Black Maureen M, Hager Erin R, Wang Yan, Hurley Kristen M, Latta Laura W, Candelaria Margo, Caulfield Laura E
Department of Pediatrics and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
RTI International, Research Triangle Park, North Carolina, USA.
Matern Child Nutr. 2021 Jan;17(1):e13075. doi: 10.1111/mcn.13075. Epub 2020 Sep 4.
Rapid weight gain increases risks of obesity and associated co-morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler-mother physical activity, mealtime interactions and fruit/vegetable intake. The randomized three-arm, eight-session, 4-month trial, conducted 2009-2013, included two intervention arms (responsive parenting and maternal lifestyle) and an attention control (home safety). Baseline and 6- and 12-month follow-up evaluations included weight and length/height, ankle accelerometry, video-recorded mealtime interactions (Emotional Availability Scales) and 24-h diet recalls (Healthy Eating Index-2015 [HEI-2015]). Analyses used linear mixed-effects models with repeated measures comparing intervention versus control changes in BMI z score. We recruited 277 racially mixed (70% African American) toddler-mother dyads (mean ages 20.1 months and 27.3 years) from US WIC and primary care clinics and randomized them into intervention versus control; 31% toddlers and 73% mothers were overweight/obese. At follow-up, changes in the rate of toddler BMI z score and maternal BMI were non-significant. Maternal lifestyle group toddlers and mothers spent 24.43 and 11.01 more minutes in physical activity (95% confidence interval [CI]: 2.55, 46.32, and 95% CI: 1.48, 20.54, respectively). Fruit intake increased in both intervention groups. Hostile mealtime interactions increased in the maternal lifestyle group, and in supplementary analyses, mealtime interactions were significantly higher in the responsive parenting group than in the maternal lifestyles group, suggesting that toddler dietary interventions include responsive parenting. Intervention effects were stronger among older versus younger toddlers. Despite no impact on weight gain, additional research should examine integrated two-generation responsive parenting and maternal lifestyle interventions among toddler-mother dyads.
体重快速增加会增加肥胖及相关合并症的风险。目标是相对于对照组，降低体重指数（BMI）增长率（BMI z评分）。次要结果包括幼儿与母亲的身体活动、用餐互动以及水果/蔬菜摄入量。这项随机三臂、八节次、为期4个月的试验于2009年至2013年进行，包括两个干预组（响应式育儿和母亲生活方式）以及一个注意力对照组（家庭安全）。基线以及6个月和12个月的随访评估包括体重和身长/身高、脚踝加速度计测量、用餐互动视频记录（情感可用性量表）以及24小时饮食回忆（2015年健康饮食指数[HEI - 2015]）。分析采用线性混合效应模型并重复测量，比较干预组与对照组BMI z评分的变化。我们从美国妇女、婴儿与儿童营养补充计划（WIC）和初级保健诊所招募了277对不同种族混合的（70%为非裔美国人）幼儿 - 母亲二元组（幼儿平均年龄20.1个月，母亲平均年龄27.3岁），并将他们随机分为干预组和对照组；31%的幼儿和73%的母亲超重/肥胖。在随访时，幼儿BMI z评分增长率和母亲BMI的变化不显著。母亲生活方式组的幼儿和母亲进行身体活动的时间分别多了24.43分钟和11.01分钟（95%置信区间[CI]：2.55，46.32，以及95% CI：1.48，20.54）。两个干预组的水果摄入量均有所增加。母亲生活方式组中敌对的用餐互动有所增加，在补充分析中，响应式育儿组的用餐互动显著高于母亲生活方式组，这表明幼儿饮食干预包括响应式育儿。年龄较大的幼儿与年龄较小的幼儿相比，干预效果更强。尽管对体重增加没有影响，但后续研究应考察幼儿 - 母亲二元组中综合的两代响应式育儿和母亲生活方式干预措施。
