Skip to main content

Advertisement

SpringerLink
Log in

Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

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. Conclusion: 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Amaro S, Viggiano A, Costanzo A, Madeo I, Viggiano A, Baccari ME, Marchitelli E, Raia M, Viggiano E, Deepak S, Monda M, Luca B (2006) Kalèdo, a new educational board-game, gives nutritional rudiments and encourages healthy eating in children: a pilot cluster randomized trial. Eur J Pediatr 165:630–635. doi:10.1007/s00431-006-0153-9

    Article  PubMed  Google Scholar 

  2. Baranowski T, Baranowski J, Cullen KW, Marsh T, Islam N, Zakeri I, Honess-Morreale L, deMoor C (2003) Squire’s Quest! Dietary outcome evaluation of a multimedia game. Am J Prev Med 24:52–61

    Article  PubMed  Google Scholar 

  3. Bartfay WJ, Bartfay E (1994) Promoting health in schools through a board game. West J Nurs Res 16:438–446. doi:10.1177/019394599401600408

    Article  CAS  PubMed  Google Scholar 

  4. Baur LA, Hazelton B, Shrewsbury VA (2011) Assessment and management of obesity in childhood and adolescence. Nat Rev Gastroenterol Hepatol 8:635–645. doi:10.1038/nrgastro.2011.165

    Article  CAS  PubMed  Google Scholar 

  5. Binkin N, Fontana G, Lamberti A, Cattaneo C, Baglio G, Perra A, Spinelli A (2010) A national survey of the prevalence of childhood overweight and obesity in Italy. Obes Rev 11:2–10. doi:10.1111/j.1467-789X.2009.00650.x

    Article  CAS  PubMed  Google Scholar 

  6. Biro FM, Huang B, Morrison JA, Horn PS, Daniels SR (2010) BMI, BMI indices, and waist-to-height changes during teen years in girls are influenced by childhood BMI. J Adolesc Health 46:245–250. doi:10.1016/j.jadohealth.2009.06.023

    Article  PubMed Central  PubMed  Google Scholar 

  7. Blakely G, Skirton H, Cooper S, Allum P, Nelmes P (2009) Educational gaming in the health sciences: systematic review. J Adv Nurs 65:259–269

  8. Bonati M, Campi R (2005) What can we do to improve child health in southern Italy? PLoS Med 2:e250. doi:10.1371/journal.pmed.0020250

    Article  PubMed Central  PubMed  Google Scholar 

  9. Cacciari E, Milani S, Balsamo A, Dammacco F, De Luca F, Chiarelli F, Pasquino AM, Tonini G, Vanelli M (2002) Italian cross-sectional growth charts for height, weight and BMI (6-20 y). Eur J Clin Nutr 56:171–180. doi:10.1038/sj.ejcn.1601314

    Article  CAS  PubMed  Google Scholar 

  10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Cole TJ, Faith MS, Pietrobelli A, Heo M (2005) What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile? Eur J Clin Nutr 59:419–425. doi:10.1038/sj.ejcn.1602090

    Article  CAS  PubMed  Google Scholar 

  12. Committee on School Health (2004) Soft drinks in schools. Pediatrics 113:152–154

    Article  Google Scholar 

  13. Contento I, Balch G, Bronner Y, Lytle L, Maloney S, Olson C (1995) Special issue—the effectiveness of nutrition education and implications for nutrition education policy, programs and research: a review of research. J Nutr Educ 27:277–422

    Google Scholar 

  14. Contento IR, Randell JS, Basch CE (2002) Review and analysis of evaluation measures used in nutrition education intervention research. J Nutr Educ Behav 34:2–25

    Article  PubMed  Google Scholar 

  15. Cullen KW, Watson K, Baranowski T, Baranowski JH, Zakeri I (2005) Squire’s Quest: intervention changes occurred at lunch and snack meals. Appetite 45:148–151

    Article  PubMed  Google Scholar 

  16. Flodmark C-E, Marcus C, Britton M (2006) Interventions to prevent obesity in children and adolescents: a systematic literature review. Int J Obes (Lond) 30:579–589. doi:10.1038/sj.ijo.0803290

    Article  Google Scholar 

  17. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH (2007) Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 150:12–17

    Article  PubMed  Google Scholar 

  18. Gillis L (2003) Use of an interactive game to increase food acceptance—a pilot study. Child Care Health Dev 29:373–375

    Article  CAS  PubMed  Google Scholar 

  19. Johnson F, Wardle J, Griffith I (2002) The adolescent food habits checklist: reliability and validity of a measure of healthy eating behaviour in adolescents. Eur J Clin Nutr 56:644–649

    Article  CAS  PubMed  Google Scholar 

  20. Johnson-Taylor WL, Everhart JE (2006) Modifiable environmental and behavioral determinants of overweight among children and adolescents: report of a workshop. Obesity 14:929–966. doi:10.1038/oby.2006.109

    Article  PubMed  Google Scholar 

  21. Lakshman RR, Sharp SJ, Ong KK, Forouhi NG (2010) A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial. BMC Public Health 10:123. doi:10.1186/1471-2458-10-123

    Article  PubMed Central  PubMed  Google Scholar 

  22. Micciolo R, Di Francesco V, Fantin F, Canal L, Harris TB, Bosello O, Zamboni M (2010) Prevalence of overweight and obesity in Italy (2001-2008): is there a rising obesity epidemic? Ann Epidemiol 20:258–264. doi:10.1016/j.annepidem.2010.01.006

    Article  PubMed  Google Scholar 

  23. Murray DM (2001) Statistical models appropriate for designs often used in group-randomized trials. Stat Med 20:1373–1385

    Article  CAS  PubMed  Google Scholar 

  24. Murray DM, Hannan PJ, Wolfinger RD, Baker WL, Dwyer JH (1998) Analysis of data from group-randomized trials with repeat observations on the same groups. Stat Med 17:1581–1600

    Article  CAS  PubMed  Google Scholar 

  25. Naser KA, Gruber A, Thomson GA (2006) The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster? Int J Clin Pract 60:1093–1097. doi:10.1111/j.1742-1241.2006.01003.x

    Article  CAS  PubMed  Google Scholar 

  26. Prentice AM (2006) The emerging epidemic of obesity in developing countries. Int J Epidemiol 35:93–99. doi:10.1093/ije/dyi272

    Article  PubMed  Google Scholar 

  27. Siervogel RM, Demerath EW, Schubert C, Remsberg KE, Chumlea WC, Sun S, Czerwinski SA, Towne B (2003) Puberty and body composition. Horm Res 60:36–45. doi:10.1159/000071224

    Article  CAS  PubMed  Google Scholar 

  28. Silveira JA, Taddei JA, Guerra PH, Nobre MR (2013) The effect of participation in school-based nutrition education interventions on body mass index: a meta-analysis of randomized controlled community trials. Prev Med 56:237–243. doi:10.1016/j.ypmed.2013.01.011

    Article  PubMed  Google Scholar 

  29. Singh AS, Mulder C, Twisk JWR, Van Mechelen W, Chinapaw MJM (2008) Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 9:474–488. doi:10.1111/j.1467-789X.2008.00475.x

    Article  CAS  PubMed  Google Scholar 

  30. Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ (2005) Interventions for preventing obesity in children. Cochrane Database Syst Rev CD001871. doi:10.1002/14651858.CD001871.pub2

  31. Turconi G, Celsa M, Rezzani C, Biino G, Sartirana MA, Roggi C (2003) Reliability of a dietary questionnaire on food habits, eating behaviour and nutritional knowledge of adolescents. Eur J Clin Nutr 57:753–763. doi:10.1038/sj.ejcn.1601607

    Article  CAS  PubMed  Google Scholar 

  32. Turnin MC, Tauber MT, Couvaras O, Jouret B, Bolzonella C, Bourgeois O, Buisson JC, Fabre D, Cance-Rouzaud A, Tauber JP, Hanaire-Broutin H (2001) Evaluation of microcomputer nutritional teaching games in 1,876 children at school. Diabetes Metab 27:459–464

    CAS  PubMed  Google Scholar 

  33. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD (2011) Interventions for preventing obesity in children. Cochrane Database Syst Rev CD001871. doi:10.1002/14651858.CD001871.pub3

  34. Zheng W, Suzuki K, Sato M, Yokomichi H, Shinohara R, Yamagata Z (2014) Adolescent growth in overweight and non-overweight children in Japan: a multilevel analysis. Paediatr Perinat Epidemiol 28:263–269. doi:10.1111/ppe.12116

    Article  PubMed  Google Scholar 

  35. (2010) Italian National Survey “OKkio alla SALUTE.” http://www.epicentro.iss.it/okkioallasalute/ReportRegionali2010.asp. Accessed 20 Mar 2012

Download references

Acknowledgments

Kaledo was patented by Bruno De Luca and Salvatore Amaro as members of the non-profit organization Associazione Culturale Kaledo. At present, this national patent has expired.

Authors have no conflict of interest to declare. This research was funded by Second University of Naples, Associazione Culturale Kaledo, Regione Campania (Assessorato all’Istruzione), Provincia di Napoli, Provincia di Salerno Assessorato allo Sport, Comune di Cercola (Assessorato all’istruzione) and Fondazione per l’Assistenza all’Infanzia.

The authors would like to thank the school principals and the teachers of the schools Bordiga I (Naples), Matilde Serao (Volla-NA), Giovanni Falcone (Volla-NA), Caravita (Cercola-NA), S. Alfonso (Pagani-SA), Eduardo De Filippo (Sant’Egidio del Monte-SA), A. Genovesi (Nocera Inferiore-SA), SMS Marconi (S. Giorgio a Cremano-NA), Bordiga III (Naples), Antonio Custra (Cercola-NA), SMS Aniello Criscuolo (Pagani-SA), Quasimodo (Salerno), IPIA (Naples), Istituto Agrario De Cillis (Naples), Liceo Scientifico Portici (Portici-NA), ITIS Marconi (Nocera Inferiore-SA), ITIS San Giorgio (S. Giorgio a Cremano-NA), ITIS Galilei (Nocera Inferiore-SA), and Liceo Regina Margherita (Salerno) for their collaboration and free participation in the research. We also thank the editor and the anonymous reviewers for their constructive comments, which helped us to improve the manuscript. Finally, we would like to thank Fr. Salvatore Coppola who coined the word Kaledo from the ancient Greek words χαλως εδω (eating well).

Author information

Authors and Affiliations

  1. Department of Experimental Medicine (Section of Human Physiology), Second University of Naples, Via De Crecchio, 8, 80138, Naples, Italy

    Alessandro Viggiano, Emanuela Viggiano, Eleonora Andreozzi, Giuliana Gargano, Lucia Incarnato, Celeste Fevola, Pietro Volta, Caterina Tolomeo, Giuseppina Scianni, Caterina Santangelo, Roberta Battista, Marcellino Monda, Adela Viggiano, Bruno De Luca & Salvatore Amaro

  2. ASL NA1 center DSB32, Naples, Italy

    Anna Di Costanzo

  3. Department of Medicine and Surgery, University of Salerno, Salerno, Italy

    Andrea Viggiano

  4. High School Filippo Silvestri, Naples, Italy

    Vincenzo Romano

  5. School Giovanni Falcone, Volla (Naples), Italy

    Ines Rianna

  6. Cardiac Intensive Care Unit, Melfi Hospital, Melfi (Potenza), Italy

    Claudia Vicidomini

Authors
  1. Alessandro Viggiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuela Viggiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Di Costanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Viggiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eleonora Andreozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vincenzo Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ines Rianna
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Claudia Vicidomini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giuliana Gargano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lucia Incarnato
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Celeste Fevola
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Pietro Volta
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Caterina Tolomeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Giuseppina Scianni
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Caterina Santangelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Roberta Battista
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Marcellino Monda
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Adela Viggiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Bruno De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Salvatore Amaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Viggiano.

Additional information

Communicated by David Nadal

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Viggiano, A., Viggiano, E., Di Costanzo, A. et al. Kaledo, a board game for nutrition education of children and adolescents at school: cluster randomized controlled trial of healthy lifestyle promotion. Eur J Pediatr 174, 217–228 (2015). https://doi.org/10.1007/s00431-014-2381-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-014-2381-8

Keywords

Search

Navigation