Objective The aims of the review were to identify school-based randomised and non-randomised controlled trials to increase daily or lunchtime fruit and vegetable intake in children and to determine the impact of school-based interventions to change fruit and vegetable consumption at lunchtime and over the whole day.

Design A systematic literature review was carried out to identify appropriate trials. This was followed by meta-analysis techniques to determine the pooled estimate of the difference in daily fruit and vegetable intake in the intervention group compared with the control group.

Participants Trials carried out in schools where children were aged 5 to 11 years were included. All trials reported in English language journals were eligible.

Results 28 randomised and non-randomised controlled trials were identified that reported daily fruit and/or vegetable intake. A median intake of 0.4 portions more fruit and vegetables was consumed in the intervention group compared to the control group. The qualitative review of 7 studies reporting lunchtime intake, either in addition to daily intake or independently in studies concentrating solely on lunchtime intake, revealed a median difference of 0.2 portions more fruit and vegetables in the intervention group at lunchtime. The meta-analysis of daily intake included 13 studies classified into one of two groups: behavioural change studies with a school and/or home component that relied on families improving eating behaviour; and free school fruit and vegetable scheme where fruit and vegetables are distributed to children. The short term impact of both type of programme was determined using the follow up data collected within 3 months of the end of the intervention. This was the longest follow-up period in most cases. The pooled estimates (95% CI) for behavioural change studies and free fruit and vegetable schemes were 0.43 (0.21 to 0.65) and 0.44 (0.20 to 0.67) portions respectively. The pooled estimate (95% CI) for all studies was 0.42 (95% CI 0.27 to 0.58) portions more in the intervention group. The majority of the difference was due to fruit not vegetables. Heterogeneity was high for the meta-analysis with lunchtime intake but reasonable for daily intake.

Conclusion School-based interventions have the potential to moderately improve fruit and vegetable intake in children, with approximately half of the increase attributable to improvements in lunchtime intake.