Constructing a polygenic risk score for childhood obesity using functional data analysis.

Obesity is a highly heritable condition that affects increasing numbers of adults and, concerningly, of children. However, only a small fraction of its heritability has been attributed to specific genetic variants. These variants are traditionally ascertained from genome-wide association studies (GWAS), which utilize samples with tens or hundreds of thousands of individuals for whom a single summary measurement (e.g., BMI) is collected. An alternative approach is to focus on a smaller, more deeply characterized sample in conjunction with advanced statistical models that leverage longitudinal phenotypes. Novel functional data analysis (FDA) techniques are used to capitalize on longitudinal growth information from a cohort of children between birth and three years of age. In an ultra-high dimensional setting, hundreds of thousands of single nucleotide polymorphisms (SNPs) are screened, and selected SNPs are used to construct two polygenic risk scores (PRS) for childhood obesity using a weighting approach that incorporates the dynamic and joint nature of SNP effects. These scores are significantly higher in children with (vs. without) rapid infant weight gain-a predictor of obesity later in life. Using two independent cohorts, it is shown that the genetic variants identified in very young children are also informative in older children and in adults, consistent with early childhood obesity being predictive of obesity later in life. In contrast, PRSs based on SNPs identified by adult obesity GWAS are not predictive of weight gain in the cohort of young children. This provides an example of a successful application of FDA to GWAS. This application is complemented with simulations establishing that a deeply characterized sample can be just as, if not more, effective than a comparable study with a cross-sectional response. Overall, it is demonstrated that a deep, statistically sophisticated characterization of a longitudinal phenotype can provide increased statistical power to studies with relatively small sample sizes; and shows how FDA approaches can be used as an alternative to the traditional GWAS.

Effects of the Sleep SAAF responsive parenting intervention on rapid infant weight gain: A randomized clinical trial of African American families.

Responsive parenting (RP) interventions reduce rapid infant weight gain but their effect for underserved populations is largely unknown. The Sleep SAAF (Strong African American Families) study is a two-arm randomized clinical trial for primiparous African American mother-infant dyads that compares an RP intervention to a child safety control over the first 16 weeks postpartum. Here we report on intervention effects on rapid infant weight gain and study implementation. Families were recruited from a mother/baby nursery shortly after delivery. Community Research Associates (CRAs) conducted intervention home visits at 3 and 8 weeks postpartum, and data collection home visits at 1, 8, and 16 weeks postpartum. To examine rapid infant weight gain, conditional weight gain (CWG) from 3 to 16 weeks, the primary outcome, and upward crossing of 2 major weight-for-age percentile lines were calculated. Among the 212 mother-infant dyads randomized, 194 completed the trial (92% retention). Randomized mothers averaged 22.7 years, 10% were married, and 49% participated in the Supplemental Nutrition Assistance Program (SNAP). Adjusting for covariates, mean CWG was lower among RP infants (0.04, 95% CI [-0.33, 0.40]) than among control infants (0.28, 95% CI [-0.08, 0.64]), reflecting non-significantly slower weight gain (p = 0.15, effect size d = 0.24). RP infants were nearly half as likely to experience upward crossing of 2 major weight-for-age percentile lines (14.1%) compared to control infants (24.2%), p = 0.09, odds ratio = 0.52 (95% CI [0.24, 1.12]). Implementation data revealed that participating families were engaged in the intervention visits and intervention facilitators demonstrated high fidelity to intervention materials. Findings show that RP interventions can be successfully implemented among African American families while suggesting the need for modifications to yield stronger effects on infant weight outcomes.

INSIGHT responsive parenting educational intervention for firstborns is associated with growth of second-born siblings.

OBJECTIVE: The aim of this study was to test whether the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention, delivered to parents of firstborn children, is associated with the BMI of first- and second-born siblings during infancy. METHODS: Participants included 117 firstborn infants enrolled in a randomized controlled trial and their second-born siblings enrolled in an observation-only ancillary study. The RP curriculum for firstborn children included guidance on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. Anthropometrics were measured in both siblings at ages 3, 16, 28, and 52 weeks. Growth curve models for BMI by child age were fit. RESULTS: Second-born children were delivered 2.5 (SD 0.9) years after firstborns. Firstborn and second-born children whose parents received the RP intervention with their first child had BMI that was 0.44 kg/m2 (95% CI: -0.82 to 0.06) and 0.36 kg/m2 (95% CI: -0.75 to 0.03) lower than controls, respectively. Linear and quadratic growth rates for BMI for firstborn and second-born cohorts were similar, but second-born children had a greater average BMI at 1 year of age (difference = -0.33 [95% CI: -0.52 to -0.15]). CONCLUSIONS: A RP educational intervention for obesity prevention delivered to parents of firstborns appears to spill over to second-born siblings.

Sex Differences in Maternal Restrictive Feeding Practices in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study.

BACKGROUND: Intervention Nurses Start Infants Growing on Healthy Trajectories tested an early life responsive parenting (RP) intervention designed for obesity prevention. Body mass index z-score 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 2-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 (ie, structure-based feeding, pressure). CONCLUSIONS: 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.

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

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.

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

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.

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

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.

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

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: R2 = 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.

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

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.

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

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.

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

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 .

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

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.

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

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 (Mage = 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.

INSIGHT Study Maternal Return to Work and Infant Weight Outcomes.

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.

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

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.

Child Weight Gain Trajectories Linked To Oral Microbiota Composition.

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.

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

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.

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

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.

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

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.

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

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.