The need to prevent childhood obesity extends down to our youngest children. Obesity and excessive weight gain in the first year of life are independently associated with higher blood pressure, recurrent wheezing, higher hospital admission rates, and other adverse physical and psychosocial health conditions in childhood. Thus, effective approaches to obesity prevention in early childhood are needed. Because nearly two-thirds of U.S. children under 6 years of age are routinely cared for outside of the home, organized child care is an important setting for obesity prevention. Recent studies suggest that children who attend child care are more likely to be obese than children cared for at home by a parent or other caregiver, and younger children might be most at risk. Our own research found that infants who spent time in child care during the first 6 months of life were heavier at one yea and still heavier at 3 years of age than children cared for at home. These previous studies identified a relationship between child care and obesity, but failed to pinpoint specific causal pathways. The proposed longitudinal study will examine factors contributing to the development of obesity that may be influenced by the child care setting, including dietary behaviors, physical activity and inactivity, stress, and sleep duration and quality. To accomplish these aims, we propose a diverse southern cohort of 800 black, white, and Latino/a infants in various child care arrangements, followed regularly from birth to 12 months of age. Frequent in-home assessments throughout infancy will help pinpoint exactly when children begin to gain weight excessively and will identify risk factors related to energy intake, energy expenditure, stress, and sleep associated with obesity. To mitigate participant burden and enhance retention, we will use Interactive Voice Response (IVR) technology to supplement in-person visits through innovative telephone-administered assessments with parents and child care providers. Results of this study will provide new information on the relationship between child care attendance and obesity and may help determine causality in instances where the associations between these variables have been unclear. Findings will inform state and federal policy governing child care settings and will also guide intervention efforts to help prevent obesity in young children in chil care.

Public Health Relevance

It is a public health priority to understand determinants of excessive weight gain in the first year of life. Knowledge of energy intake, energy expenditure, stress, and sleep in infants attending child care will inform both intervention and policy efforts o improve the child care system and help prevent obesity in very young children.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Kuczmarski, Robert J
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Khatiwada, A; Shoaibi, A; Neelon, B et al. (2018) Household chaos during infancy and infant weight status at 12 months. Pediatr Obes 13:607-613
Gonzalez-Nahm, Sarah; Mendez, Michelle A; Benjamin-Neelon, Sara E et al. (2018) DNA methylation of imprinted genes at birth is associated with child weight status at birth, 1 year, and 3 years. Clin Epigenetics 10:90
Hesketh, Kathryn R; Evenson, Kelly R; Stroo, Marissa et al. (2018) Physical activity and sedentary behavior during pregnancy and postpartum, measured using hip and wrist-worn accelerometers. Prev Med Rep 10:337-345
Neelon, Brian; Shoaibi, Azza; Benjamin-Neelon, Sara E (2018) A multivariate discrete failure time model for the analysis of infant motor development. Stat Med :
Mueller, Noel T; Zhang, Mingyu; Hoyo, Cathrine et al. (2018) Does cesarean delivery impact infant weight gain and adiposity over the first year of life? Int J Obes (Lond) :
Benjamin Neelon, Sara E; Østbye, Truls; Bennett, Gary G et al. (2017) Cohort profile for the Nurture Observational Study examining associations of multiple caregivers on infant growth in the Southeastern USA. BMJ Open 7:e013939
Costa, Silvia; Adams, Jean; Gonzalez-Nahm, Sarah et al. (2017) Childcare in Infancy and Later Obesity: a Narrative Review of Longitudinal Studies. Curr Pediatr Rep 5:118-131
Costa, Silvia; Adams, Jean; Phillips, Veronica et al. (2016) The relationship between childcare and adiposity, body mass and obesity-related risk factors: protocol for a systematic review of longitudinal studies. Syst Rev 5:141
Benjamin Neelon, Sara E; Stroo, Marissa; Mayhew, Meghan et al. (2015) Correlation between maternal and infant cortisol varies by breastfeeding status. Infant Behav Dev 40:252-8