Intervention to promote physical activation and improve sleep and feeding practices in infants for preventing obesity early in life (The Baby-Act Trial)

项目摘要 在美国，婴儿肥胖症正在增加，尤其是西班牙裔。体重在关键时期快速增加 婴儿期增加了儿童期肥胖的风险，持续到成年期，增加了慢性疾病的风险。 糖尿病和高血压等疾病。这一严重的健康威胁可以通过多方面的措施加以预防。 在婴儿期进行干预，以解决与早期肥胖发展相关的多种风险因素。电流 有证据表明，试验应特别关注与体力活动、睡眠、营养 饱腹感、压力和提高育儿技能，应在多个层面上提供， 计划是可翻译的，具有成本效益和可持续的。为此目的，在联合国系统内进行的干预措施 联邦WIC计划提供了一个潜在的强有力的方式，培养早期健康的行为，并帮助 预防肥胖。作为WIC计划的一部分，成功的干预措施可以转化为 政策，因为每个州都制定自己的教育材料，并决定如何进行营养教育， 切实贯彻我们的目标是测试多方面和多层次干预的临床有效性 集中在三个主要领域：身体活动（即，婴儿激活、睡眠和屏幕时间）、营养和 成长监测，在健康自我赋权理论框架内，并通过WIC计划提供 使用多媒体方法。身体活动和生长监测组件是新的WIC 课程，而营养成分是基于WIC准则，但交付不同（通过自我， 基于授权的消息和基于多媒体的）。为此，我们将进行一个集群随机 在波多黎各WIC（PR-WIC）计划的孕妇参与者中进行的对照试验。平等 许多诊所将随机分配至对照组（常规治疗）或WIC+组（常规治疗+干预） 在圣胡安地区。生活方式干预将侧重于与年龄相适应的婴儿身体活动， 健康的睡眠和限制屏幕时间，健康的饮食模式和生长监测。内容将 采用多媒体方式（网络平台、移动的信息和电话跟踪）提供。参与 干预将在怀孕的最后三个月开始开始，并持续到婴儿12个月大。我们 我已经在10对母婴中对这种干预的信息进行了试点测试，在他们的第一年 生活，具有很好的可接受性。我们将确定干预可能产生的影响程度 体重增加，婴儿活动和营养从出生到12个月的年龄相比，对照组。我们还将 评估这种干预的成本，作为对当前WIC课程的修改。这种做法没有 之前在婴儿中进行过测试。如果成功的话，这种干预措施可以作为一种政策支持的最佳措施， PR-WIC计划的实践，以帮助预防婴儿肥胖。这将有助于改善少数民族的健康， 消除西班牙裔和其他高危群体之间的健康差距。

Project Summary Infant obesity is increasing in the U.S., particularly among Hispanics. Rapid weight gain during critical periods of infancy increases the risk of obesity in childhood, continuing into adulthood and increasing the risk of chromic diseases such as diabetes and hypertension. This serious health threat could be prevented through multifaceted interventions during infancy that address multiple risk factors associated with early obesity development. Current evidence suggests that trials should focus particularly on risk factors related to physical activity, sleep, nutrition, satiety, stress and increasing parenting skills, and should be delivered at multiple levels, using population-level programs to be translatable, cost-effective and sustainable. To this end, interventions carried out within the federal WIC program provide a potentially powerful way of fostering early healthy behaviors and helping in preventing obesity. Successful interventions done as part of the WIC program could be translated into their policies, since each state develops its own educational materials and determines how nutritional education is implemented. Our goal is to test the clinical effectiveness of a multi-faceted and multi-leveled intervention focusing on three main areas: physical activity (i.e., infant activation, sleep and screen time), nutrition and growth monitoring, framed in the Health Self-Empowerment Theory, and delivered through the WIC Program using a multi-media approach. The physical activity and growth-monitoring components are new to the WIC curriculum, while the nutrition component is based on WIC guidelines but delivered differently (through self- empowerment-based messages and multi-media based). For this, we will conduct a cluster-randomized controlled trial among pregnant women participants of the Puerto Rico WIC (PR-WIC) program. An equal number of clinics will be randomized to the control (usual care) arm or to the WIC+ (usual care + intervention) arm in the San Juan area. The lifestyle intervention will focus on age-appropriate infant physical activation, healthy sleep and limiting screen time, healthy dietary patterns and growth monitoring. The content will be delivered with a multi-media approach (web-platform, mobile messages and phone follow-up). Participation in the intervention will begin in the last trimester of pregnancy and continue until the infant is 12 months old. We have already pilot-tested the information of this intervention among 10 mother-infant dyads during their first year of life, with excellent acceptability. We will determine the extent to which the intervention may impact adequate weight gain, infant activity and nutrition from birth to 12 months of age compared to the control arm. We will also evaluate the cost of this intervention as a modification of the current WIC curriculum. Such approach has not been tested before among infants. If successful, this intervention could be adopted as a policy-supported best practice by the PR-WIC program to help prevent infant obesity. This will help improve minority health and eliminate health disparities among Hispanics and other at-risk groups.