{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:11:54Z","timestamp":1783944714843,"version":"3.55.0"},"reference-count":46,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"High-Level Talent Research Fund of Shandong Provincial Maternal and Child Health Care Hospital","award":["SDMCH-RC2025001"],"award-info":[{"award-number":["SDMCH-RC2025001"]}]},{"name":"Shandong Province Traditional Chinese Medicine Science and Technology","award":["Z20243204"],"award-info":[{"award-number":["Z20243204"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Early childhood obesity has become a major public health concern globally. The preschool period (ages 4\u20136 years) represents a critical window for obesity prevention due to its long-term implications on growth trajectories and behaviour formation. However, existing evidence for effective interventions targeting this age group remains limited and inconsistent, particularly in low- and middle-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The Peking University-Smart Monitoring and Responsive Technology for Early Childhood Health is a cluster-randomised controlled trial designed to evaluate the effectiveness and sustainability of a multi-component, digital health\u2013assisted obesity prevention intervention. The trial involves approximately 980 children aged 4\u20136 years (middle and senior kindergarten classes) from 14 kindergartens, randomly allocated to either the intervention (n=7) or control (n=7) groups. The intervention spans 9 months, followed by a 12-month post-intervention follow-up. Interventions are delivered across kindergartens, families and healthcare systems. A digital Smart Health Platform is integrated into the intervention to provide health education, real-time feedback and interactive support, enabling personalised health management and promoting parental engagement. Data are collected at baseline, 4, 9 and 21 months. The primary outcome is the between-group difference in changes in body mass index Z-score at 9 months. Secondary outcomes include other anthropometric indicators, dietary intake, physical activity levels and other measurements. In addition, a process evaluation will be conducted to assess fidelity and participant engagement, and a health economic evaluation will estimate cost-effectiveness and cost-benefit outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval for this study was obtained from the Ethics Committee of the Shandong Maternal and Child Health Hospital (no. 2025-042). Findings from the trial will be disseminated through peer-reviewed publications and conference presentations to inform future childhood obesity prevention policies and practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07117149\">NCT07117149<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115136","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:40:24Z","timestamp":1783942824000},"page":"e115136","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Protocol for a digital health-assisted cluster randomised controlled trial to prevent obesity in preschool children in Jinan, China"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07117149","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Li","family":"Zhang","sequence":"first","affiliation":[{"name":"Clinical Research Center for Children\u2019s Health and Diseases, Shandong Provincial Maternal and Child Health Care Hospital affiliated to Qingdao University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyu","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, Beijing, China"},{"name":"National Health Commission Key Laboratory of Reproductive Health, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunjie","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, Beijing, China"},{"name":"National Health Commission Key Laboratory of Reproductive Health, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuge","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Shandong Second Medical University, Weifang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Children\u2019s Health and Diseases, Shandong Provincial Maternal and Child Health Care Hospital affiliated to Qingdao University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai","family":"Gao","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Children\u2019s Health and Diseases, Shandong Provincial Maternal and Child Health Care Hospital affiliated to Qingdao University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Children\u2019s Health and Diseases, Shandong Provincial Maternal and Child Health Care Hospital affiliated to Qingdao University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuexia","family":"Duan","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Children\u2019s Health and Diseases, Shandong Provincial Maternal and Child Health Care Hospital affiliated to Qingdao University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8904-6034","authenticated-orcid":false,"given":"Haijun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, Beijing, China"},{"name":"National Health Commission Key Laboratory of Reproductive Health, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Children\u2019s Health and Diseases, Shandong Provincial Maternal and Child Health Care Hospital affiliated to Qingdao University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"2026071304401635000_16.7.e115136.1","unstructured":"Levels and trends in child malnutrition: UNICEF\/WHO\/The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition: United Nations Children\u2019s Fund. World Health Organization, World Bank Group, 2021."},{"key":"2026071304401635000_16.7.e115136.2","first-page":"521","article-title":"Report on nutrition and chronic disease status of Chinese residents (2020) (in Chinese)","volume":"42","year":"2020","journal-title":"Acta Nutrimenta Sinica"},{"key":"2026071304401635000_16.7.e115136.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-019-1449-8","article-title":"The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action","volume":"17","author":"Di Cesare","year":"2019","journal-title":"BMC Med"},{"key":"2026071304401635000_16.7.e115136.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003078","article-title":"Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study","volume":"17","author":"Lindberg","year":"2020","journal-title":"PLoS Med"},{"key":"2026071304401635000_16.7.e115136.5","doi-asserted-by":"publisher","DOI":"10.1079\/BJN20051418"},{"key":"2026071304401635000_16.7.e115136.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11343-1","article-title":"Exploring the importance of diversified physical activities in early childhood for later motor competence and physical activity level: a seven-year longitudinal study","volume":"21","author":"Melby","year":"2021","journal-title":"BMC Public Health"},{"key":"2026071304401635000_16.7.e115136.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1803527"},{"key":"2026071304401635000_16.7.e115136.8","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/39.1.129"},{"key":"2026071304401635000_16.7.e115136.9","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1038\/ijo.2016.39","article-title":"Age at adiposity rebound: determinants and association with nutritional status and the metabolic syndrome at adulthood","volume":"40","author":"P\u00e9neau","year":"2016","journal-title":"Int J Obes (Lond)"},{"key":"2026071304401635000_16.7.e115136.10","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28705"},{"key":"2026071304401635000_16.7.e115136.11","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.ijnurstu.2015.10.017","article-title":"Interventions to prevent and manage overweight or obesity in preschool children: A systematic review","volume":"53","author":"Ling","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"2026071304401635000_16.7.e115136.12","article-title":"Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years","volume":"3","author":"Colquitt","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2026071304401635000_16.7.e115136.13","doi-asserted-by":"crossref","DOI":"10.1111\/mcn.13354","article-title":"Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting","volume":"18","author":"Flynn","year":"2022","journal-title":"Matern Child Nutr"},{"key":"2026071304401635000_16.7.e115136.14","doi-asserted-by":"crossref","unstructured":"Hu Y , He J-R , Liu F-H , et al . Effectiveness of a Kindergarten-Based Intervention for Preventing Childhood Obesity. Pediatrics 2017;140. doi:10.1542\/peds.2017-1221","DOI":"10.1542\/peds.2017-1221"},{"key":"2026071304401635000_16.7.e115136.15","doi-asserted-by":"crossref","DOI":"10.3390\/nu10030293","article-title":"Characteristics of Effective Interventions Promoting Healthy Eating for Pre-Schoolers in Childcare Settings: An Umbrella Review","volume":"10","author":"Matwiejczyk","year":"2018","journal-title":"Nutrients"},{"key":"2026071304401635000_16.7.e115136.16","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.ypmed.2016.09.033","article-title":"Strength of obesity prevention interventions in early care and education settings: A systematic review","volume":"95 Suppl","author":"Ward","year":"2017","journal-title":"Prev Med"},{"key":"2026071304401635000_16.7.e115136.17","unstructured":"Organization. WH . MHealth: use of appropriate digital technologies for public health: report by the director-general (2017). 2017. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/274134\/B142_20-en.pdf?sequence=1&isAllowed=y2025"},{"key":"2026071304401635000_16.7.e115136.18","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.amepre.2018.12.005","article-title":"Mobile Health Applications in Weight Management: A Systematic Literature Review","volume":"56","author":"Dounavi","year":"2019","journal-title":"Am J Prev Med"},{"key":"2026071304401635000_16.7.e115136.19","doi-asserted-by":"crossref","DOI":"10.2196\/35920","article-title":"mHealth Interventions to Reduce Physical Inactivity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"10","author":"Baumann","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"key":"2026071304401635000_16.7.e115136.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-023-01405-5","article-title":"Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized controlled trial","volume":"20","author":"Alexandrou","year":"2023","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2026071304401635000_16.7.e115136.21","doi-asserted-by":"crossref","DOI":"10.2196\/32578","article-title":"The Use of Artificial Intelligence-Based Conversational Agents (Chatbots) for Weight Loss: Scoping Review and Practical Recommendations","volume":"10","author":"Chew","year":"2022","journal-title":"JMIR Med Inform"},{"key":"2026071304401635000_16.7.e115136.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.obpill.2023.100065","article-title":"Artificial intelligence and obesity management: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023","volume":"6","author":"Bays","year":"2023","journal-title":"Obes Pillars"},{"key":"2026071304401635000_16.7.e115136.23","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1001\/jamapediatrics.2015.0258","article-title":"Sustainability of Effects of an Early Childhood Obesity Prevention Trial Over Time: A Further 3-Year Follow-up of the Healthy Beginnings Trial","volume":"169","author":"Wen","year":"2015","journal-title":"JAMA Pediatr"},{"key":"2026071304401635000_16.7.e115136.24","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1001\/jama.2018.9128","article-title":"Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index: A Randomized Clinical Trial","volume":"320","author":"Barkin","year":"2018","journal-title":"JAMA"},{"key":"2026071304401635000_16.7.e115136.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09020-w","article-title":"Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis","volume":"20","author":"Heerman","year":"2020","journal-title":"BMC Public Health"},{"key":"2026071304401635000_16.7.e115136.26","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph13090911","article-title":"Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations","volume":"13","author":"D\u00f6ring","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"2026071304401635000_16.7.e115136.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-081477","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"Chan","year":"2025","journal-title":"BMJ"},{"key":"2026071304401635000_16.7.e115136.28","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.amepre.2017.01.018","article-title":"Lifestyle Interventions in Preschool Children: A Meta-analysis of Effectiveness","volume":"53","author":"Ling","year":"2017","journal-title":"Am J Prev Med"},{"key":"2026071304401635000_16.7.e115136.29","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1038\/oby.2012.89","article-title":"Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children","volume":"20","author":"Story","year":"2012","journal-title":"Obesity (Silver Spring)"},{"key":"2026071304401635000_16.7.e115136.30","doi-asserted-by":"publisher","DOI":"10.1177\/1090198111418634"},{"key":"2026071304401635000_16.7.e115136.31","doi-asserted-by":"crossref","DOI":"10.2196\/33247","article-title":"mHealth Apps Using Behavior Change Techniques to Self-report Data: Systematic Review","volume":"10","author":"Aguiar","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"key":"2026071304401635000_16.7.e115136.32","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1017\/S1368980011003077","article-title":"Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents?","volume":"15","author":"Weng","year":"2012","journal-title":"Public Health Nutr"},{"key":"2026071304401635000_16.7.e115136.33","first-page":"1783","article-title":"Research progress on assessment tools for children\u2019s eating behavior (in Chinese)","volume":"57","author":"Wang","year":"2022","journal-title":"Chin J Nurs"},{"key":"2026071304401635000_16.7.e115136.34","first-page":"483","article-title":"Development and evaluation of a parental feeding behavior scale for preschool children (in Chinese)","volume":"26","author":"Xu","year":"2018","journal-title":"Chin J Child Health Care"},{"key":"2026071304401635000_16.7.e115136.35","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1123\/pes.21.3.339","article-title":"Reliability and validity of the modified Chinese version of the Children\u2019s Leisure Activities Study Survey (CLASS) questionnaire in assessing physical activity among Hong Kong children","volume":"21","author":"Huang","year":"2009","journal-title":"Pediatr Exerc Sci"},{"key":"2026071304401635000_16.7.e115136.36","unstructured":"National Health Commission of the PRC . Guideline for sleep hygiene among children aged 0 \uff5e 5 years.(ws\/t 579-2017). National Health Commission of the PRC; 2017."},{"key":"2026071304401635000_16.7.e115136.37","first-page":"545","article-title":"Sleep problems and associated factors among children with autism spectrum disorder (in Chinese)","volume":"22","author":"Ma","year":"2024","journal-title":"Chin J Hear Speech Rehabil Sci"},{"key":"2026071304401635000_16.7.e115136.38","unstructured":"WHO . Obesity and overweight. 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight2024"},{"key":"2026071304401635000_16.7.e115136.39","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.043497"},{"key":"2026071304401635000_16.7.e115136.40","unstructured":"Guidelines for pharmacoeconomic evaluation in china. 2020."},{"key":"2026071304401635000_16.7.e115136.41","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2021.4375","article-title":"Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial","volume":"176","author":"Liu","year":"2022","journal-title":"JAMA Pediatr"},{"key":"2026071304401635000_16.7.e115136.42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199709253371301"},{"key":"2026071304401635000_16.7.e115136.43","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-4-47"},{"key":"2026071304401635000_16.7.e115136.44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-7625.2012.00795.x"},{"key":"2026071304401635000_16.7.e115136.45","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.047738"},{"key":"2026071304401635000_16.7.e115136.46","doi-asserted-by":"publisher","DOI":"10.1017\/S0029665110000029"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-115136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:40:28Z","timestamp":1783942828000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-115136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":46,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,13]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2025-115136"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-115136","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}