Cardiovascular Health Promotion in Early Childhood

Study Questions:

Does a health curriculum in preschool improve health knowledge and markers of adiposity?


The SI! Program intervention was evaluated through a cluster randomized trial involving 24 public schools in Madrid, Spain. Schools were assigned the 3-year program or usual curriculum. The SI! Program focuses on healthy behaviors to improve diet and physical activity, and to improve understanding of the human body among preschool children. The primary outcome was change in the overall knowledge, attitudes, and habits assessed via a survey developed in the Colombian Initiative for Healthy Heart Study. This questionnaire assessed the domains of knowledge (K), attitude (A), and habits (H) in relation to physical activity, diet, and heart health. The KAH score ranges from 0 to 80. Markers of adiposity were also evaluated including body weight, height, waist circumference, and skinfold thickness.


A total of 2,062 children, ages 3-5 years from 24 schools participated in the trial. After 3-year follow-up, the overall KAH score was 4.9% higher in children receiving the SI! Program compared to the usual curriculum (21.7 vs. 16.4, p < 0.001). Physical activity was the component of the score that changed the greatest. The peak effect occurred during the second year of the program. At 3 years, the children in the intervention group showed a higher probability of reducing triceps skinfold z-score compared to the control group (p = 0.027). A greater impact of the intervention (measured with greater change in the KAH score) was noted for children of parents who obtained at least a high school education and had a higher income.


The investigators concluded that the intervention to improve healthy habits among preschool children had beneficial effects on adiposity.


School-based programs that improve health knowledge when started early in childhood may reduce cardiovascular risk. Long-term follow-up is warranted to promote lifelong health.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Diet

Keywords: Adiposity, Child, Preschool, Diet, Health Behavior, Motor Activity, Pediatric Obesity, Primary Prevention, Risk Factors, Waist Circumference

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