Table 1.
Summary of results according to areas of the NOURISHING framework
| Policy area (no. studies) | Study quality | Study design | Location | Rurality | Targeted/ Universal | Intervention strategies | Indigenous involvement? | Outcomes measured | Effective for Indigenous population? |
| N Nutrition labels (n=5) | High (n=2), moderate (n=2), low (n=1) | RCT (n=2) | Australia (n=1) | Urban (n=1) | Universal (n=4) | Traffic Light Labels (n=3) | Yes (n=1) | Ability to use/ interpret food labels (n=1) | Yes (n=1) |
| cross-sectional (n=3) | Aotearoa (n=3) | Rural (n=1) | Targeted (n=1) | Health Star Rating System (n=2) | None described (n=4) | Self-reported impact on food purchases (n=1) | Yes (n=1) | ||
| USA (n=1) | Urban+rural (n=3) | Culturally tailored label (n=1) | Food purchases—simulated (n=1) | Yes (n=1) | |||||
| Food purchases-real world (n=2) | Yes (n=1) No (n=1) | ||||||||
| O Offer Healthy food in public institutions (n=21) | High (n=1), moderate (n=10), low (n=10) | RCT (n=5) | Australia (n=2) | Urban (n=1) | Universal (n=5) | Healthy food/drink provision±policy combined with nutrition education inchildcare centres (n=3) or schools (n=18) | Yes (n=18) | Anthropometry: zBMI, WC, body fat %, overweight/ obesity (n=10) | Yes (n=3) No (n=7) |
| quasi- experimental (n=14) | Aotearoa (n=4) | Rural (n=11) | Targeted (n=16) | None described (n=3) | Diet: food, drink, energy, nutrient intake (n=13) | Yes (n=8) No (n=5) | |||
| cross-sectional (n=2) | Canada (n=9) | Urban+rural (n=3) | Biochemistry: plasma vitamin/insulin (n=2) | Yes (n=2), | |||||
| USA (n=6) | Remote (n=6) | Health outcomes- dental (n=2), hearing (n=2) | Yes (n=4) | ||||||
| U Use economic tools to address food affordability (n=10) | High (n=2), moderate (n=6), low (n=2) | RCT (n=2) | Australia (n=9) | Urban (n=1) | Universal (n=1) | Subsidies/price discounts on healthier products for example, vegetables, fruit, water, diet soft drinks,±nutrition education (n=8) | Yes (n=8) | Biochemistry:nutritional biomarkers (n=3) | Yes (n=3) |
| quasi- experimental (n=4) | Aotearoa (n=1) | Rural (n=3) | Targeted (n=9) | Compulsory income management (n=2) | None (n=2) | Diet: self-reported Fruit &Vegetable intake (n=1) | No (n=1) | ||
| natural experiment (n=2) | Remote (n=6) | Food purchasing: Sales of vegetables, fruit, water, soft drinks (n=6) | Subsidies: Yes (n=2) No (n=3) Income Management: No (n=1) | ||||||
| Health Outcomes: antibiotics prescribed, low birth weight (n=2) | Subsidies: Yes (n=1) Income Management: No (n=1) | ||||||||
| I Improve nutritional quality of the whole food supply (n=10) | moderate (n=7), low (n=3) | Natural experiment (n=7); quasi- experimental (n=1) cross-sectional (n=1) case-control (n=1) | Australia (n=8) | Urban (n=1) | Universal (n=9) | Voluntary folic acid fortification (n=3) | Yes (n=4) | Biochemistry: Red Blood Cell folate, urinary iodine concentration (n=5) | Voluntary folate: No (n=1); Mandatory folate: Yes (n=3) |
| Aotearoa (n=1) | Rural (n=1) | Targeted (n=1) | Mandatory folic acid fortification of bread (n=4) | None given (n=6) | Diet: iodine intake (n=1) | Iodine: Partially (n=2) | |||
| Canada (n=1) | Remote (n=2) | Mandatory iodine fortification of salt in bread (n=2) | Health outcome: NTD prevalence (n=4) | Voluntary folate: No (n=2); Mandatory folate: Yes (n=2) | |||||
| Urban+rural/remote (n=5) | 25% salt reduction in top selling white bread (n=1) | Food purchasing: sodium density of food purchases (n=1) | Sodium restriction: Yes (n=1) | ||||||
| S Set incentives and rules to create a healthy retail and food service environment (n=10) | high (n=1), moderate (n=9), | RCT (n=3) | Australia (n=3) | Rural (n=2) | Targeted (n=10) | Increased availability and promotion of healthy foods in Indigenous community stores | Yes (n=10) | Anthropometry: BMI, obesity (n=4) | Yes-trend (n=1) No (n=3) |
| quasi- experimental (n=7) | Canada (n=5) | Remote (n=8) | Biochemistry: blood cholesterol, insulin antioxidant levels (n=2) | Yes (n=2) | |||||
| USA (n=2) | Diet: food, drink, energy, nutrient intake (n=4) | Yes (n=3) No (n=1) | |||||||
| Food purchasing: acquisition/sales of healthy/unhealthy products (n=5) | Yes (n=3) Partially (n=2) | ||||||||
|
H Harness the food supply chain and action across sectors to ensure coherence with health (n=6) |
moderate (n=4), low (n=2) | quasi- experimental (n=4) | Australia (n=4) | Rural (n=2) | Targeted (n=6) | Multisectoral collaboration to improve local food systems, supply chains and environments for example, policies re availability of sugary drinks in community stores, improved food and water supply to community settings. | Yes (n=6) | Biochemistry: nutritional biomarkers (n=1) | Yes (n=1) |
| natural experiment (n=2) | USA (n=2) | Remote (n=4) | Diet: self-reported fish intake (n=1), household healthy/unhealthy food availability (n=1) | Yes (n=1) Partially (n=1) | |||||
| Food purchasing: Sales of fruit and vegetables, water, soft drinks and/or confectionery (n=4) | Yes (n=3), Partially (n=1) | ||||||||
| I Inform people about food and nutrition through public awareness (n=4) | moderate (n=3), low (n=1) | quasi experimental (n=3) | Australia (n=1) | Urban+rural (n=1) | Universal and targeted (n=1) | Local media and community wide health promotion campaigns targeting sugary drink consumption (n=3), breast feeding (n=2) and diabetes prevention (n=1) | Yes (n=4) | Anthropometry: BMI, zBMI, waist circumference (n=2) | Partially (n=1), No (n=1) |
| cross-sectional (n=1) | Aotearoa (n=1) | Rural (n=3) | Targeted (n=3) | Diet: self-reported sugary drink intake (n=1), vegetable, fruit, wholegrain intake (n=1), | Partially (n=1) No (n=1) | ||||
| USA (n=2) | Breast feeding: (n=1) | Yes (n=1) | |||||||
| Health outcomes: dental caries (n=1), insulin resistance, diabetes (n=1) | Yes (n=2) | ||||||||
| N Nutrition advice and counselling in healthcare settings (n=4) | moderate (n=3), low (n=1) | quasi-experimental (n=3) | Australia (n=1) | Urban+rural + remote (n=2) | Universal (n=1) | Pre-natal nutrition education and counselling (n=3) Postnatal peer breast feeding counselling (n=1) | Yes (n=4) | Anthropometry: weight, BMI, waist circumference (n=3) | Yes (n=1), No (n=2) |
| cross-sectional (n=1) | Canada (n=3) | Rural (n=1) | Universal and targeted (n=1) | Telephone coaching about lifestyle change (n=1) | Breastfeeding: (n=3) | Yes (n=2), No (n=1) | |||
| Remote (n=1) | Targeted (n=2) | Diet: energy, nutrient vegetable, fruit, sugary drink intake (n=2) | Yes (n=1), No (n=1) | ||||||
| Health outcomes: gestational diabetes, preterm birth, low birth weight (n=2) | Yes (n=1), No (n=1) | ||||||||
|
G
Give nutrition education and skills (n=8) |
High (n=1), moderate (n=1), low (n=6) | RCT (n=1) | Australia (n=2) | Urban (n=2) | Universal (n=3) | School-based nutrition education curriculum±peer education and role modelling±physical activity (n=7) | Yes (n=6), | Anthropometry: BMI, zBMI, waist circumference, obesity (n=3) | Yes (n=2), No (n=1) |
| quasi experimental (n=7) | Canada (n=4) | Rural (n=2) | Targeted (n=5) | Nutrition education and food skills for adults (n=1) | Non given (n=) | Diet: self-reportedintake of fruit, vegetable, soft drink, high fat foods, % energy from fat/sugar (n=6) | Yes (n=2), No (n=4) | ||
| USA (n=2) | Remote (n=1) | ||||||||
| Urban+rural (n=2) | |||||||||
| rural+remote (n=1) |
BMI, body mass index; NTD, Neural Tube Defects; RBC, Red Blood Cell; RCT, randomised controlled trial.