You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Reductions in entrée energy density increase children's vegetable intake and reduce energy intake.
Abstract 1:
The energy density ( ED ; kcal/g ) of an entrée influences  children  's energy intake ( EI ) , but the effect of simultaneously changing both ED and portion size of an entrée on preschool children 's EI is unknown . In this within-subject crossover study , 3- to 5-year-old children ( 30 boys , 31 girls ) in a daycare facility were served a test lunch once/week for 4 weeks . The amount and type of vegetables and cheeses incorporated into the sauce of a pasta entrée were manipulated to create two versions that varied in ED by 25 % ( 1.6 or 1.2 kcal/g ) . Across the weeks , each version of the entrée was served to the children in each of two portion sizes ( 400 or 300 g ) . Lunch , consumed ad libitum , also included carrots , applesauce , and milk . Decreasing ED of the entrée by 25 % significantly ( P<0.0001 ) reduced children 's EI of the entrée by 25 % ( 63.1+/-8.3 kcal ) and EI at lunch by 17 % ( 60.7+/-8.9 kcal ) . Increasing the proportion of vegetables in the pasta entrée increased children 's vegetable intake at lunch by half of a serving of vegetables ( P<0.01 ) . Decreasing portion size of the entrée by 25 % did not significantly affect children 's total food intake or EI at lunch . Therefore , reducing the ED of a lunch entrée result ed in a reduction in  children 's EI from the entrée and from the meal in both portion size conditions . Decreasing ED by incorporating more vegetables into recipes is an effective way of reducing children 's  EI while increasing their vegetable intake


Title 2:
Parental beliefs about portion size, not children's own beliefs, predict child BMI
Abstract 2:
Summary Background Increases in portion size are thought by many to promote obesity in children . However , this relationship remains unclear . Here , we explore the extent to which a child 's  BMI is predicted both by parental beliefs about their child 's ideal and maximum portion size and /or by the child 's own beliefs . Methods Parent – child ( 5–11 years ) dyads ( N = 217 ) were recruited from a r and omized controlled trial ( n = 69 ) and an interactive science centre ( n = 148 ) . For a range of main meals , parents estimated their child 's ‘ ideal ’ and ‘ maximum tolerated ’ portions . Children completed the same tasks . Results An association was found between parents ' beliefs about their child 's ideal ( β = .34 , p < .001 ) and maximum tolerated ( β = .30 , p < .001 ) portions , and their child 's BMI . By contrast , children 's self‐reported ideal ( β = .02 , p = .718 ) and maximum tolerated ( β = −.09 , p = .214 ) portions did not predict their BMI . With increasing child BMI , parents ' estimations aligned more closely with their child 's own selected portions . Conclusions Our findings suggest that when a parent selects a smaller portion for their child than their child self‐selects , then the child is less likely to be obese . Therefore , public health measures to prevent obesity might include instructions to parents on appropriate portions for young children


Title 3:
The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: design and methods.
Abstract 3:
BACKGROUND Informed and engaged parents and healthful home environments are essential for the health of youth . Although research has shown health benefits associated with family meals , to date , no r and omized controlled trial ( RCT ) has been developed to examine the impact of a family meals intervention on behavioral and health outcomes . METHODS / DESIGN The Healthy Home Offerings via the Mealtime Environment ( HOME ) Plus study is a two-arm ( intervention versus attention-only control ) RCT being conducted in Minneapolis/St . Paul . Built on previous pilot research , HOME Plus aims to increase the frequency and healthfulness of family meals and snacks and reduce children 's sedentary behavior , particularly screen time , to promote healthier eating and activity behaviors and prevent obesity . HOME Plus is delivered to families in community setting s. The program includes 10 monthly sessions focused on nutrition and activity education , meal planning and preparation skill development . In addition , five motivational goal - setting phone calls are conducted with parents . The primary outcome measure is age- and gender-adjusted child BMI -z score at post-intervention by treatment group . Secondary household-level outcomes include family meal frequency , home availability of healthful foods ( fruits/vegetables ) and unhealthful foods ( high-fat/sugary snacks ) and beverages ( sugar-sweetened beverages ) , and the quality of foods served at meals and snacks . Secondary child outcomes include dietary intake of corresponding foods and beverages and screen time . CONCLUSIONS The HOME Plus RCT actively engages whole families of 8 - 12 year old children to promote healthier eating and activity behaviors and prevent obesity through promotion of family meals and snacks and limited media use


Title 4:
Serving smaller age-appropriate entree portions to children aged 3-5 y increases fruit and vegetable intake and reduces energy density and energy intake at lunch.
Abstract 4:
BACKGROUND Previous portion size research in children has focused on the impact of large entrée portions on children 's intake , but less attention has been given to how intake at a meal is affected across a broader range of entrée portions . OBJECTIVE The objective was to assess the effect of serving a range of entrée portions on children 's ad libitum intake and energy density consumed at the meal . DESIGN A within-subject design was used to examine the effect of varying entrée portions ( ie , 100 , 160 , 220 , 280 , 340 , and 400 g ) on children 's ad libitum energy intake of macaroni and cheese and fixed portions of unsweetened applesauce , green beans , and whole-wheat roll served with the entree .  Seventeen children ( 10 girls ) , aged 3 to 6 y , were served a series of 6 lunches , which varied only in entrée portion size , once per week . Weight , height , and weighed food intake were measured . RESULTS Increasing portion size increased children 's entrée intake ( P < 0.01 ) and decreased intake of other foods served with the entrée , including fruit and vegetables ( P < 0.0001 ) . As a result , children consumed a more-energy-dense ( kcal/g ) lunch as portion size increased ( P < 0.0001 ) . Further examination showed that BMI percentile moderated the positive association between portion size and entrée intake ( P < 0.01 ) ; overweight children showed greater increases in entree intake with increasing entrée portion . CONCLUSION Serving smaller age-appropriate entrée portions may be one strategy to improve children 's nutritional profile by decreasing intake of energy-dense foods and by promoting intake of fruit and vegetables served with the entree


Title 5:
Family Home Food Environment and Nutrition-Related Parent and Child Personal and Behavioral Outcomes of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus Program: A Randomized Controlled Trial.
Abstract 5:
BACKGROUND Research has demonstrated a significant positive association between frequent family meals and children 's dietary intake ; however , the promotion of healthful family meals has not been rigorously tested for key food environment and nutrition-related behavioral outcomes in a r and omized trial . OBJECTIVE To describe family home food environment and nutrition-related parent and child personal and behavioral outcomes of the Healthy Home Offerings via the Mealtime Environment Plus program , the first rigorously tested family meals intervention targeting childhood obesity prevention . DESIGN R and omized controlled trial . Baseline , postintervention ( 12 months , 93 % retention ) , and follow-up ( 21 months , 89 % retention ) data ( surveys and dietary recalls ) were collected . PARTICIPANTS / SETTING Children aged 8 to 12 years ( N=160 ) and their parents were r and omized to intervention ( n=81 ) or control ( n=79 ) groups . INTERVENTION The intervention included five parent goal - setting calls and 10 monthly sessions delivered to families in community setting s that focused on experiential nutrition activities and education , meal planning , cooking skill development , and reducing screen time . MAIN OUTCOME MEASURES Family home food environment outcomes and nutrition-related child and parent personal and behavioral outcomes . STATISTICAL ANALYSES PERFORMED Analyses used generalized linear mixed models . Primary comparisons were contrasts between intervention and control groups at postintervention and follow-up , with adjustments for child age and parent education . RESULTS Compared with control parents , intervention parents showed greater improvement over time in scores of self-efficacy for identifying appropriate portion sizes , with significant differences in adjusted means at both post-intervention ( P=0.002 ) and follow-up ( P=0.01 ) . Intervention children were less likely to consume at least one sugar-sweetened beverage daily at post-intervention than control children ( P=0.04 ) . CONCLUSIONS The Healthy Home Offerings via the Mealtime Environment Plus program involved the entire family and targeted personal , behavioral , and environment factors important for healthful changes in the home food environment and children 's dietary intake . The intervention improved two nutrition-related behaviors and this may inform the design of future family meal interventions
Thematic synthesis of 14 qualitative studies found that parents serve the portion sizes they learn to be appropriate for their child to be fed .
Portioning is influenced by parents ' desires for a healthy child with a balanced diet .