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Harris SJ, Paul IM, Anzman-Frasca S, Savage JS, Hohman EE. Protective Eating Behaviors Among Children at Higher Risk for Obesity in the INSIGHT Study. Child Obes 2024. [PMID: 39269885 DOI: 10.1089/chi.2024.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Background: Maternal pre-pregnancy body mass index (BMI) is positively associated with offspring overweight. We investigated behaviors that may confer resilience to childhood overweight development by examining appetitive traits in at-risk children born to mothers with pre-pregnancy overweight. Methods: This secondary analysis included children born to mothers with pre-pregnancy BMI ≥25 kg/m2 from the Intervention Nurses Start Infants Growing on Health Trajectories Study (N = 84). Mothers completed the Child Eating Behavior Questionnaire (CEBQ) at child ages 30 months and 6 years. t-tests assessed differences in appetitive traits (CEBQ subscale scores) between children with overweight (BMI ≥85th percentile) and without overweight (BMI <85th percentile). Results: The 87 children (41 female [47%]) included in this analysis were predominantly White and non-Hispanic (93%), and 34 (39%) had overweight at age 6 years. Compared with children with overweight, children without overweight had mothers who reported greater child slowness in eating when their child was 30 months (p = 0.04) and 6 years old (p = 0.004). Similarly, mothers of children without overweight reported higher child satiety responsiveness, lower enjoyment of food, and lower food responsiveness (p < 0.001 for all) when their child was 6 years old. Conclusion: Eating slower, higher satiety responsiveness, lower enjoyment of food, and lower food responsiveness were protective factors against developing overweight among those with familial risk. Strategies to promote the development of slower eating and satiety responsiveness could be explored as part of obesity prevention strategies.
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Affiliation(s)
- Sarah J Harris
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Stephanie Anzman-Frasca
- Jacobs School of Medicine and Biomedical Sciences, Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
| | - Jennifer S Savage
- Nutritional Sciences, Penn State University, University Park, Pennsylvania, USA
- Center for Childhood Obesity Research, Penn State University, University Park, Pennsylvania, USA
| | - Emily E Hohman
- Center for Childhood Obesity Research, Penn State University, University Park, Pennsylvania, USA
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2
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Karakitsiou G, Plakias S, Christidi F, Tsiakiri A. Unraveling Childhood Obesity: A Grounded Theory Approach to Psychological, Social, Parental, and Biological Factors. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1048. [PMID: 39334581 PMCID: PMC11429650 DOI: 10.3390/children11091048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/18/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024]
Abstract
Childhood obesity is a major medical and public health issue of global interest, which is influenced by a diverse array of factors and carries significant medical and psychosocial implications. Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration. This study aimed to construct a grounded theory that includes and connects the psychological, social, parental, and biological factors affecting childhood obesity. Key psychological factors include mental health issues such as depression and emotional eating, while social factors encompass socioeconomic status and cultural influences. Parental factors involve parenting styles and feeding practices, and biological factors relate to genetic predispositions and prenatal conditions. These factors interact in complex ways, highlighting the multifactorial nature of childhood obesity. The study employed a qualitative grounded theory approach, using research articles to achieve a thorough understanding. Qualitative analysis of the articles was conducted using Atlas.ti 24.0 software. Twenty-five research articles were required to reach theoretical saturation. The analysis resulted in 336 codes that were grouped into seven broad categories and twenty-four different subcategories. Through the construction of the theoretical framework, it was recognized that obesity in minors is a complex and multifactorial issue and that the network of causes and influencing factors covers a broad spectrum ranging from the individual to the family, and subsequently to society at large, which interact with each other.
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Affiliation(s)
- Georgia Karakitsiou
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Spyridon Plakias
- Department of Physical Education and Sport Science, University of Thessaly, 38221 Trikala, Greece;
| | - Foteini Christidi
- Department of Neurology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Anna Tsiakiri
- Department of Neurology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Zhao S, Jiang H, Sun H, Shao Q, Zu X, Li Y, Zhang Y, Wang A, Cui X. Effects of responsive breastfeeding intervention on breastfeeding and infant growth in China: A randomised controlled trial. MATERNAL & CHILD NUTRITION 2024; 20:e13654. [PMID: 38650116 PMCID: PMC11168374 DOI: 10.1111/mcn.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self-determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother-infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self-efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post-partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post-partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self-perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post-partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post-partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: -2.09; 95% CI: -2.88 to -1.31; p < 0.001), 6 weeks post-partum (MD: -4.35; 95% CI: -5.20 to -3.49; p < 0.001) and 3 months (MD: -4.89; 95% CI: -5.70 to -4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post-partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post-partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post-partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post-partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post-partum, the intervention group's infants showed slower weight (t = -0.90, p = 0.371) and length (t = -0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post-partum, there was a significant difference in both weight (t = -3.46, p = 0.001) and length (t = -2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self-confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow-up in future research.
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Affiliation(s)
- Shuliang Zhao
- School of NursingShandong Second Medical UniversityWeifangChina
| | - Huimin Jiang
- School of NursingShandong Second Medical UniversityWeifangChina
| | | | - Qingchun Shao
- Department of ObstetricsAffiliated Hospital of Shandong Second Medical UniversityWeifangChina
| | - Xinxia Zu
- Department of ObstetricsAffiliated Hospital of Shandong Second Medical UniversityWeifangChina
| | - Yanan Li
- School of NursingShandong Second Medical UniversityWeifangChina
| | - Yuanyuan Zhang
- School of NursingShandong Second Medical UniversityWeifangChina
| | - Aihua Wang
- School of NursingShandong Second Medical UniversityWeifangChina
| | - Xinghui Cui
- Nursing DepartmentAffiliated Hospital of Shandong Second Medical UniversityWeifangChina
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4
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Lariviere D, Craig SJC, Paul IM, Hohman EE, Savage JS, Wright RO, Chiaromonte F, Makova KD, Reimherr ML. Methylation profiles at birth linked to early childhood obesity. J Dev Orig Health Dis 2024; 15:e7. [PMID: 38660759 PMCID: PMC11268442 DOI: 10.1017/s2040174424000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Childhood obesity represents a significant global health concern and identifying its risk factors is crucial for developing intervention programs. Many "omics" factors associated with the risk of developing obesity have been identified, including genomic, microbiomic, and epigenomic factors. Here, using a sample of 48 infants, we investigated how the methylation profiles in cord blood and placenta at birth were associated with weight outcomes (specifically, conditional weight gain, body mass index, and weight-for-length ratio) at age six months. We characterized genome-wide DNA methylation profiles using the Illumina Infinium MethylationEpic chip, and incorporated information on child and maternal health, and various environmental factors into the analysis. We used regression analysis to identify genes with methylation profiles most predictive of infant weight outcomes, finding a total of 23 relevant genes in cord blood and 10 in placenta. Notably, in cord blood, the methylation profiles of three genes (PLIN4, UBE2F, and PPP1R16B) were associated with all three weight outcomes, which are also associated with weight outcomes in an independent cohort suggesting a strong relationship with weight trajectories in the first six months after birth. Additionally, we developed a Methylation Risk Score (MRS) that could be used to identify children most at risk for developing childhood obesity. While many of the genes identified by our analysis have been associated with weight-related traits (e.g., glucose metabolism, BMI, or hip-to-waist ratio) in previous genome-wide association and variant studies, our analysis implicated several others, whose involvement in the obesity phenotype should be evaluated in future functional investigations.
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Affiliation(s)
- Delphine Lariviere
- Department of Biochemistry and Molecular Biology, Penn State University, University Park, PA, USA
| | - Sarah J C Craig
- Department of Biology, Penn State University, University Park, PA, USA
- Center for Medical Genomics, Penn State University, University Park, PA, USA
| | - Ian M Paul
- Center for Medical Genomics, Penn State University, University Park, PA, USA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Emily E Hohman
- Center for Childhood Obesity Research, Penn State University, University Park, PA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Penn State University, University Park, PA, USA
- Nutrition Department, Penn State University, University Park, PA, USA
| | | | - Francesca Chiaromonte
- Center for Medical Genomics, Penn State University, University Park, PA, USA
- Department of Statistics, Penn State University, University Park, PA, USA
- L'EMbeDS, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, Pisa, Italy
| | - Kateryna D Makova
- Department of Biology, Penn State University, University Park, PA, USA
- Center for Medical Genomics, Penn State University, University Park, PA, USA
| | - Matthew L Reimherr
- Center for Medical Genomics, Penn State University, University Park, PA, USA
- Department of Statistics, Penn State University, University Park, PA, USA
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5
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Kahraman S, Havlioğlu S. The effect of home nurse visits on infant weight and breastfeeding: Systematic review and meta-analysis. Int J Nurs Pract 2024; 30:e13150. [PMID: 36967608 DOI: 10.1111/ijn.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/01/2023] [Accepted: 03/04/2023] [Indexed: 03/28/2023]
Abstract
AIMS The primary aim of this systematic review and meta-analysis is to evaluate the effects of home nurse visiting on infant weight and breastfeeding; the secondary aim is to determine the duration, frequency and content of home visits. METHODS A systematic search of the PubMed, CINAHL, Embase (Ovid), Web of Science, Google Scholar and DergiPark databases for publications between September 2000 and January 2019 was conducted using established methods in compliance with the PRISMA-P declaration guideline. Two authors independently evaluated the studies for inclusion and bias, extracted the data and checked their accuracy. RESULTS This meta-analysis includes a total of 34 studies, 28 on breastfeeding and nine on infant weight. The average effect size of the 28 studies investigating the effect on breastfeeding was found to be OR: 2.24; 95% CI: 1.73-2.90; p < 0.001. The average effect size of the nine studies investigating the effect on infant weight was found to be ES: 0.197; 95% CI: 0.027-0.368; p < 0.05. CONCLUSION There is an association between nurse home visits and breastfeeding and infant weight. Home visits by nurses should continue to remain within the nursing role and be analysed appropriately for mother and baby health.
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Affiliation(s)
- Selma Kahraman
- Department of Public Health Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Suzan Havlioğlu
- Health Services Vocational School, Harran University, Şanlıurfa, Turkey
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6
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Lariviere D, Craig SJC, Paul IM, Hohman EE, Savage JS, Wright RO, Chiaromonte F, Makova KD, Reimherr ML. Methylation profiles at birth linked to early childhood obesity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.12.24301172. [PMID: 38260407 PMCID: PMC10802761 DOI: 10.1101/2024.01.12.24301172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Childhood obesity represents a significant global health concern and identifying risk factors is crucial for developing intervention programs. Many 'omics' factors associated with the risk of developing obesity have been identified, including genomic, microbiomic, and epigenomic factors. Here, using a sample of 48 infants, we investigated how the methylation profiles in cord blood and placenta at birth were associated with weight outcomes (specifically, conditional weight gain, body mass index, and weight-for-length ratio) at age six months. We characterized genome-wide DNA methylation profiles using the Illumina Infinium MethylationEpic chip, and incorporated information on child and maternal health, and various environmental factors into the analysis. We used regression analysis to identify genes with methylation profiles most predictive of infant weight outcomes, finding a total of 23 relevant genes in cord blood and 10 in placenta. Notably, in cord blood, the methylation profiles of three genes (PLIN4, UBE2F, and PPP1R16B) were associated with all three weight outcomes, which are also associated with weight outcomes in an independent cohort suggesting a strong relationship with weight trajectories in the first six months after birth. Additionally, we developed a Methylation Risk Score (MRS) that could be used to identify children most at risk for developing childhood obesity. While many of the genes identified by our analysis have been associated with weight-related traits (e.g., glucose metabolism, BMI, or hip-to-waist ratio) in previous genome-wide association and variant studies, our analysis implicated several others, whose involvement in the obesity phenotype should be evaluated in future functional investigations.
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Affiliation(s)
- Delphine Lariviere
- Department of Biochemistry and Molecular Biology, Penn State University, University Park, PA
| | - Sarah J C Craig
- Department of Biology, Penn State University, University Park, PA
- Center for Medical Genomics, Penn State University, University Park, PA
| | - Ian M Paul
- Center for Medical Genomics, Penn State University, University Park, PA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Emily E Hohman
- Center for Childhood Obesity Research, Penn State University, University Park, PA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Penn State University, University Park, PA
- Nutrition Department, Penn State University, University Park, PA
| | | | - Francesca Chiaromonte
- Center for Medical Genomics, Penn State University, University Park, PA
- Department of Statistics, Penn State University, University Park, PA
- EMbeDS, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, Pisa, Italy
| | - Kateryna D Makova
- Department of Biology, Penn State University, University Park, PA
- Center for Medical Genomics, Penn State University, University Park, PA
| | - Matthew L Reimherr
- Center for Medical Genomics, Penn State University, University Park, PA
- Department of Statistics, Penn State University, University Park, PA
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7
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Hohman EE, Savage JS, Stansfield BK, Lavner JA. Sleep SAAF Responsive Parenting Intervention for Black Mothers Impacts Response to Infant Crying: A Randomized Clinical Trial. Acad Pediatr 2024; 24:97-104. [PMID: 37148966 PMCID: PMC10625644 DOI: 10.1016/j.acap.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Many parents use food to soothe their infant, regardless of infant hunger, which can increase risk for rapid weight gain. Interventions promoting alternative soothing strategies may help parents respond more appropriately to crying. This secondary analysis aimed to examine effects of the Sleep SAAF (Strong African American Families) responsive parenting (RP) intervention on maternal responses to infant crying and to explore moderating effects of infant negativity. METHODS Primiparous Black mothers (n = 212) were randomized to an RP or safety control intervention, delivered during home visits at 3 and 8 weeks postpartum. Parents were empowered to first use non-food soothing strategies (eg, white noise, swaddling) when responding to crying. Mothers completed the Babies Need Soothing questionnaire at 8 and 16 weeks, and the Infant Behavior Questionnaire at 16 weeks. Data were analyzed using linear or logistic regression. RESULTS RP mothers were significantly more likely than controls to use shushing/white noise to soothe their infant at 8 (OR = 4.9, 95% CI: 2.2-10.6) and 16 weeks (OR = 4.8, 95% CI: 2.2-10.5), to go for a walk in stroller/ride in car at 8 weeks (OR = 2.3, 95% CI: 1.2-4.6), and to swing/rock/bounce their infant at 16 weeks (OR = 5.5, 95% CI: 1.2-25.7). RP mothers also reported significantly more frequent use of deep breathing, exercising, and bathing/showering than controls when frustrated with crying. Infant negativity moderated some intervention effects such that the RP intervention was more effective at increasing use of some soothing practices among mothers with less negative infants. CONCLUSIONS An RP intervention positively impacted first-time Black mothers' responses to infant crying.
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Affiliation(s)
- Emily E Hohman
- Center for Childhood Obesity Research (EE Hohman and JS Savage), 129 Noll Laboratory, Pennsylvania State University, University Park.
| | - Jennifer S Savage
- Center for Childhood Obesity Research (EE Hohman and JS Savage), 129 Noll Laboratory, Pennsylvania State University, University Park; Department of Nutritional Sciences (JS Savage), 129 Noll Laboratory, Pennsylvania State University, University Park.
| | - Brian K Stansfield
- Department of Pediatrics (BK Stansfield), Medical College of Georgia, Augusta.
| | - Justin A Lavner
- Department of Psychology (JA Lavner), University of Georgia, Athens.
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Hernandez E, Hohman EE, Ferrante MJ, Anzman-Frasca S, Paul IM, Savage JS. Toddler dietary patterns from the INSIGHT randomized clinical trial comparing responsive parenting versus control: A latent class analysis. Obesity (Silver Spring) 2024; 32:141-149. [PMID: 37854008 DOI: 10.1002/oby.23900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of a responsive parenting (RP) intervention on toddler diet and explore associations with mothers' infant feeding practices and child weight status. METHODS INSIGHT tested an RP intervention designed for the prevention of obesity against a safety control among primiparous mothers and their infants. Mothers reported on feeding practices, as well as toddler diet with a Food Frequency Questionnaire (n = 229). Trained research staff obtained child anthropometrics at age 2 years. RESULTS Latent class analysis identified three dietary patterns: high fruits and vegetables (HFV, 31%); meat, potatoes, and added sugars (MPAS, 24%); and high juice, low fruits and vegetables (JLFV, 45%). Toddler dietary pattern was not related to study group (RP, control) or child weight status at age 2 years. Mothers who reported more structure-based feeding had toddlers that were more likely to have the healthier, HFV dietary pattern than MPAS and JLFV. Findings for control-based feeding practices were mixed; maternal restriction was associated with the HFV dietary pattern, whereas the use of food as a reward was associated with MPAS and JLFV. CONCLUSIONS Mothers' structure-based feeding practices in infancy, as well as some control-based feeding practices, were associated with later healthier toddler dietary patterns.
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Affiliation(s)
- Erika Hernandez
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily E Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Stephanie Anzman-Frasca
- Department of Pediatrics, University at Buffalo, Buffalo, New York, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
| | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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9
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Ruggiero CF, Moore AM, Savage JS. Direct Sibling Influence on Eating Behavior in Early Childhood: Siblings as Role Models and Caregivers. Acad Pediatr 2024; 24:119-123. [PMID: 37150478 PMCID: PMC10625651 DOI: 10.1016/j.acap.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/08/2023] [Accepted: 04/22/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Despite the majority of US children having at least 1 sibling, little is known about how siblings influence eating behavior and obesity risk. This qualitative study explored mothers' perceptions of older siblings' influences on younger siblings' eating behavior in the context of mealtimes in early childhood. METHODS A purposive subsample of mothers (n = 30) who participated in the Intervention Nurses Start Infants Growing on Healthy Trajectories and SIBSIGHT studies completed retrospective semi-structured interviews designed to explore the implications of sibling influences on maternal feeding practices during infancy and toddlerhood. Interviews were conducted by video conference with mothers between January and March 2021. All interviews were audio-recorded, transcribed, and a qualitative content analysis approach was used to code and identify themes. RESULTS Two main themes were identified related to the influence of older siblings on younger siblings during feeding interactions: 1) Older siblings as positive role models for younger siblings and 2) Older siblings acted as caregivers for younger siblings. Younger siblings received encouragement at mealtimes to try new foods. Older siblings assisted their mothers in caregiving and feeding tasks in developmentally appropriate ways. CONCLUSIONS Findings may help to elucidate the role of older siblings in shaping eating behavior and obesity risk of siblings in early childhood. Better understanding the role of siblings can aid in the development of novel interventions and anticipatory nutrition guidance in family-based clinical and community care.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research (CF Ruggiero, AM Moore, and JS Savage), The Pennsylvania State University, University Park; Nutritional Sciences (CF Ruggiero and JS Savage), 110C Chandlee Laboratory, The Pennsylvania State University, University Park.
| | - Amy M Moore
- Center for Childhood Obesity Research (CF Ruggiero, AM Moore, and JS Savage), The Pennsylvania State University, University Park.
| | - Jennifer S Savage
- Center for Childhood Obesity Research (CF Ruggiero, AM Moore, and JS Savage), The Pennsylvania State University, University Park; Nutritional Sciences (CF Ruggiero and JS Savage), 110C Chandlee Laboratory, The Pennsylvania State University, University Park.
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10
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Schratz LM, Larkin O, Dos Santos N, Martin C. Caregiver Influences on Eating Behaviors in Children: An Opportunity for Preventing Obesity. Curr Atheroscler Rep 2023; 25:1035-1045. [PMID: 38032429 DOI: 10.1007/s11883-023-01171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE OF REVIEW This review seeks to define caregiver practices that impact childhood eating behaviors and identify ways to utilize these relationships to prevent childhood obesity. RECENT FINDINGS Childhood obesity, which correlates with adult obesity and increased cardiovascular risk, is increasing in prevalence and severity. Caregivers play a significant role in shaping a child's eating behaviors and their predisposition to obesity. Maternal influences during pregnancy and infancy impact a child's future food preferences. Caregiver feeding styles (authoritarian, authoritative, indulgent, and uninvolved) are associated with distinct effects on children's eating behaviors and self-regulation. Authoritative feeding styles promote child autonomy while setting boundaries in the feeding environment. Early caregiver education and coaching regarding nutrition and feeding practices is beneficial to establishing healthy eating behaviors for children. Various caregivers, including parents, grandparents, siblings, teachers, and others, influence a child's eating habits at different stages of development. These caregivers can both positively and negatively impact a child's diet. Comprehensive interventions involving these various caregivers to promote healthy eating practices in children is ideal. Such interventions should be sensitive to cultural and environmental factors. Childhood obesity is a complex issue with long-term health effects. Early intervention using comprehensive approaches including all caregivers, community support, and public policies to address the social determinants of health will be beneficial. Future research should focus on valid outcome measures and equitable interventions that encompass all aspects of a child's life.
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Affiliation(s)
- Lorraine M Schratz
- Division of Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, 175 Cambridge Street, 5Th Floor , Boston, MA, USA.
| | - Olivia Larkin
- Division of Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, 175 Cambridge Street, 5Th Floor , Boston, MA, USA
| | - Nilse Dos Santos
- Division of Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, 175 Cambridge Street, 5Th Floor , Boston, MA, USA
| | - Christine Martin
- Division of Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, 175 Cambridge Street, 5Th Floor , Boston, MA, USA
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11
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Wentz EE, Hoose DL, Holliday K, McDonald T, Silsby K, Podvin S, Hirsh A. Knowledge is power: Relationship between professional recommendations, maternal attitudes, and screen time exposure of infants. J Pediatr Nurs 2023; 73:e213-e219. [PMID: 37741715 DOI: 10.1016/j.pedn.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend infants avoid screen media exposure, yet most infants are regularly exposed. This study aimed to explore screen exposure, maternal attitudes regarding screen media effects, and pediatricians' recommendations to better understand widespread screen media use with infants younger than 18 months of age in hopes of informing mitigation efforts. DESIGN AND METHODS Surveys consisting of 10 Likert-style questions were distributed real-time to a purposive sample of 193 mothers with infants 18 months of age or younger in Georgia, Pennsylvania, and New York. RESULTS Seventy-nine percent of infants exceeded AAP/WHO guidelines and 61% of respondents couldn't recall receiving pediatrician recommendations regarding screen exposure for their infant. Mothers with higher levels of education were associated with an accurate reflection of the adverse effects of screen usage on infant development (ANOVA; F = 10.122; df = 3; p < .001). Accurate maternal attitudes regarding adverse effects on infants was associated with less daily screen exposure (Spearman correlation; r = -0.428; p < .001). CONCLUSIONS Findings suggest that knowledge about adverse side effects of screen media usage with infants is associated with less daily exposure; and, that pediatricians may not routinely review guidelines for infants with their families, underscoring the importance of other methods of knowledge dissemination. PRACTICE IMPLICATIONS Nurses, as trusted healthcare providers, can provide counseling on infant screen media usage creating an opportunity for augmented knowledge dissemination across maternal demographics potentially leading to less screen exposure in this vulnerable population.
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Affiliation(s)
- Erin E Wentz
- Upstate Medical University, CHP - Physical Therapy, 750 E. Adams Street NAB 3318, Syracuse, NY 13210, United States of America.
| | - Danielle L Hoose
- Upstate Medical University, CHP - Physical Therapy, 750 E. Adams Street NAB 3318, Syracuse, NY 13210, United States of America
| | - Kathryn Holliday
- Upstate Medical University, CON, 750 E. Adams Street NAB, Syracuse, NY 13210, United States of America
| | - Tara McDonald
- Ivy Rehabilitation Physical Therapy, 23 Burnside Avenue, Apt. B, Cranford, NJ 07016, United States of America
| | - Kristen Silsby
- The Jackson Clinics, 3061 Mount Vernon Avenue, Unit N215, Alexandria, VA 22305, United States of America
| | - Sarah Podvin
- Rochester Hearing and Speech Center, 22 Misty Pine Road, Fairport, NY 14450
| | - Alexandra Hirsh
- Hackensack Meridian Health, 77 Orange Road, Apt. 81, Montclair, NJ 07042, United States of America
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12
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Smith AR, Eiden RD, Shisler S, Paluch RA, Piazza J, Kong KL. The effects of a music enrichment program on parent-infant interactions during mealtime: A randomized controlled trial. Appetite 2023; 187:106590. [PMID: 37148975 PMCID: PMC10401892 DOI: 10.1016/j.appet.2023.106590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Parent-child interactions are linked to childhood obesity. Music enrichment programs enhance parent-child interactions and may be a strategy for early childhood obesity prevention. OBJECTIVE We implemented a 2-year randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) vs. active play date control (control, n = 45) on parent-child interactional quality and infant weight status. METHODS Typically developing infants aged 9-to 15-months were enrolled with a primary caregiver in the Music Together ® or a play date program. Participants attended once per week group meetings for 12 months and once per month group meetings for an additional 12 months. Parent-child interaction was measured using the Parent Child Early Relational Assessment (PCERA) at baseline, month 6, 12, and 24. We used a modified intent-to-treat mixed model regression to test group differences in parent-child interactions and Weight for length z-score (zWFL) growth trajectories were modeled. RESULTS There were significant differential group changes across time for negative affect during feeding (group*month; p = 0.02) in that those parents in the music group significantly decreased their negative affect score compared with the control group from baseline to month 12 (music change = -0.279 ± 0.129; control change = +0.254 ± 0.131.; p = 0.00). Additionally, we also observed significant differential group changes across time for parent intrusiveness during feeding (group*month; p = 0.04) in that those parents in the music group significantly decreased their intrusiveness score compared with the control group from month 6 to month 12 (music change = -0.209 ± 0.121; control change = 0.326 ± 0.141; p = 0.01). We did not find a significant association between any of the changes in parental negative affect and intrusiveness with child zWFL trajectories. CONCLUSION Participating in a music enrichment program from an early age may promote positive parent-child interactions during feeding, although this improvement in the quality of parent-child interactions during feeding was not associated with weight gain trajectories.
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Affiliation(s)
- Amy R Smith
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA; Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Rina D Eiden
- Department of Psychology, Department of Psychology and the Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
| | - Shannon Shisler
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jacqueline Piazza
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA; Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA; Department of Pediatrics, University of Missouri- Kansas City, Kansas City, MO, USA
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13
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Kong KL, Anzman-Frasca S, Burgess B, Serwatka C, White HI, Holmbeck K. Systematic Review of General Parenting Intervention Impacts on Child Weight as a Secondary Outcome. Child Obes 2023; 19:293-308. [PMID: 35925814 PMCID: PMC10316528 DOI: 10.1089/chi.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
General parenting interventions have improved parent-child relationships and child behavior, with emerging evidence that they may also reduce prevalence of pediatric overweight/obesity. We conducted a systematic review on interventions that were designed to promote positive parenting and examined child weight post-hoc. We searched for studies published through January 2022 that promoted positive parenting among parents of children ages 0-18 years and reported effects on body weight as an ancillary outcome, with no intervention content focused on energy balance (e.g., feeding, physical activity). This search was carried out within ClinicalTrials.gov, ISRCTN Registry, PubMed, PsycINFO, Web of Science, and Connected Papers. Studies were imported into EndNote X9 and assessed independently by two investigators. In total, 753 clinical trials and 723 publications were assessed, and six publications met inclusion criteria. All cohorts were low-income and interventions targeted expectant mothers up through parents of adolescents. Follow-ups occurred when participants were between 2 and 25 years. Significant improvements in weight-related outcomes were observed across all studies for the intervention arm as a whole or for certain subgroups, and reasons underlying these gains tended to differ by participants' age. The magnitude of effect sizes ranged from medium to large. Interventions focused on general positive parenting are efficacious at lowering risk of overweight/obesity without focusing on physical health. Promoting attachments among infants, restructuring a toddler's home environment, praising preschoolers, and communicating with adolescents may optimize weight outcomes in parenting interventions adapted for obesity prevention.
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Affiliation(s)
- Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Stephanie Anzman-Frasca
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Brenda Burgess
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Catherine Serwatka
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
| | - Hope I. White
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Katherine Holmbeck
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Neuroscience Program, Bucknell University, Lewisburg, PA, USA
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14
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Gilbert L, Quansah DY, Arhab A, Schenk S, Gross J, Lanzi S, Stuijfzand B, Lacroix A, Horsch A, Puder JJ. Effect of the MySweetheart randomized controlled trial on birth, anthropometric and psychobehavioral outcomes in offspring of women with GDM. Front Endocrinol (Lausanne) 2023; 14:1148426. [PMID: 37351105 PMCID: PMC10284133 DOI: 10.3389/fendo.2023.1148426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction Gestational diabetes mellitus (GDM) may negatively affect offspring outcomes. A lifestyle intervention may therefore not only improve maternal, but also offspring outcomes. The effects of lifestyle interventions on birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM need further evidence. Design The MySweetheart trial is a monocentric single-blind randomized controlled trial in 211 women with GDM. It tested the effect of a pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention focusing on both the mothers and their infants and its effects on maternal (primary outcomes) and offspring (secondary outcomes) metabolic and psychobehavioral outcomes compared with guidelines-based usual-care. This paper focuses on offspring's birth, anthropometric, and maternal report of psychobehavioral outcomes at singular timepoints. Methods Women with GDM aged ≥18 years, between 24-32 weeks of gestation, speaking French or English were included and randomly allocated to either the intervention or to an active guidelines-based usual-care group using a 1:1 allocation ratio. The intervention lasted from pregnancy until 1 year postpartum and focused on improving diet, physical activity, and mental health in the mother. For the offspring it focused on supporting breastfeeding, delaying the timing of introduction of solid foods, reducing the consumption of sweetened beverages, increasing physical activity of the family, and improving parental responsiveness to infant distress, hunger, satiety and sleeping cues, and difficult behavior. Results Adverse birth and neonatal outcomes rarely occurred overall. There were no differences between groups in offspring birth, neonatal, anthropometric, or psychobehavioral outcomes up to one year. After adjustments for maternal age and the offspring's sex and age, there was a borderline significant between-group difference in birth length (β:-0.64, CI:-1.27; -0.01, p: 0.05), i.e., offspring of mothers in the intervention group were born 0.64 cm shorter compared to those in the usual-care group. Conclusion This is the first pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention in GDM focusing on both the mother and the offspring. It did not lead to a significant improvement in most birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM. ClinicalTrials.gov Identifier: NCT02890693.
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Affiliation(s)
- Leah Gilbert
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Obstetric Service, Department Woman-Mother-Child, Interdisciplinary GDM Group Lausanne, Lausanne University Hospital, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amar Arhab
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sybille Schenk
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Justine Gross
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stefano Lanzi
- Service d’angiologie, Département Cœur-Vaisseaux, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bobby Stuijfzand
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alain Lacroix
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Neonatology Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J. Puder
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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15
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Dixley A, Ball HL. The impact of swaddling upon breastfeeding: A critical review. Am J Hum Biol 2023; 35:e23878. [PMID: 36787374 PMCID: PMC10909524 DOI: 10.1002/ajhb.23878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Many parents swaddle their infants to promote sleep and reduce night-waking, however lack of definitive evidence about the pros and cons of swaddling when breastfeeding hinders postnatal recommendations regarding this infant care practice. This review critically examines research conducted on the impact of swaddling upon breastfeeding. METHODS Only two recent studies on swaddling outcomes have reported infant feed-type, therefore the purpose of this paper is to consider the known effects of swaddling on breastfeeding babies and their mothers. We interpret the existing literature on swaddling in terms of impact on breastfeeding physiology and behaviour during the immediate post-natal period, and as infancy progresses. RESULTS Infants swaddled immediately after birth show a delay in initial breastfeeding, less successful suckling at the breast, reduced intake of breastmilk and greater weight loss compared to un-swaddled babies. Swaddling visually obscures feeding cues and reduces crying, thereby eliminating two key feeding prompts typically used by parents/carers. CONCLUSIONS As swaddled babies cry less, and are fed less frequently than un-swaddled babies some clinical trials position swaddling as a 'novel weight regulation tool' to combat obesity. However, in the case of breastfed babies, by reducing feed frequency swaddling may impede maternal milk production and thereby infant growth.
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Affiliation(s)
- Allison Dixley
- Durham Infancy & Sleep Centre, Department of AnthropologyDurham UniversityDurhamUK
| | - Helen L. Ball
- Durham Infancy & Sleep Centre, Department of AnthropologyDurham UniversityDurhamUK
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16
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Ayre SK, White MJ, Harris HA, Byrne RA. 'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families. MATERNAL & CHILD NUTRITION 2023; 19:e13484. [PMID: 36808876 PMCID: PMC10019066 DOI: 10.1111/mcn.13484] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.
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Affiliation(s)
- Susannah K. Ayre
- Woolworths Centre for Childhood Nutrition Research, Faculty of HealthQueensland University of TechnologySouth BrisbaneQueenslandAustralia
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Melanie J. White
- School of Psychology & Counselling, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Holly A. Harris
- Department of Psychology, Education and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
| | - Rebecca A. Byrne
- Woolworths Centre for Childhood Nutrition Research, Faculty of HealthQueensland University of TechnologySouth BrisbaneQueenslandAustralia
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
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17
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Palacios C, Bolton J, Wang W, Gatto A, Concepción L, Sadjadi M, Varella M, Hannan J. Development and pilot testing of the Baby-Feed web application for healthcare professionals and parents to improve infant diets. Int J Med Inform 2023; 174:105047. [PMID: 36948062 DOI: 10.1016/j.ijmedinf.2023.105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/30/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Diet is key in preventing rapid infant weight gain but adherence to infant dietary recommendations is difficult to follow and low in adherence. OBJECTIVE Develop and pilot test the "Baby-Feed" web application for parents and healthcare professionals to easily evaluate infant diets and provide immediate feedback to promote adherence to current infant dietary recommendations. METHODS Baby-Feed was developed following the ADDIE (analysis, design, development, implementation, and evaluation) model. It was pilot tested among two clinicians and 25 parents of infants aged 4 to 12 months that had a scheduled well-child visit at a community health center in Miami. After 2 weeks of using Baby-Feed, parents completed a feasibility, acceptability, satisfaction, and usability questionnaire. Parents and clinicians were also asked to suggest improvements. Descriptive analysis included frequency and median (25th, 75th percentiles). One-sample binomial tests was used to evaluate if feasible, acceptable, satisfactory, and usable. RESULTS Twenty-three parents completed the evaluation (all were mothers), 31.0 (26.0, 33.0) years-old, 96% Hispanic, 83% had ≥ high school education, with 1.5 (1.0, 2.0) children. Infants' age was 6.1 (4.0, 9.0) months and 57% were boys. Binomial tests indicated that most parents (greater than87%) agreed that Baby-Feed was easy to use, learn, quick, would use it again, rated it as 4/5 stars. They used it greater than 1 times per week (p < 0.001). Parents suggested improving the visuals (more icons, colors, and pictures) and images of portion sizes, highlighting missing fields, being able to view/open it on their phones, and adding recipes and more information. The two clinicians (a pediatrician and a physician assistant) suggested to be open-access and to add more infant nutrition information. CONCLUSION Baby-Feed was feasible, usable, satisfactory, and acceptable. It could be used as a tool to easily evaluate infant diets in the healthcare setting to provide immediate feedback.
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Affiliation(s)
- Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
| | - Jennifer Bolton
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Wenjia Wang
- Vertically Integrated Projects, School of Computing and Information Sciences, Florida International University, Miami, FL, USA
| | - Alayne Gatto
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Lourdes Concepción
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Masoud Sadjadi
- Vertically Integrated Projects, School of Computing and Information Sciences, Florida International University, Miami, FL, USA
| | - Marcia Varella
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Jean Hannan
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA
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Craig SJ, Kenney AM, Lin J, Paul IM, Birch LL, Savage JS, Marini ME, Chiaromonte F, Reimherr ML, Makova KD. Constructing a polygenic risk score for childhood obesity using functional data analysis. ECONOMETRICS AND STATISTICS 2023; 25:66-86. [PMID: 36620476 PMCID: PMC9813976 DOI: 10.1016/j.ecosta.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Obesity is a highly heritable condition that affects increasing numbers of adults and, concerningly, of children. However, only a small fraction of its heritability has been attributed to specific genetic variants. These variants are traditionally ascertained from genome-wide association studies (GWAS), which utilize samples with tens or hundreds of thousands of individuals for whom a single summary measurement (e.g., BMI) is collected. An alternative approach is to focus on a smaller, more deeply characterized sample in conjunction with advanced statistical models that leverage longitudinal phenotypes. Novel functional data analysis (FDA) techniques are used to capitalize on longitudinal growth information from a cohort of children between birth and three years of age. In an ultra-high dimensional setting, hundreds of thousands of single nucleotide polymorphisms (SNPs) are screened, and selected SNPs are used to construct two polygenic risk scores (PRS) for childhood obesity using a weighting approach that incorporates the dynamic and joint nature of SNP effects. These scores are significantly higher in children with (vs. without) rapid infant weight gain-a predictor of obesity later in life. Using two independent cohorts, it is shown that the genetic variants identified in very young children are also informative in older children and in adults, consistent with early childhood obesity being predictive of obesity later in life. In contrast, PRSs based on SNPs identified by adult obesity GWAS are not predictive of weight gain in the cohort of young children. This provides an example of a successful application of FDA to GWAS. This application is complemented with simulations establishing that a deeply characterized sample can be just as, if not more, effective than a comparable study with a cross-sectional response. Overall, it is demonstrated that a deep, statistically sophisticated characterization of a longitudinal phenotype can provide increased statistical power to studies with relatively small sample sizes; and shows how FDA approaches can be used as an alternative to the traditional GWAS.
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Affiliation(s)
- Sarah J.C. Craig
- Department of Biology, Penn State University, University Park
- Center for Medical Genomics, Penn State University, University Park, PA
| | - Ana M. Kenney
- Department of Statistics, Penn State University, University Park, PA
| | - Junli Lin
- Department of Statistics, Penn State University, University Park, PA
| | - Ian M. Paul
- Center for Medical Genomics, Penn State University, University Park, PA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
| | - Jennifer S. Savage
- Department of Nutritional Sciences, Penn State University, University Park, PA
- Center for Childhood Obesity Research, Penn State University, University Park, PA
| | - Michele E. Marini
- Center for Childhood Obesity Research, Penn State University, University Park, PA
| | - Francesca Chiaromonte
- Center for Medical Genomics, Penn State University, University Park, PA
- Department of Statistics, Penn State University, University Park, PA
- EMbeDS, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, Pisa, Italy
| | - Matthew L. Reimherr
- Center for Medical Genomics, Penn State University, University Park, PA
- Department of Statistics, Penn State University, University Park, PA
| | - Kateryna D. Makova
- Department of Biology, Penn State University, University Park
- Center for Medical Genomics, Penn State University, University Park, PA
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Hale I, Fergus T, Buhler H, Purcell M, Amed S. RAISE (Raising Infants to Be Smart Eaters) Pilot Study. Child Obes 2023; 19:25-33. [PMID: 35325551 DOI: 10.1089/chi.2021.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Many of the complex determinants of obesity originate during infancy when small changes in the environment can permanently influence appetite, behavior, and energy metabolism. Parent feeding style ("how" rather than "what" to feed) has emerged as a potentially important factor in early obesity prevention. Objectives: (1) To assess the feasibility of conducting a brief responsive feeding education intervention by public health nurses during routine well-baby visits. (2) To assess whether this intervention affects parents' attitudes and behavior related to responsive feeding. Methods: Prospective, nonrandomized, comparative pilot study conducted in two communities. Intervention participants were exposed to enhanced responsive feeding education by public health nurses at routine well-baby visits from 0 to 18 months along with wall posters, handouts, automated text messages and tangible takeaways. Parent knowledge and behavior were measured using the Infant Feeding Style Questionnaire and the Toddler Development Index. Feasibility and acceptability were assessed by patients and nurses through open text feedback forms and mid-point and exit interviews. Results: Recruitment (18 intervention; 9 control) and retention fell below targets. Average adherence to protocol by nurses from 0 to 12 months was 89%. Delivery of the intervention was feasible and acceptable, but the additional research-related tasks were challenging in a busy clinical setting. Parents found the different formats and information new and helpful. There was a trend toward less nonresponsive (pressuring, restrictive, laissez-faire) feeding practices in the intervention group. Conclusions: This pilot study demonstrated encouraging results related to overall feasibility and effect on parent feeding style.
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Affiliation(s)
- Ilona Hale
- Department of Family Practice, University of British Columbia, Kimberley, British Columbia, Canada
| | - Terri Fergus
- Interior Health Authority, Cranbrook, British Columbia, Canada
| | - Holly Buhler
- Interior Health Authority, Cranbrook, British Columbia, Canada
| | - Megan Purcell
- East Kootenay Division of Family Practice, Cranbrook, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, British Columbia Children and Women's Hospital, University of British Columbia, Kimberley, British Columbia, Canada
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20
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Ruggiero CF, Moore AM, Marini ME, Kodish SR, Jones DE, McHale SM, Savage JS. Resource dilution in maternal feeding practices after birth of a secondborn. Appetite 2023; 180:106367. [PMID: 36356911 PMCID: PMC9910362 DOI: 10.1016/j.appet.2022.106367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/15/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
Firstborn children have higher prevalence of obesity than secondborn siblings. The birth of a sibling typically results in resource dilution when mothers begin to divide their time and attention between two children. This mixed-methods analysis applies the family systems process of resource dilution to test the hypothesis that characteristics of the secondborn impact how parents feed the firstborn. Participants (n = 76) were mothers of consecutively born firstborn and secondborn siblings who participated in the INSIGHT trial and an observational cohort. Quantitative analyses involved multilevel models to test if characteristics of secondborns (temperament at 16 weeks, appetite at 28 weeks) were associated with maternal feeding practices of firstborns (structure and control-based feeding) at 1, 2, and 3 years, adjusting for firstborn child characteristics. A purposive subsample (n = 30) of mothers participated in semi-structured interviews to contextualize potential sibling influences on maternal feeding practices during infancy and toddlerhood. Quantitative data showed secondborn temperament and appetite were associated with how mothers fed their firstborn. Qualitative data explained maternal feeding practices in three primary ways: 1) Mothers explained shifting predictable meal and snack routines after birth of the secondborn, but did not perceive sibling characteristics as the source; 2) Family chaos following the secondborn's birth led to "survival mode" in feeding; and 3) Social support was protective against feeding resource dilution. The family systems process of resource dilution is a focus for future research and support for families during key transitions and a direction for efforts to reduce risk for child obesity.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA; Nutritional Sciences, 110 C Chandlee Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Amy M Moore
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Michele E Marini
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Stephen R Kodish
- Nutritional Sciences, 110 C Chandlee Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA; Department of Biobehavioral Health, 219 Biobehavioral Health Building, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Damon E Jones
- Edna Bennett Pierce Prevention Research Center, 314 Biobehavioral Health Building, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Susan M McHale
- Department of Human Development and Family Studies, 114 Henderson, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Jennifer S Savage
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA; Nutritional Sciences, 110 C Chandlee Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
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21
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Insolia L, Kenney A, Chiaromonte F, Felici G. Simultaneous feature selection and outlier detection with optimality guarantees. Biometrics 2022; 78:1592-1603. [PMID: 34437713 DOI: 10.1111/biom.13553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/07/2021] [Accepted: 08/10/2021] [Indexed: 12/30/2022]
Abstract
Biomedical research is increasingly data rich, with studies comprising ever growing numbers of features. The larger a study, the higher the likelihood that a substantial portion of the features may be redundant and/or contain contamination (outlying values). This poses serious challenges, which are exacerbated in cases where the sample sizes are relatively small. Effective and efficient approaches to perform sparse estimation in the presence of outliers are critical for these studies, and have received considerable attention in the last decade. We contribute to this area considering high-dimensional regressions contaminated by multiple mean-shift outliers affecting both the response and the design matrix. We develop a general framework and use mixed-integer programming to simultaneously perform feature selection and outlier detection with provably optimal guarantees. We prove theoretical properties for our approach, that is, a necessary and sufficient condition for the robustly strong oracle property, where the number of features can increase exponentially with the sample size; the optimal estimation of parameters; and the breakdown point of the resulting estimates. Moreover, we provide computationally efficient procedures to tune integer constraints and warm-start the algorithm. We show the superior performance of our proposal compared to existing heuristic methods through simulations and use it to study the relationships between childhood obesity and the human microbiome.
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Affiliation(s)
- Luca Insolia
- Faculty of Sciences, Scuola Normale Superiore, Pisa, Italy.,Institute of Economics & EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Ana Kenney
- Department of Statistics, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Francesca Chiaromonte
- Institute of Economics & EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy.,Department of Statistics, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Giovanni Felici
- Istituto di Analisi dei Sistemi ed Informatica, Consiglio Nazionale delle Ricerche, Rome, Italy
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22
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Fangupo L, Daniels L, Taylor R, Glover M, Taungapeau F, Sa'u S, Cutfield W, Taylor B. The care of infants with rapid weight gain: Should we be doing more? J Paediatr Child Health 2022; 58:2143-2149. [PMID: 36259748 PMCID: PMC10092129 DOI: 10.1111/jpc.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/28/2022]
Abstract
Rapid weight gain (RWG) during infancy is a known risk factor for later childhood obesity. It can be measured using a range of definitions across various time periods in the first 2 years of life. In recent years, some early childhood obesity prevention trials have included a focus on preventing RWG during infancy, with modest success. Overall, RWG during infancy remains common, yet little work has examined whether infants with this growth pattern should receive additional care when it is identified in health-care settings. In this viewpoint, we contend that RWG during infancy should be routinely screened for in health-care settings, and when identified, viewed as an opportunity for health-care professionals to instigate non-stigmatising discussions with families about RWG and general healthy practices for their infants. If families wish to engage, we suggest that six topics from early life obesity prevention studies (breastfeeding, formula feeding, complementary feeding, sleep, responsive parenting, and education around growth charts and monitoring) could form the foundations of conversations to help them establish and maintain healthy habits to support their infant's health and well-being and potentially lower the risk of later obesity. However, further work is needed to develop definitive guidelines in this area, and to address other gaps in the literature, such as the current lack of a standardised definition for RWG during infancy and a clear understanding of the time points over which it should be measured.
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Affiliation(s)
- Louise Fangupo
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin, New Zealand.,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Marewa Glover
- Papaharakeke International Ltd, Auckland, New Zealand
| | | | | | - Wayne Cutfield
- A Better Start National Science Challenge, University of Auckland, Auckland, New Zealand.,The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Barry Taylor
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,A Better Start National Science Challenge, University of Auckland, Auckland, New Zealand
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23
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Heerman WJ, Perrin EM, Yin HS, Schildcrout JS, Delamater AM, Flower KB, Sanders L, Wood C, Kay MC, Adams LE, Rothman RL. The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemp Clin Trials 2022; 123:106987. [PMID: 36323344 DOI: 10.1016/j.cct.2022.106987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. METHODS This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. CONCLUSIONS By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
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Affiliation(s)
- William J Heerman
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Eliana M Perrin
- Johns Hopkins University, Department of Pediatrics, Schools of Medicine and Nursing, 200 N. Wolfe St, Rubenstein Building-2071, Baltimore, MD 21287, United States of America.
| | - H Shonna Yin
- New York University School of Medicine, Departments of Pediatrics and Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Jonathan S Schildcrout
- Vanderbilt University Medical Center, Department of Biostatistics, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave., Miami, FL 33136, United States of America.
| | - Kori B Flower
- University of North Carolina at Chapel Hill, Division of General Pediatrics and Adolescent Medicine, 231 MacNider Building, CB# 7225, 321 S. Columbia Street, UNC School of Medicine, Chapel Hill, NC 27599-7225, United States of America.
| | - Lee Sanders
- Stanford University School of Medicine, United States of America.
| | - Charles Wood
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Melissa C Kay
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Russell L Rothman
- Vanderbilt University Medical Center, Institute of Medicine and Public Health, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
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24
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Hernandez E, Lavner JA, Moore AM, Stansfield BK, Beach SRH, Smith JJ, Savage JS. Sleep SAAF responsive parenting intervention improves mothers' feeding practices: a randomized controlled trial among African American mother-infant dyads. Int J Behav Nutr Phys Act 2022; 19:129. [PMID: 36183135 PMCID: PMC9526457 DOI: 10.1186/s12966-022-01366-1] [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: 06/13/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background/Objective Parents shape children’s early experiences with food, influencing what is served, children’s food choices, and how much children eat. Responsive parenting (RP) interventions such as INSIGHT have improved maternal infant feeding practices, but have only been tested among predominantly White families. This secondary analysis of data from the Sleep SAAF (Strong African American Families) RCT tests the effects of an RP intervention designed to prevent rapid infant weight gain on African American mothers’ infant feeding practices. Methods Primiparous African American mother-infant dyads (n = 194) were randomized to an RP or safety control intervention delivered by community research associates at infant age 3 and 8 weeks. At 16 weeks, mothers completed the Babies Need Feeding questionnaire, the Infant Feeding Styles Questionnaire, and the Babies Need Soothing questionnaire. Logistic regression and general linear models examined the effect of study group on infant feeding practices. Moderation analyses explored whether effects varied by feeding mode (any breast milk versus exclusive formula), maternal age (≥ 20 years versus < 20 years), and maternal pre-pregnancy BMI (with obesity versus not). Results RP mothers reported more responsive feeding (p = 0.005, partial η2 = 0.02), lower likelihood of using beverages other than breast milk/formula to soothe their infant (p = 0.01, OR = 0.42, 95% CI [0.2–0.8]), and less pressure with cereal than control mothers (p = 0.09, partial η2 = 0.02). RP mothers also reported less pressure to finish/soothe than controls (p = 0.007, partial η2 = 0.04); feeding mode (B = 0.74, p = 0.003) and maternal age (B = 0.53, p = 0.04) moderated this effect. There were no significant group differences in bottle-feeding practices (e.g., adding cereal to bottle, using an appropriate nipple/bottle size), or in context-based or emotion-based food to soothe. Conclusions Responsive parenting education influenced some feeding practices of African American mothers. Mothers reported using less pressure, a control-based feeding practice, and more responsive feeding than controls. Trial registration Sleep SAAF: A Strong African American Families Study. www.clinicaltrials.gov NCT03505203. Registered 3 April 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01366-1.
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Affiliation(s)
- Erika Hernandez
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA, USA
| | - Justin A Lavner
- Department of Psychology, Psychology Building, University of Georgia, Athens, GA, 30602-3013, USA.
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA, USA
| | | | - Steven R H Beach
- Department of Psychology, Psychology Building, University of Georgia, Athens, GA, 30602-3013, USA.,Center for Family Research, University of Georgia, Athens, GA, USA
| | - Jessica J Smith
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA, USA
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25
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Tauriello S, Savage JS, Goldsmith J, Kubiniec E, Paul IM, Anzman-Frasca S. Effect of the INSIGHT Responsive Parenting Intervention on Parenting and Child Behavior at Ages 3 and 6 Years. J Pediatr 2022; 255:72-79. [PMID: 37081779 DOI: 10.1016/j.jpeds.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine effects of the INSIGHT study responsive parenting (RP) intervention on reported and observed general parenting and child behavior during early and middle childhood. STUDY DESIGN Primiparous mother-newborn dyads (n = 279) were randomized to RP intervention or a safety control, with intervention content delivered at research nurse home visits at infant ages 3-4, 16, 28, and 40 weeks and research center visits at 1 and 2 years. At age 3 (n = 220) and 6 years (n = 171) parenting and child behavior were observed during dyadic interactions and coded using the Iowa Family Interaction Rating Scales. Mothers also reported on child behavior (age 3) and aspects of general parenting (age 6) via the Child Behavior Checklist and The Comprehensive General Parenting Questionnaire, respectively. RESULTS RP group children had fewer mother-reported externalizing (F = 8.69, P = .004) and problem behaviors at age 3 (F = 4.53, P = .03), and higher observed prosocial (F = 4.73, P = .03) and lower antisocial (ie, externalizing; F = 4.79, P = .03) behavior at age 6 vs controls. There were no study group differences in observed maternal sensitivity at age 3 or 6 years. At age 6, RP group mothers reported higher use of structure defined by establishing consistent rules and routines (F = 5.45, P = .02) and organization of their child's environment (F = 7.12, P = .008) compared with controls. CONCLUSIONS The INSIGHT RP intervention increased parental organization of the child's environment to facilitate competence, and had beneficial impacts on child behavior at 3 and 6 years. No impacts were found on maternal sensitivity in childhood. TRIAL REGISTRATION ClinicalTrials.gov: NCT01167270.
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Affiliation(s)
- Sara Tauriello
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Jennifer S Savage
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA; Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA
| | - Juliana Goldsmith
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Elizabeth Kubiniec
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Ian M Paul
- Departments of Pediatrics & Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY.
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26
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Lavner JA, Savage JS, Stansfield BK, Beach SRH, Marini ME, Smith JJ, Sperr MC, Anderson TN, Hernandez E, Moore AM, Caldwell AL, Birch LL. Effects of the Sleep SAAF responsive parenting intervention on rapid infant weight gain: A randomized clinical trial of African American families. Appetite 2022; 175:106080. [PMID: 35577176 PMCID: PMC9653516 DOI: 10.1016/j.appet.2022.106080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
Responsive parenting (RP) interventions reduce rapid infant weight gain but their effect for underserved populations is largely unknown. The Sleep SAAF (Strong African American Families) study is a two-arm randomized clinical trial for primiparous African American mother-infant dyads that compares an RP intervention to a child safety control over the first 16 weeks postpartum. Here we report on intervention effects on rapid infant weight gain and study implementation. Families were recruited from a mother/baby nursery shortly after delivery. Community Research Associates (CRAs) conducted intervention home visits at 3 and 8 weeks postpartum, and data collection home visits at 1, 8, and 16 weeks postpartum. To examine rapid infant weight gain, conditional weight gain (CWG) from 3 to 16 weeks, the primary outcome, and upward crossing of 2 major weight-for-age percentile lines were calculated. Among the 212 mother-infant dyads randomized, 194 completed the trial (92% retention). Randomized mothers averaged 22.7 years, 10% were married, and 49% participated in the Supplemental Nutrition Assistance Program (SNAP). Adjusting for covariates, mean CWG was lower among RP infants (0.04, 95% CI [-0.33, 0.40]) than among control infants (0.28, 95% CI [-0.08, 0.64]), reflecting non-significantly slower weight gain (p = 0.15, effect size d = 0.24). RP infants were nearly half as likely to experience upward crossing of 2 major weight-for-age percentile lines (14.1%) compared to control infants (24.2%), p = 0.09, odds ratio = 0.52 (95% CI [0.24, 1.12]). Implementation data revealed that participating families were engaged in the intervention visits and intervention facilitators demonstrated high fidelity to intervention materials. Findings show that RP interventions can be successfully implemented among African American families while suggesting the need for modifications to yield stronger effects on infant weight outcomes.
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Affiliation(s)
- Justin A Lavner
- Department of Psychology, 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
| | - Brian K Stansfield
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia, Athens, GA, USA; Center for Family Research, University of Georgia, Athens, GA, USA
| | - Michele E Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Jessica J Smith
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Megan C Sperr
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Tracy N Anderson
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Erika Hernandez
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Alice Little Caldwell
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Leann L Birch
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
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27
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Ruggiero CF, Marini ME, Llewellyn CH, McHale SM, Paul IM, Savage JS. Differences in sibling temperament are associated with differences in maternal use of food to soothe during infancy: A sibling analysis. Pediatr Obes 2022; 17:e12907. [PMID: 35243805 PMCID: PMC9283211 DOI: 10.1111/ijpo.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Firstborn children are more likely to have obesity than secondborns, which may partially be explained by differential use of food to soothe (FTS) infant distress, which has been inked to higher weight status. OBJECTIVES To test associations between the birth order and maternal FTS and whether differences in sibling temperament and body mass index (BMI) z-scores were associated differences in maternal FTS. METHODS Random effect models assessed associations between birth order and FTS. Linear regressions examined associations between differences in maternal FTS and sibling differences in temperament at 16 weeks and BMI z-scores at 1 year. RESULTS Mothers (n = 117) used contextual-based FTS more with firstborns than secondborns (2.70 vs. 2.38, p < 0.0001). Sibling differences in negative affect were associated with differences in maternal contextual-based (R2 = 0.09, p = 0.002) and emotion-based (R2 = 0.09, p = 0.001) FTS. Sibling differences in effortful control were associated with differences in maternal emotion-based FTS (R2 = 0.04, p = 0.04). Finally, differences in maternal emotion-based FTS were associated with sibling differences in BMI z-scores at age 1 year (R2 = 0.14, p = 0.006). CONCLUSIONS To promote healthy child weight, mothers should learn to respond to each child's temperament and use alternatives to FTS infant distress.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michele E Marini
- Center for Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Clare H Llewellyn
- Research Department of Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Susan M McHale
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ian M Paul
- Department of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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28
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Hohman EE, Savage JS, Marini ME, Anzman-Frasca S, Buxton OM, Loken E, Paul IM. Effect of the INSIGHT Firstborn Parenting Intervention on Secondborn Sleep. Pediatrics 2022; 150:188273. [PMID: 35703026 PMCID: PMC9893513 DOI: 10.1542/peds.2021-055244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers improved firstborn infant sleep compared with controls. The goals of this analysis were to test intervention spillover effects on secondborn siblings and examine birth order differences in infant sleep. METHODS Secondborns (n = 117) of INSIGHT mothers were enrolled in an observational cohort, SIBSIGHT. The Brief Infant Sleep Questionnaire was collected at 3, 16, and 52 weeks. Generalized linear mixed models assessed differences among secondborns by firstborn randomization, as well as birth order differences at 16 and 52 weeks. RESULTS The RP group secondborns slept 42 minutes longer at night (95% confidence interval [95% CI]: 19-64) and 53 minutes longer total (95% CI: 17-90) than control secondborns. RP secondborns were more likely to self-soothe to sleep (odds ratio [OR] = 2.0, 95% CI: 1.1-3.7) and less likely to be fed back to sleep after waking (OR = 0.5, 95% CI: 0.3-0.9) than secondborns of control mothers. RP secondborns were more likely to have a bedtime ≤8 pm at 3 (OR = 2.9, 95% CI: 1.1-7.7) and 16 weeks (OR = 4.7, 95% CI: 2.0-11.0). Few differences in sleep parenting practices were observed when comparing siblings within families. Secondborns slept 37 minutes longer than firstborns at 16 weeks (CI: 7-67, P = .03). CONCLUSIONS The INSIGHT RP intervention for first-time mothers had a spillover effect to secondborns, positively impacting sleep duration and behaviors. Intervening with first-time mothers benefits both firstborns and subsequent children.
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Affiliation(s)
- Emily E. Hohman
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA,Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Michele E. Marini
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA
| | | | - Orfeu M. Buxton
- Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Eric Loken
- Educational Psychology, University of Connecticut, Storrs, CT
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey PA
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29
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Ruggiero CF, Moore AM, Marini ME, Kodish SR, McHale SM, Savage JS. A mixed methods study of siblings’ roles in maternal feeding practices in early childhood: an application of the learning from experience process. Int J Behav Nutr Phys Act 2022; 19:64. [PMID: 35672783 PMCID: PMC9171978 DOI: 10.1186/s12966-022-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Firstborn children have higher rates of obesity compared to secondborns, perhaps due, in part, to differential feeding practices. Despite the centrality of siblings in family life and potential for influence, almost nothing is known about the role of siblings in parent feeding practices in early childhood.
Methods
Participants (n = 117) were mothers of consecutively born siblings. Firstborns participated in an RCT that compared a responsive parenting intervention designed for primary prevention of obesity against a safety control. Secondborns participated in an observational cohort. Multilevel models tested whether and how firstborn characteristics (temperament, appetite, rapid weight gain) at 16 weeks and 1 year were associated maternal feeding practices of secondborns in infancy at 16 weeks, 28 weeks, and 1 year (food to soothe) and at ages 1, 2, and 3 years (structure-and control-based feeding practices). A purposive subsample (n = 30) of mothers also participated in semi-structured interviews to further illuminate potential sibling influences on maternal feeding practices during infancy and toddlerhood.
Results
Firstborn characteristics did not predict secondborn feeding in infancy (all ps > 0.05). Firstborn negative affect, however, predicted mothers’ less consistent mealtime routines (b (SE) = − 0.27 (0.09); p = 0.005) and more pressure (b (SE) = 0.38 (0.12); p = 0.001). Firstborn appetite predicted mothers’ less frequent use of food to soothe (b (SE) = − 0.16 (0.07); p = 0.02) when secondborns were toddlers. Firstborn surgency, regulation, and rapid weight gain, however, did not predict secondborn feeding practices during toddlerhood (all ps > 0.05). Interviews with mothers revealed three ways that maternal experiences with firstborns informed feeding practices of secondborns: 1) Use of feeding practices with secondborn that worked for the firstborn; 2) Confidence came from firstborn feeding experiences making secondborn feeding less anxiety-provoking; and 3) Additional experiences with firstborn and other factors that contributed to secondborn feeding practices.
Conclusions
Some firstborn characteristics and maternal experiences with firstborns as well as maternal psychosocial factors may have implications for mothers’ feeding practices with secondborns. Together, these mixed methods findings may inform future research and family-based interventions focused on maternal feeding of siblings in early childhood.
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30
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Moore AM, Smith JJ, Stansfield BK, Savage JS, Lavner JA. Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother–Infant Dyads. Nutrients 2022; 14:nu14112350. [PMID: 35684150 PMCID: PMC9182812 DOI: 10.3390/nu14112350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
The health benefits of breast milk feeding have been well-established, yet disparities exist, with African American mothers having the lowest breast milk feeding rates in the United States. This prospective, longitudinal study examined infant feeding (breast milk and/or infant formula) from birth to age 16 weeks, predictors of any breast milk feeding by age 1 week, and predictors of cessation of any breast milk feeding by ages 3, 8, and 16 weeks among primiparous African American mothers. This secondary analysis included 185 mother–infant dyads from the Sleep SAAF (Strong African American Families) study, a randomized clinical trial testing a responsive parenting vs. child safety control intervention. Mothers reported sociodemographic and psychosocial characteristics at age 1 week and infant feeding practices at ages 1, 3, 8, and 16 weeks. Rates of any breast milk feeding decreased from 66.5% at 1 week to 23.3% at 16 weeks. Bivariate logistic regression models showed that prepregnancy BMI (OR = 1.09), working prepregnancy (OR = 2.25), and food insecurity (OR = 2.49) significantly increased the odds of mothers feeding any breast milk by 1 week, whereas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation (OR = 0.21) significantly decreased the odds. Bivariate logistic regression models showed that Supplemental Nutrition Assistance Program (SNAP) participation (OR = 2.86) and racial discrimination (OR = 2.14) significantly increased the odds of cessation of any breast milk feeding by 3 weeks. SNAP (OR = 2.33) and WIC (OR = 2.38) participation significantly increased the odds of cessation of any breast milk feeding by 8 weeks, whereas higher prepregnancy BMI (OR = 0.95) decreased the odds. Higher mother’s age (OR = 0.92) significantly decreased the odds of cessation of any breast milk feeding by 16 weeks. The findings can be used to inform targeted interventions to promote mothers feeding any breast milk and help reduce breast milk feeding disparities among African American mothers.
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Affiliation(s)
- Amy M. Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802, USA;
- Correspondence:
| | - Jessica J. Smith
- Center for Family Research, University of Georgia, Athens, GA 30602, USA;
| | - Brian K. Stansfield
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802, USA;
| | - Justin A. Lavner
- Department of Psychology, University of Georgia, 156 Psychology Building, Athens, GA 30602, USA;
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Leerkes EM, Bailes LG, Eagleton SG, Buehler C, Shriver LH, Wideman L. Maternal sleep problems, depression, and infant negative emotionality are associated with maternal feeding to soothe in early infancy. Appetite 2022; 176:106098. [DOI: 10.1016/j.appet.2022.106098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/28/2022] [Accepted: 05/23/2022] [Indexed: 11/02/2022]
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32
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Adams EL, Master L, Buxton OM, Savage JS. Sleep parenting practices are associated with infant self-soothing behaviors when measured using actigraphy. Sleep Med 2022; 95:29-36. [DOI: 10.1016/j.sleep.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
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Savage JS, Hochgraf AK, Loken E, Marini ME, Craig SJC, Makova KD, Birch LL, Paul IM. INSIGHT responsive parenting educational intervention for firstborns is associated with growth of second-born siblings. Obesity (Silver Spring) 2022; 30:183-190. [PMID: 34932886 PMCID: PMC8711608 DOI: 10.1002/oby.23301] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to test whether the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention, delivered to parents of firstborn children, is associated with the BMI of first- and second-born siblings during infancy. METHODS Participants included 117 firstborn infants enrolled in a randomized controlled trial and their second-born siblings enrolled in an observation-only ancillary study. The RP curriculum for firstborn children included guidance on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. Anthropometrics were measured in both siblings at ages 3, 16, 28, and 52 weeks. Growth curve models for BMI by child age were fit. RESULTS Second-born children were delivered 2.5 (SD 0.9) years after firstborns. Firstborn and second-born children whose parents received the RP intervention with their first child had BMI that was 0.44 kg/m2 (95% CI: -0.82 to 0.06) and 0.36 kg/m2 (95% CI: -0.75 to 0.03) lower than controls, respectively. Linear and quadratic growth rates for BMI for firstborn and second-born cohorts were similar, but second-born children had a greater average BMI at 1 year of age (difference = -0.33 [95% CI: -0.52 to -0.15]). CONCLUSIONS A RP educational intervention for obesity prevention delivered to parents of firstborns appears to spill over to second-born siblings.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, the Pennsylvania State University, University Park, Pennsylvania, USA
- Nutritional Sciences, the Pennsylvania State University, State College, Pennsylvania, USA
| | - Anna K Hochgraf
- Human Development and Family Studies, the Pennsylvania State University, State College, Pennsylvania, USA
| | - Eric Loken
- Educational Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Michele E Marini
- Center for Childhood Obesity Research, the Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah J C Craig
- Center for Medical Genomics, the Pennsylvania State University, State College, Pennsylvania, USA
- Department of Biology, the Pennsylvania State University, State College, Pennsylvania, USA
| | - Kateryna D Makova
- Center for Medical Genomics, the Pennsylvania State University, State College, Pennsylvania, USA
- Department of Biology, the Pennsylvania State University, State College, Pennsylvania, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens, Georgia, USA
| | - Ian M Paul
- Center for Medical Genomics, the Pennsylvania State University, State College, Pennsylvania, USA
- Department of Pediatrics and Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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McCabe CF, Wood GC, Franceschelli-Hosterman J, Cochran WJ, Savage JS, Bailey-Davis L. Patient-reported outcome measures can advance population health, but is access to instruments and use equitable? Front Pediatr 2022; 10:892947. [PMID: 36330368 PMCID: PMC9622997 DOI: 10.3389/fped.2022.892947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Patient reported outcome measures (PROM) can engage patients and clinicians to improve health outcomes. Their population health impact may be limited by systematic barriers inhibiting access to completion. In this analysis we evaluated the association between individual parent/child characteristics and clinic factors with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire. Participants included parent-child dyads who presented at 14 pediatric clinics for regularly scheduled well-child visits (WCV) prior to age 26 months. EHL items include feeding practices, diet, play time, screen exposure, and sleep. Completion was categorized at patient- (i.e., parent-child dyad) and clinic-levels. Parents completed the 15-item EHL in the patient portal before arrival or in the clinic; ninety-three percent of EHL questionnaires were completed in the clinic vs. 7% in the patient portal. High-completers completed EHL for half of WCVs; low-completers completed at least once; and non-completers never completed. Clinics were classified by EHL adoption level (% high completion): High-adoption: >50%; Moderate-adoption: 10%-50%; and Low-adoption: <10%. Individual-level factors had negligible impact on EHL completion within moderate/low EHL adoption sites; high-adoption sites were used to evaluate infant and maternal factors in association with EHL completion using hierarchical logistic regression. Noncompletion of EHL was significantly associated (p < 0.05) with infant use of public insurance (OR = 1.92 [1.42, 2.59]), >1 clinic site for WCV (OR = 1.83 [1.34, 2.50]), non-White birth mother (OR = 1.78 [1.28, 2.47]), and body weight <2,500 grams or gestational age <34 weeks (OR = 1.74 [1.05, 2.90]). The number of WCVs, a proxy for clinic size, was evaluated but was not associated with completion. Findings indicate potential disparities between populations exposed to, completing, and benefitting from these tools.
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Affiliation(s)
- Carolyn F McCabe
- Geisinger Obesity Institute, Danville, PA, United States.,Population Health Sciences, Geisinger, Danville, PA, United States
| | - G Craig Wood
- Geisinger Obesity Institute, Danville, PA, United States
| | - Jennifer Franceschelli-Hosterman
- Geisinger Obesity Institute, Danville, PA, United States.,Nutrition and Weight Management, Geisinger Medical Center, Danville, PA, United States
| | | | - Jennifer S Savage
- Nutritional Sciences, Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
| | - Lisa Bailey-Davis
- Geisinger Obesity Institute, Danville, PA, United States.,Population Health Sciences, Geisinger, Danville, PA, United States.,Nutritional Sciences, Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
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35
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Nandy D, Craig SJC, Cai J, Tian Y, Paul IM, Savage JS, Marini ME, Hohman EE, Reimherr ML, Patterson AD, Makova KD, Chiaromonte F. Metabolomic profiling of stool of two-year old children from the INSIGHT study reveals links between butyrate and child weight outcomes. Pediatr Obes 2022; 17:e12833. [PMID: 34327846 PMCID: PMC8647636 DOI: 10.1111/ijpo.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Metabolomic analysis is commonly used to understand the biological underpinning of diseases such as obesity. However, our knowledge of gut metabolites related to weight outcomes in young children is currently limited. OBJECTIVES To (1) explore the relationships between metabolites and child weight outcomes, (2) determine the potential effect of covariates (e.g., child's diet, maternal health/habits during pregnancy, etc.) in the relationship between metabolites and child weight outcomes, and (3) explore the relationship between selected gut metabolites and gut microbiota abundance. METHODS Using 1 H-NMR, we quantified 30 metabolites from stool samples of 170 two-year-old children. To identify metabolites and covariates associated with children's weight outcomes (BMI [weight/height2 ], BMI z-score [BMI adjusted for age and sex], and growth index [weight/height]), we analysed the 1 H-NMR data, along with 20 covariates recorded on children and mothers, using LASSO and best subset selection regression techniques. Previously characterized microbiota community information from the same stool samples was used to determine associations between selected gut metabolites and gut microbiota. RESULTS At age 2 years, stool butyrate concentration had a significant positive association with child BMI (p-value = 3.58 × 10-4 ), BMI z-score (p-value = 3.47 × 10-4 ), and growth index (p-value = 7.73 × 10-4 ). Covariates such as maternal smoking during pregnancy are important to consider. Butyrate concentration was positively associated with the abundance of the bacterial genus Faecalibacterium (p-value = 9.61 × 10-3 ). CONCLUSIONS Stool butyrate concentration is positively associated with increased child weight outcomes and should be investigated further as a factor affecting childhood obesity.
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Affiliation(s)
- Debmalya Nandy
- Department of StatisticsPenn State UniversityUniversity ParkPAUSA,Present address:
Department of Biostatistics and Informatics, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sarah J. C. Craig
- Department of BiologyPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA
| | - Jingwei Cai
- Department of Molecular ToxicologyPenn State UniversityUniversity ParkPAUSA,Present address:
Department of Drug Metabolism and PharmacokineticsGenentech Inc.South San FranciscoCaliforniaUSA
| | - Yuan Tian
- Department of Molecular ToxicologyPenn State UniversityUniversity ParkPAUSA
| | - Ian M. Paul
- Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA,Department of PediatricsPenn State College of MedicineHersheyPAUSA
| | - Jennifer S. Savage
- Department of Nutritional SciencesPenn State UniversityUniversity ParkPAUSA,Center for Childhood Obesity ResearchPenn State UniversityUniversity ParkPAUSA
| | - Michele E. Marini
- Center for Childhood Obesity ResearchPenn State UniversityUniversity ParkPAUSA
| | - Emily E. Hohman
- Center for Childhood Obesity ResearchPenn State UniversityUniversity ParkPAUSA
| | - Matthew L. Reimherr
- Department of StatisticsPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA
| | - Andrew D. Patterson
- Department of Molecular ToxicologyPenn State UniversityUniversity ParkPAUSA,Department of Biochemistry & Molecular BiologyPenn State UniversityUniversity ParkPAUSA
| | - Kateryna D. Makova
- Department of BiologyPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA
| | - Francesca Chiaromonte
- Department of StatisticsPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA,Institute of EconomicsEMbeDS, Sant'Anna School of Advanced StudiesPisaItaly
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36
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Carney MC, Zhan X, Rangnekar A, Chroneos MZ, Craig SJC, Makova KD, Paul IM, Hicks SD. Associations between stool micro-transcriptome, gut microbiota, and infant growth. J Dev Orig Health Dis 2021; 12:876-882. [PMID: 33407969 PMCID: PMC8675179 DOI: 10.1017/s2040174420001324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rapid infant growth increases the risk for adult obesity. The gut microbiome is associated with early weight status; however, no study has examined how interactions between microbial and host ribonucleic acid (RNA) expression influence infant growth. We hypothesized that dynamics in infant stool micro-ribonucleic acids (miRNAs) would be associated with both microbial activity and infant growth via putative metabolic targets. Stool was collected twice from 30 full-term infants, at 1 month and again between 6 and 12 months. Stool RNA were measured with high-throughput sequencing and aligned to human and microbial databases. Infant growth was measured by weight-for-length z-score at birth and 12 months. Increased RNA transcriptional activity of Clostridia (R = 0.55; Adj p = 3.7E-2) and Burkholderia (R = -0.820, Adj p = 2.62E-3) were associated with infant growth. Of the 25 human RNAs associated with growth, 16 were miRNAs. The miRNAs demonstrated significant target enrichment (Adj p < 0.05) for four metabolic pathways. There were four associations between growth-related miRNAs and growth-related phyla. We have shown that longitudinal trends in gut microbiota activity and human miRNA levels are associated with infant growth and the metabolic targets of miRNAs suggest these molecules may regulate the biosynthetic landscape of the gut and influence microbial activity.
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Affiliation(s)
- Molly C Carney
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Zhan
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Maria Z Chroneos
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Sarah J C Craig
- Department of Biology, Eberly College of Science, Penn State University, University Park, PA, USA
| | - Kateryna D Makova
- Department of Biology, Eberly College of Science, Penn State University, University Park, PA, USA
| | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Steven D Hicks
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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37
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van Vliet MS, Schultink JM, Jager G, de Vries JHM, Mesman J, de Graaf C, Vereijken CMJL, Weenen H, de Wild VWT, Martens VEG, Houniet H, van der Veek SMC. The Baby's First Bites RCT: Evaluating a Vegetable-Exposure and a Sensitive-Feeding Intervention in Terms of Child Health Outcomes and Maternal Feeding Behavior During Toddlerhood. J Nutr 2021; 152:386-398. [PMID: 34791320 PMCID: PMC8826930 DOI: 10.1093/jn/nxab387] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parenting interventions during the first years of life on what and/or how to feed infants during complementary feeding can promote healthy eating habits. OBJECTIVES An intervention promoting repeated exposure to a variety of vegetables [repeated vegetable exposure (RVE); what] and an intervention promoting responding sensitively to child signals during mealtime [video-feedback intervention to promote positive parenting-feeding infants (VIPP-FI); how] were compared, separately and combined (COMBI), with an attention control condition (AC). Primary outcomes were vegetable consumption and self-regulation of energy intake; secondary outcomes were child anthropometrics and maternal feeding practices (sensitive feeding, pressure to eat). METHODS Our 4-arm randomized controlled trial included 246 first-time Dutch mothers and their infants. Interventions started when infants were 4-6 mo old and ended at age 16 mo. The present study evaluated effects at 18 (t18) and 24 (t24) mo of age. Vegetable acceptance was assessed using three 24-h dietary recalls, self-regulation of energy intake by an eating-in-the-absence-of-hunger experiment and mother-report, and maternal feeding behavior by observation and mother-report. RESULTS Linear mixed model and ANOVA analyses revealed no follow-up group differences regarding child vegetable intake or self-regulatory behavior. The proportion of children with overweight was significantly lower in the COMBI group, compared with the VIPP-FI group at t18 (2% compared with 16%), and with the AC group at t24 (7% compared with 20%), although this finding needs to be interpreted cautiously due to the small number of infants with overweight and nonsignificant effects on the continuous BMI z-score measure (P values: 0.29-0.82). Finally, more sensitive feeding behavior and less pressure to eat was found in the VIPP-FI and COMBI groups, compared with the RVE and AC groups, mostly at t18 (significant effect sizes: d = 0.23-0.64). CONCLUSIONS Interventions were not effective in increasing vegetable intake or self-regulation of energy intake. Future research might usefully focus on risk groups such as families who already experience problems around feeding.This trial is registered at clinicaltrials.gov as NCT03348176.
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Affiliation(s)
- Merel S van Vliet
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Janneke M Schultink
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Gerry Jager
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Jeanne H M de Vries
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Judi Mesman
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Cees de Graaf
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | | | - Hugo Weenen
- Danone Nutricia Research, Utrecht, The Netherlands
| | - Victoire W T de Wild
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Hyczko AV, Ruggiero CF, Hohman EE, Anzman-Frasca S, Savage JS, Birch LL, Paul IM. Sex Differences in Maternal Restrictive Feeding Practices in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study. Acad Pediatr 2021; 21:1070-1076. [PMID: 34020105 PMCID: PMC8349795 DOI: 10.1016/j.acap.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intervention Nurses Start Infants Growing on Healthy Trajectories tested an early life responsive parenting (RP) intervention designed for obesity prevention. Body mass index z-score at age 3 years was lower for the RP group versus controls with a larger effect for girls than boys. We sought to determine if child sex was associated with differing maternal feeding practices and whether sex moderated intervention effects on feeding. DESIGN/METHODS Mothers (N = 279) completed the Infant Feeding Styles Questionnaire (IFSQ) at 28 weeks, the Structure and Control in Parent Feeding (SCPF) at 1, 2, and 3 years, and the Child Feeding Questionnaire (CFQ) at 3 years. Study aims were tested using 2-way analysis of variance and repeated measures. RESULTS Mothers reported greater restriction (limiting food quantity) for boys at 28 weeks (IFSQ: 3.0 ± 1.1 vs 2.8 ± 1.0, P = .07) and across annual measurements from age 1 to 3 years (SCPF: P = .04). At age 3, the intervention group effect on restriction differed by sex (CFQ: P = .047) such that higher restriction was reported by RP group mothers of boys versus girls (3.4 ± 0.7 vs 3.0 ± 0.9, P = .002) with no control group sex difference (3.4 ± 0.8 vs 3.3 ± 0.9, P = .79). There were no sex differences or sex by intervention group interactions in other reported feeding practices at any assessment (ie, structure-based feeding, pressure). CONCLUSIONS Mothers of boys used more restrictive feeding through age 3. These findings may be partially explained by previously reported better self-soothing and self-regulation abilities of participating girls.
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Affiliation(s)
- Alexis V. Hyczko
- Penn State College of Medicine, 500 University Dr., Hershey, PA, USA 17033
| | - Cara F. Ruggiero
- Penn State University, Center for Childhood Obesity Research, 129 Noll Laboratory, University Park, PA, USA 16802
| | - Emily E. Hohman
- Penn State University, Center for Childhood Obesity Research, 129 Noll Laboratory, University Park, PA, USA 16802
| | - Stephanie Anzman-Frasca
- University at Buffalo, Department of Pediatrics, G56 Farber Hall, South Campus, Buffalo, NY, USA 14214-8001
| | - Jennifer S. Savage
- Penn State University, Center for Childhood Obesity Research, 129 Noll Laboratory, University Park, PA, USA 16802
| | - Leann L. Birch
- University of Georgia, Department of Foods and Nutrition, 176 Dawson Hall, Athens, GA, USA 30602-3632
| | - Ian M. Paul
- Penn State College of Medicine, 500 University Dr., Hershey, PA, USA 17033,Departments of Pediatrics & Public Health Sciences, 500 University Dr., Hershey, PA, USA 17033
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Ruggiero CF, McHale SM, Paul IM, Savage JS. Learned Experience and Resource Dilution: Conceptualizing Sibling Influences on Parents' Feeding Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115739. [PMID: 34071852 PMCID: PMC8199493 DOI: 10.3390/ijerph18115739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022]
Abstract
Studies from diverse cultures report mixed results in the relationship between birth order and risk for obesity. Explanations may thus lie in the postnatal period when growth is shaped by the family environment, including parental feeding practices, which may be affected by siblings. Consistent with a family systems perspective, we describe two processes that may explain birth order effects on parental feeding practices and child outcomes: learned experience and resource dilution. Parents learn from experience when earlier-born children influence their parents’ knowledge, expectations, and behavior toward later-born siblings through their behaviors and characteristics—which can have both positive and negative implications. Resource dilution is a process whereby the birth of each child limits the time, attention and other resources parents have to devote to any one of their children. The goal of this review is to provide a theoretical basis for examining potential sibling influences on parental responsive feeding toward developing recommendations for future research and practice aimed at preventing obesity throughout family systems.
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Affiliation(s)
- Cara F. Ruggiero
- The Center for Childhood Obesity Research, Penn State University, University Park, State College, PA 16802, USA;
- Department of Nutritional Sciences, Penn State University, University Park, State College, PA 16802, USA
- Correspondence:
| | - Susan M. McHale
- Department of Human Development and Family Studies, Penn State University, University Park, State College, PA 16802, USA;
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Jennifer S. Savage
- The Center for Childhood Obesity Research, Penn State University, University Park, State College, PA 16802, USA;
- Department of Nutritional Sciences, Penn State University, University Park, State College, PA 16802, USA
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40
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Pang WW, McCrickerd K. The impact of feeding experiences during infancy on later child eating behaviours. Curr Opin Clin Nutr Metab Care 2021; 24:246-251. [PMID: 33631770 DOI: 10.1097/mco.0000000000000744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Individual differences in appetite and eating behaviours appear early in infancy. This review synthesizes recent research investigating the impact of feeding experiences during infancy on later appetite and energy intake regulation, and appraises the consistency and longevity of any effects. RECENT FINDINGS Three themes of early feeding experiences were identified; breastfeeding, infants' first foods and caregivers' feeding practices. Recent findings suggest that breastfeeding alone is unlikely to promote better regulation of food intake later in childhood. It remains unclear whether the method of first food introduction (e.g., baby-led weaning vs traditional spoon feeding), or types of food introduced (e.g. ultra-processed foods), affect later child eating self-regulation. Randomised controlled trials (RCTs) on receiving guidance for responsive feeding showed some benefits; lower child body mass index z-scores in toddlerhood, parents reported less likelihood to pressure their child to eat or use food as a reward and lower emotional eating in the child. SUMMARY There is little consistent new evidence for the lasting impact of any one specific infant feeding experience on later eating self-regulation. More RCTs using observed and measured behaviours, with longer follow-ups of children's eating behaviours, and those conducted across different populations are warranted.
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Affiliation(s)
- Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Keri McCrickerd
- Singapore Institute for Clinical Sciences, Agency for Science, Technology & Research (A STAR), Singapore, Singapore
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Ruggiero CF, Hohman EE, Birch LL, Paul IM, Savage JS. INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years. Appetite 2021; 159:105060. [PMID: 33276013 PMCID: PMC7812701 DOI: 10.1016/j.appet.2020.105060] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
Expert guidance encourages interventions promoting structure-based practices to establish predictable eating environments in order to foster children's self-regulatory skills. However, few studies have examined whether and how child characteristics may moderate effects of interventions on maternal feeding practices. This analysis aimed to examine the effect of the INSIGHT Responsive Parenting (RP) intervention delivered largely during infancy, on child appetitive traits at 2.5 years and maternal feeding practices at 3 years. Primiparous mother-newborn dyads were randomized to a RP intervention designed for obesity prevention or a safety control intervention. Mothers completed the Child Eating Behavior Questionnaire at 2.5 years and the Structure and Control in Parent Feeding Questionnaire at 3 years. T-tests assessed study group differences on child appetitive traits at 2.5 years and maternal feeding practices at age 3. ANCOVA models assessed the effect of study group on parent feeding practices and tested appetitive traits as a moderator. Two hundred thirty-two mother-child dyads completed the trial. Mothers were predominantly white, non-Hispanic, college educated, and married. RP group mothers used more consistent meal routines, and less pressure, food to soothe, and food as reward compared to controls. Child satiety responsiveness moderated the RP intervention effect on maternal use of limiting exposure to unhealthy foods such that the RP intervention was most effective for children at higher levels of satiety responsiveness. Food responsiveness moderated RP intervention effects on maternal use of pressure, such that at lower levels of food responsiveness, control group mothers used more pressure than RP mothers. The INSIGHT RP intervention demonstrated sustained effects on maternal feeding practices through age 3 years, with some intervention effects showing moderation by child appetitive traits.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA; Nutritional Sciences, 110 C Chandlee Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Emily E Hohman
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Leann L Birch
- Foods and Nutrition, 280 Dawson Hall, 305 Sanford Dr., University of Georgia Athens, GA, 30602, USA.
| | - Ian M Paul
- Pediatrics and Public Health Sciences, 500 University Drive, Penn State College of Medicine Hershey, PA, 17033, USA.
| | - Jennifer S Savage
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA; Nutritional Sciences, 110 C Chandlee Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.
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Mihrshahi S, Jawad D, Richards L, Hunter KE, Ekambareshwar M, Seidler AL, Baur LA. A Review of Registered Randomized Controlled Trials for the Prevention of Obesity in Infancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052444. [PMID: 33801485 PMCID: PMC7967587 DOI: 10.3390/ijerph18052444] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Childhood overweight and obesity is a worldwide public health issue. Our objective was to describe planned, ongoing and completed randomized controlled trials (RCTs) designed for the prevention of obesity in early childhood. Two databases (World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) were searched to identify RCTs with the primary aim of preventing childhood obesity and at least one outcome related to child weight. Interventions needed to start in the first two years of childhood or earlier, continue for at least 6 months postnatally, include a component related to lifestyle or behaviours, and have a follow up time of at least 2 years. We identified 29 unique RCTs, implemented since 2008, with most being undertaken in high income countries. Interventions ranged from advice on diet, activity, sleep, emotion regulation, and parenting education through to individual home visits, clinic-based consultations, or group education sessions. Eleven trials published data on child weight-related outcomes to date, though most were not sufficiently powered to detect significant effects. Many trials detected improvements in practices such as breastfeeding, screen time, and physical activity in the intervention groups compared to the control groups. Further follow-up of ongoing trials is needed to assess longer-term effects.
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Affiliation(s)
- Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
- Correspondence: ; Tel.: +61-2-9850-2468
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Louise Richards
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Kylie E. Hunter
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- NHMRC Clinical Trials Centre, The University of Sydney, Locked bag 77, Camperdown, NSW 1450, Australia
| | - Mahalakshmi Ekambareshwar
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
| | - Anna Lene Seidler
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- NHMRC Clinical Trials Centre, The University of Sydney, Locked bag 77, Camperdown, NSW 1450, Australia
| | - Louise A. Baur
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood Sydney School of Public Health, The University of Sydney, Sydney, NSW 2109, Australia; (K.E.H.); (M.E.); (A.L.S.); (L.A.B.)
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (D.J.); (L.R.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Kling SM, Harris HA, Marini M, Cook A, Hess LB, Lutcher S, Mowery J, Bell S, Hassink S, Hayward SB, Johnson G, Franceschelli Hosterman J, Paul IM, Seiler C, Sword S, Savage JS, Bailey-Davis L. Advanced Health Information Technologies to Engage Parents, Clinicians, and Community Nutritionists in Coordinating Responsive Parenting Care: Descriptive Case Series of the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care Randomized Controlled Trial. JMIR Pediatr Parent 2020; 3:e22121. [PMID: 33231559 PMCID: PMC7723742 DOI: 10.2196/22121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/08/2020] [Accepted: 10/25/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs. OBJECTIVE This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists. METHODS Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month intervention, electronic systems were created to facilitate documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCPs. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit. RESULTS Dyads (N=131) attended 459 PCP (3.5, SD 1.0 per dyad) and 296 WIC (2.3, SD 1.0 per dyad) visits. Parents completed the EHL tool prior to 53.2% (244/459) of PCP visits (1.9, SD 1.2 per dyad), PCPs documented provided RP care at 35.3% (162/459) of visits, and data were shared with WIC following 100% (459/459) of PCP visits. A WIC visit followed a PCP visit 50.3% (231/459) of the time; thus, there were 1.8 (SD 0.8 per dyad) PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% (154/231) of opportunities (1.2, SD 0.9 per dyad). WIC visits were followed by a PCP visit 58.9% (116/197) of the time; thus, there were 0.9 (SD 0.8 per dyad) WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 44.0% (51/116) of opportunities (0.4, SD 0.6 per dyad). CONCLUSIONS Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence, and frequency of visits underscores the need for flexibility in pragmatic studies. TRIAL REGISTRATION ClinicalTrials.gov NCT03482908; https://clinicaltrials.gov/ct2/show/NCT03482908. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12887-018-1263-z.
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Affiliation(s)
- Samantha Mr Kling
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Holly A Harris
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
- Erasmus Medical Center, Generation R Study, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michele Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
| | - Adam Cook
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Lindsey B Hess
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
| | - Shawnee Lutcher
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Jacob Mowery
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Scott Bell
- Bureau of Women, Infants, and Children, Pennsylvania Department of Health, Harrisburg, PA, United States
| | - Sandra Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Wilmington, DE, United States
| | - Shannon B Hayward
- Maternal and Family Health Services, Wilkes-Barre, PA, United States
| | - Greg Johnson
- Bureau of Women, Infants, and Children, Pennsylvania Department of Health, Harrisburg, PA, United States
| | | | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | | | - Shirley Sword
- Bureau of Women, Infants, and Children, Pennsylvania Department of Health, Harrisburg, PA, United States
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Lisa Bailey-Davis
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
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Davison KK, Haines J, Garcia EA, Douglas S, McBride B. Fathers' food parenting: A scoping review of the literature from 1990 to 2019. Pediatr Obes 2020; 15:e12654. [PMID: 32415676 PMCID: PMC8010159 DOI: 10.1111/ijpo.12654] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND While food parenting is a robust area of inquiry, studies have largely focused on mothers. Given the diversity of family structures today and increases in fathers' engagement in caregiving, fathers' food parenting warrants attention. OBJECTIVE We present a scoping review of research on fathers' food parenting (1990-2019). Eligible studies included peer-reviewed research published in English documenting fathers' food parenting and presenting results for fathers separate from mothers. RESULTS Seventy-seven eligible studies were identified. Most studies were based in the U.S (63.6%) and utilized a cross-sectional design (93.5%). Approximately half of studies used a validated measure of food parenting (54.5%) and slightly less than 30% utilized theory (28.6%). Many studies did not report information on fathers' residential status (37.7%) or their relationship to the target child (biological vs social) (63.6%). Content analysis of study findings showed that: fathers are involved in food parenting, but at lower levels than mothers; there are few consistent mother-father differences in food parenting practices; and fathers' controlling food parenting is linked with negative nutrition outcomes in children while responsive food parenting is linked with positive child outcomes. CONCLUSION To better inform family interventions to prevent childhood obesity, future food parenting research with fathers should recognize the diversity of family structures and utilize prospective, theory-based, designs.
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Affiliation(s)
- Kirsten K Davison
- Boston College School of Social Work, Chestnut Hill, Massachusetts, USA
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Evelin A Garcia
- Boston College School of Social Work, Chestnut Hill, Massachusetts, USA
| | - Sabrina Douglas
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Brent McBride
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
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45
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Harris HA, Anzman-Frasca S, Marini ME, Paul IM, Birch LL, Savage JS. Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT. Pediatr Obes 2020; 15:e12645. [PMID: 32372570 PMCID: PMC7729434 DOI: 10.1111/ijpo.12645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Child emotional overeating is a risk factor for obesity that is learned in the home environment. Parents' use of food to soothe child distress may contribute to the development of children's emotional overeating. OBJECTIVES To examine the effect of a responsive parenting (RP) intervention on mother-reported child emotional overeating, and explore whether effects are mediated by mother-reported use of food to soothe child distress. METHODS The sample included primiparous mother-infant dyads randomized to a RP intervention (n = 105) or home safety control group (n = 102). Nurses delivered RP guidance in four behavioral domains: sleeping, fussy, alert/calm, and drowsy. Mothers reported their use of food to soothe at age 18 months and child emotional overeating at age 30 months. Mediation was analyzed using the SAS PROCESS macro. RESULTS RP intervention mothers reported less frequent use of food to soothe and perceived their child's emotional overeating as lower compared to the control group. Food to soothe mediated the RP intervention effect on child emotional overeating (mediation model: R2 = 0.13, P < .0001). CONCLUSIONS Children's emotional overeating may be modified through an early life RP intervention. Teaching parents alternative techniques to soothe child distress rather than feeding may curb emotional overeating development to reduce future obesity risk.
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Affiliation(s)
- Holly A. Harris
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michele E. Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, Georgia
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania
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46
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Bloomfield FH, Agostoni C. The potential impact of feeding formula-fed infants according to published recommendations. Pediatr Res 2020; 88:526-528. [PMID: 32634816 DOI: 10.1038/s41390-020-1056-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Frank H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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47
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Roy M, Haszard JJ, Savage JS, Yolton K, Beebe DW, Xu Y, Galland B, Paul IM, Mindell JA, Mihrshahi S, Wen LM, Taylor B, Richards R, Morenga LT, Taylor RW. Bedtime, body mass index and obesity risk in preschool-aged children. Pediatr Obes 2020; 15:e12650. [PMID: 32372572 PMCID: PMC7745736 DOI: 10.1111/ijpo.12650] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although sleep duration is a risk factor for obesity in young children, less is known about other aspects of sleep health, including bedtime, on obesity risk. OBJECTIVE To determine whether bedtime is associated with body mass index (BMI) z-score or obesity risk in children ages 2 to 5 years, and to determine if associations are independent of sleep duration. METHODS Cohort analyses were undertaken using three early life obesity prevention trials (POI, INSIGHT, Healthy Beginnings) and a longitudinal cohort study (HOME). Bedtime was assessed by questionnaire and BMI through clinical measurement between 2 and 5 years in 1642 children. Adjusted regression models examined whether BMI z-score and obesity (BMI z-score ≥ 2) were associated with bedtime, nocturnal sleep time and 24-hour sleep time. A discrete mixture model categorized children into bedtime trajectory groups across time points. RESULTS Bedtime was inconsistently associated with BMI z-score. Although each hour later of bedtime was associated with greater odds of obesity at ages 3 (OR; 95% CI: 1.05; 1.003, 1.10) and 5 (1.35; 1.08, 1.69) years, odds were attenuated after adjustment for nocturnal or 24-hour sleep time. Longer nocturnal sleep duration at 2 years was associated with lower odds of obesity (OR 0.90; 0.86, 0.94), as was longer 24-hour sleep duration at 3 years in girls (0.70; 0.62, 0.78). BMI z-score and odds of obesity were not significantly different between 'early to bed' and 'late to bed' trajectory groups. CONCLUSIONS Timing of bedtime appears inconsistently related to obesity in young children, possibly via influencing overall sleep duration.
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Affiliation(s)
- Melyssa Roy
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jennifer S. Savage
- Center for Childhood Obesity Research and Department of Nutritional Sciences, Pennsylvania State University, State College, Pennsylvania
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dean W. Beebe
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Barbara Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Ian M. Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jodi A. Mindell
- Saint Joseph’s University and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Seema Mihrshahi
- Centre of Research Excellence in the Early Prevention of Obesity in Childhood, School of Public Health University of Sydney, New South Wales, Sydney, Australia
| | - Li Ming Wen
- Centre of Research Excellence in the Early Prevention of Obesity in Childhood, School of Public Health University of Sydney, New South Wales, Sydney, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney, New South Wales, Australia
| | - Barry Taylor
- Office of the Dean, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin, New Zealand
| | - Lisa Te Morenga
- School of Health, Victoria University of Wellington, Wellington, New Zealand
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Wasser HM, Thompson AL, Suchindran CM, Goldman BD, Hodges EA, Heinig MJ, Bentley ME. Home-based intervention for non-Hispanic black families finds no significant difference in infant size or growth: results from the Mothers & Others randomized controlled trial. BMC Pediatr 2020; 20:385. [PMID: 32811460 PMCID: PMC7433206 DOI: 10.1186/s12887-020-02273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background Non-Hispanic black (NHB) infants are twice as likely as non-Hispanic white infants to experience rapid weight gain in the first 6 months, yet few trials have targeted this population. The current study tests the efficacy of “Mothers & Others,” a home-based intervention for NHB women and their study partners versus an attention-control, on infant size and growth between birth and 15 months. Methods Mothers & Others was a two-group randomized controlled trial conducted between November 2013 and December 2017 with enrollment at 28-weeks pregnancy and follow-up at 3-, 6-, 9-, 12-, and 15-months postpartum. Eligible women self-identified as NHB, English-speaking, and 18–39 years. The obesity prevention group (OPG) received anticipatory guidance (AG) on responsive feeding and care practices and identified a study partner, who was encouraged to attend home visits. The injury prevention group (IPG) received AG on child safety and IPG partners only completed study assessments. The primary delivery channel for both groups was six home visits by a peer educator (PE). The planned primary outcome was mean weight-for-length z-score. Given significant differences between groups in length-for-age z-scores, infant weight-for-age z-score (WAZ) was used in the current study. A linear mixed model, using an Intent-To-Treat (ITT) data set, tested differences in WAZ trajectories between the two treatment groups. A non-ITT mixed model tested for differences by dose received. Results Approximately 1575 women were screened for eligibility and 430 were enrolled. Women were 25.7 ± 5.3 years, mostly single (72.3%), and receiving Medicaid (74.4%). OPG infants demonstrated lower WAZ than IPG infants at all time points, but differences were not statistically significant (WAZdiff = − 0.07, 95% CI − 0.40 to 0.25, p = 0.659). In non-ITT models, infants in the upper end of the WAZ distribution at birth demonstrated incremental reductions in WAZ for each home visit completed, but the overall test of the interaction was not significant (F2,170 = 1.41, p = 0.25). Conclusions Despite rich preliminary data and a strong conceptual model, Mothers & Others did not produce significant differences in infant growth. Results suggest a positive impact of peer support in both groups. Trial registration ClinicalTrials.gov, NCT01938118, 09/10/2013.
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Affiliation(s)
- Heather M Wasser
- Department of Nutrition, University of North Carolina, 135 Dauer Drive, CB# 7400, Chapel Hill, NC, 27599-7400, USA. .,University of North Carolina, Chapel Hill, NC, USA.
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina, 135 Dauer Drive, CB# 7400, Chapel Hill, NC, 27599-7400, USA.,University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Margaret E Bentley
- Department of Nutrition, University of North Carolina, 135 Dauer Drive, CB# 7400, Chapel Hill, NC, 27599-7400, USA.,University of North Carolina, Chapel Hill, NC, USA
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49
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Hohman EE, Savage JS, Birch LL, Paul IM. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Responsive Parenting Intervention for Firstborns Affects Dietary Intake of Secondborn Infants. J Nutr 2020; 150:2139-2146. [PMID: 32412629 PMCID: PMC7398778 DOI: 10.1093/jn/nxaa135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although previous work has shown that children with older siblings tend to have poorer diet quality, no study has directly compared diets of infant siblings. OBJECTIVE The goals of this analysis were to examine birth-order differences in dietary intake between firstborn (FB) and secondborn (SB) siblings, and to determine whether a responsive parenting (RP) intervention modified birth-order effects on diet. METHODS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study randomly assigned first-time mothers to an RP intervention, which included guidance on feeding, sleep, soothing, and interactive play, or control. INSIGHT mothers who delivered a second child enrolled in an observation-only study of their SB infant (SIBSIGHT). Mothers completed FFQs for both children at ages 6 (n = 97 sibling pairs) and 12 (n = 100) mo. FB compared with SB intake of food groups of interest were compared, and the moderating effect of the RP intervention on birth-order differences was tested using generalized linear mixed models. RESULTS Though FBs and SBs had similar diets, more FBs than SBs consumed 100% fruit juice at both 6 (13.8 compared with 3.2%, P = 0.006) and 12 mo (46.0 compared with 32.0%, P = 0.01). SBs consumed fruit more frequently (FB 2.8 compared with SB 3.2 times/d, P = 0.01), and were more likely to consume fried potatoes (FB 38.4 compared with SB 57.6%, P = 0.0009) and processed meats (FB 43.0 compared with SB 58.0%, P = 0.02) than FBs at 12 mo. There were no differences by birth order in intake of sweets, snacks, or sugar-sweetened beverages at 12 mo. At 12 mo, RP-group SBs ate vegetables more times per day (3.2) than control SBs (2.2, P = 0.01). RP-SBs also consumed a greater variety of vegetables (10.2) than control-SBs (7.9, P = 0.01). CONCLUSIONS Birth order is not consistently associated with healthy or unhealthy infant dietary intake. However, an RP intervention delivered to first-time mothers may benefit subsequent infants' vegetable intake. This trial was registered at clinicaltrials.gov as NCT01167270.
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Affiliation(s)
- Emily E Hohman
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA, USA,Address correspondence to EEH (e-mail: )
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, University Park, PA, USA,Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Kong KL, Anzman-Frasca S, Epstein LH, Eiden RD, Paluch RA. Infants with big appetites: The role of a nonfood environment on infant appetitive traits linked to obesity. Am J Clin Nutr 2020; 112:948-955. [PMID: 32652028 PMCID: PMC7762759 DOI: 10.1093/ajcn/nqaa175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Individual differences in appetitive traits present in the first few weeks of life. Research has shown that infants with a greater food reinforcement ratio (FRR) have higher obesity risk. To date, limited work has examined the relation between FRR and appetitive traits of infants, and how FRR relates to appetitive traits and obesity development. OBJECTIVES To examine the relation between appetitive traits and food and nonfood reinforcement of infants aged 9-18 mo, and to examine whether food and nonfood reinforcement mediate the relation between appetitive traits and weight-for-length z-score (zWFL). METHOD This secondary data analysis was conducted by combining 4 different cohorts of infants (n = 143) who have complete data on the food/nonfood reinforcement task, Baby Eating Behavior Questionnaire, and anthropometrics and demographics assessments. Three different nonfood reinforcers were used: video (DVD; n = 27), playing with bubbles (Bubbles; n = 67), and music accompanied by instruments (Music; n = 49) for the nonfood portion of the task. For the food portion of the task, the infant's favorite food was used. RESULTS General appetite positively correlated with FRR and zWFL, but negatively correlated with nonfood reinforcement; satiety responsiveness negatively correlated with food reinforcement, FRR, and zWFL. Mediational analysis showed that effects of general appetite on zWFL were mediated by FRR (indirect effect = 0.100, 95% CI: 0.041, 0.187) and nonfood reinforcement (indirect effect = 0.076, 95% CI: 0.025, 0.156). We also observed the mediating effect of FRR on the relation of satiety responsiveness and zWFL (indirect effect = -0.097, 95% CI: -0.204, -0.026). CONCLUSIONS Our work contributes to the mechanistic understanding of the ontogeny of obesity development early in life among individuals who are born with appetitive drive for overconsumption. During early infancy, the nonfood environment may protect against this drive and prevent obesity development.
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Affiliation(s)
| | - Stephanie Anzman-Frasca
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA,Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA,Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Rina D Eiden
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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