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

描述（由申请人提供）：干预护士开始婴儿在健康轨迹上生长（INSIGHT）研究是一项正在进行的前瞻性、随机、对照试验，旨在评估旨在预防276名头胎婴儿体重快速增加和儿童肥胖的响应性父母干预的有效性。利用作为INSIGHT一部分的基础设施和广泛的数据收集，拟议的研究通过招募第二个出生的兄弟姐妹和收集兄弟姐妹及其父母的遗传标本增加了两个主要部分。具体来说，这项转化研究将a）前瞻性地评估与肥胖相关的养育方式的相似性和差异以及第一个和第二个出生的兄弟姐妹之间与体重相关的结果，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，回应性养育的程度和体重状况，和c）确定INSIGHT研究干预措施的遗留效应是否发生在参与仅观察的第二胎儿童评价的家庭中。国家健康和营养调查数据表明，需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，因为超重的婴儿和幼儿在以后的生活中患肥胖症及其并发症的风险增加。婴儿期是开始预防肥胖的最佳时机，因为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。为INSIGHT提供信息的有希望的试点研究结果表明，肥胖预防计划侧重于响应性喂养，喂养责任分工和健康饮食选择的信息，可以改善头胎婴儿的体重相关结果。有趣的是，来自不同文化的数据表明，第一个出生的孩子有更高的肥胖风险，尽管事实上，与怀孕有关的儿童肥胖风险因素（孕前体重指数高，妊娠期体重增加高，发生妊娠糖尿病，高出生体重）在怀孕期间与第二个孩子一起更常见。这表明，与养育有关的产后因素是造成第一个和第二个孩子肥胖风险差异的原因。使用响应式育儿的概念框架，可以假设，母亲有更好的响应和更适当的照顾行为，由于与他们的第一个孩子的经验。这一假设将通过比较预计在拟议资助期间出生的>100名第二胎兄弟姐妹与他们的哥哥姐姐来进行测试，其额外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调节反应性父母与一岁时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.