Table 1.
Characteristics of the included studies (n = 23).
| Authors, (Year), Country | Design | Sample | Aim | Intervention | Duration | Measurement | Main Outcomes M(SD) | EL/RG |
|---|---|---|---|---|---|---|---|---|
| Amaro et al. [27] (2006), Italy | RCT |
N = 241 children Age 11–14 year n CG = 88 n IG = 153 |
To test the changes in nutrition knowledge and dietary behaviour | CG: no intervention IG: “Kalèdo” Nutrition board-game (play session 15–30 min) |
24 weeks | Questionnaires on nutritional knowledge and food intake BMI |
Nutrition knowledge Significant difference between IG and CG at post-assessment (p < 0.05). Adjusted means were 11.24 (95% CI 10.68–11.80) for the IG and 9.24 (95% CI 8.50–9.98) for CG Dietary intake Significant difference between IG and CG at post-assessment (p < 0.01) for the variable vegetable intake. Adjusted mean number of servings per week was 3.7 (95% CI 3.5–4.1) for IG and 2.8 (95% CI 2.4–3.3) for CG BMI No significant difference between IG and CG at post-assessment. Adjusted means were 0.345 (95% CI 0.29–0.39) for IG and 0.405 (95% CI 0.34–0.46) for CG |
1b/A |
| Bannon et al. [28] (2006), USA | RCT |
N = 50 children Mean age 5 years n CG = 18 n IG1 = 14 n IG2 = 18 |
To test the influence of nutrition message framing on snack choice among children | CG: control video IG1: gain-framed nutrition video message IG2: loss-framed nutrition video message |
60 s video time | Food preference questionnaire Healthy food questionnaire |
Gain- and loss-framed messages promoting healthy snacks have the potential to positively influence children’s behaviour In IG, 56% chose apples rather than animal crackers; in CG, only 33% chose apples |
1b/A |
| Baños et al. [29] (2013), Spain | RCT |
N = 228 children Age 10–13 years n CG = 155 n IG = 73 |
To study an online game to improve children’s nutritional knowledge | CG: paper–pencil intervention IG: “ETIOBE Mates” broader e-therapy platform educational website including serious games |
2 weeks (unlimited sessions) | Nutritional knowledge questionnaire |
Baseline Nutritional knowledge CG: 6.25 (1.3) IG: 6.46 (1.3) 2 weeks follow-up Nutritional knowledge CG: 6.42 (1.5) IG: 6.94 (1.4) |
1b/A |
| Baranowski et al. [30] (2011), USA | RCT |
N = 133 children Age 10–12 years n CG = 40 n IG = 93 |
To promote behaviour change on children’s diet | CG: games on popular websites IG: “Escape from Diab” + “Nanoswarm: Invasion from Inner Space” Video-games (9 sessions of 40 min) |
2 months | BMI Mean levels of FV, non-fat vegetables, total energy |
Baseline CG Body Composition BMI %: 75.12 (1.04) BMI z-score: 0.78 (0.03) Diet (Servings) FV: 1.56 (0.18) Total Energy (kcal): 1657 (58) IG Body Composition BMI %: 77.41 (0.74) BMI z-score: 0.85 (0.02) Diet (Servings) FV: 1.88 (0.13) Total Energy (kcal): 1604 (41) 2 months follow-up CG Body Composition BMI %: 75.98 (1.09) BMI z-score: 0.80 (0.03) Diet (Servings) FV: 1.48 (0.19) Total Energy (kcal): 1653 (63) IG Body Composition BMI %: 77.28 (0.75) BMI z-score: 0.83 (0.02) Diet (Servings) FV: 2.15 (0.13) Total Energy (kcal): 1632 (42) |
1b/A |
| Chagas et al. [31] (2020), Brazil | RCT |
N = 319 adolescents Mean age 15.8 years n CG = 202 n IG = 117 |
To assess the impact of a game-based nutritional intervention on food consumption, nutritional knowledge, and self-efficacy | CG: no intervention IG: “Rango Cards”, a digital game (unlimited session) |
17 days | Nutritional knowledge questionnaire |
Baseline Nutritional knowledge CG: 4.3 (0.5) IG: 4.2 (0.4) Follow-up Nutritional knowledge CG: 4.2 (0.6) IG: 4.2 (0.5) |
1b/A |
| Cullen et al. [32] (2005), USA | RCT |
N = 1489 children Age 8–12 years n CG = 740 n IG = 749 |
To assess changes in nutritional practices | CG: no intervention IG: “Squire’s Quest!” multimedia game (10 sessions of 25 min) |
5 weeks | Servings of fruit, 100% juice, and vegetables consumed | After intervention, at snacks, the difference in means between IG and CG was significantly higher for fruit and 100% fruit juice, and for regular non-fried vegetables but not for other juice and vegetables | 1b/A |
| Cullen et al. [33] (2016), USA | RCT |
N = 387 children Age 9–11 years n CG = 97 n IG1 action plans = 98 n IG2 coping plans = 95 n IG3 action + coping plans = 97 |
To examine an online video-game to promote fruit-vegetable consumption changes | CG: no intervention IG: “Squire’s Quest II” online video-game. 10 sessions (25 min each) for 5 weeks |
5 weeks 6 months follow up |
Servings of fruit, 100% juice, and vegetables consumed | At 6 months, vegetable intake at dinner was significantly increased in action and coping groups. Overall, there were significant increases in fruit consumption at breakfast (p = 0.009), lunch (p = 0.014), and as a snack (p < 0.001) | 1b/A |
| Folkvord et al. [34] (2013), Netherlands | RCT |
N = 270 children Age 8–10 years n CG = 69 n IG1 = 69 n IG2 = 67 n IG3 = 65 |
To examine the effect of advergames that promote intake of energy-dense snacks or fruit on children | CG: no intervention IG1: advergame that promoted energy-dense snacks IG1: advergame that promoted fruit IG3: non-food products |
- | Caloric intake | Children who played an advergame that promoted food (energy-dense snacks or fruit) ate significantly more than did the children who played an advergame that promoted non-food products (p < 0.01) and also ate. Sex (male) (p < 0.05), hunger (p < 0.01), and age (p < 0.05) were significantly related to energy-dense calorie intake | 1b/A |
| Froome et al. [35] (2020), Canada | RCT |
N = 73 children Age 8–10 years n CG = 34 n IG = 39 |
To determine improvement in children’s nutritional knowledge | CG: cooking game “My Salad Shop Bar” IG: game mobile application Foodbot Factory (learning module of drinks, whole-grain food, vegetables and fruits, animal protein, plant-based protein + voiceover) (10–15 min each day) |
5 days | Nutrition knowledge |
Baseline Nutrition knowledge CG: 10.2 (3.1) IG: 10.3 (2.9) Day 5 Nutrition knowledge CG: 10.4 (3.2) IG: 13.5 (3.8) |
1b/A |
| Gan et al. [36] (2019), Philippines | RCT |
N = 360 children Age 7–10 years n CG = 180 n IG = 180 |
To increase nutrition knowledge | CG: no intervention IG: “Healthy Foodie” nutrition game (25 to 40 min to complete the game) |
2 weeks | Nutrition knowledge questionnaire |
Baseline Food Group Knowledge score CG: 9.55 (3.72) IG: 9.08 (3.48) Food Frequency Knowledge score CG: 9.67 (2.79) IG: 9.16 (2.55) 2 weeks follow-up Food Group Knowledge score CG: 8.66 (3.82) IG: 11.42 (3.25) Food Frequency Knowledge score CG: 9.22 (2.75) IG: 10.55 (2.28) |
1b/A |
| Hermans et al. [37] (2018), USA | RCT |
N = 108 children Age 10–13 years n CG = 58 n IG = 50 |
To test the short-term effectiveness of a videogame designed to teach elementary school children about nutrition and healthy food choices | CG: web-based nutrition game “Super Shopper” (not designed to educate children in healthy food choices) IG: gameplay of An Alien Health Game “Feed the Alien!” (designed to educate children in healthy food choices and the main function of the five most important macronutrients). 1 h of gameplay (30 min session) |
2 weeks | Nutritional knowledge Food intake |
Nutritional knowledge IG had better knowledge at immediate post-test, (p < 0.001) but not at 2-week follow-up (p = 0.999) Food intake Participants in both conditions ate more energy-dense foods at 2-week follow-up than at immediate post-test (p < 0.001). |
1b/A |
| Lakshman et al. [38] (2010), UK | RCT |
N = 1133 children Age 9–11 years n CG = 631 n IG = 502 |
To increase nutrition knowledge | CG: traditional healthy eating curriculum IG: “Top Grub”: card nutrition game |
9 weeks | Nutrition knowledge questionnaire Attitudes to healthy eating |
Baseline Nutrition knowledge Total score CG: 27.3 (2) IG: 28.3 (1.1) Balanced diet domain (max 0.15 points) CG: 11.3 (0.9) IG: 11.6 (0.4) Ability to identify healthier foods CG: 11.6 (0.9) IG: 12.1 (0.6) 9 weeks Nutrition knowledge Total score CG: 27.6 (2.1) IG: 29.2 (0.8) Balanced diet domain (max 0.15 points) CG: 11.5 (0.9) IG: 12.1 (0.5) Ability to identify healthier foods CG: 11.6 (1.0) IG: 12.1 (0.4) |
|
| Lu et al. [39] (2012), USA | RCT |
N = 153 children Age 10–12 years n CG = 50 n IG = 103 |
To analyse positive health outcomes | CG: no intervention IG: health videogame “Escape from Diab”. 9 sessions of 40 min |
2 months | Fruit, vegetables, and water consumption |
Baseline vs. 2 months follow-up (Only for IG) Fruit/Vegetables Preference 68.36 (13.53)/71.54 (15.49) Water Preference 2.64 (0.65)/2.59 (0.72) Intrinsic Motivation for Fruit 5.89 (1.94)/6.15 (2.18) Intrinsic Motivation for Vegetable 3.76 (1.82)/3.73 (1.94) Intrinsic Motivation for Water 5.19 (1.95)/5.51 (1.91) Fruit Self-Efficacy 9.49 (2.12)/10.39 (2.29) Vegetable Self-Efficacy 4.69 (2.24)/5.32 (2.22) Water Self-Efficacy 3.56 (1.39)/3.69 (1.54) Story immersion correlated positively (p < 0.03) with an increase in Fruit and Vegetable Preference (r = 0.27), Intrinsic Motivation for Water (r = 0.29), Vegetable Self-Efficacy (r = 0.24) |
1b/A |
| Mack et al. [40] (2020), Germany | RCT |
N = 82 children Age 9–12 year n CG = 40 n IG = 42 |
To evaluate the gain in knowledge about important lifestyle factors with the focus on nutrition | CG: brochure healthy lifestyle IG: nutrition games modules (2 sessions of 45 min) |
2 weeks | Maintenance of knowledge questionnaire Food frequency questionnaire Healthy nutrition index |
Baseline Knowledge score % Food pyramid score CG: 49 (14) IG: 50 (13) % of dietary energy-density score CG: 41 (19) IG: 51 (18) Healthy nutrition index (reported by children) CG: 8.9 (2.2) IG: 8.8 (2.1) 4 weeks follow-up Knowledge score% Food pyramid CG: 54 (12) IG: 77 (12) % of dietary energy-density score CG: 46 (22) IG: 64 (17) Healthy nutrition index (reported by children) CG: 9.3 (2.5) IG: 9.5 (2.2) |
1b/A |
| Putnam et al. [41] (2018), USA | RCT |
N = 132 children Age 4–5 years n CG = 44 n IG = 88 |
To encourage healthier snack selection and consumption | CG: game adventure app IG: game adventure app with “Dora the Explorer” |
- | Snack choices | Children who were aware of Dora were 10.34 times more likely to select healthier snack items than those who were unaware of her (p = 0.008) | 1b/A |
| Sharma [42] (2015), USA | RCT |
N = 94 children Age 8–12 years n CG = 50 n IG = 44 |
To evaluate dietary behaviours | CG: usual programs IG: “Quest to Lava Mountain” adventure game (90 min play game) |
6 weeks | Dietary Intake |
Baseline Dietary intake fruit (servings per 1000 kcal) CG: 0.81 (0.67) IG: 0.84 (0.67) Vegetables (servings per 1000 kcal) CG: 0.51 (0.33) IG: 0.56 (0.42) Dietary fibre (g/1000 kcal) CG: 8.82 (2.46) IG: 8.29 (2.59) Sugars (g/1000 kcal) CG: 55.33 (16.94) IG: 55.35 (13.47) Total fat (g/1000 kcal) CG: 32.31 (6.01) IG: 32.84 (5.45) Energy (kcal) CG: 1632.51 (443.37) IG: 1415.49 (412.02) Carbohydrates (g/1000 kcal) CG: 51.83 (7.97) IG: 49.79 (6.98) Protein (g/1000 kcal) CG: 15.86 (3.71) IG: 17.37 (3.80) Calcium (mg/1000 kcal) CG: 520.92 (180.32) IG: 597.36 (186.07) 6 weeks follow-up Dietary intake fruit (servings per 1000 kcal) CG: 0.79 (0.68) IG: 0.71(0.67) Vegetables (servings per 1000 kcal) CG: 0.45 (0.37) IG: 0.50 (0.44) Dietary fibre (g/1000 kcal) CG: 7.96 (2.82) IG: 8.35 (2.61) Sugars (g/1000 kcal) CG: 60.94 (15.97) IG: 50.45 (18.93) Total fat (g/1000 kcal) CG: 31.90 (6.83) IG: 34.78 (6.83) Energy (kcal) CG: 1331.46 (524.92) IG: 1304.11 (571.60) Carbohydrates (g/1000 kcal) CG: 52.40 (8.31) IG: 48.49 (9.03) Protein (g/1000 kcal) CG: 15.70 (4.21) IG: 16.72 (5.72) Calcium (mg/1000 kcal) CG: 561.83 (262.32) IG: 538.15 (168.55) |
1b/A |
| Sharps et al. [43] (2016), UK | RCT |
N = 143 children Age 6–11 years n CG = 46 n IG1 = 49 n IG2 = 48 |
To increase intake of fruit and vegetables through board games | CG: non-food-related game IG1: descriptive social norm-based message. Fruit and vegetables related game IG2: health message and image condition. Fruit and vegetables related game 7 min of playtime every day |
- | Food intake |
Food intake Significant main effect of condition on fruit and vegetable intake (p = 0.01). IG2 ate significantly more fruit and vegetables than children in CG (p = 0.009). There was no significant main effect of conditioning on high-calorie snack food intake (p = 0.99) |
1b/A |
| Rosi et al. [44] (2016), Italy | RCT |
N = 145 children Age 8–10 years n CG = 33 n IG1 = 58 n IG2 = 54 |
To improve nutritional education | CG: no intervention IG1: “Master of Taste” nutritional educator IG2: “Master of Taste” supported by a humanoid robot |
1 year | Cultural–nutritional awareness factor (score of the nutritional knowledge level) |
Baseline Cultural–nutritional awareness factor CG: 5.5 (1.5) IG1: 6.2 (1.7) IG2: 5.9 (1.3) 1 year follow-up Cultural–nutritional awareness factor CG: 6.1 (1.4) IG1: 6.9 (1.1) IG2: 6.9 (1.1) |
1b/A |
| Spook et al. [45] (2016), Netherlands | RCT |
N = 231 adolescents Mean age 17.28 years n CG = 126 n IG = 105 |
To assess dietary intake | CG: no intervention IG: “Balance It”, interactive multimedia game (unlimited sessions) |
4 weeks | Dietary intake (fruit and vegetable consumption, snack consumption, and soft drink consumption) |
Baseline Behavioural outcomes (mean portion/day) Fruit intake CG: 0.80 (0.68) IG: 0.81 (0.68) Vegetable intake CG: 1.32 (0.38) IG: 1.26 (0.33) Snack consumption CG: 0.98 (0.51) IG: 0.91 (0.50) Soft drink consumption CG: 1.11 (0.59) IG: 1.07 (0.53) 4 weeks follow-up Behavioural outcomes (mean portion/day) Fruit intake CG: 0.81 (0.62) IG: 1.05 (0.75) Vegetable intake CG: 1.28 (0.36) IG: 1.21 (0.41) Snack consumption CG: 0.90 (0.48) IG: 0.86 (0.51) Soft drink consumption CG: 1.07 (0.57) IG: 0.92 (0.57) |
1b/A |
| Thompson et al. [46], (2016) USA | RCT |
N = 387 children Aged 9–11 years n CG = 97 n IG1 action = 98 n IG2 coping = 95 n IG3 action + coping = 97 |
To evaluate the dietary intake of healthy children | CG: no intervention Intervention: serious game “Squire’s Quest! II” (10 sessions of 25 min) IG1 Action: set a goal and then created an action plan to meet the goal. IG2: Coping, a goal to eat more FV and then to create a coping plan IG3: Both IG1 + IG2 |
5 weeks | Fruit and vegetable intake |
Baseline Energy (kcal) CG: 1496 (34.71) IG1: 1477 (34.93) IG2: 1487 (35.04) IG3: 1476 (35.13) Vitamin C (mg) CG: 96.89 (7.97) IG1: 74.25 (8.01) IG2: 73.37 (8.03) IG3: 84.99 (8.04) Sodium (mg) CG: 2655 (45.33) IG1:2626 (45.58) IG2: 2646 (45.71) IG3: 2623 (45.81) Potassium (mg) CG: 1732 (38.1) IG1: 1668 (38.35) IG2: 1693 (38.48) IG3: 1823 (38.59) Total dietary fibre (g) CG: 11.02 (0.34) IG1: 11.33 (0.35) IG2: 11.16 (0.35) IG3: 11.4 (0.35) Added sugars (g) CG: 54.74 (2.25) IG1: 58.69 (2.26) IG2: 56.83 (2.26) IG3: 58.16 (2.27) 6 months follow-up Energy (kcal) CG: 1523 (39.09) IG1: 1444 (38.94) IG2: 1510 (39.79) IG3: 1482 (39.31) Vitamin C (mg) CG: 92.66 (11.98) IG1: 87.22 (11.91) IG2: 96.91 (12.11) IG3: 104.47 (11.98) Sodium (mg) CG: 2740 (50.96) IG1: 2562 (50.70) IG2: 2667 (51.91) IG3: 2670 (51.14) Potassium (mg) CG: 1789 (45.66) IG1: 1905 (45.47) IG2: 1854 (46.42) IG3: 1858 (45.86) Total dietary fibre (g) CG: 11.5 (0.42) IG1: 12.75 (0.42) IG2: 12.14 (0.42) IG3: 12.15 (0.42) Added sugars (g) CG: 48.2 (2.25) IG1: 50.79 (2.24) IG2: 53.83 (2.29) IG3: 50.13 (2.26) |
1b/A |
| Viggiano et al. [47] (2015), Italy | RCT |
N = 3110 children Age 9–19 years n CG = 1447 n IG = 1663 |
To promote nutrition education and to improve dietary behaviour | CG: no intervention IG: “Kalèdo” nutrition board-game (15–30 min session) |
20 weeks | BMI z-score Nutrition Knowledge |
Baseline Normal Weight CG: 52.55% IG: 51.6% Overweight CG: 32.6% IG: 34.9% Obesity CG: 14.8% IG: 13.3% BMI z-score CG: 0.59 IG: 0.58 Nutrition Knowledge CG: 4.4 (4.2–4.5) IG: 4.2 (4.1–4.4) Food Habits CG: 27.3 IG: 27.2 18 months follow-up Normal Weight CG: 52.55% IG: 63.55% Overweight CG: 32% IG: 27.8% Obesity CG: 15.45% IG: 8.65% BMI z-score CG: 0.58 IG: 0.34 Nutrition Knowledge CG: 5.6 (5.4–5.7) IG: 6.2 (6.1–6.4) Food Habits CG: 28.6 IG: 29.3 |
1b/A |
| Viggiano et al. [48] (2018), Italy | RCT |
N = 1007 children Age 7–11 years n CG: 356 n IG: 651 |
To improve knowledge in nutrition and to promote a healthy lifestyle | CG: no intervention IG: “Kalèdo” nutrition board-game. 20 sessions of 15–30 min |
20 weeks | Food frequency consumption BMI z-score |
8 months follow-up IG significantly increased the consumption of healthy food (p < 0.01) compared to CG 18 months follow-up The increase in the consumption of healthy foods in GI was maintained over time (p < 0.01). Significantly higher consumption of healthy food in girls (mean 9.41; CI 95% 7.61–11.22) compared to boys (mean 7.11; CI 95% 5.46–8.76). IG decreased junk food consumption (p < 0.01) compared to the CG |
1b/A |
| Zask et al. [49] (2012), Australia | RCT |
N = 1005 children Age 3–6 years n CG = 537 n IG = 468 |
To increasing fruit and vegetable intake and decreasing unhealthy food consumption | CG: no intervention IG: “Tooty Fruity Vegie” a game health promotion program |
10 months | Dietary intake BMI |
Baseline Number of fruit and vegetables serves CG: 1.95 (0.17) IG: 1.91 (0.13) BMI z-scores CG: 0.11 (0.08) IG: 0.14 (0.06) Mean waist circumference in cm CG: 52.33 (0.29) IG: 52.54 (0.23) 10 months follow-up Number of fruit and vegetables serves CG: 1.73 (0.12) IG: 2.31 (0.11) BMI z- scores CG: 0.24 (0.09) IG: 0.11 (0.06) Mean waist circumference in cm CG: 53.49 (0.28) IG: 52.89 (0.29) |
1b/A |
BMI = body mass index; CG = control group; EL = evidence level; FV = fruit and vegetable; IG = intervention group; RCT = randomized controlled trial; RG = recommendation grade.