human
***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 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 The rapid increase in the prevalence of obesity in the last decade indicates a need for effective treatment programs . We conducted a short-term , repeated- measures , clinical - outcome trial in three groups of children and adolescents in two different locations . Two cohorts ( n=34 ) were enrolled in a 36-wk multi-disciplinary weight-management program at the Children 's Hospital of New Orleans . One cohort ( n=16 ) was enrolled in a similar intervention at the General Clinical Research Center ( GCRC ) at the Medical Center of Louisiana for a 10-wk summer weight-loss program . Subjects were offered a protein-sparing modified fast ( PSMF ) diet ( 600 - 800 kcal/d ; 2 g protein/kg body weight ) , followed by a balanced hypocaloric diet , and they participated in behavior-modification sessions and a moderate-intensity ( 45 - 55 % volume of oxygen consumed at maximal effort [ VO(2)max ] ) , progressive exercise program . The following parameters were examined at baseline , 10 wk , and 36 wk ( cohort 1 only ) : Weight , height , percentage of ideal body weight ( % IBW ) , relative body fat ( % fat ) , fat free body ( FFB ) mass , estimated VO(2)max mL/kg min(BW ) [ adjusted for body weight ] ) , blood chemistries , lipid profiles ( total cholesterol [ TC ] , triglycerides [ TG ] , low-density lipoprotein [ LDL ] , high-density lipoprotein [ HDL ] , and insulin-like growth factor-1 [ IGF-1 ] ) . All three groups experienced significant decreases in weight , % IBW and % fat at 10 wk . The weight loss was maintained at 26 wk in cohorts 1 and 2 , and at 36 wk in cohort 1 . There were no significant decreases in height velocity during the study . In addition , measures of estimated VO(2)max mL/kg/min(BW ) and IGF-1 parameters were significantly greater at 10 wk compared to baseline . Measures of TC , TG , and LDL were significantly lower at 10 wk , with no significant changes noted in HDL . We conclude that a multi-disciplinary weight-management program , including PSMF , behavior modification , and exercise , provides an effective method of treatment for obesity in children and adolescents . Long-term , r and omized , and controlled clinical trials are needed to confirm the results of this preliminary , short-term observation Background : This study aim ed to assess the salt intake of Iranian children , and to assess the correlation of urinary electrolytes excretion with blood pressure . Methods : This cross-sectional study was conducted in 2011 - 2012 among 3 - 10-year-old children , selected by multi-stage cluster sampling from urban and rural areas of Isfahan , Iran . The sodium ( Na ) , potassium ( K ) , and creatinine ( Cr ) were measured in a r and om sample of the children 's first morning fasting urine . Three-day averages of dietary intakes were analyzed by the Nutritionist-4 software . Results : The mean ( SD ) of urinary Na was 177.17 ( 28.68 ) mEq/day without significant difference according to gender and living area . The mean ( SD ) dietary intakes of Na and K were 2017.76 ( 117.94 ) and 1119.06 ( 76.03 ) mg/day , respectively . Children of urban and rural areas consumed similar sources of salty foods ( bread , cheese , and snacks ) and had low intake of vegetables . No significant association was documented between urinary electrolytes excretions and blood pressure . Conclusions : This study , which to the best of our knowledge is the first of its kind in the Middle East and North Africa region , revealed that Iranian young children consume a large amount of sodium and small amount of potassium . The non-significant associations of electrolyte excretions with blood pressure may be because of the very young age group of participants . Given the development of preference to salt taste from early childhood , and the tracking of risk factors of chronic diseases from this age , reducing salt intake of young children should be emphasized Introduction The current salt intake is very high for children as well as adults in China . A reduction in salt intake is one of the most cost-effective measures to curb the rapidly growing disease burden attributed to blood pressure and cardiovascular disease in the Chinese population . A lower salt diet starting from childhood has the potential to prevent the development of such conditions . The School-EduSalt ( School-based Education Programme to Reduce Salt ) study aims to determine whether an education programme targeted at school children can lower salt intake in children and their families . Methods and analysis The study is design ed as a cluster r and omised controlled trial . The location is Changzhi , Shanxi province in northern China . The study population will consist of 28 primary schools with 280 children aged ≈11 years and 560 adult family members . Children in the intervention group will be educated on how to reduce salt intake . They will then be empowered to deliver the salt reduction message home to their families . In particular , children need to persuade the person who does the cooking to reduce the amount of salt used during food preparations . The duration of the intervention is one school term ( ≈4.5 months ) . The primary outcome is the difference between the intervention and the control group in the change in 24 h urinary sodium and the secondary outcome is the difference between the intervention and control group in the change of blood pressure . An economic evaluation will be undertaken to assess cost-effectiveness . Ethics and dissemination The study has been approved by The Queen Mary Research Ethics Committee ( QMREC2012/81 ) and Peking University Health Science Centre IRB ( IRB00001052 - 12072 ) . Study findings will be disseminated widely through conference presentations and peer- review ed publications . Protocol Registration Protocol Registered on Clinical Trials.gov NCT01821144 Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families . Design Cluster r and omised controlled trial , with schools r and omly assigned to either the intervention or control group . Setting 28 primary schools in urban Changzhi , northern China . Participants 279 children in grade 5 of primary school , with mean age of 10.1 ; 553 adult family members ( mean age 43.8 ) . Intervention Children in the intervention group were educated on the harmful effects of salt and how to reduce salt intake within the schools ’ usual health education lessons . Children then delivered the salt reduction message to their families . The intervention lasted for one school term ( about 3.5 months ) . Main outcome measures The primary outcome was the difference between the groups in the change in salt intake ( as measured by 24 hour urinary sodium excretion ) from baseline to the end of the trial . The secondary outcome was the difference between the two groups in the change in blood pressure . Results At baseline , the mean salt intake in children was 7.3 ( SE 0.3 ) g/day in the intervention group and 6.8 ( SE 0.3 ) g/day in the control group . In adult family members the salt intakes were 12.6 ( SE 0.4 ) and 11.3 ( SE 0.4 ) g/day , respectively . During the study there was a reduction in salt intake in the intervention group , whereas in the control group salt intake increased . The mean effect on salt intake for intervention versus control group was −1.9 g/day ( 95 % confidence interval −2.6 to −1.3 g/day ; P<0.001 ) in children and −2.9 g/day ( −3.7 to −2.2 g/day ; P<0.001 ) in adults . The mean effect on systolic blood pressure was −0.8 mm Hg ( −3.0 to 1.5 mm Hg ; P=0.51 ) in children and −2.3 mm Hg ( −4.5 to −0.04 mm Hg ; P<0.05 ) in adults . Conclusions An education programme delivered to primary school children as part of the usual curriculum is effective in lowering salt intake in children and their families . This offers a novel and important approach to reducing salt intake in a population in which most of the salt in the diet is added by consumers . Trial registration Clinical Trials.gov NCT01821144 BACKGROUND The objective of this study , focused on parents and children to reduce sedentary behavior , consumption of soft drinks and high-fat and salt containing snacks , and increase the consumption of fruits and vegetables , was to assess the effect of a six month intervention and an 18 month follow-up intervention on the body mass index , food consumption and physical activity of 2nd and 3rd grade elementary school children . METHODS This was a r and omized cluster controlled trial . School children were selected from 2nd and 3rd ( n = 532 ) grade . MEASUREMENTS BMI z-score for age and sex was calculated and classified according to the WHO ( 2006 ) . Abdominal obesity was defined as WC > 90th of NHANES III . RESULTS At six months of the study differences were observed in BMI , -0.82 ( p = 0.0001 ) . At 24 months , results such as an increase of z-score BMI and waist circumference , a decrease in abdominal obesity , eighth per cent remission and an incidence of 18 % of overweight and obesity were observed . Additionally , an increase ( p = 0.007 ) in vegetable intake and physical activity ( p = 0.0001 ) was also reported , along with a decrease in sedentary activities and the consumption of snacks high in fat and salt . CONCLUSIONS The results of this study indicate that with a comprehensive intervention there is a positive response to lifestyle changes and a reduction of abdominal obesity BACKGROUND Identification of the behavioural , normative and control beliefs influencing children 's behaviour is an important prerequisite in design ing effective interventions . The current study aims to evaluate the effectiveness of an intervention program , based on the Theory of Planned Behaviour ( TPB ) , on  obesity indices and blood pressure ( BP ) in Ioannina , Greece . METHODS Participants were 646 fifth grade pupils ( 360 girls and 286 boys ) . The intervention group ( IG ) consisted of 321 children in 13 r and omly selected schools while the rest ( n = 325 children ) served as the  control group ( CG ) . Based on the outcome of the TPB question naire , the intervention focused on overcoming the barriers in accessing physical activity areas , increasing the availability of fruits and vegetables and increasing parental support . General linear mixed model and mediating variable analysis were used to evaluate the differences between the two groups and to test whether changes in certain dietary , physical activity and anthropometrical indices mediated the effect 
    Output:
    
agent
***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 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 The rapid increase in the prevalence of obesity in the last decade indicates a need for effective treatment programs . We conducted a short-term , repeated- measures , clinical - outcome trial in three groups of children and adolescents in two different locations . Two cohorts ( n=34 ) were enrolled in a 36-wk multi-disciplinary weight-management program at the Children 's Hospital of New Orleans . One cohort ( n=16 ) was enrolled in a similar intervention at the General Clinical Research Center ( GCRC ) at the Medical Center of Louisiana for a 10-wk summer weight-loss program . Subjects were offered a protein-sparing modified fast ( PSMF ) diet ( 600 - 800 kcal/d ; 2 g protein/kg body weight ) , followed by a balanced hypocaloric diet , and they participated in behavior-modification sessions and a moderate-intensity ( 45 - 55 % volume of oxygen consumed at maximal effort [ VO(2)max ] ) , progressive exercise program . The following parameters were examined at baseline , 10 wk , and 36 wk ( cohort 1 only ) : Weight , height , percentage of ideal body weight ( % IBW ) , relative body fat ( % fat ) , fat free body ( FFB ) mass , estimated VO(2)max mL/kg min(BW ) [ adjusted for body weight ] ) , blood chemistries , lipid profiles ( total cholesterol [ TC ] , triglycerides [ TG ] , low-density lipoprotein [ LDL ] , high-density lipoprotein [ HDL ] , and insulin-like growth factor-1 [ IGF-1 ] ) . All three groups experienced significant decreases in weight , % IBW and % fat at 10 wk . The weight loss was maintained at 26 wk in cohorts 1 and 2 , and at 36 wk in cohort 1 . There were no significant decreases in height velocity during the study . In addition , measures of estimated VO(2)max mL/kg/min(BW ) and IGF-1 parameters were significantly greater at 10 wk compared to baseline . Measures of TC , TG , and LDL were significantly lower at 10 wk , with no significant changes noted in HDL . We conclude that a multi-disciplinary weight-management program , including PSMF , behavior modification , and exercise , provides an effective method of treatment for obesity in children and adolescents . Long-term , r and omized , and controlled clinical trials are needed to confirm the results of this preliminary , short-term observation Background : This study aim ed to assess the salt intake of Iranian children , and to assess the correlation of urinary electrolytes excretion with blood pressure . Methods : This cross-sectional study was conducted in 2011 - 2012 among 3 - 10-year-old children , selected by multi-stage cluster sampling from urban and rural areas of Isfahan , Iran . The sodium ( Na ) , potassium ( K ) , and creatinine ( Cr ) were measured in a r and om sample of the children 's first morning fasting urine . Three-day averages of dietary intakes were analyzed by the Nutritionist-4 software . Results : The mean ( SD ) of urinary Na was 177.17 ( 28.68 ) mEq/day without significant difference according to gender and living area . The mean ( SD ) dietary intakes of Na and K were 2017.76 ( 117.94 ) and 1119.06 ( 76.03 ) mg/day , respectively . Children of urban and rural areas consumed similar sources of salty foods ( bread , cheese , and snacks ) and had low intake of vegetables . No significant association was documented between urinary electrolytes excretions and blood pressure . Conclusions : This study , which to the best of our knowledge is the first of its kind in the Middle East and North Africa region , revealed that Iranian young children consume a large amount of sodium and small amount of potassium . The non-significant associations of electrolyte excretions with blood pressure may be because of the very young age group of participants . Given the development of preference to salt taste from early childhood , and the tracking of risk factors of chronic diseases from this age , reducing salt intake of young children should be emphasized Introduction The current salt intake is very high for children as well as adults in China . A reduction in salt intake is one of the most cost-effective measures to curb the rapidly growing disease burden attributed to blood pressure and cardiovascular disease in the Chinese population . A lower salt diet starting from childhood has the potential to prevent the development of such conditions . The School-EduSalt ( School-based Education Programme to Reduce Salt ) study aims to determine whether an education programme targeted at school children can lower salt intake in children and their families . Methods and analysis The study is design ed as a cluster r and omised controlled trial . The location is Changzhi , Shanxi province in northern China . The study population will consist of 28 primary schools with 280 children aged ≈11 years and 560 adult family members . Children in the intervention group will be educated on how to reduce salt intake . They will then be empowered to deliver the salt reduction message home to their families . In particular , children need to persuade the person who does the cooking to reduce the amount of salt used during food preparations . The duration of the intervention is one school term ( ≈4.5 months ) . The primary outcome is the difference between the intervention and the control group in the change in 24 h urinary sodium and the secondary outcome is the difference between the intervention and control group in the change of blood pressure . An economic evaluation will be undertaken to assess cost-effectiveness . Ethics and dissemination The study has been approved by The Queen Mary Research Ethics Committee ( QMREC2012/81 ) and Peking University Health Science Centre IRB ( IRB00001052 - 12072 ) . Study findings will be disseminated widely through conference presentations and peer- review ed publications . Protocol Registration Protocol Registered on Clinical Trials.gov NCT01821144 Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families . Design Cluster r and omised controlled trial , with schools r and omly assigned to either the intervention or control group . Setting 28 primary schools in urban Changzhi , northern China . Participants 279 children in grade 5 of primary school , with mean age of 10.1 ; 553 adult family members ( mean age 43.8 ) . Intervention Children in the intervention group were educated on the harmful effects of salt and how to reduce salt intake within the schools ’ usual health education lessons . Children then delivered the salt reduction message to their families . The intervention lasted for one school term ( about 3.5 months ) . Main outcome measures The primary outcome was the difference between the groups in the change in salt intake ( as measured by 24 hour urinary sodium excretion ) from baseline to the end of the trial . The secondary outcome was the difference between the two groups in the change in blood pressure . Results At baseline , the mean salt intake in children was 7.3 ( SE 0.3 ) g/day in the intervention group and 6.8 ( SE 0.3 ) g/day in the control group . In adult family members the salt intakes were 12.6 ( SE 0.4 ) and 11.3 ( SE 0.4 ) g/day , respectively . During the study there was a reduction in salt intake in the intervention group , whereas in the control group salt intake increased . The mean effect on salt intake for intervention versus control group was −1.9 g/day ( 95 % confidence interval −2.6 to −1.3 g/day ; P<0.001 ) in children and −2.9 g/day ( −3.7 to −2.2 g/day ; P<0.001 ) in adults . The mean effect on systolic blood pressure was −0.8 mm Hg ( −3.0 to 1.5 mm Hg ; P=0.51 ) in children and −2.3 mm Hg ( −4.5 to −0.04 mm Hg ; P<0.05 ) in adults . Conclusions An education programme delivered to primary school children as part of the usual curriculum is effective in lowering salt intake in children and their families . This offers a novel and important approach to reducing salt intake in a population in which most of the salt in the diet is added by consumers . Trial registration Clinical Trials.gov NCT01821144 BACKGROUND The objective of this study , focused on parents and children to reduce sedentary behavior , consumption of soft drinks and high-fat and salt containing snacks , and increase the consumption of fruits and vegetables , was to assess the effect of a six month intervention and an 18 month follow-up intervention on the body mass index , food consumption and physical activity of 2nd and 3rd grade elementary school children . METHODS This was a r and omized cluster controlled trial . School children were selected from 2nd and 3rd ( n = 532 ) grade . MEASUREMENTS BMI z-score for age and sex was calculated and classified according to the WHO ( 2006 ) . Abdominal obesity was defined as WC > 90th of NHANES III . RESULTS At six months of the study differences were observed in BMI , -0.82 ( p = 0.0001 ) . At 24 months , results such as an increase of z-score BMI and waist circumference , a decrease in abdominal obesity , eighth per cent remission and an incidence of 18 % of overweight and obesity were observed . Additionally , an increase ( p = 0.007 ) in vegetable intake and physical activity ( p = 0.0001 ) was also reported , along with a decrease in sedentary activities and the consumption of snacks high in fat and salt . CONCLUSIONS The results of this study indicate that with a comprehensive intervention there is a positive response to lifestyle changes and a reduction of abdominal obesity BACKGROUND Identification of the behavioural , normative and control beliefs influencing children 's behaviour is an important prerequisite in design ing effective interventions . The current study aims to evaluate the effectiveness of an intervention program , based on the Theory of Planned Behaviour ( TPB ) , on  obesity indices and blood pressure ( BP ) in Ioannina , Greece . METHODS Participants were 646 fifth grade pupils ( 360 girls and 286 boys ) . The intervention group ( IG ) consisted of 321 children in 13 r and omly selected schools while the rest ( n = 325 children ) served as the  control group ( CG ) . Based on the outcome of the TPB question naire , the intervention focused on overcoming the barriers in accessing physical activity areas , increasing the availability of fruits and vegetables and increasing parental support . General linear mixed model and mediating variable analysis were used to evaluate the differences between the two groups and to test whether changes in certain dietary , physical activity and anthropometrical indices mediated the effect 
    Output:
    