Low Income Mothers' Feeding Beliefs and Practices as Child Obesity Risk Factors

描述（由申请人提供）：儿童肥胖症的流行仍然相对有增无减，并且在学龄前年龄范围内已经存在低收入儿童中肥胖症的较高患病率。众所周知，父母教养方式影响肥胖风险，父母教养方式被纳入儿童肥胖预防，评估和治疗专家建议。尽管母亲喂养方式对儿童肥胖风险的重要性，但母亲喂养方式的表征仍然相对简单，其随时间的潜在变化，特别是与儿童体重状况有关的变化，几乎完全未被探索。需要更好地了解母亲的喂养方式以及它们如何随着时间的推移而变化，以应对儿童体重状况的变化，从而为干预措施提供信息和定制。因此，拟议的项目力求查明4至6岁儿童的低收入母亲的喂养方式。我们关注这一人群，因为这一人群中肥胖症的患病率很高，而且在这一领域与低收入家庭的工作明显缺乏。我们还进行了大量的初步工作，确定了初步的母亲喂养方式。其中一种喂养方式我们称之为“控制型肥胖”，这种喂养方式的母亲所生的孩子中有一半以上是肥胖的。因此，该项目还将寻求更好地了解这种特定的喂养方式及其与儿童体重状况的关系。该项目小组是唯一的定位，以解决这一研究问题。首席研究员被授予NIH挑战奖，以研究低收入3至5岁儿童的压力，饮食行为，昼夜唾液皮质醇和肥胖风险之间的关系。数据收集工作正在提前进行，我们预计到2011年8月将招募350名儿童。我们建议在300名参与者中实现4个目标，其中大部分参与者来自现有队列。目标1：使用多种方法确定产妇喂养方式。目的2：确定基线时不同喂养方式母亲的体重指数z评分和儿童肥胖患病率的差异。目标3：研究在两年时间内从一种喂养方式到另一种喂养方式的转变。目的4：确定儿童体重指数z评分的变化是否可以预测从一种喂养方式到另一种喂养方式的转变。我们识别喂养方式的多方法方法将包括一个关于喂养的成熟的半结构化访谈，我们将使用一个成熟的编码方案对母亲的信心、权威和投资进行编码;在实验室和家中喂养期间的母婴互动录像，我们将使用一个可靠和有效的方案进行编码;以及一系列问卷调查。该项目的结果将有助于制定更有针对性和更有效的肥胖预防和治疗干预措施。 公共卫生相关性：儿童肥胖症是一个日益严重的公共卫生问题，低收入人群是肥胖症流行的最大负担。在儿童时期发展的肥胖很可能会跟踪到成年，并与大量不良的健康，行为和社会后果有关。更好地了解产妇喂养方式，特别是在低收入人群中，将为制定更有效的干预和预防方案提供信息。

DESCRIPTION (provided by applicant): The childhood obesity epidemic continues relatively unabated, and a higher prevalence of obesity among low- income children is already present in the preschool age range. It is well-recognized that parenting style impacts obesity risk, and parenting style was included in the Expert Recommendations for the Prevention, Assessment, and Treatment of Childhood Obesity. Despite the perceived importance of maternal feeding styles to childhood obesity risk, the characterization of maternal feeding styles remains relatively simplistic and their potential change over time, particularly in relation to the child's weight status, is nearly entirely unexplored. An improved understanding of maternal feeding styles as well as how they change over time in response to changes to a child's weight status is needed to inform and tailor interventions. The proposed project therefore seeks to identify maternal feeding styles among low-income mothers of 4- to 6-year-old children. We focus on this population given the high prevalence of obesity within this group, and the remarkable lack of prior work in this area with low-income families. We have also conducted substantial preliminary work that has identified preliminary maternal feeding styles. One of these feeding styles we call "Conflicted Controllers," and more than half of the children of mothers with this feeding style are obese. This project therefore also will seek to better understand this specific feeding style and its development in relation to child weight status. The project team is uniquely positioned to address this research question. The Principal Investigator was awarded an NIH Challenge Grant to examine relationships between stress, eating behavior, diurnal salivary cortisol, and obesity risk among low-income 3- to 5-year-old children. Data collection is proceeding ahead of schedule, and we anticipate enrolling 350 children by August 2011. We propose to address 4 aims with 300 participants, drawing most participants from this existing cohort. The aims are: Aim 1: To identify maternal feeding styles using a multi-method approach. Aim 2: To identify differences in body mass index z-score and the prevalence of child obesity across maternal feeding styles at baseline. Aim 3: To examine transitions from one feeding style to another over a two year period. Aim 4: To determine if changes in child body mass index z-score predict transition from one feeding style to another. Our multi-method approach to identifying feeding styles will include a well-developed semi-structured interview about feeding from which we will code maternal confidence, authority, and investment using a well-established coding scheme; videotaped maternal-child interactions during feeding both in the laboratory and at home which we will code using a reliable and validated scheme; and a series of questionnaires. The results of this project will contribute to more tailored and effective interventions for obesity prevention and treatment. PUBLIC HEALTH RELEVANCE: Childhood obesity is a growing public health problem, and low-income populations carry the greatest burden of the obesity epidemic. Obesity that develops in childhood is very likely to track into adulthood, and is associated with a large number of adverse health, behavioral, and social outcomes. An improved understanding of maternal feeding styles, particularly within low-income populations, would inform the development of more effective intervention and prevention programs.