Public Health Nutrition


Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial

Freia De Bocka1a2 c1, Luise Breitensteina1 and Joachim E Fischera1

a1 Competence Center for Social Medicine and Occupational Health Promotion, Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl-Strasse 7–11, D-68167 Mannheim, Germany

a2 Children's Hospital, University Medicine Mannheim, Heidelberg University, Mannheim, Germany


Objective To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children.

Design Using a cluster-randomized study design with waiting-list controls, we tested a 6-month intervention administered once weekly by a nutrition expert consisting of joint meal preparation and activities for children and parents such as tasting and preparing nutritious, fresh foods. At baseline, 6 and 12 months, a parent-completed questionnaire assessed fruit and vegetable intakes (primary outcomes) and water and sugared drinks consumption (secondary outcomes). Direct measurement assessed BMI, skinfold thickness and waist-to-height-ratio. An intention-to-treat analysis used random-effects panel regression models to assess the intervention effect, adjusted for each child's age, gender, immigrant background and maternal education.

Setting Eighteen pre-schools from three south German regions.

Subjects Healthy children aged 3–6 years.

Results Three hundred and seventy-seven (80 %) eligible pre-school children participated in the study. Of these, 348 provided sufficient data for analysis. The sample mean age was 4·26 (sd 0·78) years; the majority (53·2 %) were boys. Children's fruit and vegetable intakes increased significantly (P < 0·001 and P < 0·05, respectively); no significant changes in the consumption of water, sugared drinks or anthropometric measurements were noted.

Conclusions Nutritional interventions in pre-schools have the potential to change eating behaviours in young children, which in the long term might reduce risk for developing overweight.

(Received November 19 2010)

(Accepted June 25 2011)

(Online publication August 23 2011)


c1 Corresponding author: Email