Improving WIC Services: Identifying Children at Risk for Obesity in the First 24 Months of Life

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PROJECT SUMMARY/ABSTRACT Children in low-income families and who are racial/ethnic minorities are disproportionately affected by risk factors for obesity in the first 24 months of life, such as lower rates of exclusive breastfeeding and higher rates of food insecurity. Reaching over 7 million low-income, racially diverse participants, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is in an important position to improve dietary patterns in early childhood, a critical developmental period for establishing lifelong eating habits. A federal requirement of WIC is to identify nutritional risk of children and provide nutrition education to all low-income families served by the program. The effectiveness of this counseling is directly related to the effectiveness of nutrition screening measures. Currently, WIC programs around the country use nutrition questionnaires to assess nutrition risk of all infants and young children and use results to determine counseling services based on these assessments. Few of these questionnaires are validated, however, and none have proven predictive validity to identify obesity and diet quality at 24 months of age. Our long-term goal is to identify effective dietary strategies to prevent obesity and reduce disparities in low-income infants and toddlers. The overall objective of this proposed study is to better understand how diet patterns during a critical time period during infancy are associated with risk for obesity in the first 24 months of life. This work is relevant to my K01 award because my research with school-aged children has led me to identify ways to improve nutrition earlier in life. Children as early as 24 months have already established dietary habits that can impact long-term weight and health. We will use data from the first-ever national cohort of WIC-enrolled children followed longitudinally from ages 0 to 24 months in the USDA’s WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2). WIC ITFPS-2 collects extensive data on diet, feeding behaviors, and anthropometry from the largest, most diverse cohort of WIC participants studied to date. Finally, this study will provide the preliminary evidence for a R01 proposal to conduct a randomized controlled trial to test if targeting nutritionally at-risk infants for more specific WIC nutrition education services compared to providing standard education services reduces obesity disparities in a low-income population.