Activity and behavioral development in stunted and nonstunted children and response to nutritional supplementation. Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Children's food and activity patterns following a six-month child weight management program. Psychosocial correlates of physical activity in healthy children. Physical activity to prevent obesity in young children: cluster randomised controlled trial Effect of the Great Activity Programme on healthy lifestyle behaviours in 7–11 year olds A healthy school start - Parental support to promote healthy dietary habits and physical activity in children: Design and evaluation of a cluster-randomised intervention Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme Evaluation of a pilot school programme aimed at the prevention of obesity in children. The effects of a 2-year individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet in children. Relationships of physical activity with dietary behaviors among adults. Effects of an energy and micronutrient supplement on motor development and motor activity in undernourished children in Indonesia Intervention study shows suboptimal growth among children receiving a food supplement for five months in a slum in Bangladesh Movement skills and physical activity in obese children: randomized controlled trial. A controlled trial of health promotion programs in 11-year-olds using physical activity "enrichment" for higher risk children. Randomised trial of early diet in preterm babies and later intelligence quotient Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies.
It is frequently assumed that undernutrition in young children leads to poor development through reduced activity . 3 groups of 26 1-year-old stunted children were studied :  nutritional supplementation , supplementation with psychosocial stimulation , and controls .  26 nonstunted comparison children were also studied .  Activity levels were measured by extensive observation in the homes , and development using 4 subscales of the Griffith 's Mental Development Scales . Initially , stunted children were less active than nonstunted ones ( p < .01 ) , but after 6 months they caught up regardless of treatment . The mental ages of the stunted children were lower than those of the nonstunted children initially , and improved with either treatment . Initially , activity levels made a significant contribution to the variance in the locomotor subscale only , but not 6 months later . Activity did not predict change in development over 6 or 12 months , nor did change in activity over 6 months predict change in development over 12 months Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : OBJECTIVE To describe the impact of a parent-led , family-focused child weight management program on the food intake and activity patterns of pre-pubertal children . METHODS An assessor-blinded , r and omized controlled trial involving 111 ( 64 % female ) overweight , pre-pubertal children 6 - 9 years of age r and omly assigned to parenting-skills training plus intensive diet and activity education ( P + DA ) , parenting-skills training alone ( P ) , or a 12-month wait-listed control ( WLC ) . Study outcomes were assessed at baseline , 6 months , and 12 months . This paper presents data on food intake assessed via a vali date d 54-item parent-completed dietary question naire and activity behaviours assessed via a parent-report 20-item activity question naire . RESULTS Intake of energy-dense nutrient-poor foods was lower in both intervention groups at 6 months ( mean difference , P + DA - 1.5 serves [ CI - 2.0 ; -1.0 ] ; P - 1.0 serves [ -2.0 ; -0.5 ] ) and 12 months ( mean difference P + DA - 1.0 serves [ CI - 2.0 ; -0.5 ] ; P - 1.0 serves [ - 1.5 ; 0.0 ] ) compared to baseline . Intake of vegetables , fruit , breads and cereals , meat and alternatives and dairy foods remained unchanged . Regardless of study group there were significant reductions over time in the reported time spent engaged in small screen activities and an increase in the time reported spent in active play . CONCLUSION A child weight management intervention that promotes food intake in line with national dietary guidelines achieves a reduction in children 's intake of energy-dense , nutrient-poor foods . This was achieved without compromising intake of nutrient-rich food and changes were maintained even once the intervention ceased BACKGROUND Underst and ing the determinants of physical activity in children is critical for the treatment and prevention of childhood obesity . Social-cognitive theory has been used to underst and behavioral patterns in children . OBJECTIVES To explore the relationship between health beliefs , self-efficacy , social support , and sedentary activities and physical  activity levels in children and to examine the relationship between physical activity and  children 's  self-esteem . METHODS Ninety-two children aged 10 to 16 years completed the study .  Physical activity was monitored for 1 week with a motion detector ( Actitrac ; IM Systems , Baltimore , Md ) . Moderate-level activity and high-level activity were defined based on the results of treadmill testing . Health beliefs , self-efficacy , social influences , and time spent in sedentary behaviors were determined through question naires . Self-esteem was measured using the Piers-Harris Children 's Self-Concept Scale . Chronic anxiety was measured with the Revised Children 's Manifest Anxiety Scale . RESULTS There was a significant decline in physical activity levels between ages 10 and 16 years , particularly in girls . Preteen girls spent approximately 35 % more time in low- and high-level activity than did teenage girls ( P<.001 ) . Overall , children spent 75.5 % of the day inactive , with a mean + /- SD of 5.2 + /- 1.8 hours watching television , sitting at the computer , and doing homework . In contrast , only 1.4 % of the day ( 12.6 + /- 12.2 minutes ) was spent in vigorous activity . Time spent in sedentary behaviors was inversely correlated with the amount of moderate-level activity ( P<.001 ) but not high-level activity . In contrast , time spent in high-level activity correlated with self-efficacy scores ( P<.001 ) and social influences scores ( P<.005 ) . High-level physical activity was also associated with improved self-esteem ( P<.05 ) . Higher health beliefs scores were not correlated with physical activity levels . CONCLUSIONS Children and adolescents are largely sedentary . Correlates of high- and low-level physical activity are different . Time spent on sedentary activities is inversely correlated with moderate-level activity , while self-efficacy and social influences are positively correlated with more intense physical activity . In addition , increased high-level physical activity is an important component in the development of self-esteem in children Objective To assess whether a physical activity intervention reduces body mass index in young children . Design Cluster r and omised controlled single blinded trial over 12 months . Setting Thirty six nurseries in Glasgow , Scotl and . Participants 545 children in their preschool year , mean age 4.2 years ( SD 0.2 ) at baseline . Intervention Enhanced physical activity programme in nursery ( three 30 minute sessions a week over 24 weeks ) plus home based health education aim ed at increasing physical activity through play and reducing sedentary behaviour . Main outcome measure Body mass index , expressed as a st and ard deviation score relative to UK 1990 reference data . Secondary measures were objective ly measured physical activity and sedentary behaviour ; fundamental movement skills ; and evaluation of the process . Results Group allocation had no significant effect on the primary outcome measure at six and 12 months or on measures of physical activity and sedentary behaviour by accelerometry . Children in the intervention group had significantly higher performance in movement skills tests than control children at six month follow-up ( P=0.0027 ; 95 % confidence interval 0.3 to 1.3 ) after adjustment for sex and baseline performance . Conclusions Physical activity can significantly improve motor skills but did not reduce body mass index in young children in this trial . Trial registration Current Controlled Trials IS RCT N36363490 Abstract The study investigated the effect of a school-based healthy lifestyles intervention on physical activity and dietary variables . In total 378 children ( 177 intervention , 201 control ; age 9.75 ± 0.82 years ( mean ± s ) ) took part in the 7-month intervention comprising : preparation for and participation in 3 highlight events ( a dance festival , a walking event and a running event ) ; an interactive website for pupils , teachers and parents ; and vacation activity planners . Primary outcome measures were objective ly measured physical activity ( pedometers and accelerometers ) , endurance fitness and dietary variables . Multi-level modelling was employed for data analysis . The increase in physical activity was greater in the intervention group than the control group ( steps : 1049 vs 632 daily steps each month ; moderate to vigorous physical activity ( MVPA ) total : 4.6 min · day−1 · month−1 vs 1.3 min · day−1 · month−1 ; MVPA bouts : 5.4 min · day−1 · month−1 vs 2.6 min · day−1 · month−1 ; all P < 0.05 ) . The increase in multi-stage fitness test distance was greater for intervention participants ( 46 vs 29 m · month−1 of intervention , group × month interaction , P < 0.05 ) . There were no differences between groups in dietary variables , body composition , knowledge of healthy lifestyles or psychological variables . Thus an intervention centred around highlight events and including relatively few additional re sources can impact positively on the objective ly measured physical activity of children Background Childhood obesity is multi-factorial and determined to a large extent by dietary habits , physical activity and sedentary behaviours . Previous research has shown that school-based programmes are effective but that their effectiveness can be improved by including a parental component . At present , there is a lack of effective parental support programmes for improvement of diet and physical activity and prevention of obesity in children . Methods / Design This paper describes the rationale and design of a parental support programme to promote healthy dietary habits and physical activity in six-year-old children starting school . The study is performed in close collaboration with the school health care and is design ed as a cluster-r and omised controlled trial with a mixed methods approach . In total , 14 pre-school classes are included from a municipality in Stockholm county where there is large variation in socio-economic status between the families . The school classes are r and omised to intervention ( n = 7 ) and  control ( n = 7 ) groups including a total of 242 children . The intervention is based on social cognitive theory and consists of three main components : 1 ) a health information brochure ; 2 ) two motivational interviewing sessions with the parents ; and 3 ) teacher-led classroom activities with the children . The primary outcomes are physical activity in the children measured objective ly by accelerometry , children 's dietary and physical activity habits measured with a parent-proxy question naire and parents ' self-efficacy measured by a question naire . Secondary outcomes are height , weight and waist circumference in the children . The duration of the intervention is six months and includes baseline , post intervention and six months follow-up measurements . Linear and logistic regression models will be used to analyse differences between intervention and control groups in the outcome variables . Mediator and moderator analysis will be performed . Participants will be interviewed . Discussion The results from this study will show if it is possible to promote a healthy lifestyle and a normal weight development among children from low-income districts with relatively limited efforts involving parents . Hopefully the study will provide new insights to the further development of effective programmes to prevent overweight and obesity in children . Trial registration IS RCT N : IS RCT Objectives To assess the behavioural and weight status outcomes in English children in a feasibility study of a novel primary school-based obesity prevention programme . Design Exploratory cluster r and omised controlled trial of the Healthy Lifestyles Programme . Setting Four city primary schools ( two control and two intervention ) in the South West of Engl and . Participants 202 children aged 9–10 years , of whom 193 and 188 were followed up at 18 and 24 months , respectively . No child was excluded from the study ; however , to be eligible , schools were required to have at least one single Year 5 class . Intervention Four-phase multicomponent programme using a range of school-based activities including lessons , assemblies , parents ' evenings , interactive drama workshops and goal setting to engage and support schools , children and their families in healthy lifestyle behaviours . It runs over the spring and summer term of Year 5 and the autumn term of Year 6 . Primary and secondary outcomes Weight status outcomes were body mass index , waist circumference and body fat st and ard deviation scores ( SDS ) at 18 and 24 months , and behavioural outcomes were physical activity , television ( TV ) viewing/screen time and food intake at 18 months . Results At 18 months of follow-up , intervention children consumed less energy-dense snacks and more healthy snacks ; had less ‘ negative food markers ’ , more ‘ positive food markers ’ , lower mean TV/screen time and spent more time doing moderate-vigorous physical activity each day than those in the control schools . Intervention children had lower anthropometric measures at 18 and 24 months than control children , with larger differences at 24 months than at 18 months for nearly all measures . Conclusions Results from this exploratory trial show consistent positive changes in favour of the intervention across all targeted behaviours , which , in turn , appear to affect weight status and body shape . A definitive trial is now justified This paper describes the development , implementation and evaluation of a school- and family-based intervention to prevent obesity in children aged 5 - 7 years . In addition , the efficacy of three different intervention programmes was compared . Children aged 5 - 7 years ( n=213 ) were recruited from three primary schools in Oxford and r and omly allocated to a control group or one of three intervention groups : nutrition group , physical activity group , and combined nutrition and physical activity group . The setting for the interventions was lunchtime clubs , where an interactive and age-appropriate nutrition and /or physical activity curriculum was delivered . The intervention lasted for 20 weeks over four school terms ( approximately 14 months ) . Children 's growth , nutrition knowledge , diet and physical activity were assessed at baseline and at the end of the intervention . Significant improvements in nutrition knowledge were seen in all children ( p<0.01 ) between baseline and post-intervention , and results were highly significant in the nutrition and combined group ( p<0.001 ) . Overall , fruit and vegetable intake increased significantly ( p<0.01 and < 0.05 , respectively ) , with changes seen in fruit consumption in the nutrition group ( p<0.05 ) and the control group ( p<0.05 ) in particular . No significant changes in the rates of overweight and obesity were seen as a result of the intervention . Gender differences were not detected in the majority of assessment s and there was no clear effect of programme type per se . This pilot study has demonstrated that school may be a suitable setting for the promotion of healthy lifestyles in children , but requires replication in other social setting s. Future initiatives should be long-lasting , multi-faceted and sustainable , involving all children in a school , and should target the whole environment and be behaviourally focused . The ultimate goal of any such programme is to lead to positive behaviour change which will have a beneficial effect on long-term health . Successful targeting of the family remains a challenge to such interventions OBJECTIVE To investigate the effects of a long-term , individualized and family-based lifestyle intervention on physical activity , sedentary behavior and diet quality in children . METHODS We carried out a 2-year intervention study in a population sample of 506 children aged 6 - 8years in Finl and in 2007 - 2012 . We allocated the participants at baseline in the intervention and control group . We assessed  physical activity and sedentary behavior  by question naires and diet by food records . RESULTS Total physical activity ( + 9min/d in intervention group vs. -5min/d in control group , p=0.001 for time*group interaction ) , unsupervised physical activity ( + 7min/d vs. -9min/d , p<0.001 ) and organized sports ( + 8min/d vs. + 3min/d , p=0.001 ) increased in the intervention group but not in the control group . Using computer and playing video games increased less in the intervention group than in the control group ( + 9min/d vs. + 19min/d , p=0.003 ) . Consumption of vegetables ( + 12g/d vs. -12g/d , p=0.001 ) ,  high-fat vegetable-oil based margarine ( + 10g/d vs. + 3g/d , p<0.001 ) and low-fat milk ( + 69g/d vs. + 11g/d , p=0.042 ) and intake of dietary fiber ( + 1.3g/d vs. + 0.2g/d , p=0.023 ) , vitamin C ( + 4.5mg/d vs. -7.2mg/d , p=0.042 ) and vitamin E ( + 1.4mg/d vs. + 0.5mg/d , p=0.002 ) increased in the intervention group but not in the control group . Consumption of butter-based spreads increased in the control group but not in the intervention group ( + 2g/d vs. -1g/d , p=0.002 ) . CONCLUSIONS Individualized and family-based lifestyle intervention increased physical activity , attenuated increase in sedentary behavior and enhanced diet quality  in children . TRIAL REGISTRATION Clinical Trials.gov : NCT01803776 BACKGROUND Physical activity and diet are important influences on health , but few data are available about the relationship between these two factors . The purpose of this study was to examine relationships between physical activity and  dietary quality  and to identify determinants of the combination of sedentary behavior and suboptimal diet . METHODS The design of this study was cross-sectional . The setting was a large managed-care organization and the participants were 1,322 racially diverse men and women ages 25 - 91 years . We categorized subjects ' physical activity into vigorous , moderate , and sedentary based on answers to two vali date d interviewer-administered questions about intensity and duration of specified activities . Dietary assessment was by means of a vali date d short food frequency question naire . We defined suboptimal diet as consuming unhealthful quantities of at least two of the following five food groups : fruits , vegetables , whole grain foods , whole-fat dairy foods , and red and processed meats . RESULTS Seven hundred fifty-four ( 57 % ) subjects were sedentary and 617 ( 47 % ) consumed a suboptimal diet . Using multiple linear regression , we found that sedentary individuals consumed smaller amounts of foods and nutrients considered to be healthful , such as fruits and vegetables , fiber , calcium , folate , and vitamins A , C , and E , than more active participants . For nutrients considered to be harmful , such as saturated fat , trans fat , and dietary cholesterol , the association with physical activity was inverse . In multiple logistic regression analyses , the strongest sociodemographic correlates of the joint presence of inactivity and poor diet were less education [ odds ratio for 1-year decrease 1.14 ( 95 % confidence interval 1.06 , 1.22 ) ] , nonwhite race [ 1.48 ( 1.05 , 2.07 ) ] , and nonmarried status [ 1.49 ( 1.06 , 2.10 ) ] . CONCLUSIONS  Physical activity and diet quality  are correlated behaviors . Suboptimal diet and sedentary behavior tend to cluster in individuals who are less educated , not married , and of nonwhite race . Programs that target diet and activity together , informed by their joint determinants , may attain enhanced outcomes Objectives : This paper reports the effects of an energy and micronutrient supplement on the motor development , motor milestones and motor activity of nutritionally at risk infants and toddlers in Pangalengan , Indonesia . Design : Two cohorts of children were r and omly assigned to three treatments E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Evaluations of intake were made at baseline and every 2 months thereafter . Motor development was assessed with the Bayley Scale and with a custom-made scale to assess gross motor development leading to bipedal locomotion . Motor activity was assessed through 4 h continuous observations of the child ’s interaction with the social and physical environment . Results : In the 12-month-old cohort , as compared to the M and S groups the children that received the E supplement walked at an earlier age , had higher scores in the Bayley Scale and were motorically more active . Similar intergroup differences were observed in the 18-month-old cohort in the total motor activity score . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , This study assessed weight and height changes among underweight children who received a locally produced , cereal‐based , ready‐to‐use supplementary food PURPOSE The purpose of this study was to evaluate the Hunter Illawarra Kids Challenge Using Parent Support physical activity program in overweight children . METHODS A multisite r and omized controlled trial was conducted with three intervention arms : 1 ) child-centered physical activity skill development program ( Activity ) , 2 ) parent-centered dietary modification program ( DIET ) , or 3 ) both programs combined ( PA+DIET ) .  Movement skill proficiency , perceived athletic competence , accelerometer-assessed physical activity , and parent-reported time spent in screen behaviors were assessed at baseline , 6 months , and 12 months in 165 prepubertal children aged 5.5 - 9 yr ( 59 % girls , 78 % obese ) . Differences in changes in outcomes between groups were assessed using linear mixed models . RESULTS Compared with the diet group , the activity group ( mean ( 95 % confidence interval ) : + 7.7 units ( 3.8 - 11.6 units ) ) and the activity + diet group ( + 6.7 units ( 2.9 - 10.5 units ) ) displayed 11%-13 % greater improvement in overall movement skill proficiency ( gross motor quotient ) at 6 months . Perceived athletic competence increased across groups at follow-up ( across groups : 6 months = + 0.21 units ( 0.11 - 0.31 units ) , 12 months = + 0.21 units ( 0.07 - 0.35 units ) ) . Groups did not differ statistically for change in physical activity outcomes . Total screen time ( min·wk(-1 ) ) decreased in all groups at 6 months ( across groups : -385.4 ( -501.0 to -269.8 ) ) and in the activity group ( -261.8 ( -470.5 to -53.1 ) ) and activity + diet group ( -340.5 ( -534.6 to -146.4 ) ) at 12 months . The diet group reported greater reductions in TV or DVD viewing time at 6 months compared with the activity group ( 248.6 ( 24.0 - 473.3 ) ) . CONCLUSIONS The activity and the activity + diet programs were efficacious in improving overweight children 's movement skill proficiency . All programs were efficacious in reducing time spent in screen behaviors . Other correlates may need to be targeted in addition to movement skills to increase physical activity among overweight children OBJECTIVE To evaluate the short and long term benefits of a school and home based physical activity " enrichment " program for children at higher risk of cardiovascular disease as identified by cluster analysis . STUDY DESIGN During two 10-week school terms , 800 11-year-olds took part in a r and omized controlled trial with the st and ard physical activity and nutrition program in six schools , the st and ard program in a further seven schools  but with the addition of physical activity enrichment for higher risk children in those schools  , and no program in five control schools . Cluster analysis identifying the 29 % or so highest risk children used systolic blood pressure , percent body fat , physical fitness , and blood cholesterol . RESULTS Fitness improved significantly in program schools , particularly with enrichment in higher risk boys . Substantial improvements persisted 6 months later in girls from program schools . At " Enrichment " schools , cholesterol showed significant benefits in higher risk girls and , 6 months later , in both boys and higher risk girls . Sodium intake and , in girls , subscapular skinfolds were lower in " Enrichment " schools when the program ended , but not 6 months later . CONCLUSION Two-semester health programs with physical activity enrichment for higher risk children can produce benefits sustained for at least 6 months . Improvements extend to lower risk children exposed indirectly to the enrichment . Attenuation of effects on diet and body composition in the longer-term suggest the need for on-going programs abstract Objectives : To determine whether perinatal nutrition influences cognitive function at 7 1/2 - 8 years in children born preterm . Design : R and omised , blinded nutritional intervention trial . Blinded follow up at 7 1/2 - 8 years . Setting : Intervention phase in two neonatal units ; follow up in a clinic or school setting . Subjects : 424 preterm infants who weighed under 1850 g at birth ; 360 of those who survived were tested at 7 1/2 - 8 years . Interventions : St and ard infant formula versus nutrient enriched preterm formula r and omly assigned as sole diet ( trial A ) or supplements to maternal milk ( trial B ) fed for a mean of 1 month . Main outcome measures : Intelligence quotient ( IQ ) at 7 1/2 - 8 years with abbreviated Weschler intelligence scale for children ( revised ) . Results : There was a major sex difference in the impact of diet . At 7 1/2 - 8 years boys previously fed st and ard versus preterm formula as sole diet had a 12.2 point disadvantage ( 95 % confidence interval 3.7 to 20.6 ; P<0.01 ) in verbal IQ . In those with highest intakes of trial diets corresponding figures were 9.5 point disadvantage and 14.4 point disadvantage in overall IQ ( 1.2 to 17.7 ; P<0.05 ) and verbal IQ ( 5.7 to 23.2 ; P<0.01 ) . Consequently , more infants fed term formula had low verbal IQ ( < 85 ) : 31 % versus 14 % for both sexes ( P=0.02 ) and 47 % versus 13 % in boys P=0.009 ) . There was a higher incidence of cerebral palsy in those fed term formula ; exclusion of such children did not alter the findings . Conclusions : Preterm infants are vulnerable to suboptimal early nutrition in terms of their cognitive performance — notably , language based skills — at 7 1/2 - 8 years , when cognitive scores are highly predictive of adult ones . Our data on cerebral palsy generate a new hypothesis that suboptimal nutritional management during a critical or plastic early period of rapid brain growth could impair functional compensation in those sustaining an earlier brain insult . Cognitive function , notably in males , may be permanently impaired by suboptimal neonatal nutrition The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight
A healthier dietary pattern was associated with better cognitive outcomes in all studies , although some of the reported associations were weak and the measures used varied across the studies .
Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes  in young children .
Objective Given the high prevalence of suboptimal nutrition and low activity levels in children , we systematic ally review ed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood ( six months to five years ) .