Home intervention for reducing sugary drinks & obesity in Hispanic women-infants

项目摘要 婴儿期饮用含糖饮料和果汁（SSB/J）与早期肥胖有关。 童年.这是一个重大的公共卫生问题，需要以家庭为基础的解决办法。然而，干预措施旨在 基于先前研究的有限效果，SSB/J减少仍然存在争议，并关注是否靶向 一个因素会影响多个因素的肥胖问题。然而，尽管先前在肥胖症患者中进行的试验 青少年在白人中没有显示出SSB/J降低的效果，在西班牙裔中有很大的显著效果。 此外，没有研究检查婴儿期开始食用时SSB/J减少的影响 脂肪组织正在迅速发育因此，我们建议进行一项试验，旨在减少SSB/J的消耗， 低收入的西班牙裔产后母亲和婴儿是肥胖症高危人群。 虽然需要母婴干预，但它们带来了许多挑战，包括依从性和 潴留我们提出了一个创新的解决方案，合并了SSB/J有效干预措施的组成部分 减少和母婴营养，纳入现有的家访计划（HVP），这是联邦政府 在全国范围内提供支助，以促进高危人群的儿童发展。为期24个月的干预将 重点是用水取代母亲摄入的SSB/J，并推迟SSB/J的引入和限制其获取 在婴儿中，使用家访、电话，在一组中，使用送水/无热量饮料。 在妊娠前超重/肥胖的西班牙裔母亲（n=240）将被随机分配， 新生儿分为三组。第1组（疗效）将接受改良HVP，重点关注 SSB/J减少加上家庭交付。第2组（平移）与第1组相同，但未进行家庭递送。 第3组（对照组）将接受标准治疗HVP。主要结果将是通过DEXA检测母亲的体脂 和婴儿。目标1测试干预是否会降低产后母亲的肥胖和代谢风险。 目标2测试干预是否减少婴儿体脂和身长体重的轨迹。我们将 还检查这些效果是否在没有送货上门的情况下保持，从而支持 干预方法。目的3测试是否对婴儿的影响是通过母体传播介导的 与母亲甜味偏好的变化、使用SSB/J安抚婴儿、使用含糖食物有关 以及母乳中糖的分布。总之，这次试验将产生经验证据 支持一个可扩展的，公共卫生，生命周期的战略，以解决西班牙裔母亲和婴儿的肥胖问题。

Project Summary Consumption of sugar sweetened beverages and juices (SSB/J) in infancy is associated with obesity in early childhood. This is a significant public health issue requiring family based solutions. Yet interventions aimed at SSB/J reduction remain controversial based on limited effects in prior studies and concerns whether targeting a single factor will have an impact on the multi-factorial problem of obesity. However, while a prior trial in obese teenagers showed no effect of SSB/J reduction in Caucasians, there was a large significant effect in Hispanics. Furthermore, no study has examined the effects of SSB/J reduction during infancy when consumption begins and adipose tissue is rapidly developing. We therefore propose a trial aimed at reducing SSB/J consumption in low-income, Hispanic post-partum mothers and infants, a segment of the population at high risk for obesity. Although maternal-infant interventions are needed, they present many challenges including compliance and retention. We propose an innovative solution that merges components of effective interventions for SSB/J reduction and maternal-infant nutrition, into an existing home visit program (HVP), which are federally supported nationwide for promoting child development in high-risk populations. The 24-month intervention will focus on replacing mothers’ intake of SSB/J with water, and delaying introduction and limiting access to SSB/J in infants using home visits, telephone calls and in one group, home delivery of water/non-caloric beverages. Hispanic mothers who were overweight/obese prior to pregnancy (n=240) will be randomized with their newborn infants to one of three groups. Group 1 (efficacy) will receive a modified HVP incorporating a focus on SSB/J reduction plus home delivery. Group 2 (translation) will be identical to Group 1 without home delivery. Group 3 (control) will receive standard of care HVP. The main outcome will be body fat by DEXA in mothers and infants. Aim 1 tests whether the intervention will reduce obesity and metabolic risk in post-partum mothers. Aim 2 tests whether the intervention reduces the trajectory for body fat and weight-for-length in infants. We will also examine if these effects are maintained without home delivery, thus supporting scalability of the intervention approach. Aim 3 tests whether the effects on infants are mediated via maternal transmission related to changes in maternal sweet taste preference, use of SSB/J to sooth infants, use of sugary foods during weaning, and the profile of sugars in breast milk. In summary, this trial will generate empirical evidence to support a scalable, public health, life-course strategy for addressing obesity in Hispanic mothers and infants.