Dietitian-Led School-Based Nutrition Education and Its Effects on Knowledge, Attitudes, Behaviours and Anthropometric Measurements: A Randomised Controlled Trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomisation was conducted among individual students rather than by class (or school), so contamination across classmates remains plausible.
    • "Randomisation was carried out using a random numbers table (https://www.randomizer.org) among individuals who met the inclusion criteria." (PDF p. 4)
    • Relevant Quotes: 1) "The study population consisted of 8 classes with approximately 35 students each, for a total of 280 students." (PDF p. 4) 2) "As shown in the flowchart (Figure 1), 70 students were initially randomised (35 intervention, 35 control)." (PDF p. 4) 3) "Randomisation was carried out using a random numbers table (https://www.randomizer.org) among individuals who met the inclusion criteria." (PDF p. 4) 4) "Participants were assigned to the control (n=35) and intervention (n=35) groups by the researchers according to the numbers generated in the programme." (PDF p. 4) Detailed Analysis: Criterion C requires that the unit of randomisation be the class (or a stronger unit such as the school) to reduce contamination between intervention and control students who share the same classroom and school environment. The paper explicitly states that randomisation occurred "among individuals" and describes a single-school setting with multiple classes. In a classroom-based education intervention delivered "during school hours", individual-level allocation within the same school creates a realistic risk that students or teachers may share information or behaviours across conditions. The intervention is not described as one-to-one tutoring/personal teaching, so the tutoring exception to class-level randomisation does not apply. Final sentence: Criterion C is not met because participants were randomised as individuals, not by class (or school), and no tutoring-type exception applies.
  • E

    Exam-based Assessment

    • The main knowledge outcome (NKT) was researcher-prepared and aligned to the delivered nutrition education, rather than a widely recognised standardised exam.
    • "Nutrition knowledge test (NKT): In order to evaluate the nutritional behaviours, knowledge level and attitudes of the students, questions prepared by making use of the literature and in parallel with the nutrition education given were used [11,12]." (PDF p. 6)
    • Relevant Quotes: 1) "Data were collected via sociodemographic forms, anthropometric measurements, Nutrition Knowledge Test (NKT), Nutrition Attitude Scale (NAS), Nutrition Behaviour Scale (NBS), and Child Physical Activity Questionnaire (CPAQ)." (PDF p. 2) 2) "Nutrition knowledge test (NKT): In order to evaluate the nutritional behaviours, knowledge level and attitudes of the students, questions prepared by making use of the literature and in parallel with the nutrition education given were used [11,12]." (PDF p. 6) 3) "First, the NKT was developed by the researchers and has not undergone validity–reliability analyses; this may limit the psychometric sensitivity of the measurements." (PDF p. 16) Detailed Analysis: Criterion E requires outcome measurement using a standardised, widely recognised exam-based assessment, rather than a test created or assembled for the study and tailored to the intervention. The paper’s NKT is described as "questions" prepared "in parallel with the nutrition education given", and the limitations explicitly state the NKT "was developed by the researchers" and lacks reported validity/reliability testing. This indicates it is not a widely recognised standardised exam. Although the study uses established scales (e.g., NAS, NBS, CPAQ), these are not presented as standardised academic examinations (e.g., national curriculum tests) and are not exam-based achievement measures in core school subjects. Final sentence: Criterion E is not met because the primary knowledge test is researcher-developed and aligned to the intervention rather than a standardised exam.
  • T

    Term Duration

    • The main between-group outcome comparison is at the 8-week post-test, which is shorter than one academic term.
    • "The total intervention period of nutrition education for students was 8 weeks, and for parents, it was applied for a total of 4 weeks." (PDF p. 4)
    • Relevant Quotes: 1) "The total intervention period of nutrition education for students was 8 weeks, and for parents, it was applied for a total of 4 weeks." (PDF p. 4) 2) "The study was conducted as a pre-test (1st test before the training), nutrition education to the students and parents included in the intervention group, post-test to be applied after the training (2nd test) and follow-up test to be applied 2 months after the training (3rd test)." (PDF p. 4) 3) "The pre-test and post-test were applied to all participants and the follow-up test was applied only to the intervention group." (PDF p. 4) Detailed Analysis: Criterion T requires that outcomes be measured at least one full academic term (typically about 3 to 4 months) after the intervention begins. Here, the intervention lasted 8 weeks and the "post-test" was applied "after the training". The post-test is the key time point where both groups are measured and compared. A later "follow-up test" occurred "2 months after the training", but it was "applied only to the intervention group", so it cannot function as a term-later between-group outcome comparison. Final sentence: Criterion T is not met because the between-group outcome assessment is tied to the end of an 8-week intervention, which is shorter than a full academic term.
  • D

    Documented Control Group

    • The control group is clearly described, including the control condition, sample size, and baseline characteristics reported alongside outcomes.
    • "During the study period, the control group did not receive any nutrition education, educational materials, or intervention-related content." (PDF p. 8)
    • Relevant Quotes: 1) "The study was completed with a total of 67 participants, 32 intervention and 35 control group students, who met the inclusion criteria and participated voluntarily." (PDF p. 4) 2) "During the study period, the control group did not receive any nutrition education, educational materials, or intervention-related content. Students in the control group continued their normal school curriculum without any additional contact from the research team." (PDF p. 8) 3) "Table 1 presents the sociodemographic characteristics. The study included 32 intervention and 35 control group students." (PDF p. 10) 4) "Table 4. Evaluation of NKT, NAS, NBS and CPAQ Scores of Students in the Intervention and Control Groups" (PDF p. 13) Detailed Analysis: Criterion D requires that the control group be sufficiently documented to support meaningful comparison, including what the control condition received and baseline characteristics. The paper provides a clear description of the control condition (no nutrition education or materials; continued normal curriculum), the control-group sample size, and baseline descriptive characteristics and outcomes reported alongside intervention outcomes in the tables. Final sentence: Criterion D is met because the control condition and baseline characteristics are explicitly described and reported for comparison with the intervention group.

• Level 2 Criteria

  • S

    School-level RCT

    • The study was conducted in a single school and randomised individuals, not schools.
    • "Data were collected from 4th-grade students attending a public primary school located in an urban district of Mardin, a culturally diverse city in Türkiye’s Southeastern Anatolia region." (PDF p. 3)
    • Relevant Quotes: 1) "Data were collected from 4th-grade students attending a public primary school located in an urban district of Mardin, a culturally diverse city in Türkiye’s Southeastern Anatolia region." (PDF p. 3) 2) "Randomisation was carried out using a random numbers table (https://www.randomizer.org) among individuals who met the inclusion criteria." (PDF p. 4) Detailed Analysis: Criterion S requires randomisation at the school (or comparable implementation-unit) level. The study context is one "public primary school", and the randomisation description explicitly states allocation "among individuals", not among schools. Final sentence: Criterion S is not met because the trial did not randomise schools and appears to be a single-school, individual-level randomised study.
  • I

    Independent Conduct

    • The intervention and analysis were conducted by the study team without clear third-party evaluation independent of the intervention designers.
    • "After the pre-test was completed, the students and parents included in the intervention group were given "nutrition education" by the dieticians in the study team." (PDF p. 7)
    • Relevant Quotes: 1) "After the pre-test was completed, the students and parents included in the intervention group were given "nutrition education" by the dieticians in the study team." (PDF p. 7) 2) "Authors' contributions Conceptualization, Ç.A., H.K., and N.A.; methodology, Ç.A., H.K., and N.A.; software, Ç.A.; formal analysis, Ç.A.; investigation, Ç.A., H.K. and N.A.; data check, Ç.A. and H.K.; writing—original draft preparation, Ç.A., H.K., and N.A.; writing—review and editing, Ç.A., H.K., and N.A." (PDF p. 18) 3) "The researcher collecting the data was blinded to group allocation throughout the study." (PDF p. 4) Detailed Analysis: Criterion I requires independent conduct relative to the intervention designers/providers to reduce risks of bias in implementation, measurement, and analysis. The intervention is delivered by "dieticians in the study team" and the author contribution statement indicates the authors performed the formal analysis and investigation. While the data collector was blinded to allocation (a positive safeguard), the paper does not describe an external/third-party evaluator conducting the implementation and/or analysis independently from the study team. Final sentence: Criterion I is not met because the intervention and core study activities were conducted by the study team without documented independent evaluation.
  • Y

    Year Duration

    • The study does not measure outcomes for at least 75% of an academic year after intervention start, and term-duration (T) is not met.
    • "The total intervention period of nutrition education for students was 8 weeks, and for parents, it was applied for a total of 4 weeks." (PDF p. 4)
    • Relevant Quotes: 1) "The total intervention period of nutrition education for students was 8 weeks, and for parents, it was applied for a total of 4 weeks." (PDF p. 4) 2) "The study was conducted as a pre-test (1st test before the training), nutrition education to the students and parents included in the intervention group, post-test to be applied after the training (2nd test) and follow-up test to be applied 2 months after the training (3rd test)." (PDF p. 4) Detailed Analysis: Criterion Y requires that outcomes be measured at least 75% of an academic year after the intervention begins. The paper describes an 8-week intervention and a follow-up 2 months after training, which is far shorter than a typical academic year threshold. Additionally, per the ERCT dependency rule, if criterion T is not met, then criterion Y is not met. Final sentence: Criterion Y is not met because the study duration and follow-up are much shorter than an academic year and T is not met.
  • B

    Balanced Control Group

    • Although the intervention adds instructional time and materials, these inputs are integral to the education programme being tested against a business-as-usual control.
    • "Nutrition education was given to the students for eight weeks, one lesson hour (35 min) per week in the school during school hours, and to the parents face-to-face in the school conference room for one hour per week for four weeks." (PDF p. 7)
    • Relevant Quotes: 1) "Nutrition education was given to the students for eight weeks, one lesson hour (35 min) per week in the school during school hours, and to the parents face-to-face in the school conference room for one hour per week for four weeks." (PDF p. 7) 2) "The nutrition education tools given to children consisted of an 8-week education programme, brochure and activities such as educational games and puzzles developed to reinforce the information [11,23,24]." (PDF p. 7) 3) "During the study period, the control group did not receive any nutrition education, educational materials, or intervention-related content. Students in the control group continued their normal school curriculum without any additional contact from the research team." (PDF p. 8) Detailed Analysis: Criterion B compares the nature, quantity, and quality of resources (time, staffing, materials) provided to intervention and control conditions. When additional resources are provided only to the intervention group, the criterion is still met if those added resources are explicitly the treatment variable/package being tested (i.e., the study is intentionally evaluating an added educational programme against business-as-usual). This study clearly provides extra instructional time (weekly 35-minute sessions), specialist delivery (dietitians), and additional materials (brochures, games, puzzles) to the intervention group, while the control group continues the normal curriculum with no nutrition education. Here, the additional time and materials are not separable accidental add-ons; they are the core components of the "school-based nutrition education programme" being evaluated. Under the ERCT criterion-B logic, a business-as-usual control is acceptable when the intervention is intentionally defined as an added programme (added time/materials/staff) compared to standard practice. Final sentence: Criterion B is met because the extra time, staffing, and materials are integral to the education programme being tested against business-as-usual.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication of this specific trial was identified in the paper or via post-publication searches.
    • Relevant Quotes: 1) (No statements describing an independent replication of this study were found in the paper.) (N/A) Detailed Analysis: Criterion R requires independent replication by a different research team in a different context and published in a peer-reviewed outlet. The paper does not describe itself as a replication and does not cite an independent replication of this specific trial. Because the article was published on 09 February 2026 and describes a specific single-school RCT in Mardin, Türkiye, an external replication of this exact trial is also unlikely to exist yet; targeted searching did not identify an independent, peer-reviewed replication study of this exact intervention and design. Final sentence: Criterion R is not met because no independent replication of this specific trial was found.
  • A

    All-subject Exams

    • Exam-based assessment (E) is not met, so all-subject exams (A) cannot be met; additionally, outcomes are nutrition/health measures rather than standardised exams across core school subjects.
    • "Data were collected via sociodemographic forms, anthropometric measurements, Nutrition Knowledge Test (NKT), Nutrition Attitude Scale (NAS), Nutrition Behaviour Scale (NBS), and Child Physical Activity Questionnaire (CPAQ)." (PDF p. 2)
    • Relevant Quotes: 1) "Data were collected via sociodemographic forms, anthropometric measurements, Nutrition Knowledge Test (NKT), Nutrition Attitude Scale (NAS), Nutrition Behaviour Scale (NBS), and Child Physical Activity Questionnaire (CPAQ)." (PDF p. 2) 2) "The primary results of this study are the evaluation of the Nutrition Knowledge Test, Nutrition Attitude Scale, Nutrition Behavior Scale, and Children's Physical Activity Questionnaire scores." (PDF p. 4) Detailed Analysis: Criterion A requires standardised exam-based assessment across all main subjects taught at school, and ERCT rule: if criterion E is not met then criterion A is not met. The study measures nutrition knowledge, attitudes, behaviours, physical activity, and anthropometrics. It does not measure standardised academic achievement across core school subjects (e.g., mathematics, language, science) using standardised exams. Final sentence: Criterion A is not met because E is not met and the study does not assess all core subjects via standardised exams.
  • G

    Graduation Tracking

    • Year duration (Y) is not met and no graduation tracking (or follow-up paper tracking the cohort to graduation) was identified.
    • "The study was conducted as a pre-test (1st test before the training), nutrition education to the students and parents included in the intervention group, post-test to be applied after the training (2nd test) and follow-up test to be applied 2 months after the training (3rd test)." (PDF p. 4)
    • Relevant Quotes: 1) "The study was conducted as a pre-test (1st test before the training), nutrition education to the students and parents included in the intervention group, post-test to be applied after the training (2nd test) and follow-up test to be applied 2 months after the training (3rd test)." (PDF p. 4) 2) "The pre-test and post-test were applied to all participants and the follow-up test was applied only to the intervention group." (PDF p. 4) Detailed Analysis: Criterion G requires that participants be tracked until graduation from the relevant educational stage, and ERCT rule: if criterion Y is not met, then criterion G is not met. In this trial, the only described follow-up beyond post-test is "2 months after the training", and it was applied only to the intervention group. There is no mention of tracking students to an end-of-stage graduation or using administrative records to observe graduation outcomes. Internet searching for subsequent follow-up publications by the same authors that track this cohort through graduation did not identify any peer-reviewed follow-up paper reporting graduation outcomes for this specific RCT cohort. Final sentence: Criterion G is not met because the study does not meet the year-duration prerequisite and no graduation tracking (in this paper or follow-up publications) was found.
  • P

    Pre-Registered

    • The reported registration date is after the reported data collection period, so the protocol was not prospectively pre-registered.
    • "Data were collected between November 2024 and April 2025." (PDF p. 4)
    • Relevant Quotes: 1) "Data were collected between November 2024 and April 2025." (PDF p. 4) 2) "Trial registration: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT07168928, Registered 11 September 2025)." (PDF p. 2) Detailed Analysis: Criterion P requires that the full protocol be publicly registered before data collection begins. The paper states that data collection occurred "between November 2024 and April 2025", but the ClinicalTrials.gov registration date reported in the paper is "Registered 11 September 2025", which is after the data collection window described in the methods. Therefore, the registration is not prospective relative to data collection and does not satisfy ERCT pre-registration. Final sentence: Criterion P is not met because the reported registration date is after the reported data collection period.