***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: Background Many unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five . Presently , approximately 70 percent of children in the United States are currently enrolled in early childcare facilities , making this an ideal setting to implement and evaluate childhood obesity prevention efforts . We describe here the methods for conducting an obesity prevention r and omized trial in the child care setting . Methods / design A r and omized , controlled obesity prevention trial is currently being conducted over a three year period ( 2010-present ) . The sample consists of 28 low-income , ethnically diverse child care centers with 1105 children ( sample is 60 % Hispanic , 15 % Haitian , 12 % Black , 2 % non-Hispanic White and 71 % of caregivers were born outside of the US ) . The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children ’s nutrition and physical activity behaviors . . The Healthy Caregivers-Healthy Children ( HC2 ) intervention arm schools received a combination of ( 1 ) implementing a daily curricula for teachers/parents ( the nutritional gatekeepers ) ; ( 2 ) implementing a daily curricula for children ; ( 3 ) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce ; and ( 4 ) creation of a center policy for dietary requirements for meals and snacks , physical activity and screen time . Control arm schools received an attention control safety curriculum . Major outcome measures include pre-post changes in child body mass index percentile and z score , fruit and vegetable and other nutritious food intake , amount of physical activity , and parental nutrition and physical activity knowledge , attitudes , and beliefs , defined by intentions and behaviors . All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment . Discussion Although few attempts have been made to prevent obesity during the first years of life , this period may represent the best opportunity for obesity prevention . Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting .Trial registration Trial registration number : OBJECTIVE Determine whether Color Me Healthy ( CMH ) , an interactive nutrition and physical activity program for preschool children , increases fruit and vegetable consumption . DESIGN Intervention study . Data were collected at baseline , 1 week post-intervention , and 3 months post-intervention . SETTING Child care centers . PARTICIPANTS Preschool children ( n = 263 ) in 17 child care centers . INTERVENTION Child care centers were r and omly assigned to 1 of 2 conditions ; children ( n = 165 ) in 10 centers received the CMH curriculum , and children ( n = 98 ) in 7 centers acted as comparisons and did not receive the curriculum . MAIN OUTCOME MEASURES Process and outcome evaluation . Consumption of fruit and vegetable snacks . ANALYSIS Data were analyzed using repeated- measures analysis of variance and hierarchical linear modeling . RESULTS Children who received CMH significantly increased their consumption of fruit snacks by approximately 20.8 % and vegetable snacks by approximately 33.1 % between baseline assessment and the assessment conducted 3 months after the completion of the CMH program . Hierarchical linear modeling determined that group assignment ( ie , CMH or control ) was the only significant predictor of fruit and vegetable consumption . CONCLUSIONS AND IMPLICATION S Findings suggest that CMH may be used in child care setting s for developing healthful eating habits 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 BACKGROUND Laboratory and home-based research suggest that repeated exposure to vegetables may increase consumption among children . Effectiveness of repeated exposure to vegetables has not been tested in a community-based preschool setting . OBJECTIVE This r and omized controlled trial tested the hypotheses that children who are served unfamiliar vegetables repeatedly in the preschool lunch setting will increase consumption of them , and that consumption will be influenced by peer eating behaviors and parental feeding behaviors . SUBJECTS/ SETTING Data were collected in two private preschools in a small northeastern city in 2007 . Ninety-six children ( aged 3 to 6 years ) participated . DESIGN Schools were r and omly assigned to condition . During the first 6 weeks , Preschool A served three vegetables at lunch on 10 separate occasions ( ie , 30 days of exposure ) , while Preschool B continued routine practice . In the 7th week , schools reversed conditions and Preschool B served the vegetables for the next 6 weeks . Consumption data were collected daily in the intervention school and at baseline and post-intervention meals in the control school . PRIMARY OUTCOMES /STATISTICAL ANALYSES : Analysis of variance was used to examine the effect of vegetable exposure on vegetable intake ; multilevel models were used to examine the effect of peer eating behaviors and parental feeding practice s on vegetable intake . RESULTS Repeated exposure did not increase vegetable consumption . Greater consumption by tablemates was a significant predictor of greater vegetable consumption ; across the three vegetables , 1 g of peer intake was associated with roughly a 1/5-g intake increase among the subjects . Overall , children demonstrated wide fluctuation in vegetable consumption from day to day , creating as much variability within subjects as between them . CONCLUSIONS Further research should explore the conditions necessary for repeated exposure to increase vegetable consumption in preschool setting s. Creating opportunities for young children to serve as peer models has promise as a strategy to promote vegetable consumption Background Obesity is the most common chronic pediatric disease in westernized , especially low socioeconomic societies . We previously demonstrated the beneficial effects of a r and omized prospect i ve school-based health education program for low socioeconomic status Arab-Israeli kindergarten children . Methods To examine whether the effects of our program on nutrition and physical activity knowledge and preferences , anthropometric measures , and fitness persisted one year after the end of intervention . We were able to perform the one year follow-up in 203 kindergarten children ( 59 % of our 342 original cohort ; 85 control , 118 intervention ) . Results At one year following the intervention BMI and BMI percentiles approached baseline level in both the intervention ( 16.4±0.2 kg/m2 and 61.5±2.4 % , respectively ) and control group participants ( 16.5±0.2 kg/m2 and 58.5±3.3 % , respectively ) . Yet , a year after the end of the intervention , the decrease in BMI % ile from baseline was significantly greater in the intervention group ( -7.8±1.5 vs. -1.9±1.9 , p<0.012 ) . Nutritional and physical activity knowledge and preferences , and physical fitness remained significantly elevated in the intervention compared to the control group participants . Conclusions The beneficial effects of a kindergarten dietary-physical activity intervention applied by the kindergarten teachers , on nutrition and physical activity knowledge and preferences , fitness , and BMI percentile were evident one year after the end of intervention . This promising program may play a role in health promotion , prevention and treatment of childhood obesity Background Nearly one in five 4-year-old children in the United States are obese , with low-income children almost twice as likely to be obese as their middle/upper-income peers . Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested , and effects are modest . We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress . Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity . Methods / design The Growing Healthy study is a r and omized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start , a federally-funded preschool program for low-income children . Interventions are delivered by community-based , nutrition-education staff partnering with Head Start . The first intervention ( n = 200 ) , Preschool Obesity Prevention Series ( POPS ) , addresses evidence -based obesity prevention behaviors for preschool-aged children and their parents . The second intervention ( n = 200 ) comprises POPS in combination with the Incredible Years Series ( IYS ) , an evidence -based approach to improving self-regulation among preschool-aged children . The comparison condition ( n = 200 ) is Usual Head Start Exposure . We hypothesize that POPS will yield positive effects compared to Usual Head Start , and that the combined intervention ( POPS + IYS ) addressing behaviors well-known to be associated with obesity risk , as well as self-regulatory capacity , will be most effective in preventing excessive increases in child adiposity indices ( body mass index , skinfold thickness ) . We will evaluate additional child outcomes using parent and teacher reports and direct assessment s of food-related self-regulation . We will also gather process data on intervention implementation , including fidelity , attendance , engagement , and satisfaction . Discussion The Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers . If the project is effective in preventing obesity , results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children . Trial registration number Clinical trials.gov Identifier : Background The onset of inadequate behaviors leading to the development of risk factors for chronic diseases is known to occur early in life . An effective program for health promotion should therefore focus on children and their environment , as the starting point for behavior development . The overarching objective of the Program SI ! ( Salud Integral - Comprehensive Health ) is to intervene at the school level , to establish and develop life-lasting habits that will help preserving health during adulthood . The Program SI ! comprises five consecutive subprograms according to the five stages of education in Spain , the first being in preschoolers . This study aims to evaluate the efficacy of Program SI ! to establish and improve lifestyle behaviors in children ( preschoolers aged 3–5 years ) , their parents , and teachers , and also improving the school environment . A secondary objective is to evaluate improvements in cardiovascular health-related markers ( anthropometric parameters , blood pressure , and dietary and physical activity patterns ) in these same children . Methods / design 24 public schools from the city of Madrid ( Spain ) were allocated through stratified r and omization to intervention or control . The intervention schools follow the Program SI ! , which provides didactic units , emotions cards , healthy tips , and online re sources . The intervention schools integrate the Program SI ! into their scholar curriculum organized in four complete weeks during each academic year during the 3 years of preschool education . Control schools follow their normal curriculum . Primary outcomes are 1-year , and 3-year changes from baseline of scores for knowledge , attitudes , and habits ( KAH ) of children , their parents and teachers in regards to a healthy lifestyle . Secondary outcomes are 1-year , and 3-year changes from baseline in clinical and anthropometric parameters of children . Discussion The Program SI ! is a long-term health promotion program starting in 3 years old . It incorporates the traditional areas of intervention ( diet and physical activity ) , introducing additional components such as knowledge of the human body and management of emotions to achieve a comprehensive intervention . The Program SI ! is design ed to be an effective , sustainable health promotion program for the adoption of healthy behaviors from early in life . Trial registration Trial registration number : Background Strategies to increase fruit and vegetable consumption of preschool aged children are needed . Objectives Evaluate the independent effects of the following meal service strategies on intake of fruits and vegetables of preschool children : 1 . ) Serving fruits and vegetables in advance of other menu items as part of traditional family style meal service ; and 2 . ) Serving meals portioned and plated by providers . Methods Fifty-three preschool aged children completed a r and omized crossover experiment conducted at a Head Start center in Minneapolis , 
    Output:
    
Seventeen of the 26 included studies were located in North America , 1 in South America , 5 in Asia , and 3 in a European context .Healthy eating interventions in day care facilities increased fruit and vegetable consumption and nutrition related knowledge among the target groups .