Prevention of Overfeeding During Infancy

描述(由申请人提供)： 预防婴儿期的过度喂养本应用程序解决了广泛的挑战领域(01)行为、行为改变，以及预防和特定挑战主题01-DK-102：发现与肥胖相关的行为机制。越来越明显的是，预防儿童肥胖症必须在生命的早期就开始，因为在过去的20年里，美国儿童超重的流行率甚至在最小的年龄段都有所增加。后来肥胖的关键风险因素之一是婴儿期体重快速增加；相关的行为因素是父母的养育方式和相关的婴儿喂养做法。婴儿过度喂养，特别是那些用奶瓶喂养的婴儿，可能会导致体重迅速增加，但关于如何有效解决这一问题的信息很少。众所周知，配方奶喂养的婴儿比母乳喂养的婴儿消耗更多的能量，增加更多的体重，即使在生命的头几个月也是如此。此外，母乳喂养的婴儿患儿童肥胖症的风险较低，尽管其机制尚不清楚。一种可能的机制是，用奶瓶喂养可能会鼓励过度摄入。母乳喂养的婴儿能够根据内部的饱腹感自我调节摄入量，但奶瓶喂养可能会造成过度喂养。该项目的总体目标是确定防止婴儿期过度喂养的战略。一个目标是评估允许婴儿更好地控制奶瓶喂养时的摄入量对摄入量的影响。这将通过使用一种新的乳头来实现，这种乳头(在功能上)模仿人类乳房的乳头，并允许婴儿自我调节乳汁流量。第二个目标是评估父母喂养方式与婴儿摄入量之间的关系。在这项研究的一组中，配方奶粉喂养的婴儿将被随机分配使用新型乳头或传统乳头。我们假设a)与随机使用传统乳头喂养的婴儿相比，随机接受新型乳头喂养的婴儿每种饲料的摄入量更低，以及b)与非威权喂养方式的父母的孩子相比，具有威权喂养方式的父母的婴儿每次喂养的婴儿将有更高的配方奶粉摄入量。其他结果包括24小时摄入量，婴儿体重增加，以及照顾者报告的婴儿挑剔。这项研究的另一项研究将在母乳喂养和奶瓶喂养的婴儿身上进行。在该队列中，我们将a)比较母乳的母乳摄入量和奶瓶喂养的母乳摄入量，b)评估使用新型乳头与传统乳头相比，奶瓶喂养的母乳摄入量是否不同，以及c)研究父母的喂养方式是否与婴儿的摄入量有关。我们假设，母乳喂养时每种饲料的摄入量将低于奶瓶喂养时的摄入量，使用新型乳头时的摄入量也低于传统乳头，并且母乳喂养的婴儿的摄入量与父母的喂养方式无关。计划在头3个月内用奶瓶喂养婴儿的母亲，无论是母乳还是配方奶粉，在从加州大学戴维斯医学中心的产科病房出院前都将被招募。婴儿将被随机分配到新乳头或传统乳头，并将向母亲提供奶瓶和乳头。在整个研究过程中，将与母亲保持两周一次的联系。在婴儿3个月和4个月大的两个时间点，母亲将完成婴儿奶粉/配方奶粉摄入量的48小时称重记录(包括在所有母乳喂养之前和之后的称重测试)。一名研究助理将测量婴儿的体重和长度，并进行离职访谈，以评估照顾者的喂养方式，以及他们对被分配到的乳头以及婴儿的喂养模式和生长的看法。目标样本量为110名配方奶(或混合奶)婴儿和110名在~4mo纯母乳喂养的婴儿。这项研究的结果将为配方奶和母乳喂养婴儿之间摄入量差异的原因提供重要证据，这对于设计有效的干预措施以减少婴儿期过度喂养和随后的儿童肥胖至关重要。在美国，儿童肥胖症已经达到了流行的程度，鉴于2-5岁儿童中有四分之一超重或肥胖，很明显有必要在生命早期就进行预防。婴儿时期的过度喂养无疑会导致儿童肥胖，但导致过度喂养的因素尚不清楚。这项拟议的研究将促进我们对影响婴儿摄入量的行为因素的了解，从而促进开发有效的工具和策略来预防儿童肥胖。

DESCRIPTION (provided by applicant): Prevention of Overfeeding During Infancy This application addresses broad Challenge Area (01) Behavior, Behavioral Change, and Prevention and specific Challenge Topic, 01-DK-102: Discovery of Behavioral Mechanisms Relevant to Obesity. It is becoming increasingly evident that prevention of child obesity must begin very early in life, as the prevalence of child overweight in the U.S. in the past 20 years has increased even in the youngest age groups. One of the key risk factors for later obesity is a rapid rate of weight gain during infancy; related behavioral factors are parenting styles and associated infant feeding practices. Overfeeding of infants, particularly those who are bottle-fed, presumably contributes to rapid weight gain, but there is little information on how to effectively address this issue. It is well-documented that formula-fed infants consume more energy and gain more weight than breastfed infants, even during the first few months of life. Furthermore, breastfed infants have a lower risk of developing child obesity, although the mechanisms for this remain unclear. One potential mechanism is that being fed from a bottle may encourage excessive intake. Infants who feed at the breast are able to self-regulate intake based on internal satiety cues, but bottle- feeding creates the possibility of overfeeding. The overall goal of this project is to identify strategies to prevent overfeeding during infancy. One objective is to evaluate the impact on intake of allowing the infant greater control over the amount consumed when feeding from a bottle. This will be accomplished via the use of a novel nipple that mimics (functionally) the nipple of a human breast and allows the infant to self-regulate milk flow. The second objective is to evaluate the relationship between parental feeding styles and infant intake. In one arm of the study, formula-fed infants will be randomly assigned to use the novel nipple or a conventional nipple. We hypothesize that a) infants randomized to be fed with the novel nipple will have a lower intake per feed compared to infants randomized to use a conventional nipple, and b) infants of parents with an authoritarian feeding style will have a higher intake of formula per feed compared with children of parents with non- authoritarian feeding styles. Additional outcomes include 24-h intake, infant weight gain, and caregiver-reported infant fussiness. The other arm of the study will be conducted with infants who are fed human milk both at the breast and with a bottle. In that cohort, we will a) compare intake of human milk at the breast to intake of expressed human milk fed by bottle, b) evaluate whether the intake of human milk fed by bottle is different when using the novel nipple compared to a conventional nipple, and c) examine whether parental feeding style is related to infant intake. We hypothesize that intake per feed will be lower when fed at the breast than when fed by bottle and also lower when using the novel nipple compared to a conventional nipple, and that intake of human milk-fed infants is not related to parental feeding style. Mothers who plan to use a bottle within the first 3 months to feed their infants either breast milk or formula will be recruited before discharge from the maternity ward of the University of California, Davis Medical Center. Infants will be randomized to the novel nipple or the conventional nipple, and a supply of bottles and nipples will be provided to the mother. Biweekly contact will be maintained with the mother throughout the study. At two time points, when the baby is 3 and 4 months old, the mother will complete a 48-hour weighed record of infant milk/formula intake (including test-weighing before and after all breast feeds). A research assistant will measure the infant's weight and length, and conduct an exit interview to evaluate caregivers' feeding style and their perceptions of the nipple to which they were assigned and their infant's feeding patterns and growth. The target sample size is 110 formula-fed (or mixed- fed) infants and 110 infants fed exclusively breast milk at ~ 4 mo. The results of the study will provide important evidence regarding the reasons for the difference in intake between formula-fed and breastfed infants, which is critical for designing effective interventions to reduce overfeeding during infancy and subsequent child obesity. Childhood obesity has reached epidemic proportions in the U.S., and the need for prevention very early in life is evident given that one-fourth of children aged 2-5 years are overweight or obese. Overfeeding during infancy undoubtedly contributes to child obesity, but the factors leading to overfeeding are not well understood. The proposed study will advance our understanding of the behavioral factors affecting infant intake, thereby facilitating the development of effective tools and strategies for prevention of child obesity.