Publications by authors named "Jennifer S Savage"

92 Publications

Learned Experience and Resource Dilution: Conceptualizing Sibling Influences on Parents' Feeding Practices.

Int J Environ Res Public Health 2021 May 27;18(11). Epub 2021 May 27.

The Center for Childhood Obesity Research, Penn State University, University Park, State College, PA 16802, USA.

Studies from diverse cultures report mixed results in the relationship between birth order and risk for obesity. Explanations may thus lie in the postnatal period when growth is shaped by the family environment, including parental feeding practices, which may be affected by siblings. Consistent with a family systems perspective, we describe two processes that may explain birth order effects on parental feeding practices and child outcomes: learned experience and resource dilution. Parents learn from experience when earlier-born children influence their parents' knowledge, expectations, and behavior toward later-born siblings through their behaviors and characteristics-which can have both positive and negative implications. Resource dilution is a process whereby the birth of each child limits the time, attention and other resources parents have to devote to any one of their children. The goal of this review is to provide a theoretical basis for examining potential sibling influences on parental responsive feeding toward developing recommendations for future research and practice aimed at preventing obesity throughout family systems.
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http://dx.doi.org/10.3390/ijerph18115739DOI Listing
May 2021

Sex Differences in Maternal Restrictive Feeding Practices in the INSIGHT Study.

Acad Pediatr 2021 May 18. Epub 2021 May 18.

Penn State College of Medicine, 500 University Dr., Hershey, PA, USA 17033; Departments of Pediatrics & Public Health Sciences, 500 University Dr., Hershey, PA, USA 17033. Electronic address:

Background: INSIGHT tested an early life responsive parenting (RP) intervention designed for obesity prevention. BMIz at age 3 years was lower for the RP group versus controls with a larger effect for girls than boys. We sought to determine if child sex was associated with differing maternal feeding practices and whether sex moderated intervention effects on feeding.

Design/methods: Mothers (N=279) completed the Infant Feeding Styles Questionnaire (IFSQ) at 28 weeks, the Structure and Control in Parent Feeding (SCPF) at 1, 2, and 3 years, and the Child Feeding Questionnaire (CFQ) at 3 years. Study aims were tested using two-way analysis of variance and repeated measures.

Results: Mothers reported greater restriction (limiting food quantity) for boys at 28 weeks (IFSQ: 3.0 ± 1.1 vs. 2.8 ± 1.0, P = .07) and across annual measurements from age 1 to 3 years (SCPF: P = .04). At age 3, the intervention group effect on restriction differed by sex (CFQ: P = .047) such that higher restriction was reported by RP group mothers of boys versus girls (3.4 ± 0.7 vs. 3.0 ± 0.9, P = .002) with no control group sex difference (3.4 ± 0.8 vs. 3.3 ± 0.9, P = .79). There were no sex differences or sex by intervention group interactions in other reported feeding practices at any assessment (i.e., structure-based feeding, pressure).

Conclusion: Mothers of boys used more restrictive feeding through age 3. These findings may be partially explained by previously reported better self-soothing and self-regulation abilities of participating girls.
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http://dx.doi.org/10.1016/j.acap.2021.05.002DOI Listing
May 2021

The Relative Reinforcing Value of Cookies Is Higher Among Head Start Preschoolers With Obesity.

Front Psychol 2021 30;12:653762. Epub 2021 Apr 30.

Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States.

The relative reinforcing value (RRV) of food measures how hard someone will work for a high-energy-dense (HED) food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED (cookies) to low-energy-dense (LED; fruit) food would be greater in children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics (i.e., age, sex, and reward sensitivity) and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached (breakpoint) for cookies (cookie Pmax) and fruit (fruit Pmax), the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined (RRV cookie), and response rates (responses per minute). Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson's correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores (BMIZ). Statistical significance was defined as < 0.05. Children with obesity (17%) had a greater cookie Pmax [ (1, 121) = 4.95, = 0.03], higher RRV cookie [ (1, 121) = 4.28, = 0.04], and responded at a faster rate for cookies [ (1, 121) = 17.27, < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ ( = 0.26, < 0.01); and RRV cookie was positively associated with BMIZ for older children (5-year-olds: = 2.40, = 0.02) and boys ( = 2.55, = 0.01), but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood.
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http://dx.doi.org/10.3389/fpsyg.2021.653762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120894PMC
April 2021

Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity.

J Behav Med 2021 May 5. Epub 2021 May 5.

Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.

Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity: PA, energy intake: EI, theories of planned behavior/self-regulation constructs) compared to a usual care group. Pregnant women with overweight/obesity (N = 31) were randomized to a usual care control group or usual care + intervention group from 8 to 2 weeks gestation and completed the intervention through 36 weeks gestation. Intervention women received weekly evidence-based education/counseling (e.g., GWG, PA, EI) delivered by a registered dietitian in a 60-min face-to-face session. GWG was monitored weekly; women within weight goals continued with education while women exceeding goals received more intensive dosages (e.g., additional hands-on EI/PA sessions). All participants used mHealth tools to complete daily measures of weight (Wi-Fi scale) and PA (activity monitor), weekly evaluation of diet quality (MyFitnessPal app), and weekly/monthly online surveys of motivational determinants/self-regulation. Daily EI was estimated with a validated back-calculation method as a function of maternal weight, PA, and resting metabolic rate. Sixty-five percent of eligible women were randomized; study completion was 87%; 10% partially completed the study and drop-out was 3%. Compliance with using the mHealth tools for intensive data collection ranged from 77 to 97%; intervention women attended > 90% education/counseling sessions, and 68-93% dosage step-up sessions. The intervention group (6.9 kg) had 21% lower GWG than controls (8.8 kg) although this difference was not significant. Exploratory analyses also showed the intervention group had significantly lower EI kcals at post-intervention than controls. A theoretical, adaptive intervention with varied dosages to regulate GWG is feasible to deliver to pregnant women with overweight/obesity.
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http://dx.doi.org/10.1007/s10865-021-00227-9DOI Listing
May 2021

Head Start Parents With or Without Food Insecurity and With Lower Food Resource Management Skills Use Less Positive Feeding Practices in Preschool-Age Children.

J Nutr 2021 May;151(5):1294-1301

Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA.

Background: Food resource management (FRM), strategies to stretch limited food resource dollars, may mitigate the impact of household food insecurity (HFI) on family members, including young children. However, little is known about how FRM and HFI are associated with child feeding practices.

Objectives: The study aimed to explore relationships between HFI, FRM, and child feeding practices of low-income parents.

Methods: In a cross-sectional sample of 304 Head Start households, caregivers completed the USDA HFI module [classifying them as either food secure (FS) or food insecure (FI)], FRM behavior subscale (classifying them as being high or low in management skills based on a median score split), Comprehensive Feeding Practices Questionnaire, and Perceived Stress Scale. Households were categorized into 4 HFI-FRM subgroups: FS/high FRM (30.6%), FS/low FRM (31.3%), FI/high FRM (18.8%), and FI/low FRM (19.4%). Multivariable linear regression was used to examine whether feeding practices differed across HFI-FRM categories and whether the addition of parental perceived stress contributed to differences in feeding practices by HFI-FRM group.

Results: In our study, 38% of households were FI. Compared to the FS/high FRM group in the adjusted models, the FS/low FRM group used less monitoring (-0.53; 95% CI: -0.78 to -0.28), modeling (-0.38; 95% CI: -0.64 to -0.13), and involvement (-0.57; 95% CI: -0.82 to -0.32) in feeding. A similar pattern emerged for the FI/low FRM group. The use of food as a reward was higher in the FI/high FRM (0.35; 95% CI: 0.02-0.67) and FI/low FRM groups (0.33; 95% CI: 0.01-0.66) compared to the FS/high FRM group. Perceived stress was positively associated with the use of negative, controlling feeding practices, and contributed to differences in using food as a reward within the HFI-FRM group.

Conclusions: Suboptimal child feeding is evident in low-income caregivers with low FRM skills, with or without food insecurity. Promoting high FRM skills, in addition to addressing food insecurity, could potentially synergistically improve child feeding practices in low-income households.
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http://dx.doi.org/10.1093/jn/nxab001DOI Listing
May 2021

Influence of prenatal perceived stress on postpartum weight retention is mediated by high gestational weight gain in women with overweight.

Clin Obes 2021 Jun 6;11(3):e12446. Epub 2021 Mar 6.

Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, State College, Pennsylvania, USA.

Women with excessive gestational weight gain (GWG) are at risk for poor psychosocial well-being and postpartum weight retention (PPWR). Scant research has examined longitudinal interrelations of GWG, psychosocial factors, and PPWR. This study examined: (a) pre-pregnancy weight status (ie, normal, overweight, obesity) differences in PPWR and its psychosocial determinants (perceived social support, perceived stress, depression) in women with excessive GWG (ie, above 2009 Institute of Medicine guidelines); and (b) whether GWG mediated associations between psychosocial determinants and PPWR. Women (N = 1352) reported third trimester perceived social support, perceived stress, and depressive symptoms, GWG, and 6- and 12-month PPWR via telephone interviews. Multivariate ANOVA analyses showed women with normal weight had higher 6-month PPWR than women with obesity; univariate ANOVA showed no group differences in psychosocial factors. Hayes mediation analyses indicated that GWG mediated the association between perceived stress and PPWR in women with overweight but not women with normal weight or obesity; perceived stress predicted GWG, and in turn, PPWR. Prenatal perceived stress may be a modifiable target of GWG and PPWR. Future research is needed to examine the utility of tailoring perinatal weight regulation interventions to reduce perceived stress in pregnant women with overweight.
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http://dx.doi.org/10.1111/cob.12446DOI Listing
June 2021

Preschoolers will drink their GREENS! Children accept, like, and drink novel smoothies containing dark green vegetables (DGVs).

Appetite 2021 Jul 5;162:105148. Epub 2021 Feb 5.

Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA; Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA.

Dark green vegetables (DGVs; e.g., spinach) are a nutrient rich source of essential vitamins and minerals; yet, children's intakes of DGVs fall well below dietary recommendations and creative solutions are needed. This study describes preschoolers (3-5 y) willingness to taste, liking, and intake of fruit-based smoothies containing DGVs (i.e., spinach, collards, kale), commonly referred to as "green smoothies," and explores individual differences in children's eating responses. Using a between-subjects design, preschoolers were randomized to either a FRUIT ONLY smoothie condition (n = 36) or FRUIT+DGV smoothie condition (n = 32). Children's acceptance and intake were collected in one tasting session and one ad libitum snack session, respectively. Parents reported on child food pickiness, food responsiveness, and approach, and children's intake of fruits and DGVs. Children self-reported on previous experience with the study fruits and DGVs. The initial tasting session revealed that the majority of children (84.3%) in the FRUIT+DGV condition willingly tasted all five green smoothies and rated the green smoothies as moderately liked (2.3 ± 0.1). Children in the FRUIT+DGV condition consumed 225.7 ± 31.4 g (9.0 ± 1.3 oz; 1.1 ± 0.2 cups; 91.9 ± 12.9 kcals) of their most preferred green smoothie, providing 18.3 ± 3.7 g (or 0.7 ± 0.1 cups) of DGVs. Children's willingness to try, liking, and intake did not differ by smoothie condition. Individual differences in children's intake are reported. In conclusion, children were willing to try fruit smoothies supplemented with DGVs. Children rated the green smoothies as moderately-liked and children's intake during snack met 31% of their weekly USDA recommendations for DGVs. Adding DGVs to fruit-based smoothies may compliment other effective feeding strategies for increasing children's vegetable consumption.
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http://dx.doi.org/10.1016/j.appet.2021.105148DOI Listing
July 2021

Agreement in Infant Growth Indicators and Overweight/Obesity between Community and Clinical Care Settings.

J Acad Nutr Diet 2021 Mar 16;121(3):493-500. Epub 2020 Dec 16.

Background: Infants from low-income backgrounds receive nutrition care from both community and clinical care settings. However, mothers accessing these services have reported receiving conflicting messages related to infant growth between settings, although this has not been examined quantitatively.

Objective: Describe the agreement in infant growth assessments between community (Special Supplemental Nutrition Program for Women, Infants, and Children) and clinical (primary care providers) care settings.

Design: A cross-sectional, secondary data analysis of infant growth measures abstracted from electronic data management systems.

Participants And Setting: Participants included a convenience sample of infants (N = 129) from northeastern Pennsylvania randomized to the WEE Baby Care study from July 2016 to May 2018. Infants had complete anthropometric data from both community and clinical settings at age 6.2 ± 0.4 months. Average time between assessments was 2.7 ± 1.9 weeks.

Main Outcome Measures: Limits of agreement and bias in weight-for-age, length-for-age, weight-for-length, and body-mass-index-for-age z scores as well as cross-context equivalence in weight status between care settings.

Statistical Analysis Performed: Bland-Altman analyses were used to describe the limits of agreement and bias in z scores between care settings. Cross-context equivalence was examined by dichotomizing infants' growth indicators at the 85th and 95th percentile cut-points and cross-tabulating equivalent and discordant categorization between settings.

Results: Strongest agreement was observed for weight-for-age z scores (95% limits of agreement -0.41 to 0.54). However, the limits of agreement intervals for growth indicators that included length were wider, suggesting weaker agreement. There was a high level of inconsistency for classification of overweight/obesity using weight-for-length z scores, with 15.5% (85th percentile cut-point) and 11.6% (95th percentile cut-point) discordant categorization between settings, respectively.

Conclusions: Infant growth indicators that factor in length could contribute to disagreement in the interpretation of infant growth between settings. Further investigation into the techniques, standards, and training protocols for obtaining infant growth measurements across care settings is required.
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http://dx.doi.org/10.1016/j.jand.2020.11.009DOI Listing
March 2021

INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years.

Appetite 2021 04 1;159:105060. Epub 2020 Dec 1.

Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA; Nutritional Sciences, 110 C Chandlee Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA. Electronic address:

Expert guidance encourages interventions promoting structure-based practices to establish predictable eating environments in order to foster children's self-regulatory skills. However, few studies have examined whether and how child characteristics may moderate effects of interventions on maternal feeding practices. This analysis aimed to examine the effect of the INSIGHT Responsive Parenting (RP) intervention delivered largely during infancy, on child appetitive traits at 2.5 years and maternal feeding practices at 3 years. Primiparous mother-newborn dyads were randomized to a RP intervention designed for obesity prevention or a safety control intervention. Mothers completed the Child Eating Behavior Questionnaire at 2.5 years and the Structure and Control in Parent Feeding Questionnaire at 3 years. T-tests assessed study group differences on child appetitive traits at 2.5 years and maternal feeding practices at age 3. ANCOVA models assessed the effect of study group on parent feeding practices and tested appetitive traits as a moderator. Two hundred thirty-two mother-child dyads completed the trial. Mothers were predominantly white, non-Hispanic, college educated, and married. RP group mothers used more consistent meal routines, and less pressure, food to soothe, and food as reward compared to controls. Child satiety responsiveness moderated the RP intervention effect on maternal use of limiting exposure to unhealthy foods such that the RP intervention was most effective for children at higher levels of satiety responsiveness. Food responsiveness moderated RP intervention effects on maternal use of pressure, such that at lower levels of food responsiveness, control group mothers used more pressure than RP mothers. The INSIGHT RP intervention demonstrated sustained effects on maternal feeding practices through age 3 years, with some intervention effects showing moderation by child appetitive traits.
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http://dx.doi.org/10.1016/j.appet.2020.105060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812701PMC
April 2021

Advanced Health Information Technologies to Engage Parents, Clinicians, and Community Nutritionists in Coordinating Responsive Parenting Care: Descriptive Case Series of the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care Randomized Controlled Trial.

JMIR Pediatr Parent 2020 Nov 24;3(2):e22121. Epub 2020 Nov 24.

Geisinger Obesity Institute, Geisinger, Danville, PA, United States.

Background: Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs.

Objective: This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists.

Methods: Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month intervention, electronic systems were created to facilitate documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCPs. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit.

Results: Dyads (N=131) attended 459 PCP (3.5, SD 1.0 per dyad) and 296 WIC (2.3, SD 1.0 per dyad) visits. Parents completed the EHL tool prior to 53.2% (244/459) of PCP visits (1.9, SD 1.2 per dyad), PCPs documented provided RP care at 35.3% (162/459) of visits, and data were shared with WIC following 100% (459/459) of PCP visits. A WIC visit followed a PCP visit 50.3% (231/459) of the time; thus, there were 1.8 (SD 0.8 per dyad) PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% (154/231) of opportunities (1.2, SD 0.9 per dyad). WIC visits were followed by a PCP visit 58.9% (116/197) of the time; thus, there were 0.9 (SD 0.8 per dyad) WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 44.0% (51/116) of opportunities (0.4, SD 0.6 per dyad).

Conclusions: Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence, and frequency of visits underscores the need for flexibility in pragmatic studies.

Trial Registration: ClinicalTrials.gov NCT03482908; https://clinicaltrials.gov/ct2/show/NCT03482908.

International Registered Report Identifier (irrid): RR2-10.1186/s12887-018-1263-z.
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http://dx.doi.org/10.2196/22121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723742PMC
November 2020

Short Nighttime Sleep Duration and High Number of Nighttime Awakenings Explain Increases in Gestational Weight Gain and Decreases in Physical Activity but Not Energy Intake among Pregnant Women with Overweight/Obesity.

Clocks Sleep 2020 Nov 14;2(4):487-501. Epub 2020 Nov 14.

Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, 201 Old Main, University Park, PA 16802, USA.

Pregnant women are at a high risk for experiencing sleep disturbances, excess energy intake, low physical activity, and excessive gestational weight gain (GWG). Scant research has examined how sleep behaviors influence energy intake, physical activity, and GWG over the course of pregnancy. This study conducted secondary analyses from the Healthy Mom Zone Study to examine between- and within-person effects of weekly sleep behaviors on energy intake, physical activity, and GWG in pregnant women with overweight/obesity (PW-OW/OB) participating in an adaptive intervention to manage GWG. The overall sample of = 24 ( age = 30.6 years, = 3.2) had an average nighttime sleep duration of 7.2 h/night. In the total sample, there was a significant between-person effect of nighttime awakenings on physical activity; women with >1 weekly nighttime awakening expended 167.56 less physical activity kcals than women with <1 nighttime awakening. A significant within-person effect was also found for GWG such that for every increase in one weekly nighttime awakening there was a 0.76 pound increase in GWG. There was also a significant within-person effect for study group assignment; study group appeared to moderate the effect of nighttime awakenings on GWG such that for every one increase in weekly nighttime awakening, the control group gained 0.20 pounds more than the intervention group. There were no significant between- or within-person effects of sleep behaviors on energy intake. These findings illustrate an important need to consider the influence of sleep behaviors on prenatal physical activity and GWG in PW-OW/OB. Future studies may consider intervention strategies to reduce prenatal nighttime awakenings.
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http://dx.doi.org/10.3390/clockssleep2040036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711788PMC
November 2020

Time for bed! Earlier sleep onset is associated with longer nighttime sleep duration during infancy.

Sleep Med 2020 09 14;73:238-245. Epub 2020 Jul 14.

Department of Biobehavioral Health, Penn State University, University Park, PA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States. Electronic address:

Objective/background: Clinical recommendations include putting infants to bed using a consistent bedtime routine at an appropriate hour to promote longer nighttime sleep. Actigraphy was used in this exploratory study to examine how bedtime routines and nighttime sleep onset were associated with nighttime total sleep time (TST) and efficiency from 6 to 24 weeks of age.

Patients/methods: Infants (n = 24) wore sleep actigraphs for three, one-week periods at 6, 15, and 24 weeks of age. Nighttime TST, sleep efficiency, sleep onset and offset were quantified. Mothers reported on infant bedtime routines using the Brief Infant Sleep Questionnaire at each age. Multilevel models examined between- and within-person associations.

Results: As infants aged, sleep onset was earlier, and bedtime routines became shorter (p's < 0.05). Infants fell asleep between 7 and 8:00PM on 24% of the nights. Most mothers (70%) reported that they often fed infants to sleep for the night. For every 1 h earlier in infants' usual sleep onset, nighttime TST was 34.4 min longer that night (p < 0.01). Infants with earlier than usual sleep onset had slightly earlier sleep offset the next morning (8.4 min for every 1 h earlier in onset; p = 0.02). Between-person analyses showed similar patterns. Infants with a more consistent bedtime routine and who were not typically fed to sleep at bedtime had longer nighttime TST at 6 weeks, with a trend or no association at later ages.

Conclusion: Infants who fell asleep earlier also slept longer at night. Keeping infants up later in hopes of them sleeping in longer may be counterproductive.
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http://dx.doi.org/10.1016/j.sleep.2020.07.003DOI Listing
September 2020

Identifying ActiGraph non-wear time in pregnant women with overweight or obesity.

J Sci Med Sport 2020 Dec 11;23(12):1197-1201. Epub 2020 Aug 11.

Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, United States; Department of OBGYN, College of Medicine, The Pennsylvania State University, United States. Electronic address:

Objectives: Non-wear time algorithms have not been validated in pregnant women with overweight/obesity (PW-OW/OB), potentially leading to misclassification of sedentary/activity data, and inaccurate estimates of how physical activity is associated with pregnancy outcomes. We examined: (1) validity/reliability of non-wear time algorithms in PW-OW/OB by comparing wear time from five algorithms to a self-report criterion and (2) whether these algorithms over- or underestimated sedentary behaviors.

Design: PW-OW/OB (N = 19) from the Healthy Mom Zone randomized controlled trial wore an ActiGraph GT3x + for 7 consecutive days between 8-12 weeks gestation.

Methods: Non-wear algorithms (i.e., consecutive strings of zero acceleration in 60-second epochs) were tested at 60, 90, 120, 150, and 180-min. The monitor registered sedentary minutes as activity counts 0-99. Women completed daily self-report logs to report wear time.

Results: Intraclass correlation coefficients for each algorithm were 0.96-0.97; Bland-Altman plots revealed no bias; mean absolute percent errors were <10%. Compared to self-report (M = 829.5, SD = 62.1), equivalency testing revealed algorithm wear times (min/day) were equivalent: 60- (M = 816.4, SD = 58.4), 90- (M = 827.5, SD = 61.4), 120- (M = 830.8, SD = 65.2), 150- (M = 833.8, SD = 64.6) and 180-min (M = 837.4, SD = 65.4). Repeated measures ANOVA showed 60- and 90-min algorithms may underestimate sedentary minutes compared to 150- and 180-min algorithms.

Conclusions: The 60, 90, 120, 150, and 180-min algorithms are valid and reliable for estimating wear time in PW-OW/OB. However, implementing algorithms with a higher threshold for consecutive zero counts (i.e., ≥150-min) can avoid the risk of misclassifying sedentary data.
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http://dx.doi.org/10.1016/j.jsams.2020.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606752PMC
December 2020

Development and preliminary testing of a technology-enhanced intervention to improve energy intake regulation in children.

Appetite 2020 12 16;155:104830. Epub 2020 Aug 16.

The Pennsylvania State University, Departments of Nutritional Sciences and Food Science. 321 Chandlee Laboratory, University Park, PA, 16802, USA. Electronic address:

Interventions designed to improve children's self-regulation of energy intake have yielded mixed results. We tested the efficacy of a technology-enhanced intervention designed to teach children to eat in response to internal hunger and fullness cues. Thirty-two children (mean age 4.9 ± 0.8 y) completed this within-subjects, pre-post design study that took place across 10 laboratory sessions, each scheduled approximately 1 week apart. The intervention was conducted across weeks 4-7 in small groups focused on teaching children how food travels through the body and how to respond to hunger and fullness signals. Children's short-term energy compensation, a measure of intake regulation, was collected at baseline and follow-up using a preloading protocol. Twenty-five minutes prior to receiving a standardized test meal, children consumed a low-energy (3 kcal) or high-energy (150 kcal) preload beverage, presented in random order at baseline and follow-up. Knowledge of intervention concepts was also assessed at baseline and follow-up. Linear mixed models were used to examine changes in short-term energy compensation and knowledge from baseline to follow-up. Knowledge related to the intervention improved from baseline to follow-up (3.5 ± 0.3 to 7.0 ± 0.3 correct responses out of a possible 10; P < 0.001). Children's energy compensation also improved from baseline to follow-up, as evidenced by a time-by-preload condition interaction (P = 0.02). However, this improvement was driven by boys who increased the adjustment for beverage energy content from baseline to follow-up (P = 0.04). Girls showed no change in energy compensation with the intervention (P = 0.58). The overall increase in knowledge, paired with the improvement in energy compensation in boys, suggests that this technology-enhanced intervention may be efficacious for some children. Further research is needed to determine whether boys and girls will benefit from different, personalized intervention strategies for obesity prevention.
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http://dx.doi.org/10.1016/j.appet.2020.104830DOI Listing
December 2020

Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families.

Nutrients 2020 Jul 31;12(8). Epub 2020 Jul 31.

Department of Nutritional Sciences, Penn State College of Health and Human Development, 108C Chandlee Laboratory, University Park, PA 16802, USA.

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children ( = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all -values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.
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http://dx.doi.org/10.3390/nu12082304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468708PMC
July 2020

Biography of Leann L Birch, PhD, 25 June 1946 - 26 May 2019.

J Nutr 2020 06;150(6):1343-1347

Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA.

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http://dx.doi.org/10.1093/jn/nxaa127DOI Listing
June 2020

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Responsive Parenting Intervention for Firstborns Affects Dietary Intake of Secondborn Infants.

J Nutr 2020 08;150(8):2139-2146

Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.

Background: Although previous work has shown that children with older siblings tend to have poorer diet quality, no study has directly compared diets of infant siblings.

Objective: The goals of this analysis were to examine birth-order differences in dietary intake between firstborn (FB) and secondborn (SB) siblings, and to determine whether a responsive parenting (RP) intervention modified birth-order effects on diet.

Methods: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study randomly assigned first-time mothers to an RP intervention, which included guidance on feeding, sleep, soothing, and interactive play, or control. INSIGHT mothers who delivered a second child enrolled in an observation-only study of their SB infant (SIBSIGHT). Mothers completed FFQs for both children at ages 6 (n = 97 sibling pairs) and 12 (n = 100) mo. FB compared with SB intake of food groups of interest were compared, and the moderating effect of the RP intervention on birth-order differences was tested using generalized linear mixed models.

Results: Though FBs and SBs had similar diets, more FBs than SBs consumed 100% fruit juice at both 6 (13.8 compared with 3.2%, P = 0.006) and 12 mo (46.0 compared with 32.0%, P = 0.01). SBs consumed fruit more frequently (FB 2.8 compared with SB 3.2 times/d, P = 0.01), and were more likely to consume fried potatoes (FB 38.4 compared with SB 57.6%, P = 0.0009) and processed meats (FB 43.0 compared with SB 58.0%, P = 0.02) than FBs at 12 mo. There were no differences by birth order in intake of sweets, snacks, or sugar-sweetened beverages at 12 mo. At 12 mo, RP-group SBs ate vegetables more times per day (3.2) than control SBs (2.2, P = 0.01). RP-SBs also consumed a greater variety of vegetables (10.2) than control-SBs (7.9, P = 0.01).

Conclusions: Birth order is not consistently associated with healthy or unhealthy infant dietary intake. However, an RP intervention delivered to first-time mothers may benefit subsequent infants' vegetable intake. This trial was registered at clinicaltrials.gov as NCT01167270.
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http://dx.doi.org/10.1093/jn/nxaa135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398778PMC
August 2020

Bedtime, body mass index and obesity risk in preschool-aged children.

Pediatr Obes 2020 09 6;15(9):e12650. Epub 2020 May 6.

Department of Medicine, University of Otago, Dunedin, New Zealand.

Background: Although sleep duration is a risk factor for obesity in young children, less is known about other aspects of sleep health, including bedtime, on obesity risk.

Objective: To determine whether bedtime is associated with body mass index (BMI) z-score or obesity risk in children ages 2 to 5 years, and to determine if associations are independent of sleep duration.

Methods: Cohort analyses were undertaken using three early life obesity prevention trials (POI, INSIGHT, Healthy Beginnings) and a longitudinal cohort study (HOME). Bedtime was assessed by questionnaire and BMI through clinical measurement between 2 and 5 years in 1642 children. Adjusted regression models examined whether BMI z-score and obesity (BMI z-score ≥ 2) were associated with bedtime, nocturnal sleep time and 24-hour sleep time. A discrete mixture model categorized children into bedtime trajectory groups across time points.

Results: Bedtime was inconsistently associated with BMI z-score. Although each hour later of bedtime was associated with greater odds of obesity at ages 3 (OR; 95% CI: 1.05; 1.003, 1.10) and 5 (1.35; 1.08, 1.69) years, odds were attenuated after adjustment for nocturnal or 24-hour sleep time. Longer nocturnal sleep duration at 2 years was associated with lower odds of obesity (OR 0.90; 0.86, 0.94), as was longer 24-hour sleep duration at 3 years in girls (0.70; 0.62, 0.78). BMI z-score and odds of obesity were not significantly different between 'early to bed' and 'late to bed' trajectory groups.

Conclusions: Timing of bedtime appears inconsistently related to obesity in young children, possibly via influencing overall sleep duration.
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http://dx.doi.org/10.1111/ijpo.12650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745736PMC
September 2020

Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT.

Pediatr Obes 2020 10 5;15(10):e12645. Epub 2020 May 5.

Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania, USA.

Background: Child emotional overeating is a risk factor for obesity that is learned in the home environment. Parents' use of food to soothe child distress may contribute to the development of children's emotional overeating.

Objectives: To examine the effect of a responsive parenting (RP) intervention on mother-reported child emotional overeating, and explore whether effects are mediated by mother-reported use of food to soothe child distress.

Methods: The sample included primiparous mother-infant dyads randomized to a RP intervention (n = 105) or home safety control group (n = 102). Nurses delivered RP guidance in four behavioral domains: sleeping, fussy, alert/calm, and drowsy. Mothers reported their use of food to soothe at age 18 months and child emotional overeating at age 30 months. Mediation was analyzed using the SAS PROCESS macro.

Results: RP intervention mothers reported less frequent use of food to soothe and perceived their child's emotional overeating as lower compared to the control group. Food to soothe mediated the RP intervention effect on child emotional overeating (mediation model: R = 0.13, P < .0001).

Conclusions: Children's emotional overeating may be modified through an early life RP intervention. Teaching parents alternative techniques to soothe child distress rather than feeding may curb emotional overeating development to reduce future obesity risk.
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http://dx.doi.org/10.1111/ijpo.12645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729434PMC
October 2020

Patterns of infant-only wake bouts and night feeds during early infancy: An exploratory study using actigraphy in mother-father-infant triads.

Pediatr Obes 2020 10 22;15(10):e12640. Epub 2020 Apr 22.

Department of Nutritional Sciences, Center for Childhood Obesity Research, Penn State University, Pennsylvania, USA.

Background: Infants' ability to fall back to sleep without parental involvement may reduce nighttime feeding frequency.

Objective: We describe the associations between infant-only wake bouts ("self-soothing") and nighttime feeds using actigraphy from 6 to 24 weeks of age.

Methods: Mother-father-infant triads (N = 20) wore sleep monitors, and mothers recorded infant night feeds, when infants were 6, 15 and 24 weeks of age. Actigraphy data were matched within-families to quantify infant-only wake bouts (infants woke; mothers/fathers remained asleep). Mixed models tested associations between infant-only wake bouts and night feeding frequency.

Results: The proportion of infant-only wake bouts/night increased from 6 to 15 weeks of age (6 weeks: 52% [95% CI: 45-59]; 15 weeks: 64% [57-71]; 24 weeks: 62% [55-69]; P < .01). For every 10% increase in the proportion of infant-only wake bouts/night, there were 0.36 fewer feeds/night (P < .01) at 24 weeks; these concurrent associations were not found at 6 and 15 weeks. The proportion of infant-only wake bouts/night at 6 weeks predicted a faster rate of decline in the number of feeds/night from 6 to 24 weeks (P < .01).

Conclusion: Infants' ability to fall back to sleep without parent involvement at 6 weeks was associated with the trajectory of nighttime feeding frequency across early infancy.
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http://dx.doi.org/10.1111/ijpo.12640DOI Listing
October 2020

System Identification Approaches For Energy Intake Estimation: Enhancing Interventions For Managing Gestational Weight Gain.

IEEE Trans Control Syst Technol 2020 Jan 12;28(1):63-78. Epub 2018 Oct 12.

Exercise Psychology Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, USA.

Excessive maternal weight gain during pregnancy represents a major public health concern that calls for novel and effective gestational weight management interventions. In (HMZ), an on-going intervention study, energy intake underreporting has been found to be an important consideration that interferes with accurate weight control assessment, and the effective use of energy balance models in an intervention setting. In this paper, a series of estimation approaches that address measurement noise and measurement losses are developed to better understand the extent of energy intake underreporting. These include back-calculating energy intake from an energy balance model developed for gestational weight gain prediction, a Kalman filtering-based approach to recursively estimate energy intake from intermittent measurements in real-time, and an approach based on semi-physical identification principles which features the capability of adjusting future self-reported energy intake by parameterizing the extent of underreporting. The three approaches are illustrated by evaluating with participant data obtained through the HMZ intervention study, with the results demonstrating the potential of these methods to promote the success of weight control. The pros and cons of the presented approaches are discussed to generate insights for users in future applications.
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http://dx.doi.org/10.1109/TCST.2018.2871871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941743PMC
January 2020

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting intervention for firstborns impacts feeding of secondborns.

Am J Clin Nutr 2020 01;111(1):21-27

Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA.

Background: The Intervention Nurses Start Infant Growing on Healthy Trajectories (INSIGHT) study's responsive parenting (RP) intervention, initiated in early infancy, prevented the use of nonresponsive, controlling feeding practices and promoted use of structure-based feeding among first-time parents compared with controls.

Objectives: We sought to examine the spillover effect of the RP intervention on maternal feeding practices with their secondborn (SB) infants enrolled in an observational-only study, SIBSIGHT, and to test the moderating effect of spacing of births.

Methods: SB infants of mothers participating in the INSIGHT study were enrolled into the observation-only ancillary study, SIBSIGHT. SBs were healthy singleton infants ≥36 weeks of gestation. Infant feeding practices (i.e., food to soothe, structure vs. control-based practices) were assessed using validated questionnaires: Babies Need Soothing Questionnaire, Infant Feeding Styles Questionnaire, and the Structure and Control in Parent Feeding Questionnaire.

Results: SBs (n = 117 [RP: 57, control: 60]; 43% male) were delivered 2.5 ± 0.8 y after firstborns (FBs). At age 1 y, the Structure and Control in Parent Feeding Questionnaire revealed that the mothers in the RP group used more consistent feeding routines (4.19 [0.43] compared with 3.77 [0.62], P = 0.0006, Cohen's D: 0.69) compared with control group mothers. From the Infant Feeding Styles Questionnaire, RP group mothers also used less nonresponsive, controlling feeding practices such as pressuring their SB infant to finish (1.81 [0.52] compared with 2.24 [0.68], P = 0.001, Cohen's D: 0.68) compared with controls. In contrast to our hypotheses, no differences were detected in bottle-feeding practices such as putting to bed with a bottle/sippy cup or adding cereal to the bottle, despite observing study group differences in FBs. Spacing of births did not moderate intervention effects.

Conclusions: RP guidance given to mothers of FBs may prevent the use of some nonresponsive, controlling feeding practices while establishing consistent feeding routines in subsequent siblings.
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http://dx.doi.org/10.1093/ajcn/nqz277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944525PMC
January 2020

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age.

Public Health Nutr 2020 03 28;23(4):701-710. Epub 2019 Nov 28.

Department of Nutritional Sciences, Penn State College of Health and Human Development, 108C Chandlee Laboratory, University Park, PA 16802, USA.

Objective: To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations.

Design: Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors.

Setting: Head Start pre-school classrooms in four regions across central Pennsylvania, USA.

Participants: Low-income children of pre-school age (n 362) and their caregivers.

Results: Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6).

Conclusion: Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.
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http://dx.doi.org/10.1017/S136898001900332XDOI Listing
March 2020

Parents' and Children's Categorization of Candy are Similar: A Card Sort Protocol.

Nutrients 2019 Oct 15;11(10). Epub 2019 Oct 15.

Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802, USA.

American children frequently consume candy and, in excess, this may contribute to poor diets with attendant effects on obesity risk. Despite the ubiquity of candy in children's diets, parental concern about children's candy intake, and the diversity of confectionery products available, very little is known about how children and their parents conceptualize candy. Card sorting tasks offer a novel and visual technique to explore and compare an individuals' perceptions of foods and are useful where literacy is limited (e.g. young children). This study aimed to understand and compare how young school-aged children and parents categorize various candy products using a photo card sorting task. In individual laboratory sessions, children ( = 42, 5 to 8 years old) and parents ( = 35) categorized 51 types of candy based on their similarity. A cluster analysis showed that parents created more categories of candies than children (11 versus 8). For example, parents distinguished between candied fruit and candied nuts, whereas children tended to collapse these categories. However, 7 clusters were virtually identical between parents and children (93% similarity). The findings from this study can inform the measurement of candy intake and the development of education materials targeted towards parent feeding around candy.
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http://dx.doi.org/10.3390/nu11102472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835906PMC
October 2019

A longitudinal study of sleep-wake patterns during early infancy using proposed scoring guidelines for actigraphy.

Sleep Med 2019 11 8;63:98-105. Epub 2019 Jun 8.

Center for Childhood Obesity Research, Penn State University, University Park, PA, United States; Department of Nutrition Sciences, Penn State University, University Park, PA, United States. Electronic address:

Objective/background: We describe developmental and day-to-night sleep patterns across the first six months of life using actigraphy and compare these to mother-reported perceptions of infant sleep.

Patients/methods: This observational, burst design included three, one-week bursts of data collection at six, 15, and 24 weeks of age. Infants wore an actigraphy device (Actiwatch Spectrum) on their right ankle for each one-week period. Data were scored using a SAS-based hierarchical, algorithmic methodology and independently assessed for necessary corrections by two trained scorers in a Visual Basic. Mothers completed the Brief Infant Sleep Questionnaire (BISQ) at each burst. Mixed models tested developmental patterns over time and multilevel models examined day-to-night sleep patterns at each burst.

Results: Daytime nap sleep duration decreased over time (p = 0.02) with marginal significance for nighttime sleep interval duration increasing over time (p = 0.09). Total 24-h sleep duration was time invariant (p > 0.05). These longitudinal patterns were similar when examining mothers' perception of infant sleep. Daily variations demonstrated nighttime sleep interval and maintenance efficiency did not predict next-day nap sleep duration. Yet, at 24 weeks of age, daytime nap sleep was associated with that nights' sleep interval. For every 1-h above infants' average total daytime nap sleep duration, infants slept ∼15 min longer and 1.0% less efficiently that night (p ≤ 0.05). Mothers overestimated daytime nap sleep and total 24-h sleep, when compared to actigraphy (p < 0.01).

Conclusion: Changes to infants' usual daytime sleep duration impacted subsequent sleep bouts and mothers tended to overestimate infants' sleep. These patterns should be explored in relation to parenting practices.
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http://dx.doi.org/10.1016/j.sleep.2019.05.017DOI Listing
November 2019

Ecological momentary assessment of using food to soothe during infancy in the INSIGHT trial.

Int J Behav Nutr Phys Act 2019 09 5;16(1):79. Epub 2019 Sep 5.

Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA.

Background: Use of food to soothe infant distress has been linked to greater weight in observational studies. We used ecological momentary assessment to capture detailed patterns of food to soothe and evaluate if a responsive parenting intervention reduced parents' use of food to soothe.

Methods: Primiparous mother-newborn dyads were randomized to a responsive parenting intervention designed for obesity prevention or a safety control group. Responsive parenting curriculum included guidance on using alternative soothing strategies (e.g., swaddling), rather than feeding, as the first response to infant fussiness. After the initial intervention visit 3 weeks after delivery, mothers (n = 157) were surveyed for two 5-8 day bursts at infant ages 3 and 8 weeks. Surveys were sent via text message every 4 h between 10:00 AM-10:00 PM, with 2 surveys sent at 8:00 AM asking about nighttime hours. Infant fusses and feeds were reported for each 4-h interval. Food to soothe was defined as "Fed First" and "Not Fed First" in response to a fussy event. Use of food to soothe was modeled using random-intercept logistic regression.

Results: The control group had greater odds of having Fed First, compared to the responsive parenting group at ages 3 and 8 weeks (3 weeks: OR = 1.9; 95% CI = 1.4-2.7; p < 0.01; 8 weeks: OR = 1.4; 95% CI = 1.0-2.1; p = 0.053). More responsive parenting mothers reported using a responsive parenting intervention strategy first, before feeding, than controls at ages 3 and 8 weeks (3 weeks: 58.1% vs. 41.9%; 8 weeks: 57.1% vs. 42.9%, respectively; p < 0.01 for both). At both ages combined, fewer fusses from responsive parenting infants were soothed best by feeding compared to controls (49.5% vs. 61.0%, respectively; p < 0.01). For both study groups combined, parents had greater odds of having Fed First during the nighttime compared to the daytime at both ages (3 weeks: OR = 1.6, 95% CI = 1.4-1.8; p < 0.01; 8 weeks: OR = 2.1; 95% CI = 1.7-2.6; p < 0.01).

Conclusions: INSIGHT's responsive parenting intervention reduced use of food to soothe and increased use of alternative soothing strategies in response to infant fussiness. Education on responsive parenting behaviors around fussing and feeding during early infancy has the potential to improve later self-regulation and weight gain trajectory.

Trial Registration: NCT01167270 . Registered July 21, 2010.
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http://dx.doi.org/10.1186/s12966-019-0837-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727410PMC
September 2019

Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial.

Nutrients 2019 Apr 21;11(4). Epub 2019 Apr 21.

Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.

Excess maternal weight gain during pregnancy elevates infants' risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women ( = 27) with a BMI > 24. At study enrollment (6-13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14-34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.
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http://dx.doi.org/10.3390/nu11040899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520673PMC
April 2019

Exploring infant signing to enhance responsive parenting: Findings from the INSIGHT study.

Matern Child Nutr 2019 07 19;15(3):e12800. Epub 2019 Mar 19.

Center for Childhood Obesity Research, Pennsylvania State University, University Park, Pennsylvania.

Responsive parenting is a promising framework for obesity prevention, yet attempts to date have largely relied on parents accurately interpreting their child's cues. Infant signing or "baby sign language" could enhance these interventions by improving bidirectional parent-child communication during the preverbal and emerging language years. In a clinical trial testing, a responsive parenting intervention designed for obesity prevention, we pilot tested a brief intervention at age 40 weeks with a subset of participating dyads that taught the signing gesture of "all done" to improve parental recognition of satiety. In addition, we surveyed all participating mothers at child age 18 months on the use of infant signing gestures in the prior year. Two hundred twenty-eight mothers completed the survey including 72 responsive parenting group mothers that received the signing instructions. A majority of mothers, 63.6%, reported teaching their infant signs in the prior year, and 61.4% of infants were using signs to communicate at 18 months (median signs = 2). The signs for "more" and "all done" were used by over half of study participants and were the most common signs used. Other signs related to eating or drinking were commonly used. Signing intervention group infants were more likely to use the sign for "all done" than controls (63.9% vs. 45.5%; P = 0.01), but there was no difference between groups with regard to the use of the sign for "more" (56.9% vs. 51.3%; P = 0.43). Signing is commonly used by parents of young children and holds potential to improve parental responsiveness and obesity prevention efforts.
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http://dx.doi.org/10.1111/mcn.12800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594880PMC
July 2019

Patterns of Gestational Weight Gain and Infants Born Large-for-Gestational Age Across Consecutive Pregnancies.

Womens Health Issues 2019 Mar - Apr;29(2):194-200. Epub 2018 Dec 7.

Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania; Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania. Electronic address:

Introduction: Factors that occur between consecutive pregnancies may influence repeated excessive gestational weight gain (GWG) and infants born large-for-gestational age (LGA). We examined interpregnancy interval, weight retention, and GWG in women's first pregnancy as predictors of excessive GWG and LGA in women's second pregnancy.

Methods: We used data from women's first two live births during the First Baby Study, a 3-year prospective observational cohort of first-time mothers (N = 549). GWG was calculated as weight at delivery minus prepregnancy weight for first and second pregnancies and categorized using the Institute of Medicine guidelines. Weight retention at 6 and 12 months and interpregnancy interval (time from first live birth to conception of second infant) were quantified. Infants were considered LGA if birthweight was in the 90th percentile or greater for gestational age.

Results: Many women (51.7%) exceeded GWG recommendations in both pregnancies. Women who exceeded guidelines in their first pregnancy had a 5.08 greater odds (p < .01) for exceeding guidelines in their second pregnancy, compared with women who did not exceed guidelines in their first pregnancy. Interpregnancy interval and weight retention had no association with exceeding guidelines in women's second pregnancy. Exceeding guidelines in women's first pregnancy resulted in a 4.48 greater odds (p < .01) of first-born infants being LGA, and exceeding guidelines in women's second pregnancy resulted in a 1.82 greater odds of second-born infants being large-for-gestational age (p = .02), compared with women who met guidelines in their first or second pregnancy, respectively.

Conclusions: Exceeding GWG guidelines in women's first pregnancy predicted exceeding guidelines in their second pregnancy, independent of interpregnancy interval and weight retention.
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http://dx.doi.org/10.1016/j.whi.2018.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424600PMC
May 2019

A Kernel-Based Metric for Balance Assessment.

J Causal Inference 2018 Sep 18;6(2). Epub 2018 May 18.

University of Colorado School of Public Health, Biostatistics and Informatics, 13001 E. 17th Place, Aurora, 80045, Colorado, United States,

An important goal in causal inference is to achieve balance in the covariates among the treatment groups. In this article, we introduce the concept of distributional balance preserving which requires the distribution of the covariates to be the same in different treatment groups. We also introduce a new balance measure called kernel distance, which is the empirical estimate of the probability metric defined in the reproducing kernel Hilbert spaces. Compared to the traditional balance metrics, the kernel distance measures the difference in the two multivariate distributions instead of the difference in the finite moments of the distributions. Simulation results show that the kernel distance is the best indicator of bias in the estimated casual effect compared to several commonly used balance measures. We then incorporate kernel distance into genetic matching, the state-of-the-art matching procedure and apply the proposed approach to analyze the Early Dieting in Girls study. The study indicates that mothers' overall weight concern increases the likelihood of daughters' early dieting behavior, but the causal effect is not significant.
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http://dx.doi.org/10.1515/jci-2016-0029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258021PMC
September 2018