Growing Right Onto Wellness (GROW): Changing Early Childhood BMI Trajectories

描述(由申请人提供)： 童年时期养成的饮食偏好和活动习惯会对L身体指数和健康的终身轨迹产生深远影响。具体地说，儿童早期体重指数的快速增加已经确定会影响成年后的死亡率和发病率。不幸的是，这种不健康的模式存在的时间越长，扭转它们就越困难。因此，以学龄前儿童为目标的健康生活方式干预具有巨大的潜力，可以影响终身健康。此外，营养和活动模式不仅在儿童一级决定，而且在家庭和社区内决定。在田纳西州纳什维尔Vanderbilt Pediatrics和Metro Parks and Recreation之间现有合作伙伴关系的成功基础上，我们将实施并评估旨在预防学龄前儿童肥胖的干预措施，方法涉及多个风险水平，既以家庭为基础，又以社区为中心。在启动大型随机对照试验(RCT)之前，将进行形成性研究(焦点小组和先导性研究)，以完善干预成分。在RCT中，来自低收入社区的600名亲子-学龄前儿童将被随机分配到两种情况之一。在干预条件下，一组亲子二人组将参加一个经过经验测试、对识字敏感的技能培养课程，以改善：1)热量摄入和适当的常量营养素，以及2)父母和孩子的常规体力活动。干预条件将发生在社区中心，并利用包括目标设定、自我监控和解决问题在内的工具。在控制条件下，亲子二人组将接受识字促进/学校成功课程。这两个条件将在以下阶段进行90分钟的会议：1)启动阶段(为期3个月，每周一次)；2)维护阶段(每两周，为期6个月)；以及3)可持续阶段(每月，为期27个月)。令人感兴趣的主要结果将是在三年随机对照试验中在多个时间点测量的儿童早期体重指数轨迹。在整个研究过程中，从儿童和父母那里收集的其他指标将包括：生物电阻抗；腰围；活动描记；3天饮食回忆；问卷；社交网络数据；以及唾液，以评估与肥胖相关的遗传风险评分。相关性：儿童肥胖预防必须在学龄前进行，因为60%的烤箱/体重学龄前儿童将继续成为超重的青少年。通过在公共社区中心进行和测试试验，可输出的干预措施可能导致宏观层面的系统变革，以解决这一日益扩大的公共卫生危机。

DESCRIPTION (provided by applicant): Food preferences and activity habits set in early childhood can profoundly influence lifelong trajectories for Body l\/lass Index (BMI) and health. Specifically, rapid BMI gain in early childhood has been established to affect adulthood mortality and morbidity. Unfortunately, the longer such unhealthy patterns are in place, the more difficult it can be to reverse them. Therefore, healthy lifestyle interventions targeted at children as early as preschool 'have enormous potential to affect lifelong health. Furthermore, nutrition and activity patterns are determined not only at the child level, but within the family and the community. Building on the success of an existing partnership between Vanderbilt Pediatrics and Metro Parks and Recreation in Nashville, TN, we will conduct and evaluate an intervention intended to prevent obesity in preschoolers in an approach that affects multiple levels of risk and is both family-based and community centered. Prior to launching a large randomized controlled trial (RCT), formative research (focus groups and pilot studies) will be conducted to refine the intervention components. In the RCT, 600 parent-preschool children dyads from low income neighborhoods will be randomly assigned to one of two conditions. In the intervention condition, groups of parent-child dyads will participate in an empirically tested, literacy-sensitive, skills building curriculum to improve: 1) caloric intake with appropriate macronutrients, and 2) routine physical activity for both parent and child. The intervention condition will occur in community centers and utilize tools including goal setting, self-monitoring, and problem solving. In the control condition parent-child dyad groups will receive a literacy promotion/school success curriculum. Both conditions will have 90-minute sessions in: 1) an initiation phase (weekly for 3 months); 2) a maintenance phase (biweekly for 6 months); and 3) a sustainability phase (monthly for 27 months). The primary outcome of interest will be early childhood BMI trajectories measured at multiple time points over the three year RCT. Additional measures collected throughout the study from children and parents will include: bioelectrical impedance; waist circumference; actigraphy; 3-day diet recalls; questionnaires; social network data; and saliva to assess a genetic risk score associated with obesity. RELEVANCE: Pediatric obesity prevention must occur in preschool given that 60% of oven/weight preschoolers will go on to become overweight adolescents. By conducting and testing trials in public community centers, exportable interventions could result allowing for a macro-level system change to address this expanding public health crisis.