***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 To evaluate the impact of nutrition education in kindergartens and to promote healthy dietary habits in children . DESIGN Prospect i ve cohort study . Four kindergartens with 1252 children were r and omized to the intervention group and three with 850 children to the control group . The personal nutritional knowledge , attitudes and dietary behaviours of the parents were also investigated . Each month , children and parents in the intervention group participated in nutrition education activities . The main outcome measures were anthropometrics and diet-related behaviours of the children and the nutritional knowledge and attitudes of the parents at baseline , 6 months ( mid-term ) and 1 year ( post-test ) . Baseline demographic and socio-economic characteristics were also collected . SETTING Seven kindergartens from Hefei , the capital city of Anhui Province , eastern China . SUBJECTS Two thous and one hundred and two 4- to 6-year-old pre-schoolers from seven kindergartens participated . RESULTS The prevalence of children 's unhealthy diet-related behaviours decreased significantly and good lifestyle behaviours increased in the group receiving nutrition education compared with controls . Parental eating habits and attitudes to planning their children 's diets also changed appreciably in the intervention group compared with the control group ( P < 0.05 ) . However , there were no statistically significant differences in children 's height , weight , height-for-age Z-score or weight-for-age Z-score between the two groups . CONCLUSIONS Kindergarten-based nutrition education improves pre-schoolers ' lifestyle behaviours and brings about beneficial changes in parents ' attitudes to planning their children 's diets and their own personal eating habits OBJECTIVE We examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise ( CHILE ) study , a group r and omized controlled trial to design , implement , and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico . METHODS CHILE was a 5-year evidence -based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children . The intervention included a classroom curriculum , teacher and food service training , family engagement , grocery store participation , and healthcare provider support . Height and weight measurements were obtained four times ( fall of 2008 , spring and fall of 2009 , and spring of 2010 ) , and body mass index ( BMI ) z-scores in the intervention and comparison groups were compared . RESULTS At baseline , demographic characteristics in the comparison and intervention groups were similar , and 33 % of all the children assessed were obese or overweight . At the end of the intervention , there was no significant difference between the two groups in BMI z-scores . CONCLUSIONS Obesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex . Although the CHILE intervention was implemented successfully , changes in overweight and obesity may take longer than 2years to achieve This study examined the effect of an early childhood obesity  prevention program on changes in Body Mass Index ( BMI ) z-score and nutrition practice s.  Eight child care centers were r and omly assigned to an intervention or attention control arm . Participants were a multiethnic sample of children aged 2 to 5 years old ( N = 307 ) . Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake , decreased intake of simple carbohydrate snacks , and decreased screen time . Control centers received an attention control program .  Height , weight , and nutrition data were collected at baseline and at 3 , 6 , and 12 months . Analysis examined height , weight , and BMI z-score change by intervention condition ( at baseline and at 3 , 6 , and 12 months ) . Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group . Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants . Similarly , intervention children consumed less junk food , ate more fresh fruits and vegetables , drank less juice , and drank more 1 % milk compared to children at control sites at 6 months post baseline . Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later . Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group Objective To investigate the effect of a  preschool physical activity intervention program delivered in licensed childcare setting s , with or without a parent‐facilitated home component , on  children 's daily physical activity , sedentary time , and body composition . Study design For this cluster r and omized controlled trial , 18 childcare centers were r and omly allocated in equal numbers to the typical curriculum comparison group , childcare intervention alone ( CC ) , or childcare intervention with parental involvement . Accelerometers  were used to asses physical activity and sedentary time , and body composition was measured by bioelectrical impedance . Results Linear mixed model regression analyses showed no differences between the CC , the childcare intervention with parental involvement , and the comparison groups in changes from baseline to 6 months in total physical activity ( P for time × group interaction = .665 ) or moderate‐to‐vigorous physical activity ( P for time × group interaction = .164 ) when adjusted for baseline physical activity levels . Furthermore , no group differences were found for changes in light physical activity , sedentary time , or anthropometric variables . Conclusions An affordable and easily scalable preschool intervention program delivered in licensed childcare setting s , with or without the addition of a parent‐driven home physical activity promotion , seems to have no significant effect on physical activity , sedentary time , or body composition . Trial registration IS RCT N : IS RCT N94022291 Early social and economic deprivation , associated with poor nutrition and physical inactivity , may lead to adverse health trajectories . A cluster-r and omized controlled-trial examining the effect of a school-based comprehensive intervention on nutrition knowledge , eating habits , and behaviors among low socioeconomic status ( LSES ) school-aged children was performed . LSES school-aged children ( 4–7 years ) and their mothers were recruited from 11 schools , located in one town . The intervention was implemented on three levels : children , mothers , and teachers . The intervention ( IArm ) included nutrition classes for children , mothers , and teachers and physical activity ( PA ) classes for children ; the control ( CArm ) received PA only . Interventions were conducted by professional personnel , who were trained during in a two-day session to deliver the specific program in schools . Family data were obtained by parental interviews . Food knowledge observations , packed lunch records , and anthropometric measurements were obtained in school at baseline , six months , and at the end of the school year . Of 258 children enrolled , 220 ( 87.6 % ) completed the six-month program . Only children in the IArm improved their nutrition knowledge and eating-habits and increased food variety and fruit and vegetable consumption , quality score of packed lunches ( p < 0.001 for all ) , habitual water drinking increased ( p = 0.02 ) , and decreased sweet-drink consumption ( p = 0.05 ) . A school-based comprehensive nutrition intervention targeting LSES population improved eating habits , nutritional knowledge , and healthier packed lunches BACKGROUND School programs can be effective in modifying knowledge , attitudes , and habits relevant to long-term risk of chronic diseases associated with sedentary lifestyles . As part of a long-term research strategy , we conducted an educational intervention in preschool facilities to assess changes in preschoolers ' knowledge , attitudes , and habits toward healthy eating and living an active lifestyle . METHODS Using a cluster design , we r and omly assigned 14 preschool facilities in Bogotá , Colombia to a 5-month educational and playful intervention ( 7 preschool facilities ) or to usual curriculum ( 7 preschool facilities ) . A total of 1216 children aged 3 - 5 years , 928 parents , and 120 teachers participated . A structured survey was used at baseline , at the end of the study , and 12 months later to evaluate changes in knowledge , attitudes , and habits . RESULTS Children in the intervention group showed a 10.9 % increase in weighted score , compared with 5.3 % in controls . The absolute adjusted difference was 3.90 units ( 95 % confidence interval [ CI ] , 1.64 - 6.16 ; P < .001 ) . Among parents , the equivalent statistics were 8.9 % and 3.1 % , respectively ( absolute difference 4.08 units ; 95 % CI , 2.03 to 6.12 ; P < .001 ) , and among teachers , 9.4 % and 2.5 % , respectively ( absolute difference 5.36 units ; 95 % CI , -0.29 - 11.01 ; P = .06 ) . In the intervened cohort 1 year after the intervention , children still showed a significant increase in weighted score ( absolute difference of 6.38 units ; P < .001 ) . CONCLUSIONS A preschool-based intervention aim ed at improving knowledge , attitudes , and habits related to healthy diet and active lifestyle is feasible , efficacious , and sustainable in very young children Objective To develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children . Methods A cluster-r and omised controlled trial was carried out in areas with low to medium socio-economic status . Participants were six-year-old children ( n = 243 ) and their parents . Fourteen pre-school classes were r and omly assigned to intervention ( n = 7 ) and control groups ( n = 7 ) . The intervention lasted for 6 months and included : 1 ) Health information for parents , 2 ) Motivational Interviewing with parents and 3 ) Teacher-led classroom activities with children .  Physical activity was measured by accelerometry , dietary and physical activity habits  and  parental self-efficacy  through a question naire . Body weight and height were measured and BMI st and ard deviation score was calculated . Measurements were conducted at baseline , post-intervention and at 6-months follow-up . Group differences were examined using analysis of covariance and Poisson regression , adjusted for gender and baseline values . Results There was no significant intervention effect in the primary outcome physical activity . Sub-group analyses showed a significant gender-group interaction in total physical activity ( TPA ) , with girls in the intervention group demonstrating higher TPA during weekends ( p = 0.04 ) , as well as in sedentary time , with boys showing more sedentary time in the intervention group ( p = 0.03 ) . There was a significantly higher vegetable intake ( 0.26 servings ) in the intervention group compared to the control group ( p = 0.003 ) . At follow-up , sub-group analyses showed a sustained effect for boys . The intervention did not affect the prevalence of overweight or obesity . Conclusions It is possible to influence vegetable intake in children and girls ’ physical activity through a parental support programme . The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term . These findings are an important contribution to the further development of evidence -based parental support programmes to prevent overweight and obesity in children . Trial Registration Controlled-trials.com IS RCT Objective To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children . Design Cluster r and omised controlled single blinded trial ( Ballabeina study ) over one school year ; r and omisation was performed after stratification for linguistic region . Setting 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerl and . Participants 652 of the 727 preschool children had informed consent and were present for baseline measures ( mean age 5.1 years ( SD 0.7 ) , 72 % migrants of multicultural origins ) . No children withdrew , but 26 moved away . Intervention The multidimensional culturally tailored lifestyle intervention included a physical activity programme , lessons on nutrition , media use ( use of television and computers ) , and sleep and adaptation of the built environment of the preschool class . It lasted from August 2008 to June 2009 . Main outcome measures Primary outcomes were aerobic fitness ( 20 m shuttle run test ) and body mass index ( BMI ) . Secondary outcomes included motor agility , balance , percentage body fat , waist circumference , physical activity , eating habits , media use , sleep , psychological health , and cognitive abilities . Results Compared with controls , children in the intervention group had an increase in aerobic fitness at the end of the intervention ( adjusted mean difference : 0.32 stages ( 95 % confidence interval 0.07 to 0.57 ; P=0.01 ) but no difference in BMI ( −0.07 kg/m2 , −0.19 to 0.06 ; P=0.31 ) . Relative to controls , children in the intervention group had beneficial effects in motor agility ( −0.54 s , −0.90 to −0.17 ; P=0.004 ) , percentage body fat ( −1.1 % , −2.0 to −0.2 ; P=0.02 ) , and waist circumference ( −1.0 cm , −1.6 to −0.4 ; P=0.001 ) . There were also significant benefits in the intervention group in reported physical activity , media use , and eating habits , but not in the remaining secondary outcomes . Conclusions A multidimensional intervention increased aerobic fitness and reduced body fat but not B 
    Output:
    
The interventions predominantly targeted the socio-cultural and physical environments in both the childcare and home setting s. Including changes in the political environment in the intervention and a higher level of intensity of parental involvement appeared to positively impact intervention effectiveness .
Conclusion Childcare-based interventions with direct parental involvement show promising effects on the children ’s energy balance-related behaviours .
However , evidence on effectiveness is limited , particularly for weight-related outcomes .