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

描述（由申请人提供）： 儿童早期的食物偏好和活动习惯可以深刻影响身体指数（BMI）和健康的终身轨迹。具体而言，已确定幼儿期BMI快速增加会影响成年期死亡率和发病率。不幸的是，这种不健康的模式存在的时间越长，就越难扭转。因此，早在学龄前就针对儿童的健康生活方式干预具有影响终身健康的巨大潜力。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。在范德比尔特儿科与田纳西州纳什维尔地铁公园和娱乐中心现有合作伙伴关系成功的基础上，我们将进行和评估旨在预防学龄前儿童肥胖的干预措施，这种干预措施影响多个风险水平，以家庭为基础，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（焦点小组和试点研究），以完善干预成分。在随机对照试验中，来自低收入社区的600名父母-学龄前儿童将被随机分配到两种情况之一。在干预条件下，父母-孩子二人组将参加一个经验测试，识字敏感，技能建设课程，以改善：1）热量摄入与适当的宏量营养素，和2）日常体力活动的父母和孩子。干预条件将发生在社区中心，并利用工具，包括目标设定，自我监控和解决问题。在控制条件下，父母-子女二元组将接受扫盲促进/学校成功课程。两种情况都将有90分钟的会议：1）启动阶段（每周一次，持续3个月）; 2）维持阶段（每两周一次，持续6个月）; 3）可持续阶段（每月一次，持续27个月）。关注的主要结果将是在三年RCT的多个时间点测量的幼儿BMI轨迹。在整个研究过程中，从儿童和父母那里收集的其他措施包括：生物电阻抗;腰围;活动记录; 3天饮食回忆;问卷调查;社交网络数据;和唾液，以评估与肥胖相关的遗传风险评分。相关性：儿童肥胖预防必须发生在学龄前，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，以解决这一不断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.