TABLE 2.
Main characteristics and quality rating of the identified systematic reviews including interventions targeting improvements in dietary, PA, and weight-related outcomes among university students1
| Characteristics of identified studies | Results | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Review | Main objective | Search methodology | Total number | Total number of participants | Quality rating of individual studies | Outcomes reported in studies | Synthesis/presentation of studies | Number of effective studies | Authors’ conclusions | Methodological quality |
| Christoph and An (20) | To investigate the effect of nutrition label use on diet quality among university students. | 4 databases were searched until 18 May, 2017 following the PRISMA guidelines. English-language limitation applied. No country limitation applied. | n = 22 (5 RCTs, 17 cohort or pre–post interventions) | ∼27,100 | Risk of bias: high: n = 1; average: n = 19; low: n = 2. Assessment tool adapted from US National Heart, Lung, and Blood Institute. | Dietary intake, diet quality, and food choices. | Studies were presented in tables and categorized by the type of dietary outcome into: - Calories selected or consumed (n = 13) - Noncaloric measures (n = 12). A meta-analysis was conducted showing fewer calories ordered/consumed among pre–post interventions using nutrition labels vs. no labels (mean decrease of calories: 36.0; 95% CI: −60.2, −11.8, P = 0.038, I2 = 98.6) and among studies using contextual vs. simple labels (mean decrease of calories: 66.9; 95% CI: −86.7, −47.2, P = 0.002, I2 = 86.4). A meta-analysis on RCTs showed no difference. | Overall: 16 of 21 (76%). Assessing caloric selection/intake: 8 of 13 (62%). Assessing macronutrient selection/intake (diet quality): 9 of 12 (75%). | Nutrition labeling had a moderate but positive effect on dietary intake among university students. | Moderate |
| Maselli et al. (24) | To conduct a systematic review of interventions designed to improve PA among university students. | 5 databases were searched until November, 2016 following PRISMA guidelines. English-language limitation applied. No country or other limitation applied. | n = 27 (24 RCTs, 3 non-RCTs) | 11,376 | Risk of bias: high: n = 27; average: n = 7; low: n = 3. Assessment tool: Cochrane Collaboration Tool. | All PA outcomes. | Studies were presented in tables. A specific approach was not used. A meta-analysis was not conducted. | Overall: 16 of 27 (59%). | Personalized approaches and PA sessions seem promising parts of an intervention. High risk of bias of studies limits the strength of conclusions with regards to effectiveness. | Moderate |
| Deliens et al. (18) | To provide an overview of interventions aiming to improve dietary intake among university students. | 4 databases searched from January, 2000 until December, 2014 following the PRISMA guidelines. English-language limitation applied. No country limitations applied. | n = 20 (12 RCTs, 1 non- RCT, 7 pre–post without control group). | 13,578 | Risk of bias: high: n = 1; average: n = 19. Assessment tool: The Academy of Nutrition and Dietetics Quality Criteria. | Dietary habits, nutrient intakes, consumption of foods/fluids/beverages, and food or drinks sales/purchases. | Studies were presented in tables and categorized by the type of intervention into: - Media/web-based intrapersonal (n = 6); - Non-media–based intrapersonal (n = 6); - Combined intrapersonal (n = 1); - Environmental (n = 7). A meta-analysis was not conducted. | Overall: 13 of 20 (65%). According to type of intervention: - Web/media-based: 5 of 6 (83%); - Intrapersonal: 2 of 6 (33%); - Combined intrapersonal: 1 of 1 (100%); - Environmental: 5 of 7 (71%). | Nutrition education, with self-regulation, provided through technology and POP message strategies, may improve dietary intakes in the short term. | Moderate |
| Roy et al. (21) | To evaluate food environment interventions targeting young adults in university settings. | 7 databases searched from 1998 until December, 2014. The PRISMA guidelines were used. English-language limitation applied. No country limitation applied. | n = 15 (3 RCTs, 2 pre–post interventions, 6 quasi-experimental, and 4 cross-sectional). | ∼3753 | Risk of bias: high: n = 3; average: n = 7; low: n = 5. Assessment tool: The Academy of Nutrition and Dietetics Quality Criteria. | Food choices, nutrition knowledge, and/or food/drink sales. | Studies were presented in tables and categorized by the type of intervention into: - Information about healthy foods through signage and labels (n = 10); - Availability of healthy foods through changing catering practices and portion sizes (n = 3); - Nutrition information with incentives (e.g., price reductions and availability of healthy foods) (n = 2). A meta-analysis was not conducted. | Overall: 13 of 15 (87%). According to type of intervention: - Information through signage and labels: 8 of 10 (80%); - Availability/portion size (assessing dietary intakes): 3 of 3 (100%); - Nutrition information with incentives: 2 of 2 (100%). | Nutrition information, healthy options, and decreased portion sizes as well as price reductions and increased availability of healthy options seem useful interventions to help improve dietary habits. | Moderate |
| Plotnikoff et al. (26) | To examine the effectiveness of interventions aimed at improving PA, diet, and/or weight-related behaviors among university students. | 5 databases searched following the PRISMA guidelines from January, 1970 until April, 2014. English-language limitation applied. No country limitations applied. | n = 41 (16 RCTs, 12 non-RCTs, 13 pre–post with no control group). | 19,589 | Risk of bias: high: n = 8; average: n = 30; low: n = 4. Assessment tool: The Academy of Nutrition and Dietetics Quality Criteria. | Dietary intakes, diet quality, and related behavioral aspects (self-efficacy etc.). PA outcomes and related behavioral aspects (perceived barriers etc.). Changes in body weight and body composition. | Studies were presented in tables and categorized based on the outcomes of interest into: - Studies assessing dietary outcomes (n = 24); - Studies assessing PA outcomes (n = 29); - Studies assessing weight-related outcomes (n = 12). A meta-analysis was conducted for total, moderate, and vigorous PA (vs. control conditions). A significantly higher level was found only for moderate PA (standardized mean difference: 0.18; 95% CI: 0.06, 0.30, P = 0.005, I2 = 0%). | Overall: 34 of 41 (83%). Assessing dietary outcomes: 12 of 24 (50%). Assessing PA outcomes: 18 of 29 (62%). Assessing weight outcomes: 4 of 12 (33%). | Interventions including university courses with frequent face-to-face contact and feedback to provide encouragement and support were effective at improving PA, dietary, and weight-related outcomes. | Moderate |
| Kelly et al. (22) | To review research literature evaluating nutrition and dietary interventions in university settings. | 2 databases searched between January, 2001 and June, 2011 following the Institute of Medicine Guidelines. English-language limitation and country limitation (US only) applied. | n = 14 (6 RCTs, 1 quasi-experimental, 7 non-experimental). | ∼2691 | N/A | Intakes of foods/drinks/nutrients, healthy eating rating, food sales, and other aspects of dietary behavior (cooking skills, goal setting, etc.). | Studies were presented in tables and categorized by the type of intervention into: - In-person (n = 6); - Online (n = 5); - Environmental (n = 3). A meta-analysis was not conducted. | Overall: 11 of 14 (79%). According to type of intervention: - In-person: 5 of 6 (83%); - Online: 3 of 5 (60%); - Environmental: 3 of 3 (100%). | In-person strategies including self-regulation, self-monitoring, and goal setting were promising in improving students’ dietary behavior, whereas environmental strategies could promote sales of healthy foods. | Critically low |
| Lua and Wan (23) | To summarize studies on the effectiveness of nutrition educational interventions used by university students. | 4 databases were searched from 1990 until 2011; no specific guidelines were mentioned. English-language limitation applied. No country limitations applied. | n = 14 (4 RCTs, 9 longitudinal, 1 cross-sectional). | 1536 | N/A | Dietary intake, aspects of dietary behavior (self-efficacy etc.), body weight, and body composition. | Studies were presented in tables. A specific approach was not used. A meta-analysis was not conducted. | Overall: 13 of 14 (93%). | Nutrition education with dietary supplements appeared the best methods for improving diet and promoting health. | Critically low |
| Laska et al. (25) | To review studies examining weight gain prevention interventions among young adults. | 5 databases searched from 1985 until July, 2011 following a snowball strategy. No language limitation applied. Country limitations (United States and Canada only) applied. | n = 8 including university students (4 RCTs, 4 quasi-experimental). | 877 | N/A | Primary outcomes included changes in body weight and body composition. | Studies assessing weight-related outcomes were presented in tables and categorized by the type of intervention into: - University courses (n = 6); - Other strategies (n = 2). Studies addressing dietary intake (n = 19), PA (n = 8), or multiple health behaviors (n = 1) were briefly mentioned as text. A meta-analysis was not conducted. | Overall (assessing weight variables): 6 of 8 (75%). According to type of intervention: - University courses: 5 of 6 (83%); - Other strategies: 1 of 2 (50%). | University course-based interventions showed some promising results in preventing weight gain among postsecondary students. | Critically low |
1 N/A, not applicable; PA, physical activity; POP, point-of-purchase; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.