McCormick David P, Niebuhr Bruce, Reyna Lucia, Reifsnider Elizabeth
University of Texas Medical Branch (DP.ßMcCormick and B.ßNiebuhr), Galveston.
University of Texas Medical Branch (DP.ßMcCormick and B.ßNiebuhr), Galveston.
Acad Pediatr. 2023 Jul;23(5):963-970. doi: 10.1016/j.acap.2023.03.010. Epub 2023 Mar 25.
This project aimed to prevent obesity in high-risk infants using community health workers.ßto provide mothers with culturally appropriate nutrition and health education.
This randomized controlled trial enrolled mothers prenatally and infants at birth. Mothers were Spanish-speaking WIC participants with obesity. Trained, Spanish-fluent, community health workers visited homes of intervention mothers to encourage breastfeeding, and promote delayed introduction of solid foods, adequate sleep, limited screen time, and active play. A blinded research assistant collected data at the home. Outcomes were weight-for-length and BMI-z scores, obesity at age 3.ßyears and percent time obese during follow-up. Data were analyzed using multiple variable regression.
Of 177 children enrolled at birth, 108 were followed to age 30...36.ßmonths. At the final visit, 24% of children were obese. Obese status at age 3.ßdid not differ between intervention and control (P.ß=.ß.32). Using BMI-z at the final visit, we observed a significant interaction between education and breastfeeding (P.ß=.ß.01). Time spent while obese from birth until age 30...36.ßmonths, by multiple variable analysis, did not show significant differences between intervention and control, but breastfed children experienced significantly less time obese than formula fed (P.ß=.ß.03). Formula-fed children in the control group, spent 29.8% of time obese, while breastfed infants in the intervention group spent 11.9% of time obese.
The educational intervention did not prevent obesity at age 3.ßyears. However, time spent obese from birth to age 3.ßyears was best in breastfed children living in homes regularly visited by community health workers.
本项目旨在利用社区卫生工作者预防高危婴儿肥胖,为母亲提供符合文化背景的营养与健康教育。
这项随机对照试验在产前招募母亲,婴儿出生时纳入。母亲为讲西班牙语的肥胖妇女、参加妇女、婴儿与儿童营养补充计划(WIC)者。经过培训、能流利说西班牙语的社区卫生工作者走访干预组母亲的家庭,鼓励母乳喂养,促进延迟引入固体食物、充足睡眠、限制屏幕使用时间以及积极玩耍。一名盲法研究助理在家庭中收集数据。结局指标为身长体重比和BMI-Z评分、3岁时的肥胖情况、随访期间肥胖的百分比时间。数据采用多变量回归分析。
177名出生时登记的儿童中,108名随访至30……36个月。在末次访视时,24%的儿童肥胖。干预组和对照组3岁时的肥胖状况无差异(P = .32)。根据末次访视时的BMI-Z评分,我们观察到教育程度与母乳喂养之间存在显著交互作用(P = .01)。通过多变量分析,从出生到30……36个月期间肥胖的时间,干预组和对照组之间未显示出显著差异,但母乳喂养的儿童肥胖时间明显少于配方奶喂养的儿童(P = .03)。对照组中配方奶喂养的儿童,29.8%的时间处于肥胖状态,而干预组中母乳喂养的婴儿,11.9%的时间处于肥胖状态。
教育干预未能预防3岁时的肥胖。然而,对于居住在社区卫生工作者定期走访家庭中的母乳喂养儿童,从出生到3岁期间肥胖的时间是最短的。