Prevention of Overweight in Infancy (POI.nz) study: a randomised controlled trial of sleep, food and activity interventions for preventing overweight from birth

Taylor, Barry; Heath, Anne‐Louise M; Galland, Barbara; Gray, Andrew; Lawrence, Julie; Sayers, Rachel; Dale, Kelly; Coppell, Kirsten J; Taylor, Rachael W

doi:10.1186/1471-2458-11-942

Cited by 99 publications

(119 citation statements)

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“…Exclusive breastfeeding (no other liquids or solids since birth) and full breastfeeding (no other liquids or solids in the past 48 hours) status to the nearest day were derived from questionnaires administered every 4 weeks from 3 to 27 weeks of age. 18 Dietary intake was assessed by using a validated food frequency questionnaire 26 at 12 and 24 months. 20 Parents indicated how many minutes per week their child spent playing actively outside and inside and watching television at multiple time points.…”

Section: Discussionmentioning

confidence: 99%

“…Because the protocol is published, 18 only essential details are presented here. Ethical approval was obtained from the Lower South Regional Ethics Committee (LRS/08/12/063), and adult participants provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…Emphasis was on the following: (1) recognizing tired signs and putting the infant down to sleep while awake; (2) without associated settling behaviors (eg, feeding); (3) in a quiet, slightly darkened area; and (4) using safe sleep practices. 18,22 Parents who indicated their child's sleep was a problem from 6 months of age were offered a more intensive personalized intervention, adhering to modified "extinction" techniques. 18 Overall, 26.6% of parents in the sleep and combination groups received this extra support.…”

Section: Methodsmentioning

confidence: 99%

“…18,22 Parents who indicated their child's sleep was a problem from 6 months of age were offered a more intensive personalized intervention, adhering to modified "extinction" techniques. 18 Overall, 26.6% of parents in the sleep and combination groups received this extra support. Families in the combination group received the FAB and sleep interventions condensed into 9 contacts (combined antenatal education sessions).…”

Section: Methodsmentioning

confidence: 99%

“…18 Analyses were designed to examine questions on the effectiveness of the interventions by using modified intention-totreat principles (all available data were used for each analysis with participants analyzed as per their assigned group). Self-selected groups (eg, those who chose to receive extra sleep support) are not examined here.…”

Section: Methodsmentioning

confidence: 99%

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Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT

et al. 2017

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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...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT

et al. 2017

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Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight

et al. 2017

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IMPORTANCE Baby-led approaches to complementary feeding, which promote self-feeding of all nonliquid foods are proposed to improve energy self-regulation and lower obesity risk. However, to date, no randomized clinical trials have studied this proposition.OBJECTIVE To determine whether a baby-led approach to complementary feeding results in a lower body mass index (BMI) than traditional spoon-feeding. DESIGN, SETTING, AND PARTICIPANTS The 2-year Baby-Led Introduction to Solids (BLISS) randomized clinical trial recruited 206 women (168 [81.6%] of European ancestry; 85 [41.3%] primiparous) in late pregnancy from December 19, 2012, through March 17, 2014, as part of a community intervention in Dunedin, New Zealand. Women were randomized to a control condition (n = 101) or the BLISS intervention (n = 105) after stratification for parity and education. All outcomes were collected by staff blinded to group randomization, and no participants withdrew because of an adverse event. Data were analyzed based on intention to treat.INTERVENTIONS Mothers in the BLISS group received lactation consultant support (Ն5 contacts) to extend exclusive breastfeeding and delay introduction of complementary foods until 6 months of age and 3 personalized face-to-face contacts (at 5.5, 7.0, and 9.0 months). MAIN OUTCOMES AND MEASURESThe primary outcome was BMI z score (at 12 and 24 months). Secondary outcomes included energy self-regulation and eating behaviors assessed with questionnaires at 6, 12, and 24 months and energy intake assessed with 3-day weighed diet records at 7, 12, and 24 months. RESULTS Among the 206 participants (mean [SD] age, 31.3 [5.6] years), 166 were available for analysis at 24 months (retention, 80.5%). The mean (SD) BMI z score was not significantly different at 12 months (control group, 0.20 [0.89]; BLISS group, 0.44 [1.13]; adjusted difference, 0.21; 95% CI, −0.07 to 0.48) or at 24 months (control group, 0.24 [1.01]; BLISS group, 0.39 [1.04]; adjusted difference, 0.16; 95% CI, −0.13 to 0.45). At 24 months, 5 of 78 infants (6.4%) were overweight (BMIՆ95th percentile) in the control group compared with 9 of 87 (10.3%) in the BLISS group (relative risk, 1.8; 95% CI, 0.6-5.7). Lower satiety responsiveness was observed in BLISS infants at 24 months (adjusted difference, −0.24; 95% CI, −0.41 to −0.07). Parents also reported less food fussiness (adjusted difference, −0.33; 95% CI, −0.51 to −0.14) and greater enjoyment of food (adjusted difference, 0.25; 95% CI, 0.07 to 0.43) at 12 months in BLISS infants. Estimated differences in energy intake were 55 kJ (95% CI, −284 to 395 kJ) at 12 months and 143 kJ (95% CI, −241 to 526 kJ) at 24 months. CONCLUSIONS AND RELEVANCEA baby-led approach to complementary feeding did not result in more appropriate BMI than traditional spoon-feeding, although children were reported to have less food fussiness. Further research should determine whether these findings apply to individuals using unmodified baby-led weaning.

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