An educational intervention to promote healthy lifestyles in preschool children: A cluster-RCT.

OBJECTIVE
Promoting 4 healthy behaviours among preschool children: ⩾4 servings of fruit and vegetables/day, ⩾2 h/day of active play, ⩽1 hour/day of TV-watching and 0 sugar sweetened beverages/day.

METHODS
We conducted a c-RCT on 425 three-year-old children at 16 childcare centres based in Cesena, Italy. We randomly allocated 8 childcare centres (199 children) to the intervention group and 8 childcare centres (226 children) to the control group. All the randomized childcare centres completed our study protocol. Parents recorded their children's target behaviours at home over 3 Saturdays, at baseline and at follow-up. Then trained nurses measured children's weight and height. We conducted a 6-month-long intervention trial in local health care centres where nurses and primary care paediatricians respectively conducted 2 subsequent motivational interviews with parents to encourage children's healthy behaviours at home. At the same time, teachers involved children in learning experiences about healthy behaviours. Our primary outcome is a children's combined health behaviour score (CHBS) at home. Our secondary outcomes measure the BMI z-score and the percentage of children that show a BMI trajectory crossing upward. After collecting CHBS and BMI data at baseline as well as at 1 and 2-year follow-ups, we performed an Intent-to-Treat (ITT) analysis.

RESULTS
After 2 years from baseline, 48.4% of intervention group children showed a low-risk CHBS in comparison with 28.0% of control group children. A multilevel analysis showed that they were by far more likely to achieve low-risk scores (adjusted OR 3.41; 95% CI: 1.48-7.88; P 0.004). Our BMI outcomes showed no significant difference between groups.

CONCLUSIONS
A multidimensional educational intervention, which consists of motivational interviews with parents and teacher-led learning experiences for children, improved preschool children's CHBS in the long term without influencing the outcomes of BMI z-score and BMI increase.International Journal of Obesity accepted article preview online, 28 December 2016. doi:10.1038/ijo.2016.239.