Preventing Obesity through Intervention during Infancy

描述（由申请人提供）：这项研究将测试一种新型早期干预计划预防儿童肥胖的效果。护士将在出生后的第一年进行三次家访，为首次父母及其婴儿提供干预措施，然后每年进行一次临床研究中心访问，直到3岁。国家健康和营养检查调查（NHANES）的数据表明，需要早期干预以预防肥胖：从2007年到2008年，超过10%的2岁以下儿童已经肥胖，超过20%的2至5岁儿童超重或肥胖。这些发现引起了人们的关注，因为超重的婴儿和幼儿以及婴儿生长迅速的婴儿在以后的生活中患肥胖症及其并发症的风险增加。此外，预防和治疗年龄较大的儿童肥胖的尝试取得了有限的成功。相反，婴儿期可能是开始预防肥胖的适当时机。这是一个快速生长和发育可塑性的关键时期，具有持久的代谢和行为后果。 基于有前途的试点研究结果，并使用生态/发展框架，拟议的研究旨在提供和测试一个计划，以防止儿童肥胖症的两个手臂随机试验，其中包括儿童安全控制计划。肥胖预防计划的重点是从婴儿期到3岁的反应性喂养，喂养责任分工和健康饮食选择的信息。因此，干预措施将教导第一次为人父母的人：a）认识到婴儿饥饿和饱足的暗示，并只在饥饿时更有选择地使用喂养，B）使用替代安抚策略来喂养挑剔但不饥饿的婴儿和幼儿，c）为儿童提供适当比例的健康食品，并让儿童决定消费量，以及d）如何通过反复接触来提高对适合发育的食物（例如蔬菜）的接受度。这一信息在出生后的第一年尤其重要，因为婴儿的饮食从最初的纯牛奶饮食急剧转变为他们文化中的成人饮食的许多食物。在这一转变过程中，随着食品被介绍给儿童，有许多机会来解决饮食内容以及父母喂养方式。我们建议调查我们的干预措施对母乳喂养和配方奶粉喂养母婴二人组的影响。假设干预计划在母乳喂养和配方奶粉喂养的婴儿中均显示有效性，主要结果是3岁时的体重指数（BMI）百分位数。这一结果为长期肥胖风险提供了重要的见解。 公共卫生相关性：美国的肥胖流行病继续恶化，几乎没有经过验证的预防策略。虽然婴儿期是代谢和行为发育的关键时期，具有长期影响，但这一时期的生活在很大程度上被忽视，作为肥胖预防的目标。这项拟议的研究将评估一项预防肥胖的创新早期干预计划，该计划将通过家庭护士访问为父母及其婴儿提供多种干预措施。

DESCRIPTION (provided by applicant): This research will test the effects of a novel early intervention program to prevent childhood obesity. Nurses will deliver interventions to first-time parents and their infants at three home visits in the first year after birth followed by annual clinical research center visits until age 3. National Health and Nutrition Examination Survey (NHANES) data demonstrate the need for early intervention to prevent obesity: from 2007 to 2008, over 10 percent of children less than 2 years were already obese and over 20 percent of children between ages 2 and 5 years were overweight or obese. These findings are cause for concern because overweight infants and toddlers and those with rapid infant growth are at increased risk of obesity and its co-morbidities later in life. Further, attempts to prevent and treat obesity with older children have had limited success. In contrast, infancy may be an opportune time to begin obesity prevention. It is a critical period of rapid growth and developmental plasticity with long-lasting metabolic and behavioral consequences. Based on promising pilot study results and using an ecological/developmental framework, the proposed research seeks to deliver and test a program to prevent childhood obesity in a two arm randomized trial that includes a child safety control program. The obesity prevention program focuses on messages of responsive feeding, division of feeding responsibility, and healthy dietary choices that extend from infancy through age 3 years. As such, the intervention will teach first-time parents a) to recognize infant hunger and satiety cues and use feeding more selectively in response only to hunger, b) to use alternative soothing strategies to feeding for the fussy, but non-hungry infant and toddler, c) to provide children with appropriate portions of healthy foods and allow children to determine the amount consumed, and d) how to improve acceptance of developmentally appropriate foods such as vegetables through repeated exposure. This information is especially important during the first year after birth as infants make a dramatic dietary transition from the initial exclusive milk diet to one with many foods of the adult diet of their culture. During this transition, as foods are being introduced to children, there are numerous opportunities to address dietary content as well as parent feeding style. We propose to investigate the impact of our intervention on both intent to breastfeed and intent to formula feed mother-infant dyads. The intervention program is hypothesized to show efficacy in both breast and formula fed infants as measured by the primary outcome, body mass index (BMI) percentile at age 3 years. This outcome provides significant insight into long-term obesity risk. PUBLIC HEALTH RELEVANCE: The obesity epidemic in the United States continues to worsen, and there are few proven prevention strategies. Although infancy is a critical period for metabolic and behavioral development with long-term consequences, this period of life has largely been ignored as a target for obesity prevention. The proposed research will evaluate an innovative early intervention program for obesity prevention that will deliver several interventions to parents and their infants through home nurse visits.