Starting Early Program Impacts on Feeding at Infant 10 Months Age: A Randomized Controlled Trial

Abstract

Background: Disparities in obesity-promoting feeding patterns begin in pregnancy and infancy, underscoring the need for early primary prevention in high-risk groups. We sought to determine the impact of a primary care-based child obesity prevention intervention beginning during pregnancy on maternal infant feeding practices, knowledge, and styles at 10 months in low-income Hispanic families. Methods: The Starting Early Program (StEP) randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomized to standard care or an intervention with prenatal/postpartum individual nutrition counseling and nutrition and parenting support groups coordinated with pediatric visits. Feeding practices (breastfeeding, family meals, juice, and cereal in the bottle) were assessed using questions from the Infant Feeding Practices Study II. Feeding styles were assessed using the Infant Feeding Style Questionnaire. We analyzed impacts on feeding practices, knowledge, and styles using regression analyses adjusting for covariates. Results: Four hundred twelve mothers completed 10-month assessments. Intervention mothers were more likely to give breast milk as the only milk source [adjusted odds ratio (AOR) 1.65, 95% confidence interval (CI) 1.06-2.58] and have daily family meals (AOR 1.91, 95% CI 1.19-3.05), and less likely to give juice (AOR 0.60, 95% CI 0.39-0.92) or cereal in the bottle (AOR 0.54, 95% CI 0.30-0.97) compared to controls. Intervention mothers were more likely to exhibit lower pressuring, indulgent and laissez-faire feeding styles, and to have higher knowledge. Attending a greater number of group sessions increased intervention impacts. Conclusions: StEP led to reduced obesity-promoting feeding practices and styles, and increased knowledge and provides great potential for population-scalability.

Associations between maternal and paternal feeding styles of infants in a racially diverse US birth cohort

“…Instead, mean absolute scores were similar, and mothers and fathers were correlated (although correlations were stronger at 12 than at 6 months). Responsive feeding has been associated with obesity in numerous prior studies of infants and toddlers 33 and is a target for intervention 9,11,34‐38 . For example, higher maternal pressuring and indulgent feeding have been associated with greater energy intake and reduced odds of breast‐feeding in a sample of predominantly Black infants living in the Southeastern US 39 .…”

“…Pressuring was also associated with lower infant weight‐for‐age 39 . Two recent interventions aimed to prevent obesity in infants through maternal responsive feeding 9,11,37,38 . The Starting Early Program was a randomized controlled trial targeting Hispanic families that enrolled women in pregnancy and intervened through 10 months postpartum.…”

“…At the end of the study, women in the intervention group reduced obesity‐promoting feeding styles. Specifically, intervention women were more likely to exhibit lower pressuring, indulgent, and laissez‐faire feeding styles when infants were 10 months of age 37 . In the Intervention Nurses Start Infant Growing on Healthy Trajectories (INSIGHT) study of predominantly white families, women who participated in a 1‐year responsive feeding intervention were less likely to use non‐responsive feeding practices such as pressuring their infant to finish the bottle 9 .…”

USDA Research Combats Childhood Obesity: A Collection of Projects that Integrate Research, Education, and Extension Targeting Low-Income, Ethnically Diverse Children and Families

“…These six reflect research not previously published. [1][2][3][4][5][6] Projects funded by this USDA effort, collectively contributed to meeting the following 5 AFRI COP goals. In addition to the 6 projects featured in this supplement, we highlight 10 others here.…”

“…In this supplement, articles by Austin et al, 6 Messito et al, 1 van den Berg et al, 2 and Thompson et al 3 contain training components. AFRI COP funding supported university level training such as the Transdisciplinary Obesity Prevention (TOP) graduate certificate program 20 and an online training certificate program for community family educators.…”