Preventing Obesity through Intervention during Infancy

项目总结/摘要 这种竞争性的更新申请旨在继续对参与的儿童进行纵向评估 在干预护士开始婴儿在健康轨迹上生长（INSIGHT）研究中，一项正在进行的研究， 一项前瞻性、随机、对照试验，旨在测试一项针对儿童的反应性父母（RP）干预措施。 肥胖的一级预防与家庭安全控制。在美国，23%的2-5岁奥尔兹已经 超重和9%已经肥胖。到6-11岁时，34%的美国儿童超重， 肥胖，强调需要具有持续效果的早期预防干预措施。几乎没有 到目前为止，有效的预防方法，我们开始INSIGHT招募了279名婴儿的出生队列， 在出生后第一年接受四次家访，然后每年进行一次诊所访视的父母， 年龄3岁。INSIGHT课程包括RP信息，通过年龄2岁的婴儿喂养，睡眠， 互动游戏，情绪调节和正常的生长模式;这些领域是根据证据选择的 将它们与肥胖风险以及它们被改变的潜力联系起来。到目前为止，INSIGHT的结果非常 阳性：RP婴儿在1岁时的平均身长体重低于对照组， 1岁时超重（两者p<0.05）。在3岁时，我们的主要结果，体重指数（BMI）z- RP组中的评分显著低于对照组（-0.13 vs. +0.15; p= 0.04）。一个适合于 具有立方时间趋势的整个干预期证实了干预组的主效应（p= 0.0003）。 这些结果使INSIGHT成为预防儿童肥胖最成功的早期干预试验 迄今RP组儿童也表现出改善的睡眠时间和行为，饮食内容， 和情绪调节INSIGHT保留了超过83%的参与者，直到3岁，但长期 RP干预的效果尚未评估。 美国学龄儿童的肥胖率很高， 具有持续效果的初级预防干预措施是这种竞争性更新的科学前提 应用程序，建议测试我们的RP干预对儿童的持续疗效和长期影响。 体重指数。根据5岁至9岁参与者的年生长测量结果， 将使用多层次模型来检查从幼儿到9岁的BMI增长曲线，并假设 RP效应将在各时间点持续存在。我们进一步预计，RP组家长将利用更多的反应， 父母的做法，和RP组儿童将表现出更大的自我调节的饮食行为（抑制 控制和食欲调节），更好的睡眠，更多的身体活动，以及更少的久坐行为。 主要评估点发生在参与者6岁时。

PROJECT SUMMARY/ABSTRACT This competitive renewal application seeks to continue the longitudinal evaluation of children participating in the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study, an ongoing, prospective, randomized, controlled trial testing a responsive parenting (RP) intervention designed for the primary prevention of obesity versus a home safety control. In the US, 23% of 2-5 year olds are already overweight and 9% are already obese. By ages 6-11 years, 34% of US children are overweight and 17% are obese, highlighting the need for early life preventive interventions with sustained effects. With virtually no effective prevention approaches to date, we began INSIGHT by recruiting a birth cohort of 279 infants and parents who received four home visits during the first year after birth followed by annual clinic visits through age 3 years. The INSIGHT curriculum includes RP messages through age 2 years about infant feeding, sleep, interactive play, emotion regulation, and normal growth patterns; these areas were selected based on evidence linking them to obesity risk and their potential to be modified. Thus far, results from INSIGHT have been very positive: RP infants had lower mean weight-for-length at 1 year than controls and were less likely to be overweight at age 1 year (p<.05 for both). At age 3 years our primary outcome, body mass index (BMI) z- score, was significantly lower in the RP group than control (-0.13 vs. +0.15; p=.04). A multilevel model fit for the entire intervention period with a cubic time trend confirmed a main effect for intervention group (p=.0003). These results make INSIGHT the most successful early intervention trial for the prevention of childhood obesity to date. RP group children also have demonstrated improved sleep duration and behaviors, dietary content, and emotion regulation. INSIGHT has retained over 83% of participants through age 3 years, but the long-term effects of the RP intervention have not yet been assessed. The high rates of obesity among school age children in the US and the complete lack of existing early life primary preventive interventions with sustained effects form the scientific premise for this competitive renewal application, which proposes to test the sustained efficacy and long-term effects of our RP intervention on child BMI. Following attainment of annual growth measurements from participants from ages 5 through 9 years, we will use multilevel modeling to examine BMI growth curves from early childhood to age 9, and hypothesize that RP effects will persist across time points. We further expect that RP group parents will utilize more responsive parenting practices, and RP group children will exhibit greater self-regulation of eating behaviors (inhibitory control and appetite regulation), better sleep, more physical activity, and less sedentary behavior at the study's primary assessment point which occurs when participants are 6 years old.