Dietary interventions among university students: A systematic review

Abstract

Purpose

This study aimed to provide an overview of available literature on interventions aiming to improve dietary intake among university students.

Materials and methods

A systematic review was conducted following the PRISMA guidelines. Web of Science, PubMed, PsycINFO and SPORTDiscus were searched for relevant articles. Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research.

Results

Twenty studies were identified, consisting of 12 randomised controlled trials, 1 quasi-experiment and 7 pre-experiments. Six studies were conducted outside the US. Risk of bias assessment revealed an average quality score of 5.8/10. Of the 13 interventions which were effective in improving students’ dietary intake, 8 used an intrapersonal approach, with 6 of them using the web or some kind of media to facilitate the intervention. The 5 remaining studies used an environmental (point-of-purchase) approach. Only 1 intervention, using 10 web-based lessons, based on non-diet principles and focused on eating competence and size acceptance to promote healthy eating, was found to be effective in the long term.

Conclusions

Nutrition education, enhancing self-regulation components towards dietary intake (often facilitated by the worldwide web or other media devices), and point-of-purchase messaging strategies may improve university or college students’ dietary intake. Future high quality randomised controlled trials should evaluate sustainability of intervention effects, as well as further investigate the effectiveness of realistic and low-cost environmental (preferably combined with intrapersonal) interventions which can easily and instantly reach a great part of the university population.

Introduction

The transition from high school to college or university has been shown to be a critical period for weight and fat gain (Deliens et al., 2013, Fedewa et al., 2014, Finlayson et al., 2012). Many university students do not meet the recommended dietary guidelines, which may result in inappropriate weight gain (Crombie et al., 2009, Fedewa et al., 2014, Vella-Zarb and Elgar, 2009). Weight gain and altered dietary patterns during college or university may have unfavourable physiological consequences that could lead to diet-related chronic diseases in later life, such as overweight and obesity, cardiovascular diseases, type 2 diabetes (Roger et al., 2012), and subsequently, increased health care costs (Finkelstein, Trogdon, Cohen, & Dietz, 2009).

It has been recommended that health experts and universities make students aware of the importance of a healthy dietary pattern and to promote healthy eating habits on university campuses (Crombie et al., 2009). To do so, it is important to get an overview of effective strategies promoting healthy dietary intake in university settings. Kelly and colleagues (Kelly, Mazzeo, & Bean, 2013) conducted a systematic review of intervention studies (published between 2001 and 2011) aiming to improve university students’ dietary intake. Although long-term efficacy was rarely studied, it was concluded that particularly interventions using self-regulation strategies along with a face-to-face or online approach were effective. In this review, studies recruiting students from specific courses (e.g. nutrition or health class, human biology course) were not excluded. It is likely, however, that students enrolled in such classes are intrinsically interested in dietary intake and nutrition in general. To minimize selection bias, which often results in low external validity, systematic reviews should only include interventions focusing on students from a variety of courses and study disciplines. Furthermore, Kelly’s review (Kelly et al., 2013) excluded studies conducted outside the United States (US). Because of socio-cultural and socio-economic differences between the US and Europe or other parts of the world (fast food and all-you-can-eat dining culture), we cannot generalize these results to other non-US student populations. Given the fact that the past few years research on university students’ dietary intake has gained interest outside the US, a more complete and more global overview of literature on dietary interventions aiming to improve dietary intake among university students is needed. Therefore, the aim of this systematic review was to provide a more recent overview of available literature (including US and non-US studies) on interventions aiming to improve dietary intake among university students from a variety of courses and study disciplines.