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Okitundu-Luwa D, Imbula Essam B, Sombo Ayanne MT, Ndjukendi Omba A, Otete Djamba F, Kayembe Kalula T, Kamanga Mbuyi T, Guedeney A, Kashala-Abotnes E. Sustained social withdrawal behavior and 'difficult' temperament among infants, in relation to maternal affectivity in a low-income area of Kinshasa, Democratic Republic of Congo. Eur Child Adolesc Psychiatry 2023; 32:427-437. [PMID: 34536147 DOI: 10.1007/s00787-021-01873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
Little is known about the relationship between maternal affectivity, social withdrawal and temperament in infants in low-income countries. The goal of the study was to assess the prevalence of social withdrawal behavior in infants aged 8 ± 2.3 months and to explore associations between maternal affectivity during pregnancy and postpartum, infant social withdrawal (as a sign of stress) and 'difficult' temperament as assessed by the mothers. 458 mother-infant dyads were recruited in the city's public mother and child health-care centers. The eight items of the Alarm Distress Baby scale (8-ADBB) and the five-item M (modified) ADBB (M-ADBB) were used to assess sustained withdrawal behavior (ISSWB). The Goldberg Depression and Anxiety Scales were used to assess maternal affectivity and mental well-being. A specially designed questionnaire was used to identify stressful events faced by the mother during pregnancy. The ELDEQ-QCB was used to assess the degree of difficulty in managing the baby. Using the M-ADBB, we found a striking figure of 69.2% for ISSWB with 8-ABB (range 0-29) and 72.7% with the M-ADBB (range 0-10). ISSWB was linked to negative maternal affectivity and to high incidence of stressful events for the mothers, and to the child being viewed as 'difficult' by the mother. Positive prenatal affectivity was a protective factor of ISSWB (OR 0.46). Results are compared with previous studies in Africa. Early screening for ISSWB and identification of factors affecting maternal mental well-being could help in early intervention and increase the chances of better child development.
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Affiliation(s)
- Daniel Okitundu-Luwa
- Unités de Neurologie Pédiatrique et de Neuropsychologie, Département de Neurologie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, B.P.825, Kinshasa, Democratic Republic of the Congo.
| | - Brigitte Imbula Essam
- Service de Psychiatrie Femme et Enfants, Département de psychiatrie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marie-Thérèse Sombo Ayanne
- Unité de Neuropsychologie, Département de Neurologie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ally Ndjukendi Omba
- Service de Psychiatrie Femme et Enfants, Département de psychiatrie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Franck Otete Djamba
- Médecin Chargé de la Recherche et la Documentation Scientifique à la Fondation pour la Promotion et la Protection de la sante mentale de l'enfant «FOPPROSAME Asbl», Kinshasa, Democratic Republic of the Congo
| | - Tharcisse Kayembe Kalula
- Service de Neurodiagnostic, Département de Neurologie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Timothée Kamanga Mbuyi
- Département de Psychologie Clinique, Faculté de Psychologie et Sciences de l'Education Département et, Consultant au Département de Neurologie, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoine Guedeney
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Bichat, APHP, Paris et Université de Paris, Paris, France
| | - Espérance Kashala-Abotnes
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
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2
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Eagleton SG, Shriver LH, Buehler C, Wideman L, Leerkes EM. Longitudinal Associations Among Food Insecurity During Pregnancy, Parental Mental Health Symptoms, Controlling Feeding Styles, and Infant Food Responsiveness. J Nutr 2023; 152:2659-2668. [PMID: 36166350 PMCID: PMC9840003 DOI: 10.1093/jn/nxac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood. OBJECTIVES This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive). METHODS Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness. RESULTS Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness. CONCLUSIONS Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.
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Affiliation(s)
- Sally G Eagleton
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Lenka H Shriver
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Cheryl Buehler
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Esther M Leerkes
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
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Chen TL, Chien LY. Feeding self-efficacy and feeding outcome expectancy mediate the association between maternal depressive symptoms and responsive feeding. Acta Psychol (Amst) 2022; 230:103755. [DOI: 10.1016/j.actpsy.2022.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/01/2022] Open
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Coleta H, Schincaglia RM, Gubert MB, Pedroso J. Factors associated with infant feeding styles in the Federal District, Brazil. Appetite 2022; 179:106290. [DOI: 10.1016/j.appet.2022.106290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 01/21/2023]
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Ruggiero CF, Moore AM, Marini ME, Kodish SR, McHale SM, Savage JS. A mixed methods study of siblings’ roles in maternal feeding practices in early childhood: an application of the learning from experience process. Int J Behav Nutr Phys Act 2022; 19:64. [PMID: 35672783 PMCID: PMC9171978 DOI: 10.1186/s12966-022-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Firstborn children have higher rates of obesity compared to secondborns, perhaps due, in part, to differential feeding practices. Despite the centrality of siblings in family life and potential for influence, almost nothing is known about the role of siblings in parent feeding practices in early childhood.
Methods
Participants (n = 117) were mothers of consecutively born siblings. Firstborns participated in an RCT that compared a responsive parenting intervention designed for primary prevention of obesity against a safety control. Secondborns participated in an observational cohort. Multilevel models tested whether and how firstborn characteristics (temperament, appetite, rapid weight gain) at 16 weeks and 1 year were associated maternal feeding practices of secondborns in infancy at 16 weeks, 28 weeks, and 1 year (food to soothe) and at ages 1, 2, and 3 years (structure-and control-based feeding practices). A purposive subsample (n = 30) of mothers also participated in semi-structured interviews to further illuminate potential sibling influences on maternal feeding practices during infancy and toddlerhood.
Results
Firstborn characteristics did not predict secondborn feeding in infancy (all ps > 0.05). Firstborn negative affect, however, predicted mothers’ less consistent mealtime routines (b (SE) = − 0.27 (0.09); p = 0.005) and more pressure (b (SE) = 0.38 (0.12); p = 0.001). Firstborn appetite predicted mothers’ less frequent use of food to soothe (b (SE) = − 0.16 (0.07); p = 0.02) when secondborns were toddlers. Firstborn surgency, regulation, and rapid weight gain, however, did not predict secondborn feeding practices during toddlerhood (all ps > 0.05). Interviews with mothers revealed three ways that maternal experiences with firstborns informed feeding practices of secondborns: 1) Use of feeding practices with secondborn that worked for the firstborn; 2) Confidence came from firstborn feeding experiences making secondborn feeding less anxiety-provoking; and 3) Additional experiences with firstborn and other factors that contributed to secondborn feeding practices.
Conclusions
Some firstborn characteristics and maternal experiences with firstborns as well as maternal psychosocial factors may have implications for mothers’ feeding practices with secondborns. Together, these mixed methods findings may inform future research and family-based interventions focused on maternal feeding of siblings in early childhood.
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Helle C, Hillesund ER, Øverby NC. Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years. PLoS One 2022; 17:e0261222. [PMID: 34995296 PMCID: PMC8740973 DOI: 10.1371/journal.pone.0261222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022] Open
Abstract
Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.
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Affiliation(s)
- Christine Helle
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- * E-mail:
| | - Elisabet R. Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina C. Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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7
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Gross RS, Brown NM, Mendelsohn AL, Katzow MW, Arana MM, Messito MJ. Maternal Stress and Infant Feeding in Hispanic Families Experiencing Poverty. Acad Pediatr 2022; 22:71-79. [PMID: 33940204 PMCID: PMC8556387 DOI: 10.1016/j.acap.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/10/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Maternal stress has been associated with early child obesity through pathways related to decreased exclusive breastfeeding and increased nonresponsive maternal-infant feeding styles. We sought to gain an in-depth understanding of how maternal stress, sadness, and isolation are perceived to affect feeding, in order to inform modifiable targets of intervention. METHODS We conducted semi-structured qualitative interviews with Hispanic mothers living in poverty with young infants between 3 and 7 months old (n = 32) from the intervention group of a randomized controlled trial of an early child obesity prevention intervention (Starting Early Program). Bilingual English-Spanish interviewers conducted the interviews, which were audio recorded, transcribed, and translated. Building on an existing theoretical framework developed by the National Scientific Council on the Developing Child, we used an iterative process of textual analysis to code the transcripts, until thematic saturation was reached. RESULTS Three key themes were described: 1) maternal stress responses were varied and included positive (brief and mild), tolerable (sustained but limited long-term impacts), or toxic stress (sustained and severe); 2) buffers included support from family, infants, health care providers, social service programs, and community organizations; 3) perceived effects on infant feeding included decreased breastfeeding due to concerns about stress passing directly through breast milk and indirectly through physical closeness, and increased nonresponsive feeding styles. CONCLUSIONS Maternal stress, particularly toxic stress, was perceived to negatively affect infant feeding. Mothers reported disrupting healthy feeding to avoid infant exposure to stress. Interventions to enhance buffering may help to mitigate toxic stress and promote healthy feeding interactions.
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Affiliation(s)
- Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
| | - Nicole M. Brown
- Strong Children Wellness Medical Group, 163-18 Jamaica Avenue, Jamaica, NY, 11432
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
| | - Michelle W. Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Ave, New Hyde Park, NY, 11040
| | - Mayela M. Arana
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
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Bensignor MO, Freese RL, Sherwood NE, Berge JM, Kunin-Batson A, Veblen-Mortenson S, French SA. The Relationship between Household SNAP Participation, Parent Feeding Styles, and Child Eating Behaviors. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021; 19:23-37. [PMID: 38174344 PMCID: PMC10760976 DOI: 10.1080/19320248.2021.1994506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This cross-sectional analysis of the Minnesota Now Everybody Together for Amazing Healthful Kids (NET-Works) study evaluated whether SNAP participation was associated with specific parental feeding styles and child eating behaviors. Associations between parent-reported feeding styles and child eating behaviors and SNAP participation were examined using multiple linear regression analyses and responses from 534 parent/child dyads (49.1% female children, 91.7% female parents). SNAP participation was not associated with specific feeding styles or child eating behaviors when adjusting for food insecurity, timing in SNAP cycle, and other covariates in this large, ethnically and racially diverse sample of predominantly mothers and preschool-aged children. Other factors, such as food insecurity, not SNAP participation, may influence parental feeding and child eating behaviors, and screening by health care providers is recommended.
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Affiliation(s)
- Megan O Bensignor
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN
- Healthy Weight Research Center, University of Minnesota, Minneapolis, MN
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Nancy E Sherwood
- Healthy Weight Research Center, University of Minnesota, Minneapolis, MN
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jerica M Berge
- Healthy Weight Research Center, University of Minnesota, Minneapolis, MN
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | - Alicia Kunin-Batson
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN
- Healthy Weight Research Center, University of Minnesota, Minneapolis, MN
| | - Sara Veblen-Mortenson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Simone A French
- Healthy Weight Research Center, University of Minnesota, Minneapolis, MN
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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9
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Feldens CA, Vítolo MR, Maciel RR, Baratto PS, Rodrigues PH, Kramer PF. Exploring the risk factors for early-life sugar consumption: A birth cohort study. Int J Paediatr Dent 2021; 31:223-230. [PMID: 32815208 DOI: 10.1111/ipd.12713] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/26/2020] [Accepted: 08/10/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sugar consumption in early childhood is the primary cause of negative health outcomes, including early childhood caries. AIM To investigate risk factors associated with early-life sugar consumption. DESIGN Explanatory variables were collected at baseline of a birth cohort in Porto Alegre, Southern Brazil. At six months of age, data were collected on child feeding practices, including the number of foods and beverages containing sugar. Multivariate Poisson regression analysis with robust variance was performed. RESULTS Virtually all children (98.3%) had consumed sugar by the age of 6 months. Multivariable analysis showed that the number of sweet items was significantly larger in children whose mothers were less than 20 years of age (MR = 1.19; 95% CI: 1.05-1.36), those from non-nuclear families (MR = 1.12; 95% CI: 1.04-1.20), those whose mothers had less than eight years of schooling (MR = 1.34; 95% CI: 1.20-1.50) and those whose mothers smoked (MR = 1.23; 95% CI: 1.13-1.35). Moreover, the number of sweet items was significantly lower among children who breastfed in the first hour of life (MR = 0.85; 95% CI: 0.76-0.95). CONCLUSION Sugar consumption begins very early, especially in children with no access to breastfeeding in the first hours of life and those from younger, less educated, and smoking mothers.
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Affiliation(s)
| | - Márcia Regina Vítolo
- Graduate Program in Pediatrics: Child and Adolescent Health Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Renata Rocha Maciel
- Graduate Program in Dentistry, Universidade Luterana do Brasil, Canoas, Brazil
| | - Paola Seffrin Baratto
- Graduate Program in Pediatrics: Child and Adolescent Health Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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10
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Graf MD, Karp SM, Lutenbacher M, Wasser H, Bushaw A, Dietrich MS. Clinical strategies for addressing obesity in infants and toddlers. Nurse Pract 2021; 46:28-33. [PMID: 33475327 DOI: 10.1097/01.npr.0000731552.88748.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.
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11
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Echevarría-Castro N, Matayoshi-Pérez A, Alvarado GF. Association between Maternal Depressive Symptoms with Overweight/Obesity among Children Aged 0-5 Years According to the 2016 Demographic and Family Health Survey. Child Obes 2020; 16:307-315. [PMID: 32429683 DOI: 10.1089/chi.2019.0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Overweight and obesity among children under the age of 5 have become a public health problem. The worldwide prevalence is 4.9% and 6.0%, whereas in Peru it is 7.4% and 1.9%, respectively. The causes of these problems are multifactorial and must be studied to prevent the multiple consequences on children's health. Methods: Secondary data analysis of the 2016 Demographic and Family Health Survey (DHS). The sample size was 7935 children and their mothers. The dependent variable was childhood overweight/obesity, measured according to the Z-score of the BMI >2 standard deviation (SD), while the main independent variable consisted of the maternal depressive symptoms (DS) (Patient Health Questionnaire-9 score >10 points). The software STATA/MP 14.0 was used for statistical analysis. Results: The prevalence of overweight/obesity among children aged 0-5 years was 4.5% and the prevalence of moderate and severe maternal DS was 7.1%. No maternal depressive symptoms were found to be associated with the outcome [adjusted PR = 1.36 95% confidence interval (CI) = 0.59-3.09 p = 0.47]. An association was found between socioeconomic status (SES) Q3 (adjusted PR = 3.86 95% CI = 1.9-7.6 p < 0.0001), Q4 (adjusted PR = 5.53 95% CI = 2.76-11.1 p < 0.0001), Q5 (adjusted PR = 6.9 95% CI = 3.24-14.7 p = < 0.0001), maternal BMI (adjusted PR = 1.06 95% CI = 1.03-1.08 p < 0.0001), and cesarean delivery (adjusted PR = 1.42 95% CI = 1.01-1.99 p = 0.042). Conclusions: No association was found between maternal depressive symptoms and overweight/obesity among children aged 0-5 years. The upper SES quintiles, maternal BMI, and cesarean delivery were associated with the outcome.
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Affiliation(s)
- Nataly Echevarría-Castro
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Scientific Society of Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Andrea Matayoshi-Pérez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Scientific Society of Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Germán F Alvarado
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Matvienko-Sikar K, Cooney J, Flannery C, Murphy J, Khashan A, Huizink A. Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review. J Reprod Infant Psychol 2020; 39:180-204. [PMID: 32046507 DOI: 10.1080/02646838.2020.1724917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.
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Affiliation(s)
| | - Jennifer Cooney
- School of Applied Psychology, University College Cork , Cork, Ireland
| | - Caragh Flannery
- School of Public Health, University College Cork , Cork, Ireland
| | - Jennifer Murphy
- School of Public Health, University College Cork , Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork , Cork, Ireland.,Irish Centre for Fetal and Neonatal Transnational Research (INFANT) Centre, Cork University Maternity Hospital , Cork, Ireland
| | - Anja Huizink
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam , Amsterdam, The Netherlands
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Bahorski JS, Childs GD, Loan LA, Azuero A, Rice MH, Chandler-Laney PC, Hodges EA, Wasser HM, Thompson AL, Bentley ME. Parental Self-Efficacy in New Mothers Predicts Infant Growth Trajectories. West J Nurs Res 2019; 42:254-261. [PMID: 31170891 DOI: 10.1177/0193945919854464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine whether parental self-efficacy (PSE) is associated with change in infant weight-for-length z score (WLZ) from age 3 to 12 months. Data were drawn from the Infant Care, Feeding, and Risk of Obesity study, conducted with low-income, African American mother-infant dyads (n = 127). PSE was measured at infant age of 3 months. Infant anthropometrics were measured at infant age of 3 and 12 months, WLZ change between these time points was calculated, and infants stratified into WLZ change categories (expected, excessive, or slow). To analyze the data, ANCOVA, multiple regression, and post hoc techniques were used. Controlling for infant birthweight, PSE at 3 months was associated with infant WLZ change (η2 = 0.05, p = .04). Mothers of infants who exhibited excessive growth had higher PSE than mothers of infants who exhibited slow growth (Tukey-adjusted p = .03). This finding suggests that infants of mothers with high PSE may have increased obesity risk, but more research is needed.
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Affiliation(s)
| | | | - Lori A Loan
- The University of Alabama at Birmingham, USA
| | | | | | | | - Eric A Hodges
- The University of North Carolina at Chapel Hill, USA
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Katzow M, Messito MJ, Mendelsohn AL, Scott MA, Gross RS. The Protective Effect of Prenatal Social Support on Infant Adiposity in the First 18 Months of Life. J Pediatr 2019; 209:77-84. [PMID: 30879731 PMCID: PMC6535345 DOI: 10.1016/j.jpeds.2019.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/22/2019] [Accepted: 02/13/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether prenatal social support was associated with infant adiposity in the first 18 months of life in a low-income, Hispanic sample, known to be at high risk of early child obesity. STUDY DESIGN We performed a longitudinal analysis of 262 low-income, Hispanic mother-infant pairs in the control group of the Starting Early child obesity prevention trial. Prenatal social support was measured using an item from the Maternal Social Support Index. We used multilevel modeling to predict weight-for-length z-score trajectories from birth to age 18 months and logistic regression to predict macrosomia and overweight status at ages 6, 12, and 18 months. RESULTS High prenatal social support was independently associated with lower infant adiposity trajectories from birth to age 18 months (B = -0.40; 95% CI, -0.63 to -0.16), a lower odds of macrosomia (aOR = 0.35; 95% CI, 0.15-0.80), and a lower odds of overweight at ages 12 (aOR = 0.28; 95% CI, 0.10-0.74) and 18 months (aOR = 0.35; 95% CI, 0.14-0.89). Prenatal social support was not significantly associated with overweight status at age 6 months. CONCLUSIONS Prenatal social support may protect against excessive infant adiposity and overweight in low-income, Hispanic families. Further research is needed to elucidate mechanisms underlying these associations and to inform preventive strategies beginning in pregnancy.
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Affiliation(s)
- Michelle Katzow
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY.
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Marc A. Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, New York
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15
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Bahorski JS, Childs GD, Loan LA, Azuero A, Morrison SA, Chandler-Laney PC, Hodges EA, Rice MH. Self-efficacy, infant feeding practices, and infant weight gain: An integrative review. J Child Health Care 2019; 23:286-310. [PMID: 30071746 PMCID: PMC8513131 DOI: 10.1177/1367493518788466] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It has been suggested that self-efficacy specific to parenting or feeding may influence the decisions parents make regarding infant feeding; however, a review of this topic has not been conducted. The purpose of this integrative review is to synthesize the literature regarding the potential role of self-efficacy in infant feeding practices or infant weight gain. A total of 40 articles were used to guide this review, which were classified into three categories examining an association with self-efficacy (1) breastfeeding; (2) infant feeding practices such as parental feeding style and dietary quality; and (3) infant weight gain. Evidence regarding breastfeeding self-efficacy (BFSE) and breastfeeding is extensive; mothers with a higher sense of BFSE more often initiate breastfeeding and breastfeed for longer durations. The evidence regarding self-efficacy and the association with infant feeding practices other than breastfeeding is sparse. However, several studies report that mothers who have a higher sense of self-efficacy are more likely to follow infant feeding practices which align with recommendations. The authors have speculated an association between self-efficacy and infant weight gain; yet, to date, no study has found a significant association. More research is needed on the topic, particularly in diverse populations and with fathers and mothers.
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Affiliation(s)
- Jessica S Bahorski
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gwendolyn D Childs
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lori A Loan
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon A Morrison
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula C Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric A Hodges
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marti H Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Gross RS, Mendelsohn AL, Messito MJ. Additive effects of household food insecurity during pregnancy and infancy on maternal infant feeding styles and practices. Appetite 2018; 130:20-28. [PMID: 30031787 DOI: 10.1016/j.appet.2018.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/02/2018] [Accepted: 07/16/2018] [Indexed: 12/28/2022]
Abstract
Food insecurity, or the limited access to food, has been associated with maternal child feeding styles and practices. While studies in other parenting domains suggest differential and additive impacts of poverty-associated stressors during pregnancy and infancy, few studies have assessed relations between food insecurity during these sensitive times and maternal infant feeding styles and practices. This study sought to analyze these relations in low-income Hispanic mother-infant pairs enrolled in a randomized controlled trial of an early obesity prevention program (Starting Early). Food insecurity was measured prenatally and during infancy at 10 months. Food insecurity timing was categorized as never, prenatal only, infancy only, or both. Regression analyses were used to determine relations between food insecurity timing and styles and practices at 10 months, using never experiencing food insecurity as the reference, adjusting for family characteristics and material hardships. 412 mother-infant pairs completed 10-month assessments. Prolonged food insecurity during both periods was associated with greater pressuring, indulgent and laissez-faire styles compared to never experiencing food insecurity. Prenatal food insecurity was associated with less vegetable and more juice intake. If food insecurity is identified during pregnancy, interventions to prevent food insecurity from persisting into infancy may mitigate the development of obesity-promoting feeding styles and practices.
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Affiliation(s)
- Rachel S Gross
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA.
| | - Alan L Mendelsohn
- Department of Pediatrics, Division of Developmental - Behavioral Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA.
| | - Mary Jo Messito
- Department of Pediatrics, Division of General Pediatrics, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA.
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17
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El Ghaziri N, Darwiche J. Adult Self-Esteem and Family Relationships. SWISS JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1024/1421-0185/a000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract. We conducted a literature review to examine the effects of self-esteem in the family context, selecting 40 studies exploring the associations between self-esteem, coparental relationship, parent-child relationship, and global family functioning. The research focused primarily on self-esteem and the parent-child relationship. The evidence indicates that parents with high self-esteem experience enhanced satisfaction with their children and exhibit more positive interactions with them. It was also found that parents’ high self-esteem is associated with less physical abuse and child neglect. Studies focusing on coparenting and family functioning are still rare, and more evidence is needed to establish robust conclusions.
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Affiliation(s)
- Nahema El Ghaziri
- Family and Development Research Center, Institute of Psychology, University of Lausanne, Switzerland
| | - Joëlle Darwiche
- Family and Development Research Center, Institute of Psychology, University of Lausanne, Switzerland
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18
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Barrett KJ, Wasser HM, Thompson AL, Bentley ME. Contributions of nonmaternal caregivers to infant feeding in a low-income African-American sample. MATERNAL AND CHILD NUTRITION 2018; 14:e12610. [PMID: 29693776 DOI: 10.1111/mcn.12610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022]
Abstract
Infant feeding is a well-established topic of interest in obesity research, yet few studies have focused on contributions of nonmaternal caregivers (NMCs)-such as fathers, grandparents, and daycare providers-to infant feeding. Data from the Infant Care, Feeding and Risk of Obesity Project in North Carolina were used to investigate (a) which factors were associated with NMC feeding styles and (b) how NMCs' and mothers' feeding styles compared. Multivariate regression models utilizing random effects were used to analyse data from 108 NMCs who were identified by mothers as being heavily involved in infant feeding. Feeding styles were measured using the Infant Feeding Style Questionnaire. Several individual characteristics were important. Higher laissez faire-attention scores were reported by men and NMCs who lived in the same household as infant. Men reported higher indulgent-coax and indulgent-pamper scores. Perceptions of fussier infants, older infant age, and higher infant weight-for-length z-scores were also important. Mothers' and NMCs' feeding styles differed. Compared with mothers, grandparents reported lower laissez faire and indulgent-permissive scores. Fathers reported higher pressure-soothe and indulgent scores. Daycare providers reported higher restriction-diet quality and responsive satiety. Feeding styles were also predicted to change over time for all caregiver types. These findings highlight the importance of helping all caregivers develop skills that will promote optimal infant feeding outcomes. Given the paucity of research in this area, it is important to improve our understanding of what influences caregivers' feeding styles, especially among diverse populations, and how exposure to different feeding styles may shape children's obesity risk.
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Affiliation(s)
- Katherine J Barrett
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Heather M Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret E Bentley
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Greydanus DE, Agana M, Kamboj MK, Shebrain S, Soares N, Eke R, Patel DR. Pediatric obesity: Current concepts. Dis Mon 2018; 64:98-156. [DOI: 10.1016/j.disamonth.2017.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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COSTA KAOD, ANTUNES MMDC, CABRAL PC, SILVA GAPD. Feeding style of adolescent mothers and complementary feeding practice of their infants. REV NUTR 2018. [DOI: 10.1590/1678-98652018000100005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective To evaluate feeding styles of adolescent mothers and complementary feeding practices of their infants. Methods A cross-sectional study comparing a group of dyads of 50 adolescent mothers (ages 15 to 19) with 62 adult mothers (ages 24 to 44) and their infants (9 to 24 months) was performed. All mothers and infants were assisted by three basic health family units in the city of Recife, Brazil. Data were collected through a structured interview on socioeconomic conditions, maternal styles of feeding the child, and evaluation of infant feeding practices. The food styles were classified as responsive, authoritative, and passive, according to the adapted form of Carvalhaes, Perosa and Silveira of 2009. The frequency of food intake was calculated for six food groups (1. Bread and cereals; 2. Fruits and vegetables; 3. Meat, eggs, and beans; 4. Milk and dairy products; 5. Sugars, sweets, and fats; 6. Industrialized food). Children’s anthropometry and body mass index by age were classified into Z-score according to the World Health Organization Standard Curves, 2006. Results Adolescent mothers began complementary feeding more frequently before the seventh month (.=0,02), presented less responsive (.=0.04) and more authoritarian feeding styles (.=0.01), and their children received more foods with sugars, oils, and fats (.=0.02), and less meat, eggs, and beans (.=0.06) than the children of adult mothers. Conclusion Adolescent mothers adopt less responsive eating styles and offer more inadequate complementary feeding for their infants.
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21
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Lindsay AC, Mesa T, Greaney ML, Wallington SF, Wright JA. Associations Between Maternal Depressive Symptoms and Nonresponsive Feeding Styles and Practices in Mothers of Young Children: A Systematic Review. JMIR Public Health Surveill 2017; 3:e29. [PMID: 28550007 PMCID: PMC5466702 DOI: 10.2196/publichealth.6492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/16/2016] [Accepted: 03/25/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children's eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity. OBJECTIVE The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research. METHODS Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed. RESULTS The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association. CONCLUSIONS This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs.
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Affiliation(s)
- Ana Cristina Lindsay
- Exercise and Health SciencesCollege of Nursing and Health SciencesUniversity of Massachusetts BostonBoston, MAUnited States
| | - Tatiana Mesa
- Exercise and Health SciencesCollege of Nursing and Health SciencesUniversity of Massachusetts BostonBoston, MAUnited States
| | - Mary L Greaney
- Department of KinesiologyKinesiology/Health StudiesUniversity of Rhode IslandKingston, RIUnited States
| | - Sherrie F Wallington
- Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterGeorgetown UniversityWashington, DCUnited States
| | - Julie A Wright
- Exercise and Health SciencesCollege of Nursing and Health SciencesUniversity of Massachusetts BostonBoston, MAUnited States
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22
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Hohman EE, Paul IM, Birch LL, Savage JS. INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants. Obesity (Silver Spring) 2017; 25:185-191. [PMID: 28008749 PMCID: PMC5189916 DOI: 10.1002/oby.21705] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether a responsive parenting (RP) intervention affects infant dietary patterns. METHODS Primiparous mother-newborn dyads (n = 291) were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) RP intervention or control. Curricula were delivered at nurse home visits at ages 3, 16, 28, and 40 weeks. RP group feeding guidance advised responsive feeding, delayed introduction of solids, repeated exposure to novel foods, and age-appropriate portion sizes. Latent class analysis identified patterns of dietary exposure at 9 months. Class membership at 9 months was used to predict BMI percentile at 2 years. RESULTS Five dietary patterns were identified: "Breastfed, Fruits and Vegetables," "Breastfed, Low Variety," "Formula, Fruits and Vegetables," "Formula, Low Variety," and "Formula, High Energy Density." Over 60% of infants had patterns low in fruits and vegetables or high in energy-dense foods. RP group infants were less likely than control to be in the "Formula, Low Variety" class (OR = 0.40, 95% CI 0.23-0.71) or "Formula, High Energy Density" class (OR = 0.28, 95% CI 0.12-0.61) relative to the "Formula, Fruits and Vegetables" class. Dietary pattern at 9 months was significantly associated with BMI percentile at 2 years. CONCLUSIONS While a majority of infants consumed diets low in fruits and vegetables, the INSIGHT RP intervention was associated with healthier dietary patterns.
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Affiliation(s)
- Emily E. Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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