Preventing Obesity through Intervention during Infancy

项目摘要/摘要 这项竞争性续签申请旨在继续对参与的儿童进行纵向评估 在干预护士开始婴儿健康成长轨迹(Insight)研究中，一项正在进行的 前瞻性、随机性、对照试验，测试反应性育儿(RP)干预 肥胖症的一级预防与家庭安全控制。在美国，23%的2-5岁儿童已经 超重和9%的人已经肥胖。到6-11岁时，34%的美国儿童超重，17%的儿童超重 他强调，需要采取具有持续效果的早期生活预防性干预措施。几乎没有 到目前为止有效的预防方法，我们通过招募279名婴儿和 父母在出生后第一年接受了四次家访，然后每年通过 年龄3岁。洞察课程包括从2岁到2岁的关于婴儿喂养、睡眠、 互动游戏、情绪调节和正常成长模式；这些领域是根据证据选择的 将它们与肥胖风险和它们被修改的可能性联系起来。到目前为止，洞察的结果是非常 阳性：1岁时RP婴儿的平均身长体重比对照组低，而且更不可能 在1岁时超重(p&lt；两个都是0.05)。在3岁时，我们的主要结果，身体质量指数(BMI)z- 评分，RP组显著低于对照组(-0.13比+0.15；p=0.04)。一种适用于多层次的模型 整个干预期呈三次时间趋势，证实了干预组的主效应(p=.0003)。 这些结果使Insight成为预防儿童肥胖最成功的早期干预试验 到目前为止。RP组儿童的睡眠时间和行为、饮食内容、 和情绪调节。Insight在3岁时保留了83%以上的参与者，但从长远来看 RP干预的效果尚未评估。 美国学龄儿童的高肥胖率和完全缺乏现有的早期生活 具有持续效果的初级预防干预措施构成了这一竞争性更新的科学前提 应用，它建议测试我们的RP干预对儿童的持续疗效和长期效果 体重指数。在参与者从5岁到9岁获得年度增长测量后，我们 将使用多水平建模来检查从幼儿到9岁的BMI增长曲线，并假设 RP效应将在不同的时间点持续存在。我们还期待RP小组的家长将利用更多的响应 父母的养育方式和RP组的孩子将表现出更强的饮食行为自我调节(抑制性 控制和食欲调节)，更好的睡眠，更多的体力活动，以及更少的久坐行为 初级评估点，在参与者6岁时进行。

PROJECT SUMMARY/ABSTRACT This competitive renewal application seeks to continue the longitudinal evaluation of children participating in the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study, an ongoing, prospective, randomized, controlled trial testing a responsive parenting (RP) intervention designed for the primary prevention of obesity versus a home safety control. In the US, 23% of 2-5 year olds are already overweight and 9% are already obese. By ages 6-11 years, 34% of US children are overweight and 17% are obese, highlighting the need for early life preventive interventions with sustained effects. With virtually no effective prevention approaches to date, we began INSIGHT by recruiting a birth cohort of 279 infants and parents who received four home visits during the first year after birth followed by annual clinic visits through age 3 years. The INSIGHT curriculum includes RP messages through age 2 years about infant feeding, sleep, interactive play, emotion regulation, and normal growth patterns; these areas were selected based on evidence linking them to obesity risk and their potential to be modified. Thus far, results from INSIGHT have been very positive: RP infants had lower mean weight-for-length at 1 year than controls and were less likely to be overweight at age 1 year (p<.05 for both). At age 3 years our primary outcome, body mass index (BMI) z- score, was significantly lower in the RP group than control (-0.13 vs. +0.15; p=.04). A multilevel model fit for the entire intervention period with a cubic time trend confirmed a main effect for intervention group (p=.0003). These results make INSIGHT the most successful early intervention trial for the prevention of childhood obesity to date. RP group children also have demonstrated improved sleep duration and behaviors, dietary content, and emotion regulation. INSIGHT has retained over 83% of participants through age 3 years, but the long-term effects of the RP intervention have not yet been assessed. The high rates of obesity among school age children in the US and the complete lack of existing early life primary preventive interventions with sustained effects form the scientific premise for this competitive renewal application, which proposes to test the sustained efficacy and long-term effects of our RP intervention on child BMI. Following attainment of annual growth measurements from participants from ages 5 through 9 years, we will use multilevel modeling to examine BMI growth curves from early childhood to age 9, and hypothesize that RP effects will persist across time points. We further expect that RP group parents will utilize more responsive parenting practices, and RP group children will exhibit greater self-regulation of eating behaviors (inhibitory control and appetite regulation), better sleep, more physical activity, and less sedentary behavior at the study's primary assessment point which occurs when participants are 6 years old.