Publications by authors named "Leann L Birch"

139 Publications

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

Assessing health disparities in foods and beverages served in early care and education programs across Georgia.

Pediatr Obes 2021 Mar 17:e12787. Epub 2021 Mar 17.

Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA.

Background: Obesity disproportionately impacts children who are Black and Hispanic, those who live in rural communities and those who have low income. Predisposition to obesity early in life is profoundly impacted by feeding habits during the preschool years. The early care and education (ECE) setting impacts children's health by providing daily meals.

Objective: The goal of this study was to identify whether or not health disparities in foods and beverages served in ECE programs in Georgia exist based on socioeconomic, demographic and geographic variables.

Methods: A random sample was drawn from 3054 ECE programs across the state of Georgia. The likelihood of serving specific foods and beverages in ECE programs in the previous day was measured. Percentages and frequencies, logistic regressions, Spearman's rho and Odds ratio tests determined outcomes.

Results: A total of 974 surveys were returned. Data were stratified based on the income level of the participant families, race of enrolled children and geographic location of the ECE program. Disparities existed between programs based on race of enrolled children and geographic location. For example, although the odds of providing sweets increased by 0.6% as the percentage of Black children enrolled increased, the provision of healthier foods, such as the odds of providing fruits (P = .001), vegetables (P = .001) and protein (P = .001) also increased. However, after results were adjusted for covariates findings did not remain significant.

Conclusions: Future research focused on evaluating the foods and beverages provided in ECE programs and the relationship of how income, race and location are related may provide further understanding about the disproportionate childhood obesity rates in America.
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http://dx.doi.org/10.1111/ijpo.12787DOI 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

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

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

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

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

Sleep SAAF: a responsive parenting intervention to prevent excessive weight gain and obesity among African American infants.

BMC Pediatr 2019 07 5;19(1):224. Epub 2019 Jul 5.

Department of Foods and Nutrition, University of Georgia, Athens, USA.

Background: Responsive parenting interventions that shape parenting behaviors in the areas of sleep and soothing, appropriate and responsive feeding, and routines represent a promising approach to early obesity prevention and have demonstrated effectiveness in our previous trials. However, this approach has yet to be applied to the populations most at-risk for the development of early obesity, including African Americans. The Sleep SAAF (Strong African American Families) study is a two-arm randomized controlled clinical trial evaluating whether a responsive parenting intervention focused on promoting infant sleeping and self-soothing can prevent rapid weight gain during the first 16 weeks postpartum among first-born African American infants. The responsive parenting intervention is compared to a child safety control intervention.

Methods: Three hundred first-time African American mothers and their full-term infants will be enrolled from one mother/baby nursery. Following initial screening and consent in the hospital, mothers and infants are visited at home by Community Research Associates for data collection visits at 1 week, 8 weeks, and 16 weeks postpartum and for intervention visits at 3 weeks and 8 weeks postpartum. The primary study outcome is a between-group comparison of infant conditional weight gain (CWG) scores from 3 weeks to 16 weeks; additional weight-related outcomes include differences in change in infants' weight for age over time and differences in infants' weight outcomes at age 16 weeks. Several other outcomes reflecting infant and maternal responses to intervention (e.g., sleeping, soothing, feeding, maternal self-efficacy, maternal depressive symptoms) are also assessed.

Discussion: The Sleep SAAF trial can inform efforts to prevent rapid weight gain and reduce risk for obesity early in the lifespan among African Americans.

Trial Registration: NCT03505203 . Registered April 3, 2018 in clinicaltrials.gov .
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http://dx.doi.org/10.1186/s12887-019-1583-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610994PMC
July 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

Dieting is associated with reduced bone mineral accrual in a longitudinal cohort of girls.

BMC Public Health 2018 Nov 22;18(1):1285. Epub 2018 Nov 22.

Center for Childhood Obesity Research and Department of Nutritional Sciences, The Pennsylvania State University, 103 Noll Laboratory, University Park, PA, 16802, USA.

Background: Peak bone mass accrual occurs during adolescence, a time when dieting and related eating behaviors are common. Impaired bone mineral accrual is a known consequence of eating disorders in adolescents, but the effects of subclinical dieting behaviors on bone mineral content (BMC) have not been described in this age group. The goal of this analysis was to determine whether dieting behavior in preadolescence and adolescence is associated with bone mineral accrual in adolescent girls.

Methods: Non-Hispanic white girls (n = 139) were followed in a longitudinal cohort study. BMC was assessed at ages 9 and 15y. Dieting to lose weight was reported every 2 years, and dietary restraint and disinhibition, eating attitudes, weight concerns, and body esteem were assessed at age 11y. Girls were classified as "early dieters" if they first dieted by age 11y (31.7%), "adolescent dieters" if they first dieted after 11y (46.8%), or non-dieters if they did not report dieting by 15 y (21.6%). The effect of dieting related variables on BMC at 15y and change in BMC from 9 to 15y was assessed using linear regression, controlling for height, weight, BMI, physical activity, and pubertal status.

Results: Girls who first reported dieting to lose weight by age 11y had a 4.2% lower bone mineral accrual across adolescence (p = 0.02) and 3.1% lower BMC at age 15y (p = 0.005) than girls who first reported dieting after 11y or not at all. Number of weight control behaviors used, dietary restraint, and weight concerns were also negatively associated with BMC (p < 0.05).

Conclusions: Dieting behavior in preadolescence is associated with reduced bone mineral accrual. Strategies to promote optimal bone development should include prevention of dieting.

Trial Registration: Clinicaltrials.gov NCT03342430, November 17, 2017. Retrospectively registered.
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http://dx.doi.org/10.1186/s12889-018-6206-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251190PMC
November 2018

Child Weight Gain Trajectories Linked To Oral Microbiota Composition.

Sci Rep 2018 09 19;8(1):14030. Epub 2018 Sep 19.

Center for Medical Genomics, Penn State University, University Park, PA, 16802, USA.

Gut and oral microbiota perturbations have been observed in obese adults and adolescents; less is known about their influence on weight gain in young children. Here we analyzed the gut and oral microbiota of 226 two-year-olds with 16S rRNA gene sequencing. Weight and length were measured at seven time points and used to identify children with rapid infant weight gain (a strong risk factor for childhood obesity), and to derive growth curves with innovative Functional Data Analysis (FDA) techniques. We showed that growth curves were associated negatively with diversity, and positively with the Firmicutes-to-Bacteroidetes ratio, of the oral microbiota. We also demonstrated an association between the gut microbiota and child growth, even after controlling for the effect of diet on the microbiota. Lastly, we identified several bacterial genera that were associated with child growth patterns. These results suggest that by the age of two, the oral microbiota of children with rapid infant weight gain may have already begun to establish patterns often seen in obese adults. They also suggest that the gut microbiota at age two, while strongly influenced by diet, does not harbor obesity signatures many researchers identified in later life stages.
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http://dx.doi.org/10.1038/s41598-018-31866-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145887PMC
September 2018

Feasibility of Including Behavioral Feeding Training Within a Parent Intervention for Young Children With Type 1 Diabetes.

J Clin Psychol Med Settings 2019 06;26(2):220-227

Children's National Health System, Center for Translational Science, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.

Young children with T1D frequently display challenging eating behaviors interfering with diabetes management. The current study explored the feasibility and acceptability of a behavioral parent feeding training session with young children with type 1 diabetes. As part of a larger intervention pilot focused on healthy eating and physical activity, 9 young children (M = 4.22) with type 1 diabetes (T1D) and their mothers participated in a novel/non-preferred food training session. Parents were taught strategies and then were given an opportunity to use the strategies with their child. The paradigm was video recorded and content was coded for parent and child behavior. Feasibility was high, and all parents rated the feeding session as acceptable. All parents demonstrated using at least one behavioral feeding skill (M = 3.38, SD = 1.60). All 9 (100%) children touched at least one of their non-preferred foods (M = 2.05, SD = 0.75), and 5 (56%) ate at least one novel/non-preferred food (M = 1.65, SD = 0.87). Parents of young children with T1D demonstrated use of parenting skills after receiving brief instructions, with more children than not trying at least one novel/non-preferred food.
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http://dx.doi.org/10.1007/s10880-018-9577-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414282PMC
June 2019

INSIGHT Study Maternal Return to Work and Infant Weight Outcomes.

Acad Pediatr 2019 Jan - Feb;19(1):67-73. Epub 2018 Aug 23.

Center for Childhood Obesity Research (SG Eagleton, EE Hohman, and JS Savage) and Department of Nutritional Sciences (SG Eagleton and JS Savage), Penn State College of Health and Human Development, University Park, Pa; Department of Foods and Nutrition, University of Georgia (LL Birch), Athens, Ga.

Objective: Maternal return to work within 12 weeks of delivery is associated with poor child health and development. However, little is known about the impact of return to work on the risk of child obesity. We examined whether timing of maternal return to work is associated with rapid infant weight gain from 0 to 6 months and weight-for-length at 1 year.

Methods: Secondary data analysis of 279 mother-newborn dyads from the Intervention Nurses Start Infants Growing on Healthy Trajectories Study, a randomized controlled trial evaluating a responsive parenting (RP) intervention. Rapid infant weight gain from 0 to 6 months was assessed using conditional weight gain (CWG) scores. Infant weight-for-length was calculated using World Health Organization reference values. Analysis of variance (ANOVA) examined whether infant weight outcomes differed by timing of maternal return to work (≤12 weeks vs >12 weeks after delivery). Moderation by study group (RP intervention vs safety control) and mediation by breastmilk feeding were examined in ANOVA models.

Results: Among 261 mothers, approximately one half (n = 130) returned to work within 12 weeks. Compared with infants of mothers who returned to work after 12 weeks, infants of mothers who returned to work within 12 weeks had greater CWG scores from 0 to 6 months (P = .006) and were heavier at 1 year (P = .05). These associations were not moderated by study group or mediated by breastmilk feeding.

Conclusions: Maternal return to work within 12 weeks was associated with rapid infant weight gain in the first 6 months and greater weight-for-length at 1 year, although the mechanisms to explain our findings are unclear.
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http://dx.doi.org/10.1016/j.acap.2018.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321792PMC
February 2020

Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial.

JAMA 2018 08;320(5):461-468

Department of Foods and Nutrition, University of Georgia, Athens.

Importance: Rapid growth and elevated weight status in early childhood increase risk for later obesity, but interventions that improve growth trajectories are lacking.

Objective: To examine effects of a responsive parenting intervention designed to promote developmentally appropriate, prompt, and contingent responses to a child's needs on weight outcomes at 3 years.

Design, Setting, And Participants: A single-center randomized clinical trial comparing a responsive parenting intervention designed to prevent childhood obesity vs a home safety intervention (control) among 279 primiparous mother-child dyads (responsive parenting group, 140; control group, 139) who enrolled and completed the first home visit from January 2012 through March 2014 with follow-up to age 3 years (completed by April 2017).

Interventions: Research nurses conducted 4 home visits during infancy and annual research center visits. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety.

Main Outcomes And Measures: The primary outcome was body mass index (BMI) z score at 3 years (z score of 0 represents the population mean; 1 and -1 represent 1 SD above and below the mean, respectively). BMI percentile at 3 years was designated previously as the primary outcome. Secondary outcomes included the prevalence of overweight (BMI ≥85th percentile and <95th percentile) and obesity (BMI ≥95th percentile) at 3 years.

Results: Among 291 mother-child dyads randomized, 279 received the first home visit and were included in the primary analysis. 232 mother-child dyads (83.2%) completed the 3-year trial. Mean age of the mothers was 28.7 years; 86% were white and 86% were privately insured. At age 3 years, children in the responsive parenting group had a lower mean BMI z score (-0.13 in the responsive parenting group vs 0.15 in the control group; absolute difference, -0.28 [95% CI, -0.53 to -0.01]; P = .04). Mean BMI percentiles did not differ significantly (47th in the responsive parenting group vs 54th in the control group; reduction in mean BMI percentiles of 6.9 percentile points [95% CI, -14.5 to 0.6]; P = .07). Of 116 children in the responsive parenting group, 13 (11.2%) were overweight vs 23 (19.8%) of 116 children in the control group (absolute difference, -8.6% [95% CI, -17.9% to 0.0%]; odds ratio [OR], 0.51 [95% CI, 0.25 to 1.06]; P = .07); 3 children (2.6%) in the responsive parenting group were obese vs 9 children (7.8%) in the control group (absolute difference, -5.2% [95% CI, -10.8% to 0.0%]; OR, 0.32 [95% CI, 0.08 to 1.20]; P = .09).

Conclusions And Relevance: Among primiparous mother-child dyads, a responsive parenting intervention initiated in early infancy compared with a control intervention resulted in a modest reduction in BMI z scores at age 3 years, but no significant difference in BMI percentile. Further research is needed to determine the long-term effect of the intervention and assess its efficacy in other settings.

Trial Registration: ClinicalTrials.gov Identifier: NCT01167270.
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http://dx.doi.org/10.1001/jama.2018.9432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142990PMC
August 2018

More rapid increase in BMI from age 5-15 is associated with elevated weight status at age 24 among non-Hispanic white females.

Eat Behav 2018 12 23;31:12-17. Epub 2018 Jul 23.

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

Background: A rapidly increasing BMI trajectory throughout childhood is associated with negative health outcomes in adulthood such as obesity, cardiovascular disease, and diabetes. The purpose of the current study was to assess whether BMI trajectories from age 5-15 predicted changes in weight and BMI from adolescence to adulthood, and dieting-related behaviors in young adulthood.

Methods: Non-Hispanic White female participants from Early Dieting in Girls (n = 182), a longitudinal cohort study, were followed from age 5 to 15 and completed a follow-up survey at age 24. Participants were classified by age 5-15 BMI trajectory groups: UPC, accelerated weight gain from age 5-9; DDPC, accelerated weight gain from 5 to 9 followed by a decrease; 60PT, weight tracked along 60th percentile; 50PT, weight tracked along 50th percentile. Data at age 24 included self-reported weight, height, dietary restraint, disinhibition, and dieting.

Results: Majority of participants (80.8%) completed the follow-up survey; of these participants, 60% in UPC group had obesity at age 24, compared to <10% in the other 3 groups. Participants in the UPC group had greater increases in BMI since age 15, compared to the 50PT group, and trend-level greater weight increases than those in the DDPC and 60PT groups. Dietary restraint, but not disinhibition, differed across the groups.

Conclusions: Children with accelerated weight gain continued to have the greatest weight gain from adolescence to adulthood and the highest prevalence of obesity in adulthood.
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http://dx.doi.org/10.1016/j.eatbeh.2018.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226326PMC
December 2018

INSIGHT responsive parenting intervention and infant feeding practices: randomized clinical trial.

Int J Behav Nutr Phys Act 2018 07 9;15(1):64. Epub 2018 Jul 9.

Department of Foods and Nutrition, University of Georgia, Athens, GA, USA.

Background: What, when, how, how much, and how often infants are fed have been associated with childhood obesity risk. The objective of this secondary analysis was to examine the effect of a responsive parenting (RP) intervention designed for obesity prevention on parents' infant feeding practices in the first year after birth.

Methods: Primiparous mother-newborn dyads were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study RP intervention or child safety control. Research nurses delivered intervention content at home at infant age 3-4, 16, 28, and 40 weeks, and at a research center at 1 year. RP feeding guidance advised feeding that was contingent (i.e., feed in response to hunger and satiety signs, alternatives to using food to soothe), and developmentally appropriate (i.e., delaying introduction of solids, age-appropriate portion sizes). Infant feeding practices (i.e., bottle use, introduction of solids, food to soothe) were assessed by phone interviews and online surveys and dietary intake was assessed using a food frequency questionnaire.

Results: RP mothers were more likely to use of structure-based feeding practices including limit-setting (p < 0.05) and consistent feeding routines (p < 0.01) at age 1 year. RP group mothers were less likely to use non-responsive feeding practices such as pressuring their infant to finish the bottle/food (p < 0.001), and using food to soothe (p < 0.01), propping the bottle (p < 0.05) assessed between 4 and 8 months, and putting baby to bed with a bottle at age 1 year (p < 0.05). Few differences were seen between groups in what specific foods or food groups infants were fed.

Conclusions: Anticipatory guidance on RP in feeding can prevent the use of food to soothe and promote use of more sensitive, structure-based feeding which could reduce obesity risk by affecting how and when infants are fed during the first year.

Trial Registration: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study. www.clinicaltrials.gov . NCT01167270. Registered 21 July 2010.
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http://dx.doi.org/10.1186/s12966-018-0700-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038199PMC
July 2018

Effects of the INSIGHT Obesity Preventive Intervention on Reported and Observed Infant Temperament.

J Dev Behav Pediatr 2018 12;39(9):736-743

Department of Foods and Nutrition, University of Georgia, Athens, GA.

Objective: Infants higher on negative reactivity and lower on regulation, aspects of temperament, have increased obesity risk. Responsive parenting (RP) has been shown to impact the expression of temperament, including the developing ability to regulate negative emotions. The aim of this analysis was to test the effects of the INSIGHT study's RP intervention designed for the primary prevention of obesity on reported and observed infant negativity and regulation.

Methods: The sample included 240 mother-infant dyads randomized 2 weeks after birth to the RP intervention or a safety control intervention. Both groups received 4 home visits during the infant's first year. In the RP group, nurses delivered RP guidance in domains of sleep, feeding, soothing, and interactive play. At 1 year, mother-reported temperament was measured by a survey, and a frustration task was used to observe temperament in the laboratory. Effects of the RP intervention were tested using general linear models.

Results: The RP intervention reduced overall reported infant negativity, driven by lower distress to limitations (p < 0.05) and faster recovery from distress (p < 0.01) in the RP group versus controls. There were no intervention effects on reported regulation or observed negativity. The intervention did increase observed regulation, particularly the use of self-comforting strategies (p < 0.05) during the frustration task.

Discussion: An RP intervention designed for early obesity prevention affected reported infant negativity and observed regulation, outcomes that have been linked with subsequent healthy development. Interventions grounded in an RP framework have the potential for widespread effects on child health and well-being.
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http://dx.doi.org/10.1097/DBP.0000000000000597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261801PMC
December 2018

INSIGHT responsive parenting intervention reduces infant's screen time and television exposure.

Int J Behav Nutr Phys Act 2018 03 15;15(1):24. Epub 2018 Mar 15.

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

Background: Sedentary behaviors, including screen time, in childhood have been associated with an increased risk for overweight. Beginning in infancy, we sought to reduce screen time and television exposure and increase time spent in interactive play as one component of a responsive parenting (RP) intervention designed for obesity prevention.

Methods: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control intervention. Primiparous mother-newborn dyads (N = 279) were randomized after childbirth. Research nurses delivered intervention content at infant ages 3, 16, 28, and 40 weeks and research center visits at 1 and 2 years. As one component of INSIGHT, developmentally appropriate messages on minimizing screen time, reducing television exposure in the home, and promoting parent-child engagement through interactive play were delivered. Mothers self-reported their infant's screen time at ages 44 weeks, 1, 1.5, 2 and 2.5 years; interactive play was reported at 8 and 20 weeks and 2 years.

Results: More RP than control parents reported their infants met the American Academy of Pediatrics' no screen time recommendation at 44 weeks (53.0% vs. 30.2%) and at 1 year on weekdays (42.5% vs. 27.6%) and weekends (45.5% vs. 26.8%), but not after age 1 year. RP mothers and RP children had less daily screen time than controls at each time point (p ≤ 0.01). Fewer RP than control group mothers reported the television was ever on during infant meals (p < 0.05). The frequency of tummy time and floor play did not differ by study group; approximately 95% of infants spent time in restrictive devices (i.e. swing) at 8 and 20 weeks. At 2 years of age, there were no study group differences for time children spent in interactive play.

Conclusion: From infancy to early childhood, the INSIGHT RP intervention reduced screen time and television exposure, but did not increase the frequency or amount of interactive play.

Trial Registration: clinicaltrials.gov NCT01167270 . Registered on 21 July 2010.
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http://dx.doi.org/10.1186/s12966-018-0657-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855973PMC
March 2018

Differences in early risk factors for obesity between African American formula-fed infants and White breastfed controls.

Pilot Feasibility Stud 2017 15;3:58. Epub 2017 Nov 15.

Department of Foods and Nutrition, University of Georgia, Athens, GA USA.

Background: Previous RCTs to prevent early rapid weight gain were conducted in predominantly White, well-educated, middle-income mother-infants at low risk for obesity. To inform the design of an RCT in a higher-risk sample, we conducted a short-term, longitudinal study to compare maternal feeding beliefs and behaviors, infant sleep, intake, and growth of African American formula feeding (AAFF) dyads to a comparison sample of White breastfeeding (WBF) dyads. We also assessed the feasibility of recruiting and retaining AAFF participants.

Methods: AAFF ( = 32) and WBF ( = 25) mother-infants were assessed at 2, 8, and 16 weeks postpartum. Data included demographics and maternal reports of feeding beliefs and behaviors, infant sleep, meal size, and feeding frequency, and measured infant length and weight.

Results: AAFF and WBF mothers differed in demographics. AAFF mothers reported greater agreement with pressuring the infant to eat and feeding to soothe a fussy infant. Compared to WBF infants, AAFF infants slept fewer hours and consumed more grams/feeding from 2 to 16 weeks. There were no group differences in feeding frequency, which resulted in AAFF infants consuming more grams/day of milk than WBF infants. AAFF infants had lower gestational age, lower weight at 2 weeks, and had more rapid weight gain from 8 to 16 weeks.

Conclusions: Findings point to potentially modifiable risk factors that may underlie disparities in early obesity among AAFF infants, including short sleep duration, feeding beliefs and behaviors, and rapid growth, but also confirm the challenges of recruiting and retaining AAFF participants, all of which inform the design and feasibility of an early preventive intervention.

Trial Registration: Retrospectively registered in clinicaltrials.gov on August 23, 2016 (2013102510).
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http://dx.doi.org/10.1186/s40814-017-0198-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688749PMC
November 2017

Pacifier Use and Early Life Weight Outcomes in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study.

Child Obes 2018 01 4;14(1):58-66. Epub 2017 Oct 4.

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

Background: Although widely used by infants, little is known about the long-term effects of pacifiers. We investigated relationships between pacifier use in infancy and appetite, temperament, feeding, and weight outcomes through age 2 years using data from the Intervention Nurses Start Infants Growing on Healthy Trajectories study.

Methods: Mother-newborn dyads were randomized to a responsive parenting intervention for obesity prevention or a control group. Infants with data on pacifier use (n = 250) were categorized as using a pacifier beyond early infancy (≥4 months of age) or not. Anthropometrics were measured at 6 months, 1, and 2 years with overweight defined as weight-for-length ≥95th percentile at 1 year and BMI ≥85th percentile at 2 years. Mothers completed questionnaires on temperament, appetite, and feeding.

Results: Infants who used a pacifier at 4 months or later (68%) had greater conditional weight gain from birth to 6 months (p = 0.01), weight-for-length z-score at 1 year (p < 0.001), and BMI z-score at 2 years (p < 0.001) than infants who did not. Infants using a pacifier at ≥4 months were more likely to be overweight at ages 1 year (11.7% vs. 1.3%, p = 0.03) and 2 years (20.1% vs. 7.9%, p = 0.03). Pacifier use was associated with shorter breastfeeding duration and less responsive parent feeding styles, but these variables did not mediate the relationship between pacifiers and weight. Parent-reported temperament and appetite were unrelated to pacifier use.

Conclusions: Pacifier use beyond early infancy is associated with accelerated infant growth and toddler overweight, although the reasons for this relationship are unclear.
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http://dx.doi.org/10.1089/chi.2017.0177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743033PMC
January 2018

Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study.

Pediatrics 2017 Jul 5;140(1). Epub 2017 Jun 5.

Department of Foods and Nutrition, University of Georgia, Athens, Georgia.

Objectives: The American Academy of Pediatrics recommends infant-parent room-sharing until age 1. We assessed the association between room-sharing and sleep outcomes.

Methods: The Intervention Nurses Start Infants Growing on Healthy Trajectories study is an obesity prevention trial comparing a responsive parenting intervention with a safety control among primiparous mother-infant dyads. Mothers completed the Brief Infant Sleep Questionnaire at 4, 9, 12, and 30 months. Reported sleep duration and overnight behaviors, adjusted for intervention group, were compared among early independent sleepers (own room <4 months), later independent sleepers (own room between 4 and 9 months), and room-sharers at 9 months.

Results: At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers ( = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively ( = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months ( = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months ( < .01 for both).

Conclusions: Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.
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http://dx.doi.org/10.1542/peds.2017-0122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495531PMC
July 2017

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes.

Psychol Sport Exerc 2017 May 20;30:73-81. Epub 2017 Feb 20.

Mount Nittany Physician Group, State College, Pennsylvania.

Objectives: Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).

Design: Randomized control trial with two intervention arms and control (standard care).

Method: Participants (=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.

Results: At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls ('s < .05) and significantly higher exercise min and subjective norm than the Home group ('s < .05); these effect sizes were medium-large (η = .11-.23). There was a medium effect (η = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.

Conclusion: A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.
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http://dx.doi.org/10.1016/j.psychsport.2017.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393351PMC
May 2017

Metabolism-related microRNAs in maternal breast milk are influenced by premature delivery.

Pediatr Res 2017 Aug 24;82(2):226-236. Epub 2017 May 24.

Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania.

BackgroundMaternal breast milk (MBM) is enriched in microRNAs, factors that regulate protein translation throughout the human body. MBM from mothers of term and preterm infants differs in nutrient, hormone, and bioactive-factor composition, but the microRNA differences between these groups have not been compared. We hypothesized that gestational age at delivery influences microRNA in MBM, particularly microRNAs involved in immunologic and metabolic regulation.MethodsMBM from mothers of premature infants (pMBM) obtained 3-4 weeks post delivery was compared with MBM from mothers of term infants obtained at birth (tColostrum) and 3-4 weeks post delivery (tMBM). The microRNA profile in lipid and skim fractions of each sample was evaluated with high-throughput sequencing.ResultsThe expression profiles of nine microRNAs in lipid and skim pMBM differed from those in tMBM. Gene targets of these microRNAs were functionally related to elemental metabolism and lipid biosynthesis. The microRNA profile of tColostrum was also distinct from that of pMBM, but it clustered closely with tMBM. Twenty-one microRNAs correlated with gestational age demonstrated limited relationships with method of delivery, but not other maternal-infant factors.ConclusionPremature delivery results in a unique MBM microRNA profile with metabolic targets. This suggests that preterm milk may have adaptive functions for growth in premature infants.
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http://dx.doi.org/10.1038/pr.2017.54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552431PMC
August 2017

Family, friend, and media factors are associated with patterns of weight-control behavior among adolescent girls.

Eat Weight Disord 2018 Apr 17;23(2):215-223. Epub 2017 Mar 17.

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

Purpose: To examine the relationship of family, friend, and media factors on weight-control group membership at 15 years separately and in a combined model.

Methods: Subjects included 166 15 year girls. Latent class analysis identified four patterns of weight-control behaviors: non-dieters, lifestyle, dieters, and extreme dieters. Family (family functioning, priority of the family meals, maternal/paternal weight-teasing, and mother's/father's dieting), friend (weight-teasing and dieting), and media variables (media sensitivity and weekly TV time) were included as predictors of weight-control group membership.

Results: Family functioning and priority of family meals predicted membership in the Extreme Dieters group, and maternal weight-teasing predicted membership in both dieters and extreme dieters. Friend's dieting and weight-teasing predicted membership in both dieters and extreme dieters. Media sensitivity was significantly associated with membership in lifestyle, dieters, and extreme dieters. In a combined influence model with family, friend, and media factors included, the following remained significantly associated with weight-control group membership: family functioning, friends' dieting, and media sensitivity.

Conclusion: Family, friends, and the media are three sources of sociocultural influence, which play a role in adolescent girls' use of patterns of weight-control behaviors; family functioning was a protective factor, whereas friend's dieting and media sensitivity were risk factors. These findings emphasize the need for multidimensional interventions, addressing risk factors for dieting and use of unhealthy weight-control behaviors at the family, peer, and community (e.g., media) levels.
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http://dx.doi.org/10.1007/s40519-016-0359-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601019PMC
April 2018

Psychological and neural contributions to appetite self-regulation.

Obesity (Silver Spring) 2017 03;25 Suppl 1:S17-S25

Banner Alzheimer's Institute, Phoenix, Arizona, USA.

Objective: This paper reviews the state of the science on psychological and neural contributions to appetite self-regulation in the context of obesity.

Methods: Three content areas (neural systems and cognitive functions; parenting and early childhood development; and goal setting and goal striving) served to illustrate different perspectives on the psychological and neural factors that contribute to appetite dysregulation in the context of obesity. Talks were initially delivered at an NIH workshop consisting of experts in these three content areas, and then content areas were further developed through a review of the literature.

Results: Self-regulation of appetite involves a complex interaction between multiple domains, including cognitive, neural, social, and goal-directed behaviors and decision-making. Self-regulation failures can arise from any of these factors, and the resulting implications for obesity should be considered in light of each domain. In some cases, self-regulation is amenable to intervention; however, this does not appear to be universally true, which has implications for both prevention and intervention efforts.

Conclusions: Appetite regulation is a complex, multifactorial construct. When considering its role in the obesity epidemic, it is advisable to consider its various dimensions together to best inform prevention and treatment efforts.
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http://dx.doi.org/10.1002/oby.21789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328502PMC
March 2017

Development of a theory-based questionnaire to assess structure and control in parent feeding (SCPF).

Int J Behav Nutr Phys Act 2017 01 26;14(1). Epub 2017 Jan 26.

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

Background: Parents shape children's eating environments and act as powerful socialization agents, impacting young children's behavioral controls of food intake. Most feeding measures assess parents' use of control to manage children's intake of energy dense foods. The Structure and Control in Parent Feeding (SCPF) questionnaire was developed to assess more positive aspects of feeding practices with their young children -setting limits, providing routines-that promote self-regulation, as well as controlling feeding practices.

Methods: A mixed method approach was used to develop the SCPF. In 2013, cognitive interviews informed the modification, deletion and/or replacement of items. In 2014, the survey was distributed statewide to mothers of toddlers aged 12 to 36 months participating in the Women, Infants, and Children program. In 2016, exploratory factor analyses was conducted to test our theoretical parenting model and content validity and criterion validity were assessed (n = 334).

Results: Exploratory factor analysis (EFA) and second-order EFA revealed a 2-factor, 22-item Structure model and a 2-factor, 12-item Control model. Internal consistencies for all factors exceeded 0.70. As predicted, the Structure superfactor was positivity associated with responsiveness, whereas the Control superfactor was positively associated with demandingness on the Caregiver's Feeding Styles Questionnaire. The Structure subscales were also positively associated with mealtime behaviors and Control subscales were positively associated with control-oriented feeding measures from the Control in Parent Feeding Practices questionnaire.

Conclusion: The SCPF questionnaire is a reliable tool that can be used to assess aspects of structure- and control-based feeding practices to better understand how parents feed their toddlers.
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http://dx.doi.org/10.1186/s12966-017-0466-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5270355PMC
January 2017

INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants.

Obesity (Silver Spring) 2017 01;25(1):185-191

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

Objective: To determine whether a responsive parenting (RP) intervention affects infant dietary patterns.

Methods: Primiparous mother-newborn dyads (n = 291) were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) RP intervention or control. Curricula were delivered at nurse home visits at ages 3, 16, 28, and 40 weeks. RP group feeding guidance advised responsive feeding, delayed introduction of solids, repeated exposure to novel foods, and age-appropriate portion sizes. Latent class analysis identified patterns of dietary exposure at 9 months. Class membership at 9 months was used to predict BMI percentile at 2 years.

Results: Five dietary patterns were identified: "Breastfed, Fruits and Vegetables," "Breastfed, Low Variety," "Formula, Fruits and Vegetables," "Formula, Low Variety," and "Formula, High Energy Density." Over 60% of infants had patterns low in fruits and vegetables or high in energy-dense foods. RP group infants were less likely than control to be in the "Formula, Low Variety" class (OR = 0.40, 95% CI 0.23-0.71) or "Formula, High Energy Density" class (OR = 0.28, 95% CI 0.12-0.61) relative to the "Formula, Fruits and Vegetables" class. Dietary pattern at 9 months was significantly associated with BMI percentile at 2 years.

Conclusions: While a majority of infants consumed diets low in fruits and vegetables, the INSIGHT RP intervention was associated with healthier dietary patterns.
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http://dx.doi.org/10.1002/oby.21705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5189916PMC
January 2017

Application of the multiphase optimization strategy to a pilot study: an empirical example targeting obesity among children of low-income mothers.

BMC Public Health 2016 11 22;16(1):1181. Epub 2016 Nov 22.

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

Background: Emerging approaches to building more efficient and effective behavioral interventions are becoming more widely available. The current paper provides an empirical example of the use of the engineering-inspired multiphase optimization strategy (MOST) to build a remotely delivered responsive parenting intervention to prevent obesity among children of low-income mothers with and without depressive symptoms.

Methods: Participants were 107 mothers with (n = 45) and without (n = 62) depressive symptoms who had a child aged 12 to 42 months participating in the Women, Infants and Children program. Participants were randomized to one of sixteen experimental conditions using a factorial design that included a combination of the following eight remotely delivered intervention components: responsive feeding curriculum (given to all participants), parenting curriculum, portion size guidance, obesogenic risk assessment, personalized feedback on mealtime routines, feeding curriculum counseling, goal setting, mobile messaging, and social support. This design enabled efficient identification of components with low feasibility and acceptability.

Results: Completion rates were high (85%) and did not statistically differ by depressive symptoms. However, mothers with depressive symptoms who received obesogenic risk assessment and personalized feedback on mealtime routines components had lower completion rates than mothers without depressive symptoms. All intervention components were feasible to implement except the social support component. Regardless of experimental condition, most participants reported that the program increased their awareness of what, when, and how to feed their children.

Conclusions: MOST provided an efficient way to assess the feasibility of components prior to testing them with a fully powered experiment. This framework helped identify potentially challenging combinations of remotely delivered intervention components. Consideration of how these results can inform future studies focused on the optimization phase of MOST is discussed.
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http://dx.doi.org/10.1186/s12889-016-3850-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120514PMC
November 2016

Eating in the absence of hunger during childhood predicts self-reported binge eating in adolescence.

Eat Behav 2017 01 10;24:7-10. Epub 2016 Nov 10.

Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA 16802, United States.

Objective: The objectives of the current study were to examine whether eating in the absence of hunger (EAH) at age 7 predicted reports of self-reported binge eating at age 15 and to identify factors among girls with high-EAH that moderated risk of later binge eating.

Method: Subjects included 158 girls assessed at age 7 and age 15. Logistic regression was used to predict binge eating at age 15 from calories consumed during EAH at age 7. A series of logistic regressions were used to examine the odds of reporting binge eating given levels of risk factors (e.g., anxiety) among those with high-EAH in childhood.

Results: Girls' EAH intake predicted reports of binge eating at age 15; after adjusting for age 7 BMI, for each additional 100kcal consumed, girls were 1.7 times more likely to report binge eating in adolescence. Among those with high-EAH, BMI, anxiety, depression, dietary restraint, emotional disinhibition, and body dissatisfaction all predicted binge eating.

Discussion: EAH during childhood predicted reports of binge eating during adolescence; girls with elevated BMI, negative affect, and maladaptive eating- and weight-related cognitions were at increased risk. High-EAH in childhood may be useful for indicating those at risk for developing binge eating.
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http://dx.doi.org/10.1016/j.eatbeh.2016.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5258820PMC
January 2017

Girls' picky eating in childhood is associated with normal weight status from ages 5 to 15 y.

Am J Clin Nutr 2016 12 26;104(6):1577-1582. Epub 2016 Oct 26.

Department of Foods and Nutrition, University of Georgia, Athens, GA; and.

Background: Picky eating has been associated with lower weight status and limited food intake and variety in childhood. Little is known about how the persistence of picky eating in childhood is associated with changes in weight and food intake from childhood into adolescence.

Objective: We determined whether picky eating identified in childhood was related to growth, nutrition, and parental use of pressure over a 10-y period.

Design: Non-Hispanic white girls (n = 181) participated in a longitudinal study and were assessed biannually from ages 5 to 15 y. The Child Feeding Questionnaire was used to classify girls as persistent picky eaters or nonpicky eaters and to assess parental use of pressure to eat. Height and weight were measured to calculate body mass index (BMI) z scores at each occasion. Three 24-h dietary recalls obtained at each occasion were used to determine intakes of fruit and vegetables. With the use of repeated-measures analyses, differences between persistent picky eaters and nonpicky eaters in BMI z scores, dietary intake, and use of pressure were examined.

Results: From ages 5 to 15 y, persistent picky eaters (n = 33; 18%) had lower BMI (tracking at the 50th percentile) than did nonpicky eaters (n = 148; tracking at the 65th percentile) (P = 0.02). Persistent picky eaters were less likely to be overweight into adolescence. Both groups consumed less than the recommended amounts of fruit and vegetables, although persistent picky eaters had lower intakes of vegetables than did nonpicky eaters at all time points (P = 0.02). Persistent picky eaters also received higher amounts of pressure (P = 0.01).

Conclusions: Findings that persistent picky eaters were within the normal weight range, were less likely to be overweight, and had similar fruit intakes to those of nonpicky eaters suggest that higher parental concerns about persistent picky eaters are unwarranted. All parents and children could benefit from evidence-based anticipatory guidance on alternatives to coercive feeding practices to increase fruit and vegetable consumption.
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http://dx.doi.org/10.3945/ajcn.116.142430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118736PMC
December 2016