Effectiveness of a Multifactorial Intervention in the First 1000 Days of Life to Prevent Obesity and Overweight in Childhood: Study Protocol

Impact of an early 1000-day intervention for obesity prevention on adiposity and BMI at two years of age: A quasi-experimental study

Background

The 1000-day period encompassing pregnancy and the first two years of postnatal life is critical for preventing childhood obesity. Existing interventions targeting this period have been characterised by great variability in duration, objectives, and evaluation indicators. We aimed to evaluate the impact of an intervention developed during the entire 1000-day period on body mass index and body fat percentage at two years of age.

Methods

We designed a prospective, interventional, quasi-experimental study (ie, without randomisation or blinding of both groups) targeting mother-child pairs from the beginning of pregnancy up to two years of age belonging to the basic health area of Puerto Real (Cádiz). We developed and delivered an intervention from pregnancy to two years and assessed its effect.

Results

The duration of breastfeeding and vitamin D supplementation increased significantly after the intervention. The intervention group showed lowed skinfolds values, a significantly lower body fat percentage, as well as a lower accumulation of factor at two years than the control group.

Conclusions

The intervention has had an impact on body fat percentage at two years, potentially justified through its overall effect and the lower accumulation of early risk factors.

The Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale): Construction and Pilot Testing of a Tool to Measure Factors Associated with Childhood Obesity

(1) Background: Childhood obesity poses a global health challenge. In the period from two to six years, the fundamental risk factors are associated with modifiable habits, related to parental attitudes. In this study, we will analyze the construction and pilot test of the PRELSA Scale, designed to be a comprehensive tool that covers the whole problem of childhood obesity, from which we can later develop a brief instrument. (2) Methods: First, we described the scale construction process. After that, we conducted a pilot test on parents to check the instrument's comprehensibility, acceptability, and feasibility. We detected items to be modified or eliminated through two criteria: the frequencies of the categories of each item and responses in the Not Understood/Confused category. Finally, we sought expert opinion through a questionnaire to ensure the content validity of the scale. (3) Results: The pilot test on parents detected 20 possible items for modification and other changes in the instrument. The experts' questionnaire showed good values on the scale's content, highlighting some feasibility problems. The final version of the scale went from 69 items to 60. (4) Conclusions: Developing scales that detect parental attitudes associated with the onset of childhood obesity may be the basis for future interventions to address this health challenge.

Adiposity and feeding practices in the first two years of life among toddlers in Guadalajara, Mexico

BACKGROUND

Feeding practices in the first two years of life have a direct impact on nutritional status and adiposity. The purpose of this study was to identify the differences in feeding practices during the first two years of life by sex and type of feeding in the first semester of postnatal life and their relationships with adiposity in toddlers.

METHODS

An analytical cross-sectional study that included 150 toddlers aged 12 to 24 months who were healthy, full-term, and had adequate weight for their gestational ages, was conducted at the New Civil Hospital and at a private practice in Guadalajara. Body compositions were obtained by bioelectrical impedance (BIA) measurements, and a modified questionnaire was used. Then, the parents completed two 24-h dietary recalls. In addition to the descriptive statistics, ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used in the contrast analysis of the quantitative variables. To analyze the qualitative variables, we used X² tests. Afterward, linear regression tests were conducted to identify the relationships between adiposity and feeding practices during the first two years.

RESULTS

There were direct relationships between adiposity and duration of full breastfeeding (r = 0.610, p = 0.021), age of introduction of ultra-processed products (r = 0.311, p = 0.011), sugar (r = 0.186; p = 0.024) and age at which eggs were introduced (r = -0.202; p = 0.016).

CONCLUSIONS

Adiposity was related to feeding practices in the first two years of life in toddlers.

Involvement of Non-Parental Caregivers in Obesity Prevention Interventions among 0-3-Year-Old Children: A Scoping Review

INTRODUCTION

We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions.

METHODS

We conducted a scoping review following the Arksey and O'Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded.

RESULTS

Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions (n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions (n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake (n = 5), parental feeding practices (n = 3), and screen time (n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.

Prevalence, Trends, and Socioeconomic Determinants of Coexisting Forms of Malnutrition Amongst Children under Five Years of Age in Pakistan

In Pakistan, malnutrition is a chronic issue. Concerns regarding coexisting forms of malnutrition (CFM) in an individual child are emerging, as children suffering from CFM have a 4 to 12-fold higher risk of death compared with healthy children. This study assessed the prevalence, trends, and socioeconomic determinants of various types of CFM using Pakistan Demographic and Health Survey (PDHS) datasets. Data from children aged 0-5 years old, with complete height and weight information, and valid anthropometry, from all regions of Pakistan (except residents of Azad Jammu Kashmir (AJK) and Federally Administered Tribal Areas (FATA), and non-de jure residents), were included. The prevalence of CFM was 30.6% in 2012-2013 and 21.5% in 2017-2018 PDHS. Both PDHSs reported a significantly higher prevalence of CFM in Sindh and Baluchistan compared with other regions of Pakistan. Improved socioeconomic status significantly reduced the odds of various types of CFM, except the coexistence of underweight with wasting. The high prevalence of CFM in Pakistan can be averted by multisectoral collaboration and by integrating nutrition-sensitive and nutrition-specific interventions.

Early Risk Factors for Obesity in the First 1000 Days-Relationship with Body Fat and BMI at 2 Years

(1) Background: Obesity is defined as an excessive accumulation of body fat. Several early developmental factors have been identified which are associated with an increased risk of childhood obesity and increased adiposity in childhood. The primary objective of the present study is to analyse the effect of various early risk factors on Body Mass Index (BMI) and body fat percentage at 2 years of age. (2) Methods: A prospective cohort study design was used, with the sample consisting of 109 mother-child pairs from whom data were collected between early pregnancy and 2 years old. Adiposity was determined based on skinfold measurements using the Brooks and Siri formulae. Mean comparison tests (Student's t-test and ANOVAs) and multiple linear regression models were used to analyse the relationship between early programming factors and dependent variables. (3) Results: Maternal excess weight during early pregnancy (β = 0.203, p = 0.026), gestational smoking (β = 0.192, p = 0.036), and accelerated weight gain in the first 2 years (β = - 0.269, p = 0.004) were significantly associated with high body fat percentage. Pre-pregnancy BMI and accelerated weight gain in the first 2 years were associated with high BMI z-score (β = 0.174, p = 0.047 and β = 0.417, p = 0.000 respectively). The cumulative effect of these variables resulted in high values compared to the baseline zero-factor group, with significant differences in BMI z-score (F = 8.640, p = 0.000) and body fat percentage (F = 5.402, p = 0.002) when three factors were present. (4) Conclusions: The presence of several early risk factors related to obesity in infancy was significantly associated with higher BMI z-score and body fat percentage at 2 years of age. The presence of more than one of these variables was also associated with higher adiposity at 2 years of age. Early prevention strategies should address as many of these factors as possible.

The Perceptions and Needs of French Parents and Pediatricians Concerning Information on Complementary Feeding

Appropriate complementary feeding (CoF) is the key to preventing childhood obesity and promoting long-term health. Parents must be properly informed through the CoF process. Pediatricians have opportunities to interact with parents during the CoF transition and influence parental feeding decisions. They can convey public health nutrition messages to parents. With the release of new CoF recommendations in France in 2019, and from the perspective of their conversion into official public health communication material, the aim of this study was to explore parents’ and pediatricians’ perceptions and needs regarding information on CoF. Two online surveys were disseminated to gather information on CoF communication and guidance: one for parents (n = 1001, January 2020); one for pediatricians (n = 301, October 2019). The results showed that the importance of CoF for children’s healthy growth was well recognized by both parents and pediatricians. Parents acknowledged pediatricians as the most influential source of advice; and pediatricians were aware of their responsibility in counselling parents on CoF. However, pediatricians neglected the fact that parents gave high trust to their personal network when looking for advice. The Internet was a well-recognized source of information according to all. Diverging from what pediatricians considered useful, parents were interested in practical advice for implementing CoF. This study highlights common expectations and points of divergence between parents’ needs and pediatricians’ perceptions of those needs with regard to CoF information.

Grow well/Crecer bien: a protocol for research on infant feeding practices in low-income families

BACKGROUND

The prevalence of obesity among children remains high. Given obesity's significant lifelong consequences, there is great interest in preventing obesity early in life. There is a need to better understand the relation of common infant feeding styles and practices to obesity in infants using longitudinal study designs. There is also an urgent need to understand the role of caregivers other than mothers in feeding. A better understanding of variation in feeding styles and practices can inform the identification of risk groups and the tailoring of interventions to them.

METHODS

In partnership with Early Head Start programs across four counties in southern California, mothers and infants will be enrolled in a two-year longitudinal study collecting survey and anthropometric data. A subsample of mothers and their selected other caregivers will participate in qualitative research involving feeding diaries and dyadic interviews. The results will be used to develop and test an enhanced nutrition education program.

DISCUSSION

We outline a study methodology to examine feeding styles and practices and their association with early childhood obesity risk and enhance an existing intervention to promote healthy infant feeding and growth among children in low-income families.