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Quah PL, Loo BKG, Chia MYH, Chua TBK, Tan TSZ, Chan PC, Tan KH. Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore. PLoS One 2024; 19:e0298968. [PMID: 38408072 PMCID: PMC10896501 DOI: 10.1371/journal.pone.0298968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.
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Affiliation(s)
- Phaik Ling Quah
- Division of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Benny Kai Guo Loo
- General Paediatric Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michael Yong Hwa Chia
- Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Terence Buan Kiong Chua
- Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Teresa Shu Zhen Tan
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Poh Chong Chan
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Division of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Barnett LM, Verswijveren SJJM, Colvin B, Lubans DR, Telford RM, Lander NJ, Schott N, Tietjens M, Hesketh KD, Morgan PJ, Hinkley T, Downing KL, Telford RD, Cohen KE, Ridgers ND, Abbott G. Motor skill competence and moderate- and vigorous-intensity physical activity: a linear and non-linear cross-sectional analysis of eight pooled trials. Int J Behav Nutr Phys Act 2024; 21:14. [PMID: 38326890 PMCID: PMC10848369 DOI: 10.1186/s12966-023-01546-7] [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: 08/06/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Few studies have examined the relationship between motor skill competence and device-measured physical activity in large samples and none have used non-linear modelling. This study assessed the linear and non-linear associations between motor skill competence and physical activity in children using pooled data from eight studies. METHODS Cross-sectional ActiGraph accelerometer and motor skills competence data from 988 children (50.8% boys) aged 3-11 years were included. Total, object control and locomotor skill competence were assessed using the Test of Gross Motor Skill Development. Linear mixed models were fitted to examine linear associations between motor skill competence and physical activity. Then, restricted cubic splines models were used to assess potential non-linear relationships. Interactions by sex and age were assessed. RESULTS There was evidence of positive linear associations between total skill, and object control and locomotor skills, with moderate- and vigorous-intensity physical activity; however, the associations with total skill competence and object control better fitted a non-linear model. Non-linear models indicated associations were positive but relatively weak in the low to mid ranges of TGMD/object control scores but at high ranges (~ > 70 out of 100/ and ~ 35 out of 50) the association strength increased for both moderate- and vigorous-intensity physical activity. There were sex interactions for locomotor skills only, specifically for vigorous activity with boys having a stronger positive association than girls. CONCLUSIONS There appears to be a threshold for object control skill proficiency that children need to reach to enhance their physical activity levels which provides support for a motor skill "proficiency barrier". This provides a tangible benchmark for children to achieve in motor competence programs.
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Affiliation(s)
- L M Barnett
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Health and Social Development, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - S J J M Verswijveren
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
| | - B Colvin
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - D R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40600, Jyväskylä, Finland
| | - R M Telford
- University of Canberra, Research Institute for Sport and Exercise, Bruce, ACT, 2617, Australia
- The Australian National University, National Centre for Epidemiology and Population Health, ANU College of Health & Medicine, 62 Mills Rd, Acton, ACT, 2601, Australia
| | - N J Lander
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
| | - N Schott
- Department of Sport Psychology and Human Movement Sciences Organization, University of Stuttgart, Institute for Sport and Movement Science, Allmandring 28, Stuttgart, 70569, Germany
| | - M Tietjens
- University of Muenster, Institute of Sport and Exercise Sciences, Horstmarer Landweg 62 b, 48149, Münster, Germany
| | - K D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
| | - P J Morgan
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | | | - K L Downing
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
| | - R D Telford
- University of Canberra, Research Institute for Sport and Exercise, Bruce, ACT, 2617, Australia
| | - K E Cohen
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - N D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
- University of South Australia, Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, Frome Road, Adelaide, SA, 5001, Australia
| | - G Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia
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Park SY, Love P, Zheng M, Campbell KJ, Lacy KE. Breakfast consumption trends among young Australian children aged up to 5 years: results from InFANT program. Front Endocrinol (Lausanne) 2023; 14:1154844. [PMID: 37635972 PMCID: PMC10448523 DOI: 10.3389/fendo.2023.1154844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 08/29/2023] Open
Abstract
Breakfast is considered a healthy dietary habit which can track over time from childhood to adulthood. The breakfast meal has the potential to improve daily dietary quality, particularly if it includes a range of food groups and adequate nutrient intakes. However, research on breakfast consumption trends among young Australian children aged up to 5 years is currently limited. This study assessed children's usual breakfast food group and nutrient intakes at ages 1.5 (n = 369), 3.5 (n = 242), and 5.0 (n =240) years using three 24-hour dietary recalls from the Melbourne InFANT program. Tracking of food groups at breakfast across the three ages was assessed by Pearson correlation of energy-adjusted food intake residuals. The main food groups consumed at breakfast were grains, milk/alternatives and discretionary items, with vegetables rarely consumed at any age. Our study found that while breakfast contributed about 20% of total daily energy, this provided 20%-29.1% of total daily intake across all ages for carbohydrates, total sugars, calcium and potassium. For the contribution to daily recommendations, breakfast contributed more than about a third of daily recommended intakes for some micronutrients (e.g., iron, calcium and zinc), and a large proportion (over 40%) of sodium intake. Children consumed 11.9% -15.2% of their energy at breakfast from saturated fat, which is higher than the recommended total energy contribution of saturated fat (no more than 10% from saturated fat). For tracking of most food groups and nutrients, tracking was found to be low or moderate over time. Given the contribution that breakfast can make to ensure children achieve their daily dietary intakes, early interventions for young Australian children should focus on practical strategies to increase vegetable intake while reducing sodium and saturated fat intake at breakfast.
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Affiliation(s)
- Seon Y. Park
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, Geelong, VIC, Australia
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Johnson BJ, Downing KL, Chadwick P, Gubbels JS. Editorial: Behavior change approaches to improve children and families' dietary intake and 24h movement behaviors. Front Public Health 2023; 11:1211601. [PMID: 37361166 PMCID: PMC10289156 DOI: 10.3389/fpubh.2023.1211601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
| | - Katherine L. Downing
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Jessica S. Gubbels
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Thorsteinsdottir F, Campbell KJ, Heitmann BL, Zheng M. Longitudinal Trajectories of Dietary Fibre Intake and Its Determinants in Early Childhood: Results from the Melbourne InFANT Program. Nutrients 2023; 15:nu15081932. [PMID: 37111151 PMCID: PMC10145308 DOI: 10.3390/nu15081932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/08/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Optimal nutrition during early childhood, including dietary fibre intake, is important for children's health and development. Knowledge of fibre intake and its determinants in early childhood is limited. We aimed to describe fibre intake and sources and to identify trajectories of fibre intake at age 9, 18, 42, and 60 months and its child and maternal determinants. Associations between fibre trajectory groups and BMI z-scores and child overweight status were also assessed. METHODS This is a secondary analysis of longitudinal data from the Melbourne InFANT Program, trial registration: Current Controlled Trials (ISRCTN81847050). Group-based trajectory modelling was used to identify trajectories of fibre intake from ages 9 to 60 months (n = 503). Multivariable logistic or linear regression was used to assess the determinants of fibre intake trajectories and the association between fibre intake trajectories and obesity outcomes. RESULTS Four fibre intake trajectory groups were identified, with three groups following stable, rising trajectories of "Low" (52.3%), "Moderate" (32.2%), and "High" (13.3%), respectively. The remaining followed an "unstable" trajectory (2.2%). Girls versus boys were more likely to follow the "Low" fibre intake trajectory, whereas children who were breastfed for ≥6 months and whose mother had a university education were less likely to follow the "Low" fibre trajectory. No association was found between fibre trajectory groups and obesity outcomes. CONCLUSION Most children followed a stable, rising trajectory of low fibre intake in early childhood. Child sex, breastfeeding duration and maternal education were significant determinants of low fibre intake trajectory.
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Affiliation(s)
- Fanney Thorsteinsdottir
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- The Boden Group, Faculty of Medicine and Health, Sydney University, Sydney, NSW 2006, Australia
- The Department of Public Health, Section for General Medicine, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
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Zheng M, Hesketh KD, Vuillermin P, Dodd J, Wen LM, Baur LA, Taylor R, Byrne R, Mihrshahi S, Burgner D, Tang MLK, Campbell KJ. Understanding the pathways between prenatal and postnatal factors and overweight outcomes in early childhood: a pooled analysis of seven cohorts. Int J Obes (Lond) 2023:10.1038/s41366-023-01301-9. [PMID: 37012427 DOI: 10.1038/s41366-023-01301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND/OBJECTIVES Childhood overweight and obesity are influenced by a range of prenatal and postnatal factors. Few studies have explored the integrative pathways linking these factors and childhood overweight. This study aimed to elucidate the integrative pathways through which maternal pre-pregnancy body mass index (BMI), infant birth weight, breastfeeding duration, and rapid weight gain (RWG) during infancy are associated with overweight outcomes in early childhood from ages 3 to 5 years. SUBJECTS/METHODS Pooled data from seven Australian and New Zealand cohorts were used (n = 3572). Generalized structural equation modelling was used to examine direct and indirect associations of maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration, and RWG during infancy with child overweight outcomes (BMI z-score and overweight status). RESULTS Maternal pre-pregnancy BMI was directly associated with infant birth weight (β 0.01, 95%CI 0.01, 0.02), breastfeeding duration ≥6 months (OR 0.92, 95%CI 0.90, 0.93), child BMI z-score (β 0.03, 95%CI 0.03, 0.04) and overweight status (OR 1.07, 95%CI 1.06, 1.09) at ages 3-5 years. The association between maternal pre-pregnancy BMI and child overweight outcomes was partially mediated by infant birth weight, but not RWG. RWG in infancy exhibited the strongest direct association with child overweight outcomes (BMI z-score: β 0.72, 95%CI 0.65, 0.79; overweight status: OR 4.49, 95%CI 3.61, 5.59). Infant birth weight was implicated in the indirect pathways of maternal pre-pregnancy BMI with RWG in infancy, breastfeeding duration, and child overweight outcomes. The associations between breastfeeding duration (≥6 months) and lower child overweight outcomes were fully mediated by RWG in infancy. CONCLUSIONS Maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration and RWG in infancy act in concert to influence early childhood overweight. Future overweight prevention interventions should target RWG in infancy, which showed the strongest association with childhood overweight; and maternal pre-pregnancy BMI, which was implicated in several pathways leading to childhood overweight.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - Jodie Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Li Ming Wen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Describing the longitudinal breakfast quality index trajectories in early childhood: results from Melbourne InFANT program. Eur J Clin Nutr 2023; 77:363-369. [PMID: 36494475 DOI: 10.1038/s41430-022-01249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Breakfast quality in early childhood remains understudied. This study describes the changes in breakfast quality index (BQI) (i.e. trajectory) in early childhood and assesses its associations with obesity outcomes. METHODS Data from children who participated in the Melbourne InFANT Program were used (n = 328). The Melbourne InFANT Program was a 15-month early obesity prevention intervention conducted from 2008 to 2013. Dietary intakes at ages 1.5, 3.5 and 5.0 years were assessed using three parent-proxy reported 24 h recalls. A revised nine-item BQI tool developed based on Australian dietary recommendations for young children was used to calculate BQI scores. Group-based trajectory modelling identified BQI trajectory groups. Multivariable linear and logistic regression examined the associations between identified BQI trajectory groups and obesity outcomes at age 5 years. RESULTS Mean BQI at ages 1.5, 3.5 and 5.0 years was 4.8, 4.8, 2.7 points, respectively. Two BQI trajectory groups were identified, and both showed a decline in BQI. The mean BQI of most children (74%) decreased from 5.0 to 4.0 points from ages 1.5 to 5.0 years (referred as "High BQI" group). The remaining children (26%) had a mean BQI of 4.8 and 1.2 points at age 1.5 and 5.0 years, respectively (referred as "Low BQI" group). The "Low BQI" group appeared to show higher risk of overweight (OR:1.30, 95% CI: 0.60, 2.81, P = 0.66) at age 5 years than the "High BQI" group. No difference in body mass index (BMI) z-score was found between the two groups. CONCLUSIONS Two BQI trajectory groups were identified. Both groups showed a decline in breakfast quality from ages 1.5 to 5.0 years. Our study highlights the need for early health promotion interventions and strategies to improve and maintain breakfast quality across early childhood.
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The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position on the Role of the Registered Dietitian Nutritionist in the Care of the Pediatric Patient With Chronic Gastrointestinal Diseases. J Pediatr Gastroenterol Nutr 2023; 76:390-399. [PMID: 36580920 DOI: 10.1097/mpg.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The optimization of nutrition is essential for the growth and development of all children, including those with gastrointestinal (GI) conditions that can variably affect nutrient intake, absorption, or metabolism. Registered Dietitian Nutritionists (RDNs) are essential partners in delivering high quality care for pediatric GI disorders, but limited evidence is available to support the role of the RDN in the care of these patients. This position paper outlines the evidence supporting the role of the RDN in the management of chronic pediatric GI issues in both inpatient and outpatient settings. Gaps in the literature, opportunities for future research, and barriers to RDN access are discussed.
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Zheng M, Silva M, Heitkonig S, Abbott G, McNaughton SA, Campbell KJ. Evaluation of a Food Frequency Questionnaire for Capturing Free Sugars Intake in Australian Young Children: The InFANT FFQ. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1557. [PMID: 36674312 PMCID: PMC9864467 DOI: 10.3390/ijerph20021557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Excess free sugars intake contributes to dental caries and obesity in children. Food frequency questionnaires (FFQ) that assess free sugars intake in young children are limited. This study evaluated the utility of a 68-item FFQ to assess free sugars intake in Australian young children against three 24-h recalls at ages 1.5, 3.5, and 5.0 years. Free sugars intakes estimated from two methods were compared using group- and individual-level validation tests. Group-level tests revealed that mean free sugars intakes estimated from two methods were similar and Bland-Altman tests revealed no presence of proportional bias at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ underestimated the free sugars intake compared to the recalls, and Bland-Altman tests revealed proportional bias. For individual-level tests, the deattenuated correlation (R) between free sugars intakes estimated from two methods exhibited good agreement across three time-points (R: 0.54-0.62), as were the percentage agreement (68.5-73.6%) and weighted kappa (Kw: 0.26-0.39). The FFQ showed good validity at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ showed good validity for individual-level tests only. The FFQ provided stronger validity in the ranking of individuals according to free sugars intake than comparing absolute free sugars intake at group level.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Mihiri Silva
- Murdoch Childrens Research Institute, Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Melbourne Dental School, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Stephanie Heitkonig
- Murdoch Childrens Research Institute, Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
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Marshall S, Johnson BJ, Hesketh KD, Campbell KJ, Fraser K, Love P, Denney-Wilson E, Salmon J, McCallum Z, Laws R. Mapping intervention components from a randomized controlled trial to scale-up of an early life nutrition and movement intervention: The INFANT program. Front Public Health 2023; 10:1026856. [PMID: 36711339 PMCID: PMC9880042 DOI: 10.3389/fpubh.2022.1026856] [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: 08/24/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Early life parent-focused interventions can effectively improve infant and child nutrition and movement (physical activity and sedentary behavior) as well as parents' health behaviors. Scale-up of such interventions to real-world settings is essential for population-wide benefits. When progressing to scale-up, intervention components may be modified to reflect contextual factors and promote feasibility of scale-up. The INFANT program, an efficacious early life nutrition and movement behavioral intervention began as a randomized controlled trial (RCT), was modified after a small-scale translation, and is currently being scaled-up in Victoria, Australia. This study mapped and compared discrete intervention components of both the original RCT and the scaled-up version of INFANT to examine modifications for scaling up. Methods Discrete intervention components, specifically the target behaviors (child-related and parent-related behaviors), delivery features and behavior change techniques (BCTs) from the RCT and the scaled-up program were coded and mapped using established frameworks and taxonomies. Publications and unpublished materials (e.g., facilitator notes, handouts, videos, app) were coded. Coding was performed independently in duplicate, with final coding validated in a meeting with interventionists. Interventionists reported the rationale for modifications made. Results The INFANT RCT and scaled-up version targeted the same obesity prevention-related nutrition and movement behaviors. Key modified delivery features at scale-up included reduced number of sessions, a broader range of professionals facilitating groups, the addition of a mobile app for parents replacing hard-copy materials and tangible tools (e.g., pedometers), and broadening of content (e.g., early feeding, updated 24-h movement guidelines). BCTs used across the RCT and scale-up sessions were unchanged. However, the BCTs identified in the between-session support materials were almost double for the scale-up compared with the RCT, primarily due to the reduced number of sessions and the app's capacity to include more content. Conclusions INFANT is one of few early life nutrition and movement behavioral interventions being delivered at scale. With INFANT as an example, this study provides critical understanding about what and why intervention components were altered as the RCT was scaled-up. Unpacking these intervention modifications provides important insights for scale-up feasibility, outcome effects, and how to optimize implementation strategies for population-level benefits.
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Affiliation(s)
- Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Brittany J. Johnson
- Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration, Sydney, NSW, Australia,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Kylie Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Elizabeth Denney-Wilson
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia,Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Zoe McCallum
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia,*Correspondence: Rachel Laws ✉
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11
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Gago C, Aftosmes-Tobio A, Beckerman-Hsu JP, Oddleifson C, Garcia EA, Lansburg K, Figueroa R, Yu X, Kitos N, Torrico M, Leonard J, Jurkowski JK, Mattei J, Kenney EL, Haneuse S, Davison KK. Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children. Int J Behav Nutr Phys Act 2023; 20:4. [PMID: 36631869 PMCID: PMC9832428 DOI: 10.1186/s12966-022-01400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION ClinicalTrials.gov, NCT03334669 , Registered October 2017.
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Affiliation(s)
- Cristina Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Jacob P Beckerman-Hsu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Evelin A Garcia
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kindra Lansburg
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Xinting Yu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Merieka Torrico
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Jessie Leonard
- Community Action Agency of Somerville (CAAS), Somerville, MA, 02143, USA
| | - Janine K Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA.
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12
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Wood CT, Howard JB, Perrin EM. Exploring the Feasibility and Acceptability of Providing Caregivers Who Formula-feed with Smaller Infant Bottles in a Primary Care Clinic. Matern Child Health J 2023; 27:178-185. [PMID: 36352291 DOI: 10.1007/s10995-022-03519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Larger bottle size is associated with faster weight gain in infants, but little is known about acceptability and feasibility of providing bottles in primary care clinics. METHODS We randomized parent-infant dyads (N = 40) to receive a set of 4-ounce bottles or to continue using their own bottles. Demographic and anthropometric information were collected at enrollment and one follow-up visit 1-5 months later. The primary aim was to assess feasibility and acceptability of the intervention strategy. We compared components of bottle feeding, including usual bottle sizes used, number and volume of feeds with Wilcoxon rank-sum tests, and changes in weight-for-age and weight-for-length z-scores during the study period with t-tests, using p < 0.05 as an indicator of statistical significance. RESULTS Of participants randomized to receive bottles, 90% were using the 4oz bottles at follow up. The intervention group reported a significantly lower median bottle size (4oz) than the control group (8oz) at follow up, and parents reported acceptability and continued use of the bottles. CONCLUSIONS FOR PRACTICE An intervention to provide smaller bottles was feasible, mostly acceptable, resulted in lower median bottle size. Further research is needed to determine whether it represents a novel way to prevent rapid infant weight gain.
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Affiliation(s)
- Charles T Wood
- Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, 3116 N. Duke St, 27704, Durham, NC, USA.
| | - Janna B Howard
- Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, 3116 N. Duke St, 27704, Durham, NC, USA
| | - Eliana M Perrin
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Downing KL, del Pozo Cruz B, Sanders T, Zheng M, Hnatiuk JA, Salmon J, Hesketh KD. Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors. Int J Behav Nutr Phys Act 2022; 19:160. [PMID: 36581865 PMCID: PMC9798690 DOI: 10.1186/s12966-022-01386-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/26/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors. METHODS Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment. RESULTS Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality. CONCLUSIONS Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.
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Affiliation(s)
- Katherine L. Downing
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Borja del Pozo Cruz
- grid.10825.3e0000 0001 0728 0170Center for Active and Healthy Ageing, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Taren Sanders
- grid.411958.00000 0001 2194 1270Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Miaobing Zheng
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jill A. Hnatiuk
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jo Salmon
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie D. Hesketh
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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14
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Griffiths A, Brooks R, Haythorne R, Kelly G, Matu J, Brown T, Ahmed K, Hindle L, Ells L. The impact of Allied Health Professionals on the primary and secondary prevention of obesity in young children: A scoping review. Clin Obes 2022; 13:e12571. [PMID: 36451267 DOI: 10.1111/cob.12571] [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: 09/13/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine 'contact points', as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomized controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under 5 years old). AHP-related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g. lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g. body mass index (BMI) z-score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine 'contact points' in the prevention of obesity in young children. AHP interventions could be effective in optimizing weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.
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Affiliation(s)
- Alex Griffiths
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Rob Brooks
- School of Health Studies, University of Bradford, Bradford, UK
| | - Rebecca Haythorne
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Gill Kelly
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Jamie Matu
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Tamara Brown
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Kanar Ahmed
- Department of Health and Social Care, Office for Health Improvement and Disparities, England, UK
| | - Linda Hindle
- Department of Health and Social Care, Office for Health Improvement and Disparities, England, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
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15
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Delisle Nyström C, Campbell KJ, Crawford D, Hesketh KD. Mothers as advocates for healthier lifestyle behaviour environments for their children: results from INFANT 3.5-year follow-up. BMC Public Health 2022; 22:2211. [PMID: 36447165 PMCID: PMC9706958 DOI: 10.1186/s12889-022-14659-8] [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: 09/13/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The amount of time children spend outside of their home environment has increased over the past decades. Therefore, the quality of the health behaviour environments where young children spend time is likely to impact their health behaviour opportunities. The aim of this study was to describe the proportion of mothers who consider it possible to make changes in their local communities to increase opportunities for children to eat healthily, be physically active, and limit screen time exposure, as well as the proportion who have attempted to do so. The characteristics of mothers with differing advocacy beliefs and intentions were explored. METHODS Cross-sectional data collected using questionnaires from 307 mothers who participated in the 3.5-year follow-up of the INFANT cluster-randomized controlled trial were used. Frequencies were used to assess the number of mothers who thought it possible to bring about change in their local communities and for the those who had attempted to do so. Binary logistic regression analyses were used to compare sociodemographic characteristics of mothers with differing responses. RESULTS Most mothers thought it was possible to bring about change in their local community with regards to providing more opportunities for their child to eat healthily (83.7%), be physically active (90.9%) as well as limit exposure to screen time (63.5%). However, less than 19% and 11% of mothers have thought about or tried to bring about change in their child's childcare centre or local community, respectively. No sociodemographic differences were found between the mothers who thought it was possible to bring about actioning change (p-values > 0.1) or for those that have thought about change (p-values > 0.1). CONCLUSION As children are continuously being exposed to obesogenic environments future quantitative and qualitative studies are needed to describe how to promote parental advocacy and engagement, in order to provide children with environments that support healthy lifestyle behaviours.
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Affiliation(s)
- Christine Delisle Nyström
- grid.4714.60000 0004 1937 0626Department of Biosciences and Nutrition, Karolinska Institutet, Neo, 141 83 Huddinge, Sweden ,grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), Deakin University, 3125 Geelong, Australia
| | - Karen J Campbell
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), Deakin University, 3125 Geelong, Australia
| | - David Crawford
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), Deakin University, 3125 Geelong, Australia
| | - Kylie D Hesketh
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), Deakin University, 3125 Geelong, Australia
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16
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Love P, Laws R, Taki S, West M, Hesketh KD, Campbell KJ. Factors contributing to the sustained implementation of an early childhood obesity prevention intervention: The INFANT Program. FRONTIERS IN HEALTH SERVICES 2022; 2:1031628. [PMID: 36925886 PMCID: PMC10012774 DOI: 10.3389/frhs.2022.1031628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
Background The INFANT Program is an efficacious, group-based program for first-time parents, delivered at three-monthly intervals when INFANT are aged 3-18 months through an existing universal care service in Victoria, Australia. Many lessons have been learnt from its origins as a cluster randomized control trial to its small-scale, community-level implementation. This study aimed to describe factors contributing to its sustained implementation to inform large-scale implementation across Australia. Methods This study used a multi-site qualitative exploratory approach. INFANT facilitators trained between 2013 and 2017 were sent an online survey, with optional telephone interviews. The Consolidated Framework for Implementation Research (CFIR) was selected as the underpinning theoretical framework as it offered the opportunity to explore a breadth of possible barriers and enablers across patterns of implementation (never, discontinued, ongoing). Results All participants were female (n = 31), the majority were Maternal and Child Health Nurses (48%), representing five regional and nine metro local government areas (LGAs), across all patterns of implementation (never implemented n = 4; discontinued implementation n = 5; ongoing implementation n = 5). All consenting participants were interviewed (n = 11) representing four regional and seven metro LGAs, across all patterns of implementation (never implemented n = 3; discontinued implementation n = 4; ongoing implementation n = 4). The main reason for attending INFANT Program training was to become skilled to implement the program. Mapping identified barriers and enablers to the CFIR revealed the inner and outer settings and implementation process to be of greatest influence. Main differences between LGAs with ongoing and discontinued implementation related to funding availability, organizational management support and endorsement, organizational resourcing and capacity, integration into routine practice and establishing role clarity with partner organizations, and planning for sustained implementation from the start. Conclusion This study provides important insights into the barriers and enablers to the sustained implementation of an evidence-based intervention (the INFANT Program) during small scale community-level implementation. The authors therefore contend that the pre-requisite for scale-up of a population health intervention is not just proof of effectiveness but also proof of sustained implementation at the local/organizational level. Study findings have broad transferability given their similarity to those identified for health promotion interventions implemented globally, in healthcare, education and community settings.
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Affiliation(s)
- Penelope Love
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Rachel Laws
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Madeline West
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Karen J. Campbell
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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17
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Killedar A, Wen LM, Tan EJ, Marshall S, Taki S, Buchanan L, Rissel C, Xu H, Baur LA, Hayes A. Economic evaluation of the Communicating Healthy Beginnings Advice by Telephone trial for early childhood obesity prevention. Obesity (Silver Spring) 2022; 30:2256-2264. [PMID: 36168138 PMCID: PMC9828236 DOI: 10.1002/oby.23547] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to conduct an economic evaluation of the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial to prevent childhood obesity. METHODS Cost-effectiveness analyses were conducted for the telephone and short message service (SMS) delivery of Healthy Beginnings advice, compared with usual care, which included child health services unrelated to Healthy Beginnings. Costs were valued in 2018 Australian dollars, and costs and outcomes were discounted at 5% per year. The costs of upscaling both delivery modes to all yearly births in New South Wales, Australia, were estimated and compared with the original Healthy Beginnings home-visiting intervention. RESULTS At child age 2 years, the SMS delivery was more cost-effective ($5154 per unit BMI and $979 per 0.1 BMI z score units avoided) than the telephone delivery ($10,665 per unit BMI and $2017 per 0.1 BMI z score units avoided). The costs of upscaling the SMS ($7.64 million) and the telephone delivery modes ($37.65 million) were lower than the home-visiting intervention ($108.45 million). CONCLUSIONS SMS delivery of Healthy Beginnings advice was more cost-effective than telephone delivery but less cost-effective than the original home-visiting approach ($4230 per unit BMI avoided, as calculated in an earlier study). Both the SMS and telephone interventions were more affordable than the home-visiting approach.
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Affiliation(s)
- Anagha Killedar
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
| | - Li Ming Wen
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- Health Promotion Unit, Population Health Research and Evaluation HubSydney Local Health DistrictSydneyNew South WalesAustralia
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Eng Joo Tan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Sarah Marshall
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah Taki
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- Health Promotion Unit, Population Health Research and Evaluation HubSydney Local Health DistrictSydneyNew South WalesAustralia
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Limin Buchanan
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Child and Family HealthCommunity Health Services, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Chris Rissel
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation HubSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Louise A. Baur
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- Discipline of Child and Adolescent Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Alison Hayes
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in ChildhoodAustralia
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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18
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Zheng M, Hesketh KD, Vuillermin P, Dodd J, Wen LM, Baur LA, Taylor R, Byrne R, Mihrshahi S, Sly PD, Tang MLK, Campbell KJ. Determinants of rapid infant weight gain: A pooled analysis of seven cohorts. Pediatr Obes 2022; 17:e12928. [PMID: 35510714 PMCID: PMC9540679 DOI: 10.1111/ijpo.12928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Rapid weight gain (RWG) in infancy is strongly associated with subsequent obesity risk, but little is known about the factors driving RWG. This study explored the child and maternal factors associated with infant RWG. METHODS Data from seven Australian and New Zealand cohorts were used (n = 4542). Infant RWG was defined as a change in weight z-score ≥0.67 from birth to age 1 year. Univariable and multivariable logistic regression assessed the association between child and maternal factors and infant RWG in each cohort. Meta-analysis was conducted to obtain pooled effect sizes. RESULTS Multivariable analyses revealed boys were more likely to experience RWG (OR 1.42 95% CI 1.22, 1.66) than girls. Higher birth weight in kg (OR 0.09, 95% CI 0.04, 0.20) and gestational age in weeks (OR 0.69, 95% CI 0.48, 0.98) were associated with lower RWG risk. Children who were breastfed for ≥6 months showed lower RWG risk (OR 0.45, 95% CI 0.38, 0.53). Children of native-born versus overseas-born women appeared to have higher RWG risk (OR 1.37, 95% CI 0.99, 1.90). Maternal smoking during pregnancy increased RWG risk (OR 1.60, 95% CI 1.28, 2.01), whereas children who started solids ≥6 months (OR 0.77, 95% CI 0.63, 0.93) and children with siblings (OR 0.68, 95% CI 0.57, 0.81) showed lower RWG risk in univariable analysis, but these associations were attenuated in multivariable analysis. No association was found for maternal age, education, marital status and pre-pregnancy BMI. CONCLUSION Maternal country of birth, smoking status, child sex, birth weight, gestational age, infant feeding and parity were potential determinants of infant RWG.
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Affiliation(s)
- Miaobing Zheng
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
| | - Kylie D. Hesketh
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
| | | | - Jodie Dodd
- Discipline of Obstetrics and GynaecologyThe Robinson Research Institute, The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Li Ming Wen
- School of Public Health and Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Louise A. Baur
- School of Public Health and Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Rachael Taylor
- Department of MedicineUniversity of OtagoDunedinNew Zealand
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of MedicineHealth and Human Sciences, Macquarie UniversitySydneyNew South WalesAustralia
| | - Peter D. Sly
- Children's Health and Environment ProgramThe University of QueenslandBrisbaneAustralia
| | | | - Karen J. Campbell
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesGeelongAustralia
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19
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Seidler AL, Hunter KE, Baur L, Espinoza D, Taylor RW, Wen LM, Hesketh KD, Campbell K, Daniels L, Mihrshahi S, Rissel C, Taylor B, Askie LM. Examining the sustainability of effects of early childhood obesity prevention interventions: Follow-up of the EPOCH individual participant data prospective meta-analysis. Pediatr Obes 2022; 17:e12919. [PMID: 35396815 PMCID: PMC9541553 DOI: 10.1111/ijpo.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although early childhood obesity prevention has become an important issue internationally, little evidence exists regarding longer term effects (i.e., sustainability) of early interventions. OBJECTIVE To determine whether intervention benefits at 2 years of age were sustained at 3.5 and 5 years. METHODS Follow-up of the Early Prevention of Obesity in Children (EPOCH) individual participant data prospective meta-analysis of four randomized controlled trials including 2196 mother-child dyads at baseline. Interventions were home- or community-based, commenced within 6 months of birth, ended by 2 years of age, and comprised multiple sessions. Controls received standard care. BMI z-score (primary outcome), other anthropometric measures and weight-related behaviours were initially measured at 1.5-2 years and followed up at 3.5 and 5 years. RESULTS Positive intervention effects on BMI z-scores at 1.5-2 years of age were not apparent by 3.5 years (-0.04 adjusted mean difference; 95% CI:-0.14, 0.06; p = 0.424), and 5 years (0.03; 95% CI: -0.08, 0.14; p = 0.60). While prolonged intervention benefits were detected for a few, but not the majority of, weight-related behaviours at 3.5 years, these effects diminished over time. CONCLUSION This meta-analysis found that initial positive effects of childhood obesity interventions faded out after interventions ended, pointing toward the importance of a suite of interventions implemented at multiple stages across childhood.
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Affiliation(s)
- Anna Lene Seidler
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kylie E. Hunter
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Louise Baur
- Specialty of Child and Adolescent HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - David Espinoza
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | | | - Li Ming Wen
- Health Promotion Unit, Sydney Local Health District, School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Kylie D. Hesketh
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Karen Campbell
- Institute for Physical Activity and NutritionDeakin UniversityGeelongVictoriaAustralia
| | - Lynne Daniels
- Centre Child Health Research, School Exercise Nutrition SciencesQueensland University TechnologyBrisbaneQueenslandAustralia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human SciencesMacquarie UniversityNew South WalesAustralia
| | - Chris Rissel
- Sydney School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Barry Taylor
- Department of Women's and Children's HealthUniversity of OtagoDunedinNew Zealand
| | - Lisa M. Askie
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
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20
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Prioreschi A, Ong KK, Rolfe EDL, Westgate K, Micklesfield LK, Brage S. Associations between abdominal adiposity, body size and objectively measured physical activity in infants from Soweto, South Africa. Matern Child Health J 2022; 26:1632-1640. [PMID: 35612772 PMCID: PMC9329383 DOI: 10.1007/s10995-022-03406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Considering the importance of the early life period, in conjunction with the increasing prevalence of adiposity and insufficient physical activity already evident in early childhood, this study aimed to determine associations between abdominal adiposity, body size, and objectively measured physical activity in infancy. METHODS Infants (n = 138, aged 3-24 months) from Soweto, South Africa were recruited to this cross-sectional study. Visceral (VAT) and subcutaneous abdominal fat (SAT) were measured using ultrasound. Physical activity was assessed using accelerometry and analysed at the hourly level. Multilevel linear regression analyses were run with body composition exposures adjusted for age, sex, and length; models with VAT and SAT were also adjusted for total abdominal fat. RESULTS Mean (SD) age was 11.8 (7.6) months; 86% were normal weight, 7% were underweight and 7% overweight. In linear models, no body composition variable was significantly associated with physical activity. Physical activity was higher with each increasing length tertile (ANOVA p < 0.01); with a mean(95%CI) 29(60-60)mg in the lowest tertile, 39(71-71)mg in the middle tertile, and 50(81-82)mg in the highest tertile. Infants with normal weight had higher mean(95%CI) physical activity (40(70-80)mg) than underweight (34(73-85)mg, p = 0.01) or overweight infants (31(63-78)mg, ANOVA p < 0.01). When also adjusting for total abdominal fat, infants in the lowest SAT tertile had higher physical activity than those in the middle or highest SAT tertiles (p < 0.01). CONCLUSIONS These findings lend support for higher physical activity as a marker of healthy growth in the first two years of life.
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Affiliation(s)
- Alessandra Prioreschi
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ken K Ong
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Emanuella De Lucia Rolfe
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Kate Westgate
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Lisa K Micklesfield
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Soren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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21
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Flynn AC, Suleiman F, Windsor‐Aubrey H, Wolfe I, O'Keeffe M, Poston L, Dalrymple KV. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. MATERNAL & CHILD NUTRITION 2022; 18:e13354. [PMID: 35333450 PMCID: PMC9218326 DOI: 10.1111/mcn.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/01/2023]
Abstract
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
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Affiliation(s)
- Angela C. Flynn
- Department of Women and Children's HealthKing's College LondonLondonUK
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Fatma Suleiman
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Hazel Windsor‐Aubrey
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Ingrid Wolfe
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Majella O'Keeffe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Lucilla Poston
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Kathryn V. Dalrymple
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
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22
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Wen LM, Xu H, Taki S, Buchanan L, Rissel C, Phongsavan P, Hayes AJ, Bedford K, Moreton R, Baur LA. Effects of telephone support or short message service on body mass index, eating and screen time behaviours of children age 2 years: A 3-arm randomized controlled trial. Pediatr Obes 2022; 17:e12875. [PMID: 34821063 PMCID: PMC9285384 DOI: 10.1111/ijpo.12875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few randomized controlled trial (RCT) interventions targeted children's early risk behaviours using telephone or short message service (SMS) support. OBJECTIVE To evaluate the effectiveness of telephone or SMS early intervention focusing on mothers' behaviours starting from late pregnancy to improve BMI, and eating and screen time behaviours of children aged 2 years in comparison with the control group. METHODS A 3-arm RCT was conducted in Australia, 2017-2019. Two arms involved the interventions using nurse-led telephone or SMS support, delivered in nine stages from late pregnancy to age 2 years. The third arm was control. The primary outcome was children's objectively measured BMI and BMI z-score at 2 years. Secondary outcomes included child eating and screen time behaviours as reported by parents at 2 years. RESULTS At 2 years, 797 mother-child dyads (69%) completed the telephone survey with 666 (58%) completing weight and height measurements. The study found no statistically significant difference in BMI between the groups. The mean BMI for telephone support was 16.93 (95% CI: 16.73 to 17.13), for SMS 16.92 (95% CI: 16.73 to 17.11) or for control 16.95 (95% CI: 16.73 to 17.16) with a difference of -0.02 (95% CI: -0.31 to 0.27, p = 0.907) in telephone versus control, and a difference of -0.03 (95% CI: -0.30 to 0.24, p = 0.816) in SMS versus control. Telephone support was associated with higher odds of no bottle at bedtime (adjusted odds ratio [AOR]: 2.99; 95% CI: 2.01 to 4.47), family meals (AOR: 2.05; 95% CI: 1.26 to 3.33), drinking from a cup (AOR: 1.89; 95% CI: 1.24 to 2.88), less screen time (<1 h/day) (AOR: 1.56; 95% CI: 1.10 to 2.23) and not eating dinner in front of the TV (AOR: 1.50; 95% CI: 1.09 to 2.06). SMS support was also associated with higher odds of no bottle at bedtime (AOR 2.30, 95% CI: 1.58 to 3.33) than the control. CONCLUSION The telephone or SMS support intervention had no significant effects on BMI, but was effective in increasing no bottle use at bedtime. Telephone support showed more effects than SMS on reducing screen time and eating behaviours.
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Affiliation(s)
- Li Ming Wen
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia,Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia,Sydney Institute for Women, Children and Their Families, Sydney Local Health DistrictCamperdownAustralia,Charles Perkins Centre, The University of SydneyCamperdownAustralia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia
| | - Sarah Taki
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia,Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia
| | - Limin Buchanan
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia,Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia,Sydney Institute for Women, Children and Their Families, Sydney Local Health DistrictCamperdownAustralia
| | - Chris Rissel
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia
| | - Philayrath Phongsavan
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,Charles Perkins Centre, The University of SydneyCamperdownAustralia
| | - Alison J. Hayes
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia
| | - Karen Bedford
- Health Promotion Unit, Population Health Research & Evaluation HubSydney Local Health DistrictCamperdownAustralia
| | - Renee Moreton
- Population HealthSydney Local Health DistrictCamperdownAustralia
| | - Louise A. Baur
- Faculty of Medicine and HealthSydney School of Public Health, The University of SydneySydneyAustralia,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH)SydneyAustralia,Charles Perkins Centre, The University of SydneyCamperdownAustralia,Discipline of Child and Adolescent Health, Sydney Medical School, The University of SydneyCamperdownAustralia
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23
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Hesketh KD, Downing KL, Galland BC, Nicholson JM, Taylor R, Orellana L, Abdelrazek M, Koorts H, Brown V, Haines J, Campbell KJ, Barnett LM, Löf M, Moodie M, Carson V, Salmon J. Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers. BMJ Open 2022; 12:e057521. [PMID: 35351726 PMCID: PMC8961153 DOI: 10.1136/bmjopen-2021-057521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception. METHODS AND ANALYSIS A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T0), mid-intervention (T1; 6 months post baseline), at intervention conclusion (T2; 12 months post baseline) and 1-year post intervention (T3; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted. ETHICS AND DISSEMINATION The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media. TRIAL REGISTRATION NUMBER ACTRN12620001280998; U1111-1252-0599.
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Affiliation(s)
- Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Liliana Orellana
- Faculty of Health Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lisa M Barnett
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- School of Health & Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Marie Löf
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
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24
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Gago CM, Jurkowski J, Beckerman-Hsu JP, Aftosmes-Tobio A, Figueroa R, Oddleifson C, Mattei J, Kenney EL, Haneuse S, Davison KK. Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices? Soc Sci Med 2022; 296:114761. [PMID: 35123371 PMCID: PMC8894077 DOI: 10.1016/j.socscimed.2022.114761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS Parent empowerment may be an important target in interventions to prevent obesity in low-income children.
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Affiliation(s)
- Cristina M. Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Janine Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | | | | | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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25
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Zheng M, Hesketh KD, McNaughton SA, Salmon J, Crawford D, Cameron AJ, Lioret S, Campbell KJ. Quantifying the overall impact of an early childhood multi-behavioural lifestyle intervention. Pediatr Obes 2022; 17:e12861. [PMID: 34658152 DOI: 10.1111/ijpo.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The overall impact of interventions targeting multiple behaviours remains largely unexplored. OBJECTIVES This study adopted an integrative lifestyle pattern analysis approach to assess the overall effectiveness of an early childhood intervention on change across multiple behaviours. METHODS The Melbourne INFANT program was a 15-month cluster-randomized controlled trial involving 4-month-old infants and their parents at baseline in 2008 (n = 542). The intervention included six education sessions helping parents to promote a healthy diet, physical activity and limit sedentary behaviour in their infants. Participants were followed-up twice post-intervention, at ages 3.6 (2011) and 5 years (2013), to assess sustained effects of the intervention. Previous principal component analyses identified two lifestyle patterns from dietary intake, outdoor time and television viewing time. Random effect linear regression models were conducted to assess the impact of the intervention on lifestyle patterns. RESULTS The intervention group had a lower 'Discretionary consumption and TV' lifestyle pattern score than the control group at all time points with adjusted mean difference: -0.29, 95% CI -0.49, -0.09, p = 0.004 post-intervention at age 1.5 years; -0.29, 95% CI -0.54, -0.04, p = 0.02 at the first follow-up (age 3.6 years); and -0.21, 95% CI -0.43, 0.01, p = 0.06 at the second follow-up (age 5.0 years). No evidence of between-group differences was found for the 'Fruit, vegetables and outdoor' lifestyle pattern score. CONCLUSION This early childhood intervention designed to promote change in more than one obesity-related behaviour was effective in improving correlated unhealthy lifestyle behaviours. Lifestyle pattern analysis is a useful and interpretable approach for evaluating multi-behavioural interventions.
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Affiliation(s)
- Miaobing Zheng
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Sarah A McNaughton
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - David Crawford
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Sandrine Lioret
- INSERM, INRAE, Université de Paris, Research Center in Epidemiology and Biostatistics (CRESS), Paris, France
| | - Karen J Campbell
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition Research, Geelong, Victoria, Australia
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26
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Berleze A, Valentini NC. Intervention for Children with Obesity and Overweight and Motor Delays from Low-Income Families: Fostering Engagement, Motor Development, Self-Perceptions, and Playtime. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052545. [PMID: 35270238 PMCID: PMC8909693 DOI: 10.3390/ijerph19052545] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023]
Abstract
Obesity is increasing globally, affecting children’s health and development. This study examines the influence of a motor skill intervention on the daily routine, self-perceptions, body mass index, motor development, and engagement in physical education lessons of children with obesity and overweight with motor delays. Children were randomly assigned to intervention and control groups. The daily routine at home, self-perceptions, motor development, BMI, and engagement were assessed. Significant group by time interactions were found for play (p < 0.0001) and television (p < 0.0001) time, perceived social (p = 0.003) and motor (p < 0.0001) competence, global self-worth (p < 0.0001), BMI (p = 0.001), motor development (p < 0.0001), and engagement (p = 0.029). From pre-to-post intervention, children with obesity and overweight in the intervention group increased (1) playtime at home; (2) self-perceptions of social and motor competence and global worth; (4) engagement in the lessons, and improved scores, in motor skills; and (6) reduced BMI and screen time. The intervention promoted the health and improved the self-concept of children with obesity/ overweight.
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27
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Mauch CE, Wycherley TP, Bell LK, Laws RA, Byrne R, Golley RK. Parental work hours and household income as determinants of unhealthy food and beverage intake in young Australian children. Public Health Nutr 2022; 25:1-29. [PMID: 35135652 PMCID: PMC9991677 DOI: 10.1017/s1368980022000349] [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: 03/17/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined parental work hours and household income as determinants of discretionary (energy dense, nutrient poor) food and beverage intake in young children, including differences by eating occasion. DESIGN Secondary analysis of cross-sectional data. Three hierarchical regression models were conducted with percent energy from discretionary food and beverages across the day, at main meals, and at snack times being the outcomes. Dietary intake was assessed by 1x24-hour recall and 1-2x24-hour food record(s). Both maternal/paternal work hours were included, and total household income. Covariates included household, parent and child factors. SETTING Data from the NOURISH/SAIDI studies were collected between 2008-13. PARTICIPANTS Participants included 526 mother-child dyads (median(IQR) child age 1.99(1.96,2.03) years). Forty-one percent of mothers did not work while 57% of fathers worked 35-40 hours/week. Most (85%) households had an income of ≥$50k AUD/year. RESULTS Household income was consistently inversely associated with discretionary energy intake (β= -0.12 to -0.15). Maternal part-time employment (21-35 hours/week) predicted child consumption of discretionary energy at main meals (β=0.10, p=0.04). Paternal unemployment predicted a lower proportion of discretionary energy at snacks (β= -0.09, p=0.047). CONCLUSIONS This work suggests that household income should be addressed as a key opportunity-related barrier to healthy food provision in families of young children. Strategies to reduce the time burden of healthy main meal provision may be required in families where mothers juggle longer part-time working hours with caregiving and domestic duties. The need to consider the role of fathers and other parents/caregivers in shaping children's intake was also highlighted.
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Affiliation(s)
- Chelsea E Mauch
- Caring Futures Institute, College of Nursing and Health Sciences, Level 7, SAHMRI building, North Terrace, Flinders University, Adelaide, SA5000, Australia
- Early Prevention of Obesity in Childhood Centre of Research Excellence, Sydney, Australia
| | - Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Lucinda K Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Level 7, SAHMRI building, North Terrace, Flinders University, Adelaide, SA5000, Australia
| | - Rachel A Laws
- Early Prevention of Obesity in Childhood Centre of Research Excellence, Sydney, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Melbourne, Australia
| | - Rebecca Byrne
- Early Prevention of Obesity in Childhood Centre of Research Excellence, Sydney, Australia
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children’s Health Research, South Brisbane, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Level 7, SAHMRI building, North Terrace, Flinders University, Adelaide, SA5000, Australia
- Early Prevention of Obesity in Childhood Centre of Research Excellence, Sydney, Australia
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28
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O'Reilly SL, Burden C, Campoy C, McAuliffe FM, Teede H, Andresen J, Campbell KJ, Geraghty AA, Harrison CL, Laws R, Norman JE, Maindal HT, Vrangbæk K, Segurado R, Versace VL, Skinner TC. Bump2Baby and Me: protocol for a randomised trial of mHealth coaching for healthy gestational weight gain and improved postnatal outcomes in high-risk women and their children. Trials 2021; 22:963. [PMID: 34963483 PMCID: PMC8713543 DOI: 10.1186/s13063-021-05892-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Gestational diabetes (GDM) impacts 8–18% of pregnancies and greatly increases both maternal and child risk of developing non-communicable diseases such as type 2 diabetes and obesity. Whilst lifestyle interventions in pregnancy and postpartum reduce this risk, a research translation gap remains around delivering implementable interventions with adequate population penetration and participation. Impact Diabetes Bump2Baby is an implementation project of an evidence-based system of care for the prevention of overweight and obesity. Bump2Baby and Me is the multicentre randomised controlled trial investigating the effectiveness of a mHealth coaching programme in pregnancy and postpartum for women at high risk of developing GDM. Methods Eight hundred women will be recruited in early pregnancy from 4 clinical sites within Ireland, the UK, Spain, and Australia. Women will be screened for eligibility using the validated Monash GDM screening tool. Participants will be enrolled from 12 to 24 weeks’ gestation and randomised on a 1:1 basis into the intervention or control arm. Alongside usual care, the intervention involves mHealth coaching via a smartphone application, which uses a combination of synchronous and asynchronous video and text messaging, and allows for personalised support and goal setting with a trained health coach. The control arm receives usual care. All women and their children will be followed from early pregnancy until 12 months postpartum. The primary outcome will be a difference in maternal body mass index (BMI) of 0.8 kg/m2 at 12 months postpartum. Secondary maternal and infant outcomes include the development of GDM, gestational weight gain, pregnancy outcomes, improvements in diet, physical activity, sleep, and neonatal weight and infant growth patterns. The 5-year project is funded by the EU Commission Horizon 2020 and the Australian National Health and Medical Research Council. Ethical approval has been received. Discussion Previous interventions have not moved beyond tightly controlled efficacy trials into routine service delivery. This project aims to provide evidence-based, sustainable support that could be incorporated into usual care for women during pregnancy and postpartum. This study will contribute evidence to inform the early prevention of non-communicable diseases like obesity and diabetes in mothers and the next generation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620001240932. Registered on 19 November 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05892-4.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Christy Burden
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, Victoria, Australia
| | | | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Geelong, Geelong, Victoria, Australia
| | - Aisling A Geraghty
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Geelong, Geelong, Victoria, Australia
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Helle T Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark
| | - Karsten Vrangbæk
- Department of Public Health, Center for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark
| | - Ricardo Segurado
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Timothy C Skinner
- Institut for Psykologi, Center for Sundhed of Samfund, Københavns Universitet, Øster Farimagsgade, København K, Denmark.,University Department of Rural Health, La Trobe University, Bendigo, Australia
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29
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Opie RS, Zheng M, Torres S, Campbell K. The impact of maternal post-partum depressive symptoms on child diet at 18 months. MATERNAL & CHILD NUTRITION 2021; 17:e13187. [PMID: 34323001 PMCID: PMC8476412 DOI: 10.1111/mcn.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
Post-partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post-partum (baseline) on child diet at 18 months of age (follow-up). This study used longitudinal data from 263 first-time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Women self-reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale [CES-D]) and child diet (fruits, vegetables and discretionary foods). Multiple linear regression analyses were used to explore the relationship between maternal depressive symptoms at baseline and child fruit and vegetable intake and discretionary food intake (g day-1 ) at follow-up. Baseline maternal depressive symptoms were associated with higher childhood consumption of discretionary foods at 18 months of age (β = 0.45, 95% confidence interval [CI] 0.03 to 0.87, P = 0.034 [adjusted]). There was no evidence of association for maternal depressive symptoms and child intake of fruits and vegetables. Further longitudinal studies are warranted to confirm these findings, with the hope of translating this knowledge into optimal clinic care and improved physical and mental health for mother and child.
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Affiliation(s)
- Rachelle S. Opie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Susan Torres
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
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30
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Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
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Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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31
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How to Support Child Healthcare Nurses in Sweden to Promote Healthy Lifestyle Behaviors from the Start of Life. CHILDREN-BASEL 2021; 8:children8080696. [PMID: 34438588 PMCID: PMC8392879 DOI: 10.3390/children8080696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Child healthcare (CHC) nurses have a key role in promoting and supporting healthy lifestyle behaviors from a young age. Thus, this study aims to investigate the perspectives of CHC nurses regarding discussing food introduction, physical activity/active play, and screen time with parents; explore facilitators and barriers influencing the discussion of healthy lifestyle behaviors with parents; and explore the perspectives of CHC nurses regarding a complementary program to promote healthy lifestyle behaviors from the start of life. A total of fifteen nurses participated in semi-structured interviews, which were recorded, transcribed verbatim, and analyzed using thematic analysis. There were four themes that were generated: parental needs; facilitators and barriers; parental groups; and future working methods. This study found that CHC nurses have seen an increase in the need for support among today’s parents. Time, the need to tailor information, and confidence to address sensitive topics were perceived as the largest barriers during daily work for the nurses. Furthermore, large variations in parental groups were found. Finally, the CHC nurses displayed a willingness and openness to change and develop current working methods using digital solutions. These solutions could possibly ease the workload and at the same time, support parents to create healthy lifestyle behaviors from the start of their child’s life.
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32
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Taveras EM, Perkins ME, Boudreau AA, Blake-Lamb T, Matathia S, Kotelchuck M, Luo M, Price SN, Roche B, Cheng ER. Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status. Pediatrics 2021; 148:peds.2020-046706. [PMID: 34326179 PMCID: PMC8579422 DOI: 10.1542/peds.2020-046706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the effects of the First 1000 Days intervention on the prevalence of infant overweight and maternal postpartum weight retention and care. METHODS Using a quasi-experimental design, we evaluated the effects of the First 1000 Days program among 995 term, low-income infants and their mothers receiving care in 2 intervention community health centers and 650 dyads in 2 comparison health centers. The program includes staff training, growth tracking, health and behavioral screening, patient navigation, text messaging, educational materials, and health coaching. Comparison centers implemented usual care. Infant outcomes were assessed at 6 and 12 months, including weight-for-length z score and overweight (weight for length ≥97.7th percentile). We also examined maternal weight retention and receipt of care 6 weeks' post partum. RESULTS The mean birth weight was 3.34 kg (SD 0.45); 57% of infants were Hispanic; 66% were publicly insured. At 6 months, infants had lower weight-for-length z scores (β: -.27; 95% confidence interval [CI]: -.39 to -.15) and lower odds of overweight (adjusted odds ratio [OR]: 0.46; 95% CI: 0.28 to 0.76) than infants in comparison sites; differences persisted at 12 months (z score β: -.18; 95% CI: -.30 to -.07; adjusted OR for overweight: 0.60; 95% CI: 0.39 to 0.92). Mothers in the intervention sites had modestly lower, but nonsignificant, weight retention at 6 weeks' post partum (β: -.51 kg; 95% CI: -1.15 to .13) and had higher odds (adjusted OR: 1.50; 95% CI: 1.16 to 1.94) of completing their postpartum visit compared with mothers in the comparison sites. CONCLUSIONS An early-life systems-change intervention combined with coaching was associated with improved infant weight status and maternal postpartum care.
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Affiliation(s)
- Elsie M. Taveras
- The Kraft Center for Community Health,Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children,Department of Nutrition, Harvard T.H. Chan School of Public
Health, Harvard University, Boston, Massachusetts
| | - Meghan E. Perkins
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Alexy Arauz Boudreau
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Tiffany Blake-Lamb
- The Kraft Center for Community Health,Department of Obstetrics and Gynecology, Massachusetts General
Hospital, Boston, Massachusetts
| | - Sarah Matathia
- The Kraft Center for Community Health,Massachusetts General Hospital Everett Family Care Community
Health Center, Everett, Massachusetts
| | - Milton Kotelchuck
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Mandy Luo
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Sarah N. Price
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Brianna Roche
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Erika R. Cheng
- Division of Children’s Health Services Research,
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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33
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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Marshall S, Xu H, Taki S, Laird Y, Love P, Wen LM, Rissel C. Engagement, satisfaction, retention and behavioural outcomes of linguistically diverse mothers and infants participating in an Australian early obesity prevention trial. Health Promot J Austr 2021; 33:350-360. [PMID: 34245623 DOI: 10.1002/hpja.521] [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: 10/21/2020] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. METHODS Healthy Beginnings is a nurse-led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6- and 12-month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). RESULTS Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6-month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%-65%) compared to those speaking English (70%-80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. CONCLUSIONS Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Taki
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Yvonne Laird
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Penelope Love
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li Ming Wen
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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35
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Zheng M, Hesketh KD, Wu JHY, Heitmann BL, Downing K, Campbell KJ. Nighttime sleep duration trajectories were associated with body mass index trajectories in early childhood. Pediatr Obes 2021; 16:e12766. [PMID: 33369282 DOI: 10.1111/ijpo.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The respective contribution of total, daytime and nighttime sleep duration in childhood obesity remains unclear. OBJECTIVES To assess the longitudinal association between developmental trajectories of sleep duration and BMI z-score in early childhood. METHODS Data were from the Melbourne INFANT program, a prospective cohort with 4-month-old infants being followed-up until age 60 months (n = 528). Sleep duration (total, daytime, nighttime) and BMI z-score were measured using questionnaire at ages 4, 9, 18, 43 and 60 months. Group-based trajectory modelling was used to describe longitudinal trajectories from ages 4 to 60 months. Multivariable logistic regression was conducted to assess the association between sleep duration and BMI z-score trajectories. RESULTS Three nighttime sleep duration trajectory groups were identified: "Long stable" (10.5 to 11.0 hours, 61%), "catchup long" (8.0 to 11.5 hours, 23%) and "short stable" (8.7 to 9.8 hours, 16%) nighttime sleepers. BMI z-score trajectory groups were classified as "low-BMIz" (-1.5 to -0.5 unit, 21%), "mid-BMIz" (-0.5 to 0.5 unit, 58%) and "high-BMIz" (0.8 to 1.4 unit, 21%). With adjustment for child and maternal covariates, both "catchup long" (OR 3.69 95%CI 1.74, 7.92) and "long stable" nighttime sleepers (OR 4.27 95%CI 2.21, 8.25) revealed higher odds of being in the "mid-BMIz" than the "high-BMIz" group. By contrast, total or daytime sleep duration trajectories were not associated with BMI z-score trajectories. CONCLUSIONS Longer nighttime, but not total or daytime, sleep duration was associated with lower BMI z-score trajectories in early childhood. Our findings reinforce the importance of nighttime sleep for healthy body-weight development in early childhood.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jason H Y Wu
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Berit L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Katherine Downing
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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36
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Nutritional Strategies for Childhood Obesity Prevention. Life (Basel) 2021; 11:life11060532. [PMID: 34201017 PMCID: PMC8227398 DOI: 10.3390/life11060532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the spread of obesity represents a challenge for clinicians in which obesity prevention plays a key role in achieving this purpose. The aim of this review is to analyze the nutritional interventions that can be implemented to prevent childhood obesity. METHODS Searching PubMed and Cochrane Library between 2019 and 2021. Further searching with no date range for articles selected for their specific relevance in the pediatric area or for their scientific relevance. A total of 871 articles were identified and 90 were included. RESULTS We organized the results of the selected articles into age groups, and according to the subjects targeted for interventions or to the site of interventions, reserving an in-depth analysis on specific nutritional aspects. Promotion of breastfeeding, reduction of protein content of formulated milks, and diet of the first 12-24 months, involving family and schools in interventions that promote physical activity and healthy diet, are promising strategies for reduction of the risk of obesity. To increase the efficacy of interventions, a multidimensional approach is crucial. CONCLUSIONS A multidimensional approach, which takes into consideration different areas of intervention, is pivotal for childhood obesity prevention. Integrated programs involving several components (nutrition and physical activity at first) at different levels (individual, family, school, and institutional) are crucial.
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37
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How to Change Young Children's Physical Activity and Sedentary Behavior: Mechanisms of Behavior Change in the INFANT Cluster Randomized Controlled Trial. CHILDREN-BASEL 2021; 8:children8060470. [PMID: 34199542 PMCID: PMC8229819 DOI: 10.3390/children8060470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022]
Abstract
Background: Understanding the mechanisms (mediators) of behavior change is crucial to designing more effective interventions. However, this is rarely reported. This paper investigates the mechanisms that explain the lack of intervention effect on physical activity and the significant effect on television viewing time from an early childhood trial. Methods: Secondary analyses were undertaken of data from a cluster randomized controlled trial. The Melbourne Infant Feeding, Activity and Nutrition Trial (INFANT) was a 15-month group program promoting obesity-protective behaviors from the age of 4 months. Outcomes relevant to the current study were child physical activity (accelerometer), television viewing time (maternal report) and 12 potential mediator scales (maternal report). Linear regression models used the product of coefficients method with a joint significance test. Results: Complete data were from 398 mother-child dyads. Despite weak evidence of an intervention effect on the mother’s physical activity knowledge and optimism, there was no effect on children’s physical activity, and no clear mechanisms were identified. An intervention effect was observed for the mothers’ television knowledge (unstandardized regression coefficient for a path (a) = 0.34, 95% confidence interval (CI95) = 0.22, 0.45), with weak evidence for maternal efficacy (a = 0.11, CI95 = −0.02, 0.24) and the use of television (a = −0.10, CI95 = −0.22, 0.01). The intervention impact on television knowledge explained 75% of the difference between the intervention and control groups in children’s television viewing. Conclusions: In the very early childhood period, as mothers are commencing their parenting journey, improving their behavioral knowledge appears to be the biggest contributor to reducing child television viewing, constituting a relatively simple strategy that could be implemented across clinical and public health settings. In contrast, it remains unclear what mechanisms may increase physical activity levels in this age group.
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Narzisi K, Simons J. Interventions that prevent or reduce obesity in children from birth to five years of age: A systematic review. J Child Health Care 2021; 25:320-334. [PMID: 32295414 PMCID: PMC8076837 DOI: 10.1177/1367493520917863] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Childhood obesity worldwide affects 5.6% or 38.3 million children under five years of age. The longer children are overweight or obese, the more likely they are to become obese adults with all the contingent morbidity involved. An extensive number of preventive interventions to combat childhood obesity have been carried out worldwide. This article reports a systematic review of interventions aimed to reducing or preventing obesity under-fives. The search was performed with six different databases: Web of Science, PsycINFO, Cochrane, PubMed, Medline, and CINAHL. Studies meeting the inclusion criteria were independently assessed using Joanna Briggs Institute methodology. Thirty studies involving 23,185 children across nine countries were included. Twenty-two were randomised controlled trials, and 8 quasi-experimental pretest/post-test design with comparison. These studies fell into four different categories: home-based interventions with family involvement (n = 12), preschool/early childhood settings (n = 9), multicomponent interventions across multiple settings (n = 6) and healthcare setting (n = 3). Future research should focus on increasing the accessibility of education on diet and physical activity for deprived families as well as the cultural acceptability of interventions to prevent childhood obesity.
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Affiliation(s)
- Katia Narzisi
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, UK,Katia Narzisi, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK.
| | - Joan Simons
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, UK
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Zheng M, Lioret S, Hesketh KD, Spence A, Taylor R, Campbell KJ. Association Between Longitudinal Trajectories of Lifestyle Pattern and BMI in Early Childhood. Obesity (Silver Spring) 2021; 29:879-887. [PMID: 33899335 DOI: 10.1002/oby.23136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the association between longitudinal trajectories of lifestyle patterns (LPs) and BMI z score in early childhood. METHODS Data of children (n = 439) who participated in the 18-, 42-, and 60-month follow-ups of the Melbourne InFANT Program were used. Multitrajectory modeling identified groups of children following similar LPs and BMI z score trajectories, and multinomial logistic regression assessed the determinants of the trajectory groups. RESULTS Three trajectory groups of child LPs and BMI z scores were identified: "Unhealthy LP, Low BMIz" (30%), "Healthy LP, Mid BMIz" (53%), and "Unhealthy LP, High BMIz" (17%). Relative to the "Unhealthy LP, Low BMIz" group, the maternal "Fruit and vegetables" dietary pattern was associated with higher odds (odds ratio [OR] 1.22, 95% CI: 1.01-1.47) of children following the "Healthy LP, Mid BMIz" group. Maternal prepregnancy BMI (≥25 kg/m2 ) (OR 2.50, 95% CI: 1.31-4.75) and maternal TV-viewing time ≥130 min/d (OR 2.55, 95% CI: 1.13, 5.72) increased the odds of children following the "Unhealthy LP, High BMIz" group. Child sex, breastfeeding duration, and maternal physical activity were not associated with the identified trajectory groups. CONCLUSIONS Three trajectory groups of LPs and BMI z scores in early childhood were revealed, with maternal prepregnancy BMI, dietary pattern, and TV-viewing time being identified as significant determinants.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sandrine Lioret
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Early Origin of the Child's Health and Development ORCHAD team, Villejuif, France
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Alison Spence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Protein Intake During Infancy and Subsequent Body Mass Index in Early Childhood: Results from the Melbourne InFANT Program. J Acad Nutr Diet 2021; 121:1775-1784. [PMID: 33839065 DOI: 10.1016/j.jand.2021.02.022] [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: 06/25/2020] [Revised: 01/31/2021] [Accepted: 02/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The link between high protein intake during infancy and obesity later in childhood has been much debated, and the association with differing protein sources remains unclear. OBJECTIVE This study aimed to examine the associations between total protein intake and protein from different sources (ie, nondairy animal, dairy, and plant) reported at age 9 months and development in body mass index (BMI) z scores until age 5 years. DESIGN This study involved a secondary data analysis of the Melbourne InFANT (Infant Feeding, Activity and Nutrition Trial) program, an observational prospective cohort study that was conducted from 2008 to 2013. PARTICIPANTS/SETTING Participants were children (n = 345) who completed both the 9-month and 5-year follow-up visits within the Melbourne InFANT program. MAIN OUTCOME MEASURES BMI z score was measured at age 5 years. STATISTICAL ANALYSES PERFORMED Linear mixed models with a random effect for clusters of mother's group and with adjustment for baseline child and maternal covariates were conducted. RESULTS With adjustment for covariates, every 1 g or 1% energy increase in total protein intake at age 9 months was associated with a 0.016-unit (95% CI 0.003 to 0.029) or 0.034-unit (95% CI 0.005 to 0.063) increase in BMI z score at age 5 years, respectively. With respect to protein sources, associations of similar magnitude were found for nondairy animal protein. No evidence of an association with BMI z score was found for dairy (including milk, yogurt, cheese, breast milk, and infant formula) and plant proteins. CONCLUSIONS High intakes of total protein, nondairy animal protein, but not dairy or plant proteins, during infancy were associated with higher BMI z score in early childhood. These findings can inform dietary recommendations regarding protein intakes during infancy. CLINICAL TRIAL REGISTRATION The InFANT program was registered with Current Controlled Trials (ISRCTN81847050); http://www.isrctn.com/ISRCTN81847050.
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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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Ferré N, Luque V, Closa-Monasterolo R, Zaragoza-Jordana M, Gispert-Llauradó M, Grote V, Koletzko B, Escribano J. Association of Protein Intake during the Second Year of Life with Weight Gain-Related Outcomes in Childhood: A Systematic Review. Nutrients 2021; 13:583. [PMID: 33578699 PMCID: PMC7916342 DOI: 10.3390/nu13020583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022] Open
Abstract
There is accumulating evidence that early protein intake is related with weight gain in childhood. However, the evidence is mostly limited to the first year of life, whereas the high-weight-gain-velocity period extends up to about 2 years of age. We aimed to investigate whether protein intake during the second year of life is associated with higher weight gain and obesity risk later in childhood. We conducted a systematic review with searches in both PubMed®/MEDLINE® and the Cochrane Central Register of Controlled Trials. Ten studies that assessed a total of 46,170 children were identified. We found moderate-quality evidence of an association of protein intake during the second year of life with fat mass at 2 years and at 7 years. Effects on other outcomes such as body mass index (BMI), obesity risk, or adiposity rebound onset were inconclusive due to both heterogeneity and low evidence. We conclude that higher protein intakes during the second year of life are likely to increase fatness in childhood, but there is limited evidence regarding the association with other outcomes such as body mass index or change in adiposity rebound onset. Further well-designed and adequately powered clinical trials are needed since this issue has considerable public health relevance.
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Affiliation(s)
- Natalia Ferré
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, 43201 Reus, Spain; (N.F.); (V.L.); (R.C.-M.)
- Institut d’Investigació Sanitaria Pere Virgili, 43001 Tarragona, Spain; (M.Z.-J.); (M.G.-L.)
| | - Verónica Luque
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, 43201 Reus, Spain; (N.F.); (V.L.); (R.C.-M.)
- Institut d’Investigació Sanitaria Pere Virgili, 43001 Tarragona, Spain; (M.Z.-J.); (M.G.-L.)
| | - Ricardo Closa-Monasterolo
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, 43201 Reus, Spain; (N.F.); (V.L.); (R.C.-M.)
- Institut d’Investigació Sanitaria Pere Virgili, 43001 Tarragona, Spain; (M.Z.-J.); (M.G.-L.)
- Pediatrics Unit, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Marta Zaragoza-Jordana
- Institut d’Investigació Sanitaria Pere Virgili, 43001 Tarragona, Spain; (M.Z.-J.); (M.G.-L.)
| | | | - Veit Grote
- Department Paediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospital, Ludwig-Maximilians Universität München, 43201 Munich, Germany; (V.G.); (B.K.)
| | - Berthold Koletzko
- Department Paediatrics, Dr. von Hauner Children’s Hospital, LMU University Hospital, Ludwig-Maximilians Universität München, 43201 Munich, Germany; (V.G.); (B.K.)
| | - Joaquín Escribano
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, 43201 Reus, Spain; (N.F.); (V.L.); (R.C.-M.)
- Institut d’Investigació Sanitaria Pere Virgili, 43001 Tarragona, Spain; (M.Z.-J.); (M.G.-L.)
- Pediatrics Unit, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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Butler ÉM, Fangupo LJ, Cutfield WS, Taylor RW. Systematic review of randomised controlled trials to improve dietary intake for the prevention of obesity in infants aged 0-24 months. Obes Rev 2021; 22:e13110. [PMID: 32776705 DOI: 10.1111/obr.13110] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
Improving dietary intake early in life is a common behavioural target in obesity prevention trials. We undertook a systematic review of randomised controlled trials aiming to improve dietary intake of complementary foods during infancy (0-24 months). PubMed, Cochrane Library, EMBASE, Medline, and PsycInfo were searched for trials focussed on obesity prevention conducted between January 2000 and August 2019 where dietary intake was an outcome. Two reviewers screened studies and extracted data from selected articles. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 tools. The protocol was registered on Open Science Framework (https://osf.io/6srg7/). Seventeen articles from 12 trials were selected for data extraction. Statistically significant group differences in outcomes were observed in 36 of 165 (21.8%) of dietary variables examined. Measurement and analysis of outcomes varied between studies. Overall risk of bias was rated as high, primarily due to missing outcome data. Improving dietary intake at this age appears challenging based on a relatively limited number of studies. Future research could consider dietary pattern analyses, which may provide more meaningful outcomes for this age group. Opportunities exist for further exploration of maternal-focussed interventions, responsive feeding interventions, and interventions delivered outside of homes.
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Affiliation(s)
- Éadaoin M Butler
- A Better Start - National Science Challenge, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Louise J Fangupo
- A Better Start - National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- A Better Start - National Science Challenge, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Rachael W Taylor
- A Better Start - National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
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Acceptance of a Nordic, Protein-Reduced Diet for Young Children during Complementary Feeding-A Randomized Controlled Trial. Foods 2021; 10:foods10020275. [PMID: 33573094 PMCID: PMC7911089 DOI: 10.3390/foods10020275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/13/2023] Open
Abstract
Early life is critical for developing healthy eating patterns. This study aimed to investigate the effects of a Nordic, protein-reduced complementary diet (ND) compared to a diet following the current Swedish dietary guidelines on eating patterns and food acceptance. At 4–6 months (mo) of age infants were randomized to a Nordic group (NG, n = 41) or a Conventional group (CG, n = 40), and followed until 18 mo of age. Daily intake of fruits and vegetables (mean ± sd) at 12 mo was significantly higher in the NG compared to the CG: 341 ± 108 g/day vs. 220 ± 76 g/day (p < 0.001), respectively. From 12 to 18 mo, fruit and vegetable intake decreased, but the NG still consumed 32% more compared to the CG: 254 ± 99 g/day vs. 193 ± 67 g/day (p = 0.004). To assess food acceptance, both groups were tested with home exposure meals at 12 and 18 mo. No group differences in acceptance were found. We find that a ND with parental education initiates healthy eating patterns during infancy, but that the exposure meal used in the present study was insufficient to detect major differences in food acceptance. This is most likely explained by the preparation of the meal. Nordic produce offers high environmental sustainability and favorable taste composition to establish healthy food preferences during this sensitive period of early life.
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Seidler AL, Hunter KE, Espinoza D, Mihrshahi S, Askie LM. Quantifying the advantages of conducting a prospective meta-analysis (PMA): a case study of early childhood obesity prevention. Trials 2021; 22:78. [PMID: 33482883 PMCID: PMC7821475 DOI: 10.1186/s13063-020-04984-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022] Open
Abstract
Background For prospective meta-analyses (PMAs), eligible studies are identified, and the PMA hypotheses, selection criteria, and analysis methods are pre-specified before the results of any of the studies are known. This reduces publication bias and selective outcome reporting and provides a unique opportunity for outcome standardisation/harmonisation. We conducted a world-first PMA of four trials investigating interventions to prevent early childhood obesity. The aims of this study were to quantitatively analyse the effects of prospective planning on variations across trials, outcome harmonisation, and the power to detect intervention effects, and to derive recommendations for future PMA. Methods We examined intervention design, participant characteristics, and outcomes collected across the four trials included in the EPOCH PMA using their registration records, protocol publications, and variable lists. The outcomes that trials planned to collect prior to inclusion in the PMA were compared to the outcomes that trials collected after PMA inclusion. We analysed the proportion of matching outcome definitions across trials, the number of outcomes per trial, and how collaboration increased the statistical power to detect intervention effects. Results The included trials varied in intervention design and participants, this improved external validity and the ability to perform subgroup analyses for the meta-analysis. While individual trials had limited power to detect the main intervention effect (BMI z-score), synthesising data substantially increased statistical power. Prospective planning led to an increase in the number of collected outcome categories (e.g. weight, child’s diet, sleep), and greater outcome harmonisation. Prior to PMA inclusion, only 18% of outcome categories were included in all trials. After PMA inclusion, this increased to 91% of outcome categories. However, while trials mostly collected the same outcome categories after PMA inclusion, some inconsistencies in how the outcomes were measured remained (such as measuring physical activity by hours of outside play versus using an activity monitor). Conclusion Prospective planning led to greater outcome harmonisation and greater power to detect intervention effects, while maintaining acceptable variation in trial designs and populations, which improved external validity. Recommendations for future PMA include more detailed harmonisation of outcome measures and careful pre-specification of analyses to avoid research waste by unnecessary over-collection of data.
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Affiliation(s)
- A L Seidler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia. .,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.
| | - K E Hunter
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - D Espinoza
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - S Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.,Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - L M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
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Variation in outcomes of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) according to maternal education and age 2 and 3·5 years post-intervention. Public Health Nutr 2021; 24:1460-1468. [PMID: 33427160 DOI: 10.1017/s1368980021000045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age. DESIGN Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children's BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years). SETTING Population based. PARTICIPANTS Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old. RESULTS At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively. CONCLUSIONS Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother's education level or age, which is important in community-based interventions.
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Ekambareshwar M, Ekambareshwar S, Mihrshahi S, Wen LM, Baur LA, Laws R, Taki S, Rissel C. Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review. Int J Behav Nutr Phys Act 2021; 18:10. [PMID: 33422066 PMCID: PMC7796572 DOI: 10.1186/s12966-020-01074-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders’ acceptability of interventions. Methods A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers’ behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. Results Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants’ perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. Conclusion There is limited reporting of stakeholders’ experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants’ acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. Trial registration PROSPERO registration: CRD42019108658
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.
| | - Swathi Ekambareshwar
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rachel Laws
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
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Laws R, Love P, Hesketh KD, Koorts H, Denney-Wilson E, Moodie M, Brown V, Ong KL, Browne J, Marshall S, Lioret S, Orellana L, Campbell KJ. Protocol for an Effectiveness-Implementation Hybrid Trial to Evaluate Scale up of an Evidence-Based Intervention Addressing Lifestyle Behaviours From the Start of Life: INFANT. Front Endocrinol (Lausanne) 2021; 12:717468. [PMID: 34975744 PMCID: PMC8715861 DOI: 10.3389/fendo.2021.717468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents' knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children's diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life; 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia. METHODS AND ANALYSIS A hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the 'Outcomes for Implementation Research' and 'RE-AIM' frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a sample of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age. IMPACT This is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally. CLINICAL TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry https://www.anzctr.org.au/, identifier ACTRN12620000670976.
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Affiliation(s)
- Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- *Correspondence: Rachel Laws,
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Kok-Leong Ong
- La Trobe Analytics Lab, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer Browne
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | | | | | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
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Delisle Nyström C, Abbott G, Cameron AJ, Campbell KJ, Löf M, Salmon J, Hesketh KD. Maternal knowledge explains screen time differences 2 and 3.5 years post-intervention in INFANT. Eur J Pediatr 2021; 180:3391-3398. [PMID: 34075476 PMCID: PMC8502736 DOI: 10.1007/s00431-021-04134-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
Very few early childhood interventions have observed sustained effects regarding television viewing and none have examined the mechanisms behind sustained intervention effects at long-term follow-ups. Thus, the aim of this study was to investigate potential mechanisms relating to the maintained intervention effect on television viewing at two long-term follow-ups in the Melbourne Infant Feeding Activity and Nutrition Trial (INFANT). INFANT was a cluster-randomised controlled trial. At the 2- and 3.5-year follow-ups, a total of 262 infant/mother pairs had complete information. Television viewing was assessed via a questionnaire at both follow-ups and six potential mediators were measured post-intervention (i.e. 15 months after baseline). Causal mediation analysis was conducted. At the 2- and 3.5-year follow-ups, the positive impacts of INFANT on maternal television viewing knowledge were maintained (B = 0.34 units; 95% confidence interval (CI95): 0.21, 0.48). An indirect effect of the intervention on reducing children's television viewing time was observed at the 2- and 3.5-year follow-ups (B = -11.73 min/day; CI95: -22.26, -3.28 and B = -4.78 min/day; CI95: -9.48, -0.99, respectively) via improved maternal television viewing knowledge.Conclusion: The positive impacts of INFANT on maternal television viewing knowledge were maintained at both follow-ups, with better maternal knowledge associated with less television viewing time in their children. These results have implications for paediatricians and healthcare professionals as educating new parents early on regarding screen time may lead to the development of healthier screen time habits that are sustained through to the pre-school years. What is Known: • Lifestyle behaviours inclusive of screen time have been found to be established before the pre-school years and track. • Few trials have evaluated the long-term mechanisms related to maintained intervention effectiveness. What is New: • This study shows the positive impacts of a low-dose intervention on maternal television viewing knowledge at two long-term follow-ups. • Better maternal television viewing knowledge was associated with less television viewing time in their children.
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Affiliation(s)
- Christine Delisle Nyström
- Department of Biosciences and Nutrition, Karolinska Institutet, Neo, 141 83, Huddinge, Sweden. .,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125, Australia.
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| | - Adrian J. Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, 3125 Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Neo, 141 83 Huddinge, Sweden ,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia ,Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 53 Linköping, Sweden
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, 3125 Australia
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50
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Henström M, Müssener U, Campbell KJ, Hesketh KD, Rosell M, Delisle Nyström C. The Need for an Evidence-Based Program in Sweden to Support Parents to Create Healthy Lifestyle Behaviors from the Start of Life-Parental Perceptions. Nutrients 2020; 12:nu12123823. [PMID: 33327562 PMCID: PMC7765081 DOI: 10.3390/nu12123823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022] Open
Abstract
In Sweden, there have been no interventions promoting the development of healthy lifestyle behaviors starting in infancy. Thus this paper aims to: (i) investigate Swedish parents’ experiences regarding feeding of solid foods, screen time, and physical activity in healthy infants; (ii) investigate parents’ needs and perceptions regarding information/support provided in primary child healthcare (CHC) and (iii) explore whether a parenting program focused on child diet and active play would be relevant and utilized. Semi-structured interviews were conducted with 20 parents. These were recorded, transcribed verbatim and analyzed using thematic analysis. Seven themes emerged: Feeling excited to enter a new phase; Parents’ responsibility of doing it “right” can be stressful; Motivated to learn during specific time windows; Information to trust; The importance of social support from peers; Experiences of support received from CHC; and the Infant, Feeding, Activity, and Nutrition Trial (INFANT) for a Swedish context. Parents were excited to enter new phases in their child’s development. However, this came with worry they were doing things “right”, leading parents to want more information/support. Overall, Swedish parents were very positive about the prospects of engaging in a primary CHC delivered program to support them to promote healthy lifestyle behaviors from birth and felt this could complement the care currently provided.
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Affiliation(s)
- Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Group MLÖ, 141 83 Huddinge, Sweden; (M.H.); (M.R.)
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83 Linköping, Sweden;
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3125, Australia; (K.J.C.); (K.D.H.)
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3125, Australia; (K.J.C.); (K.D.H.)
| | - Magdalena Rosell
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Group MLÖ, 141 83 Huddinge, Sweden; (M.H.); (M.R.)
| | - Christine Delisle Nyström
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, Group MLÖ, 141 83 Huddinge, Sweden; (M.H.); (M.R.)
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3125, Australia; (K.J.C.); (K.D.H.)
- Correspondence: ; Tel.: +46-76-401-4500
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