title: Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion.
abstract: During childhood and adolescence, a game could be an effective educational tool to learn healthy eating habits. We developed Kaledo, a new board game, to promote nutrition education and to improve dietary behavior. A two-group design with one pre-treatment assessment and two post-treatment assessments was employed. A total of 3,110 subjects (9-19 years old) from 20 schools in Campania, Italy, were included in the trial. In the treated group, the game was introduced each week over 20 consecutive weeks. Control group did not receive any intervention. The primary outcomes were (i) score on the "Adolescent Food Habits Checklist" (AFHC), (ii) scores on a dietary questionnaire, and (iii) BMI z-score. At the first post-assessment (6 months), the treated group obtained significantly higher scores than the control group on the AFHC (14.4 (95 % confidence interval (CI) 14.0 to 14.8) vs 10.9 (95 % CI 10.6 to -11.2); F(1,20) = 72.677; p < 0.001) and on four sections of the dietary questionnaire: "nutrition knowledge" (6.5 (6.4 to 6.6) vs 4.6 (4.5 to 4.7); F(1,16) = 78.763; p < 0.001), "healthy and unhealthy diet and food" (11.2 (11.0 to 11.4) vs 10.4 (10.3 to 10.6); F(1,32) = 21.324; p < 0.001), "food habits" (32.4 (32.0 to 32.8) vs 27.64 (27.3 to 28.0); F(1,26) = 195.039; p < 0.001), and "physical activity" (13.4 (13.2 to 13.7) vs 12.0 (11.8 to 12.6); F(1,20) = 20.765; p < 0.001). Moreover, the treated group had significantly lower BMI z-score with respect to the controls at the first (0.44 (0.42 to 0.46) vs 0.58 (0.56 to 0.59), F(1,18) = 16.584, p = 0.001) and at the second (18 months) (0.34 (0.30 to 0.38) vs 0.58 (0.54 to 0.62), F(1,13) = 7.577; p = 0.017) post-assessments.
  
  
  CONCLUSIONS
  Kaledo improved nutrition knowledge and dietary behavior over 6 months and had a sustained effect on the BMI z-score. Therefore, it may be used as an effective tool in childhood and adolescence obesity prevention programs.
authors.affiliation: Department of Experimental Medicine (Section of Human Physiology), Second University of Naples, Via De Crecchio, 8, 80138, Naples, Italy, alessandro.viggiano@unina2.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Viggiano
authors.forename: Emanuela
authors.initials: E
authors.lastname: Viggiano
authors.forename: Anna
authors.initials: A
authors.lastname: Di Costanzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Viggiano
authors.forename: Eleonora
authors.initials: E
authors.lastname: Andreozzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Romano
authors.forename: Ines
authors.initials: I
authors.lastname: Rianna
authors.forename: Claudia
authors.initials: C
authors.lastname: Vicidomini
authors.forename: Giuliana
authors.initials: G
authors.lastname: Gargano
authors.forename: Lucia
authors.initials: L
authors.lastname: Incarnato
authors.forename: Celeste
authors.initials: C
authors.lastname: Fevola
authors.forename: Pietro
authors.initials: P
authors.lastname: Volta
authors.forename: Caterina
authors.initials: C
authors.lastname: Tolomeo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Scianni
authors.forename: Caterina
authors.initials: C
authors.lastname: Santangelo
authors.forename: Roberta
authors.initials: R
authors.lastname: Battista
authors.forename: Marcellino
authors.initials: M
authors.lastname: Monda
authors.forename: Adela
authors.initials: A
authors.lastname: Viggiano
authors.forename: Bruno
authors.initials: B
authors.lastname: De Luca
authors.forename: Salvatore
authors.initials: S
authors.lastname: Amaro
mesh_terms: D000293:Adolescent; D002648:Child; D053198:Child Nutrition Sciences / Q000193:education* / Q000295:instrumentation*; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009752:Nutritional Status / Q000502:physiology*; D063766:Pediatric Obesity / Q000517:prevention & control; D012572:School Health Services