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Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population.
Acad Pediatr 2018; 18(3):324-333APed

Abstract

OBJECTIVES

Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. We hypothesized that parent education, initiated prenatally and provided in the home, would reduce the incidence of infant overweight at age 12 months.

METHODS

Pregnant obese Latina women were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects.

RESULTS

Compared to controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age 6 months. Infants overweight at 6 months were likely to be overweight at age 12 months (r = 0.60, P < .0001). Overweight was more common in formula-fed infants at ages 6 months (P < .06) and 12 months (P = .005). Breastfeeding was less common in families with employed mothers (P = .02) and unemployed fathers (P < .01), but the father living with the mother at the time of the prenatal visit predicted successful breastfeeding at infant age 2 months (P < .003). Compared to formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed for ≥2 months (P = .01).

CONCLUSIONS

The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding.

Authors+Show Affiliations

College of Nursing and Health Innovation, Arizona State University, Phoenix, Ariz.Division of General Academic Pediatrics, Department of Pediatrics, Primary Care Pavilion, University of Texas Medical Branch at Galveston, Galveston, Tex. Electronic address: david.mccormick@utmb.edu.USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Tex.College of Nursing and Health Innovation, Arizona State University, Phoenix, Ariz.College of Nursing and Health Innovation, Arizona State University, Phoenix, Ariz.Department of Nursing Systems, University of Texas School of Nursing, Houston, Tex.College of Nursing and Health Innovation, Arizona State University, Phoenix, Ariz.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29277462

Citation

Reifsnider, Elizabeth, et al. "Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population." Academic Pediatrics, vol. 18, no. 3, 2018, pp. 324-333.
Reifsnider E, McCormick DP, Cullen KW, et al. Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population. Acad Pediatr. 2018;18(3):324-333.
Reifsnider, E., McCormick, D. P., Cullen, K. W., Todd, M., Moramarco, M. W., Gallagher, M. R., & Reyna, L. (2018). Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population. Academic Pediatrics, 18(3), pp. 324-333. doi:10.1016/j.acap.2017.12.007.
Reifsnider E, et al. Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population. Acad Pediatr. 2018;18(3):324-333. PubMed PMID: 29277462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population. AU - Reifsnider,Elizabeth, AU - McCormick,David P, AU - Cullen,Karen W, AU - Todd,Michael, AU - Moramarco,Michael W, AU - Gallagher,Martina R, AU - Reyna,Lucia, Y1 - 2017/12/23/ PY - 2015/04/17/received PY - 2017/11/15/revised PY - 2017/12/15/accepted PY - 2017/12/27/pubmed PY - 2019/6/18/medline PY - 2017/12/27/entrez KW - child KW - infant KW - intervention KW - obesity KW - prevention SP - 324 EP - 333 JF - Academic pediatrics JO - Acad Pediatr VL - 18 IS - 3 N2 - OBJECTIVES: Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. We hypothesized that parent education, initiated prenatally and provided in the home, would reduce the incidence of infant overweight at age 12 months. METHODS: Pregnant obese Latina women were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects. RESULTS: Compared to controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age 6 months. Infants overweight at 6 months were likely to be overweight at age 12 months (r = 0.60, P < .0001). Overweight was more common in formula-fed infants at ages 6 months (P < .06) and 12 months (P = .005). Breastfeeding was less common in families with employed mothers (P = .02) and unemployed fathers (P < .01), but the father living with the mother at the time of the prenatal visit predicted successful breastfeeding at infant age 2 months (P < .003). Compared to formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed for ≥2 months (P = .01). CONCLUSIONS: The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding. SN - 1876-2867 UR - https://www.unboundmedicine.com/medline/citation/29277462/Randomized_Controlled_Trial_to_Prevent_Infant_Overweight_in_a_High_Risk_Population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1876-2859(17)30607-1 DB - PRIME DP - Unbound Medicine ER -