Background Heterogeneity in the outcomes collected and reported in trials of interventions to prevent obesity in the first five years of life highlights the need for a core outcome set to streamline intervention evaluation and synthesis of effects. This study aimed to develop a core outcome set for use in early childhood obesity prevention intervention studies in children from birth to five years of age (COS-EPOCH). Methods The development of the core outcome set followed published guidelines and consisted of three stages: (1) systematic scoping review of outcomes collected and reported in early childhood obesity prevention trials; (2) e-Delphi study with stakeholders to prioritise outcomes; (3) meeting with stakeholders to reach consensus on outcomes. Stakeholders included parents/caregivers of children aged ≤ five years, policy-makers/funders, researchers, health professionals, and community and organisational stakeholders interested in obesity prevention interventions. Results Twenty-two outcomes from nine outcome domains (anthropometry, dietary intake, sedentary behaviour, physical activity, sleep, outcomes in parents/caregivers, environmental, emotional/cognitive functioning, economics) were included in the core outcome set: infant tummy time; child diet quality, dietary intake, fruit and vegetable intake, non-core food intake, non-core beverage intake, meal patterns, weight-based anthropometry, screentime, time spent sedentary, physical activity, sleep duration, wellbeing; parent/caregiver physical activity, sleep and nutrition parenting practices; food environment, sedentary behaviour or physical activity home environment, family meal environment, early childhood education and care environment, household food security; economic evaluation. Conclusions The systematic stakeholder-informed study identified the minimum outcomes recommended for collection and reporting in early childhood obesity prevention trials. Future work will investigate the recommended instruments to measure each of these outcomes. The core outcome set will standardise guidance on the measurement and reporting of outcomes from early childhood obesity prevention interventions, to better facilitate evidence comparison and synthesis, and maximise the value of data collected across studies.
Objectives Australian Infant Feeding Guidelines recommend first foods be iron rich with no added sugars and that nutrient poor discretionary foods be avoided. They also encourage exposing infants to a variety of foods and flavours with increasingly complex textures. Here, we compare nutritional and textural properties of commercially available infant and toddler foods with established guidelines. Methods Infant and toddler food products available as of August 2019 were identified by searching for ‘baby food’ on retailer websites and by location in the ‘baby food’ section of major supermarket chains (Coles, Woolworths, Aldi and Foodland) in Adelaide, South Australia. Manufacturer websites were cross checked to identify all available products. Nutrient composition of foods was obtained from the nutrient information panel on the product label, manufacturer or retailer websites. In total, 446 products from 17 brands were reviewed, which accounted for over 90% of the market share. Results Most products were poor sources of iron, and 80% of first foods were fruit-based. Half of all products were purees in squeeze pouches and one third of all products were discretionary foods. The nutritional content of many products was inconsistent with guidelines, being low in iron, sweet, smooth in consistency, or classified as discretionary. Conclusions Reformulation of products is warranted to improve iron content, particularly in mixed main dishes, expand the range of vegetable only foods, and textural variety. Greater regulatory oversight and front of package labelling are needed to better inform parents and caregivers. Frequent consumption of commercial baby foods low in iron may increase risk of iron deficiency. Excessive consumption of purees via squeeze pouches may also have implications for overweight and obesity risk. Funding Sources There are no funding sources to declare for this research.
Early childhood settings (ECS) offer a unique opportunity to intervene to improve children's nutrition. This paper reviews the literature on early childhood setting interventions that aim to improve children's dietary intake. Environmental and individual determinants of children's dietary intakes were also investigated. Prospective intervention studies targeting centres, staff, parents/caregivers or children, were reviewed. Methodological quality was assessed. Twenty six studies (14 weak, 12 moderate quality) were included. Interventions were delivered primarily via training workshops and/or written materials. Study findings favoured intervention effectiveness in 23 studies. Improvements were seen in children's intake for 8 out of 11 studies assessing dietary intake outcomes. Small increases in fruit and vegetable consumption were observed in five studies. Most studies measuring parental or centre food provision observed postintervention improvements across a number of food groups, including fruit, vegetables, whole grains and sweetened beverages. Significant improvements in child, parent and/or staff knowledge, attitudes or behaviours were observed consistently across studies. For those studies that included a comparison group, these improvements were observed only in the intervention group. ECS interventions can achieve changes in children's dietary intake and associated socioenvironmental-determinants, although the quality of current research limits confidence in study findings. Future intervention development needs to carefully consider the behavioural targets, modifiable determinants and utilise ageappropriate and effective behaviour change theory, in addition to inclusion of dietary intake outcomes.
IntroductionBehavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of intervention-covariate interactions. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups.Methods and analysisSystematic searches of Medline, Embase, CENTRAL, CINAHL, PsycInfo, and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2020 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis (PMA) will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index (BMI) z-score at age 24 +/- 6 months using World Health Organisation Growth Standards, and effect differences will be explored among pre-specified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events.Ethics and disseminationApproved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations, and media releases.RegistrationProspectively registered on PROSPERO: CRD42020177408STRENGTHS AND LIMITATIONS OF THIS STUDYThis will be the largest individual participant data (IPD) meta-analysis evaluating behavioural interventions for the prevention of early childhood obesity to date, and will provide the most reliable and precise estimates of early intervention effects to inform future decision-making.IPD meta-analysis methodology will enable unprecedented exploration of important individual and trial-level characteristics that may be associated with childhood obesity or that may be effect modifiers.The proposed innovative methodologies are feasible and have been successfully piloted by members of our group.It may not be possible to obtain IPD from all eligible trials; in this instance, aggregate data will be used where available, and sensitivity analyses will be conducted to assess inclusion bias.Outcome measures may be collected and reported differently across included trials, potentially increasing imprecision; however, we will harmonise available data where possible, and encourage those planning or conducting ongoing trials to collect common core outcomes following prospective meta-analysis methodology.
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