Leann Birch - US grants

DESCRIPTION: (investigator's abstract) This competitive continuation grant proposes 5 years of funding to continue the prospective longitudinal study of the developing behavioral controls of food intake, with a focus on dieting, and concurrent emergence of problems of energy balance (overweight, obesity, and eating disorders) among girls. 192 girls were followed longitudinally from ages 5 to 9 years, and this application proposes to continue through 11, 13, and 15 years, when problems of energy balance are pervasive among girls. Overweight, obesity, and chronic dieting have reached epidemic proportion in the US and pose major threats to adolescent girls' health, including elevated risk for CVD, NIDDM, cancer, depression, and low self-esteem. Specific aims are unchanged: 1) to characterize individual differences among girls in the development of the behavioral controls of food intake and weight status from middle childhood through middle adolescence. 2) To identify familial predictors of individual differences among girls in the behavioral controls of food intake and weight status. The investigators propose to use longitudinal data to evaluate whether familial influences such as parents' weight status, dieting history and child feeding strategies identified in childhood predict differences in eating and weight patterns into adolescence. Such information is essential in designing effective preventive interventions to address the epidemic levels of overweight, chronic dieting and weight concerns among girls and women. 3) To obtain descriptive data on what girls are doing when they report dieting. Girls report that they are dieting, but specific weight control strategies used can have very different implications for health; for example, are dieting girls eating more fruits and vegetables, or using purgatives and fasting?

disease /disorder prevention /control

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This is a study to assess the effectiveness of a visiting nurses program to improve the health of newborns. The study objectives are to: 1. teach parents to calm their infants and improve their sleep; 2. teach parents about their infant's nutrition and 3. assess the effect of improved sleep and nutrition on infant growth in the first year.

DESCRIPTION (provided by applicant): Given the rise in the prevalence of childhood overweight and obesity, it is essential to develop nutritionally sound dietary strategies that prevent excessive weight gain and encourage the maintenance of healthy body weight in children. One dietary approach that has shown promise in adults involves varying the properties of foods that affect satiety and energy intake. For example, consuming foods that are reduced in dietary energy density (kcal/g) leads to decreased energy intake and improved diet quality in adults. Changes in the portion size and the variety of available foods can also affect energy intake. The proposed studies will extend these findings and determine how changes in foods and meals can be used strategically to moderate energy intake and improve diet quality in preschool children. The specific focus will be on reducing energy density and energy intake by increasing children's intake of vegetables at meals. In a series of crossover studies in [three] childcare centers, different strategies for influencing energy density and food intake will be tested by serving meals that are varied in portion size, variety, and meal structure. One strategy is to serve vegetables at the start of a meal when there are no competing foods available. It is hypothesized that vegetable intake will increase and that this effect will depend upon the portion served. Another strategy is to increase the proportion of vegetables served at meals. Public health organizations recommend this approach, and while it is likely to improve diet quality, its effect on energy intake has not been determined. Finally, the effect of increasing the variety of vegetables served at the meal will be assessed. The specific aims are to determine the effects on vegetable intake and energy intake of the following: 1) varying the portion size of vegetables served at the start of a meal;2) increasing the proportion of vegetables served during a meal either by adding extra vegetables or by substituting vegetables for other foods;and 3) increasing the variety of vegetables at the start of a meal or at the main course. In recent years there have been significant advances in understanding the influence of energy density, portion size, and variety of foods on energy intake and diet quality among adults, but much of this knowledge has not yet been extended to children. The proposed studies apply the findings from previous research on satiety in adults to advancing understanding of how the properties of foods and the structure of meals influence energy intake in preschool children. These data will translate to the development of specific strategies that can be adapted to children's energy needs and inform the design of effective public health messages to help prevent childhood obesity. PUBLIC HEALTH RELEVANCE: Because of the increasing rates of childhood overweight and obesity, there is an urgent need to find effective strategies that will help to reduce excess energy intake in children. The proposed studies will indicate how modifications in the portion size and variety of foods served at meals can be employed to increase vegetable intake, improve diet quality, and help to moderate energy intake in children. Such strategies will be of practical use in preventing childhood obesity and its serious consequences to health.

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.

Project Summary Racial disparities in overweight and obesity among Black children compared to White children begin early in development and continue throughout the lifespan. Infancy is a critical period for later obesity risk, and rapid weight gain during infancy is one of the most consistent risk factors associated with later overweight and obesity. Despite these well-established associations and the clear need for intervention, there has been limited attention to modifiable behavioral, social/contextual, and biological determinants of early rapid weight gain and to approaches to prevent excess infant weight gain among African American infants living in underserved, low SES contexts. Multi-component responsive parenting programs that teach parents to interact with their child in ways that are responsive, appropriate, and contingent hold great promise in reducing rapid weight gain and later obesity risk, but remain largely untested in this population and may be too burdensome to implement in their existing form in these high-stress contexts. Furthermore, the potential for moderation of intervention effectiveness by stressors common to underserved populations, including depressive symptoms, poverty, and relationship strain, has not been considered. The current proposal seeks funding to examine the impact of a responsive parenting intervention focused on infant sleep and soothing to reduce rapid weight gain among African Americans living in underserved, low SES contexts in the rural South. To do this, we propose a microtrial, a short-term longitudinal randomized experimental design that can provide a more focused test of the efficacy of a single intervention component and the conditions under which this component is efficacious. Specifically, we plan to pursue the following specific aims: (1) To assess the effects of responsive parenting, focused on infant sleep and soothing, on reducing rapid weight gain from 2 weeks to 8 weeks among African American infants; (2) To assess effects of responsive parenting on parental and infant behaviors (sleep, soothing, and feeding), and whether these behaviors mediate effects on infant growth; and (3) To examine moderation of intervention effects by individual and contextual factors common among African American mothers. The proposed microtrial represents an important step in efforts to better intervene to reduce obesity risk among rural African Americans by understanding factors in infancy that affect long-term outcomes. Data from this project will be used to inform the development of a multi-component program tailored to this high- need context in order to prevent child obesity.