Early Risk Factors for Obesity: Parenting, Child Behavior, and Attachment

描述(由申请人提供)：父母在预防儿童早期肥胖的努力中发挥着核心作用。尽管人们知道压力如何影响肥胖，以及父母教养方式如何塑造孩子的压力反应，但还没有研究考察观察到的亲子互动的情绪质量和孩子的依恋安全感与肥胖之间的关系。本申请中提议的流行病学研究利用了两项大型国家研究的数据，即早期儿童纵向研究、出生队列(ECLS-B)和NICHD早期儿童保育和青年发展研究(SECCYD)。这项研究的目的是确定早期亲子关系的情感质量如何影响儿童肥胖的风险。核心假设是，母亲的敏感度和反应能力较低，孩子们观察到的消极行为和缺乏与母亲的互动，以及不安全的依恋，都会增加孩子在进入小学之前患肥胖症的风险，并与青春期体重增加有关。这项研究的基本原理是，它将支持制定预防儿童早期肥胖的新策略。这些策略将超越通常对饮食和体力活动的关注，以早期亲子关系的质量为目标，通过提高儿童应对压力的能力来影响能量平衡。与儿童体重的三个关键预测因素相对应的三个具体目标将被追求：1)母亲的敏感性和响应性，2)儿童的参与度和行为，以及3)依恋安全。在这两项研究中，父母教养、儿童行为和依恋的这些方面在24个月大时使用基于亲子互动直接观察的有效测量进行了评估。在这两项研究中，儿童的身高和体重也被重复测量。这些预测因子的水平将与两个结果相关：1)幼儿园肥胖的风险(在ECLS-B中使用Logistic回归)，以及2)青春期的BMI轨迹(在SECCYD中使用分层线性混合效应模型)。每个目标的一个组成部分是评估效果修正，以调查社会人口学特征在多大程度上存在关联差异。该项目具有创新性，因为它将发展心理学领域确立的概念应用于儿童肥胖对公共健康的挑战，并使研究领域超越了目前对肥胖和育儿的研究，目前的研究主要集中在与儿童的食物摄入量和活动直接相关的育儿实践，或基于自我报告的育儿方式。该项目将确定和描述儿童早期肥胖的新风险因素，这些因素侧重于亲子关系的情感质量。拟议的流行病学研究具有重要意义，因为这些结果可以用来改进现有的肥胖预防战略，以防止儿童进入小学之前肥胖。可以预期，这些新战略将对儿童的体重和能量平衡产生重要的积极影响，同时也有利于他们的社交和情感发展。 公共卫生相关性：拟议的研究将确定儿童早期肥胖的新风险因素。它将提供证据，证明儿童肥胖与父母和孩子之间的关系的情感质量以及孩子是否对父母有安全的情感依恋有关。这项工作侧重于从其他研究中已知的积极育儿方面，以在儿童的社会和情感发展中产生理想的结果，增加这些结果的健康权重可能会加强干预措施的重要性，以提高育儿技能，协调儿科、营养、儿童发展和公共卫生领域的努力。

DESCRIPTION (provided by applicant): Parents play a central role in efforts to prevent obesity in early childhood. Despite what is known about how stress affects obesity and about how parenting shapes children's stress response, no studies have examined how the emotional quality of observed parent-child interaction and children's attachment security are related to obesity. The epidemiologic research proposed in this application utilizes data from two large national studies, the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) and the NICHD Study of Early Child Care and Youth Development (SECCYD). The objective of the research is to determine how the emotional quality of early parent-child relationships affects risk for childhood obesity. The central hypothesis is that low levels of maternal sensitivity and responsiveness, children's observed negative behavior and lack of engagement with their mother, and insecure attachment, will increase children's risk for obesity before they enter elementary school, and be associated with higher weight gain into adolescence. The rationale for this research is that it will support development of new strategies to prevent obesity in early childhood. These strategies would move beyond the usual focus on diet and physical activity to target the quality of the early parent-child relationship, affecting energy balance by improving children's ability to respond to stress. Three specific aims will be pursued corresponding to three key predictors of children's weight: 1) maternal sensitivity and responsiveness, 2) child engagement and behavior, and 3) attachment security. These aspects of parenting, child behavior, and attachment were assessed in both studies at 24 months of age using validated measures based on direct observations of parent-child interaction. Children's heights and weights were also measured repeatedly in both studies. Levels of these predictors will be examined in relation to two outcomes: 1) risk of obesity at kindergarten (in ECLS-B using logistic regression), and 2) BMI trajectory through adolescence (in SECCYD using hierarchical linear mixed effects models). A component of each aim is assessment of effect modification to investigate the extent to which associations differ by sociodemographic characteristics. The project is innovative because it applies concepts established in the field of developmental psychology to the public health challenge of childhood obesity and moves the research field beyond its current examination of obesity and parenting, which is largely focused on parenting practices that are directly related to children's food intake and activity, or parenting styles that are based on self-report. This project will identify and characterize new risk factors for early childhood obesity that focus on the emotional quality of the parent-child relationship. The proposed epidemiologic research is significant because the results can be used to improve existing obesity prevention strategies for preventing obesity before children enter elementary school. These new strategies can be expected to have an important positive impact on children's weight and energy balance while also benefiting their social and emotional development. PUBLIC HEALTH RELEVANCE: The proposed research will identify new risk factors for early childhood obesity. It will provide evidence that childhood obesity is associated with the emotional quality of the relationship between the parent and the child and whether the child has secure emotional attachment to the parent. The work focuses on aspects of positive parenting that are already known from other research to produce desirable outcomes in children's social and emotional development, and adding healthy weight to these outcomes could reinforce the importance of interventions to improve parenting skills, aligning efforts in the fields of pediatrics, nutrition, child development, and public health.