***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 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 The aim of the study was to evaluate the associations between  food behavior  and educational level among Lithuanian adult population . Five health behavior surveys were carried out within the international Finbalt Health Monitor project in 1994 - 2002 . For every survey the national r and om sample of 3000 inhabitants aged 20 - 64 was taken from the National Population Register . The study material was collected through mailed question naires covering sociodemographic characteristics and some nutrition habits . The respondents were categorized according to the level of education into three groups : persons having incomplete secondary , secondary and university education . Multiple regression analysis was used for evaluation of associations between level of education and nutrition habits . The persons with university education have a healthier diet than those with incomplete secondary education . The consumption of fish , vegetables and fruit , use of vegetable oil for cooking , was substantially higher in those with university education as compared to persons with incomplete secondary education . The proportion of persons drinking whole milk was the highest among the low educated men and women . The high-educated women consumed meat less often than those with incomplete secondary education did . However , persons with university education preferred butter on bread . The high-educated men consumed cheese daily more often than those with low education . The positive trends in nutrition habits of Lithuanians were observed between 1994 and 2002 . However , educational differences in nutrition habits still remain significant . In conclusion , alongside with other health interventions , the programs aim ed at reducing inequalities in health should consider the educational differences in nutrition habits of Lithuanians paying more attention to less educated persons Objective To investigate the effectiveness of a school based intervention to increase physical activity , reduce sedentary behaviour , and increase fruit and vegetable consumption in children . Design Cluster r and omised controlled trial . Setting 60 primary schools in the south west of Engl and . Participants Primary school children who were in school year 4 ( age 8 - 9 years ) at recruitment and baseline assessment , in year 5 during the intervention , and at the end of year 5 ( age 9 - 10 ) at follow-up assessment . Intervention The Active for Life Year 5 ( AFLY5 ) intervention consisted of teacher training , provision of lesson and child-parent interactive homework plans , all material s required for lessons and homework , and written material s for school newsletters and parents . The intervention was delivered when children were in school year 5 ( age 9 - 10 years ) . Schools allocated to control received st and ard teaching . Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day , accelerometer assessed minutes of sedentary behaviour per day , and reported daily consumption of servings of fruit and vegetables . Results 60 schools with more than 2221 children were recruited ; valid data were available for fruit and vegetable consumption for 2121 children , for accelerometer assessed physical activity and sedentary behaviour for 1252 children , and for secondary outcomes for between 1825 and 2212 children for the main analyses . None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group . The difference in means comparing the intervention group with the control group was –1.35 ( 95 % confidence interval –5.29 to 2.59 ) minutes per day for moderate to vigorous physical activity , –0.11 ( –9.71 to 9.49 ) minutes per day for sedentary behaviour , and 0.08 ( –0.12 to 0.28 ) servings per day for fruit and vegetable consumption . The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account : self reported time spent in screen viewing at the weekend ( –21 ( –37 to –4 ) minutes per day ) , self reported servings of snacks per day ( –0.22 ( –0.38 to –0.05 ) ) , and servings of high energy drinks per day ( –0.26 ( –0.43 to –0.10 ) ) were all reduced . Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results . Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity , decreasing sedentary behaviour , and increasing fruit and vegetable consumption in primary school children . Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level , as well as at the school environment level . These findings have relevance for research ers , policy makers , public health practitioners , and doctors who are involved in health promotion , policy making , and commissioning services . Trial registration Current Controlled Trials IS RCT N50133740 OBJECTIVE To evaluate the impact of an 18-month school obesity prevention intervention on the health behaviors of 4th and 5th grade students based on ecological principles and formative research conducted in Mexico . MATERIAL S AND METHODS A R and omized Control Trial ( RCT ) , design was used to assign 27 schools to one of three conditions : basic or plus interventions and control .  School environment measures , children 's eating and physical activity behaviors , and body mass index were assessed four times over a 2-year period in a sample of 830 students . RESULTS In the intervention schools , the availability of healthy foods increased with a concomitant decrease in unhealthy food availability . Food intake showed the same trend . In the intervention schools , children did not engage in more moderate to vigorous physical activity ( MVPA ) in physical education ( PE ) class or recess but increased steps taken . Obesity prevalence did not change . CONCLUSION The intervention improved the school food environment and child healthy behaviors Objective To assess the effectiveness of a multi-component school based intervention in improving knowledge and behavioral practice s regarding diet , physical activity and tobacco use in middle schoolchildren of rural-Ballabgarh , North-India . Methods A total of 40 middle schools were grouped into two , based on geographic proximity and r and omly assigned to the intervention or control group in a cluster r and omized controlled trial . The target population consisted of 2,348 children study ing in 6th and 7th grade s in these schools . The intervention consisted of a school component ( policies ) , a classroom component ( activities ) and a family component [ Information Education & Communication ( IEC ) material ] . The main outcome measures were knowledge and behavioral changes in physical activity , diet and tobacco which were self- reported . Results Post-intervention , a significant number of intervention schools adopted the tobacco policy ( 16/19 ) , physical activity policy ( 6/19 ) and healthy food policy ( 14/19 ) as compared to the control schools ( n = 21 ) . Knowledge about physical activity , diet and tobacco improved significantly in the intervention group as compared to the control group . Proportion of students attending Physical Training ( PT ) classes for five or more days in a week in the intervention group compared to the control group increased significantly ( 17.8 % ; p < 0.01 ) . Proportion of students consuming fruits increased in the intervention group compared to the control group ( 10 % ; p < 0.01 ) . Pre-post decrease in the prevalence of current smoking was significantly more in the intervention group as compared to the control group ( 7.7 % ; p < 0.01 ) . Conclusions Healthy setting s approach for schools is feasible and effective in improving knowledge and behavioral practice s of non-communicable diseases ( NCD ) risk factors in adolescents in rural India Increasing prevalence of childhood obesity calls for comprehensive and cost-effective educative measures in developing countries such as India . School-based educative programmes greatly influence children 's behaviour towards healthy living . We aim ed to evaluate the impact of a school-based health and nutritional education programme on knowledge and behaviour of urban Asian Indian school children . Benchmark assessment of parents and teachers was also done . We educated 40 196 children ( aged 8 - 18 years ) , 25 000 parents and 1500 teachers about health , nutrition , physical activity , non-communicable diseases and healthy cooking practice s in three cities of North India . A pre-tested question naire was used to assess r and omly selected 3128 children , 2241 parents and 841 teachers before intervention and 2329 children after intervention .  Low baseline knowledge and behaviour scores were reported in 75 - 94 % government and 48 - 78 % private school children , across all age groups . A small proportion of government school children gave correct answers about protein ( 14 - 17 % ) , carbohydrates ( 25 - 27 % ) and saturated fats ( 18 - 32 % ) . Private school children , parents and teachers performed significantly better than government school subjects ( P < 0.05 ) . Following the intervention , scores improved in all children irrespective of the type of school ( P < 0.001 ) . A significantly higher improvement was observed in younger children ( aged 8 - 11 years ) as compared with those aged 12 - 18 years , in females compared with males and in government schools compared with private schools ( P < 0.05 for all ) . Major gaps exist in health and nutrition-related knowledge and behaviour of urban Asian Indian children , parents and teachers . This successful and comprehensive educative intervention could be incorporated in future school-based health and nutritional education programmes The purpose of this study was to assess the effects of a six-months ’ nutrition program , delivered and taught by classroom teachers with in-service nutrition training , on the prevention of overweight and obesity among children in grade s 1 to 4 . In this r and omized trial , four hundred and sixty four children from seven elementary schools were allocated to a nutrition educational program delivered by their own teachers . Intervened teachers had 12 sessions of three hours each with the research ers throughout six months , according to the topics nutrition and healthy eating , the importance of drinking water and healthy cooking activities . After each session , teachers were encouraged to develop activities in class focused on the learned topics . Sociodemographic , anthropometric , dietary , and physical activity assessment s were performed at baseline and at the end of the intervention . In the intervention group the increase in Body Mass Index ( BMI ) z-score was significantly lower than in the control group ( p = 0.009 ) ; fewer proportion of children became overweight in the intervened group compared with the control ( 5.6 % vs. 18.4 % ; p = 0.037 ) . Our study provides further support to decrease the overweight epidemic , involving classroom teachers in a training program and making them dedicated interventionists Background Numerous studies in schools in the Western Cape Province , South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat . HealthKick ( HK ) was a three-year r and omised controlled trial aim ed at promoting healthy eating habits . Methods Sixteen schools were selected from two low-income school districts and r and omly allocated to intervention ( n =  
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Conclusions Interventions with a multicomponent approach that were age appropriate and of adequate duration ( ≥ 6 months ) , that engaged parents , and that ensured fidelity and proper alignment between the stated objectives , the intervention , and the desired outcomes were more likely to succeed