Summary of findings 3. Combined dietary and physical activity interventions with a caregiver component compared to interventions without a caregiver component for improving children's dietary intake and physical activity behaviors.
| Combined dietary and physical activity interventions with a caregiver component compared to interventions without a caregiver component for improving children's dietary intake and physical activity behaviors | ||||||
| Patient or population: children aged 4 to 14 years Setting: child + caregiver arm: home, school, not reported; child‐only arm: school, community Intervention: combined dietary and physical activity interventions with a caregiver component Comparison: combined dietary and physical activity interventions without a caregiver component | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk—combined dietary and physical activity interventions without a caregiver component | Corresponding risk—combined dietary and physical activity interventions with a caregiver component | |||||
|
Children's percentage of total energy intake from saturated fat Measured by food frequency questionnaire and 24‐hour recall Follow‐up: end of intervention (9 months) |
Mean percentage of total energy intake from saturated fat in the control group was 10.34% | Mean percentage of total energy intake from saturated fat in the intervention groups was0.06% higher (0.67 lower to 0.80 higher) | ‐ | 216 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | WHO recommends that intake of saturated fat is less than 10% of total energy intake (WHO 2018) |
|
Children's sodium intake (mg/d) Measured by 24‐hour recall Follow‐up: end of intervention (2.5 months and 2.5 years) |
Mean sodium intake in the control group was 3112.11 mg/d | Mean sodium intake in the intervention group was 35.94 mg/d more (322.60 fewer to 394.47 more) | ‐ | 315 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | WHO recommends that adults consume less than 2 grams of sodium per day. This estimate should be adjusted downward for children based on their energy requirements (WHO 2018) |
|
Children's fruit and vegetable intake (servings/d) Measured by food frequency questionnaire Follow‐up: end of intervention (3 years) |
Mean fruit and vegetable intake in the control group was 1.84 servings/d | Mean fruit and vegetable intake in the intervention group was 0.38 servings/d more (0.51 fewer to 1.27 more) | ‐ | 134 (1 RCT) | ⊕⊝⊝⊝ Very lowa,c,d | WHO recommends consuming more than 400 grams of fruit and vegetables per day (WHO 2018) |
|
Children's SSB intake (SSB drinks/d, soft drink glasses/d and regular soda servings/d) Measured by questionnaires Follow‐up: end of intervention (9 months, 21 months, and 3 years) |
‐ | Mean SSB intake in the intervention group was 0.28 standard deviations lower (0.44 lower to 0.12 lower) | ‐ | 651 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | WHO recommends reducing consumption of SSB. The recommendation for intake of free sugars is less than 10% of total energy intake (WHO 2018) The observed standard deviation of 0.28 probably represents a small, significant difference between arms |
|
Children's total physical activity (min/d) Measured by questionnaires Follow‐up: end of intervention (21 months and 2.5 years) |
Mean total physical activity score in the control group was 135.54 min/d | Mean total physical activity score in the intervention group was 1.81 min/d more (15.18 less to 18.8 more) | ‐ | 573 (2 RCTs) | ⊕⊕⊝⊝ Lowa,c | WHO recommends that physical activity beyond 60 minutes of MVPA per day provides additional benefits (WHO 2010) |
|
Children's MVPA (min/d) Measured by questionnaire Follow‐up: end of intervention (2.5 years) |
Mean MVPA score in the control group was 123.97 min/d | Mean MVPA score in the intervention group was 0.05 min/d less (18.57 less to 18.47 more) | ‐ | 622 (1 RCT) | ⊕⊝⊝⊝ Very lowa,c,d | WHO recommends that youth aged 5 to 17 years should do at least 60 minutes of MVPA daily (WHO 2010) |
| Adverse effects (not reported by intervention arm) | ‐ | ‐ | ‐ | ‐ | ‐ | No studies reported data for adverse effects by intervention arm |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MVPA: moderate to vigorous physical activity; RCT: randomized controlled trial; SSB: sugar‐sweetened beverage; WHO: World Health Organization. | ||||||
| GRADE Working Group grades of evidence. High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by one level for risk of bias: high attrition. bDowngraded by one level for indirectness: small effective sample size. cDowngraded by one level for imprecision: CI includes both potentially important benefits and potentially important harms. dDowngraded by one level for indirectness: one trial only.