Children’s vegetable intake is well below recommended levels, and primary schools provide an important setting for improving intake. A recent systematic review of fruit and vegetable provisioning interventions targeting snack breaks found increased fruit and vegetable intake but did not assess fruit and vegetable intake separately1. Because combined fruit and vegetable interventions in schools tend to benefit fruit intake more than vegetable intake2, this review aimed to determine whether fruit and vegetable provisioning interventions targeting snack breaks in primary schools are effective in increasing vegetable intake. It also aimed to describe the characteristics of interventions that were effective in increasing vegetable intake.
A rapid review was conducted in accordance with Cochrane Rapid Review recommendations. Three databases (PubMed, Scopus and Cochrane Central) were searched using a strategy developed in consultation with an expert librarian (PROSPERO; CRD420251148716). Eligible studies were interventional studies conducted in primary schools that provided vegetables, or fruit and vegetables, during snack breaks and reported a quantified measure of vegetable, or fruit and vegetable intake. Risk of bias was assessed using Cochrane’s Risk of Bias tool (RoB 2) for (cluster) randomized trials and ROBINS-1 for non-randomized studies. Title and abstract screening were conducted in duplicate by two reviewers, with disagreements resolved through discussion. Two reviewers independently extracted data from included studies, with critical elements checked by a second reviewer.
A total of 2,705 articles were retrieved, of which 27 met the eligibility criteria. Most studies were conducted in Europe or the US, with only one Australian study. Most evaluated existing programs (68%), often national and government-funded, while 32% were researcher-led trials. All interventions provided fruit and vegetables, almost always free to students. Among the 14 studies measuring vegetable intake separately, 57% reported increases in vegetable intake and 79% reported increased fruit intake. Interventions that increased vegetable intake were more often multicomponent, combining provisioning with classroom education and parental awareness, whereas ineffective interventions more commonly relied on provisioning alone. Effective interventions provided a variety of fruit and vegetables free of charge, most commonly as a daily portion during each school day. Effective interventions were more often researcher-led trials (63%), whereas ineffective interventions were more often existing programs (83%).
In conclusion, fruit and vegetable provisioning interventions in primary schools aimed at snack breaks that increase vegetable intake typically provide both fruit and vegetables and use complex, multicomponent intervention designs.