Improving the Dietary Intake of Health Care Workers through Workplace Dietary Interventions: A Systematic Review and Meta-Analysis

Abstract

The workplace has been identified as a potential location for dietary intervention delivery due to the amount of time spent and the meals eaten in this setting. It is recommended that interventions are tailored to specific occupational groups, and to date, there is limited synthesis of the evidence relating to health care workers. This review characterizes and evaluates the effectiveness of dietary interventions in health care workers to aid the design and implementation of interventions. The MEDLINE database was searched to September 2020. The reference list of an umbrella review was hand-searched for additional titles against inclusion criteria. The search included 1) population, 2) intervention, and 3) work environment. Studies were assessed for risk of bias. Harvest plots and forest plots were created to display study quality, direction, and size of effect of selected primary (energy, fruit and vegetable, and fat intake) and secondary outcomes (weight, BMI, blood pressure, and serum cholesterol concentrations). Thirty-nine articles assessing 34 interventions were eligible for inclusion. Intervention types most commonly used were environmental, educational, educational plus behavioral, and behavioral. Due to the heterogeneity in study design and intervention type, results were largely inconclusive. For dietary outcomes, interventions produced small-moderate favorable changes in fruit, vegetable, and fat intake. Decreased fat intake was mainly observed in environmental interventions and increases in fruit and vegetable intake were observed when an educational and/or behavioral component was present. Interventions producing weight loss were mostly nonrandomized trials involving education and physical activity. Total and LDL cholesterol decreased in interventions involving physical activity. Meta-analyses revealed significant decreases in energy intake, weight, blood pressure, total cholesterol, and LDL cholesterol in nonrandomized trials where data were available. Much more research is needed into strategies to promote diet quality improvement in health care workers. A protocol for this review is registered at PROSPERO (CRD42021234906).