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Table 3 Characteristics of studies

From: A systematic review of types of healthy eating interventions in preschools

Study Aim of study Setting Age (years) Ethnicity Detailed description of the intervention Theoretical foundation
Single intervention
Bannon et al.; [16] The purpose of the study was to develop and test a commercial for apples on kindergarten children’s snack choice. Kindergarten in Elementary school (USA) 51 92% Caucasian The children were shown 60 s videos with either 1 positive gain-framed video; 1 negative loss-framed video; 1 control video prior to apple/animal crackers eating. Not stated
4% African- American 4% Hispanic
Birch et al.; [17] The influence of peer models’ food selections and eating behaviours on preschoolers’ food preferences was investigated. Preschool (USA) 3,11 87% Caucasians. A target child who preferred vegetable A to B was seated with 3 or 4 peers with opposite preference patterns. 17 situations were arranged. Children were served their preferred and non-preferred vegetable pairs at lunch and asked to choose 1. On day 1 the target child chose first, while on days 2, 3, and 4 peers chose first. Not stated
8% African American
5% Asians, Middleclass families
O’Connell et al.; [18] The trial tested the hypotheses that children who are served unfamiliar vegetables repeatedly in the preschool lunch setting will increase consumption of them, and that consumption will be influenced by peer eating behaviours and parental feeding behaviours. Preschool (USA) 4-52 Caucasians: 69% Serving of unfamiliar vegetables repeatedly in a preschool lunch setting 10 times during a 6 week period. Influence of between child variability and thus peer influence. Not stated
Asian 8%
African-American: 5%
Hispanic: 6%.
Other: 12%
From highly educated households.
Harnack et al.; [19] To evaluate the effects on serving vegetables first or together with the meal on fruit, vegetables and energy intake among preschoolers. Preschool (USA) Missing Not stated Meal service strategy: serving vegetables first, compared with serving all food items at the same time compared with control (no change). Every strategy was implemented in two weeks. Not stated
Hendy; [20] The purpose of the study was to examine the effectiveness of trained peer models to increase food acceptance of preschool children and the test whether the same gender would be the most effective. Preschool (USA) 3-62 90% Caucasians Three novel foods presented during the preschool meal. 16 children were trained by their teachers to serve as peer models and given toy reinforcement. Social cognitive theory.
8% African American
2% Hispanic
Leahy et al.; [21] To test the effect of reducing the energy density of an entrée on children’s ad libitum intake. Preschools, (USA) 3,91 Caucasians: 69% Children were served two version of a macaroni and cheese dish with the same palatability; one was energy dense and the other calorie-reduced. Each version was served 3 times. Not stated
Asian: 27%
African-American: 4%
90% of the mothers and 85% of fathers reported having at least a 4-year university degree
Noradilah; [22] The objective of this study was to determine the effects of multiple exposures to the acceptance of a targeted vegetable among Malay preschoolers. Kindergartens (Malaysia) 5-62 The majority of the fathers of the subjects (89.2%) had education up to secondary school, were self-employed (59.5%) and had monthly incomes of below RM1500 (91.9%). Meanwhile, the majority of the mothers were housewives (73%) with secondary education level (86.5%). The children were exposed to three exposures of round cabbage in the kindergarten setting. The test vegetable had been decided upon based on questionnaire data from the parents. The parents served the vegetable at home once in order to determine the child’s liking of round cabbage. Not stated
Ramsey; [23] The objective of this study was to compare kindergarteners’ intake of food from a school lunch meal when they are pre-served a larger entrée portion to when they are allowed t0 choose from three preplated entrée portion sizes. Kindergartens (USA) 2-72 Not stated A portion size of 4 chicken nuggets was the standard amount offered to the kindergarteners before the study. In the study they were given the choice to self-select smaller entrée portion sizes of 2, 3 and 4 nuggets. Not stated
Educational intervention       
Baskale et al.; [24] The purpose was to develop and implement a program based upon Piaget’s theories. It also determined the average levels of knowledge children would have about nutrition following the program would be different in terms of group, group time, whether there would be any differences in food consumption frequencies between the study and the control group and whether there would be changes in anthropometric measurements of the children. Nursery schools (Turkey) 52 Different socio-economic layers, but the groups were not significantly different. Activities were carried out once a week by a nurse educator in the course of 6 weeks. The sessions were carried out in the children’s classroom and the lengths were 20–30 minutes. The themes were the food pyramid, variation of fruits and vegetables, and healthy bones. Piaget’s cognitive development theory
Parents in both intervention and control group were given nutrition education in 1 ½ -2 hours.
Cason KL; [25] The objective of the educational program were to enable preschool children to identify nutritious snack foods, identify and name vegetables, increase willingness to try novel vegetables, help to prepare and consume nutritious foods using developmentally appropriate practices and acquire behaviours that contribute to nutritionally sound food choice and a healthy lifestyle. Preschool (USA) 4,41 63% African Americans A theory-based curriculum of 12 lessons of 40 minutes every second week developed for preschool children, the core topics of healthy snacking, fruit and vegetables identification, and the Food Guide Pyramid. Multiple intelligence theory.
37% Caucasians
Cespedes; [26] The objective was to implement and evaluate a nutritional and physical activity educational intervention in preschools. Preschools (Colombia) 3,71 Low-income: 58% Children were provided educational and interactive classroom activities throughout 5 months (1 hour daily). Parents participated in 3 workshops and weekly healthy messages were distributed. Teachers participated in 3 centralised workshops and 2 hourly personalised sessions every 14 days. Teachers also received a guidebook. Social cognitive theory and the trans-theoretical model
Middle-income: 42%
Gorelick et al.; [27] To develop a developmentally age appropriate educational curriculum and assess the success of the project curricular objectives. Preschools (USA) 3-52 Primarily Caucasians A kit with assessment instruments, fifty classroom activities, patterns to make materials for the classrooms lessons, a recipe book and two film strips. The educational curriculum was delivered by teachers. Piaget’s developmentally theory
Wide SES range
Hu et al.; [28] To evaluate the impact of nutrition education in kindergartens and to promote healthy dietary habits in preschool children. Kindergarten (China) 4-62 Low-income: 14% Monthly nutrition education sessions were held over two semesters. The nutrition educational program consisted of a flexible curriculum for children and parents. An illustrated book to all children and pamphlets were delivered to parents. Two series of promotional pictures providing information regarding nutrition were shown to the children. Not stated
Middle-income: 57%
High income: 29%
Johnson SL; [29] Objective was to investigate whether children could be taught to focus on internal cues of hunger and satiety and consequently improve their self-regulation of energy intake. Preschool (USA) 4,71 Primarily high socio economic population. Introduction of hunger through video and role-play with adults and dolls. Children were instructed before, during and after eating to attend to cues of hunger and satiation. Not stated
Nemet; [30, 31] To examine the effects of a randomized school-based intervention on nutrition and physical activity knowledge and preferences, anthropometric measures and fitness in low socioeconomic children. Kindergarten (Israel) 3-62 All kindergartens were situated in a low-socio economic area. Three all-day seminars for teachers. Parents were invited for two health-day festivals. The nutritional intervention was designed mainly to improve nutritional knowledge and was delivered by preschool teachers. Monthly pamphlets with nutrition information were sent home via the children, who were asked to present the nutritional information to their parents. Not stated
Parcel et al.; [32] To evaluate the impact of a health curriculum on educational and behavioural outcomes Preschool (USA) 2-42 Not stated Health education curriculum that was designed to teach selected age-appropriate types of behaviour that enables children to assume greater responsibility for their own health. The classes were taught everyday by a project employee, 1 teacher and 2 aides. The teachers additionally received two-three in-house training. Social Learning theory
Piziak V; [33] The purpose was to test the effectiveness of a bilingual nutrition game to increase the servings of healthful foods particular vegetables, fruit and water offered to children and decrease the servings of sugar sweetened beverages in the Head Start population. Preschool (USA) 3-52 The study took place at Head Start, a governmentally funded locally operated school for low-income families. Mexican-American: 57,3% A pictorial nutrition education game played at class and during meals, the game lends itself to nutrition education. The cards and boards show colour images of culturally appropriate foods and the reverse side gives the name in English and Spanish which may also be used to improve reading skills. Not stated
Sirikulchaya-nonta et al.; [34] To evaluate the use of food experience, multimedia, and role models for promoting fruit and vegetable consumption. Kindergarten (Thailand) 4-52 Not stated The program consisted of 11 activities of 30–40 minutes duration that presented information on health benefits of F&V as manner to improve familiarity with and acceptance of the concept. Teachers, peers, and parents were used as role models while eating together. A take-home letter was sent to the parents once. Social Learning theory
Witt et al.; [35] Determine whether an interactive nutrition and physical activity program for preschool children increases fruit and vegetable consumption Child care centres (USA) 4-52 Not stated The Color me healthy program was implemented for 6 weeks; 2 circle-time lessons and 1 imaginary trip were taught to children each week. The lessons were 15–30 minutes in duration. Not stated
Bayer et al.; [36] The intervention focused on improving health behaviour on a daily basis in the day care setting, aiming at establishing a health promoting behaviour patterns that might also be maintained outside of the day care setting. Kindergarten (Germany) 3-62 Children: German nationality: A behavioural intervention programme using a box-set with activities for kindergarten teachers. Included 2 day training session for KG teachers and a hotline for additional advice. Newsletters for parents was provided and availability of fruit, vegetables and water as well. An internet platform with additional information was established. Not stated
Intervention: 91,6
Control: 92,4%
Parents: Educational level medium – high:
Intervention: 73%
Control: 71%
Brouwer et al.; [37] The purpose of this study was to assess the feasibility of a garden-based intervention to promote fruit and vegetable intake among children attending childcare. Childcare centres (USA) 4,81 Child care directors: A garden-based intervention with a structured curriculum for child-care providers, consultations by a gardener, and technical assistance from a health educator. The curriculum included an overview module followed by monthly modules designed around a specific crop. Not stated
75% African American
50% College degree.
All centres had children from low-income families
De Bock et al.; [38] To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children. Kindergarten (Germany) 4,21 Without immigrant background: 65% With immigrant background: 32% Maternal educational level: Low: 16% Middle: 56% High: 21% Missing: 7% A nutritional intervention, consisting of fifteen 2 hours sessions once weekly over a period of 6 months. Ten modules only targeted children, another five parents and children or parents exclusively. Intervention activities consisted of familiarizing with different food types and preparation methods as well as cooking and eating meals together in groups of children, teachers and parents. Availability of fruit, vegetables and water was increased. Social Learning theory and Zajonc’ Exposure theory as well as the RE-AIM framework for the process evaluation
Hammond et al.; [39] To evaluate the impact of an early childhood nutrition education program on kindergarten students familiarity with and stated willingness-to-try 16 test foods Kindergarten (CAN) 52 Cultural inheritance: Nutrition Educational Program that includes 4 steps; food introduction activities, cooking, journal keeping activity, and communication between child and parents Not stated
Intervention: Canadian/British/English: 59% Other: 41%
Control: Canadian/British/English: 81% Other: 19%
Hoffman et al.; [40] The purpose of this study was to examine the impact of a multi-year, multicomponent school-based F&V consumption during school lunch. Kindergarten (USA) 62 Experimental group: African-American: 29% Latino: 41% Asian: 24% Caucasian: 3% Other: 2% Control: Multi-year, multi-component fruit and vegetable promotion program, that included school-wide, classroom, lunchroom and family components to promote F & V consumption with an emphasis on F&V in the school lunch. Program components were designed to capture students’ attention and to increase retention of nutrition information using influential role models and deliver consistent messages across the setting. Social Learning theory
African-American: 36%
Latino: 51%
Asian: 0%
Caucasian: 4%
Other: 9%
Vereecken et al.; [41] To develop and assist Belgian preschools in the implementation of a healthy school policy and evaluate the impact of the intervention in children’s food consumption. Preschools (Belgium) 3-42 Intervention: Education low: 60% Education medium: 22% Education high: 18% Control: Education low: 57% Education medium: 26% Education high: 17% A two-days training was given to school staff. An educational package, including an educational map for the teachers, an educative story and educational material was developed. Food messages and newsletters directed at the school staff and parents were made available. Intervention Mapping
Williams et al.; [42] To evaluate the effects on a preschool nutrition education and food service intervention Preschools (USA) 2-52 Minority, primarily African-American: 67% Latino: 33% The majority lived in families with annual income below poverty lines. There was two intervention types; 1 with food service modification and nutrition education and 1 with food service modification and safety education. The nutrition education segment included a curriculum. The food service modification consisted of help to decrease the consumption of total and saturated fat. Not stated
  1. 1Mean; 2Range.