Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules

• Published in: International Journal of Obesity Vol. 36; no. 10; pp. 1292 - 1298
• Main Authors: Daniels, L A, Mallan, K M, Battistutta, D, Nicholson, J M, Perry, R, Magarey, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2012; Nature Publishing Group
• Subjects: 692/308/409; 692/699/1702/393; 692/700/1720; 692/700/459; Australia - epidemiology; Biological and medical sciences; Body Mass Index; Breast Feeding - methods; Breast Feeding - statistics & numerical data; Care and treatment; Eating behavior; Education; Epidemiology; Feeding; Feeding Behavior; Female; Follow-Up Studies; General aspects; Health Education; Health Promotion and Disease Prevention; Humans; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infants; Internal Medicine; Intervention; Male; Maternal-Child Health Centers; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Mother-Child Relations; Nutrition; Obesity; Obesity - epidemiology; Obesity - prevention & control; Obesity in children; original-article; Pregnancy; Prevention; Prevention and actions; Primary Prevention; Program Evaluation; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk factors; Satiety Response; Surveys and Questionnaires; Weight Gain; Australia; Queensland Australia; randomised controlled trial; infant; feeding practices; childhood obesity; Human; Evaluation; Obesity; Prognosis; Nutrition; Nutrition disorder; Metabolic diseases; Infant; Feeding; Prevention; Randomization; Professional practice; Randomised controlled trial; Clinical trial; Evolution; Child; Age; Nutritional status
• ISSN: 0307-0565; 1476-5497; 1476-5497
• DOI: 10.1038/ijo.2012.96

Objective: To evaluate a universal obesity prevention intervention, which commenced at infant age 4–6 months, using outcome data assessed 6 months after completion of the first of two intervention modules and 9 months from baseline. Design: Randomised controlled trial of a community-based early feeding intervention. Subjects and methods: Six hundred and ninety-eight first-time mothers (mean age 30±5 years) with healthy term infants (51% male) aged 4.3±1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over 3 months, that provided anticipatory guidance on early feeding practices. Outcome data reported here were assessed at infant age 13.7±1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) of >+0.67. Maternal feeding practices were assessed via self-administered questionnaire. Results: There were no differences according to group allocation on key maternal and infant characteristics. At follow-up ( n =598 (86%)), the control group infants had higher BMI-for-age z-score (BMIZ) (0.42±0.85 vs 0.23±0.93, P =0.009) and were more likely to show rapid weight gain from baseline to follow-up (odds ratio (OR)=1.5, confidence interval (CI) 95%=1.1–2.1, P =0.014). Mothers in the control group were more likely to report using non-responsive feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, P =0.001) or using games (67% vs 29%, P <0.001). Conclusions: These results provide early evidence that anticipatory guidance targeting the ‘when, what and how’ of solid feeding can be effective in changing maternal feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.