Departments of Medicine.
Biostatistics Unit.
Am J Clin Nutr. 2018 Aug 1;108(2):228-236. doi: 10.1093/ajcn/nqy090.
Our Prevention of Overweight in Infancy (POI) study suggested that a brief sleep intervention in infancy reduced the risk of obesity at age 2 y. In contrast, we observed no benefit from the nutrition and activity intervention.
The objective of the study was to determine how these interventions influenced growth at ages 3.5 and 5 y compared with usual care (Control).
A follow-up of a parallel, 4-arm, single-blind, 2-y, randomized controlled trial in 802 women (86% European, 48% primiparous) recruited in pregnancy (58% response rate) was undertaken. All groups received standard Well-Child care with additional support for 3 intervention groups: FAB (promotion of breastfeeding, healthy eating, physical activity: 8 contacts, antenatal, 18 mo); Sleep (prevention of sleep problems: antenatal, 3 wk); Combination (both interventions). Follow-up measures were collected by staff blinded to group allocation. The primary outcome was child body mass index (BMI) z score, and secondary outcomes were prevalence of obesity (BMI ≥95th percentile), self-regulation (psychological measures), sleep, physical activity (accelerometry, questionnaires), and dietary intake (food-frequency questionnaire). Analyses were conducted through the use of multiple imputation.
Retention was 77% at age 3.5 y and 69% at age 5 y. Children in the FAB group had significantly higher BMI z scores than did Controls at age 5 y (adjusted difference: 0.25; 95% CI: 0.04, 0.47) but not at age 3.5 y (0.15; 95% CI: -0.04, 0.34). Children who received the Sleep intervention (Sleep and Combination groups) had significantly lower BMI z scores at age 3.5 y (-0.24; 95% CI: -0.38, -0.10) and at age 5 y (-0.23; 95% CI: -0.38, -0.07) than children who did not (Control and FAB groups).
A conventional intervention had unexpected adverse long-term weight outcomes, whereas positive outcomes from a less conventional sleep intervention remained promising at age 5 y. More intensive or extended sleep intervention might have larger or longer-lasting effects and should be investigated. This trial was registered at clinicaltrials.gov as NCT00892983.
我们的婴儿超重预防（POI）研究表明，婴儿期的短暂睡眠干预可降低 2 岁时肥胖的风险。相比之下，我们没有观察到营养和活动干预的益处。
本研究旨在确定这些干预措施如何影响 3.5 岁和 5 岁时的生长情况，与常规护理（对照组）相比。
对 802 名女性（86%为欧洲人，48%为初产妇）进行了一项平行、4 组、单盲、2 年、随机对照试验的随访，这些女性在妊娠期间招募（58%的应答率）。所有组均接受标准的儿童保健，另外为 3 个干预组提供额外支持：FAB（促进母乳喂养、健康饮食、身体活动：8 次联系，产前，18 个月）；睡眠（预防睡眠问题：产前，3 周）；组合（两种干预）。通过对组分配不知情的工作人员收集随访测量值。主要结局是儿童体重指数（BMI）z 评分，次要结局是肥胖患病率（BMI≥95 百分位）、自我调节（心理测量）、睡眠、身体活动（加速度计、问卷）和饮食摄入（食物频率问卷）。分析通过使用多重插补进行。
3.5 岁时的保留率为 77%，5 岁时为 69%。FAB 组的儿童在 5 岁时的 BMI z 评分明显高于对照组（调整差异：0.25；95%置信区间：0.04，0.47），但在 3.5 岁时没有（0.15；95%置信区间：-0.04，0.34）。接受睡眠干预（睡眠和组合组）的儿童在 3.5 岁时（-0.24；95%置信区间：-0.38，-0.10）和 5 岁时（-0.23；95%置信区间：-0.38，-0.07）的 BMI z 评分明显低于未接受干预的儿童（对照组和 FAB 组）。
常规干预具有意想不到的不良长期体重结局，而不太常规的睡眠干预的积极结果在 5 岁时仍然有希望。更密集或更长期的睡眠干预可能会产生更大或更持久的效果，应进行研究。该试验在 clinicaltrials.gov 上注册为 NCT00892983。
