Thorland William, Currie Dustin, Colangelo Claire
William Thorland is Director of Evaluation and Research, Nurse-Family Partnership, National Service Office, Denver, CO. He can be reached via e-mail at
MCN Am J Matern Child Nurs. 2017 Nov/Dec;42(6):352-357. doi: 10.1097/NMC.0000000000000369.
Increased prevalence of high levels of body weight in early childhood has become a public health concern, given its potential association with adult obesity and related comorbidities. Both socioeconomic status and race-ethnicity are related to increased prevalence. The purpose of this study was to identify additional risk factors common to children of low-income families; and to guide quality improvement initiatives within home visiting programs, potentially fostering more desirable physical development outcomes.
A cohort of children (n = 14,318) of all mothers enrolled in Nurse-Family Partnership between 2007 and 2010 was evaluated. Measures consisted of demographics, health behaviors, and physical growth metrics collected by specially educated nurses during the course of home visits that also delivered the program model. Measures of weight (W) versus length (L) were converted to percentiles using the Centers for Disease Control and Prevention-World Health Organization norms with high W/L (≥97.7th percentile) defining a binary outcome. Multiple logistic regression modeling was then used to derive risk models for that outcome.
Across each of the four time points for body measures (child's age 6, 12, 18, and 24 months), race-ethnicity, prepregnancy body mass index (BMI), maternal weight gain, and breastfeeding duration emerged as common risk factors.
Moderation of weight gain during pregnancy, extending breastfeeding duration, and normalization of BMI before subsequent pregnancies may potentially serve as means of lowering the prevalence of high body weight levels in young children of low-income families served by home visitors.
鉴于幼儿期高水平体重的患病率增加可能与成人肥胖及相关合并症有关，这已成为一个公共卫生问题。社会经济地位和种族都与患病率增加有关。本研究的目的是确定低收入家庭儿童共有的其他风险因素；并指导家访项目中的质量改进举措，有可能促进更理想的身体发育结果。
对2007年至2010年期间参加护士-家庭伙伴关系项目的所有母亲的子女队列（n = 14318）进行了评估。测量内容包括人口统计学、健康行为以及由经过专门培训的护士在进行家访并提供项目模式的过程中收集的身体生长指标。体重（W）与身长（L）的测量值使用疾病控制和预防中心-世界卫生组织的标准转换为百分位数，高W/L（≥第97.7百分位数）定义为二元结局。然后使用多因素逻辑回归模型推导该结局的风险模型。
在身体测量的四个时间点（儿童6、12、18和24个月龄）中的每一个时间点，种族、孕前体重指数（BMI）、母亲体重增加和母乳喂养持续时间均成为常见风险因素。
孕期体重增加适度、延长母乳喂养持续时间以及在后续妊娠前使BMI正常化，可能是降低家访服务的低收入家庭幼儿高体重水平患病率的手段。
