A Pilot-Feasibility Study of a Home-based Intervention to Reduce Obesity Risk for Bottle-fed Infants

摘要 肥胖症最早的产后风险因素之一是婴儿早期体重迅速增加和配方奶粉喂养 婴儿比母乳喂养的婴儿有更大的体重过度增加的风险。有很多好处 纯母乳喂养，使促进母乳喂养成为理想。然而， 母亲配方奶粉喂养，无论是完全或结合母乳喂养，这些母亲报告缺乏 支持学习和采用健康的奶瓶喂养方法。越来越多的证据表明， 配方奶喂养的母亲可能会发展更多的控制喂养的做法，由于他们的喂养能力，以回应 在奶瓶中的配方奶量，而不是对婴儿饱足感的暗示作出反应，导致过度喂养，快速 体重增加和肥胖风险。拟议试点/可行性研究的总体目标是评估 以家庭为基础的干预措施，以提高配方奶喂养母亲对婴儿饱腹感的反应 提示和中度配方奶粉喂养婴儿的体重增加率在12周内。我们特别 建议为母亲提供不透明的加重瓶（而不是传统的透明瓶）， 喂养他们的婴儿;根据我们的初步研究，我们假设，母亲的评估能力， 婴儿在喂养期间消耗的量将促进响应于婴儿饱食而喂养的能力 提示。对于拟议的研究，完全配方喂养的母亲与<2周大的婴儿将 随机分配使用加重的不透明瓶（干预组或不透明组）或使用其首选的透明瓶 瓶（对照组或透明组）。我们将在12- 14学年开始和结束时进行家庭评估， 一周的研究期，在此期间，我们将视频记录母亲喂养他们的婴儿使用清晰或不透明 瓶.我们还将进行两次临时家庭评估（2周和6周后），以评估喂养充足性 和对干预的忠诚。在喂养观察期间，将通过奶瓶重量评估婴儿摄入量。 视频记录将随后编码为母亲对婴儿线索的反应，使用护理儿童 亲子互动喂养量表（NCAFS）。我们假设母亲在不透明的 一组会给他们的婴儿喂得更少，对婴儿暗示的反应水平会有更大的提高 与清洁组的母亲相比。婴儿的体重和长度将在开始和结束时测量 将使用WHO生长标准计算身长体重z评分（WLZ）。 我们假设，与透明环境相比，不透明环境中婴儿的WLZ变化将显著降低 组我们亦会透过收集和分析客观及 主观数据涉及母亲使用和喜欢奶瓶的程度，以及 母亲或婴儿中度干预效果。拟议的可行性研究是迈向 了解母亲接受和使用不透明奶瓶的情况，并与传统的透明奶瓶进行比较， 不透明瓶改善家庭环境中喂养互动结果的潜力。

ABSTRACT One of the earliest postnatal risk factors for obesity is rapid weight gain during early infancy and formula-fed infants are at greater risk for excessive weight gain than breastfed infants. There are many benefits of exclusive breastfeeding, making promotion of breastfeeding the ideal. However, significant proportions of mothers formula-feed, either exclusively or in combination with breastfeeding, and these mothers report a lack of support for learning and adopting healthy bottle-feeding practices. A growing body of evidence suggests that formula-feeding mothers may develop more controlling feeding practices due to their ability to feed in response to amount of formula in the bottle, instead of in response to infant satiety cues, leading to overfeeding, rapid weight gain, and risk for obesity. The overall objective of the proposed pilot/feasibility study is to evaluate a home- and family-based intervention to increase formula-feeding mothers’ responsiveness to infant satiety cues and moderate formula-feeding infants’ rates of weight gain over a 12-week period. Specifically, we propose to provide mothers with opaque, weighted bottles (instead of conventional, clear bottles) with which to feed their infants; based on our preliminary studies, we hypothesize that removal of mothers’ abilities to assess the amount the infant consumes during a feeding will facilitate abilities to feed in response to infant satiation cues.For the proposed research, exclusively formula-feeding mothers with <2-week-old infants will be randomized to use weighted, opaque bottles (intervention or opaque group) or to use their preferred, clear bottles (control or clear group). We will conduct home-based assessments at the beginning and end of the 12- week study period, during which we will video-record mothers feeding their infants using clear or opaque bottles. We will also conduct two interim home assessments (after 2 and 6 weeks) to assess feeding adequacy and fidelity to the intervention. During feeding observations, infant intake will be assessed via bottle weight. Video-records will be later coded for maternal responsiveness to infant cues using the Nursing Child Assessment Parent-Child Interaction Feeding Scale (NCAFS). We hypothesize that mothers in the opaque group will feed their infants less and show greater increases in their levels of responsiveness to infant cues compared to mothers in the clear group. Infants’ weight and length will be measured at the beginning and end of the 12-week study; weight-for-length z-scores (WLZ) will be calculated using the WHO Growth Standards. We hypothesize that WLZ change will be significantly lower for infants in the opaque compared to the clear group. We will also explore the feasibility of our intervention by collecting and analyzing objective and subjective data related to the extent to which mothers use and like the bottles, and whether characteristics of mothers or infants moderate intervention effects. The proposed feasibility study is a critical step toward understanding mothers’ acceptance and use of opaque bottles compared to conventional, clear bottles, and the potential for opaque bottles to improve the outcome of feeding interactions in home-based settings.