| Cândido et al.3333 Cândido NA, Sousa TM, Santos LC. Effectiveness of different interventions in public nurseries based on food and nutrition education: promoting breast-feeding and healthy complementary feeding. Public Health Nutr. 2018; 21 (13): 2454-61. 2018, Minas Gerais - Brazil |
To analyze the effectiveness of different interventions based on food and nutrition education for nursery professionals and parents/ guardians of babies. |
202 parents and 90 professionals responsible for children under 2 years of age in a public educational institutional |
8 months |
CG = received standard written guidelines (professionals - posters placed where they would spent most of workday; parents (reports with information of posters attached to school notebooks once a month)
IG = professionals - received the same information than the CG and participated in bimonthly reunions concerning complementary healthy feeding.
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Application of an adapted questionnaire concerning breastfeeding and complementary feeding before and after activities. |
After intervention, there was a significant result indicating that it is possible to increase the average number of correct answers given by the IG (12.2 vs. 10.7; p= 0.001). Besides, there were improvements between **IG parents concerning beliefs (soups and broths do not feed my child: p=0.012), attitudes (to offer meat as of the sixth month: p= 0.032) and intentions (do not offer soups and broths: p=0.003; to offer vegetables: p=0.018; to offer meat: p< 0.001). |
Previously, the professionals presented knowledge on breastfeeding and complementary feeding, although it was insufficient for the adequate care of babies, after the intervention, the CG and IG evolved positively. IG was the group with the highest learning.
In relation to parents, in the IG there was a significant improvement of the rate in some assessed parameters, however with a very low adhesion. In the CG, no change was observed with regard to beliefs, attitudes and intentions after intervention.
A comparison between CG and IG demonstrated that written guidelines, isolated, without reunions, lead to few effective results.
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| Joseph et al.2626 Joseph LS, Gorin AA, Mobley SL, Mobley AR. Impact of a Short-Term Nutrition Education Child Care Pilot Intervention on Preschool Children’s Intention To Choose Healthy Snacks and Actual Snack Choices. Child Obes. 2015 Oct; 11 (5): 513-20. 2015, Connecticut -United States Gerais - Brazil |
To determine whether a short-term educational program may positively influence the choices of snacks of preschoolers in a nursery environment and determine which characteristics of children (sex, age, BMI, z-score, ethnicity, race, preferences and knowledge) are associated to the choice of a healthy snack instead of an unhealthy snack. |
49 preschoolers from public educational institutions |
2 weeks |
Nine interactive lessons of 30 minutes performed by a nutritionist that teaches and qualifies children about the distinction between healthy and unhealthy snacks.
Extension classroom materials were provided to each teacher.
Informative bulletins with support activities were sent to parents as a reinforcement.
The service was provided to each child on a daily basis.
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The previous and posterior evaluations included: questionnaires about knowledge and preference for snacks and a rehearsal of selection of these snacks by preschoolers, which allowed children to choose a healthy or an unhealthy option of snack, similar to the current nutritional environment. The choice for the snack of each child and the amount consumed were registered in a registry form of snack test. Height and weight of children were assessed and the BMI z-score was calculated. Reports from parents concerning sociodemographic data and children's eating habits were also collected at the onset of the study. letados no início do estudo. |
The children significantly improved their preferences for healthier snacks (p=0.03) and the ability to distinguish them (p=0.03) from other snacks. However, they did not significantly improve (p>0.05) their snack choices in the face of a healthy and unhealthy choice immediately after the short-term nutritional educational program.
Younger children (p=0.03) or that had higher scores of knowledge on nutrition (p=0.02) were more prone to select the healthy snack after the intervention.
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A program of short-term nutritional education improves the knowledge of preschoolers about healthy snacks, although it is not related to immediate healthier choices for all children.. |
| Nicholson et al.2222 Nicholson JS, Barton JM, Simons AL. Ability to Categorize Food Predicts Hypothetical Food Choices in Head Start Preschoolers. J Nutr Educ Behav. 2018; 50 (3): 238-46. 2018, Florida - United States |
To investigate whether preschoolers are able to identify and categorize foods and their ability to classify foods as healthy predicts their hypothetical eating choice. |
235 preschoolers from public educational institution |
12 months |
The teachers implemented an intervention of nutritional education in which children were taught to identify and categorize foods, according to their rate of consumption, as "sometimes" (that is, unhealthy) or "anytime" (that is, healthy).
In order to select snacks, the PSS tool was used - which include cards with printed pictures of foods and drinks in pairs of high contrast - the easiest (ex: carrots and donuts) and pairs of low contrast -the hardest (golden fish and French fries) to assess their ability to classify food items with more details in differences of nutrients.
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The preschoolers saw pairs of foods and were asked to identify the snacks. The researchers registered each answer as 0 (incorrect) or 1 (correct). When a food was incorrectly identified, the researchers provided the correct answer.
The TSG was also used: an online tool with which teachers could follow the progress of preschoolers within the year in order to assess the progress in the socioemotional, physical, language, cognitive, literacy and mathematics subscales. At the end of the school year, height and weight of preschoolers were assessed, as well as the BMI.
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The number of snacks that preschoolers identified as healthy among the easy pairs (high contrast) was assessed by age, sex, BMI and children's cognition.
In relation to categorizing foods as healthy (D=.317; p<0.001) it was a positive predictor that children selected a higher number of healthy snacks. (Change frequency = 18.43; p<0.001)
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When controlling the characteristics of each child and their cognitive functioning, preschoolers that were more prone to categorize foods as healthy or unhealthy were more able to say that they would choose healthy foods.
The pairs of foods of low-contrast (hardest) in which foods had to be classified based on multiple dimensions were out of the cognitive skills of preschoolers.
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| Sigman-Grant et al.2323 Sigman-Grant M, Byington TA, Lindsay AR, Lu M, Mobley AR, Fitzgerald N, et al. Preschoolers can distinguish between healthy and unhealthy foods: the all 4 kids study. J Nutr Educ Behav. 2014; 46 (2): 121-7. 2014, Nevada, Connecticut, New Jersey and Oklahoma - United States |
To determine changes in preschoolers' abilities to distinguish healthy and unhealthy foods and eating preferences reported after the participation in a nutritional education program. |
191 preschoolers from public educational institutions in Nevada
128 preschoolers from public educational institutions in Connecticut, New Jersey and Oklahoma
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9 weeks |
24 classes were given by extension instructors with 8 nutrition lessons presented in the fourth and sixth weeks, however, in all lessons, references to healthy snacks occurred. The researchers were qualified in the PSS test protocols. |
Individual interviews were made with each preschooler, in a location separated from other children. The interviews were performed from 1 to 2 weeks before and after intervention. The researchers used 3 rounds of questions: during the first round, the preschooler was asked to name the foods; in the second round, 9 pairs of foods were used, being 1 healthy and 1 unhealthy; in the third round, the preschooler was invited to demonstrate the food that keep heart, muscles and bones strong. |
There was a statistically significant improvement in the identification scores before and after study for both groups from Nevada (p<0.001). For preference and distinction of unhealthy and healthy foods, no difference was observed in the pre-test. In the post-test, the intervention group demonstrated significantly a preference for healthier foods (p<0.006) and the ability to distinguish them (p<0.03) than preschoolers from the comparison group. The comparison of results between Nevada and 3 states demonstrated the generalization of the study tool. |
Resulted in higher comprehension of preschoolers concerning healthy foods and changed their reported eating preferences. |
| Baskale et al.3232 Baskale H, Bahar Z. Outcomes of nutrition knowledge and healthy food choices in 5- to 6-year-old children who received a nutrition intervention based on Piaget’s theory. J Spec Pediatr Nurs. 2011; 16: 263-79. 2011, Smyrna -Turkey |
To develop nutritional education for children in preschool age based on Piaget's theory, and investigate the effects of this education in nutritional knowledge and in the anthropometric measurements of children. |
238 binomials (mothers-preschoolers) from educational institutions (not declared if public of private) |
14 months |
IG= An educational content was elaborated, considering characteristics and the child' learning. The messages were simple, positive and guided for behavior, averting abstract concepts. During the education based on games, the active participation of students was maintained and activities such as playing, painting, coloring and interactive stories were included. When using the food pyramid, the focus was on a single aspect, such as a determined group of foods. Thus, the child was helped with the development of abilities of food classification - colorful pictures of foods were used, specific to the culture. Each intervention session was conducted once a week during 6 weeks.
CG = did not receive nutritional education, but received a general education program. The study plan includes courses about nutrition each 2 months.
Mothers= Child's feeding is not isolated from the family. Due to this reason, the parents of the experimental and control groups received nutritional education with the principles of adult education. The assessment of mother's knowledge was not performed. After the program, an educational booklet was given to all mothers.
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a sociodemographic data form and a children's nutritional knowledge form were used as data collection tools. In this form, there are 30 images of foods in 5 food groups. The form was implemented before the education (pre-test), after the education (post-test1) and 1 year after the education (post-test2). Each correct answer received 1 score point whilst each wrong answer received 0), a food intake frequency form (contained questions about food groups). A form for registry of anthropometric measurements (were registered before and 1 year after education). |
Sociodemographic characteristics: the analysis demonstrated that groups were not statistically different (p>0.05).
Nutritional knowledge: the results of this analysis established that there was a significant difference in the experimental group between pre-test and post-test 1(t=14.395, p<0.001) and pre-test and post-test 2(t+14,080, p<0.001). No significant statistical difference was found between measurements of post-test 1 and 2 of the experimental and control groups.
Frequency of food intake CG= some foods (milk and dairy products, white and red meat, fish, some vegetables (green leaves, roots, cabbage) and fruits.) Were slightly higher in pre-test, however no significant difference was observed IG = demonstrated an increase in post-test 1, pre and post-test 2 in citric fruits consumption, as well as other fruits (apples, pears, bananas, strawberries, cherries, grapes, kiwi, watermelons) (p=0.014). In the pre and post-test2 there was a decrease in sugar intake (p=0.042). There was no significant increase in the cereal consumption (bread, pita bread, pizza, spaghetti and rice), as well as butter, honey, jam, molasses, mayonnaise, ketchup, pasty sweets, dairy desserts and soft drinks. (p>0.05). Anthropometric measurements: an assessment of BMI values of the experimental group before and after education according to groups and sex did not show significant difference between experimental and control groups for girls and boys.
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The scores of nutritional knowledge of the IG increased and the eating preferences of the group changed positively. No significant difference was observed between anthropometric measurements of the experimental and control groups. |
| Piziak et al.2727 Piziak V. A Pilot Study of a Pictorial Bilingual Nutrition Education Game to Improve the Consumption of Healthful Foods in a Head Start Population. Int. J Environ Res Public Health. 2012 Apr; 9 (4): 1319-25. 2012, Texas -United States |
To test the effectiveness of a nutrition bilingual game in order to increase portions of healthy foods, mainly vegetables, fruits and water offered to children and decrease the portions of sugary drinks in the Head Start population. |
413 binomials (parents-preschoolers) from public educational institution |
12 months |
Nutritional education game that follows the lottery model - a pictorial bingo game. The game moderator shows a card with colorful images of foods (culturally appropriate) and tells a story or rhyme to describe the image. The players then place a token on the board if they have the image. Both board and cards can be used to play a variety of nutritional bingos. The teachers were authorized to play the game in English or Spanish. The parents learned about the game in a reunion and were encouraged to dispute prizes and counseled about healthy eating habits.
The teachers were instructed about the game and received basic nutritional knowledge before the school year.
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At the start and end of the school year, the parents answered a questionnaire about food frequency of their children during the week and weekend. |
There was a statistically significant increase in vegetables served outside of the Head Start after class during the week and weekends (p=0.02). The study was not able to demonstrate any other statistically significant changes in feeding. |
The findings of this study demonstrate that the intake of vegetable portions may be improved in the age group using a simple game of pictorial nutritional education that incorporates elements of familiar culture for most students and their parents. This familiarity simplifies the instruction of parents and teachers. The game is easy to reproduce, helping with the control of costs. |
| Larsen et al.2828 Larsen AL, Liao Y, Alberts J, Huh J, Robertson T, Dunton GF. RE-AIM Analysis of a School-Based Nutrition Education Intervention in Kindergarteners. J Sch Health. 2017 Jan; 87 (1): 36-46. 2017, Califórnia - United States |
To assess the impact of Building a Healthy Me (BHM)in public health within classrooms of kindergarten from California using the RE-AIM framework (Reach, effectiveness, adoption, implementation and maintenance). |
IG (assessed in pre-post research) = 25 classrooms (414 students and 264 parents) from public educational institution
CG (assessed post-research) = 4 classrooms (103 students) from public educational institution
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12 months |
IG= classrooms that planned to implement the BHM program CG= classrooms that did not request the BHM program.
BHM Program: consisted in 8 units - unit 1 provided a global view about the 5 food groups, units 2-6 focused on each food group, unit 7 focused on healthy snacks and unit 8 focused on healthy breakfast
Distribution of educational booklets for parents.
The program includes a teacher's guide with instructions and class plans, a poster with nutritional information, a box with pictures of foods, a student's book, and homework for the family to develop concepts learned during units.
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. . Students- A research that assessed sex, age and nutritional knowledge was carried out, based on images of foods or drinks. Children were invited to circle foods that belonged to the correct group that was asked.
Country - the survey assessed sociodemographic data of children and parents, habitual food intake of children during the previous month, parents' usual practices related to nutrition awareness at home and satisfaction of parents with the BHM Program. The assessment of food intake frequency and use of foods labels was also performed
Teachers - a registry was fulfilled during the entire program reporting about each lesson and a survey was performed with teachers from the intervention group after the survey about their opinion of each BHM unit.
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The intervention students improved on the knowledge about food groups and healthy options of breakfast/snack, and scored higher than control students score in the knowledge of foods in the post-intervention (p<0.05). The parents of children of the intervention group increased the use of food labels, and children from the intervention group increased the intake of several healthy foods and decreased the intake of sweets and French fries (p<0.05). The BHM Program reached 41% of kindergartenstudents that attend public schools in California, and the teachers implemented most of the class material. |
The BHM program was effective, broadly implementing with accuracy, emphasizing its potential impact in public health, demonstrating evidence of improvements on the knowledge of children from kindergarten on nutrition, healthy feeding and the use of food labels by the parents. |
| Santos et al.3030 Santos SV, Silva DE, Almeida MEF, Abranches MV. Uso de técnicas gastronômicas: uma estratégia para melhorar a aceitabilidade da alimentação de pré-escolares do interior de Minas Gerais. J. Health Biol Sci. 2017; 5 (3): 228-33. 2017, Minas Gerais - Brazil |
To assess the acceptance of school feeding, before and after the execution of gastronomic techniques, by children in preschool age. |
26 preschoolers from a public educational institution. |
10 days |
Stage 1 : Children fed on their original meals offered in school for 5 days
Stage 2: Alterations occurred in the meals, with the application of gastronomic techniques by food handlers guided by the researchers, so that they could provide a better presentation of the preparations by means of the usage of formatting hoops and spices/aromatic herbs, attempting to color, decorate and assure a better finalization of the offered dishes.
Children became to feed on these modified meals for 5 days
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Affective test of hedonic facial scale of 5 points for acceptability assessment, applied in stages 1 and 2. |
Although the preparations available in 4 of 5 days were accepted (Al>85%) by the children, after the intervention, an increase of the Al was observed, and all meals started to be accepted.
The food offered in day 5 of each stage was similar, however in stage 1 it was not accepted (Al=80%) and stage 2, after alteration of the presentation of dishes, the Al received the adequate classification (88.5%).
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The acceptance of a preparation that comprised school feeding in the study increased after the use of gastronomic techniques, possibly due to the fact that the meal was presented in a more colorful, attractive and diversified manner, which encouraged the desire of consumption. In this way, a favorable strategy. |
| Miguel et al.2929 Miguel RG, Ivanovic DM. Impact of a short-term school vegetable gardens program on food-related behavior of preschoolers and their mothers - São Paulo, Brazil. Rev Chil Nutr. 2011; 38 (2): 136-46. 2011, São Paulo - Brazil |
To assess the impact of a short--term program of school vegetable gardens (VEGA-PRO) focused on preschoolers and their mothers in São Paulo, Brazil, concerning eating habits in relation to vegetable consumption. |
231 mother-preschoolers binomials from two public educational institutions and 2 private. CG= 103 preschoolers that did not participate in VEGAPRO.
IG= 129 preschoolers that participated in VEGAPRO.
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2 months |
The VEGAPRO was developed for preschoolers of the IG a vegetable Garden experience which consisted in 26 educational sessions of approximately 60 minutes, in school hours, without accounting the time used by teachers to reinforce the program in the classroom. During these educational sessions, preschoolers prepared the soil, sowed, irrigated and cared for agricultural plants, harvesting the vegetables and consuming them in school and at home.
Lectures were performed with each preschooler, exposing their opinion to researchers and their teachers, regarding their experiences with the Garden, reinforcing their knowledge on nutritional value of each vegetable.
Games and songs related to each vegetable were part of these activities.
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Pre-test was elaborated to be performed in one session, in order to determine the habits standard related to vegetable consumption of both preschoolers and their mothers.
The post-test was started immediately after VEGAPRO conclusion, also in an attempt to determine eating attitudes related to the consumption of vegetables.
Both researchers and kindergarten teachers registered their opinions and observations in camp notes.
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Preschoolers that participated in the VEGAPRO increased the number of daily meals and the frequency of vegetable intake (p<0.02). Mothers from the IG significantly increased the number of daily meals in which they consumed vegetables. (p<0.01) |
The findings corroborate the hypothesis that preschoolers enrolled in VEGAPRO increased the number of daily meals and the frequency of vegetable intake, as well as the number of vegetables that they like to eat and mothers experienced positive changes in their eating habits under the influence of their children. |
| Andrade et al.3131 Andrade MER, Costa NMB, Castro LCV. Perfil nutricional de pré-escolares antes e após intervenção com educação em creches municipais de Viçosa - MG. Nutrire Rev Soc Bras Alim Nutr. 2012; 27 (2): 133-46. 2012, Minas Gerais - Brazil |
To evaluate the nutritional profile of preschoolers before and after nutritional education intervention |
101 preschoolers from public educational institution |
9 months |
Students - weekly activities such as plays, games dynamics and puppets
Collaborators - qualification courses approaching the subjects: "Good practices of personal hygiene and food manipulation" and "Correct preparing and portioning of foods"
Parents and Teachers - Reunions approaching principles of healthy feeding in the childhood.
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The children were submitted to anthropometric and dietetic measurements, before and after intervention with works of nutritional education.
The consumption of foods by the children in nurseries was assessed by means of the direct weighing of foods during 2 days of the week.
Meals prepared at home were evaluated with the foods registry method, directed for parents or guardians, during 1 day of the weekend.
The evaluation of the available amount of food for the per capita intake of sodium (salt and spices), sugar and cooking oil was performed by means of data collection in the scholar feeding area.
To assess the quality of diet, the DQI-Rwas used.
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It was observed that the average availability of sugar decreased from 20.30g to 14.88g after the nutritional intervention, although this reduction did not significantly affect in the prevalence of inadequacy of consumption (p=0.14). It was observed a significant decrease of the prevalence of cooking oil inadequacy, however, without a significant difference in the available amount for consumption. Such an outcome is due to the fact that 35.64% of children, during the study period, changed their age groups and thus, were included in another range of recommendation.
It was also assessed, the per capita intake of sodium during the study period, and it was 12.87% of inadequacy. It was not possible to evaluate the sodium intake before and after the intervention period, since the period of salt and spice delivery was annual.
It was observed a significant improvement in fruits consumption and significant reduction in the iron, cereals and legumes intake.
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The diets of all children were classified as "need modifications", before and after nutritional intervention. In face of this, it was verified the importance of continuity of nutritional education activities, in order to promote healthy eating habits among preschoolers. |
| Rosa et al.2424 Rosa SAM, Buchweitz MRD, Nagahama D, Diniz DB. Super-heróis em educação nutricional: o lúdico na promoção da saúde e prevenção da anemia em pré-escolares. Mundo Saúde. 2015; 39 (4): 495-503. 2015, Ceará -Brazil |
To evaluate the impact of a nutritional education intervention concerning the knowledge and attitudes of preschoolers, aiming to encourage healthy eating habits and prevention of anemia. |
78 preschoolers from a public educational institution. |
12 months |
Based on learning by modeling with characters representing anemia and super-heroes, iron, Vitamin C and health by means of videos, songs, replicas of foods that are a source of iron and Vitamin C, theater plays and games. Positive reinforcers were used by means of a sticker album, aiming to fix the learning.
The school's menu was adjusted to meet what is preconized by PNAE< with the introduction of new preparations and foods, in order to adequate total energy and nutrients intake, specially iron and Vitamin C
Food handlers were qualified to execute the new menu.
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In order to measure the incorporation of knowledge and the acceptance of preparations with foods rich in iron and Vitamin c, an educational booklet was used.
The analysis of satisfaction in relation to the menus was performed by means of the hedonic scale fulfilled by the responsible teacher, observing the child during meals in 3 moments: before and after intervention and at the maintenance stage (of positive reinforcers).
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Most (62.74%) answered correctly about how to fight anemia, mentioning educational approaches used during intervention. The low initial acceptance of meals decreased significantly (p<0.05). The acceptance index concerning the encouraged foods quintupled after intervention (14.7% to 76%). |
The use of a ludic methodology associated to super-heroes and positive reinforcers demonstrate a considerable impact in the assimilation of knowledge on healthy feeding and its effect in preschooler children's health, promoting changes in acceptance and eating habits towards the consumption of more varied foods, mainly fruits and vegetables, as well as foods rich in iron. |
| Kim et al.2525 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): 1590. 2019, Gyeonggi - South Korea |
To improve the eating habits and nutritional state of children in preschool age by means of a thematic program of nutrition based on the NASA Mission X, of 10 weeks |
679 preschoolers from private educational institutions. |
10 weeks |
IG= A nutritional intervention was carried out by a team of nutrition professionals with the cooperation of 14 teachers. The Mission X intervention consisted of 4 thematic nutritional items: 1. Energy of an astronaut. 2. Hydration Station. 3. Living bones, Strong bones and 4. Reduced gravity, low fat.
The curriculum of the 4 thematic sessions was sent to the teachers and nutrition professionals' team in a total of 3 qualification sessions of 30 minutes.
CG= All key-concepts of the nutrition sessions were equally offered to the control group after the follow-up of 10 weeks.
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In the beginning of the study, parents were asked about the general characteristics of their children.
The measurement of height, weight, BMI and BMI percentile was performed. The eating habits of children, according to the parents' self-report, was assessed with the nutritional coefficient.
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Significant changes in anthropometric variables were observed in both groups after intervention (p<0.05). Nevertheless, none of the mean differences diverged significantly between the groups in the linear regression model of mixed-effects adjusted for age, sex and type of school
The total score of the nutritional quotient of the IG increased significantly (p<0.05) after the intervention program
There was an increase in the consumption of fruits (2.0 vs - 1.5, p<0.05) and a decrease in the foods with high-energy rates, high levels of sodium and snacks (0.5 vs. - 1.2, p<0.05), in the IG compared with the CG.
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A strong point of this study is the fact that it is the first to promote healthy eating habits in South Korean children in preschool age, improving eating habits and the nutritional status of small children |
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