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Garden-based interventions and early childhood health: an umbrella review

International Journal of Behavioral Nutrition and Physical Activity volume 17, Article number: 121 (2020) Cite this article

Abstract

Background

Garden-based interventions show promise for improving not only child nutrition, but other indicators of child health. Yet, existing systematic reviews of garden-based interventions often focus on one particular health outcome or setting, creating a need to holistically summarize review-level evidence on the role of garden-based interventions in early childhood. To fill this gap, we performed an umbrella review of garden-based interventions to examine their role in early childhood health promotion for children ages 6 years and younger, examining effective components of garden-based interventions and critically evaluating existing evidence.

Methods

We searched the following databases: PubMed, PubMed, PsycINFO, ERIC, CINAHL, Embase, Scopus, OVID-Agricola, and CAB Direct, limiting to reviews published from 1990 to August 2019. Of the 9457 references identified, we included a total of 16 unique reviews for analysis.

Results

Across reviews, garden based-interventions were most effective at improving nutrition-related outcomes for children, including nutritional status and fruit and vegetable consumption. Few reviews examined child health outcomes of garden-based interventions that were not nutrition related, such as physical activity, or academic performance. Across settings, there was the most evidence in support of garden-based interventions conducted in home gardens, compared to evidence from early care and education or community settings. We were unable to report on most effective components of garden-based interventions due to limitations of included reviews.

Conclusions

Existing evidence is difficult to interpret due to methodological limitations at both the review and primary study level. Therefore, the lack of evidence for certain child health outcomes should not necessarily be interpreted as an absence of an effect of garden-based interventions for specific outcomes, but as a product of these limitations. Given the breadth of evidence for garden-based interventions to improve a number of dimensions of health with older children and adult populations, we highlight areas of future research to address evidence gaps identified in this umbrella review. Further research on the role of garden-based interventions, including their impact on non-nutrition early childhood health outcomes and how effectiveness differs by setting type is necessary to fully understand their role in early childhood health promotion.

PROSPERO registration

CRD42019106848.

Background

In recent years, evidence from on the linkage between early childhood behaviors, sustained quality of life, and adult heath has come from the fields of epigenetics, nutrition, physical activity, and neuropsychology [1, 2]. This has led global and national organizations to prioritize interventions focusing on early childhood health [3,4,5,6]. Epigenetic research exploring the developmental origins of health has found that early childhood nutrition, in particular, is a vital determinant of adult health [1]. Early childhood environmental exposures, including nutrition, influence the gut microbiome and brain development, which are critical in the maintenance of a healthy immune response [1] and proper physical and socioemotional development [7]. With both early childhood physical activity and nutrition influencing cardiometabolic health [8], establishing healthy habits in these behavioral areas in early life quintessential to long-term health promotion [9]. Ultimately, the large number of habits developed during the first years of life and the impact early childhood health has on future health, makes it an ideal time for health promotion [9,10,11].

Effective approaches for early childhood health include both macro-and micro-level interventions. On a macro-level, policies and environments can promote early childhood health. At a micro-level, innovative strategies, such as interventions that include multiple components such as experimental learning and education have shown positive health outcomes for young children. These types of interventions may prove key in health promotion during early childhood. Garden-based interventions, which typically include hands-on learning with fruits and vegetables, nutrition education about food origins and systems, and production of fresh produce, have been associated with improved child health outcomes [12,13,14,15,16,17,18].

Garden-based interventions have demonstrated improvements in nutrition-related indicators, such as child nutritional status and food security, fruit and vegetable consumption, and weight status [14, 16, 17, 19,20,21,22]. Additionally, garden-based interventions have been utilized as a form of therapy for specific disorders and diseases, including autism spectrum disorder [23] and childhood cancer [19]. There may be additional health benefits of garden-based interventions, such as socioemotional development or biological health measures. Indeed, improvements in biological measures for children, such as vitamin A status (serum retinol) and iron deficiency anemia have resulted from garden-based interventions [24, 25]. These hands-on interventions may also increase outdoor physical activity [26] and improve academic performance [27]. For older youth and adults, gardens have improved mental health, and may help reduce anxiety, stress, and anger [16, 28, 29].

To date, several reviews have examined the impact of garden-based interventions on children and reported positive effects for many child health outcomes [15, 19, 27, 30,31,32,33]. However, the impact of garden-based interventions during early childhood is difficult to collate as few reviews have assessed multiple child health outcomes in the same article. Most existing reviews focused on a singular outcome, such as fruit and vegetable intake [30], academic performance [27], or mental health [34]. Further, some reviews focused on a single type of gardening program (e.g., farm-to-preschool) [32], rather than exploring the multiple settings in which garden-based interventions can occur. Additionally, most reviews do not singularly focus on early childhood; rather, early childhood outcomes are included as sub analyses of the review. Thus, there is a need to comprehensively collate the evidence regarding the impact of garden-based interventions on a variety of early childhood outcomes. In effort to address this evidence gap, we conducted an umbrella review to summarize existing review level evidence of garden-based interventions on health outcomes for children ages 6 years and younger.

Methods

For this umbrella review, we aimed to 1) identify and synthesize existing review-level evidence on garden-based interventions for children ages 6 and younger; 2) examine which components of garden-based interventions are most effective at improving child health outcomes; and 3) critically evaluate included reviews both narratively and quantitatively; and 4) identify potential gaps in the literature and highlight possible areas for improvement in the field of garden-based interventions, including but not limited to study design, measurement, and health outcomes. We used guidance from the Joanna Briggs Institute (JBI) Methodology for Umbrella Reviews [35] and the Cochrane Handbook’s Methodology for conducting an overview of reviews [36] to strategically create an a priori protocol for this umbrella review [37]. The published protocol for this review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRSIMA-P) 2015 Statement [38] and registered with PROSPERO (International Prospective Register of Systematic Reviews, CRD42019106848). We used the systematic review management software Covidence [39] to streamline the review process.

Search strategy

In January 2019, we searched PubMed, PsycINFO, ERIC, CINAHL, Embase, Scopus, OVID-Agricola, and CAB Direct, restricting to articles published after January 1990. We also searched review registries, including the Cochrane Register of Systematic Reviews, the JBI Database of Systematic Reviews and Implementation Reports, and PROSPERO. We included the first 200 results of Google Scholar, when sorted by relevance. For included articles, we performed forward and backward citation searches to identify any relevant reviews. Prior to data analysis, we conducted an updated search for articles published between January and August 2019.

We crafted search terms using synonyms for gardening and young children used in prior reviews [15, 30, 31, 40], including additional terms created through collaboration with a medical librarian specializing in systematic reviews. For each database searched, we used database-specific controlled vocabulary and key terms. For databases without advanced search options (e.g., Google Scholar), we used a simpler search strategy that was comprised of a variation of gardening terms (e.g., “gardening”, “review”, and “children”). A pilot search informed the development of the final search strategy, which is located in Additional file 1.

Eligibility criteria

We delineated a priori inclusion and exclusion criteria utilizing the population, intervention, context, outcome, and study design (PICOS) [41]. We applied eligibility criteria at both the systematic review and primary study level. For a review to be eligible for inclusion, at least one primary study had to meet all inclusion criteria. For example, if a review appeared eligible for inclusion, but further examination revealed no primary studies that met inclusion, we excluded the review.

Participants

We included reviews that included children ages 6 years and younger. A review did not have to include only children 6 years and younger; we included reviews with at least one primary study with our population of interest. We did not employ any limitations regarding gender, socioeconomic status, or specific child health conditions.

Intervention

We included systematic reviews that focused on or included garden-based interventions. As garden-based interventions are inherently complex to define due to variation in type and setting, we included any intervention that engaged children in active learning about nutrition, food systems, agriculture, or environmental health through connections with outside fruit or vegetable gardens or farms, raised garden beds, greenhouses, container gardens, microfarms, or other alternative gardening methods [37]. We also included farm-to-preschool and farm-to-child care programs, which often link young children with fresh produce from local farms.

Context

We included garden-based interventions occurring in any country and setting, including homes, early care and education programs (e.g., preschool or child care), community centers or community gardens, afterschool programs, and summer camps. We included garden-based interventions that focused on gardening interventions only, as well as multi-component interventions that included gardening.

Outcomes

We included reviews with at least one of the following child-level health outcomes of interest: nutrition-related behaviors (e.g., consumption, attitudes, preferences, dietary quality), nutritional status, anthropometric measures (e.g., body mass index (BMI), body fat percentile, BMI z-score), physical activity, cognition-related outcomes (e.g., academic performance, developmental milestones), mental health (e.g., social behavior, stress, anxiety), screen time, and biological outcomes (e.g., hemoglobin, serum retinol, microbiome). We excluded reviews that did not report on at least one of the child health outcomes of interest for our population of interest. We considered adverse or unintended consequences when noted in reviews. Although we included reviews that reported on both child and parent-level health outcomes, we extracted only child-level outcomes for our population of interest for analysis. We excluded reviews that included only parent-, school-, or community-related outcomes. We extracted health outcomes for our population of interest only. In instances that a review included multiple health outcomes of interest, but we could not disaggregate outcomes for our population of interest, we excluded that outcome.

Types of studies

We included peer-reviewed systematic reviews, with or without meta-analyses, published January 1990 through August 2019 [41]. We used the following definition of systematic review, which aligns with the definition of a systematic review provided in the PRISMA-P 2015 statement: a review which (a) has an explicit set of aims; (b) employs a reproducible methodology, including a systematic search strategy and selection of studies; and (c) systematically presents and synthesis characteristics of included studies [42]. We excluded reviews that failed to meet this definition. We included systematic reviews of studies that had randomized, quasi-randomized, and non-randomized designs. We excluded reviews that included qualitative studies only.

Study screening and selection

We imported the associated Endnote X9 (Clarivate Analytics) library for each database search directly into Covidence. Citations were automatically de-duplicated as part of the import process. Two teams, each consisting of two reviewers, independently screened titles and abstracts. During this iterative screening process, Covidence automatically filtered citations into one of three lists, ‘Irrelevant”, “Resolve Conflicts”, and “Full Text Review”. We resolved disagreements between reviewers using consensus; no third reviewer was necessary. If a review team could not make an inclusion decision during the title and abstract screening phase, the article moved forward to full text review. After title and abstract screening, we gathered citations in their full-text, PDF form for full-text review. The same two teams of reviewers independently completed full-text screening, during which both reviewers had to agree on a final inclusion or exclusion decision.

Data extraction

Three reviewers across two teams independently extracted data from included articles directly into a customized data extraction form within Covidence. For each included article, we extracted the following: citation details, aims or objectives, review type, eligibility criteria (e.g., population, setting, intervention type, study design), search strategy and results (e.g., number of databases searched, date range, inclusion of gray literature, number of included studies), relevant child-level health outcomes, and funding source. We also extracted data at the primary study level for eligible studies, which included citation details, population, setting, intervention type and design, results, limitations, and conclusions to enable us to account for primary study overlap [36]. We contacted corresponding authors for missing information and clarification, if needed.

Quality appraisal

Three reviewers split into two teams independently performed quality assessment of included reviews via the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) questionnaire [43]. The AMSTAR 2 is a 16-item validated quality assessment tool that allows for inclusion of both randomized and observational studies and as such, is not intended to be scored [44]. Reviewers resolved any discrepancies through discussion and consensus on appraisal criteria.

Results

Out of 9452 titles and abstracts screened for inclusion, 20 reviews were eligible. However, 4 reviews were previous versions of a living systematic review [45,46,47,48] and therefore, not included in data extraction. Fig. 1 describes results of the systematic search and study selection process, in accordance with PRISMA reporting guidelines [38]. See Additional file 2 for the full list of excluded studies.

Fig. 1
figure 1

PRISMA flow diagram

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Description of included reviews

Table 1 details characteristics of the 16 included Systematic reviews [27, 30, 31, 48,49,50,51,52,53,54,55,56,57,58,59,60], including aim, topic area, interventions and populations included, databases searched, and funding source. Included reviews were published in English between 2004 and 2019. Five reviews included gray literature as part of their search strategy [31, 51, 52, 57, 59]. Five reviews focused on garden-based interventions and therefore, included only garden-based interventions [27, 30, 31, 54, 56]. Other reviews focused on improving nutrition status or healthy eating and included an array of agricultural, obesity prevention, nutrition education, and multi-component interventions. Similarly, some reviews examined one specific outcome (e.g., vegetable intake, physical activity) [49, 50], whereas others examined a number of outcomes (e.g., obesogenic behaviors) [60]. Three reviews included interventions that assessed vegetable-related outcomes only (e.g., intake, preferences, purchasing, provision) [49, 55, 59]; an additional 3 reviews included only interventions that measured fruit or vegetable outcomes [30, 48, 56]. Although only 5 reviews conducted formal meta-analysis [48, 50, 56,57,58,59], several reviews reported an inability to do so due to variation in study design and measures [27, 60], heterogeneity [55], and lack of sufficient data [58].

Table 1 Characteristics of included systematic reviews
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The level of scientific evidence presented in reviews varied, with some reviews finding no significant association between garden-based interventions and health outcomes, and other reviews reporting only positive outcomes. Across reviews, multi-component and multi-setting interventions appeared to be most effective [30, 48, 59, 60]. Of reviews that examined agricultural interventions, garden-based interventions [27, 30, 31, 54, 56] seemed to be more effective in improving nutrition-related indicators than other interventions, such as only nutrition education, agriculture technology, or livestock production.

Reviews included a total of 465 primary studies. The number of primary studies included in reviews that met our inclusion criteria ranged from 1 [50] to 6 [52] across reviews. Most reviews (n = 10) assessed the quality of original studies via an array of tools, including the Effective Public Health Practice Project Quality Assessment Tool [30, 31, 55, 59], Stetler’s Level of Quantitative Evidence [60], an adapted version of Critical Appraisal Skills Programme for RCTs [53], and the Cochrane Risk of Bias tool [48]. Two reviews developed their own rating system to appraise quality [51, 57] and one adapted the Cochrane Risk of Bias tool [58]. The remaining 6 reviews did not perform any quality assessment of original studies [27, 49, 50, 52, 54, 56].

Quality of included reviews

Hodder et al. 2019 was the highest quality review, fulfilling 15 out of 16 of the AMSTAR 2 elements [48]. In contrast, Beets et al. fulfilled only one and partially fulfilled two AMSTAR 2 appraisal elements [50]. Most reviews included the PICO elements in their inclusion criteria, either explicitly or implicitly, whereas only 3 reviews explicitly stated they developed an a priori protocol [31, 48, 59]. A small number of reviews (n = 5) investigated publication bias and discussed its impact on review results [31, 48, 56, 59]. Of included reviews, Hodder et al. 2019 was the only review that reported on funding of included studies [48]; the remaining reviews did not report on funding for primary studies. Table 2 provides comprehensive results of the AMSTAR 2 quality appraisal.

Table 2 AMSTAR 2 appraisal
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Overlap

We used a validated measure, the corrected covered area (CCA), to calculate the extent of overlap at the primary study level across included reviews [61]. We calculated the CCA by dividing the frequency of repeated occurrences of primary studies across reviews by the product of index publications and reviews, reduced by the total number of primary studies. The CCA was estimated to be 4.7, representing only slight overlap amongst included reviews [61]. The citation matrix used for calculating overlap is available in Additional file 3. Namenek Brouwer et al. was the article included in the most number of reviews (n = 7) [14].

Garden-based interventions

Table 3 describes characteristics of garden-based interventions, including setting, country, relevant findings, and conclusions. Across included reviews, 24 unique primary garden-based intervention studies met inclusion criteria [14, 24, 25, 62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82] and were published between 1991 [70] and 2017 [25]. Most garden-based interventions (n = 15) were implemented in the home [24, 25, 64, 67,68,69,70,71, 73,74,75,76,77, 82] and 8 were conducted in school, afterschool, or early care and education settings [14, 63, 65, 66, 78,79,80,81]. Only one community garden-based intervention included our age group of interest [62].

Table 3 Characteristics and findings of garden-based interventions among included reviews
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Effective components of garden-based interventions

Reviews discussed a number of components of garden-based interventions, including hands-on gardening, utilization of produce from garden (e.g., consumption, taste-testing, sale), staff training, nutrition education and cooking components. Amongst reviews, there was consensus that garden-based interventions that aimed to increase healthy eating behaviors should include a nutrition education component, as multi-component interventions may be more effective than garden-only interventions [13, 32]. However, due to limitations in study design and description of interventions, most reviews were unable to report which components of garden-based interventions were most effective for young children, including component effectiveness by setting. Table 4 details a list of garden-based intervention components of included primary studies with our age range of interest by review.

Table 4 Components of garden-based interventions in included reviews
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Early child health outcomes of garden-based interventions

Garden-based interventions examined numerous health outcomes of garden-based interventions for young children, including nutrition-related, weight status, physical activity, academic performance, mental health, and biological measures. Some studies that examined vegetable intake did so via self-reported measures, whereas others used biological assessments. For example, Faber et al. examined both consumption of yellow and green-leafy vegetables, as well as serum retinol [24]. Garden-based interventions included measures of undernutrition, including stunting, wasting, and underweight [51, 52, 57] but did not report on measures of overweight and obesity for children ages 6 and younger. Biological measures used across garden-based interventions included blood lipids, hemoglobin concentration, and serum retinol. Additional measures included prevalence of night blindness, diarrhea, and respiratory-related infections [51].

Across reviews, there was more evidence for improving nutrition-related outcomes, compared to other outcomes, such as physical activity or academic performance. There was insufficient evidence relating to the effects of garden-based interventions on macronutrient intake. However, there was evidence that garden-based interventions positively affected micronutrient intake, as demonstrated via biological indicators, including serum retinal [52, 57] and hemoglobin concentrations [51]. There was insufficient evidence that garden-based interventions were associated with improvements in anthropometric measures, such as body mass index (BMI) and weight-for-height [53, 58]. There was no evidence that garden-based interventions improved cognitive-related outcomes, including academic performance or mental health in our target age group. Biological measures revealed evidence that garden-based interventions resulted in improvements in prevalence of child anemia [53].

Effective settings of garden-based interventions

Across settings, garden-based interventions conducted in the home were consistently associated with improvements in child nutrition status, including wasting [51, 52, 57], stunting [51, 52, 57], and underweight [57]. Moderate evidence across reviews found that garden-based interventions improved fruit and vegetable intake [27, 30, 51, 52, 58, 83], as well as vegetable only intake in the early care and education, school, and home settings [49, 50, 55]. Only 1 garden-based intervention in an early care and education setting examined physical activity as an outcome at follow-up, but found no difference in physical activity levels between the intervention and control groups [80]. As there was only one review that included a community garden-based intervention [55], there was insufficient evidence to examine the effect of gardens within a community setting.

Recommendations for garden-based interventions

We extracted recommendations for future research and practice related to garden-based interventions across reviews (Table 5). Recommendations for future research included utilization of randomized or quasi-randomized designs with larger sample sizes to establish causal relationships [27, 30, 31, 48, 50, 53,54,55, 57]. Other recommendations were to improve outcome measures, including more standardized measures to allow for pooling of results for meta-analyses [30, 31, 48, 54,55,56,57,58]. Reviews also recommended examining effects of garden-based interventions on subgroups of children, including children with attention deficit disorders, children from low socioeconomic status groups, and younger children. Practice recommendations included the integration of theory-based [31], age-appropriate garden curricula [27] and age-appropriate evaluation tools [30].

Table 5 Summary of research and practice recommendations for garden-based interventions
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Discussion

This umbrella review provides a comprehensive synthesis of existing systematic review level evidence of the impact of garden-based interventions on health outcomes for children ages 6 years and younger. Of the 16 reviews included in this review, 5 focused exclusively on garden-based interventions [27, 30, 31, 54, 56]. Included reviews varied in quality and included a small number of primary-level garden-based interventions with children within our target age range. Across reviews, nutrition-related health outcomes, such as improving nutritional status and correlates of nutrition status had the most evidence. These included fruit and vegetable intake, mediators of fruit and vegetable intake (e.g., knowledge, willingness to taste, provision), and biological measures (e.g., serum retinol, hemoglobin). There was no review-level evidence that garden-based interventions improved BMI or other anthropometric measures in early childhood.

Across settings, there was the most evidence in support of improved child health outcomes for home gardens, compared to community gardens or early care and education settings. However, few primary level interventions have been conducted in these settings, which may explain the lack of evidence. It may also be that the 3 reviews that included the most relevant primary level studies focused on nutrition-sensitive agriculture in low- to middle-income countries, where interventions typically focus on the home or community setting.

Of included reviews, those from the United States (US) and other high-income countries focused more on obesogenic behaviors (e.g., improving fruit and vegetable intake and knowledge, physical activity, screen time), and reviews of low- to middle-income countries focused on improving undernutrition or nutrition status. This is not a surprising finding, as the US has higher rates of childhood obesity (12.7%), whereas higher rates of undernutrition are more often found in low-income countries [85]. However, with obesity prevalence rising in low- to middle-income countries, the triple burden of malnutrition may prompt changes in intervention approaches toward decreasing the prevalence of obesogenic behaviors and environments [86].

There was insufficient evidence that garden-based interventions were associated with non-nutrition early childhood health outcomes, such as academic performance or physical activity. We found no evidence that garden-based interventions were associated with improvements in developmental milestones or socio-emotional outcomes. For older children, evidence suggests garden-based interventions in the school setting improve academic performance, attendance, and prosocial behaviors [30, 87, 88]. It seems plausible that we would see similar improvements in preschool-aged children in early care and education settings if studies assessed these outcomes via developmentally appropriate measures.

Review-level evidence gaps

There was evidence that garden-based interventions are linked to improvements in multiple early childhood nutrition outcomes. However, there was little to no evidence on the relationship between garden-based interventions and anthropometric or weight status measures, physical activity, academic performance, and biological measures. A small number of reviews focused exclusively on garden-based interventions; these reviews varied in quality and included less than a dozen garden-based interventions with children in our target age range. Search strategy limitations of included reviews (e.g., inclusion of only a few databases, inadequate search terms, study design) and singular outcomes of interest reduced the number of primary studies included versus existing evidence available. For example, several systematic reviews focused on children, but failed to have critical early childhood search terms necessary to yield relevant studies. In fact, there are several published studies on the effect of garden-based interventions in early childhood that were not included in any included review [26, 89]. There are also several ongoing garden-based interventions with forthcoming results, including a randomized control trial testing the effectiveness of a community-based agricultural intervention [90] and another cluster randomized control trial examining effects of a garden-based early care and education center intervention [91]. These emerging results will, no doubt, contribute to this body of literature.

Although we aimed to examine and report on the components of garden-based interventions that were most effective, we were unable to do so due to limitations in available evidence. First, there was little effort done in the reviews to holistically evaluate effective intervention components. This is probably due, in part, to the array of fields which the reviews were focused and the array of interventions that were included. Therefore, a focus of future research is to determine what type of garden-based intervention components (e.g., cultivation, harvesting, nutrition education, cooking) are most effective. An additional and critical limitation of included reviews is poor quality, when rates via AMSTAR 2. For example, there were just 3 reviews with an a priori protocol specified. Additionally, many reviews did not include, either in the paper or in a supplement, a detailed search strategy or a full list of excluded studies. It is essential that systematic reviews understand the importance of rigorous reporting needed to properly assess existing evidence when undertaking evidence syntheses. Taken together, limitations of previous review create a need for a rigorous systematic review on garden-based interventions and effects on early childhood health outcomes that addresses these crucial limitations of prior systematic reviews.

Primary study-level evidence gaps

At a primary study level, there is a need for more convincing evidence on the holistic effects of garden-based interventions in child health promotion, particularly among young children, when interventions may have the greatest potential to impact healthy behaviors [59, 92]. Prior systematic reviews reported that most existing studies of garden-based interventions are of poor quality and have numerous limitations. Enhanced rigor of future research in this area, particularly relating to a more robust study design, enhanced measurement of more appropriate outcomes for young children are needed. Additionally, future garden-based interventions should age, developmentally, and culturally tailored. More robust evidence would not only help to delineate any dose-response relationship, but also effectiveness and sustainability of associated benefits.

Design of garden-based interventions

Multiple reviews call for age- and setting-specific garden-based interventions, as there is a need to understand what interventions work for which children across settings [31, 45, 59, 93]. There is some evidence that children who struggle in a traditional school environment benefit most from garden-based interventions [94], but the extent to which benefits are enhanced for children among different demographic characteristics remains unknown. Authors of future studies should consider using evidence-based curricula that are tailored to the developmental stages of the intended audience [30, 32]. A few garden-based curricula have been designed for use with young children [14, 95], one of which is “Watch Me Grow”, designed specifically for implementation in early care and education settings [14]. There are many more garden-based curricula available for older children [96,97,98]. As these curricula have shown positive results, it seems plausible that researchers could easily tailor these curricula and interventions for use during early childhood.

Measurement

Measurement issues at a primary-study level, such as lack of standardization across the field [56] and reliance of self-report or parental reports as a proxy for the child’s food preferences and behavior [32, 58], hindered our interpretation of evidence in this review. Multiple reviews called for improved use of validated measures across studies to allow for sophisticated meta-analysis. Standardized measures that future garden-based interventions could use in early childhood include using consistent measuring of fruit and vegetable consumption (e.g., weight vs. volume), validated and reliable scales (e.g., food preference, picky eating, social-emotional health), anthropometrics (BMI, BMI-z score), and the use of biological measures, for which collation is more straightforward [99]. Unfortunately, garden-based interventions rarely used biological measures, which are arguably more resource and time intensive, but may produce more accurate data on health effects. Future studies should incorporate biological sampling methods, as more affordable and feasible assessments become available (e.g., skin carotenoids scans). There is convincing evidence that increasing vegetable consumption is more challenging than increasing fruit consumption, which creates a need for future studies to differentiate between the two when analyzing consumption habits [30]. Additionally, fruit intake is typically higher in young children, which leaves less room for improvement compared to vegetables [12, 30]. Lastly, several reviews mentioned that the use of parental reports as a proxy for the child can be problematic, particularly relating to use of non-validated parental measures or parental measures that are culturally inappropriate. Further, as there are several validated child health measures where the child is the respondent, this would be preferable over parental report, as appropriate.

Beyond standardized child health measures, another important point of consideration for future garden-based interventions in early childhood is to include age-appropriate outcome and evaluation measures. For example, we did not find a single intervention examining developmental milestones or social-emotional outcomes, which would be very interesting to assess in early childhood, where there is an emphases on appropriate social-emotional development. Numerous reliable indicators of child development exist that are both age- and developmentally appropriate (e.g., World Health Organization Motor Milestones, Bayley Scales, Ages and Stages Questionnaire) [100, 101] that could be used in future studies. The Ages and Stages Questionnaire is a short, validated scale that addresses numerous child development components, including motor, cognitive, and social-emotional development) [101] and would be easy to integrate as an outcome.

Effective components of garden-based interventions

As mentioned as an evidence gap at the review level, an evidence gap at the primary-study level relates to effective intervention components. Future garden-based interventions could examine intervention effectiveness as a part of the study aim. For example, multiple intervention groups could be formed with a combination of different strategies (e.g., cultivation, harvesting, nutrition education, cooking), enabling comparison of these strategies to the control group. This is a vital area of future research that will enable future studies to be not only more effective, but cost-efficient as well.

Limitations

There are limitations of this umbrella review. In effort to reduce bias into this review and increase the strength of evidence, we included only systematic reviews that underwent peer-review. In turn, these criteria excluded many potentially relevant reviews that examined garden-based interventions in children [15, 19, 29, 32, 33, 88, 102, 103]. Many of the included systematic reviews were lacking in quality and due to limitations in their search strategy and overall scope. As umbrella reviews inherently rely on the accuracy and quality (e.g., appropriate design, reduced risk of biases, reporting) of included studies, this is a limitation. Incomplete reporting of the AMSTAR 2 elements in the included reviews could have resulted in a poorer quality assessment score. Included reviews often lacked an a priori protocol and a duplicated study screening and data extraction process, which may have introduced bias in their reviews. However, we utilized an a priori protocol and restricted inclusion of reviews to only systematic reviews to reduce potential biases. The date restrictions in our search strategy could have missed recently published reviews not yet indexed in databases.

Conclusion

We conducted an umbrella review to comprehensively summarize and critically evaluate existing systematic review level evidence of the role of garden-based interventions in early childhood health promotion. However, the full impact of garden-based interventions on early childhood health promotion and associated health outcomes cannot be determined due to limitations within available review- and primary-level evidence. Thus, it is important that this review’s findings not be taken as an absence of an effect, but rather as a product of the limitations of existing evidence. A key finding of this review is that garden-based interventions were most frequently associated with improvements in nutrition-related outcomes, including improvements in nutritional status, fruit and vegetable consumption, micronutrient deficiencies, and enhanced mediators of healthy eating. Until the evidence gaps identified in this umbrella review are addressed, researchers and policymakers should focus on the utility of garden-based interventions as a tool to aid in promoting global early childhood nutrition.

Availability of data and materials

The data used and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

JBI:

Joanna Briggs Institute

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols

BMI:

Body Mass Index

AMSTAR:

A Measurement Tool to Assess Systematic Reviews

References

  1. Canani RB, Di Costanzo M, Leone L, Bedogni G, Brambilla P, Cianfarani S, et al. Epigenetic mechanisms elicited by nutrition in early life. Nutr Res Rev. 2011;24(2):198–205.

    CAS  PubMed  Google Scholar 

  2. Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet. 2004;364(9430):257–62.

    PubMed  Google Scholar 

  3. Organization WH. Ending childhood obesity. Geneva: World Health Organization; 2016.

    Google Scholar 

  4. Reilly JJ, Martin A, Hughes AR. Early-life obesity prevention: critique of intervention trials during the first one thousand days. Curr Obes Rep. 2017;6(2):127–33.

    PubMed  PubMed Central  Google Scholar 

  5. Demaio AR, Branca F. Decade of action on nutrition: our window to act on the double burden of malnutrition. BMJ Glob Health. 2018;3(Suppl 1):e000492.

    PubMed  Google Scholar 

  6. Willumsen JF. Improving children’s diets to address the double burden of malnutrition: a healthy diet is key for all. Public Health Nutr. 2019;22(17):3187–8.

    PubMed  PubMed Central  Google Scholar 

  7. Perignon M, Fiorentino M, Kuong K, Burja K, Parker M, Sisokhom S, et al. Stunting, poor iron status and parasite infection are significant risk factors for lower cognitive performance in Cambodian school-aged children. PLoS One. 2014;9(11):e112605.

    PubMed  PubMed Central  Google Scholar 

  8. Qureshi F, Koenen KC, Tiemeier H, Williams MA, Misra S, Kubzansky LD. Childhood assets and cardiometabolic health in adolescence. Pediatrics. 2019;143(3):e20182004.

    PubMed  PubMed Central  Google Scholar 

  9. Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: a systematic review. Am J Prev Med. 2013;44(6):651–8.

    PubMed  Google Scholar 

  10. Waters E, de Silva-Sanigorski A, Burford BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;3:1–71.

  11. Schwarzenberg SJ, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2):e20173716.

    PubMed  Google Scholar 

  12. Evans A, Ranjit N, Rutledge R, Medina JL, Jennings R, Smiley A, et al. Exposure to multiple components of a garden-based intervention for middle school students increases fruit and vegetable consumption. Health Promot Pract. 2012;13(5):608–16.

  13. McAleese JD, Rankin LL. Garden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescents. J Am Diet Assoc. 2007;107(4):662–5.

    CAS  PubMed  Google Scholar 

  14. Namenek Brouwer R, Neelon S. Watch me grow: a garden-based pilot intervention to increase vegetable and fruit intake in preschoolers. BMC Public Health. 2013;13(363):2–6.

    Google Scholar 

  15. Robinson-O'Brien R, Story M, Heim S. Impact of garden-based youth nutrition intervention programs: a review. J Am Diet Assoc. 2009;109(2):273–80.

    PubMed  Google Scholar 

  16. Carney PA, Hamada JL, Rdesinski R, Sprager L, Nichols KR, Liu BY, et al. Impact of a community gardening project on vegetable intake, food security and family relationships: a community-based participatory research study. J Community Health. 2012;37(4):874–81.

    PubMed  PubMed Central  Google Scholar 

  17. Duncan MJ, Eyre E, Bryant E, Clarke N, Birch S, Staples V, et al. The impact of a school-based gardening intervention on intentions and behaviour related to fruit and vegetable consumption in children. J Health Psychol. 2015;20(6):765–73.

    PubMed  Google Scholar 

  18. Jaenke RL, Collins CE, Morgan PJ, Lubans DR, Saunders KL, Warren JM. The impact of a school garden and cooking program on Boys' and Girls' fruit and vegetable preferences, taste rating, and intake. Health Educ Behav. 2011;39(2):131–41.

  19. Blair D. The child in the garden: an evaluative review of the benefits of school gardening. Program Evaluation. 2009;40(2):15–38.

    Google Scholar 

  20. Cabalda AB, Rayco-Solon P, Solon JAA, Solon FS. Home gardening is associated with Filipino preschool Children's dietary diversity. J Am Diet Assoc. 2011;111(5):711–5.

    PubMed  Google Scholar 

  21. Heim S, Stang J, Ireland M. A garden pilot project enhances fruit and vegetable consumption among children. J Am Diet Assoc. 2009;109(7):1220–6.

    PubMed  Google Scholar 

  22. Gatto NM, Martinez LC, Spruijt-Metz D, Davis JN. LA sprouts randomized controlled nutrition, cooking and gardening programme reduces obesity and metabolic risk in Hispanic/Latino youth. Pediatr Obes. 2017;12(1):28–37.

    CAS  PubMed  Google Scholar 

  23. Flick KM. The application of a horticultural therapy program for preschool children with autism Spectrum disorder. J Ther Horticulture. 2012;22(1):38–45.

  24. Faber M, Phungula MA, Venter SL, Dhansay MA, Benadé AS. Home gardens focusing on the production of yellow and dark-green leafy vegetables increase the serum retinol concentrations of 2–5-y-old children in South Africa. Am J Clin Nutr. 2002;76(5):1048–54.

    CAS  PubMed  Google Scholar 

  25. Osei A, Pandey P, Nielsen J, Pries A, Spiro D, Davis D, et al. Combining home garden, poultry, and nutrition education program targeted to families with young children improved anemia among children and anemia and underweight among nonpregnant women in Nepal. Food Nutr Bull. 2017;38(1):49–64.

    PubMed  Google Scholar 

  26. Lee RE, Parker NH, Soltero EG, Ledoux TA, Mama SK, McNeill L. Sustainability via active garden education (SAGE): results from two feasibility pilot studies. BMC Public Health. 2017;17(1):242.

    PubMed  PubMed Central  Google Scholar 

  27. Berezowitz C, Bontrager Yoder A, Schoeller D. School gardens enhance academic performance and dietary outcomes in children. J Sch Health. 2015;85(8):508–18.

    PubMed  Google Scholar 

  28. Soga M, Gaston KJ, Yamaura Y. Gardening is beneficial for health: a meta-analysis. Prev Med Rep. 2017;5:92–9.

    PubMed  Google Scholar 

  29. Dickey KJ. One seed at a time: how an Urban Community gardening program promotes Prosocial development in youth; 2019.

    Google Scholar 

  30. Savoie-Roskos MR, Wengreen H, Durward C. Increasing fruit and vegetable intake among children and youth through gardening-based interventions: a systematic review. J Acad Nutr Diet. 2017;117(2):240–50.

    PubMed  Google Scholar 

  31. Ohly H, Gentry S, Wigglesworth R, Bethel A, Lovell R, Garside R. A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence. BMC Public Health. 2016;16:286.

    PubMed  PubMed Central  Google Scholar 

  32. Hoffman JA, Schmidt EM, Wirth C, Johnson S, Sobell SA, Pelissier K, et al. Farm to preschool: the state of the research literature and a snapshot of national practice. J Hunger Environmen Nutr. 2017;12(4):443–65.

    Google Scholar 

  33. Ozer EJ. The effects of school gardens on students and schools: conceptualization and considerations for maximizing healthy development. Health Educ Behav. 2007;34(6):846–63.

    PubMed  Google Scholar 

  34. McCormick R. Does access to green space impact the mental well-being of children: a systematic review. J Pediatr Nurs. 2017;37:3–7.

    PubMed  Google Scholar 

  35. Aromataris E, Fernandez RS, Godfrey C, Holly C, Khalil H, Tungpunkom P. Methodology for JBI umbrella reviews; 2014.

    Google Scholar 

  36. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. 2019;3(10):ED000142.

  37. Skelton K, Herbert A, Benjamin-Neelon SE. Garden-based interventions and early childhood health: a protocol for an umbrella review. Syst Rev. 2019;8(1):1–8.

    Google Scholar 

  38. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    PubMed  Google Scholar 

  39. Innovation VH. Covidence systematic review software. Melbourne: Veritas Health Innovation Melbourne, VIC; 2017.

  40. Hoffman JA, Agrawal T, Wirth C, Watts C, Adeduntan G, Myles L, et al. Farm to family: increasing access to affordable fruits and vegetables among urban head start families. J Hunger Environ Nutr. 2012;7(2–3):165–77.

    Google Scholar 

  41. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40.

    PubMed  Google Scholar 

  42. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.

    PubMed  PubMed Central  Google Scholar 

  43. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.

  44. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7(1):10.

    PubMed  PubMed Central  Google Scholar 

  45. Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton-McHarg T, Tzelepis F, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2018;5:CD008552.

    PubMed  Google Scholar 

  46. Hodder RK, Stacey FG, Wyse RJ, O'Brien KM, Clinton-McHarg T, Tzelepis F, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2017;9:CD008552.

    PubMed  Google Scholar 

  47. Wolfenden L, Wyse RJ, Britton BI, Campbell KJ, Hodder RK, Stacey FG, et al. Interventions for increasing fruit and vegetable consumption in children aged 5 years and under. Cochrane Database Syst Rev. 2012;11:CD008552.

    PubMed  PubMed Central  Google Scholar 

  48. Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2019;(5):1–150.

  49. Appleton KM, Hemingway A, Saulais L, Dinnella C, Monteleone E, Depezay L, et al. Increasing vegetable intakes: rationale and systematic review of published interventions. Eur J Nutr. 2016;55(3):869–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Beets MW, Beighle A, Erwin HE, Huberty JL. After-school program impact on physical activity and fitness: a meta-analysis. Am J Prev Med. 2009;36(6):527–37.

    PubMed  Google Scholar 

  51. Berti PR, Krasevec J, FitzGerald S. A review of the effectiveness of agriculture interventions in improving nutrition outcomes. Public Health Nutr. 2004;7(5):599–609.

    PubMed  Google Scholar 

  52. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40.

    PubMed  Google Scholar 

  53. Bird FA, Pradhan A, Bhavani R, Dangour AD. Interventions in agriculture for nutrition outcomes: a systematic review focused on South Asia. Food Policy. 2019;82:39–49.

    Google Scholar 

  54. Davis JN, Spaniol MR, Somerset S. Sustenance and sustainability: maximizing the impact of school gardens on health outcomes. Public Health Nutr. 2015;18(13):2358–67.

    PubMed  Google Scholar 

  55. Hendrie GA, Lease HJ, Bowen J, Baird DL, Cox DN. Strategies to increase children's vegetable intake in home and community settings: a systematic review of literature. Matern Child Nutr. 2017;13(1):e12276.

    Google Scholar 

  56. Langelloto G, Gupta A. Gardening increases vegetable consumption in school-aged children: a meta-analytical synthesis. HortTechnology. 2012;22(4):430–45.

    Google Scholar 

  57. Masset E, Haddad L, Cornelius A, Isaza-Castro J. Effectiveness of agricultural interventions that aim to improve nutritional status of children: systematic review. BMJ. 2012;344:d8222.

    PubMed  PubMed Central  Google Scholar 

  58. Mikkelsen M, Husby S, Skov L, Perez-Cueto F. A systematic review of types of healthy eating interventions in preschools. Nutr J. 2014;13(56):1–19.

    Google Scholar 

  59. Nekitsing C, Blundell-Birtill P, Cockroft JE, Hetherington MM. Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years. Appetite. 2018;127:138–54.

    PubMed  Google Scholar 

  60. Sisson SB, Krampe M, Anundson K, Castle S. Obesity prevention and obesogenic behavior interventions in child care: a systematic review. Prev Med. 2016;87:57–69.

    PubMed  Google Scholar 

  61. Pieper D, Antoine S-L, Mathes T, Neugebauer EAM, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67(4):368–75.

    PubMed  Google Scholar 

  62. Castro DC, Samuels M, Harman AE. Growing healthy kids: a community garden-based obesity prevention program. Am J Prev Med. 2013;44(3 Suppl 3):S193–9.

    PubMed  Google Scholar 

  63. Meinen A, Friese B, Wright W, Carrel A. Youth gardens increase healthy behaviors in young children. J Hunger Environ Nutr. 2012;7(2–3):192–204.

    Google Scholar 

  64. Birdi TJ, Shah SU. Implementing perennial kitchen garden model to improve diet diversity in Melghat, India. Global J Health Sci. 2016;8(4):10.

    Google Scholar 

  65. Wright W, Rowell L. Examining the effect of gardening on vegetable consumption among youth in kindergarten through fifth grade. WMJ. 2010;109(3):125.

    PubMed  Google Scholar 

  66. Hermann JR, Parker SP, Brown BJ, Siewe YJ, Denney BA, Walker SJ. After-school gardening improves children’s reported vegetable intake and physical activity. J Nutr Educ Behav. 2006;38(3):201–2.

    PubMed  Google Scholar 

  67. Marsh R. Building on traditional gardening to improve household food security. Food Nutr Agric. 1998:4–14.

  68. English R, Badcock J, Giay T, Ngu T, Waters A, Bennett S. Effect of nutrition improvement project on morbidity from infectious diseases in preschool children in Vietnam: comparison with control commune. BMJ. 1997;315(7116):1122–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Phillips M, Sanghvi T, Suárez R, McKigney J, Fiedler J. The costs and effectiveness of three vitamin a interventions in Guatemala. Soc Sci Med. 1996;42(12):1661–8.

    CAS  PubMed  Google Scholar 

  70. Brun T, Geissler C, Kennedy E. The impact of agricultural projects on food, nutrition and health. World Rev Nutr Diet. 1991;65:99.

    CAS  PubMed  Google Scholar 

  71. Chang Y, Zhai F, Li W, Ge K, Jin D, De Onis M. Nutritional status of preschool children in poor rural areas of China. Bull World Health Organ. 1994;72(1):105.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Malekafzali H. Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran. East Mediterr Health J. 2000;6(2–3):238–45.

    CAS  PubMed  Google Scholar 

  73. Khamhoung K, Bodhisane N, Pathammavong C, Ouenvilay S, Senthavisouk B, Pongpaew P, et al. Nutritional status of pre-school children and women in selected villages in the Suvannakhet Province, Lao PDR--an intervention trial. Southeast Asian J Trop Med Public Health. 2000;31:63–74.

    PubMed  Google Scholar 

  74. Laurie SM, Faber M. Integrated community-based growth monitoring and vegetable gardens focusing on crops rich in β-carotene: project evaluation in a rural community in the eastern cape, South Africa. J Sci Food Agric. 2008;88(12):2093–101.

    CAS  Google Scholar 

  75. Makhotla L, Hendriks S. Do home gardens improve the nutrition of rural pre-schoolers in Lesotho? Dev South Afr. 2004;21(3):575–81.

    Google Scholar 

  76. Schipani S, van der Haar F, Sinawat S, Maleevong K. Dietary intake and nutritional status of young children in families practicing mixed home gardening in Northeast Thailand. Food Nutr Bull. 2002;23(2):175–80.

    PubMed  Google Scholar 

  77. Olney DK, Talukder A, Iannotti LL, Ruel MT, Quinn V. Assessing impact and impact pathways of a homestead food production program on household and child nutrition in Cambodia. Food Nutr Bull. 2009;30(4):355–69.

    PubMed  Google Scholar 

  78. Sirikulchayanonta C, Iedsee K, Shuaytong P, Srisorrachatr S. Using food experience, multimedia and role models for promoting fruit and vegetable consumption in Bangkok kindergarten children. Nutr Diet. 2010;67(2):97–101.

    Google Scholar 

  79. De Bock F, Breitenstein L, Fischer JE. Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial. Public Health Nutr. 2012;15(3):466–75.

    PubMed  Google Scholar 

  80. Adams J, Zask A, Dietrich U. Tooty fruity vegie in preschools: an obesity prevention intervention in preschools targeting children's movement skills and eating behaviours. Health Prom J Aust. 2009;20(2):112–9.

    Google Scholar 

  81. Farfan-Ramirez L, Diemoz L, Gong EJ, Lagura MA. Curriculum intervention in preschool children: nutrition matters! J Nutr Educ Behav. 2011;43(4):S162–S5.

    PubMed  Google Scholar 

  82. Smitasiri S, Sa-ngobwarchar K, Kongpunya P, Subsuwan C, Banjong O, Chitchumroonechokchai C, et al. Sustaining behavioural change to enhance micronutrient status through community-and women-based interventions in north-East Thailand: vitamin a. Food Nutr Bull. 1999;20(2):243–51.

    Google Scholar 

  83. Davis KL, Brann LS. Examining the benefits and barriers of instructional gardening programs to increase fruit and vegetable intake among preschool-age children. J Environ Public Health. 2017;2017.

  84. Sisson S, Kiger A, Anundson K, Rasbold A, Krampe M, Campbell J, et al. Differences in preschool-age children's dietary intake between meals consumed at childcare and at home. Prev Med Rep. 2017;6:33–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  85. Collaborators GO. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.

    Google Scholar 

  86. Popkin BM, Corvalan C, Grummer-Strawn LM. Double burden of malnutrition 1 dynamics of the double burden of malnutrition and the changing nutrition reality; 2019.

    Google Scholar 

  87. Delgado-Noguera M, Tort S, Martínez-Zapata MJ, Bonfill X. Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis. Prev Med. 2011;53(1–2):3–9.

    PubMed  Google Scholar 

  88. Draper C, Freedman D. Review and analysis of the benefits, purposes, and motivations associated with community gardening in the United States. J Community Pract. 2010;18(4):458–92.

    Google Scholar 

  89. Sharma SV, Hedberg AM, Skala KA, Chuang R-J, Lewis T. Feasibility and acceptability of a gardening-based nutrition education program in preschoolers from low-income, minority populations. J Early Child Res. 2015;13(1):93–110.

    Google Scholar 

  90. Seguin RA, Morgan EH, Hanson KL, Ammerman AS, Pitts SBJ, Kolodinsky J, et al. Farm fresh foods for healthy kids (F3HK): an innovative community supported agriculture intervention to prevent childhood obesity in low-income families and strengthen local agricultural economies. BMC Public Health. 2017;17(1):306.

    PubMed  PubMed Central  Google Scholar 

  91. Lee RE, Lorenzo E, Szeszulski J, Arriola A, Bruening M, Estabrooks PA, et al. Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: sustainability via active garden education (SAGE). Contemp Clin Trials. 2019;77:8–18.

    PubMed  Google Scholar 

  92. Brown CL, Vander Schaaf EB, Cohen GM, Irby MB, Skelton JA. Association of picky eating and food neophobia with weight: a systematic review. Child Obes. 2016;12(4):247–62.

    PubMed  PubMed Central  Google Scholar 

  93. DeCosta P, Moller P, Bom Frost M, Olsen A. Changing children's eating behavior - a review of experimental research. Appetite. 2017;113:327–57.

    PubMed  Google Scholar 

  94. Nelson J, Martin K, Nicholas J, Easton C, Featherstone G. Food growing activities in schools: report submitted to Defra; 2011.

    Google Scholar 

  95. Izumi B, Hoffman J, Eckhardt C, Johnson A, Hallman J, Barberis D. Harvest for healthy kids: a nutrition education curriculum aligned with the head start child development and early learning framework. NHSA Dialog. 2015;18(2):43–56.

  96. Martinez LC, Gatto NM, Spruijt-Metz D, Davis JN. Design and methodology of the LA sprouts nutrition, cooking and gardening program for Latino youth: a randomized controlled intervention. Contemp Clin Trials. 2015;42:219–27.

    PubMed  PubMed Central  Google Scholar 

  97. White JA, Hagedorn RL, Waterland NL, Barr ML, Famodu OA, Root AE, et al. Development of iGrow: a curriculum for youth/adult dyads to increase gardening skills, culinary competence, and family meal time for youths and their adult caregivers. Int J Environ Res Public Health. 2018;15(7):1401.

    PubMed Central  Google Scholar 

  98. Johnson-Jennings M, Paul K, Olson D, LaBeau M, Jennings D. Ode'imin Giizis: proposing and piloting gardening as an indigenous childhood health intervention. J Health Care Poor Underserved. 2020;31(2):871–88.

    Google Scholar 

  99. Frongillo EA, Tofail F, Hamadani JD, Warren AM, Mehrin SF. Measures and indicators for assessing impact of interventions integrating nutrition, health, and early childhood development. Ann N Y Acad Sci. 2014;1308(1):68–88.

    PubMed  Google Scholar 

  100. Group WMGRS, de Onis M. WHO motor development study: windows of achievement for six gross motor development milestones. Acta Paediatr. 2006;95:86–95.

    Google Scholar 

  101. Kerstjens JM, Bos AF, ten Vergert EM, de Meer G, Butcher PR, Reijneveld SA. Support for the global feasibility of the ages and stages questionnaire as developmental screener. Early Hum Dev. 2009;85(7):443–7.

    PubMed  Google Scholar 

  102. Williams DR, Dixon PS. Impact of garden-based learning on academic outcomes in schools: synthesis of research between 1990 and 2010. Rev Educ Res. 2013;83(2):211–35.

    Google Scholar 

  103. Stein MJ. Community gardens for health promotion and disease prevention. Int J Hum Caring. 2008;12(3):47–52.

    Google Scholar 

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Acknowledgements

We would like to thank both the authors of the Systematic reviews and the authors of the original research studies included in this review.

Funding

DAZ is partially supported by a grant from the National Institutes of Health T32DK062707. The funder did not have any involvement in the review, including review design and manuscript preparation.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA

    Kara R. Skelton, Chenery Lowe, Daniel A. Zaltz & Sara E. Benjamin-Neelon

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  2. Chenery Lowe
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Contributions

KS and SBN conceptualized this review and the associated a priori protocol. KS, CL, and DZ screened studies and performed data extraction. KS analyzed the data. KS drafted the manuscript; CL, DZ, and SBN thoughtfully edited the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kara R. Skelton.

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Supplementary information

Additional file 1.

Search Strategy. Details search strategy of the review.

Additional file 2.

List of Excluded Studies. Details list of excluded studies and reason for exclusion at the full-text review level.

Additional file 3.

Overlap Matrix. Details the matrix used to calculate overlap at the primary study level.

Additional file 4.

PRISMA Checklist. PRISMA Checklist for Systematic Reviews.

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Skelton, K.R., Lowe, C., Zaltz, D.A. et al. Garden-based interventions and early childhood health: an umbrella review. Int J Behav Nutr Phys Act 17, 121 (2020). https://doi.org/10.1186/s12966-020-01023-5

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Keywords

  • Early childhood
  • Early years
  • Child nutrition
  • Gardens
  • Preschool
  • Physical activity
  • Agriculture

International Journal of Behavioral Nutrition and Physical Activity

ISSN: 1479-5868

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