***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: Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design BACKGROUND Childhood obesity is a major public health problem in the United States , particularly among American Indian communities . OBJECTIVE The objective was to evaluate the effectiveness of a school-based , multicomponent intervention for reducing percentage body fat in American Indian schoolchildren . DESIGN This study was a r and omized , controlled , school-based trial involving 1704 children in 41 schools and was conducted over 3 consecutive years , from 3rd to 5th grade s , in schools serving American Indian communities in Arizona , New Mexico , and South Dakota . The intervention had 4 components : 1 ) change in dietary intake , 2 ) increase in physical activity , 3 ) a classroom curriculum focused on healthy eating and lifestyle , and 4 ) a family-involvement program . The main outcome was percentage body fat ; other outcomes included dietary intake , physical activity , and knowledge , attitudes , and behaviors . RESULTS The intervention result ed in no significant reduction in percentage body fat . However , a significant reduction in the percentage of energy from fat was observed in the intervention schools . Total energy intake ( by 24-h dietary recall ) was significantly reduced in the intervention schools but energy intake ( by direct observation ) was not . Motion sensor data showed similar activity levels in both the intervention and control schools . Several components of knowledge , attitudes , and behaviors were also positively and significantly changed by the intervention . CONCLUSIONS These results document the feasibility of implementing a multicomponent program for obesity prevention in elementary schools serving American Indian communities . The program produced significant positive changes in fat intake and in food- and health-related knowledge and behaviors . More intense or longer interventions may be needed to significantly reduce adiposity in this population BACKGROUND The long-term consequences of modified fat intake in early childhood are poorly known . The r and omized prospect i ve STRIP baby project evaluates the effects of repeated dietary counseling on  nutrient intakes  and serum lipid values in children 7 months to 3 years old . METHODS AND RESULTS One thous and sixty-two infants were r and omized to intervention and control groups at 7 months of age . The families of the 540 intervention children were counseled to reduce the child 's intake of saturated fat and cholesterol but to ensure adequate energy intake . Five hundred twenty-two control children consumed an unrestricted diet . Food records were kept , and serum lipids were measured at 5- to 12-month intervals . Intakes of saturated fat , fat as proportion of energy ( E% ) , and cholesterol were lower in the intervention children than in control children at 13 , 24 , and 36 months of age . Fat intake by the intervention children decreased from 29 + /- 5 E% at 8 months of age to 26 + /- 6 E% at 13 months and then increased to 30 + /- 5 E% at 24 months and to 31 + /- 5 E% at 36 months . The control children consumed 29 + /- 4 E% , 28 + /- 5 E% , 33 + /- 5 E% , and 33 + /- 5 E% of fat at 8 , 13 , 24 , and 36 months , respectively . The ratio of dietary poly-unsaturated to saturated fats of the intervention children was consistently higher than that of the control children ( P < .0001 ) . Baseline adjusted mean serum cholesterol concentration was lower in the intervention children than control children between 13 and 36 months ( P < .0001 ; 95 % confidence interval of the difference between the group means , -0.27 to -0.12 mmol/L ) . The effect was significant only in boys ( 95 % confidence interval , -0.39 to -0.20 mmol/L in boys ; -0.21 to 0.01 mmol/L in girls ) . CONCLUSIONS Repeated individualized dietary counseling markedly reduces the increase in serum cholesterol concentration that occurs in control children during the first years of life R and omized controlled trials ( RCTs ) are essential for evaluating the efficacy of clinical interventions , where the causal chain between the agent and the outcome is relatively short and simple and where results may be safely extrapolated to other setting s. However , causal chains in public health interventions are complex , making RCT results subject to effect modification in different population s. Both the internal and external validity of RCT findings can be greatly enhanced by observational studies using adequacy or plausibility design s. For evaluating large-scale interventions , studies with plausibility design s are often the only feasible option and may provide valid evidence of impact . There is an urgent need to develop evaluation st and ards and protocol s for use in circumstances where RCTs are not appropriate Most of the counselling in health care targeted at child nutrition is delivered via the parents , but little is known about the effects of such counselling on the nutrition knowledge and dietary habits of the parents . In the Special Turku Coronary Risk Factor Intervention Project for Children ( STRIP ) , we studied how 6.5 years of child-targeted nutrition counselling affected the knowledge , attitudes and dietary habits of the parent mainly responsible for food purchase and preparation . We used a question naire and a 24-h recall interview in a time-restricted cohort of 98 families belonging to the intervention group and 89 families belonging to the control group in the STRIP project .  After controlling for background variables , the intervention parents had better knowledge than the control parents of causal relationships between food choices and coronary heart disease and of the nutritional composition of foods . Knowledge of nutrition concepts did not differ between the two groups . The quality of fat was better in the diet of the intervention parents , they consumed less salt and they also had more knowledge concerning these subjects compared to the control parents ( higher behavioural capability scores ) . The behavioural capability scores of the total group correlated poorly with their nutrient intakes . Thus , child-targeted nutrition intervention delivered to the parents increased parental nutrition knowledge and improved the quality of the parents ' diet . However , as nutrition knowledge of the parents correlated poorly with their nutrient intakes , other factors than knowledge appear to influence parental dietary decisions Objective : To evaluate the effect of dietary low-saturated fat , low-cholesterol intervention on fat intake and fatty acid compositions in serum cholesterol ester ( CE ) , phospholipid ( PL ) and triglyceride ( TG ) fractions in five-year-old children . Design and subjects : The STRIP project is a prospect i ve , r and omised intervention project in which 1062 seven-month-old infants were recruited from the well-baby clinics . 764 children participated in the 5-year follow-up ; 202 of them were r and omly selected for this study .  Diet was assessed with 4-d dietary records . Serum CE , PL and TG fatty acid compositions were analysed with gas-liquid chromatography . Results : Saturated fat intake of intervention children ( mean ( confidence interval ) ) ( girls 11.9 ( 11.2–12.6 ) % of energy intake ( E% ) ; boys 12.5 ( 11.9–13.1 ) ) was lower than that of the control children ( girls 14.4 ( 13.7–15.2 ) E% ; boys 15.0 ( 14.3–15.8 ) E% ) ( P=0.0001 for the difference between intervention and control groups ) . The intake of unsaturated fat differed only slightly . Dietary ratios of polyunsaturated to saturated fatty acids ( PS ratios ) of the intervention and control diets were 0.44 and 0.33 , respectively ( P=0.0001 ) . Furthermore , serum cholesterol concentrations of the intervention and control children differed ( 4.28 ( 4.13–4.43 ) mmol/L vs 4.49 ( 4.35–4.63 ) mmol/L ; P=0.04 ) . Relative proportion of saturated fatty acids in serum TG was lower ( 34.9 % vs 36.3 % ; P=0.04 ) and that of n-6 polyunsaturated fatty acids higher ( 13.9 % vs 12.4 % ; P=0.0004 ) in the intervention than in the control children , whereas serum CE and PL fatty acid compositions of intervention and control groups were closely similar . However , intake of linoleic acid correlated better with serum linoleic acid relative content in the CE fraction ( r=0.36 ; P=0.0001 ) than in the PL ( r=0.27 ; P=0.0002 ) or in the TG ( r=0.23 ; P=0.0016 ) fraction Conclusions : Intervention result ed in decreased intake of saturated fatty acids and lowered serum total and LDL cholesterol concentrations . Of serum lipid fractions , TG fatty acid composition was the most sensitive and parallelled the findings in dietary food records BACKGROUND No national policy for health education in schools exists to date in Greece . The first attempt to apply a school-based health education intervention program was launched in 1992 on all 4,171 pupils registered in the first grade in two counties of Crete . The 1,510 pupils registered in a third county served as controls . METHODS The school-based intervention and the seminars organized for parents were primarily aim ed at improving children 's diet , fitness , and physical activity . Pupils in the first grade in a representative sample of 40 schools were examined prior to the intervention program on a variety of health knowledge , dietary , physical activity , fitness , anthropometric , and biochemical indices . The same measurements were taken after 3 years of the program on 288 intervention group and 183 control group pupils . RESULTS Positive serum lipid level changes occurred to a greater extent in the intervention group than the control group . BMI increased less in the intervention group than for controls . The increase in health knowledge and physical activity and fitness levels occurred to a higher extent in the intervention group compared to controls . CONCLUSIONS The short-term changes observed in the present study are markedly encouraging and indicate great potential for progressive improvement . Continuation and expansion of such a program may prove to be beneficial in initiating long-term changes Project SPARK evaluates multiple effects of a health-related physical education ( PE ) program for elementary school students . Seven schools were r and omly assigned to one of three conditions : usual PE or control , trained classroom teachers , or PE specialists . The intervention was implemented throughout the fourth and fifth grade s. Data are available from one cohort of 550 children who were measured in the fall and spring of both grade s.  Adiposity was assessed by triceps and calf skinfolds , and body mass index ( BMI ) was also measured . Data at each measurement point were analyzed by ANOVAs , covarying for baseline values . At no measurement point were there significant group differences in total skinfold . At both fifth grade measurement points for boys and girls , however , there was a trend for the control group to have higher skinfold values than the two intervention groups . At the final measure , the difference between the highest and lowest groups was about 3 mm for girls and 2 mm for boys . BMI s were significantly lower at some measurement points for boys and girls , but this could be due to increased lean body mass in intervention students . After two years , there was a trend for the children exposed to the PE intervention to have lower levels of body fat , but the differences were not significant 
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A recent synthesis of 147 programmes addressing childhood overweight and obesity provides a concrete example of using a broader approach to identify evidence for best practice ( Flynn et al. 2006 ) .
Incorporating evaluation and population health frameworks as criterion components in addition to traditional method ological rigour criteria , this synthesis has identified programmes that provide context ual information that can be used to populate what Swinburn et al. ( 2005 ) have described as the ' promise table ' .