Consumption of sugar sweetened beverages and juices (SSB/J) in infancy is associated with obesity in early childhood. This is a significant public health issue requiring family based solutions. Yet interventions aimed at SSB/J reduction remain controversial based on limited effects in prior studies and concerns whether targeting a single factor will have an impact on the multi-factorial problem of obesity. However, while a prior trial in obese teenagers showed no effect of SSB/J reduction in Caucasians, there was a large significant effect in Hispanics. Furthermore, no study has examined the effects of SSB/J reduction during infancy when consumption begins and adipose tissue is rapidly developing. We therefore propose a trial aimed at reducing SSB/J consumption in low-income, Hispanic post-partum mothers and infants, a segment of the population at high risk for obesity. Although maternal-infant interventions are needed, they present many challenges including compliance and retention. We propose an innovative solution that merges components of effective interventions for SSB/J reduction and maternal-infant nutrition, into an existing home visit program (HVP), which are federally supported nationwide for promoting child development in high-risk populations. The 24-month intervention will focus on replacing mothers? intake of SSB/J with water, and delaying introduction and limiting access to SSB/J in infants using home visits, telephone calls and in one group, home delivery of water/non-caloric beverages. Hispanic mothers who were overweight/obese prior to pregnancy (n=240) will be randomized with their newborn infants to one of three groups. Group 1 (efficacy) will receive a modified HVP incorporating a focus on SSB/J reduction plus home delivery. Group 2 (translation) will be identical to Group 1 without home delivery. Group 3 (control) will receive standard of care HVP. The main outcome will be body fat by DEXA in mothers and infants.
Aim 1 tests whether the intervention will reduce obesity and metabolic risk in post-partum mothers.
Aim 2 tests whether the intervention reduces the trajectory for body fat and weight-for-length in infants. We will also examine if these effects are maintained without home delivery, thus supporting scalability of the intervention approach.
Aim 3 tests whether the effects on infants are mediated via maternal transmission related to changes in maternal sweet taste preference, use of SSB/J to sooth infants, use of sugary foods during weaning, and the profile of sugars in breast milk. In summary, this trial will generate empirical evidence to support a scalable, public health, life-course strategy for addressing obesity in Hispanic mothers and infants.
This study will determine whether reducing sugary beverage consumption during the post-partum period and infancy is effective for improving obesity and metabolic outcomes in Hispanic mothers and infants. This information will support public health/policy efforts using a life-course/family approach for reducing obesity and metabolic risk in this high-risk population, starting in early-life, and incorporation of these strategies into existing federally supported home visit programs.
|Salvy, S-J; de la Haye, K; Galama, T et al. (2017) Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention. Obes Rev 18:149-163|