Peer-reviewed article
Global Implementation of the Nutrition‐Friendly School Initiative ( NFSI ): A Scoping Review of Strategies, Challenges, Barriers, and Facilitators
Maryam Karkhaneh, Nasrin Omidvar, Farid Zayeri, Vahid Yazdi Feyzabadi, Hamid Abbasi et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This scoping review looks at how the Nutrition-Friendly School Initiative (NFSI), a whole-school approach to child malnutrition, has been put into practice around the world. It searched several databases and gray literature and included 16 records. The authors report that NFSI implementation is linked to better nutrition knowledge, eating habits and some health measures. Resource shortages, limited training, weak policy enforcement and cultural resistance were common barriers. The authors call the NFSI promising but say longer-term evaluations are needed.
Key points
- Sixteen records that explicitly implemented the NFSI framework were included.
- Evidence suggests NFSI improves nutrition knowledge, dietary behaviors, and selected health outcomes such as BMI, stunting and micronutrient status.
- Main facilitators were institutional commitment, multisectoral collaboration and stakeholder engagement.
- Main barriers were limited resources, insufficient training, weak policy enforcement and sociocultural resistance.
- Sustainable implementation needs cross-sector collaboration, equitable resource allocation, supportive school food environments and stronger monitoring systems.
Limitations
The abstract does not name the countries covered, the designs of the included studies, or the size of any effects, so it is unclear how strong the evidence is. The authors themselves say stronger long-term evaluations are needed.
Abstract
BACKGROUND: The Nutrition-Friendly School Initiative (NFSI) is a whole-school approach designed to address the triple burden of malnutrition among school-aged children. However, evidence on its implementation across diverse settings remains fragmented. METHODS: This scoping review followed Arksey and O'Malley's framework and searched PubMed, Web of Science, Embase, Scopus, and gray literature sources for studies explicitly implementing the NFSI framework. FINDINGS: Sixteen records were included. Evidence suggests that NFSI implementation improves nutrition knowledge, dietary behaviors, and selected health outcomes, including BMI, stunting, and micronutrient status. Major facilitators included institutional commitment, multisectoral collaboration, and stakeholder engagement. Common barriers were limited resources, insufficient training, weak policy enforcement, and sociocultural resistance. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Integrating NFSI principles into education and public health systems may strengthen school nutrition policies and reduce health inequities. Sustainable implementation requires cross-sector collaboration, equitable resource allocation, supportive school food environments, and stronger monitoring systems, particularly in resource-constrained settings. CONCLUSION: The NFSI is a promising framework for promoting child nutrition and health, but stronger long-term evaluations and more comprehensive implementation strategies are needed.