Effect of Birth Order and Genetics on Infant Parenting and Obesity Risk

描述(由申请人提供)：干预护士启动婴儿在健康轨迹上成长(Insight)研究是一项正在进行的前瞻性、随机、对照试验，旨在评估响应性育儿干预的有效性，旨在防止276名第一出生婴儿的婴儿体重迅速增加和儿童肥胖。作为洞察的一部分，这项拟议的研究利用了基础设施和广泛的数据收集，通过招募第二个出生的兄弟姐妹并从兄弟姐妹及其父母那里收集基因样本，增加了两个主要部分。具体地说，这项转化研究将a)前瞻性地评估第一胎和第二胎兄弟姐妹之间与肥胖相关的养育方式的异同以及与体重相关的结果，b)探索与食欲、气质和肥胖易感性相关的兄弟姐妹之间的遗传差异如何影响亲子互动、父母的反应程度和体重状况，以及c)确定洞察力研究干预在参与仅限观察的第二胎子女评估的家庭中是否发生延续效应。国家健康和营养检查调查数据表明，有必要进行早期干预，以预防肥胖：26.7%的2-5岁儿童已经超重或肥胖。这些发现令人担忧，因为超重的婴儿和蹒跚学步的孩子在以后的生活中患肥胖症及其共病的风险增加。婴儿期是开始预防肥胖的好时机，因为它是快速生长和发育可塑性的关键时期，会产生长期的代谢和行为后果。前景看好的先导性研究结果表明，关注响应性喂养、喂养责任分工和健康饮食选择的肥胖预防计划可以改善第一个出生婴儿的体重相关结局。有趣的是，来自不同文化的数据显示，第一个孩子患肥胖症的风险更高，尽管与怀孕有关的儿童肥胖风险因素(孕前体重指数高、妊娠体重增加、妊娠期糖尿病发生、出生体重高)在怀孕第二个孩子期间更为常见。这表明，与育儿相关的出生后因素是导致第一胎和第二胎肥胖风险差异的原因。使用响应性育儿的概念框架，可以假设，由于第一个孩子的经验，母亲的响应性和更适当的照顾行为得到了改善。这一假说将通过比较有望在拟议的资助期间出生的100个第二出生的兄弟姐妹和他们的大兄弟姐妹来检验，另一个目标是探索肥胖遗传易感性的差异以及观察到的食欲和气质差异如何缓和一岁时响应性父母教养方式与体重状况之间的关联。

DESCRIPTION (provided by applicant): The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing prospective, randomized, controlled trial evaluating the efficacy of a responsive parenting intervention designed to prevent rapid infant weight gain and childhood obesity among 276 first-born infants. Capitalizing on the infrastructure and extensive data collection occurring as part of INSIGHT, the proposed research adds two major pieces by enrolling second born siblings and collecting genetic specimens from both siblings and their parents. Specifically, this translational research will a) prospectively evaluate obesity-related parenting similarities and differences as well as weight-related outcomes between first and second-born siblings, b) explore how genetic differences among siblings that are associated with appetite, temperament, and obesity susceptibility affect parent-child interactions, degree of responsive parenting, and weight status, and c) determine whether INSIGHT study intervention carryover effects occur among families participating in the observation-only second-born child evaluation. National Health and Nutrition Examination Survey data demonstrate the need for early intervention to prevent obesity: 26.7% of children aged 2-5 years are already overweight or obese. These findings are concerning as overweight infants and toddlers are at increased risk of obesity and its co-morbidities later in life. Infancyis an opportune time to begin obesity prevention because it is a critical period of rapid growth and developmental plasticity with long-lasting metabolic and behavioral consequences. The promising pilot study results that informed INSIGHT demonstrated that an obesity prevention program focused on messages of responsive feeding, division of feeding responsibility, and healthy dietary choices can improve weight-related outcomes for first-born infants. Interestingly, data from diverse cultures have shown that first-born children have a higher risk for obesity despite the fact that pregnancy related risk factors for childhood obesity (high pre-pregnancy body mass index, high gestational weight gain, occurrence of gestational diabetes, high birth weight) are more common during pregnancies with second-born children. This suggests that postnatal factors related to parenting are the cause for the disparity between first and second born children's obesity risk. Using the conceptual framework of responsive parenting, it can be hypothesized that mothers have improved responsiveness and more appropriate caretaking behaviors due to the experience gained with their first child. This hypothesis will be tested by comparing the >100 second-born siblings that can be expected to be born during the proposed funding period with their older siblings with the additional goal to explore how differences in genetic susceptibility to obesity and observed differences in appetite and temperament moderate associations between responsive parenting and weight status at age one year.