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Review
. 2023 Jun 12;6(6):CD013862.
doi: 10.1002/14651858.CD013862.pub2.

Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years

Sze Lin Yoong  1   2   3   4 , Melanie Lum  2   3   4 , Luke Wolfenden  2   3   4 , Jacklyn Jackson  3   4 , Courtney Barnes  2   3   4 , Alix E Hall  3   4 , Sam McCrabb  3   4 , Nicole Pearson  2   3   4 , Cassandra Lane  2   3   4 , Jannah Z Jones  2   3   4 , Lauren Dinour  5 , Therese McDonnell  6 , Debbie Booth  7 , Alice Grady  2   3   4
Affiliations
Review

Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years

Sze Lin Yoong et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health.

Objectives: To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions.

Search methods: We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers.

Selection criteria: We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both.

Data collection and analysis: Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS: We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3).

Authors' conclusions: ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.

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Conflict of interest statement

Sze Lin Yoong: is currently undertaking primary research that may be relevant to the review. Where we included such a study, other authors who were not directly involved in the study completed screening, data extraction and 'risk of bias assessments. This author has not received any benefit, in cash or kind, any hospitality, or any subsidy derived from any source perceived to have an interest in the outcome of the review.

Melanie Lum: declares no conflict of interest.

Jacklyn Jackson: declares no conflict of interest.

Luke Wolfenden: is currently undertaking primary research that may be relevant to the review. Where we included such a study, other authors who were not directly involved in the study completed screening, data extraction and risk of bias assessments. This author has not received any benefit, in cash or kind, any hospitality, or any subsidy derived from any source perceived to have an interest in the outcome of the review. Luke Wolfenden is Co‐ordinating Editor of Cochrane Public Health and was not involved in any stage of the editorial management or assessment of this review.

Courtney Barnes: is currently undertaking primary research that may be relevant to the review. Where we included such a study, other authors who were not directly involved in the study completed screening, data extraction and risk of bias assessments. This author has not received any benefit, in cash or kind, any hospitality, or any subsidy derived from any source perceived to have an interest in the outcome of the review.

Alix E Hall: is a Methods Editor for Cochrane Public Health and was not involved in any stage of the editorial management or assessment of this review.

Sam McCrabb: is Assistant Managing Editor and Methods Editor and was not involved in any stage of the editorial management or assessment of this review.

Nicole Pearson: is currently undertaking primary research that may be relevant to the review. Where we included such a study, other authors who were not directly involved in the study completed screening, data extraction and risk of bias assessments. This author has not received any benefit, in cash or kind, any hospitality, or any subsidy derived from any source perceived to have an interest in the outcome of the review.

Cassandra Lane: declares no conflict of interest.

Jannah Z Jones: is currently undertaking primary research that may be relevant to the review. Where we included such a study, other authors who were not directly involved in the study completed screening, data extraction and risk of bias assessments. This author has not received any benefit, in cash or kind, any hospitality, or any subsidy derived from any source perceived to have an interest in the outcome of the review.

Lauren Dinour: declares no conflict of interest.

Therese McDonnell: declares no conflict of interest.

Debbie Booth: declares no conflict of interest.

Alice Grady: is currently undertaking primary research that may be relevant to the review. Where we included such a study, other authors who were not directly involved in the study completed screening, data extraction and risk of bias assessments. This author has not received any benefit, in cash or kind, any hospitality, or any subsidy derived from any source perceived to have an interest in the outcome of the review.

Figures

1
1
Figure 1: Flow diagram
2
2
Figure 2. Risk of bias summary
3
3
Funnel plot: diet quality
4
4
Funnel plot: fruit consumption
5
5
Funnel plot: vegetable consumption
6
6
Funnel plot: non‐core foods (i.e. less healthy/discretionary) consumption
7
7
Funnel plot: sugar‐sweetened beverage consumption
8
8
Harvest plot presenting direction of effect for studies not included in the meta‐analysis for fruit consumption, vegetable consumption, non‐core foods consumption and sugar‐sweetened beverage consumption
1.1
1.1. Analysis
Comparison 1: Diet quality, Outcome 1: Diet quality
1.2
1.2. Analysis
Comparison 1: Diet quality, Outcome 2: Diet quality (sensitivity: studies at low overall risk of bias)
1.3
1.3. Analysis
Comparison 1: Diet quality, Outcome 3: Diet quality (Health Promoting Schools: curriculum versus no curriculum)
1.4
1.4. Analysis
Comparison 1: Diet quality, Outcome 4: Diet quality (SES: low versus high/unclear)
1.5
1.5. Analysis
Comparison 1: Diet quality, Outcome 5: Diet quality (intervention modality: included face‐to‐face, telephone and online delivery versus did not include face‐to‐face, telephone and online delivery)
1.6
1.6. Analysis
Comparison 1: Diet quality, Outcome 6: Diet quality (intervention delivery personnel: included healthcare professionals versus did not include healthcare professionals)
2.1
2.1. Analysis
Comparison 2: Fruit consumption, Outcome 1: Fruit consumption
2.2
2.2. Analysis
Comparison 2: Fruit consumption, Outcome 2: Fruit consumption (sensitivity: studies at low overall risk of bias)
2.3
2.3. Analysis
Comparison 2: Fruit consumption, Outcome 3: Fruit consumption (Health Promoting Schools: curriculum versus no curriculum)
2.4
2.4. Analysis
Comparison 2: Fruit consumption, Outcome 4: Fruit consumption (SES: low versus high/unclear)
2.5
2.5. Analysis
Comparison 2: Fruit consumption, Outcome 5: Fruit consumption (study size: small (< 400 participants) versus large (≥ 400 participants))
3.1
3.1. Analysis
Comparison 3: Vegetable consumption, Outcome 1: Vegetable consumption
3.2
3.2. Analysis
Comparison 3: Vegetable consumption, Outcome 2: Vegetable consumption (sensitivity: studies at low overall risk of bias)
3.3
3.3. Analysis
Comparison 3: Vegetable consumption, Outcome 3: Vegetable consumption (Health Promoting Schools: curriculum versus no curriculum)
3.4
3.4. Analysis
Comparison 3: Vegetable consumption, Outcome 4: Vegetable consumption (Health Promoting Schools: partnerships versus no partnerships)
3.5
3.5. Analysis
Comparison 3: Vegetable consumption, Outcome 5: Vegetable consumption (SES: low versus high/unclear)
3.6
3.6. Analysis
Comparison 3: Vegetable consumption, Outcome 6: Vegetable consumption (study size: small (< 400 participants) versus large (≥ 400 participants))
4.1
4.1. Analysis
Comparison 4: Fruit and vegetable consumption, Outcome 1: Fruit and vegetable consumption
4.2
4.2. Analysis
Comparison 4: Fruit and vegetable consumption, Outcome 2: Fruit and vegetable consumption (sensitivity: studies at low overall risk of bias)
5.1
5.1. Analysis
Comparison 5: Non‐core foods consumption, Outcome 1: Non‐core foods (i.e. less healthy/discretionary) consumption
5.2
5.2. Analysis
Comparison 5: Non‐core foods consumption, Outcome 2: Non‐core foods (i.e. less healthy/discretionary) consumption (sensitivity: studies at low overall risk of bias)
5.3
5.3. Analysis
Comparison 5: Non‐core foods consumption, Outcome 3: Non‐core foods (i.e. less healthy/discretionary) consumption (Health Promoting Schools: curriculum versus no curriculum)
6.1
6.1. Analysis
Comparison 6: Sugar‐sweetened beverage consumption, Outcome 1: Sugar‐sweetened beverage consumption
7.1
7.1. Analysis
Comparison 7: BMI, Outcome 1: BMI
7.2
7.2. Analysis
Comparison 7: BMI, Outcome 2: BMI (sensitivity: studies with no industry funding)
7.3
7.3. Analysis
Comparison 7: BMI, Outcome 3: BMI (Health Promoting Schools: curriculum versus no curriculum)
7.4
7.4. Analysis
Comparison 7: BMI, Outcome 4: BMI (SES: low versus high/unclear)
7.5
7.5. Analysis
Comparison 7: BMI, Outcome 5: BMI (study size: small (< 400 participants) versus large (≥ 400 participants))
8.1
8.1. Analysis
Comparison 8: BMI z‐score, Outcome 1: BMI z‐score
8.2
8.2. Analysis
Comparison 8: BMI z‐score, Outcome 2: BMI z‐score (sensitivity: studies at low overall risk of bias)
8.3
8.3. Analysis
Comparison 8: BMI z‐score, Outcome 3: BMI z‐score (Health Promoting Schools: curriculum versus no curriculum)
8.4
8.4. Analysis
Comparison 8: BMI z‐score, Outcome 4: BMI z‐score (SES: low versus high/unclear)
8.5
8.5. Analysis
Comparison 8: BMI z‐score, Outcome 5: BMI z‐score (study size: small (< 400 participants) versus large (≥ 400 participants))
9.1
9.1. Analysis
Comparison 9: Absolute weight (kg), Outcome 1: Absolute weight (kg)
9.2
9.2. Analysis
Comparison 9: Absolute weight (kg), Outcome 2: Absolute weight (kg) (SES: low versus high/unclear)
10.1
10.1. Analysis
Comparison 10: Overweight and obesity, Outcome 1: Overweight and obesity
10.2
10.2. Analysis
Comparison 10: Overweight and obesity, Outcome 2: Overweight and obesity (sensitivity: studies at low overall risk of bias)
10.3
10.3. Analysis
Comparison 10: Overweight and obesity, Outcome 3: Overweight and obesity (sensitivity: studies with no industry funding)
10.4
10.4. Analysis
Comparison 10: Overweight and obesity, Outcome 4: Overweight and obesity (SES: low versus high/unclear)
11.1
11.1. Analysis
Comparison 11: Waist circumference, Outcome 1: Waist circumference
12.1
12.1. Analysis
Comparison 12: Quality of life, Outcome 1: Quality of life
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References

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Leis 2020 {published data only}
    1. Bélanger M, Humbert L, Vatanparast H, Ward S, Muhajarine N, Chow A, et al. A multilevel intervention to increase physical activity and improve healthy eating and physical literacy among young children (ages 3-5) attending early childcare centres: the Healthy Start-Départ Santé cluster randomised controlled trial study protocol. BMC Public Health volume 2016;16:313. [DOI: 10.1186/s12889-016-2973-5] - DOI - PMC - PubMed
    1. Leis A, Ward S, Vatanparast H, Humbert M, Chow A, Muhajarine N, et al. Effectiveness of the Healthy Start-Départ Santé approach on physical activity, healthy eating and fundamental movement skills of preschoolers attending childcare centres: a randomized controlled trial. BMC Public Health 2020;20:523. [DOI: 10.1186/s12889-020-08621-9] - DOI - PMC - PubMed
    1. Sari N, Muhajarine N, Chow A. The Saskatchewan/New Brunswick Healthy Start-Départ Santé intervention: implementation cost estimates of a physical activity and healthy eating intervention in early learning centers. BMC Health Services Research 2017;17:57. [DOI: 10.1186/s12913-017-1978-9] - DOI - PMC - PubMed
Lerner‐Geva 2014 {published data only}
    1. Lerner-Geva L, Bar-Zvi E, Levitan G, Boyko V, Reichman B, Pinhas-Hamiel O. An intervention for improving the lifestyle habits of kindergarten children in Israel: a cluster-randomised controlled trial investigation. Public Health Nutrition 2015;18(9):1537-44. [DOI: 10.1017/S136898001400024X] - DOI - PMC - PubMed
Lumeng 2017 {published data only}
    1. Lumeng J, Miller A, Horodynski M, Brophy-Herb H, Contreras D, Lee H, et al. Improving self-regulation for obesity prevention in Head Start: a randomized controlled trial. Pediatrics 2017;139(5):e20162047. [DOI: 10.1542/peds.2016-2047] - DOI - PubMed
    1. Miller A, Horodynski M, Herb H, Peterson K, Contreras D, Kaciroti D, et al. Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study. BMC Public Health 2012;12:1040. [DOI: 10.1186/1471-2458-12-1040] - DOI - PMC - PubMed
Morris 2018 {published data only}
    1. Morris H, Edwards S, Cutter-Mackenzie A, Rutherford L, Williams-Smith J, Skouteris H. Evaluating the impact of teacher-designed, wellbeing and sustainability play-based learning experiences on young children's knowledge connections: a randomised trial. Australasian Journal of Early Childhood 2018;43(4):33-42. [DOI: 10.23965/AJEC.43.4.04] - DOI
    1. Skouteris H, Edwards S, Rutherford L, Cutter-MacKenzie A, Huang T, O'Connor A. Promoting healthy eating, active play and sustainability consciousness in early childhood curricula, addressing the Ben10 problem: a randomised control trial. BMC Public Health 2014;14(1):548. - PMC - PubMed
Namenek Brouwer 2013 {published data only}
    1. Namenek Brouwer R, Neelon S. Watch Me Grow: a garden-based pilot intervention to increase vegetable and fruit intake in preschoolers. BMC Public Health 2013;13:363. [DOI: 10.1186/1471-2458-13-363] - DOI - PMC - PubMed
Natale 2014a {published data only}
    1. Natale R, Lopez-Mitnik G, Uhlhorn S, Asfour L, Messiah S. Effect of a child care center-based obesity prevention program on body mass index and nutrition practices among preschool-aged children. Health Promotion Practice 2014;15(5):695-705. [DOI: 10.1177/1524839914523429] - DOI - PubMed
Natale 2014b {published data only}
    1. McCollister K, Tolbert D, Mishra S, Natale R, Uhlhorn S, Messiah S. Cost analysis of a childcare center-based intervention to prevent obesity in the preschool years. Journal of Comprehensive Pediatrics 2015;6(2):e25845. [DOI: 10.17795/compreped-25845] - DOI
    1. Natale R, Messiah S, Asfour L, Uhlhorn S, Delamater A, Arheart K. Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits. Journal of Developmental & Behavioral Pediatrics 2014;35(6):378-87. [DOI: 10.1097/DBP.0000000000000074] - DOI - PubMed
    1. Natale R, Messiah S, Asfour L, Uhlhorn S, Englebert N, Arheart K. Obesity prevention program in childcare centers: two-year follow-up. American Journal of Health Promotion 2017;31(6):502-10. [DOI: 10.1177/0890117116661156] - DOI - PubMed
    1. Natale R, Scott S, Messiah S, Schrack M, Uhlhorn S, Delamater A. Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health 2013;13:78. [DOI: 10.1186/1471-2458-13-78] - DOI - PMC - PubMed
Natale 2021 {published data only}
    1. Messiah S, Lebron C, Moise R, Mathew R, Sardinas K, Chang C, et al. Healthy caregivers-healthy children (HC2) phase 2: integrating culturally sensitive childhood obesity prevention strategies into childcare center policies. Contemporary Clinical Trials 2016;53:60-7. [DOI: 10.1016/j.cct.2016.12.011] - DOI - PubMed
    1. Natale R, Atem F, Weerakoon S, Lebron C, Mathew M, Sardinas K, et al. An implementation approach comparison of a child care center-based obesity prevention program. Journal of Developmental & Behavioral Pediatrics 2021;42(2):135-45. [DOI: 10.1097/DBP.0000000000000861] - DOI - PMC - PubMed
Nekitsing 2019a {published data only}
    1. Nekitsing C, Blundell-Birtill P, Cockroft J, Hetherington M. Taste exposure increases intake and nutrition education increases willingness to try an unfamiliar vegetable in preschool children: a cluster randomized trial. Journal of the Academy of Nutrition and Dietetics 2019;119(12):2004-13. [DOI: 10.1016/j.jand.2019.05.012] - DOI - PubMed
Nemet 2011a {published data only}
    1. Nemet D, Geva D, Eliakim A. Health promotion intervention in low socioeconomic kindergarten children. Journal of Pediatrics 2011;158(5):796-801. [DOI: 10.1016/j.jpeds.2010.10.040] - DOI - PubMed
    1. Nemet D, Geva D, Pantanowitz M, Igbaria N, Meckel Y, Eliakim A. Long term effects of a health promotion intervention in low socioeconomic Arab-Israeli kindergartens. BMC Pediatrics 2013;13:45. [DOI: 10.1186/1471-2431-13-45] - DOI - PMC - PubMed
Nemet 2011b {published data only}
    1. Nemet D, Geva D, Pantanowitz M, Igbaria N, Meckel Y, Eliakim A. Health promotion intervention in Arab-Israeli kindergarten children. Journal of Pediatric Endocrinology & Metabolism 2011;24(11-12):1001-7. [DOI: 10.1515/JPEM.2011.387] - DOI - PubMed
Pearson 2022 {published data only}
    1. Pearson N, Finch, M, Sutherland R, Kingsland M, Wolfenden L, Wedesweiler T, et al. An mHealth intervention to reduce the packing of discretionary foods in children’s lunch boxes in early childhood education and care services: cluster randomized controlled trial. Journal of Medical Internet Research 2022;24(3):e27760. [DOI: 10.2196/27760] - DOI - PMC - PubMed
    1. Pond N, Finch M, Sutherland R, Wolfenden L, Nathan N, Kingsland M, et al. Cluster randomised controlled trial of an m-health intervention in centre-based childcare services to reduce the packing of discretionary foods in children's lunchboxes: study protocol for the 'SWAP IT Childcare' trial. BMJ Open 2019;9(5):e026829. - PMC - PubMed
Peñalvo 2015 {published data only}
    1. Peñalvo J, Santos-Beneit G, Sotos-Prieto M, Bodega P, Oliva B, Orrit X, et al. The SI! Program for cardiovascular health promotion in early childhood: a cluster-randomized trial. Journal of the American College of Cardiology 2015;66(14):1525-34. [DOI: 10.1016/j.jacc.2015.08.014] - DOI - PubMed
    1. Peñalvo J, Santos-Beneit G, Sotos-Prieto M, Martínez R, Rodríguez C, Franco M, et al. A cluster randomized trial to evaluate the efficacy of a school-based behavioral intervention for health promotion among children aged 3 to 5. BMC Public Health 2013;13:656. - PMC - PubMed
Pinket 2016 {published data only}
    1. De Craemer M, Verbestel V, Verloigne M, Androutsos O, Moreno L, Iotova V, et al. Combining effect and process evaluation on European preschool children’s snacking behavior in a kindergarten-based, family-involved cluster randomized controlled trial: the ToyBox Study. International Journal of Environmental Research and Public Health 2020;17(19):7312. [DOI: 10.3390/ijerph17197312] - DOI - PMC - PubMed
    1. Manios Y, Androutsos O, Katsarou C, Iotova V, Socha P, Geyer C, et al, on behalf of the ToyBox-study group. Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study. Obesity Reviews 2014;15(3):5-13. [DOI: 10.1111/obr.12175] - DOI - PubMed
    1. Pinket A, Van Lippevelde W, De Bourdeaudhuij I, Deforche B, Cardon, Androutsos O, et al, ToyBox-Study Group. Effect and process evaluation of a cluster randomized control trial on water intake and beverage consumption in preschoolers from six European countries: the ToyBoxStudy. PLoS ONE 2016;11(4):e0152928. [DOI: 10.1371/journal.pone.0152928] - DOI - PMC - PubMed
Puder 2011 {published data only}
    1. Burgi F, Niederer I, Schindler C, Bodenmann P, Marques-Vidal P, Kriemler S, et al. Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: a cluster-randomized trial (Ballabeina). Preventive Medicine 2012;54(5):335-40. - PubMed
    1. Niederer I, Burgi F, Ebenegger V, Marques-Vidal P, Schindler C, Nydegger A, et al. Effects of a lifestyle intervention on adiposity and fitness in overweight or low fit preschoolers (Ballabeina). Obesity 2013;21(3):E287-93. - PubMed
    1. Niederer I, Kriemler S, Zahner L, Bürgi F, Ebenegger V, Hartmann T, et al. Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (Ballabeina): study design of a cluster randomized controlled trial. BMC Public Health 2009;9:94. [DOI: 10.1186/1471-2458-9-94] - DOI - PMC - PubMed
    1. Puder J, Marques-Vidal P, Schindler C, Zahner L, Niederer I, Bürgi F, et al. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial. BMJ 2011;343:d6195. [DOI: 10.1136/bmj.d6195] - DOI - PMC - PubMed
Ray 2020 {published data only}
    1. Ray C, Figuereido R, Vepsäläinen H, Lehto R, Pajulahti R, Skaffari E, et al. Effects of the preschool-based family-involving DAGIS intervention program on children's energy balance-related behaviors and self-regulation skills: a clustered randomized controlled trial. Nutrients 2020;12(9):2599. [DOI: 10.3390/nu12092599] - DOI - PMC - PubMed
    1. Ray C, Kaukonen R, Lehto R, Vepsäläinen H, Sajaniemi N, Erkkola M, et al. Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers’ energy balance-related behaviours and self-regulation skills. BMC Public Health 2019;19:1670. [DOI: 10.1186/s12889-019-7864-0] - DOI - PMC - PubMed
Reyes‐Morales 2016 {published data only}
    1. Reyes-Morales H, González-Unzaga M, Jiménez-Aguilar A, Uribe-Carvajal R. Effect of an intervention based on child-care centers to reduce risk behaviors for obesity in preschool children. Boletín Médico del Hospital Infantil de México (English Edition) 2016;73(2):75-83. [DOI: 10.1016/j.bmhimx.2015.11.010] - DOI - PubMed
Roberts‐Gray 2018 {published data only}
    1. Roberts-Gray C, Ranjit N, Sweitzer S, Byrd-Williams C, Romo-Palafox M, Briley M, et al. Parent packs, child eats: surprising results of Lunch is in the Bag‘s efficacy trial. Appetite 2018;121:249-62. [DOI: 10.1016/j.appet.2017.10.033] - DOI - PMC - PubMed
Seward 2018 {published data only}
    1. Seward K, Wolfenden L, Finch M, Wiggers J, Wyse R, Jones J, et al. Improving the implementation of nutrition guidelines in childcare centres improves child dietary intake: findings of a randomised trial of an implementation intervention. Public Health Nutrition 2018;21(3):607-17. [DOI: 10.1017/S1368980017003366] - DOI - PMC - PubMed
    1. Seward K, Wolfenden L, Finch M, Wiggers J, Wyse R, Jones J, et al. Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial. BMJ Open 2016;6(6):e010786. [DOI: 10.1136/bmjopen-2015-010786] - DOI - PMC - PubMed
    1. Yoong S, Grady A, Seward K, Finch M, Wiggers J, Lecathelinais C, et al. The impact of a childcare food service intervention on child dietary intake in care: an exploratory cluster randomized controlled trial. Quantitative Research 2019;33(7):991-1001. [DOI: 10.1177/0890117119837461] - DOI - PubMed
Stookey 2017 {published data only}
    1. Stookey R, Evans J, Chan C, Tao-Lew L, Arana T, Arthur S. Healthy Apple program to support child care centers to alter nutrition and physical activity practices and improve child weight: a cluster randomized trial. BMC Public Health 2017;17(1):965. [DOI: 10.1186/s12889-017-4951-y] - DOI - PMC - PubMed
Toussaint 2021 {published data only}
    1. Toussaint N, Streppel M, Mul S, Balledux M, Van Drongelen K, Janssen M, et al. The effects of a preschool-based intervention for early childhood education and care teachers in promoting healthy eating and physical activity in young children: a cluster randomised controlled trial. PloS One 2021;16(7):e0255023. [DOI: 10.1371/journal.pone.0255023] - DOI - PMC - PubMed
    1. Toussaint N, Streppel M, Mul S, Schreurs A, Balledux M, Van Drongelen K, et al. A preschool-based intervention for early childhood education and care (ECEC) teachers in promoting healthy eating and physical activity in toddlers: study protocol of the cluster randomized controlled trial PreSchool@HealthyWeight. BMC Public Health 2019;19(1):278. [DOI: 10.1186/s12889-019-6611-x] - DOI - PMC - PubMed
Vaughn 2021 {published data only}
    1. Hennink-Kaminski H, Vaughn A, Hales D, Moore R, Luecking C, Ward D. Parent and child care provider partnerships: protocol for the Healthy Me, Healthy We (HMHW) cluster randomized control trial. Contemporary Clinical Trials 2018;64:49-57. [DOI: 10.1016/j.cct.2017.11.007] - DOI - PubMed
    1. Vaughn A, Hennink-Kaminski H, Moore R, Burney R, Chittams J, Parker P, et al. Evaluating a child care-based social marketing approach for improving children’s diet and physical activity: results from the Healthy Me, Healthy We cluster-randomized controlled trial. Translational Behavioral Medicine 2021;11(3):775-84. [DOI: 10.1093/tbm/ibaa113] - DOI - PMC - PubMed
Vereecken 2009 {published data only}
    1. Vereecken C, Huybrechts I, Van Houte H, Martens V, Wittebroodt I, Maes L. Results from a dietary intervention study in preschools “Beastly Healthy at School”. International Journal of Public Health 2009;54(3):142-9. [EMBASE: 10.1007/s00038-009-8028-2] - PubMed
Ward 2020a {published data only}
    1. Mann C, Ward D, Vaughn A, Benjamin-Neelon S, Long Vidal L, Omar S, et al. Application of the intervention mapping protocol to develop Keys, a family child care home intervention to prevent early childhood obesity. BMC Public Health 2015;15:1227. [DOI: 10.1186/s12889-015-2573-9] - DOI - PMC - PubMed
    1. Ward D, Vaughn A, Burney R, Hales D, Benjamin-Neelon S, Tovar A, et al. Keys to healthy family child care homes: results from a cluster randomized trial. Preventive Medicine 2020;132:105974. [DOI: 10.1016/j.ypmed.2019.105974] - DOI - PMC - PubMed
    1. Østbye T, Mann C, Vaughn A, Namenek Brouwer R, Neelon S, Hales D, et al. The keys to healthy family child care homes intervention: study design and rationale. Contemporary Clinical Trials 2015;40:81-9. [DOI: 10.1016/j.cct.2014.11.003] - DOI - PMC - PubMed
Witt 2012 {published data only}
    1. Dunn C, Thomas C, Pegram L, Ward D, Schmal S. Color me healthy, preschoolers moving and eating healthfully. Journal of Nutrition Education and Behavior 2004;36(6):327-8. [DOI: 10.1016/s1499-4046(06)60403-x] - DOI - PubMed
    1. Witt K, Dunn C. Increasing fruit and vegetable consumption among preschoolers: evaluation of Color Me Healthy. Journal of Nutrition Education and Behavior 2012;44:107-13. [DOI: 10.1016/j.jneb.2011.01.002] - DOI - PubMed
Yeh 2018 {published data only}
    1. Yeh Y, Hartlieb K, Danford C, Jen K. Effectiveness of nutrition intervention in a selected group of overweight and obese African-American preschoolers. Journal of Racial and Ethnic Health Disparities 2017;5(3):553-61. [DOI: 10.1007/s40615-017-0399-0] - DOI - PubMed
Yoong 2020a {published data only}
    1. Reeves P, Edmunds K, Szewczyk Z, Grady A, Yoong S, Wolfenden L, et al. Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines. Implementation Science 2021;16(1):1. [DOI: 10.1186/s13012-020-01068-x] - DOI - PMC - PubMed
    1. Yoong S, Grady A, Wiggers J, Flood V, Rissel C, Finch M, et al. A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol. BMJ Open 2017;7(9):e017498. [DOI: 10.1136/bmjopen-2017-017498] - DOI - PMC - PubMed
    1. Yoong S, Grady A, Wiggers J, Stacey F, Rissel C, Flood V, et al. Child-level evaluation of a web-based intervention to improve dietary guideline implementation in childcare centers: a cluster-randomized controlled trial. American Journal of Clinical Nutrition 2020;111(4):854-63. [DOI: 10.1093/ajcn/nqaa025] - DOI - PMC - PubMed
Zask 2012 {published data only}
    1. Adams J, Zask A, Dietrich U. Tooty Fruity Vegie in Preschools: an obesity prevention intervention in preschools targeting children’s movement skills and eating behaviours. Health Promotion Journal of Australia 2009;20(2):112-9. [DOI: 10.1071/he09112] - DOI - PubMed
    1. Zask A, Adams J, Brooks L, Hughes D. Tooty Fruity Vegie: an obesity prevention intervention evaluation in Australian preschools. Health Promotion Journal of Australia 2012;23(1):10-5. [DOI: 10.1071/he12010] - DOI - PubMed
Zeinstra 2018 {published data only}
    1. Zeinstra G, Vrijhof M, Kremer S. Is repeated exposure the holy grail for increasing children's vegetable intake? Lessons learned from a Dutch childcare intervention using various vegetable preparations. Appetite 2018;121:316-25. [DOI: 10.1016/j.appet.2017.11.087] - DOI - PubMed

References to studies excluded from this review

Aherna 2019 {published data only}
    1. Aherna SM, Caton SJ, Blundell-Birtillc P, Hetherington MM. The effects of repeated exposure and variety on vegetable intake in pre-school children. Appetite 2019;132:37-43. - PubMed
Ariati 2019 {published data only}
    1. Ariati N, Suiraoka I, Fetria A, Padmiari I, Sugiani P, Purnamawati A, et al. Balanced nutrition services to early childhood improving children’s nutritional status. Indian Journal of Public Health Research and Development 2019;10(8):1332-7.
Batra 2014 {published data only}
    1. Batra P, Schlossman N, Balan E, Pruzensky W, Saltzman E, Roberts S. Effects of two micronutrient-fortified food aid products containing different levels of dairy protein on anthropometric variables in rural pre-school children in Guinea-Bissau. FASEB Journal. Conference: Experimental Biology 2014;28(S1):804.15.
Bayer 2009 {published data only}
    1. Bayer O, Kries R, Strauss A, Mitschek C, Toschke A, Hose A, et al. Short- and mid-term effects of a setting based prevention program to reduce obesity risk factors in children: a cluster-randomized trial. Clinical Nutrition 2009;28(2):122-8. - PubMed
Benjamin 2007 {published data only}
    1. Benjamin S, Ammerman A, Sommers J, Dodds J, Neelon B, Ward D. Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention. Journal of Nutrition Education & Behavior 2007;39(3):142-9. - PubMed
Benjamin 2008 {published data only}
    1. Benjamin S, Tate D, Bangdiwala S, Neelon B, Ammerman A, Dodds J, et al. Preparing child care health consultants to address childhood overweight: a randomized controlled trial comparing web to in-person training. Maternal & Child Health Journal 2008;12(5):662-9. - PubMed
Benjamin 2014 {published data only}
    1. Benjamin Neelon S, Taveras E, Ostbye T, Gillman M. Preventing obesity in infants and toddlers in child care: results from a pilot randomized controlled trial. Maternal & Child Health Journal 2014;18(5):1246-57. - PMC - PubMed
Braga‐Pontes 2021 {published data only}
    1. Braga-Pontes C, Simoes-Dias S, Lages M, Guarino M, Graca P. Nutrition education strategies to promote vegetable consumption in preschool children: the Veggies4myHeart Project. Public Health Nutrition 2022;25(4):1061-70. [DOI: 10.1017/S1368980021004456] - DOI - PMC - PubMed
Brophy‐Herb 2017 {published data only}
    1. Brophy-Herb H, Horodynski M, Contreras D, Kerver J, Kaciroti N, Stein M, et al. Effectiveness of differing levels of support for family meals on obesity prevention among Head Start preschoolers: the Simply Dinner study. BMC Public Health 2017;17(1):184. - PMC - PubMed
Bryant 2021 {published data only}
    1. Bryant M, Collinson M, Burton W, Stamp E, Schofield H, Copsey B, et al. Cluster randomised controlled feasibility study of HENRY: a community-based intervention aimed at reducing obesity rates in preschool children. Pilot and Feasibility Studies 2021;7(1):59. - PMC - PubMed
Buscemi 2019 {published data only}
    1. Buscemi J, Odoms-Young A, Stolley M, Schiffer L, Blumstein L, Clark M, et al. Comparative effectiveness trial of an obesity prevention intervention in EFNEP and SNAP-ED: primary outcomes. Nutrients 2019;11(5):5. - PMC - PubMed
Byrne 2002 {published data only}
    1. Byrne E, Nitzke S. Preschool children’s acceptance of a novel vegetable following exposure to messages in a storybook. Journal of Nutrition Education and Behavior 2002;34:211-4. - PubMed
Carstairs 2020 {published data only}
    1. Carstairs S, Caton S, Hetherington M, Rolls B, Cecil J. Colour as a cue to eat: effects of plate colour on snack intake in pre-school children. Food Quality and Preference 2020;83:103862.
Caton 2013 {published data only}
    1. Caton S, Ahern S, Remy E, Nicklaus S, Blundell P, Hetherington M. Repetition counts: repeated exposure increases intake of a novel vegetable in UK pre-school children compared to flavour-flavour and flavour-nutrient learning. British Journal of Nutrition 2013;109(11):2089-97. - PubMed
Chuang 2020 {published data only}
    1. Chuang R, Cox J, Mincemoyer C, Sharma S. A pilot randomized controlled trial of a nutrition and dietary intervention for early care and education providers. Journal of School Health 2020;90(11):859-68. - PubMed
Correia 2014 {published data only}
    1. Correia D, O'Connell M, Irwin M, Henderson K. Pairing vegetables with a liked food and visually appealing presentation: promising strategies for increasing vegetable consumption among preschoolers. Childhood Obesity 2014;10(1):72-6. - PubMed
Coulthard 2017 {published data only}
    1. Coulthard H, Sealy A. Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite 2017;113:84-90. - PubMed
Coulthard 2018 {published data only}
    1. Coulthard H, Williamson I, Palfreyman Z, Lyttle S. Evaluation of a pilot sensory play intervention to increase fruit acceptance in preschool children. Appetite 2018;120:609-15. - PubMed
Dazeley 2015 {published data only}
    1. Dazeley P, Houston-Price C. Exposure to foods' non-taste sensory properties. A nursery intervention to increase children's willingness to try fruit and vegetables. Appetite 2015;84:1-6. - PubMed
De Droog 2014 {published data only}
    1. De Droog S, Buijzen M, Valkenburg P. Enhancing children's vegetable consumption using vegetable-promoting picture books. The impact of interactive shared reading and character-product congruence. Appetite 2014;73:73-80. - PubMed
De Droog 2017 {published data only}
    1. De Droog S, Van Nee R, Govers M, Buijzen M. Promoting toddlers' vegetable consumption through interactive reading and puppetry. Appetite 2017;116:75-81. - PubMed
De Wild 2013 {published data only}
    1. De Wild V, De Graaf C, Jager G. Effectiveness of flavour nutrient learning and mere exposure as mechanisms to increase toddler's intake and preference for green vegetables. Appetite 2013;64:89-96. - PubMed
De Wild 2015 {published data only}
    1. De Wild V, De Graaf C, Jager G. Efficacy of repeated exposure and flavour-flavour learning as mechanisms to increase preschooler's vegetable intake and acceptance. Pediatr Obes 2015;10(3):205-12. - PubMed
De Wild 2017 {published data only}
    1. De Wild V, De Graaf C, Jager G. Use of different vegetable products to increase preschool-aged children's preference for and intake of a target vegetable: a randomized controlled trial. Journal of the Academy of Nutrition & Dietetics 2017;117(6):859-66. - PubMed
De Zwarte 2019 {published data only}
    1. De Zwarte D, Kearney J, Corish C, Glennon C, Maher L, Johnston Molloy C. Randomised study demonstrates sustained benefits of a pre-school intervention designed to improve nutrition and physical activity practices. Journal of Public Health (Oxford, England) 2019;41(4):798-806. - PubMed
Diktas 2021 {published data only}
    1. Diktas H, Roe L, Keller K, Sanchez C, Rolls B. Promoting vegetable intake in preschool children: independent and combined effects of portion size and flavor enhancement. Appetite 2021;164:105250. - PMC - PubMed
Earnesty 2019 {published data only}
    1. Earnesty D, Alaimo K, Ha W, Creger A, Weatherspoon L. Generic nutrition education intervention does not increase dietary quality in childcare homes. Journal of the Academy of Nutrition & Dietetics 2019;119(9):A72.
Eichholzer‐Helbling 1986 {published data only}
    1. Eichholzer-Helbling M, Ritzel G, Ackermann-Liebrich U, Bächlin A, Mühlemann R. Nutrition education in the kindergarten: results of an intervention trial. Sozial- und Praventivmedizin 1986;31(4-5):233-5. - PubMed
Esquivel 2016 {published data only}
    1. Esquivel M, Nigg C, Fialkowski M, Braun K, Li F, Novotny R. Head Start wellness policy intervention in Hawaii: a project of the Children's Healthy Living program. Childhood Obesity 2016;12(1):26-32. - PubMed
Ferris 2012 {published data only}
    1. Ferris A, Lora K, Quesada C, Wakefied D. Effectiveness of an Information, Motivation, Behavior (IMB)-based theoretical model for reducing sugar-sweetened beverage (SSB) consumption in preschool children. Journal of Nutrition Education & Behavior 2012;44 Suppl 4:S83.
Finch 2019a {published data only}
    1. Finch M, Seward K, Wedesweiler T, Stacey F, Grady A, Jones J, et al. Challenges of increasing childcare center compliance with nutrition guidelines: a randomized controlled trial of an intervention providing training, written menu feedback, and printed resources. American Journal of Health Promotion 2019;33(3):399-411. - PubMed
Finch 2019b {published data only}
    1. Finch M, Stacey F, Jones J, Yoong S, Grady A, Wolfenden L. A randomised controlled trial of performance review and facilitated feedback to increase implementation of healthy eating and physical activity-promoting policies and practices in centre-based childcare. Implementation Science 2019;14(1):17. - PMC - PubMed
Grady 2020 {published data only}
    1. Grady A, Seward K, Finch M, Wolfenden L, Wyse R, Wiggers J, et al. A three-arm randomised controlled trial of high- and low-intensity implementation strategies to support centre-based childcare service implementation of nutrition guidelines: 12-month follow-up. International Journal of Environmental Research & Public Health 2020;17(13):29. - PMC - PubMed
Hardy 2010 {published data only}
    1. Hardy L, King L, Kelly B, Farrell L, Howlett S. Munch and Move: evaluation of a preschool healthy eating and movement skill program. International Journal of Behavioral Nutrition & Physical Activity 2010;7:80. - PMC - PubMed
Harnack 2012 {published data only}
    1. Harnack LJ, Oakes J, French SA, Rydell SA, Farah FM, Taylor GL. Results from an experimental trial at a Head Start center to evaluate two meal service approaches to increase fruit and vegetable intake of preschool aged children. International Journal of Behavioral Nutrition and Physical Activity 2012;9:51. - PMC - PubMed
Hausner 2012 {published data only}
    1. Hausner H, Olsen A, Møller P. Mere exposure and flavour-flavour learning increase 2-3 year-old children's acceptance of a novel vegetable. Appetite 2012;58(3):1152-9. - PubMed
Hughes 2020b {published data only}
    1. Hughes S, Power T, Beck A, Betz D, Goodell L, Hopwood V, et al. Short-term effects of an obesity prevention program among low-income Hispanic families with preschoolers. Journal of Nutrition Education and Behavior 2020;52(3):224-39. - PubMed
Jouret 2009 {published data only}
    1. Jouret B, Ahluwalia N, Dupuy M, Cristini C, Nègre-Pages L, Grandjean H, et al. Prevention of overweight in preschool children: results of kindergarten-based interventions. International Journal of Obesity 2009;33(10):1075-83. [PMID: 10.1038/ijo.2009.166] - DOI - PubMed
Kashef 2021 {published data only}
    1. Kashef S, Zarnowiecki D, Brown V, Arguelles J, Cox D, Golley R. Cluster randomised controlled trial of a menu box delivery service for Australian long day care services to improve menu guideline compliance: a study protocol. BMJ Open 2021;11(4):e045136. - PMC - PubMed
Kim 2019 {published data only}
    1. Kim J, Kim G, Park J, Wang Y, Lim H. Effectiveness of teacher-led nutritional lessons in altering dietary habits and nutritional status in preschool children: adoption of a NASA mission X-based program. Nutrients 2019;11(7):13. - PMC - PubMed
Kling 2016 {published data only}
    1. Kling S, Roe L, Sanchez C, Rolls B. Does milk matter: is children's intake affected by the type or amount of milk served at a meal? Appetite 2016;105:509-18. - PMC - PubMed
Kostecka 2022 {published data only}
    1. Kostecka M. The effect of the "Colorful Eating Is Healthy Eating" long-term nutrition education program for 3-to 6-year-olds on eating habits in the family and parental nutrition knowledge. International Journal of Environmental Research and Public Health 2022;19(4):1981. - PMC - PubMed
Lanigan 2019 {published data only}
    1. Lanigan J, Bailey R, Jackson A, Shea V. Child-centered nutrition phrases plus repeated exposure increase preschoolers' consumption of healthful foods, but not liking or willingness to try. Journal of Nutrition Education & Behavior 2019;51(5):519-27. - PubMed
Lawatsch 1990 {published data only}
    1. Lawatsch D. A comparison of two teaching strategies on nutrition knowledge, attitudes and food behavior of preschool children. Journal of Nutrition Education 1990;22(3):117-23.
Leahy 2008a {published data only}
    1. Leahy K, Birch L, Fisher J, Rolls B. Reductions in entrée energy density increase children's vegetable intake and reduce energy intake. Obesity (Silver Spring, Md.) 2008;16(7):1559-65. - PubMed
Leahy 2008b {published data only}
    1. Leahy K, Birch L, Rolls B. Reducing the energy density of multiple meals decreases the energy intake of preschool-age children. American Journal of Clinical Nutrition 2008;88(6):1459-68. - PubMed
Leahy 2008c {published data only}
    1. Leahy K, Birch L, Rolls B. Reducing the energy density of an entree decreases children's energy intake at lunch. Journal of the American Dietetic Association 2008;108(1):41-8. - PubMed
Leung 2019 {published data only}
    1. Leung C, Tsang S, Heung K, Tam M. Healthy start home visiting program-school-based model: cluster randomized controlled trial. Research on Social Work Practice 2019;29(6):628-43.
Lin 2016 {published data only}
    1. Lin M, Pan L, Han J, Li L, Jiang J, Jin R. Behavioral intervention reduces unhealthy eating behaviors in preschool children via a behavior card approach. Journal of Huazhong University of Science and Technology. Medical Sciences 2016;36(6):895-903. - PubMed
Malden 2019 {published data only}
    1. Malden S, Reilly J, Gibson A, Bardid F, Summerbell C, De Craemer M, et al. A feasibility cluster randomised controlled trial of a preschool obesity prevention intervention: ToyBox-Scotland. Pilot and Feasibility Studies 2019;5(1):128. - PMC - PubMed
Mannino 2019 {published data only}
    1. Mannino M, Rollins B, Francis L. Improving preschool children's food knowledge and food choice intentions: results from a childhood obesity preventive intervention. Journal of Nutrition Education & Behavior 2019;51:S11.
McSweeney 2017 {published data only}
    1. McSweeney L, Araújo-Soares V, Rapley T, Adamson A. A feasibility study with process evaluation of a preschool intervention to improve child and family lifestyle behaviours. BMC Public Health 2017;17:1-15. - PMC - PubMed
NCT03672227 {published data only}
    1. NCT03672227. Obesity prevention in Head Start. https://clinicaltrials.gov/show/NCT03672227 2018.
NCT03957148 {published data only}
    1. NCT03957148. Effectiveness of an IMB-based intervention for reducing sweetened beverages consumption in preschool children. https://clinicaltrials.gov/show/NCT03957148 2019.
NCT04552678 {published data only}
    1. NCT04552678. Healthy Bodies Project to prevent childhood obesity. https://clinicaltrials.gov/show/NCT04552678 2020.
NCT05050539 {published data only}
    1. NCT05050539. Adaptive implementation to optimize delivery of obesity prevention practices in early care and education settings. https://clinicaltrials.gov/show/NCT05050539 2021. - PMC - PubMed
Neelon 2016 {published data only}
    1. Neelon S, Mayhew M, O'Neill J, Neelon B, Li F, Pate R. Comparative evaluation of a South Carolina policy to improve nutrition in child care. Journal of the Academy of Nutrition and Dietetics 2016;116(6):949-56. - PubMed
Nekitsing 2019b {published data only}
    1. Nekitsing C, Blundell-Birtill P, Cockroft J, Fildes A, Hetherington M. Increasing intake of an unfamiliar vegetable in preschool children through learning using storybooks and sensory play: a cluster randomized trial. Journal of the Academy of Nutrition & Dietetics 2019;1:1. - PubMed
Norman 2019 {published data only}
    1. Norman Å, Zeebari Z, Nyberg G, Elinder L. Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial. BMC Pediatrics 2019;19(1):104. - PMC - PubMed
O'Connell 2012 {published data only}
    1. O'Connell ML, Henderson K, Luedicke J, Schwartz M. Repeated exposure in a natural setting: a preschool intervention to increase vegetable consumption. Journal of the Academy of Nutrition and Dietetics 2012;112(2):230-4. - PubMed
Rhee 2019 {published data only}
    1. Rhee K, Kessl S, Manzano M, Strong D, Boutelle K. Cluster randomized control trial promoting child self-regulation around energy-dense food. Appetite 2019;133:156-65. - PMC - PubMed
Ritchie 2019 {published data only}
    1. Ritchie L, Lee D, Alkon A, Neelon M, Rios K, Soule K. Evaluation of an interactive, online training for child care providers on healthy beverages for young children. Current Developments in Nutrition 2019;3 Suppl 1:P16-039-19.
Rollins 2021 {published data only}
    1. Rollins B, Stein W, Keller K, Savage J. Preschoolers will drink their GREENS! Children accept, like, and drink novel smoothies containing dark green vegetables (DGVs). Appetite 2021;162:105148. - PubMed
Schuler 2019 {published data only}
    1. Schuler B, Fowler B, Rubio D, Kilby S, Wang Y, Hager E, et al. Building blocks for healthy children: evaluation of a child care center-based obesity prevention pilot among low-income children. Journal of Nutrition Education & Behavior 2019;51(8):958-66. - PMC - PubMed
Sirasa 2021 {published data only}
    1. Sirasa F, Mitchell L, Azhar A, Chandrasekara A, Harris N. A six-week healthy eating intervention with family engagement improves food knowledge and preferences but not dietary diversity among urban preschool children in Sri Lanka. Public Health Nutrition 2021;24(12):4328-38. - PMC - PubMed
Slining 2021 {published data only}
    1. Slining M, Wills S, Fair M, Stephenson J, Knobel S, Pearson M, et al. LiveWell in early childhood: results from a two-year pilot intervention to improve nutrition and physical activity policies, systems and environments among early childhood education programs in South Carolina. BMC Public Health 2021;21(1):919. - PMC - PubMed
Smith 2019 {published data only}
    1. Smith E, Sutarso T, Kaye G. Access with education improves fruit and vegetable intake in preschool children. Journal of Nutrition Education & Behavior 2019;5:5. - PubMed
Sojkowski 2012 {published data only}
    1. Sojkowski S, Severin S, Kannan S. Sensory exploration of seasonally and locally available vegetables and their effects on vegetable consumption of Western Massachusetts Head Start preschool children. FASEB Journal. Conference: Experimental Biology 2012;26:Meeting Abstracts.
Sweitzer 2010 {published data only}
    1. Sweitzer S, Briley M, Roberts-Gray C, Hoelscher D, Harrist R, Staskel D, et al. Lunch is in the bag: increasing fruits, vegetables, and whole grains in sack lunches of preschool-aged children. Journal of the American Dietetic Association 2010;110(7):1058-64. - PMC - PubMed
Swindle 2021 {published data only}
    1. Swindle T, McBride N, Selig J, Johnson S, Whiteside-Mansell L, Martin J, et al. Stakeholder selected strategies for obesity prevention in childcare: results from a small-scale cluster randomized hybrid type III trial. Implementation Science 2021;16(1):48. - PMC - PubMed
Vaughn 2019b {published data only}
    1. NCT03938103. Evaluation of an enhanced delivery model for go NAPSACC. https://clinicaltrials.gov/show/NCT03938103 (first received 6 May 2019).
    1. Vaughn A, Studts C, Powell B, Ammerman A, Trogdon J, Curran G, et al. The impact of basic vs. enhanced Go NAPSACC on child care centers' healthy eating and physical activity practices: protocol for a type 3 hybrid effectiveness-implementation cluster-randomized trial. Implementation Science 2019;14(1):101. - PMC - PubMed
Vepsäläinen 2022 {published data only}
    1. Vepsäläinen H, Skaffari E, Wojtkowska K, Barliska J, Kinnunen S, Makkonen R, et al. A mobile app to increase fruit and vegetable acceptance among Finnish and Polish preschoolers: randomized trial. JMIR mHealth and uHealth 2022;10(1):e30352. - PMC - PubMed
Verbestel 2014 {published data only}
    1. Verbestel V, De Coen V, Van Winckel M, Huybrechts I, Maes L, De Bourdeaudhuij I. Prevention of overweight in children younger than 2 years old: a pilot cluster-randomized controlled trial. Public Health Nutrition 2014;17(6):1384-92. - PMC - PubMed
Vitale 2020 {published data only}
    1. Vitale N, Coccia C. Effects of a Montessori-based nutrition education program with fruit and vegetable taste testing on intake, preferences, and nutrition knowledge of preschool and kindergarten children. Journal of the Academy of Nutrition & Dietetics 2020;120:A50.
Ward 2008 {published data only}
    1. Ward D, Benjamin S, Ammerman A, Ball S, Neelon B, Bangdiwala S. Nutrition and physical activity in child care: results from an environmental intervention. American Journal of Preventive Medicine 2008;35(4):352-6. - PubMed
Ward 2017 {published data only}
    1. Ward D, Vaughn A, Mazzucca S, Burney R. Translating a child care based intervention for online delivery: development and randomized pilot study of Go NAPSACC. BMC Public Health 2017;17(1):891. - PMC - PubMed
Ward 2020b {published data only}
    1. Ward S, Belanger M, Leis A. Comparison between the Healthy Start-Depart Sante online and in-person training of childcare educators to improve healthy eating and physical activity practices and knowledge of physical activity and fundamental movement skills: a controlled trial. Preventive Medicine Reports 2020;20:101264. - PMC - PubMed
Williams 1998 {published data only}
    1. Williams C, Squillace M, Bollella M, Brotanek J, Campanaro L, D'Agostino C, et al. Healthy Start: a comprehensive health education program for preschool children. Preventive Medicine 1998;27(2):216-23. - PubMed
Williams 2002 {published data only}
    1. Williams C, Bollella M, Strobino B, Spark A, Nicklas T, Tolosi L, et al. "Healthy-start": outcome of an intervention to promote a heart healthy diet in preschool children. Journal of the American College of Nutrition 2002;21(1):62-71. - PubMed
Yeom 2019 {published data only}
    1. Yeom M, Cho Y. Nutrition education on discouraging sugar intake led to improve the moderation factor of nutrition quotient in pre-school children. Annals of Nutrition & Metabolism 2019;75(3):126.
Yoong 2016 {published data only}
    1. Yoong Y, Jones J, Marshall J, Wiggers J, Seward K, Finch M, et al. A theory-based evaluation of a dissemination intervention to improve childcare cooks' intentions to implement nutritional guidelines on their menus. Implementation Science 2016;11(1):105. - PMC - PubMed

References to studies awaiting assessment

ChiCTR2200060958 {published data only}
    1. ChiCTR1800017292. Childhood Healthy Activities Model Policies Study. http://www.chictr.org.cn/showprojen.aspx?proj=29374 (first received 23 July 2018).

References to ongoing studies

Armstrong 2019 {published data only}
    1. Armstrong B, Trude A, Johnson C, Castelo R, Zemanick A, Haber-Sage S, et al. CHAMP: a cluster randomized-control trial to prevent obesity in child care centers. Contemporary Clinical Trials 2019;86:105849. - PMC - PubMed
Barnes 2020 {published data only}
    1. Barnes C, Grady A, Nathan N, Wolfenden L, Pond N, McFayden T, et al. A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres. Pilot and Feasibility Studies 2020;6(1):163. - PMC - PubMed
    1. Barnes C, Yoong S, Nathan N, Wolfenden L, Wedesweiler T, Kerr J, et al. Feasibility of a web-based implementation intervention to improve child dietary intake in early childhood education and care: pilot randomized controlled trial. Journal of Medical Internet Research 2021;23(12):e25902. - PMC - PubMed
Beckerman 2019 {published data only}
    1. Beckerman J, Aftosmes-Tobio A, Kitos N, Jurkowski J, Lansburg K, Kazik C, et al. Communities for healthy living (CHL) - a family-centered childhood obesity prevention program integrated into Head Start services: study protocol for a pragmatic cluster randomized trial. Contemporary Clinical Trials 2019;78:34-45. - PMC - PubMed
Cosco 2021 {published data only}
    1. Cosco N, Wells N, Monsur M, Goodell L, Zhang D, Xu T, et al. Research design, protocol, and participant characteristics of COLEAFS: a cluster randomized controlled trial of a childcare garden intervention. Journal of Environmental Research and Public Health 2021;18:13066. [DOI: 10.3390/ijerph182413066] - DOI - PMC - PubMed
Helland 2016 {published data only}
    1. Helland S, Bere E, Overby N. Study protocol for a multi-component kindergarten-based intervention to promote healthy diets in toddlers: a cluster randomized trial. BMC Public Health 2016;16:273. - PMC - PubMed
ISRCTN33134697 {published data only}
    1. ISRCTN33134697. NAP SACC (UK): nutrition and physical activity self-assessment for childcare. https://doi.org/10.1186/ISRCTN33134697 (first received 24 October 2019).
Lee 2019 {published data only}
    1. Lee R, Lorenzo E, Szeszulski J, Arriola A, Bruening M, Estabrooks P, et al. Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: sustainability via Active Garden Education (SAGE). Contemporary Clinical Trials 2019;77:8-18. - PMC - PubMed
Malden 2018 {published data only}
    1. Malden S, Hughes A, Gibson A, Bardid F, Androutsos O, De Craemer M, et al. Adapting the ToyBox obesity prevention intervention for use in Scottish preschools: protocol for a feasibility cluster randomised controlled trial. BMJ Open 2018;8(10):e023707. - PMC - PubMed
Mehdizadeh 2018 {published data only}
    1. Mehdizadeh A, Nematy M, Khadem-Rezaiyan M, Ghayour-Mobarhan M, Sardar MA, Leis A, et al. A customized intervention program aiming to improve healthy eating and physical activity among preschool children: protocol for a randomized controlled trial (Iran Healthy Start Study). JMIR Research Protocols 2018;7(12):e11329. - PMC - PubMed
NCT01890681 {published data only}
    1. NCT01890681. Baby nutrition and physical activity self-assessment for child care (NAP SACC) intervention study. https://clinicaltrials.gov/ct2/show/NCT01890681 (first received 2 July 2013).
NCT02580123 {published data only}
    1. NCT02580123. Smile-Kids: study on complementary feeding transition. https://clinicaltrials.gov/ct2/show/NCT02580123 (first received 20 October 2015).
NCT03575884 {published data only}
    1. NCT03575884. Fit 5 Kids screen time reduction curriculum for Latino preschoolers (Fit5Kids). https://clinicaltrials.gov/ct2/show/NCT03575884 (first received 3 July 2018).
NCT03601299 {published data only}
    1. NCT03601299. Back to Basics: addressing childhood obesity through traditional foods in Alaska. https://clinicaltrials.gov/ct2/show/NCT03601299 (first received 26 July 2018).
NCT03668678 {published data only}
    1. NCT03668678. iGrow Readers nutrition and physical activity curriculum efficacy. https://clinicaltrials.gov/ct2/show/NCT03668678 (first received 12 September 2018).
NCT04082247 {published data only}
    1. NCT04082247. Healthy Children 2021 Study in childcare centers (HC2021). https://clinicaltrials.gov/ct2/show/NCT04082247 (first received 9 September 2019).
NCT04140032 {published data only}
    1. NCT04140032. Addressing obesity in early care and education settings. https://clinicaltrials.gov/ct2/show/NCT04140032 (first received 25 October 2019).
NCT04164277 {published data only}
    1. NCT04164277. FirstStep2Health Intervention. https://clinicaltrials.gov/ct2/show/NCT04164277 (first received 15 November 2019).
NCT04711525 {published data only}
    1. NCT04711525. i-MaCHeL Study is a two-group, cluster-RCT, involves 460 preschool's child-parent dyads, to prevent childhood obesity (i-MaCHeL). https://clinicaltrials.gov/ct2/show/NCT04711525 (first received 15 January 2021).
NCT05112185 {published data only}
    1. NCT05112185. Childcare healthy beverage access, food and beverage intake, and obesity. https://www.clinicaltrials.gov/ct2/show/NCT05112185 (first received 8 November 2021).
Reeves 2018 {published data only}
    1. Reeves S, Poh B, Essau C, Summerbell C, Cheah W, Koh D, et al. ToyBox Study Malaysia: improving healthy energy balance and obesity-related behaviours among pre-schoolers in Malaysia. Nutrition Bulletin 2018;43(3):290-5.
Sisson 2019 {published data only}
    1. Sisson S, Salvatore A, Hildebrand D, Poe T, Merchant C, Slawinski M, et al. Interventions to promote healthy environments in family child care homes in Oklahoma - Happy Healthy Homes: study protocol for a randomized controlled trial. Trials 2019;20(1):541. - PMC - PubMed
Watt 2014 {published data only}
    1. Watt R, Draper A, Ohly H, Rees G, Pikhart H, Cooke L, et al. Methodological development of an exploratory randomised controlled trial of an early years’ nutrition intervention: the CHERRY programme (Choosing Healthy Eating when Really Young). Maternal and Child Nutrition April 2014;10(2):280-94. [DOI: 10.1111/mcn.12061] - DOI - PMC - PubMed
Yin 2019 {published data only}
    1. Yin Z, Ullevig S, Sosa E, Liang Y, Olmstead T, Howard J, et al. Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program. BMC Pediatrics 2019;19(1):190. - PMC - PubMed
Zarnowiecki 2021 {published data only}
    1. Zarnowiecki D, Kashef S, Poelman A, Cochet-Broch M, Arguelles J, Cox D, et al. Application of the multiphase optimisation strategy to develop, optimise and evaluate the effectiveness of a multicomponent initiative package to increase 2-to-5-year-old children's vegetable intake in long day care centres: a study protocol. BMJ Open 2021;11(12):e047618. - PMC - PubMed

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References to other published versions of this review

Yoong 2021
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