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Matvienko‐Sikar K, Griffin C, McGrath N, Toomey E, Byrne M, Kelly C, Heary C, Devane D, Kearney PM. Developing a core outcome set for childhood obesity prevention: A systematic review. MATERNAL & CHILD NUTRITION 2019; 15:e12680. [PMID: 30136417 PMCID: PMC7199036 DOI: 10.1111/mcn.12680] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
Synthesis of effects of infant feeding interventions to prevent childhood obesity is limited by outcome measurement and reporting heterogeneity. Core outcome sets (COSs) represent standardised approaches to outcome selection and reporting. The aim of this review is to identify feeding outcomes used in infant feeding studies to inform an infant feeding COS for obesity prevention interventions. The databases EMBASE, Medline, CINAHL, CENTRAL, and PsycINFO searched from inception to February 2017. Studies eligible for inclusion must examine any infant feeding outcome in children ≤1 year. Feeding outcomes include those measured using self-report and/or observational methods and include dietary intake, parent-child interaction, and parental beliefs, among others. Data were extracted using a standardised data extraction form. Outcomes were assigned to outcome domains using an inductive, iterative process with a multidisciplinary team. We identified 82 unique outcomes, representing nine outcome domains. Outcome domains were "breast and formula feeding," "introduction of solids," "parent feeding practices and styles," "parent knowledge and beliefs," "practical feeding," "food environment," "dietary intake," "perceptions of infant behaviour and preferences," and "child weight outcomes." Heterogeneity in definition and frequency of outcomes was noted in reviewed studies. "Introduction of solids" (59.5%) and "breastfeeding duration" (55.5%) were the most frequently reported outcomes. Infant feeding studies focus predominantly on consumption of milks and solids and infant weight. Less focus is given to modifiable parental and environmental factors. An infant feeding COS can minimise heterogeneity in selection and reporting of infant feeding outcomes for childhood obesity prevention interventions.
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Affiliation(s)
| | - Ciara Griffin
- School of MedicineUniversity College CorkCorkIreland
| | - Niamh McGrath
- School of Public HealthUniversity College CorkCorkIreland
| | - Elaine Toomey
- School of PsychologyNational University of IrelandGalwayIreland
| | - Molly Byrne
- School of PsychologyNational University of IrelandGalwayIreland
| | - Colette Kelly
- School of Health SciencesNational University of IrelandGalwayIreland
| | - Caroline Heary
- School of PsychologyNational University of IrelandGalwayIreland
| | - Declan Devane
- School of Nursing and MidwiferyNational University of IrelandGalwayIreland
- HRB Trials Methodology Research NetworkNational University of IrelandGalwayIreland
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Hale I, Amed S, Keidar S, Purcell M, Lee D, Farhadi D. Parents' perceptions of obesity prevention during infancy: a qualitative study. CMAJ Open 2019; 7:E81-E87. [PMID: 30782770 PMCID: PMC6380902 DOI: 10.9778/cmajo.20180066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Infancy appears to be a critical period for establishing a person's weight set point. It remains unclear which interventions during infancy may be most effective in preventing later obesity and which ones are most acceptable to parents. The aim of this study was to examine the attitudes of parents of children aged 2 years and under toward different obesity prevention messages and their preferences with regard to these messages. METHODS Using a qualitative research design, we conducted semistructured interviews followed by a focus group. Parents of children under 2 years of age were purposively recruited from 2 communities in British Columbia, Canada, and asked for their opinions about various health promotion messages relating to obesity prevention. A theoretical thematic analysis was used to analyze the data. RESULTS Thirty-three parents participated in the study. Participants reported that many of the current recommendations (no screen time, no sugary beverages) are unrealistic, unclear and inconsistent, making them difficult to follow and causing parents to feel guilty; they had a more positive response to the feeding roles message. Parents noted the importance of starting education early and targeting the broader community. INTERPRETATION Several important and interesting themes were identified in this study, which increases our understanding of parents' attitudes toward and preferences for the messages presented. Obesity prevention information for today's busy parents needs to be realistic, supportive and timely.
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Affiliation(s)
- Ilona Hale
- Department of Family Practice (Hale) and School of Population and Public Health (Lee), University of British Columbia; British Columbia Children's Hospital and SCOPE BC (Sustainable Childhood Obesity Prevention through Community Engagement) (Amed, Keidar), Vancouver, BC; East Kootenay Division of Family Practice (Purcell), Cranbrook, BC; College of Medicine (Farhadi), University of Saskatchewan, Saskatoon, Sask.
| | - Shazhan Amed
- Department of Family Practice (Hale) and School of Population and Public Health (Lee), University of British Columbia; British Columbia Children's Hospital and SCOPE BC (Sustainable Childhood Obesity Prevention through Community Engagement) (Amed, Keidar), Vancouver, BC; East Kootenay Division of Family Practice (Purcell), Cranbrook, BC; College of Medicine (Farhadi), University of Saskatchewan, Saskatoon, Sask
| | - Shelly Keidar
- Department of Family Practice (Hale) and School of Population and Public Health (Lee), University of British Columbia; British Columbia Children's Hospital and SCOPE BC (Sustainable Childhood Obesity Prevention through Community Engagement) (Amed, Keidar), Vancouver, BC; East Kootenay Division of Family Practice (Purcell), Cranbrook, BC; College of Medicine (Farhadi), University of Saskatchewan, Saskatoon, Sask
| | - Megan Purcell
- Department of Family Practice (Hale) and School of Population and Public Health (Lee), University of British Columbia; British Columbia Children's Hospital and SCOPE BC (Sustainable Childhood Obesity Prevention through Community Engagement) (Amed, Keidar), Vancouver, BC; East Kootenay Division of Family Practice (Purcell), Cranbrook, BC; College of Medicine (Farhadi), University of Saskatchewan, Saskatoon, Sask
| | - Donna Lee
- Department of Family Practice (Hale) and School of Population and Public Health (Lee), University of British Columbia; British Columbia Children's Hospital and SCOPE BC (Sustainable Childhood Obesity Prevention through Community Engagement) (Amed, Keidar), Vancouver, BC; East Kootenay Division of Family Practice (Purcell), Cranbrook, BC; College of Medicine (Farhadi), University of Saskatchewan, Saskatoon, Sask
| | - Daniel Farhadi
- Department of Family Practice (Hale) and School of Population and Public Health (Lee), University of British Columbia; British Columbia Children's Hospital and SCOPE BC (Sustainable Childhood Obesity Prevention through Community Engagement) (Amed, Keidar), Vancouver, BC; East Kootenay Division of Family Practice (Purcell), Cranbrook, BC; College of Medicine (Farhadi), University of Saskatchewan, Saskatoon, Sask
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103
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Mihrshahi S, Baur LA. What exposures in early life are risk factors for childhood obesity? J Paediatr Child Health 2018; 54:1294-1298. [PMID: 30168229 DOI: 10.1111/jpc.14195] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/20/2017] [Accepted: 07/25/2018] [Indexed: 01/11/2023]
Abstract
Globally, estimates show that 41 million children younger than 5 years of age are affected by overweight and obesity. In many regions of the world, these prevalence rates have increased dramatically, especially in low- and middle-income countries, making childhood obesity a global policy issue. Recent data show that many children are already affected by overweight or obesity by the time they start school; hence, the examination of early exposures, with interventions around these exposures, is warranted. In this review, we outline the main modifiable exposures in early life that can lead to an increased risk of obesity. These exposures can be broadly categorised into parental factors such as obesity and gestational diabetes; dietary exposures in early life, including breastfeeding and complementary feeding and feeding behaviours; physical activity, sedentary behaviours and sleep; and environmental exposures such as maternal exposure to tobacco. We also identify research gaps and opportunities for further research.
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Affiliation(s)
- Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, Sydney, New South Wales, Australia
| | - Louise A Baur
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, School of Public Health, Sydney, New South Wales, Australia.,Sydney Medical School and Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Lakshman R, Sharp SJ, Whittle F, Schiff A, Hardeman W, Irvine L, Wilson E, Griffin SJ, Ong KK. Randomised controlled trial of a theory-based behavioural intervention to reduce formula milk intake. Arch Dis Child 2018; 103:1054-1060. [PMID: 29760009 PMCID: PMC6225804 DOI: 10.1136/archdischild-2018-314784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/28/2018] [Accepted: 04/20/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the efficacy of a theory-based behavioural intervention to prevent rapid weight gain in formula milk-fed infants. DESIGN In this single (assessor) blind, randomised controlled trial, 669 healthy full-term infants receiving formula milk within 14 weeks of birth were individually randomised to intervention (n=340) or attention-matched control (n=329) groups. The intervention aimed to reduce formula milk intakes, and promote responsive feeding and growth monitoring to prevent rapid weight gain (≥+0.67 SD scores (SDS)). It was delivered to mothers by trained facilitators up to infant age 6 months through three face-to-face contacts, two telephone contacts and written materials. RESULTS Retention was 93% (622) at 6 months, 88% (586) at 12 months and 94% attended ≥4/5 sessions. The intervention strengthened maternal attitudes to following infant feeding recommendations, reduced reported milk intakes at ages 3 (-14%; intervention vs control infants), 4 (-12%), 5 (-9%) and 6 (-7%) months, slowed initial infant weight gain from baseline to 6 months (mean change 0.32 vs 0.42 SDS, baseline-adjusted difference (intervention vs control) -0.08 (95% CI -0.17 to -0.004) SDS), but had no effect on the primary outcome of weight gain to 12 months (baseline-adjusted difference -0.04 (-0.17, 0.10) SDS). By 12 months, 40.3% of infants in the intervention group and 45.9% in the control group showed rapid weight gain (OR 0.84, 95% CI 0.59 to 1.17). CONCLUSIONS Despite reducing milk intakes and initial weight gain, the intervention did not alter the high prevalence of rapid weight gain to age 12 months suggesting the need for sustained intervention. TRIAL REGISTRATION NUMBER ISRCTN20814693.
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Affiliation(s)
- Rajalakshmi Lakshman
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Annie Schiff
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Wendy Hardeman
- Health Promotion Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ed Wilson
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Primary Care Research Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ken K Ong
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Wright CM, Marryat L, McColl J, Harjunmaa U, Cole TJ. Pathways into and out of overweight and obesity from infancy to mid-childhood. Pediatr Obes 2018; 13:621-627. [PMID: 29998577 PMCID: PMC6220864 DOI: 10.1111/ijpo.12427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether high weight in infancy predicts obesity in childhood. METHOD Data from two UK cohorts (Newcastle Growth and Development N = 795, Gateshead Millennium N = 393) and one Finnish (Tampere N = 1262) were combined. Z scores of weight at 3 and 12 months and body mass index (BMI) at 5 and 8 years were categorized as raised/overweight (1 to <2 SD) or high/obese (≥2 SD). RESULTS The majority of infants with raised or high weight at birth tended to revert to normal by 3 months and to track in the same category from 3 to 12 months. Although infants with high weight were five times more likely to have BMI ≥ 2 SD at 8 years (p < 0.001), only 22% went on to have BMI ≥ 2 SD, while 64% of infants with raised weight had normal BMI at 8 years. Of children with BMI ≥ 2 SD aged 8 years, only 22% had raised weight in infancy and half had BMI ≥ 2 SD for the first time at that age. CONCLUSIONS Infants with raised weight in infancy tend to remain so, but most children who go on to have BMI ≥ 2 SD were not unusually heavy infants and the majority of infants with high weight reverted to overweight or normal weight in childhood.
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Affiliation(s)
- C. M. Wright
- School of Medicine, College of MVLSUniversity of GlasgowGlasgowUK
| | - L. Marryat
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
- Farr Institute @ Scotland/Scottish Collaboration for Public Health Research and PolicyUniversity of EdinburghEdinburghUK
| | - J. McColl
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
| | - U. Harjunmaa
- Center for Child Health ResearchUniversity of Tampere Faculty of Medicine and Life Sciences, and Tampere University HospitalTampereFinland
| | - T. J. Cole
- Population, Policy and Practice ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
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Wajid A, Mughal MK, McNeil D, Robertson HL, Kingston D. Effect of maternal mental health improvement programs on obesity in pediatric populations: a protocol for a systematic review and meta-analysis. Syst Rev 2018; 7:133. [PMID: 30157939 PMCID: PMC6116373 DOI: 10.1186/s13643-018-0798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/16/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Childhood obesity has become a global epidemic irrespective of the socioeconomic status of a country or nation. Obesity increases the risk of various diseases in children, for example asthma, sleep apnea, bone and joint problems, type-2 diabetes, and heart problems. The existing literature informs us of the many factors associated with childhood obesity. Among these factors, maternal mental health has been found to be a strong predictor. Maternal mental health programs were implemented to address the issue of childhood obesity but with little or no improvement. It suggests systematically reviewing the literature to assess the contents of these programs and carrying out meta-analysis for the overall effect of these interventions. METHODS The studies included in this review will be experimental designs such as randomized controlled trials (RCTs) which provide information on interventions to improve maternal mental health and its effects on childhood obesity. We plan to search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Scopus, and Web of Science with no restrictions as to language. Reference lists of the selected articles will also be searched for additional articles. The Cochrane EPOC Risk of Bias Tool will be used to assess the quality of studies. If the studies lend themselves to a statistical analysis, we will also carry out a meta-analysis. DISCUSSION This review will help determine the effect of maternal health improvement programs on childhood obesity. These findings, in turn, will guide the research community on the development of related programs in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42017072737 .
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Affiliation(s)
- Abdul Wajid
- University of Calgary, PF 2220, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | | | - Deborah McNeil
- Alberta Health Services, Southport Atrium, #2237, 10101 Southport Rd, SW, Calgary, AB T2W 3N2 Canada
| | - Helen Lee Robertson
- University of Calgary, PF 2220, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Dawn Kingston
- University of Calgary, PF 2220, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
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Taylor RW, Gray AR, Heath ALM, Galland BC, Lawrence J, Sayers R, Healey D, Tannock GW, Meredith-Jones KA, Hanna M, Hatch B, Taylor BJ. Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y. Am J Clin Nutr 2018; 108:228-236. [PMID: 30101329 DOI: 10.1093/ajcn/nqy090] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 04/09/2018] [Indexed: 12/16/2022] Open
Abstract
Background Our Prevention of Overweight in Infancy (POI) study suggested that a brief sleep intervention in infancy reduced the risk of obesity at age 2 y. In contrast, we observed no benefit from the nutrition and activity intervention. Objective The objective of the study was to determine how these interventions influenced growth at ages 3.5 and 5 y compared with usual care (Control). Design A follow-up of a parallel, 4-arm, single-blind, 2-y, randomized controlled trial in 802 women (86% European, 48% primiparous) recruited in pregnancy (58% response rate) was undertaken. All groups received standard Well-Child care with additional support for 3 intervention groups: FAB (promotion of breastfeeding, healthy eating, physical activity: 8 contacts, antenatal, 18 mo); Sleep (prevention of sleep problems: antenatal, 3 wk); Combination (both interventions). Follow-up measures were collected by staff blinded to group allocation. The primary outcome was child body mass index (BMI) z score, and secondary outcomes were prevalence of obesity (BMI ≥95th percentile), self-regulation (psychological measures), sleep, physical activity (accelerometry, questionnaires), and dietary intake (food-frequency questionnaire). Analyses were conducted through the use of multiple imputation. Results Retention was 77% at age 3.5 y and 69% at age 5 y. Children in the FAB group had significantly higher BMI z scores than did Controls at age 5 y (adjusted difference: 0.25; 95% CI: 0.04, 0.47) but not at age 3.5 y (0.15; 95% CI: -0.04, 0.34). Children who received the Sleep intervention (Sleep and Combination groups) had significantly lower BMI z scores at age 3.5 y (-0.24; 95% CI: -0.38, -0.10) and at age 5 y (-0.23; 95% CI: -0.38, -0.07) than children who did not (Control and FAB groups). Conclusions A conventional intervention had unexpected adverse long-term weight outcomes, whereas positive outcomes from a less conventional sleep intervention remained promising at age 5 y. More intensive or extended sleep intervention might have larger or longer-lasting effects and should be investigated. This trial was registered at clinicaltrials.gov as NCT00892983.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Maha Hanna
- Departments of Women's and Children's Health
| | - Burt Hatch
- Departments of Women's and Children's Health
| | - Barry J Taylor
- Office of the Dean, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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108
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Appleton J, Russell CG, Laws R, Fowler C, Campbell K, Denney‐Wilson E. Infant formula feeding practices associated with rapid weight gain: A systematic review. MATERNAL & CHILD NUTRITION 2018; 14:e12602. [PMID: 29655200 PMCID: PMC6866175 DOI: 10.1111/mcn.12602] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 12/11/2017] [Accepted: 02/06/2018] [Indexed: 01/10/2023]
Abstract
Excess or rapid weight gain during the first 2 years of life is associated with an increased risk of later childhood and adult overweight and obesity. When compared with breastfed infants, formula fed infants are more likely to experience excess or rapid weight gain, and this increased risk in formula fed infant populations may be due to a number of different mechanisms. These mechanisms include the nutrient composition of the formula and the way formula is prepared and provided to infants. This systematic literature review examines the association between formula feeding practice and excess or rapid weight gain. This review explores these different mechanisms and provides practical recommendations for best practice formula feeding to reduce rapid weight gain. Eighteen studies are included in this review. The findings are complicated by the challenges in study design and accuracy of measurements. Nevertheless, there are some potential recommendations for best practice formula feeding that may reduce excess or rapid weight gain, such as providing formula with lower protein content, not adding cereals into bottles, not putting a baby to bed with a bottle, and not overfeeding formula. Although further well designed studies are required before more firm recommendations can be made.
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Affiliation(s)
- Jessica Appleton
- Faculty of HealthUniversity of Technology SydneySydneyAustralia
- Sydney Children's HospitalRandwickNew South WalesAustralia
| | | | - Rachel Laws
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Cathrine Fowler
- Faculty of HealthUniversity of Technology SydneySydneyAustralia
- Tresillian Chair in Child and Family Health, Faculty of HealthUniversity of Technology SydneySydneyAustralia
- Tresillian Family Care Centres BelmoreBelmoreNew South WalesAustralia
| | - Karen Campbell
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
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Bryant M, Burton W, Collinson M, Hartley S, Tubeuf S, Roberts K, Sondaal AEC, Farrin AJ. Cluster randomised controlled feasibility study of HENRY: a community-based intervention aimed at reducing obesity rates in preschool children. Pilot Feasibility Stud 2018; 4:118. [PMID: 29977593 PMCID: PMC6013860 DOI: 10.1186/s40814-018-0309-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/13/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the UK and beyond, public funding is used to commission interventions delivered in public health early years settings aimed at improving health and well-being and reducing inequalities in order to promote school readiness. This is a key setting for obesity prevention programmes, which are often commissioned despite the limited evidence base. The HENRY (Health, Exercise, Nutrition for the Really Young) programme is an 8-week programme delivered to parents of preschool children, designed to support families to optimise healthy weight behaviours. Early evidence suggests that it may be effective, but a robust evaluation using a randomised controlled design has not been conducted. This study begins this process by evaluating the feasibility of conducting a multi-centre definitive trial to evaluate the effectiveness and cost-effectiveness of HENRY to prevent obesity in the early years. METHODS This is a multi-centre, open labelled, two group, prospective, cluster randomised, controlled, feasibility study aiming to recruit 120 parents from 12 children's centres, based in two local authority areas. Within each of the two local authorities, three centres will be randomised to HENRY and three will be randomised to a control arm of standard care (usual provision of services within children's centres). We will explore HENRY commissioning, provision and delivery and assess the feasibility of local authority, centre and parent recruitment, the processes and time required to train and certify staff to deliver the intervention, the potential sources (and associated risk) of contamination and the feasibility of the trial procedures. Research includes a process evaluation, feasibility of cost-effectiveness evaluation, with progression to the definitive trial judged against pre-defined criteria. DISCUSSION This feasibility study will support the decision to proceed to, and the design of, a future definitive trial, providing an evidence base of an approach to prevent childhood obesity, which has been deemed attractive to all stakeholders, including parents. Given the widespread adoption of the intervention, this has the potential to impact on public health in the UK and beyond. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03333733 registered 6th November 2017Protocol date: 25th October 2017Protocol version: 4.0.
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Affiliation(s)
- Maria Bryant
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Wendy Burton
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Kim Roberts
- HENRY, 8 Elm Place, Old Witney Rd, Oxfordshire, OX29 4BD UK
| | | | - Amanda J. Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
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110
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Obesity prevention: are we missing the (conception to infancy) window? Br J Gen Pract 2018; 68:262-263. [PMID: 29853573 DOI: 10.3399/bjgp18x696269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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111
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Abstract
Childhood obesity is a serious challenge for public health. The problem begins early with most excess childhood weight gained before starting school. In 2016, the WHO estimated that 41 million children under 5 were overweight or obese. Once established, obesity is difficult to reverse, likely to persist into adult life and is associated with increased risk of CVD, type 2 diabetes and certain cancers. Preventing obesity is therefore of high importance. However, its development is multi-factorial and prevention is a complex challenge. Modifiable lifestyle behaviours such as diet and physical activity are the most well-known determinants of obesity. More recently, early-life factors have emerged as key influencers of obesity in childhood. Understanding risk factors and how they interact is important to inform interventions that aim to prevent obesity in early childhood. Available evidence supports multi-component interventions as effective in obesity prevention. However, relatively few interventions are available in the UK and only one, TrimTots, has been evaluated in randomised controlled trials and shown to be effective at reducing obesity risk in preschool children (age 1-5 years). BMI was lower in children immediately after completing TrimTots compared with waiting list controls and this effect was sustained at long-term follow-up, 2 years after completion. Developing and evaluating complex interventions for obesity prevention is a challenge for clinicians and researchers. In addition, parents encounter barriers engaging with interventions. This review considers early-life risk factors for obesity, highlights evidence for preventative interventions and discusses barriers and facilitators to their success.
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112
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Ortega-Altamirano DV, Rodríguez-Oliveros G, González-Unzaga MA, Reyes-Morales H. Perceptions of childcare staff for preventing overweight in Mexican preschool children: A SWOT analysis. SALUD PUBLICA DE MEXICO 2018; 60:166-174. [PMID: 29738656 DOI: 10.21149/8897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To identify strengths, weaknesses, opportunities, and threats (SWOT) perceived by childcare staff for preventing childhood overweight. MATERIAL AND METHODS Qualitative study using an interpretative phenomenological approach; 18 in-depth, semi-structured interviews and 12 focus groups with 89 key informants working in six Mexican public childcare centers (CCC) were conducted. Through content and SWOT analyses, experts further ranked fifty-nine recurrent perceptions regarding healthy feeding and physical activity (PA), using the Delphi method. RESULTS Strengths: Acknowledgement of the CCC's responsibility in fostering healthy feeding, availability of organizational regulations, and access to PA infrastructure/indoor activities. Weaknesses: Disregard of preschool overweight as a health problem, nu- tritional misperceptions, and perceived risk of child injuries while conducting PA. Opportunities: Willingness to reduce children's access to junk foods, and parental active play with children during weekends. Threats: Limited family nutritional education, and restricted parental time/economic constraints/access to safe public spaces for PA. CONCLUSIONS The identified SWOT must be considered when developing obesityprevention interventions targeted at CCC.
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Affiliation(s)
| | | | | | - Hortensia Reyes-Morales
- Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública. Cuernavaca, México
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Fábelová L, Vandentorren S, Vuillermoz C, Garnier R, Lioret S, Botton J. Hair concentration of trace elements and growth in homeless children aged <6years: Results from the ENFAMS study. ENVIRONMENT INTERNATIONAL 2018; 114:318-325. [PMID: 29150339 DOI: 10.1016/j.envint.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Growth is an important indicator of health in early childhood. This is a critical developmental period, during which a number of factors, including exposure to metals, might play a role in later physical and metabolic functions. OBJECTIVE To study the association between exposure to arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb) and selenium (Se), and physical growth of children from homeless families aged <6years. METHODS This study was based on data of the cross-sectional survey (ENFAMS), which was conducted by the Observatoire du Samu Social on a random sample of homeless sheltered families in the Paris region during winter 2013. Families with children under 6years (N=324) were interviewed in 17 languages using face-to-face questionnaires. A nurse took anthropometric measures and collected hair samples where As, Cd, Hg, Pb and Se levels were measured. We calculated weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) and BMI-for-age Z-score (BMIZ) of children, using the 2006 WHO Child Growth Standards as a reference. Associations between ln-transformed metal exposures and growth outcomes were tested by multivariable linear regression models with adjustment for potential confounders (including maternal anthropometrical and socio-demographical characteristics, gestational age, child birthweight, breastfeeding, food insecurity of the child). Due to missing data (1.6% to 14.2% depending on the variables), we used multiple imputation by chained equations. RESULTS A strong positive correlation was found between Pb and Cd levels (r=0.65; p<0.001). Positive associations between Se level and HAZ (β=0.61; p=0.05) and between Cd and BMIZ (β=0.21; p=0.03) and negative associations between As and HAZ (β=-0.18; p=0.05) were no more significant after multiple imputation. A weak negative trend was observed between Cd and HAZ (β=-0.14; p=0.14), while positive trends were found between Se and both WAZ (β=0.55; p=0.10) and HAZ (β=0.51; p=0.06) after multiple imputation. CONCLUSION Overall, our results found no strong association between exposure to metals and physical growth of homeless children but we observed some trends that were consistent with previous studies. More research is required studying these associations longitudinally, along with higher sample sizes, for better understanding the sources of exposure in homeless population and the potential effects on growth.
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Affiliation(s)
- Lucia Fábelová
- U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Inserm, Villejuif, France.
| | - Stéphanie Vandentorren
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Paris, France; French Institute for Public Health Surveillance, Saint-Maurice, France
| | - Cécile Vuillermoz
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Paris, France
| | - Robert Garnier
- Centre antipoison et de toxicovigilance de Paris, France
| | - Sandrine Lioret
- U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Inserm, Villejuif, France
| | - Jérémie Botton
- U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Inserm, Villejuif, France; Faculty of Pharmacy, Univ. Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
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Russell CG, Denney-Wilson E, Laws RA, Abbott G, Zheng M, Lymer SJ, Taki S, Litterbach EKV, Ong KL, Campbell KJ. Impact of the Growing Healthy mHealth Program on Maternal Feeding Practices, Infant Food Preferences, and Satiety Responsiveness: Quasi-Experimental Study. JMIR Mhealth Uhealth 2018; 6:e77. [PMID: 29695373 PMCID: PMC5943630 DOI: 10.2196/mhealth.9303] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023] Open
Abstract
Background Infancy is an important life stage for obesity prevention efforts. Parents’ infant feeding practices influence the development of infants’ food preferences and eating behaviors and subsequently diet and weight. Mobile health (mHealth) may provide a feasible medium through which to deliver programs to promote healthy infant feeding as it allows low cost and easy access to tailored content. Objective The objective of this study was to describe the effects of an mHealth intervention on parental feeding practices, infant food preferences, and infant satiety responsiveness. Methods A quasi-experimental study was conducted with an mHealth intervention group (Growing Healthy) and a nonrandomized comparison group (“Baby's First Food"). The intervention group received access to a free app with age-appropriate push notifications, a website, and an online forum that provided them with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. Behavior change techniques were selected using the Behaviour Change Wheel framework. Participants in both groups completed three Web-based surveys, first when their infants were less than 3 months old (baseline, T1), then at 6 months (time 2, T2), and 9 months of age (time 3, T3). Surveys included questions on infant feeding practices and beliefs (Infant Feeding Questionnaire, IFQ), satiety responsiveness (Baby Eating Behaviour Questionnaire), and infant’s food exposure and liking. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for relevant covariates. Multivariate logistic regression adjusting for the same covariates was performed for categorical outcomes. Results A total of 645 parents (Growing Healthy: n=301, Baby's First Food: n=344) met the eligibility criteria and were included in the study, reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at T2 and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. There were approximately equal numbers of boy and girl infants, and infants were aged less than 3 months at baseline (Growing Healthy: mean 7.0, SD 3.7 weeks; Baby's First Food: mean 7.9, SD 3.8 weeks), with Growing Healthy infants being slightly younger than Baby's First Food infants (P=.001). All but one (IFQ subscale “concerns about infant overeating or becoming overweight” at T2) of the measured outcomes did not differ between Growing Healthy and Baby's First Food. Conclusions Although mHealth can be effective in promoting some health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. The sensitivity of available measurement tools and differences in baseline characteristics of participants may have also affected the results.
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Affiliation(s)
- Catherine Georgina Russell
- Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Burwood, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Rachel A Laws
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sharyn J Lymer
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,The Boden Institute of Obesity Nutrition Exercise & Eating Disorders, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Sarah Taki
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, and University of Sydney, Sydney, Australia
| | - Eloise-Kate V Litterbach
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kok-Leong Ong
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Department of Accounting and Data Analytics, La Trobe Business School, College of Arts, Social Sciences and Commerce, La Trobe University, Melbourne, Australia
| | - Karen J Campbell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Matvienko-Sikar K, Kelly C, Sinnott C, McSharry J, Houghton C, Heary C, Toomey E, Byrne M, Kearney PM. Parental experiences and perceptions of infant complementary feeding: a qualitative evidence synthesis. Obes Rev 2018; 19:501-517. [PMID: 29243375 DOI: 10.1111/obr.12653] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/23/2017] [Accepted: 10/31/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Interventions to prevent childhood obesity increasingly focus on infant feeding, but demonstrate inconsistent effects. A comprehensive qualitative evidence synthesis is essential to better understand feeding behaviours and inform intervention development. The aim of this study is to synthesize evidence on perceptions and experiences of infant feeding and complementary feeding recommendations. METHODS Databases CINAHL, EMBASE, MEDLINE, PsycINFO, Academic Search Complete, SocIndex and Maternity and Infant Care were searched from inception to May 2017. Eligible studies examined parents' experiences of complementary feeding of children (<2 years). Data were synthesized using thematic synthesis. RESULTS Twenty-five studies met inclusion criteria for review. Four key themes emerged. 'Guidelines and advice' highlights variety and inconsistencies between sources of complementary feeding information. 'Stage of weaning' describes infant feeding as a process involving different stages. 'Knowing and trying' outlines parents' engagement in feeding approaches based on instinct, prior experience or trial and error. 'Daily life' highlights problematic cost and time constraints for parents. DISCUSSION Parents predominantly understand and want to engage in healthy feeding processes. Consideration of infant feeding as a process that changes over time is necessary to support parents. Provision of clear, consistent information and guidance from trusted sources on when, what and how to feed is also essential.
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Affiliation(s)
| | - C Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Ireland
| | - C Sinnott
- Cambridge Centre for Health Services Research, University of Cambridge, UK
| | - J McSharry
- School of Psychology, National University of Ireland Galway, Ireland
| | - C Houghton
- School of Nursing & Midwifery, National University of Ireland Galway, Ireland
| | - C Heary
- School of Psychology, National University of Ireland Galway, Ireland
| | - E Toomey
- School of Psychology, National University of Ireland Galway, Ireland
| | - M Byrne
- School of Psychology, National University of Ireland Galway, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Ireland
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Reifsnider E, McCormick DP, Cullen KW, Todd M, Moramarco MW, Gallagher MR, Reyna L. Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population. Acad Pediatr 2018; 18:324-333. [PMID: 29277462 PMCID: PMC5889724 DOI: 10.1016/j.acap.2017.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 11/15/2017] [Accepted: 12/15/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. We hypothesized that parent education, initiated prenatally and provided in the home, would reduce the incidence of infant overweight at age 12 months. METHODS Pregnant obese Latina women were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects. RESULTS Compared to controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age 6 months. Infants overweight at 6 months were likely to be overweight at age 12 months (r = 0.60, P < .0001). Overweight was more common in formula-fed infants at ages 6 months (P < .06) and 12 months (P = .005). Breastfeeding was less common in families with employed mothers (P = .02) and unemployed fathers (P < .01), but the father living with the mother at the time of the prenatal visit predicted successful breastfeeding at infant age 2 months (P < .003). Compared to formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed for ≥2 months (P = .01). CONCLUSIONS The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding.
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Horsch A, Gilbert L, Lanzi S, Gross J, Kayser B, Vial Y, Simeoni U, Hans D, Berney A, Scholz U, Barakat R, Puder JJ. Improving cardiometabolic and mental health in women with gestational diabetes mellitus and their offspring: study protocol for MySweetHeart Trial, a randomised controlled trial. BMJ Open 2018; 8:e020462. [PMID: 29487077 PMCID: PMC5855393 DOI: 10.1136/bmjopen-2017-020462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) carries prenatal and perinatal risk for the mother and her offspring as well as longer-term risks for both the mother (obesity, diabetes, cardiovascular disease) and her child (obesity, type 2 diabetes). Compared with women without GDM, women with GDM are twice as likely to develop perinatal or postpartum depression. Lifestyle interventions for GDM are generally limited to physical activity and/or nutrition, often focus separately on the mother or the child and take place either during or after pregnancy, while their results are inconsistent. To increase efficacy of intervention, the multifactorial origins of GDM and the tight link between mental and metabolic as well as maternal and child health need to be heeded. This calls for an interdisciplinary transgenerational approach starting in, but continuing beyond pregnancy. METHODS AND ANALYSIS This randomised controlled trial will assess the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention aimed at improving the metabolic and mental health of 200 women with GDM and their offspring. Women with GDM at 24-32 weeks gestational age who understand French or English, and their offspring and partners can participate. The intervention components will be delivered on top of usual care during pregnancy and the first year postpartum. Metabolic and mental health outcomes will be measured at 24-32 weeks of pregnancy, shortly after birth and at 6-8 weeks and 1 year after childbirth. Data will be analysed using intention-to-treat analyses. The MySweetHeart Trial is linked to the MySweetHeart Cohort (clinicaltrials.gov/ct2/show/NCT02872974). ETHICS AND DISSEMINATION We will disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02890693; Pre-results.
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Affiliation(s)
- Antje Horsch
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | - Leah Gilbert
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Service of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Yvan Vial
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHad Laboratory, Pediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Center of Bone Diseases, Rheumatology Service, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Consultation Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Lausanne, Switzerland
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jardena J Puder
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Service of Pediatric Endocrinology, Diabetology and Obesity, Lausanne University Hospital, Lausanne, Switzerland
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Galloway AT, Watson P, Pitama S, Farrow CV. Socioeconomic Position and Picky Eating Behavior Predict Disparate Weight Trajectories in Infancy. Front Endocrinol (Lausanne) 2018; 9:528. [PMID: 30279678 PMCID: PMC6154220 DOI: 10.3389/fendo.2018.00528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/21/2018] [Indexed: 01/27/2023] Open
Abstract
Infant weight gain has long-term implications for the establishment of overall health. We examined whether socioeconomic position (SEP), the use of pressure as a feeding practice, and picky eating relate to changes infant in weight-for-length (WFL). A modified developmental design was used to examine whether current levels of child picky eating, parental use of pressure, and SEP were associated with changes in WFL during infancy. Health providers distributed survey packets during routine well-child visits made in the homes of families with young children in New Zealand (n = 193). Primary caregivers of young children provided their child's current level of picky eating, their use of pressure, and their SEP. They also reported their child's professionally-measured WFL from birth, 8, 15, and 21 months of age. A multi-level modeling analysis yielded an interaction between SEP and picky eating in predicting infant weight change over time. Children who had a low SEP and were not picky eaters were on the highest WFL trajectory and children who had a low SEP and were picky eaters were lowest on the WFL trajectory. A main effect revealed that higher levels of parental pressure predicted lower WFL in infants at each age, but did not interact with SEP or picky eating. Findings from this study indicate that the combination of eating behavior and SEP are associated with differential infant growth patterns. These results suggest that eating behavior and SEP should be included in the development of interventions designed to achieve healthy weight during childhood.
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Affiliation(s)
- Amy T Galloway
- Department of Psychology, Appalachian State University, Boone, NC, United States
- Ara Institute of Canterbury, Christchurch, New Zealand
| | - Paul Watson
- Ara Institute of Canterbury, Christchurch, New Zealand
- Royal New Zealand Plunket Trust, Wellington, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute, Otago University, Christchurch, New Zealand
| | - Claire V Farrow
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
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Beckerman JP, Alike Q, Lovin E, Tamez M, Mattei J. The Development and Public Health Implications of Food Preferences in Children. Front Nutr 2017; 4:66. [PMID: 29326942 PMCID: PMC5741689 DOI: 10.3389/fnut.2017.00066] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022] Open
Abstract
Food preferences are a primary determinant of dietary intake and behaviors, and they persist from early childhood into later life. As such, establishing preferences for healthy foods from a young age is a promising approach to improving diet quality, a leading contributor to cardiometabolic health. This narrative review first describes the critical period for food preference development starting in utero and continuing through early childhood. Infants’ innate aversion to sour and bitter tastes can lead them to initially reject some healthy foods such as vegetables. Infants can learn to like these foods through exposures to their flavors in utero and through breastmilk. As solid foods are introduced through toddlerhood, children’s food preferences are shaped by parent feeding practices and environmental factors such as food advertising. Next, we discuss two key focus areas to improve diet quality highlighted by the current understanding of food preferences: (1) promoting healthy food preferences through breastfeeding and early exposures to healthy foods and (2) limiting the extent to which innate preferences for sweet and salty tastes lead to poor diet quality. We use an ecological framework to summarize potential points of intervention and provide recommendations for these focus areas, such as worksite benefits that promote breastfeeding, and changes in food retail and service environments. Individuals’ choices around breastfeeding and diet may ultimately be influenced by policy and community-level factors. It is thus crucial to take a multilevel approach to establish healthy food preferences from a young age, which have the potential to translate into lifelong healthy diet.
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Affiliation(s)
- Jacob P Beckerman
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Queen Alike
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Erika Lovin
- Harvard Kennedy School of Government, Cambridge, MA, United States.,Wharton School of the University of Pennsylvania, Philadelphia, PA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Matvienko-Sikar K, Toomey E, Delaney L, Harrington J, Byrne M, Kearney PM. Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review. Appetite 2017; 123:56-71. [PMID: 29225141 DOI: 10.1016/j.appet.2017.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/18/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. PURPOSE This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. METHODS Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. INCLUSION CRITERIA participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. RESULTS Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. CONCLUSIONS The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations.
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Affiliation(s)
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Ireland
| | - Lisa Delaney
- School of Public Health, University College Cork, Ireland
| | | | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Ireland
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Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121491. [PMID: 29194402 PMCID: PMC5750909 DOI: 10.3390/ijerph14121491] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 12/12/2022]
Abstract
The prevalence of childhood overweight and obesity has increased in most countries the last decades. Considering this in a simplistic way, we can say that obesity is the result of an imbalance between energy intake and energy expenditure. Moreover, the environment from conception to childhood could influence the child's future health. The first 1000 days of life start with woman's pregnancy, and offer a unique window of opportunity to contribute to obesity prevention. In light of the actual literature, the aim of our article is to discuss a proposal of 10 good practices to minimize obesity in the first 1000 days emerging from published science. (1) Both the mother's and the father's behaviors are important. A balanced diet with appropriate fat and protein intake, and favoring fruits and vegetables, is recommended for both parents during the conception period and pregnancy. Furthermore, overweight/obese women who are planning to become pregnant should reduce their weight before conception. (2) During pregnancy, at birth, and during early life, body composition measurements are crucial to monitor the baby's growth. (3) Exclusive breastfeeding is recommended at the beginning of life until six months of age. (4) Four to six months of age is the optimal window to introduce complementary feeding. Until one year of age, breast milk or follow-on/commercial formula is the main recommended feeding source, and cow's milk should be avoided until one year of age. (5) Fruit and vegetable introduction should begin early. Daily variety, diversity in a meal, and repeated exposure to the food, up to eight times, are efficient strategies to increase acceptance of food not well accepted at first. There is no need to add sugar, salt, or sugary fluids to the diet. (6) Respect the child's appetite and avoid coercive "clean your plate" feeding practices. Adapt the portion of food and don't use food as reward for good behavior. (7) Limit animal protein intake in early life to reduce the risk of an early adiposity rebound. Growing-up milk for children between one and three years of age should be preferred to cow's milk, in order to limit intake and meet essential fatty acid and iron needs. (8) The intake of adequate fat containing essential fatty acids should be promoted. (9) Parents should be role models when feeding, with TV and other screens turned-off during meals. (10) Preventive interventions consisting of promoting physical activity and sufficient time dedicated to sleep should be employed. In fact, short sleep duration may be associated with increased risk of developing obesity. Based on literature reviews, and given the suggestions described in this manuscript, concerted public health efforts are needed to achieve the healthy objectives for obesity and nutrition, and to fight the childhood obesity epidemic.
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Aguayo L, Olave-Pichon A, Ariza AJ, Binns HJ. Characteristics of Very Young Hispanic Children Referred for Obesity Management. Glob Pediatr Health 2017; 4:2333794X17739192. [PMID: 29147676 PMCID: PMC5672991 DOI: 10.1177/2333794x17739192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022] Open
Abstract
Information on risks associated with obesity during infancy specific to Hispanic children is scarce. This retrospective medical record review describes characteristics and parenting practices of Hispanic children age <2 years referred for obesity care at a tertiary hospital over a 6-year period. Data on 29 Hispanic children collected from parent-completed assessment forms and clinician documentation were analyzed. Children were of mean age 16.2 ± 4.9 months; body mass index z scores ranged from 1.5 to 9.4 (mean 4.5 ± 1.7); 45% were male; 97% received public insurance; 38% were breastfed ≥6 months; and 93% had a parent who was overweight or obese. Parenting practices included bottle feeding in bed (50%), regularly drinking sweetened beverages (33%), ≥2 hours of screen time (60%), and having a TV in child’s bedroom (55%). Better understanding of factors that contribute to the development of rapid weight gain of Hispanic children can inform future clinical and public health interventions.
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Affiliation(s)
- Liliana Aguayo
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | - Adolfo J Ariza
- Northwestern University, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Helen J Binns
- Northwestern University, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
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Black L, Matvienko-Sikar K, Kearney PM. The association between childcare arrangements and risk of overweight and obesity in childhood: a systematic review. Obes Rev 2017; 18:1170-1190. [PMID: 28677302 DOI: 10.1111/obr.12575] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/21/2017] [Accepted: 05/14/2017] [Indexed: 12/13/2022]
Abstract
Over 80% of preschool-aged children experience non-parental childcare. Childcare type has the potential to influence weight outcomes, but its impact on childhood overweight/obesity is not well established. This review aims to (i) systematically evaluate the effects of childcare type on childhood overweight/obesity risk and (ii) investigate the impact of childcare intensity and age at commencement. Five electronic databases were searched for observational studies quantifying an association between childcare type ≤5 years and weight outcomes <18 years. Twenty-four studies were included (n = 127,529 children). Thirteen studies reported increased risk of overweight/obesity in children attending informal care (n = 9) or centre care (n = 4) vs. parental care. Seven studies reported decreased risk of overweight/obesity for children in centre vs. 'non-centre' care (parental and informal). Four studies reported no association between informal or centre care and overweight/obesity. Early (<3 years) informal care, especially by a relative, was associated with increased risk of overweight/obesity. Higher intensity childcare, especially when commenced early (<1 year), increased overweight/obesity risk. Later (≥3 years) centre care was associated with decreased risk of overweight/obesity. Early informal care, earlier commencement age and higher intensity represent a risk for childhood obesity. Exploration of the obesogenic aspects of these contexts is essential to inform preventative measures.
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Affiliation(s)
- L Black
- Department of Epidemiology and Public Health, University College Cork, Cork City, Ireland
| | - K Matvienko-Sikar
- Department of Epidemiology and Public Health, University College Cork, Cork City, Ireland
| | - P M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork City, Ireland
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Helle C, Hillesund ER, Omholt ML, Øverby NC. Early food for future health: a randomized controlled trial evaluating the effect of an eHealth intervention aiming to promote healthy food habits from early childhood. BMC Public Health 2017; 17:729. [PMID: 28931384 PMCID: PMC5607575 DOI: 10.1186/s12889-017-4731-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Childhood overweight and obesity is a global public health challenge. Primary prevention initiatives targeting parents have been called for to encourage a positive feeding environment and healthy eating habits that may lay a good foundation for future health. At the same time, there is a need for interventions which combine accessibility and scalability with cost effectiveness. Today’s parents are extensive Internet-users, but only a few randomized controlled trials have investigated the use of Internet to promote healthy eating habits in early childhood. In Early Food for Future Health we have developed and will evaluate an Internet-based tool for parents of children between 6 and 12 months, aiming to increase knowledge about infant nutrition and foster protective feeding behavior. Methods During springtime 2016, parents of children aged between 3 and 5 months were recruited through Norwegian child health centres and announcements on Facebook. After completing the baseline questionnaire, 718 parents were individually randomized to intervention- or control group. The intervention group received monthly emails with links to an age-appropriate web-site when their child was between 6 and 12 months. The control group received ordinary care from the child health centres. The data-collection is ongoing. All participants will be followed up at ages 12 and possibly 24 and 48 months, with questionnaires relating to eating behaviour and feeding practices, food variety and diet quality. Discussion Providing guidance and counseling to parents of infants is an important task for health authorities and the public child health services. Early Food for Future health is an intervention focusing on promoting early healthy food-habits which may prevent childhood overweight and obesity. If proven to be effective, Early Food for Future Health can be used by parents and public health nurses for supplementary guidance on feeding practices and diet. This study has the potential to provide greater insight and understanding regarding early parental feeding practices, child eating behavior and the development and efficacy of Internet-based public health interventions. Trial registration ISRCTN13601567.
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Affiliation(s)
- Christine Helle
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
| | - Elisabet Rudjord Hillesund
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Mona Linge Omholt
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Nina Cecilie Øverby
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
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Redsell SA, Rose J, Weng S, Ablewhite J, Swift JA, Siriwardena AN, Nathan D, Wharrad HJ, Atkinson P, Watson V, McMaster F, Lakshman R, Glazebrook C. Digital technology to facilitate Proactive Assessment of Obesity Risk during Infancy (ProAsk): a feasibility study. BMJ Open 2017; 7:e017694. [PMID: 28882926 PMCID: PMC5588959 DOI: 10.1136/bmjopen-2017-017694] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents. DESIGN Multicentre, pre- and post-intervention feasibility study with process evaluation. SETTING Rural and urban deprived settings, UK community care. PARTICIPANTS 66 parents of infants and 22 HVs. INTERVENTION ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training. OUTCOME MEASURES We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity. RESULTS HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (-0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable. CONCLUSION Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention. TRIAL REGISTRATION NUMBER NCT02314494 (Feasibility Study Results).
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Affiliation(s)
- Sarah A Redsell
- Professor of Public Health, Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK
| | - Jennie Rose
- Professor of Public Health, Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK
| | - Stephen Weng
- NIHR Research Fellow, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Research Fellow, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - Judy Anne Swift
- Division of Nutritional Sciences, Associate Professor of Behavioural Nutrition, School of Biosciences, University of Nottingham, Nottingham, UK
| | - Aloysius Niroshan Siriwardena
- Professor of Primary and Pre-hospital Health Care, Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Dilip Nathan
- Consultant Paediatrician, Nottingham University Hospitals Trust, Nottingham, UK
| | - Heather J Wharrad
- Professor of e-Learning and Health Informatics, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Pippa Atkinson
- Lead Health Visitor for Infant Nutrition, Nottingham City Care Partnership, Nottingham, UK
| | - Vicki Watson
- Specialist Public Health Dietician, Nottingham City Care Partnership, Nottingham, UK
| | - Fiona McMaster
- Senior Lecturer in Public Health, Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, UK
| | - Rajalakshmi Lakshman
- Consultant in Public Medicine (Lead for Children), Cambridgeshire and Peterborough Public Health Directorate, Cambridge, UK
| | - Cris Glazebrook
- Professor of Health Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
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Mothers' loss of control over eating during pregnancy in relation to their infants' appetitive traits. Appetite 2017; 120:1-5. [PMID: 28801057 DOI: 10.1016/j.appet.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/03/2017] [Accepted: 08/05/2017] [Indexed: 11/21/2022]
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Mihrshahi S, Drayton BA, Bauman AE, Hardy LL. Associations between childhood overweight, obesity, abdominal obesity and obesogenic behaviors and practices in Australian homes. BMC Public Health 2017; 18:44. [PMID: 28732475 PMCID: PMC5521098 DOI: 10.1186/s12889-017-4595-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 07/13/2017] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Despite emerging research about the role of the family and home environment on early childhood obesity, little is known on how weight-related behaviors, parent practices and the home environment influence overweight/obesity in older children and adolescents. METHODS This analysis used data from a cross-sectional, representative population survey of Australian children age 5-16 years conducted in 2015. Data included measured anthropometry to calculate body mass index (BMI; kg/m2) and waist-to-height ratio (WHtR; waist circumference/height). Information on home-based weight-related behaviors (individual eating and screen time behaviors, parent influences including rules and home environment factors) were measured using established short questions, with parental proxy reporting for children in up to grade 4, and self-report for students in grades 6, 8 and 10. Logistic regression models were used to examine associations between weight status and home-based weight-related behaviors. RESULTS Both children and adolescents who did not consume breakfast daily were more likely to be overweight/obese OR (95% CI) = 1.39 (1.07-1.81) p = 0.015, OR (95% CI) =1.42 (1.16-1.74) p = 0.001, respectively, adjusted for age, gender, socio-economic status, rural/urban residence and physical activity. There was also a significant positive association with higher waist-to-height ratio in both children and adolescents. Among children, having a TV in the bedroom was also associated with overweight and obesity OR (95% CI) = 1.54 (1.13-2.09) p = 0.006 and higher waist-to-height ratio. For adolescents, parenting practices such as having no rules on screen-time, OR (95% CI) = 1.29 (1.07-1.55) p = 0.008, and rewarding good behavior with sweets, OR (95% CI) = 2.18 (1.05-4.52) p = 0.036, were significant factors associated with overweight and obesity. The prevalence of these obesogenic behaviors were higher in certain sub-groups of children and adolescents, specifically those from social disadvantage and non-English-speaking backgrounds. CONCLUSIONS Interventions to reduce the prevalence of obesity and overweight should include promoting daily breakfast, reducing screen-time, and encouraging health-promoting parenting practices. Interventions should particularly focus on those at some social disadvantage and from non-English-speaking backgrounds.
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Affiliation(s)
- Seema Mihrshahi
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia. .,NHMRC Centre for Research Excellence in The Early Prevention of Obesity in Childhood, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia.
| | - Bradley A Drayton
- NSW Ministry of Health, NSW Biostatistics Training Program, Sydney, Australia
| | - Adrian E Bauman
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia
| | - Louise L Hardy
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia
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Wasser HM, Thompson AL, Suchindran CM, Hodges EA, Goldman BD, Perrin EM, Faith MS, Bulik CM, Heinig MJ, Bentley ME. Family-based obesity prevention for infants: Design of the "Mothers & Others" randomized trial. Contemp Clin Trials 2017; 60:24-33. [PMID: 28600160 DOI: 10.1016/j.cct.2017.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/29/2017] [Accepted: 06/05/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Our goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life. DESIGN, PARTICIPANTS, AND METHODS The design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37weeks gestation and when infants are 1, 3, 6, 9, 12, and 15months of age. RESULTS The primary outcome is infant/toddler growth and likelihood of overweight at 15months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention. CONCLUSIONS If successful in promoting healthy infant growth and enhancing caregiver behaviors, "Mothers and Others" will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2years, including interventional research and federal, state, and community health programs. TRIAL REGISTRATION ClinicalTrials.gov, NCT01938118, August 9, 2013.
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Affiliation(s)
| | | | | | - Eric A Hodges
- University of North Carolina, Chapel Hill, NC, United States.
| | | | - Eliana M Perrin
- 3643 N. Roxboro Street, Duke University, Durham, NC 27704, United States.
| | | | - Cynthia M Bulik
- University of North Carolina, Chapel Hill, NC, United States; Karolinska Institutet, Stockholm, Sweden.
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[What are the determinants of childhood obesity? : A literature review as part of the project "Nationwide Monitoring of Childhood Obesity Determinants"]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:1465-1475. [PMID: 27695939 DOI: 10.1007/s00103-016-2441-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Obesity can impair health even in childhood and unfold negative health consequences through an individual's lifespan. In Germany, to date, a systematic and periodically updated synopsis of the multifaceted determinants of childhood obesity is lacking. In this paper, we present the results of a systematic literature review on childhood obesity determinants, which was conducted over the course of the implementation of nationwide monitoring. METHODS The review was carried out in three steps. Initially, a search for etiological models of childhood obesity was conducted. Based on these results, a systematic review of reviews on childhood obesity determinants was carried out. Finally, the results were verified by taking international guidelines on childhood obesity into account. RESULTS In total, 21 etiological models, 75 reviews and 7 guidelines were identified. Over 60 determinants were extracted from these publications and were summarized into the following categories: nutritional behavior, physical activity behavior, sleeping pattern, biological determinants and diseases, prenatal and early childhood determinants, psycho-social determinants, food environment, moveability/walkability, setting and social environment, health promotion and prevention, socioeconomic, demographic, and sociocultural determinants. CONCLUSION This review demonstrates the complex patterns of childhood obesity determinants in correspondence with a socio-ecological approach. The review will form the basis for the monitoring-system "Nationwide Monitoring of Childhood Obesity Determinants", which will be implemented at the Robert Koch Institute by the end of 2017.
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132
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Gillman MW. Early infancy interventions to prevent childhood obesity. Obesity (Silver Spring) 2017; 25:817-818. [PMID: 28337849 DOI: 10.1002/oby.21829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Matthew W Gillman
- Environmental Influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Rockville, Maryland, USA
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133
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Uwaezuoke SN, Eneh CI, Ndu IK. Relationship Between Exclusive Breastfeeding and Lower Risk of Childhood Obesity: A Narrative Review of Published Evidence. Clin Med Insights Pediatr 2017; 11:1179556517690196. [PMID: 28469518 PMCID: PMC5398325 DOI: 10.1177/1179556517690196] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/02/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The pattern of infant feeding during the first 1000-day period-from conception to the second birthday-has a significant influence on the child's growth trajectory. The relationship between exclusive breastfeeding and lower risk of childhood obesity has elicited much scientific interest, given the fact that this form of malnutrition is becoming a global epidemic. AIM This narrative review aims to examine the evidence in the literature linking exclusive breastfeeding with reduction in obesity in children. LITERATURE SEARCH Using appropriate search terms, PubMed database was searched for relevant articles that met the review objective. RESULTS Evidence for the protective effect of exclusive breastfeeding against childhood obesity have been provided by studies which explored 5 physiologic mechanisms and those that established the causality between breastfeeding and lower risk of obesity. The few studies that disputed this relationship highlighted the influence of confounding factors. A new insight on molecular mechanisms, however, points to a direct and indirect effect of human milk oligosaccharides on the prevention of overweight and obesity. CONCLUSIONS The preponderance of current evidence strongly suggests that exclusivity in breastfeeding can prevent the development of obesity in children.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Chizoma I Eneh
- Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Ikenna K Ndu
- Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria
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Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017; 64:119-132. [PMID: 28027215 DOI: 10.1097/mpg.0000000000001454] [Citation(s) in RCA: 513] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
UNLABELLED This position paper considers different aspects of complementary feeding (CF), focussing on healthy term infants in Europe. After reviewing current knowledge and practices, we have formulated these recommendations: Timing: Exclusive or full breast-feeding should be promoted for at least 4 months (17 weeks, beginning of the 5th month of life) and exclusive or predominant breast-feeding for approximately 6 months (26 weeks, beginning of the 7th month) is a desirable goal. Complementary foods (solids and liquids other than breast milk or infant formula) should not be introduced before 4 months but should not be delayed beyond 6 months. CONTENT Infants should be offered foods with a variety of flavours and textures including bitter tasting green vegetables. Continued breast-feeding is recommended alongside CF. Whole cows' milk should not be used as the main drink before 12 months of age. Allergenic foods may be introduced when CF is commenced any time after 4 months. Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both) should have peanut introduced between 4 and 11 months, following evaluation by an appropriately trained specialist. Gluten may be introduced between 4 and 12 months, but consumption of large quantities should be avoided during the first weeks after gluten introduction and later during infancy. All infants should receive iron-rich CF including meat products and/or iron-fortified foods. No sugar or salt should be added to CF and fruit juices or sugar-sweetened beverages should be avoided. Vegan diets should only be used under appropriate medical or dietetic supervision and parents should understand the serious consequences of failing to follow advice regarding supplementation of the diet. METHOD Parents should be encouraged to respond to their infant's hunger and satiety queues and to avoid feeding to comfort or as a reward.
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Lucas CT, Messito MJ, Gross RS, Tomopoulos S, Fierman AH, Cates CB, Johnson SB, Dreyer B, Mendelsohn AL. Characteristics Associated With Adding Cereal Into the Bottle Among Immigrant Mother-Infant Dyads of Low Socioeconomic Status and Hispanic Ethnicity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:27-34.e1. [PMID: 27756595 PMCID: PMC5682590 DOI: 10.1016/j.jneb.2016.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Determine maternal and infant characteristics associated with adding cereal into the bottle. DESIGN Secondary data analysis. PARTICIPANTS Study participants were immigrant, low-income, urban mother-infant dyads (n = 216; 91% Hispanic, 19% US-born) enrolled in a randomized controlled trial entitled the Bellevue Project for Early Language, Literacy and Education Success. MAIN OUTCOME MEASURES Maternal characteristics (age, marital status, ethnicity, primary language, country of origin, education, work status, income, depressive symptoms, and concern about infant's future weight) and infant characteristics (gender, first born, and difficult temperament). ANALYSIS Fisher exact test, chi-square test, and simultaneous multiple logistic regression of significant (P < .05) variables identified in unadjusted analyses. RESULTS Twenty-seven percent of mothers added cereal into the bottle. After adjusting for confounding variables identified in bivariate analyses, mothers who were single (P = .02), had moderate to severe depressive symptoms (P = .01) and perceived their infant had a difficult temperament (P = .03) were more likely to add cereal into the bottle. Conversely, mothers who expressed concern about their infants becoming overweight were less likely to add cereal (P = .02). CONCLUSIONS AND IMPLICATIONS Health care providers should screen for adding cereal in infant bottles. Further research is needed to investigate the impact of adding cereal into the bottle on weight trajectories over time. Causal associations also need to be identified to effectively prevent this practice.
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Affiliation(s)
- Candice Taylor Lucas
- Department of Pediatrics, New York University School of Medicine, New York, NY; Department of Pediatrics, Pediatric Exercise and Genomics Research Center, University of California, Irvine School of Medicine, Irvine, CA.
| | - Mary Jo Messito
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Rachel S Gross
- Department of Pediatrics, Children's Hospital of Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | | | - Samantha Berkule Johnson
- Department of Pediatrics, New York University School of Medicine, New York, NY; Department of Psychology, Marymount Manhattan College, New York, NY
| | - Benard Dreyer
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine, New York, NY
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Lind MV, Larnkjær A, Mølgaard C, Michaelsen KF. Dietary protein intake and quality in early life: impact on growth and obesity. Curr Opin Clin Nutr Metab Care 2017; 20:71-76. [PMID: 27749711 DOI: 10.1097/mco.0000000000000338] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Obesity is an increasing problem and high-protein intake early in life seems to increase later risk of obesity. This review summarizes recent publications in the area including observational and intervention studies and publications on underlying mechanisms. RECENT FINDINGS Recent observational and randomized controlled trials confirmed that high-protein intake in early life seems to increase early weight gain and the risk of later overweight and obesity. Recent studies have looked at the effect of different sources of protein, and especially high-animal protein intake seems to have an effect on obesity. Specific amino acids, such as leucine, have also been implicated in increasing later obesity risk maybe via specific actions on insulin-like growth factor I. Furthermore, additional underlying mechanisms including epigenetics have been linked to long-term obesogenic programming. Finally, infants with catch-up growth or specific genotypes might be particularly vulnerable to high-protein intake. SUMMARY Recent studies confirm the associations between high-protein intake during the first 2 years and later obesity. Furthermore, knowledge of the mechanisms involved and the role of different dietary protein sources and amino acids has increased, but intervention studies are needed to confirm the mechanisms. Avoiding high-protein intake in early life holds promise as a preventive strategy for childhood obesity.
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Affiliation(s)
- Mads V Lind
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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137
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Kugler KC, Balantekin KN, Birch LL, Savage JS. Application of the multiphase optimization strategy to a pilot study: an empirical example targeting obesity among children of low-income mothers. BMC Public Health 2016; 16:1181. [PMID: 27876027 PMCID: PMC5120514 DOI: 10.1186/s12889-016-3850-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Emerging approaches to building more efficient and effective behavioral interventions are becoming more widely available. The current paper provides an empirical example of the use of the engineering-inspired multiphase optimization strategy (MOST) to build a remotely delivered responsive parenting intervention to prevent obesity among children of low-income mothers with and without depressive symptoms. Methods Participants were 107 mothers with (n = 45) and without (n = 62) depressive symptoms who had a child aged 12 to 42 months participating in the Women, Infants and Children program. Participants were randomized to one of sixteen experimental conditions using a factorial design that included a combination of the following eight remotely delivered intervention components: responsive feeding curriculum (given to all participants), parenting curriculum, portion size guidance, obesogenic risk assessment, personalized feedback on mealtime routines, feeding curriculum counseling, goal setting, mobile messaging, and social support. This design enabled efficient identification of components with low feasibility and acceptability. Results Completion rates were high (85%) and did not statistically differ by depressive symptoms. However, mothers with depressive symptoms who received obesogenic risk assessment and personalized feedback on mealtime routines components had lower completion rates than mothers without depressive symptoms. All intervention components were feasible to implement except the social support component. Regardless of experimental condition, most participants reported that the program increased their awareness of what, when, and how to feed their children. Conclusions MOST provided an efficient way to assess the feasibility of components prior to testing them with a fully powered experiment. This framework helped identify potentially challenging combinations of remotely delivered intervention components. Consideration of how these results can inform future studies focused on the optimization phase of MOST is discussed.
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Affiliation(s)
- Kari C Kugler
- The Methodology Center, The Pennsylvania State University, 404 Health & Human Development Building, University Park, PA, 16802, USA.
| | - Katherine N Balantekin
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.,Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Leann L Birch
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.,Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
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Harrison M, Brodribb W, Hepworth J. A qualitative systematic review of maternal infant feeding practices in transitioning from milk feeds to family foods. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27696658 DOI: 10.1111/mcn.12360] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/23/2016] [Accepted: 07/08/2016] [Indexed: 01/10/2023]
Abstract
Evidence supports the establishment of healthy feeding practices early in life to promote lifelong healthy eating patterns protective against chronic disease such as obesity. Current early childhood obesity prevention interventions are built on extant understandings of how feeding practices relate to infant's cues of hunger and satiety. Further insights regarding factors that influence feeding behaviors in early life may improve program designs and outcomes. Four electronic databases were searched for peer-reviewed qualitative studies published between 2000 to 2014 with transitional infant feeding practice rationale from developed countries. Reporting transparency and potential bias was assessed using the Consolidated Criteria for Reporting Qualitative Research quality checklist. Thematic synthesis of 23 manuscripts identified three themes (and six sub-themes): Theme 1. Infant (physical cues and behavioural cues) focuses on the perceived signs of readiness to start solids and the feeding to influence growth and "health happiness." Theme 2. Mother (coping strategies and knowledge and skills) focuses on the early survival of the infant and the family and the feeding to satisfy hunger and influence infant contentment, and sleep. Theme 3. Community (pressure and inconsistent advice) highlights the importance of generational feeding and how conflicting feeding advice led many mothers to adopt valued familial or culturally established practices. Overall, mothers were pivotal to feeding decisions. Satisfying infant's needs to reach "good mothering" status as measured by societal expectations was highly valued but lacked consideration of nutrition, obesity, and long term health. Maternal interpretation of healthy infant feeding and successful parenting need attention when developing strategies to support new families.
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Affiliation(s)
- Michelle Harrison
- Discipline of General Practice (DGP) and Child Health Research Centre (CHRC), Faculty of Medicine and Biomedical Sciences, The University of Queensland (UQ), Brisbane, Queensland, Australia
| | - Wendy Brodribb
- Discipline of General Practice (DGP), Faculty of Medicine and Biomedical Sciences, The University of Queensland (UQ), Brisbane, Queensland, Australia
| | - Julie Hepworth
- School of Public Health and Social Work Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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139
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Taylor RW, Heath ALM, Galland BC, Cameron SL, Lawrence JA, Gray AR, Tannock GW, Lawley B, Healey D, Sayers RM, Hanna M, Meredith-Jones K, Hatch B, Taylor BJ. Three-year follow-up of a randomised controlled trial to reduce excessive weight gain in the first two years of life: protocol for the POI follow-up study. BMC Public Health 2016; 16:771. [PMID: 27514714 PMCID: PMC4982410 DOI: 10.1186/s12889-016-3383-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Prevention of Overweight in Infancy (POI) study was a four-arm randomised controlled trial (RCT) in 802 families which assessed whether additional education and support on sleep (Sleep group); food, physical activity and breastfeeding (FAB group); or both (Combination group), reduced excessive weight gain from birth to 2 years of age, compared to usual care (Control group). The study had high uptake at recruitment (58 %) and retention at 2 years (86 %). Although the FAB intervention produced no significant effect on BMI or weight status at 2 years, the odds of obesity were halved in those who received the sleep intervention, despite no apparent effect on sleep duration. We speculate that enhanced self-regulatory behaviours may exist in the Sleep group. Self-regulation was not measured in our initial intervention, but extensive measures have been included in this follow-up study. Thus, the overall aim of the POI follow-up is to determine the extent to which augmented parental support and education on infant sleep, feeding, diet, and physical activity in the first 2 years of life reduces BMI at 3.5 and 5 years of age, and to determine the role of self-regulation in any such relationship. METHODS/DESIGN We will contact all 802 families and seek renewed consent to participate in the follow-up study. The families have received no POI intervention since the RCT finished at 2 years of age. Follow-up data collection will occur when the children are aged 3.5 and 5 years (i.e. up to 3 years post-intervention). Outcomes of interest include child anthropometry, body composition (DXA scan), diet (validated food frequency questionnaire), physical activity (accelerometry), sleep (questionnaire and accelerometry), and self-regulation (questionnaires and neuropsychological assessment). DISCUSSION Our follow-up study has been designed primarily to enable us to determine whether the intriguing benefit of the sleep intervention suggested at 2 years of age remains as children approach school age. However, cohort analyses will also investigate how BMI, self-regulation, and sleep consolidation develop during the early years. This information will be valuable to researchers and policy makers progressing the field of early childhood obesity prevention. TRIAL REGISTRATION ClinicalTrials.gov number NCT00892983 .
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Affiliation(s)
- Rachael W. Taylor
- Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | | | - Barbara C. Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Sonya L. Cameron
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Julie A. Lawrence
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gerald W. Tannock
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Blair Lawley
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Dione Healey
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Rachel M. Sayers
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Maha Hanna
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Kim Meredith-Jones
- Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Burt Hatch
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Barry J. Taylor
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
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140
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Savage JS, Birch LL, Marini M, Anzman-Frasca S, Paul IM. Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:742-9. [PMID: 27271455 PMCID: PMC4969142 DOI: 10.1001/jamapediatrics.2016.0445] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking. OBJECTIVE To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year. DESIGN, SETTING, AND PARTICIPANTS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015. INTERVENTIONS At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participant's home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors. MAIN OUTCOMES AND MEASURES Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The intervention's effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain. RESULTS Of the mothers included in the study, 246 were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full time (72%) at time of enrollment. The mean conditional weight gain score was lower among infants in the RP group compared with the control group (-0.18; 95% CI, -0.36 to -0.001), reflecting that the RP infants gained weight more slowly than control group infants (0.18; 95% CI, 0.02-0.34); this effect did not differ by feeding mode (predominantly fed breast milk or not). Infants in the RP group also had lower mean weight-for-length percentiles at 1 year than infants in the control group (57.5%; 95% CI, 52.56%-62.37% vs 64.4%; 95% CI, 59.94%-69.26%; P = .04) and were less likely to be overweight at age 1 year (5.5% vs 12.7%; P = .05). CONCLUSIONS AND RELEVANCE An RP intervention is associated with reduced rapid weight gain during the first 6 months after birth and overweight status at age 1 year. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01167270.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park2Nutritional Sciences, The Pennsylvania State University, University Park
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens
| | - Michele Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park
| | | | - Ian M Paul
- Pediatrics and Public Health Sciences, Pennsylvania State College of Medicine, University Park
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141
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Redsell SA, Weng S, Swift JA, Nathan D, Glazebrook C. Validation, Optimal Threshold Determination, and Clinical Utility of the Infant Risk of Overweight Checklist for Early Prevention of Child Overweight. Child Obes 2016; 12:202-9. [PMID: 27093465 PMCID: PMC5118965 DOI: 10.1089/chi.2015.0246] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous research has demonstrated the predictive validity of the Infant Risk of Overweight Checklist (IROC). This study further establishes the predictive accuracy of the IROC using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and examines the optimal threshold for determining high risk of childhood overweight. METHODS Using the IROC algorithm, we calculated the risk of being overweight, based on International Obesity Task Force criteria, in the first year of life for 980 children in the ALSPAC cohort at 5 years. Discrimination was assessed by the area under the receiver operating curve (AUC c-statistic). Net reclassification index (NRI) was calculated for risk thresholds ranging from 2.5% to 30%, which determine cutoffs for identifying infants at risk of becoming overweight. RESULTS At 5 years of age, 12.3% of boys and 19.6% of girls were categorized overweight. Discrimination (AUC c-statistic) ranged from 0.67 (95% confidence interval [CI], 0.62-0.72) when risk scores were calculated directly to 0.93 (95% CI, 0.88-0.98) when the algorithm was recalibrated and missing values of the risk factor algorithm were imputed. The NRI showed that there were positive gains in reclassification using risk thresholds from 5% to 20%, with the maximum NRI being at 10%. CONCLUSIONS This study confirms that the IROC has moderately good validity for assessing overweight risk in infants and offers an optimal threshold for determining high risk. The IROC algorithm has been imbedded into a computer program for Proactive Assessment of Obesity Risk during Infancy, which facilitates early overweight prevention through communication of risk to parents.
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Affiliation(s)
- Sarah A. Redsell
- Faculty of Health, Social Care, and Education, Anglia Ruskin University, Cambridge, United Kingdom
| | - Stephen Weng
- School of Medicine, Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Judy A. Swift
- Faculty of Science, University of Nottingham, Sutton Bonington, United Kingdom
| | - Dilip Nathan
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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142
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Blake-Lamb TL, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review. Am J Prev Med 2016; 50:780-789. [PMID: 26916260 PMCID: PMC5207495 DOI: 10.1016/j.amepre.2015.11.010] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/03/2015] [Accepted: 11/17/2015] [Indexed: 12/19/2022]
Abstract
CONTEXT The "first 1,000 days"-conception through age 24 months-are critical for the development and prevention of childhood obesity. This study systematically reviews existing and ongoing interventions during this period, identifies gaps in current research, and discusses conceptual frameworks and opportunities for future interventions. EVIDENCE ACQUISITION PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched to identify completed and ongoing interventions implemented during pregnancy through age 24 months that aimed to prevent overweight/obesity between ages 6 months and 18 years. English-language, controlled interventions published between January 1, 1980 and December 12, 2014, were analyzed between December 13, 2014 and March 15, 2015. EVIDENCE SYNTHESIS Of 34 completed studies from 26 unique identified interventions, nine were effective. Effective interventions focused on individual- or family-level behavior changes through home visits, individual counseling or group sessions in clinical settings, a combination of home and group visits in a community setting, and using hydrolyzed protein formula. Protein-enriched formula increased childhood obesity risk. Forty-seven ongoing interventions were identified. Across completed and ongoing interventions, the majority target individual- or family-level changes, many are conducted in clinical settings, and few target early-life systems and policies that may impact childhood obesity. CONCLUSIONS Obesity interventions may have the greatest preventive effect if begun early in life. Yet, few effective interventions in the first 1,000 days exist, and many target individual-level behaviors of parents and infants. Interventions that operate at systems levels and are grounded in salient conceptual frameworks hold promise for improving future models of early-life obesity prevention.
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Affiliation(s)
- Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;.
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Redsell SA, Edmonds B, Swift JA, Siriwardena AN, Weng S, Nathan D, Glazebrook C. Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. MATERNAL & CHILD NUTRITION 2016; 12:24-38. [PMID: 25894857 PMCID: PMC5029770 DOI: 10.1111/mcn.12184] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.
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Affiliation(s)
- Sarah A. Redsell
- Faculty of Health, Social Care and EducationAnglia Ruskin UniversityCambridgeUK
| | - Barrie Edmonds
- School of Health SciencesQueen's Medical CentreUniversity of NottinghamNottinghamUK
| | - Judy Anne Swift
- Division of Nutritional SciencesSchool of BiosciencesUniversity of NottinghamNottinghamUK
| | | | - Stephen Weng
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Dilip Nathan
- Department of Child HealthQueen's Medical CentreNottingham University Hospitals TrustNottinghamUK
| | - Cris Glazebrook
- Institute of Mental HealthUniversity of Nottingham Innovation ParkNottinghamUK
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Lakshman R, Whittle F, Hardeman W, Suhrcke M, Wilson E, Griffin S, Ong KK. Effectiveness of a behavioural intervention to prevent excessive weight gain during infancy (The Baby Milk Trial): study protocol for a randomised controlled trial. Trials 2015; 16:442. [PMID: 26445092 PMCID: PMC4595312 DOI: 10.1186/s13063-015-0941-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infancy is a period of rapid growth and habit formation and hence could be a critical period for obesity prevention. Excess weight gain during infancy is associated with later obesity and formula-fed babies are more likely to gain excess weight compared to breastfed babies. The primary trial outcome is a change in the weight standard deviation score from birth to 1 year. METHODS/DESIGN We will recruit 650 to 700 parents who introduce formula-milk feeds within 14 weeks of their baby's birth to a single (assessor) blind, parallel group, individually randomised controlled trial. The focus of the intervention is the caregiver (usually the mother), and the focus of the primary outcome is the infant. The intervention group will receive the behavioural intervention, which aims to reduce formula-milk intake, promote responsive feeding and healthy weaning, and prevent excessive weight gain during infancy. The intervention is based on Social Cognitive Theory and action planning ('implementation intentions'). It consists of three components: (1) a motivational component to strengthen parents' motivation to follow the Baby Milk feeding guidelines, (2) an action planning component to help translate motivation into action, and (3) a coping planning component to help parents deal with difficult situations. It will be delivered by trained facilitators (research nurses) over 6 months through three face-to-face contacts, two telephone contacts and written materials. The control group will have the same number of contacts with facilitators, and general issues about feeding will be discussed. Anthropometric outcomes will be measured by trained research staff, blind to group allocation, at baseline, 6 months and 12 months following standard operating procedures. Validated questionnaires will assess milk intake, temperament, appetite, sleep, maternal quality of life and maternal psychological factors. A 4-day food diary will be completed at 8 months. DISCUSSION The results of the trial will help to inform infant feeding guidelines and to understand the links between infant feeding, behaviour, appetite and growth. TRIAL REGISTRATION ISRTCN20814693 . Registration date 13 January 2011.
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Affiliation(s)
- Rajalakshmi Lakshman
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Fiona Whittle
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Wendy Hardeman
- Behavioural Science Group, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK.
| | - Ed Wilson
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Simon Griffin
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Ken K Ong
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
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