustainable behavior as well as the nutrition that offered in different settings.

Types of intervention among adolescent

There are various studies that have provided the information related to the intervention of health and sustainable dietary behavior. The articles have offered information about the health intervention in schools and the review has focused on the different life-skill education programs that helped to improve the health of adolescents. These intervention programs are involving the coping skills, self-assessment, self-esteem and motivation and control program.

What: Type of intervention practices

There are different types of practices used for managing the sustainable dietary procedure and intervention, this section of scoping review will provide the information related to the planning, selecting, preparing and enjoying the healthy meals. According to analysis of (Williams and Mummery, 2015), (Van Dongen et al., 2019) and (Sgambato et al., 2016) the evidences suggests that dietary procedure of UK children is considered to be suboptimal type as the schools in the country is offering an ideal and natural environment for maintaining the good practices of public health intervention. Moreover, these schools are offering the knowledge about the effective and sustainable methods of improving food intake. These programs are having a significant impact on the wellbeing and quality of food that required for the children after the intervention. Moreover, the other studies have focused on the middle income nations to understand the dietary habits of the adolescents and their physical and mental development. The studies have found that there is a significant improvement in nutrition knowledge and understanding among the people but there were some countries that were facing the issues in offering of food and maintaining the healthy lifestyle. The planning section has also analyzed the sustainability considering the responsibilities of the nations and schools for food acquisition, storage and preparation.

The proper planning of the intervention and improvement in healthy and sustainable diet is also increasing the financial burden on the national government and local authorities to offer food to the adolescents. The selections of articles have been done using the range of planning the intervention and maintaining the professional approach to meet the healthy food needs of the adolescents. The studies have suggested that there are many challenges that might cause the problem in future as the growing population and increasing demand of the nutrition globally might influence the proper quality in food. In addition to this, the study of Cai et al., (2020) has suggested that the obesity due to improvement of junk and fast food consumption across the world is creating the problems for people to maintain the health. The major areas of concern are high intake of fat, sugar and beverages that include the artificial fibers and sweeten. These are having a significant impact on the nutrition approach and health of the adolescents. In addition to this, the articles have suggested that low intake of vegetables and natural fruits are also causing the problem for people to maintain the effective dietary behavior and sustainability. In addition to this, the challenges related to sustainability in providing the high quality food in sufficient quantities for current generation as well as preserving the resources for future generation (Llauradó et al., 2018). The changes in climate condition and biodiversity loss as well as the imbalance of nitrogen and phosphorus is affecting the quality of the food and affecting the health of the people globally.

The effective dietary improvement and sustainable health management process is involving the preparing policies for food. According to Lane et al., (2018), poor diet in childhood is increasing the risk of obesity and poor mental health and affecting the adulthood approach. This kind of lacking in preparing the food and maintaining the proper intervention is affecting the health that is harmful in long term. However, the socio-economic conditions of individual is also having a significant impact on the preparation of food and maintaining the healthy and nutrition diet for adolescents. Schools are ideal for developing the natural environment for public health intervention as they focus on development of food standards and offering the good quality meal for the children to make habits of sustainable diet. The creation of traditional dishes and offering of the cultural food could be useful for the adolescents to maintain the healthy diet to improve the health. According to Jones et al., (2012), the social media and other platforms can be useful for offering the information about the intervention and food that could be healthy for the adolescents. In addition to this, Health Promotion Schools (HPS) framework would also be useful for the changing the lifestyle and offering of the knowledge and information to children about the healthy diet and behavior. However, changes in the approach of people to learn about the recipe and promotion of junk and fast food products is affecting the health of the children as they are not getting the required nutrition. Now, it is essential to offer a good knowledge about preparing and serving of the food.

Finally, the process of analyzing the structure of food procedure of enjoying the food is essential. As per the views of article of Eustachio Colombo et al., (2020), dietary behavior of adolescents is based on the education that provided by the parents. In this process, the role of schools is also important to provide the information related to the social dynamics and situations that could influence the health of the individual.

Where: The nutrition dietary of adolescent

Adolescence is a period of transformational growth during which both under-nutrition and obesity and overweight impede a person's ability to develop to the fullest extent possible in terms of health and development by interfering with the maturity of a number of physiological systems. On the one hand, inadequate nutrition during adolescence stunts physical development and hinders the acquisition of critical life skills. Although few initiatives have been made to specifically target the crucial life stage of adolescence, teenagers in sub-Saharan Africa have been particularly overlooked in health and nutrition programming, which has historically focused more on pregnant women and young children. Furthermore, adolescents have received little attention from international nutrition policy frameworks. Schools that met the following requirements could participate in the study: they had to be mainstream non-special schools (Driessen-Willems et al., 2021). They had to agree to be randomly assigned to an intervention; they had to engage with the intervention and implement it with their students; they had to agree to facilitate data collection in their setting; and they had to be located in the North West region of Northern Ireland. The local council provided a list of all mainstream primary schools in the area, and these schools were contacted and told about the study.

Quality of food that offered to the adolescent is playing a significant role in development and minimizing the health issues. Pupils in food for school life are significantly more likely to consume more serving of fruits and vegetables are beneficial for developing child to get the required fibres and vitamins. The sustainable food development and planning is essential for maintaining the improvement in the nutrition diet and changes the dietary of the children. However, there was wide gap identified among the children related to the dietary behaviour as some of the children are following the diet according to their culture and consuming high amount of meat and non-vegetarian products. This kind of approach in eating is not sustainable for children and lead to different types of disease or disorders. Therefore, education related to the food is essential for children at school. As per the views of Black et al., (2015), the food for life program has a range of processes and contributes towards the dietary behaviour and focus on the quality too. The inclusion of vegetables and fruits in the diet of the adolescent is helpful for improving the health and habits of eating. In school meal consideration of standards to promote the nutrition health and sustainability is beneficial for improving the health of the children. The exchange of best practices between school staff and catering with the help of local bodies can be useful for improving the diet planning and developing the nutrition program to meet the dietary expectation of the adolescent. The food and life framework is awarded as promoting the incremental changes across the wide range of activities and developing the healthy school setting. In this process, the consideration of the needs of the children and formal learning of the actions to achieve good health is having and significant impact on the overall nutrition diet.

The use of specific program and sustainable approach for offering the food is essential and helping to promote the health. The proper planning of the intervention and improvement in healthy and sustainable diet is also increasing the financial burden on the national government and local authorities to offer food to the adolescents. The selections of articles have been done using the range of planning the intervention and maintaining the professional approach to meet the healthy food needs of the adolescents. The studies have suggested that there are many challenges that might cause the problem in future as the growing population and increasing demand of the nutrition globally might influence the proper quality in food. However, there are various issues in process of offering and developing the food that gives proper nutrition to children (Eustachio Colombo et al., 2020). There is need of offering proper training and education to the children about the food processing and consuming process. The proper planning and management of the resources to offer quality food is helpful for increasing the sustainability and eating habits of the children. In addition to this, the intervention process and consideration of nutrition standards is helpful for managing the health and improving the level of understanding of adolescent.

The outcome of the reviews have suggested that each location is distinct and has particular difficulties in addressing diet availability, accessibility, and consumption; as a result, a customised solution is needed to support both the best possible health and sustainability. The goals of diets that address health, environmental, social/cultural, and economic concerns are the same for all healthy people even while the methods differ (Lane et al., 2018). Defining, creating, and executing specific activities that address contextual needs can be made easier with the help of those objectives being articulated.

Due to the amount of time spent eating in schools, the possibility of developing new eating habits there, and the significance of the social milieu at schools in influencing changes in food choice, school meal programmes are of special relevance as a target for health improvement. According to the study of Oostindjer et al., (2017), compared to home meals, school meals are a more centralised activity, and interventions at schools can aim to universally affect numerous children's eating behaviours at once. Additionally, school lunches frequently cross socioeconomic lines within a nation, at least for younger children, and children's habits are more changeable than adults. Each location is distinct and has particular difficulties in addressing diet availability, accessibility, and consumption; as a result, a customised solution is needed to support both the best possible health and sustainability. The goals of diets that address health, environmental, social/cultural, and economic concerns are the same for all healthy people even while the methods differ. Defining, creating, and executing specific activities that address contextual needs can be made easier with the help of those objectives being articulated.

Sustainable Healthy Diets are dietary regimens that support people's health and wellbeing on all levels, have little negative effects on the environment, are easily accessible, inexpensive, safe, and egalitarian, and are socially and culturally acceptable. The objectives of sustainable healthy diets are to promote functioning and physical, mental, and social wellness at all phases of life for both the present and the future generations, as well as to achieve optimal growth and development for all people (World Health Organization, 2019). They also aim to prevent all types of malnutrition.

When: Improvement of effective healthy and sustainable dietary behaviour

More than 50 nutrition guidelines or recommendations have been published or updated by WHO, some of which address the population's intake of specific nutrients. The formulation of nutrition guidelines is a difficult process that takes into accounts both methodological issues and the inherent constraints of scientific research on the connections between diet and health. People consume foods and diets rather than single nutrients, and diets are made up of numerous independent, interdependent components, which make it difficult to assign risk to individual diet components and establish nutrient-specific recommendations (World Health Organization, 2019).

A nutritious diet encourages growth and development and guards against malnutrition. The term "malnutrition" no longer exclusively refers to under-nutrition, such as stunting, wasting, being underweight, or having vitamin or mineral deficiencies, in the context of global nutrition policy. Obesity and dietary factors that raise the risk of non-communicable diseases (NCDs) like heart disease, stroke, diabetes, and some malignancies are now understood to be a part of malnutrition, in all of its forms (World Health Organization, 2019).

How: Coping strategies

By completing the structural process like what, where and when the effective dietary behaviour can be improved to maintain the sustainable diet for adolescent considering the studies that included in review shows that sustainable eating behaviour is useful for maintaining the overall health. According to study of Mat Jones (2017) the promotion of healthy diet is essential for improving the child weight and maintaining the overall development of them. The national health priority of England and other countries needed to be promoted for increasing the knowledge about the nutrition required for maintaining the health of the adolescent. However, these kinds of initiatives might increase the burden on the governments but it will be helpful for maintaining effective improvement in dietary procedure. Moreover, the study of Wang et al., (2022) suggested that knowledge related to the clean and nutritious food is helpful for improving the quality of the life of the children and maintaining the physical and mental development. The proper education related to intervention process in schools will also support the adolescents for maintaining particular lifestyle and diet.

The school garden will serve as the focal point for community workshops on best practises for agriculture, nutrition, hygiene, and the usage of innovative gardening techniques. The workshops for the intervention will be delivered by the same AEW who supports each school garden, and they will be open to the parents of all participating teenagers. The intervention package calls for significant community involvement and engagement (Driessen-Willems et al., 2021). The general people will take part in the study's conduct and dissemination in a number of different ways. First, the intervention package's school lunch component entails hiring local cooks, and will encourage parent donations of money or in-kind items to augment the school feeding programme. Second, collaboration with teenagers, focal teachers, AEWs, parents, and other community people is fundamental in the nutrition instruction, school gardens, and community workshops (Eustachio Colombo et al., 2020).

The consideration of health promotion school framework can be beneficial for improving the health and achievement of the objectives of nutritious diet and improvement in the health of the adolescent. According to the plan and framework, sustainable food offering is essential for offering the required fibre and protein to the children that could be helpful for development of them. According to Lane et al., (2018), the strategies like food leadership and school food quality is playing a critical role in managing the nutrition level and improvement in the health. As per this strategy, students, staff and parents are the wider communities to identify the aspects that could help to improve health policies including emphasis on sustainability. This kind of strategy will focus on quality of the food and including the vegetables and organic sources. These ingredients can be useful for maintaining the healthy diet that content fruits, fish, eggs and sustainable cooking methods. In addition to this, community and partnership of the parents and other stakeholders in the planning, selecting and delivery of food can be helpful for effective healthy and sustainable dietary behavior (Llauradó et al., 2018). The proper planning of the intervention and improvement in healthy and sustainable diet is also increasing the financial burden on the national government and local authorities to offer food to the adolescents. The selections of articles have been done using the range of planning the intervention and maintaining the professional approach to meet the healthy food needs of the adolescents. The studies have suggested that there are many challenges that might cause the problem in future as the growing population and increasing demand of the nutrition globally might influence the proper quality in food (Jones et al., 2012).

Application of the empirical study

The scoping literature review has provided the insight about the existing data and research on nutrition and intervention in dietary for effective improvement in health and sustainable eating behaviour. There were 14 articles have been considered for analyzing and collecting the information related to the nutrition and effective improvement in the health of the adolescents. The outcome of the reviews have suggested that each location is distinct and has particular difficulties in addressing diet availability, accessibility, and consumption; as a result, a customised solution is needed to support both the best possible health and sustainability. The goals of diets that address health, environmental, social/cultural, and economic concerns are the same for all healthy people even while the methods differ. Defining, creating, and executing specific activities that address contextual needs can be made easier with the help of those objectives being articulated.

However, the socio-economic conditions of individual is also having a significant impact on the preparation of food and maintaining the healthy and nutrition diet for adolescents. Schools are ideal for developing the natural environment for public health intervention as they focus on development of food standards and offering the good quality meal for the children to make habits of sustainable diet. The creation of traditional dishes and offering of the cultural food could be useful for the adolescents to maintain the healthy diet to improve the health. The studies have found that there is a significant improvement in nutrition knowledge and understanding among the people but there were some countries that were facing the issues in offering of food and maintaining the healthy lifestyle. The planning section has also analyzed the sustainability considering the responsibilities of the nations and schools for food acquisition, storage and preparation.

The proper planning of the intervention and improvement in healthy and sustainable diet is also increasing the financial burden on the national government and local authorities to offer food to the adolescents. The selections of articles have been done using the range of planning the intervention and maintaining the professional approach to meet the healthy food needs of the adolescents. In addition to this, Health Promotion Schools (HPS) framework would also be useful for the changing the lifestyle and offering of the knowledge and information to children about the healthy diet and behavior. However, changes in the approach of people to learn about the recipe and promotion of junk and fast food products is affecting the health of the children as they are not getting the required nutrition. Now, it is essential to offer a good knowledge about preparing and serving of the food.

References

Black, J.L., Velazquez, C.E., Ahmadi, N., Chapman, G.E., Carten, S., Edward, J., Shulhan, S., Stephens, T. and Rojas, A., 2015. Sustainability and public health nutrition at school: assessing the integration of healthy and environmentally sustainable food initiatives in Vancouver schools. Public health nutrition, 18(13), pp.2379-2391.

Brennan, S.F., Lavelle, F., Moore, S.E., Dean, M., McKinley, M.C., McCole, P., Hunter, R.F., Dunne, L., O’Connell, N.E., Cardwell, C.R. and Elliott, C.T., 2021. Food environment intervention improves food knowledge, wellbeing and dietary habits in primary school children: Project Daire, a randomised-controlled, factorial design cluster trial. International Journal of Behavioral Nutrition and Physical Activity, 18, pp.1-18.

Cai, Z., Xian, J., Xu, X., Zhang, Z., Araujo, C., Sharma, M. and Zhao, Y., 2020. Dietary Behaviours Among Han, Tujia and Miao Primary School Students: A Cross-Sectional Survey in Chongqing, China. Risk Management and Healthcare Policy, pp.1309-1318.

Driessen-Willems, M.D., Bartelink, N.H., Bessems, K.M., Kremers, S.P., Kintzen, C. and van Assema, P., 2021. Co-creation approach with action-oriented research methods to strengthen “Krachtvoer”; a school-based programme to enhance healthy nutrition in adolescents. International Journal of Environmental Research and Public Health, 18(15), p.7866.

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Jones, M., Dailami, N., Weitkamp, E., Salmon, D., Kimberlee, R., Morley, A. and Orme, J., 2012. Food sustainability education as a route to healthier eating: evaluation of a multi-component school programme in English primary schools. Health education research, 27(3), pp.448-458.

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Llauradó, E., Tarro, L., Moriña, D., Aceves-Martins, M., Giralt, M. and Solà, R., 2018. Follow-up of a healthy lifestyle education program (the EdAl study): four years after cessation of randomized controlled trial intervention. BMC Public Health, 18, pp.1-12.

Oostindjer, M., Aschemann-Witzel, J., Wang, Q., Skuland, S.E., Egelandsdal, B., Amdam, G.V., Schjøll, A., Pachucki, M.C., Rozin, P., Stein, J. and Lengard Almli, V., 2017. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´ s diet and food consumption? A cross-national comparative perspective. Critical reviews in food science and nutrition, 57(18), pp.3942-3958.

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