Preventing Childhood Obesity through Early Feeding and Parenting Guidance

描述(由申请人提供)：婴儿的早期和快速生长与幼儿肥胖的早期发展和持续性密切相关。大量研究已经将儿童肥胖/超重与严重健康后果的风险增加联系在一起，包括不利的身体、心理、行为或社会后果。最近的研究表明，即使在非常年幼的儿童身上，肥胖也会产生负面后果，随着肥胖儿童年龄的增长，肥胖会导致健康问题。医学研究所(IOM)最近发布的关于儿童早期肥胖预防政策的报告(2011年)建议了五种预防肥胖的方法：评估、监测和跟踪从出生到5岁的发育；增加幼儿的体力活动和减少久坐不动的行为；支持母乳喂养并对儿童的喂养提示做出反应；限制屏幕时间；以及促进幼儿适龄睡眠。基于该研究小组之前的工作，并与一个主要的城市卫生部门合作，我们建议测试一种干预措施，该干预措施结合了国际移民组织的所有建议，以防止高危婴儿肥胖的发展。干预将由卫生专业人员指导，并通过社区卫生工作者(CHW)在公共卫生护士(PHN)的监督下对德克萨斯州休斯敦妇女、婴儿和儿童特别补充营养计划(WIC)客户的墨西哥裔美国妇女和儿童进行家访。干预为期2年，随访1年，共进行3年的测量。这项研究的目标是 利用社区参与性研究建立的干预措施，比较卫生福利院提供的结构化家访与世界卫生组织办公室访视提供的标准护理在预防婴儿出生后头两年超重(体重/身长85百分位)和肥胖(体重/身长95百分位)方面的有效性。这项拟议的研究将提供关于干预措施的效果的前瞻性数据，该干预措施旨在预防因种族、收入和母亲BMI而导致肥胖高危儿童的儿童肥胖。我们将能够展示一个共同的社区方法在生命的头两年预防肥胖的有效性，以及干预措施从2岁到3岁的持久性。这种易于实施的肥胖预防干预措施可以在许多地点和不同的社区采用。 公共卫生相关性：这项研究将证明，在公共卫生护士的监督下，社区卫生工作者(CHW)可以为主要城市地区的低收入墨西哥和墨西哥裔美国妇女和儿童提供基于家庭的肥胖预防干预。CHW将与WIC客户合作，支持他们母乳喂养婴儿，并教他们如何喂养和照顾他们的婴儿。肥胖，特别是在低收入少数族裔儿童中，是对我国当前和未来健康的严重威胁，需要文化上一致的、社区支持的干预措施来扭转这一流行病。

DESCRIPTION (provided by applicant): Early and rapid growth in infants is strongly associated with early development and persistence of obesity in young children. Substantial research has linked child obesity/overweight to increased risks for serious health outcomes, which include adverse physical, psychological, behavioral, or social consequences. Recent studies have indicated that obesity has negative outcomes even on very young children and contributes to health problems as obese children age. The Institute of Medicine's (IOM) recent report (2011) on early childhood obesity prevention policies, recommends five approaches to preventing obesity: assess, monitor, and track growth from birth to age 5; increase physical activity and decrease sedentary behavior in young children; support breastfeeding and be responsive to children's feeding cues; limit screen time; and promote age appropriate sleep for young children. Based on the previous work by this research team, and in collaboration with a major urban health department, we propose to test an intervention that incorporates all the IOM's recommendations to prevent the development of obesity in at-risk infants. The intervention will be guided by health professionals and delivered through home visits by community health workers (CHW), supervised by public health nurses (PHN), to Mexican-American women and children who are clients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program in Houston, TX. The intervention will occur for 2 years with 1 year of follow-up, for a total of 3 years of measurements. The goal of this study is to compare the effectiveness of structured CHW- provided home visits, using an intervention created through community-based participatory research, to standard care received through WIC office visits in preventing the development of overweight (weight/length >85th percentile) and obesity (weight/length >95th percentile) in infants during their first 2 years of life. The proposed study will provide prospective data on the effects of an intervention to prevent childhood obesity in children at high risk for obesity due to ethnicity, income, and maternal BMI. We will be able to demonstrate the effectiveness of a common community approach in preventing obesity during the first 2 years of life as well as the intervention's persistence from age 2 to 3. This easy to implement obesity-prevention intervention can be adopted for many locales and diverse communities. PUBLIC HEALTH RELEVANCE: This study will demonstrate that community health workers (CHW), supervised by public health nurses, can deliver a home-based obesity prevention intervention to low-income Mexican and Mexican-American women and children in a major urban area. The CHW will work with WIC clients to support them in breastfeeding their infants and teach them about feeding and caring for their infants. Obesity, especially among low income minority children, is a grave threat to the current and future health of our nation, and culturally congruent, community supported interventions are needed to reverse this epidemic.