BackgroundRapid weight gain during the first three years of life predicts child and adult obesity, and also later cardiovascular and other morbidities. Cross-sectional studies suggest that infant diet, activity and sleep are linked to excessive weight gain. As intervention for overweight children is difficult, the aim of the Prevention of Overweight in Infancy (POI.nz) study is to evaluate two primary prevention strategies during late pregnancy and early childhood that could be delivered separately or together as part of normal health care.Methods/DesignThis four-arm randomised controlled trial is being conducted with 800 families recruited at booking in the only maternity unit in the city of Dunedin, New Zealand. Mothers are randomised during pregnancy to either a usual care group (7 core contacts with a provider of government funded "Well Child" care over 2 years) or to one of three intervention groups given education and support in addition to "Well Child" care: the Food, Activity and Breastfeeding group which receives 8 extra parent contacts over the first 2 years of life; the Sleep group which receives at least 3 extra parent contacts over the first 6 months of life with a focus on prevention of sleep problems and then active intervention if there is a sleep problem from 6 months to 2 years; or the Combination group which receives all extra contacts. The main outcome measures are conditional weight velocity (0-6, 6-12, 12-24 months) and body mass index z-score at 24 months, with secondary outcomes including sleep and physical activity (parent report, accelerometry), duration of breastfeeding, timing of introduction of solids, diet quality, and measures of family function and wellbeing (parental depression, child mindedness, discipline practices, family quality of life and health care use). This study will contribute to a prospective meta-analysis of early life obesity prevention studies in Australasia.DiscussionInfancy is likely to be the most effective time to establish patterns of behaviour around food, activity and sleep that promote healthy child and adult weight. The POI.nz study will determine the extent to which sleep, food and activity interventions in infancy prevent the development of overweight.Trial RegistrationClinical Trials NCT00892983Prospective meta-analysis registered on PROSPERO CRD420111188. Available from http://www.crd.york.ac.uk/PROSPERO
The few existing early-life obesity prevention initiatives have concentrated on nutrition and physical activity, with little examination of sleep. METHODS:This community-based, randomized controlled trial allocated 802 pregnant women (≥16 years, <34 weeks' gestation) to: control, FAB (food, activity, and breastfeeding), sleep, or combination (both interventions) groups. All groups received standard well-child care. FAB participants received additional support (8 contacts) promoting breastfeeding, healthy eating, and physical activity (antenatal-18 months). Sleep participants received 2 sessions (antenatal, 3 weeks) targeting prevention of sleep problems, as well as a sleep treatment program if requested (6-24 months). Combination participants received both interventions (9 contacts). BMI was measured at 24 months by researchers blinded to group allocation, and secondary outcomes (diet, physical activity, sleep) were assessed by using a questionnaire or accelerometry at multiple time points. RESULTS:At 2 years, 686 women remained in the study (86%). No significant intervention effect was observed for BMI at 24 months (P = .086), but there was an overall group effect for the prevalence of obesity (P = .027). Exploratory analyses found a protective effect for obesity among those receiving the "sleep intervention" (sleep and combination compared with FAB and control: odds ratio, 0.54 [95% confidence interval, 0.35-0.82]). No effect was observed for the "FAB intervention" (FAB and combination compared with sleep and control: odds ratio, 1.20 [95% confidence interval, 0.80-1.81]). CONCLUSIONS:A well-developed food and activity intervention did not seem to affect children's weight status. However, further research on more intensive or longer running sleep interventions is warranted. Departments of a the Dean, Dunedin School of Medicine, b Preventive and Social Medicine, c Women's and Children's Health, d Human Nutrition, and e Medicine, University of Otago, Dunedin, New ZealandProf B Taylor is the co-principal investigator of the Prevention of Overweight in Infancy (POI) study, contributed to study design, co-led the sleep intervention, co-wrote the manuscript, and directed the statistical analyses; Mr Gray contributed to study design, designed and completed all statistical analyses, and wrote the relevant sections of the manuscript; Dr Galland contributed to study design, co-led the sleep intervention, and reviewed and revised the manuscript; Dr Heath contributed to study design, co-led the FAB (food, activity, and breastfeeding) intervention, and reviewed and revised the manuscript; Dr Lawrence contributed to study design, coordinated and led the management of the study, and reviewed and revised the manuscript; Ms Sayers delivered the sleep intervention, and reviewed and revised the manuscript; Drs Cameron, Hanna, and Dale contributed to data collection, and reviewed and revised the manuscript; Dr Coppell contributed to study design, and reviewed and revised the manuscript; and Prof R Taylor is the co-principal inves...
An early life intervention targeting improvements in child and parent physical activity as part of a wider obesity prevention initiative had little effect on physical activity at 2 yr of age.
These findings argue against having different BMI or waist circumference cutoffs for people of Polynesian descent.
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