Wang 2007a.

Methods	Study design: cluster‐randomized controlled trial Study grouping: parallel group Study aim: "this study used the combination of school education and family education to carry out nutrition education activities. By comparing the effects of different education methods, we (1) analyze the independent role of schools and families, [and] (2) analyze the combined effect of school and family...We followed up the changes of nutrition knowledge, attitude, and practice (KAP) before and after education in accordance with the epidemiological prospective study method" (quote) [Chinese‐English translation] Study period: 1 school term; dates not specified Total number of arms: 3 Description of intervention arms: 1. Nutrition education for children and their parents (child + caregiver); 2. Nutrition education for children (child only); 3. Nutrition education for parents (not eligible) Number of clusters per arm: 1 Average cluster size: 492.33 children Sample size justification and outcome used: to detect a 5% increase in intake of soy‐based food products with a power of 90% and an alpha level of 0.05, approximately 138 children were needed per group. In consideration of clustering, study authors aimed to include 50% more children than required per sample size calculation Unit of allocation: school Missing data handling: missing values were excluded from scoring and statistical analyses Reported limitations: 1. Children may not have fully understood the questionnaire and may not have paid attention, leading to mistakes and missing responses Randomization ratio and stratification: 1:1:1:1; no stratification Participant compensation or incentives: not reported
Participants	Baseline characteristics Child + caregiver arm (intervention group) Female (PROGRESS‐Plus): not reported Age in years (PROGRESS‐Plus): not reported Race/ethnicity/language/culture (PROGRESS‐Plus): not reported Place of residence (PROGRESS‐Plus): not reported Caregiver education (PROGRESS‐Plus): not reported Religion (PROGRESS‐Plus): not reported Household income/socioeconomic status (PROGRESS‐Plus): not reported Social capital (PROGRESS‐Plus): not reported Caregiver work hours and other characteristics that may indicate disadvantage (PROGRESS‐Plus): not reported Disability (PROGRESS‐Plus): not reported Sexual orientation (PROGRESS‐Plus): not reported Child weight status: not reported Child diet: not reported Child physical activity: not reported Caregiver weight status: not reported Caregiver diet: not reported Caregiver physical activity: not reported Caregiver civil status (PROGRESS‐Plus): not reported Child‐only arm (control group) Female (PROGRESS‐Plus): not reported Age in years (PROGRESS‐Plus): not reported Race/ethnicity/language/culture (PROGRESS‐Plus): not reported Place of residence (PROGRESS‐Plus): not reported Caregiver education (PROGRESS‐Plus): not reported Religion (PROGRESS‐Plus): not reported Household income/socioeconomic status (PROGRESS‐Plus): not reported Social capital (PROGRESS‐Plus): not reported Caregiver work hours and other characteristics that may indicate disadvantage (PROGRESS‐Plus): not reported Disability (PROGRESS‐Plus): not reported Sexual orientation (PROGRESS‐Plus): not reported Child weight status: not reported Child diet: not reported Child physical activity: not reported Caregiver weight status: not reported Caregiver diet: not reported Caregiver physical activity: not reported Caregiver civil status (PROGRESS‐Plus): not reported Recruitment methods: not reported Inclusion criteria: clusters: elementary school located in Xuzhou City (schools randomly chosen); participant: child enrolled in third, fourth, or fifth grade at a participating school and caregiver Exclusion criteria: not reported Age of participating children at baseline: third to fifth grade (estimated to be 7 to 11 years old) Total number randomized by relevant group: total across all study arms: n = 1477; child + caregiver arm: n = 391; child‐only arm: n = 322 Baseline imbalances between relevant groups: not reported Total number analyzed by relevant group: number analyzed differed by outcome variable but for this review was assessed as the number of children with "behavior" data at the end of the intervention and included the following: total: n = 1091; child + caregiver arm: n = 297; child‐only arm: n = 252 Attrition by relevant group: attrition rates differed by variable but for this review were calculated by dividing the number of children without "behavior" data (which includes the habit of eating breakfast and spending on or consuming various foods) at the end of the intervention by the number of children with data at baseline: child + caregiver arm: 24.0% (94/391); child‐only arm: 21.7% (70/322) Description of sample for baseline characteristics reported above: not applicable
Interventions	Intervention characteristics Child + caregiver arm (intervention group) Brief name/description (TIDieR #1): school‐based nutrition education plus caregiver nutrition education Focus of intervention: diet Behavior change techniques: in addition to the child‐only intervention, the following technique was applied separately or differently in the child + caregiver arm: "shaping knowledge" Why: rationale, theory, or goal (TIDieR #2): no additional explanation was provided beyond that described for the child‐only arm How, where, and when and how much (TIDieR #6 to 8): in addition to the child‐only intervention, nutrition classes were provided to caregivers. The location, timing, and duration of the intervention were not specified Who: providers (TIDieR #5): "nutrition experts" and possibly other unspecified providers Economic variables and resources required for replication: not reported Strategies to address disadvantage: not reported Subgroups: not reported Assessment time points: baseline, 1 school term (length not specified; end of intervention) Co‐interventions: not reported What: materials and procedures (TIDieR #3 to 4): content of nutrition classes for caregivers was not specified Tailoring (TIDieR #9): not reported Modifications (TIDieR #10): not reported How well: planned and actual (TIDieR #11 to 12): not reported Sensitivity analyses: not reported Child‐only arm (control group) Brief name/description (TIDieR #1): school‐based nutrition education Focus of intervention: diet Behavior change techniques: "shaping knowledge," "comparison of outcomes" Why: rationale, theory, or goal (TIDieR #2): "elementary school students are in their development stage...Raising children's and adolescents' nutritional knowledge get help building better eating behavior" (quote). This work was based on the premise that the "focus should be on the earliest stage of habit formation" (quote) [Chinese‐English translation] How, where, and when and how much (TIDieR #6 to 8): intervention activities included lectures by nutrition experts, distribution of educational materials, and posting of a nutrition information board. It is unclear whether all children received all 3 components. The intervention took place during health education classes. The timing and duration of the intervention were not specified Who: providers (TIDieR #5): "nutrition experts" and possibly other unspecified providers Economic variables and resources required for replication: not reported Strategies to address disadvantage: not reported Subgroups: not reported Assessment time points: baseline, 1 school term (length not specified; end of intervention) Co‐interventions: not reported What: materials and procedures (TIDieR #3 to 4): content of nutrition lectures, educational materials, and nutrition information boards were not specified Tailoring (TIDieR #9): not reported Modifications (TIDieR #10): not reported How well: planned and actual (TIDieR #11 to 12): not reported Sensitivity analyses: not reported
Outcomes	The following instrument was used to measure outcomes relevant to this review at baseline and at end of school term (end of intervention) Children's dietary intake: questions on eating behavior (specific questions not reported) Data from end‐of‐intervention assessment were not reported.
Identification	Study name: not reported Country: China Setting: elementary schools in Xuzhuo City, China Types of reports: published journal article and Masters thesis Comments: used the following reports: Wang 2007b, as well as a thesis by Zhao 2006 Author's name: Cannan Wang Email: wcnseu@126.com Conflicts of interest: not reported Sponsorship source: Jiangsu Province Preventive Medicine Scientific Research Fund
Notes	Chinese‐English data extraction was completed by Yuan Chi and Andrew Ying
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation	Unclear risk	Judgment comment: information was insufficient to permit judgment
Allocation concealment	Unclear risk	Judgment comment: methods used to conceal the allocation sequence were not described
Blinding of participants and personnel All outcomes	Unclear risk	Judgment comment: no information on blinding of participants and personnel was provided. However, given the nature of the intervention, there would have been no way to blind participants and personnel. Also, the children were aged approximately 7 and 11 years, and their performance may or may not have been influenced by lack of blinding
Blinding of outcome assessment All outcomes	Unclear risk	Judgment comment: no information on blinding of outcome assessors was provided. Because data were reported by study participants, outcomes may or may not have been influenced by lack of blinding
Incomplete outcome data All outcomes	High risk	Judgment comment: we calculated attrition rates by dividing the number of participating children without behavior data at the end of the intervention by the number of children with data at baseline. Total attrition was 26.1% (386/1477) for the study overall and 22.0% (164/713) for the 2 relevant study arms. Differential attrition for the 2 relevant study arms was 2.3% (94/391 vs 70/322)
Selective reporting	High risk	Judgment comment: the trial was not registered and no protocol was cited that could be retrieved. Although dietary outcomes were measured, they did not align with dietary outcomes analyzed in this review
Recruitment bias	Low risk	Judgment comment: randomization was carried out after participant recruitment but before baseline data collection
Baseline imbalance	Unclear risk	Judgment comment: not reported; however, the distribution of female‐to‐male students was similar across study arms, as was the distribution of children by grade
Loss of clusters	Low risk	Judgment comment: no clusters were lost
Incorrect analysis	Unclear risk	Judgment comment: information was insufficient to permit judgment
Comparability with individually randomized trials	Unclear risk	Judgment comment: information was insufficient to permit judgment
Other sources of bias	Low risk	Judgment comment: we detected no other sources of bias