Home intervention for reducing sugary drinks & obesity in Hispanic women-infants

项目摘要 婴儿时期饮用含糖饮料和果汁(SSB/J)与早期肥胖有关 童年。这是一个重大的公共卫生问题，需要以家庭为基础的解决方案。然而，干预旨在 SSB/J的减少仍然存在争议，因为在以前的研究中影响有限，并担心目标是否 一个单一的因素将对肥胖的多因素问题产生影响。然而，虽然之前对肥胖症的试验 青少年在高加索人群中没有表现出SSB/J降低的效果，而在西班牙裔人群中有显著的影响。 此外，还没有研究检查在婴儿开始消费时降低SSB/J的影响 脂肪组织正在迅速发展。因此，我们提议进行一项试验，旨在减少#年的SSB/J消耗。 低收入、西班牙裔产后母亲和婴儿，这是肥胖高危人群的一部分。 尽管母婴干预是必要的，但它们带来了许多挑战，包括遵从性和 留存。我们提出了一种创新的解决方案，融合了SSB/J有效干预措施的组成部分 减少和母婴营养，纳入现有的家访计划(HVP)，这是联邦政府 在全国范围内支持促进高危人群中的儿童发展。为期24个月的干预将 重点是用水取代母亲对SSB/J的摄入量，推迟引入和限制获得SSB/J 在一组婴儿中，通过家访、电话和上门送水/无热量饮料。 怀孕前超重/肥胖的西班牙裔母亲(n=240)将被随机分配到他们的 新生儿分为三组。第1组(疗效)将接受修改后的HVP，其中重点放在 SSB/J减税加上送货上门。第二组(翻译)将与第一组相同，不包括送货上门。 第3组(对照组)将接受标准护理HVP。主要结果将是母亲体内由DEXA引起的体脂 还有婴儿。目标1测试干预是否会降低产后母亲的肥胖和代谢风险。 目的2测试干预是否降低了婴儿的体脂和体重比轨迹。我们会 还要检查这些效果是否在没有送货上门的情况下保持不变，从而支持 干预方法。目标3测试对婴儿的影响是否通过母体传播 与母亲甜味偏好的变化、使用SSB/J安抚婴儿、使用含糖食物有关 在断奶过程中，以及母乳中糖的分布情况。总而言之，这场审判将产生经验证据 支持一项可扩展的、公共卫生的生命周期战略，以解决拉美裔母亲和婴儿的肥胖问题。

Project Summary Consumption of sugar sweetened beverages and juices (SSB/J) in infancy is associated with obesity in early childhood. This is a significant public health issue requiring family based solutions. Yet interventions aimed at SSB/J reduction remain controversial based on limited effects in prior studies and concerns whether targeting a single factor will have an impact on the multi-factorial problem of obesity. However, while a prior trial in obese teenagers showed no effect of SSB/J reduction in Caucasians, there was a large significant effect in Hispanics. Furthermore, no study has examined the effects of SSB/J reduction during infancy when consumption begins and adipose tissue is rapidly developing. We therefore propose a trial aimed at reducing SSB/J consumption in low-income, Hispanic post-partum mothers and infants, a segment of the population at high risk for obesity. Although maternal-infant interventions are needed, they present many challenges including compliance and retention. We propose an innovative solution that merges components of effective interventions for SSB/J reduction and maternal-infant nutrition, into an existing home visit program (HVP), which are federally supported nationwide for promoting child development in high-risk populations. The 24-month intervention will focus on replacing mothers’ intake of SSB/J with water, and delaying introduction and limiting access to SSB/J in infants using home visits, telephone calls and in one group, home delivery of water/non-caloric beverages. Hispanic mothers who were overweight/obese prior to pregnancy (n=240) will be randomized with their newborn infants to one of three groups. Group 1 (efficacy) will receive a modified HVP incorporating a focus on SSB/J reduction plus home delivery. Group 2 (translation) will be identical to Group 1 without home delivery. Group 3 (control) will receive standard of care HVP. The main outcome will be body fat by DEXA in mothers and infants. Aim 1 tests whether the intervention will reduce obesity and metabolic risk in post-partum mothers. Aim 2 tests whether the intervention reduces the trajectory for body fat and weight-for-length in infants. We will also examine if these effects are maintained without home delivery, thus supporting scalability of the intervention approach. Aim 3 tests whether the effects on infants are mediated via maternal transmission related to changes in maternal sweet taste preference, use of SSB/J to sooth infants, use of sugary foods during weaning, and the profile of sugars in breast milk. In summary, this trial will generate empirical evidence to support a scalable, public health, life-course strategy for addressing obesity in Hispanic mothers and infants.