Meal time interactions and risk of obesity in toddlers

 描述(由申请人提供)：生命的头两年越来越被认为是肥胖发展的关键时期。先前的研究证明了父母在形成这一风险方面的重要性，并特别强调了母亲反应性喂养(即对儿童饥饿和饱腹感的更高反应以及较少自信的进食提示)与较低的儿童BMI之间的联系。然而，到目前为止，研究主要是基于家长报告的横断面研究，几乎只在学龄前儿童或年龄较大的儿童中进行；需要对母亲和幼儿进行纵向研究，评估在先行因素和同时因素的背景下反应喂养的客观衡量标准，以更好地了解促进反应喂养和降低儿童长期肥胖风险的因素。我们建议将156名母婴双胞胎纳入一项关于喂养相互作用和肥胖风险的前瞻性研究，在18、24和36个月时进行评估，以实现以下目标：1)了解与18个月时母亲和幼儿之间的反应性喂养相关的前瞻性因素；2)确定18和24个月时的反应性喂养是否预测18-36个月期间zBMI的变化和肥胖；以及3)探索哪些因素最能预测孩子从出生到36个月的zBMI变化。在18个月和24个月时，将通过两次家庭膳食观察来评估响应性喂养(总共4次)。在这些时间点，母亲和幼儿将佩戴加速计来评估体力活动和睡眠，母亲还将完成她们自己和幼儿摄入量的三次24小时饮食回顾，并评估可能影响母亲反应和幼儿肥胖风险的其他母亲因素(例如，对喂养习惯和方式的看法、饮食限制)和幼儿(例如，气质、食欲)。母亲和幼儿的身高、体重和周长/皮褶将在18个月、24个月和36个月时测量。我们建议从健康开端(HB)招募参与者，这是一项由NHLBI资助的两点随机对照试验，旨在测试多组分行为干预在降低怀孕期间体重过度增加风险方面的有效性。一半的乙肝参与者被随机分配到一项旨在减少妊娠体重增加的干预措施中，这提供了一个独特的机会来检查对所有上述研究目标的长期影响。HB还提供了一个独特的机会来进行这项具有成本效益的纵向研究：参与者已经登记在HB；所有参与者都超重或肥胖，42%是拉丁裔(儿童肥胖的重要风险因素)；对HB中的妇女的相关评估是在研究开始时(妊娠16周)、22-24周和35周以及分娩时、6个月和12个月进行的。当婴儿12个月大的时候，Hb就会消失。将随访延长到36个月将使我们能够理解早期生活对幼儿时期反应性喂养的影响之间的纵向联系，以及反应性喂养与肥胖风险之间的预期联系。研究结果将对这一重要且未得到充分研究的发展阶段的预防干预措施产生重要影响。

 DESCRIPTION (provided by applicant): The first two years of life are increasingly recognized as a critical period for the development of obesity. Prior studies demonstrate the importance of parents in shaping this risk with particular emphasis on associations between maternal responsive feeding (i.e., higher responsiveness to child hunger and satiety cues and fewer assertive prompts to eat) and lower child BMI. However, research to date has been primarily cross-sectional, based on parent-report, and done almost exclusively in preschoolers or older children; longitudinal studies of mothers and toddlers that assess objective measures of responsive feeding within the context of antecedent and concurrent factors, are needed to better understand factors that promote responsive feeding and reduce long-term child obesity risk. We propose to enroll 156 mother-toddler dyads into a prospective study of feeding interactions and obesity risk, with assessments at 18, 24, and 36 months, in order to achieve the following aims: 1) understand factors related prospectively to responsive feeding between mothers and toddlers at 18 months; 2) determine whether responsive feeding at 18 and 24 months predicts change in zBMI and adiposity from 18-36 months; and 3) explore which factors are most strongly predictive of child zBMI change from birth to 36 months. Responsive feeding will be assessed with two home-based meal observations at both 18 and 24 months (total of 4). At these time points, mothers and toddlers will wear accelerometers to assess physical activity and sleep, and mothers will also complete three 24-hour dietary recalls of their own and their toddler's intake, and measures assessing additional maternal (e.g., perceptions of feeding practices and styles, dietary restraint) and toddler (e.g., temperament, appetite) factors that could influence maternal responsiveness and toddler obesity risk. Mothers' and toddlers' heights, weights and circumference/skinfolds will be measured at 18, 24, and 36 months. We propose to recruit participants from Healthy Beginnings (HB), an NHLBI-funded, two site randomized controlled trial testing the efficacy of a multi-component behavioral intervention in reducing risk of excessive weight gain during pregnancy. Half of HB participants were randomized to an intervention designed to reduce pregnancy weight gain, providing a unique opportunity to examine long-term effects on all of the above-noted study aims. HB also provides a unique opportunity to cost-effectively conduct this longitudinal study: participants are already being enrolled in HB; all are overweight or obese and 42 percent are Latina (important risk factors for child obesity); relevant assessments of women in HB occur at study entry (<16 weeks gestation), 22-24 weeks and 35 weeks gestation, and mothers and infants at delivery, 6 and 12 months. HB ends when infants are 12 months old. Extending follow-up through 36 months will enable understanding of longitudinal associations between early life influences on responsive feeding during toddlerhood, and prospective associations between responsive feeding and obesity risk. Findings will have important implications for preventive interventions during this important and understudied developmental period.