***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE . The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school . METHODS . The participants in this r and omized , controlled cluster trial were second- and third- grade rs from 32 elementary schools in socially deprived areas of 2 German cities .  Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools ( N = 17 ) to promote water consumption .  Control group schools ( N = 15 ) did not receive any intervention . The prevalence of overweight ( defined according to the International Obesity Task Force criteria ) , BMI SD scores , and beverage consumption ( in glasses per day ; 1 glass was defined as 200 mL ) self-reported in 24-hour recall question naires , were determined before ( baseline ) and after the intervention . In addition , the water flow of the fountains was measured during the intervention period of 1 school year ( August 2006 to June 2007 ) . RESULTS . Data on 2950 children ( intervention group : N = 1641 ; control group : N = 1309 ; age , mean ± SD : 8.3 ± 0.7 years ) were analyzed . After the intervention , the risk of overweight was reduced by 31 % in the intervention group , compared with the control group , with adjustment for baseline prevalence of overweight and clustering according to school . Changes in BMI SD scores did not differ between the intervention group and the control group . Water consumption after the intervention was 1.1 glasses per day greater in the intervention group . No intervention effect on juice and soft drink consumption was found . Daily water flow of the fountains indicated lasting use during the entire intervention period , but to varying extent . CONCLUSION . Our environmental and educational , school-based intervention proved to be effective in the prevention of  overweight among children in elementary school , even in a population from socially deprived areas Background In childhood , inadequate fluid intakes can lead on the short term , to reduced physical and cognitive performances . However , few data are available on the fluid intake among schoolchildren in Belgium . The main aim of this study is to evaluate  total fluid intake  provided by different types of beverages in a sample of Belgian schoolchildren , in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake . A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements . Methods A child friendly “ fluids and liquid food ” diary was used to prospect ively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren . This diary also recorded the practice of  physical activity  . An adequate fluid intake was defined as an intake ≥ 75 % of the age-specific adequate intake recommended by the EFSA . Results The median ( P25-P75 ) of habitual daily fluid intake was 864 ( 608–1104 ) ml/day , with 355 ( 194–579 ) coming from drinking water . This habitual daily fluid intake varied significantly among the three investigated EFSA groups ( girls and boys aged from 8 years , girls from 9 to 13 and boys from 9 to 13 ) , except for the drinking water ( P = 0.906 ) . The highest medians of fruit juice , sugar-sweetened beverages and milk and derivatives were found among boys of 9–13 . Only 9.5 % of the children had an adequate fluid intake , with a value of 19.2 % among the 8 years old girls and boys , 7.0 % among girls of 9–13 and 8.4 % among boys of 9–13 . In the whole sample , 27.7 % of the children declared to drink less than 3 - 4x/day , 56 % drunk water less than 2x/day and 7.7 % drunk no water at all . Every day , 27.1 % and 34.1 % of the children drank respectively one fruit juice and one sugar-sweetened beverage . Conclusion Belgian schoolchildren have an inadequate total fluid intake . Given the potential health consequences , interventions involving parents and school environment to promote water consumption seem pertinent Background This study examined bidirectional relationships between  maternal feeding practice s and child food responsiveness and satiety responsiveness from 2 to 5 years . Methods Mothers ( N = 207 ) reported their own feeding practice s and child eating behaviours  using vali date d question naires at child ages 2 , 3.7 , and 5 years . Cross-lagged analyses were conducted to test for bidirectional effects , adjusting for child BMI z-score ( based on measured weight and height ) at 14 months . Results Eating behaviours and feeding practice s showed strong continuity across the three time points . Maternal feeding practice s ( higher reward for behaviour [ β = 0.12 , p = 0.025 ] and lower covert restriction [ β = −0.14 , p = 0.008 ] ) were prospect ively associated with higher food responsiveness . Conversely , increased child satiety responsiveness was primarily prospect ively associated with mothers ’ feeding practice s ( increased structured meal timing [ β = 0.11 , p = 0.038 ] , overt [ β = 0.14 , p = 0.010 ] and covert restriction [ β = 0.11 , p = 0.022 ] ) . The only exception was family meal setting , which was prospect ively negatively associated with satiety responsiveness ( β = −0.11 , p = 0.035 ) . Conclusion While maternal feeding practice s and child satiety and food responsiveness show strong continuity between child age 2 and 5 years , maternal feeding practice s appear to be associated with child food responsiveness over time . Conversely , child satiety responsiveness , but not food responsiveness , may also be associated with maternal feeding practice s over time . These results are consistent with interventions that provide feeding advice to parents on how to respond appropriately to individual child eating behaviour phenotype . Trial registration ACTRN12608000056392 . Registered 29 January 2008 INTRODUCTION Across the U.S. , afterschool programs ( ASPs , 3:00pm-6:00pm ) are trying to achieve nationally endorsed nutrition st and ards ( Healthy Eating St and ards ) calling for fruits/vegetables and water to be served every day , while eliminating sugar-sweetened beverages and foods . The purpose of this study was to evaluate the 2-year changes in the types of foods and beverages served during a community-based intervention design ed to achieve the Healthy Eating St and ards . STUDY DESIGN R and omized delayed treatment trial with an immediate ( 1-year baseline and 2-year intervention ) or delayed ( 2-year baseline and 1-year intervention ) group . SETTING / PARTICIPANTS Twenty ASPs serving 1,700 children ( aged 5 - 12 years ) were recruited , with baseline occurring spring 2013 , and outcome assessment occurring spring 2014 and 2015 . INTERVENTION The multistep intervention , Strategies To Enhance Practice for Healthy Eating , assisted ASP leaders/staff to serve foods/beverages that meet the nutrition st and ards . MAIN OUTCOME MEASURES The foods and beverages served for snack were observed directly . RESULTS Compared with non-intervention years , both the immediate and delayed groups increased the number of days/week that fruits/vegetables ( 0.6 vs 1.7 days/week and 0.6 vs 4.4 days/week , OR=3.80 , 95 % CI=1.45 , 9.95 ) and water ( 2.3 vs 3.7 days/week and 2.7 vs 4.8 days/week , OR=4.65 , 95 % CI=1.69 , 12.79 ) were served . Sugar-sweetened beverages were almost eliminated by post- assessment ( 1.2 vs 0.2 days/week and 3.2 vs 0.0 days/week , OR=0.05 , 95 % CI=0.02 , 0.13 ) . Only the immediate group decreased the number of days/week desserts were served ( 2.9 vs 0.6 days/week , OR=0.10 , 95 % CI=0.03 , 0.33 ) . Implementation barriers for the delayed group included once/month delivery schedules for fruits/vegetables and limited storage space for foods meeting the Healthy Eating St and ards . CONCLUSIONS Improvements in the foods/beverages served in ASPs can be made , yet were hindered by structural barriers related to procurement and storage of perishable foods . Additional efforts are needed to support ASPs as they work toward fully achieving the Healthy Eating St and ards Background / Objectives : Little is known on the relationship between obesity and hydration levels in children . This study assessed whether and by which mechanisms hydration status differs between obese and non-obese children . Subjects/ Methods : Hydration levels of 86 obese and 89 normal weight children ( age : 7–11 years ) were compared . Hydration was measured as the average free water reserve ( FWR = urine output/24 h minus the obligatory urine output [ total 24 h excreted solutes/97th percentile of urine osmolality of children with adequate water intake , that is , 830 mOsm/kg ] ) over 2 days . Three days of weighed dietary and fluid intakes were recorded . Non-parametric tests were used to compare variables that were skewed and to assess which variables correlated with hydration . Variables mediating the different hydration levels of obese and normal weight children were assessed by co-variance analysis . Results : Obese children were less hydrated than normal weight peers [ FWR = median ( IQR ) : 0.80 ( −0.80–2.80 ) hg/day vs 2.10 ( 0.10–4.45 ) hg/day , P<0.02 ; 32 % of obese children vs 20 % of non-obese peers had negative FWR , P<0.001 ] . Body mass index ( BMI ) z-score ( z- BMI ) and water intake from fluids correlated with FWR ( ρ=−0.18 and 0.45 , respectively , both P<0.05 ) . Water intake from fluids completely explained the different hydration between obese and normal weight children [ FWR adjusted for water from fluids and z- BMI = 2.44 ( 0.44 ) hg vs 2.10 ( 0.50 ) hg , P = NS ; B coefficient of co-variation between FWR ( hg/day ) and water intake from fluids (hg/day)=0.47 , P<0.001 ] . Conclusions : Obese children were less hydrated than normal weight ones because , taking into account their z- BMI , they drank less . Future prospect i ve studies are needed to explore possible causal relationships between hydration and obesity Abstract Purpose To describe the intake of water and all other beverages in children and adolescents in 13 countries of three continents . Methods Data of 3611 children ( 4–9 years ) and 8109 adolescents ( 10–17 years ) were retrieved from 13 cross-sectional surveys ( 47 % males ) . In three countries , stratified cluster sampling design was applied to r and omly recruit schools classes . A quota method was applied in the other countries to r and omly recruit participants . Details on the intake of all fluid types were obtained with a fluid-specific record over 7 consecutive days . Results In the total sample , the highest mean intakes were observed for water ( 738 ± 567 mL/day ) , followed by milk ( 212 ± 209 mL/day ) , regular soft beverages ( RSB ) ( 168 ± 290 mL/day ) and juices ( 128 ± 228 mL/day ) . Patterns characterized by a high contribution of water , RSB or hot beverages to total fluid intake were identified among the countries with close geographical location . Adolescents had a significantly lower milk intake and higher intake of RSB and hot beverages than children in most countries . The most consistent gender difference observed was that in both age groups males reported a significantly higher RSB consumption than females . Conclusion On average , water was the fluid consumed in the largest volume by children and adolescents , but the intake of the different fluid types varied substantially between countries . Since the RSB intake was as large , or even larger , than water intake in some countries , undertaking actions to improve fluid intake habits of children and adolescents are warranted Background Multi-level , longer-term obesity prevention interventions that focus on inequalities are scarce . Fun ‘ n healthy in Morel and ! aim ed to improve child adiposity , school policies and environments , parent engagement , health behaviours and child wellbeing . Methods All children from primary schools in an inner urban , culturally diverse and economically disadvantaged area in Victoria , Australia were eligible for participation . The intervention , fun ‘ n healthy in Morel and ! , used a Health Promoting Schools Framework and provided schools with evidence , school research data and part time support from a Community Development Worker to develop health promoting strategies . Comparison schools continued as normal . Participants were not blinded to intervention status . The primary outcome was change in adiposity . Repeated cross-sectional design with nested longitudinal sub sample . Results Students from twenty-four primary schools ( clusters ) were r and omised ( aged 5–12 years at baseline ) . 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up 
    Output:
    
There was no evidence ( ≤33 % of studies reported an association ) of associations between consumption of milk or juice , parental emotional- , modelling- or instrumental feeding practice s , eating school lunch or outside temperature and water consumption .
Conclusions There is some evidence for an association between potentially modifiable parental and child-related factors and water consumption .