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Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial

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Abstract

The board game Kaledo was proven to be effective in improving nutrition knowledge and in modifying dietary behavior in students attending middle and high school. The present pilot study aims to reproduce these results in younger students (7–11 years old) attending primary school. A total of 1313 children from ten schools were recruited to participate in the present study. Participants were randomized into two groups: (1) the treatment group which consisted of playing Kaledo over 20 sessions and (2) the no intervention group. Anthropometric measures were carried out for both groups at baseline (prior to any treatment) and at two follow-up post-assessments (8 and 18 months). All the participants completed a questionnaire concerning physical activity and a 1-week food diary at each assessment. The primary outcomes were (i) BMI z-score, (ii) scores on physical activity, and (iii) scores on a dietary questionnaire. BMI z-score was significantly lower in the treated group compared to the control group at 8 months. Frequency and duration of self-reported physical activity were also significantly augmented in the treated group compared to the control group at both post-assessments. Moreover, a significant increase in the consumption of healthy food and a significant decrease in junk food intake were observed in the treated group.

Conclusion: The present results confirm the efficacy of Kaledo in younger students in primary schools, and it can be used as a useful nutritional tool for obesity prevention programs in children.

What is Known:

• Kaledo is a new educational board game to improve nutrition knowledge and to promote a healthy lifestyle.

• In two cluster randomized trials conducted in Campania region (Italy), we showed that Kaledo could improve nutrition knowledge and dietary behavior and have a positive effect on the BMI z-score in children with age ranging from 9 to 14 years old attending school.

• Kaledo may be used as an effective tool for obesity prevention programs in middle and high school students.

What is New:

• Investigating the effects of Kaledo on younger primary school children (7–11 year olds), Kaledo could be an effective tool in obesity prevention programs for children as young as 7 years old.

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Abbreviations

BM:

Body mass index

BMR:

Basal metabolic rate

EI:

Energy intake

EE:

Energy expenditure

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Acknowledgements

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.

This research was funded by the Second University of Naples, Associazione Culturale Kaledo, Regione Campania, Provincia di Napoli, and Provincia di Salerno. The authors would like to thank the principals and teachers of the primary schools for their collaboration and free participation in the research.

Funding

This study was funded by the Second University of Naples, Associazione Culturale Kaledo, Regione Campania, Provincia di Napoli, and Provincia di Salerno.

Author information

Authors and Affiliations

  1. Department of Experimental Medicine, Second University of Naples, Via Costantinopoli, 16 80138, Naples, Italy

    Emanuela Viggiano, Alessandro Viggiano, Adela Viggiano, Eleonora Andreozzi, Daniela Di Tuoro, Lucia Incarnato, Celeste Fevola, Pietro Volta, Caterina Tolomeo, Giuseppina Scianni, Caterina Santangelo, Maria Apicella, Roberta Battista, Maddalena Raia, Ilaria Valentino, Marianna Palumbo, Giovanni Messina, Antonietta Messina, Marcellino Monda, Bruno De Luca & Salvatore Amaro

  2. Prenatal Medicine, AULSS6-Euganea, Padua, Italy

    Emanuela Viggiano

  3. ASL NA1 Center DSB32, Naples, Italy

    Anna Di Costanzo

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

    Andrea Viggiano

  5. High School Filippo Silvestri, Naples, Italy

    Vincenzo Romano

  6. Department of Predictive and Prevention Medicine, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy

    Claudia Vicidomini

  7. Unit of Cardiology, Hospital of Battipaglia, Battipaglia, Italy

    Giuliana Gargano

  8. Department of Clinical and Experimental Medicine, University of Foggia, 71122, Foggia, Italy

    Giovanni Messina

Authors
  1. Emanuela Viggiano
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  2. Alessandro Viggiano
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  3. Anna Di Costanzo
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  4. Adela Viggiano
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  5. Andrea Viggiano
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  6. Eleonora Andreozzi
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  7. Vincenzo Romano
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  8. Claudia Vicidomini
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  9. Daniela Di Tuoro
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  10. Giuliana Gargano
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  11. Lucia Incarnato
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  12. Celeste Fevola
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  13. Pietro Volta
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  14. Caterina Tolomeo
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  15. Giuseppina Scianni
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  16. Caterina Santangelo
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  17. Maria Apicella
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  18. Roberta Battista
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  19. Maddalena Raia
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  20. Ilaria Valentino
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  21. Marianna Palumbo
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  22. Giovanni Messina
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  23. Antonietta Messina
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  24. Marcellino Monda
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  25. Bruno De Luca
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  26. Salvatore Amaro
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Contributions

Emanuela Viggiano: substantial contributions to analysis and interpretation of data, drafting the article, and final approval of the version to be published.

Alessandro Viggiano: substantial contributions to conception and design of the work, interpretation of data, revising the article critically for important intellectual content, and final approval of the version to be published.

Anna Di Costanzo, Eleonora Andreozzi, Vincenzo Romano, Claudia Vicidomini, Daniela Di Tuoro, Giuliana Gargano, Lucia Incarnato, Celeste Fevola, Pietro Volta, Caterina Tolomeo, Giuseppina Scianni, Caterina Santangelo, Maria Apicella, Roberta Battista, Maddalena Raia, Marianna Palumbo, Ilaria Valentino, Giovanni Messina, and Antonietta Messina: substantial contributions to collection of data and final approval of the version to be published.

Adela Viggiano: substantial contributions to critical revision of the article, editing English, and final approval of the version to be published.

Andrea Viggiano: substantial contributions to conception and design the work, acquisition of data, and final approval of the version to be published.

Marcellino Monda: substantial contributions to interpretation of data and final approval of the version to be published.

Bruno De Luca: substantial contributions to conception and design the work, revising the article critically for important intellectual content, and final approval of the version to be published.

Salvatore Amaro: substantial contributions to conception and design the work, collection and acquisition of data, revising the article critically for important intellectual content, and final approval of the version to be published.

Corresponding author

Correspondence to Emanuela Viggiano.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Second University of Naples and in accordance with the current international guidelines, the standards on human experimentation of the Ethics Committee of the Second University of Naples, Italy, and with the Helsinki Declaration of 1975, revised in 1983.

Informed consent

Informed consent was obtained from the parents of the children who participated in the study.

Additional information

Communicated by Mario Bianchetti

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Viggiano, E., Viggiano, A., Di Costanzo, A. et al. Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial. Eur J Pediatr 177, 1371–1375 (2018). https://doi.org/10.1007/s00431-018-3091-4

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  • DOI: https://doi.org/10.1007/s00431-018-3091-4

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