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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

International Journal of Obesity volume 36, pages 1292–1298 (2012)Cite this article

Subjects

Abstract

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.

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Acknowledgements

NOURISH was funded 2008–2010 by the Australian National Health and Medical Research Council (Grant 426704). Additional funding was provided by HJ Heinz (post-doctoral fellowship KM), Meat and Livestock Australia (MLA), Department of Health South Australia, Food Standards Australia New Zealand (FSANZ), Queensland University of Technology, and NHMRC Career Development Award 390136 (JMN). We acknowledge the NOURISH investigators: Professors Ann Farrell, Geoffrey Cleghorn and Geoffrey Davidson. We acknowledge the contribution to intervention development by Associate Professor Jordana Bayer and the preparation of the growth data by Dr Seema Mihrshahi. We sincerely thank all our participants and recruiting, intervention and assessment staff including Dr Carla Rogers, Jacinda Wilson, Jo Meedeniya, Gizelle Wilson and Chelsea Mauch.

AUTHOR CONTRIBUTIONS

LD and AM led the conception, design and successful funding application for NOURISH. DB contributed methodological expertise to the RCT design and analysis protocols. Analysis was mentored by DB and undertaken by KM. RP and JN developed the intervention and RP had substantial input into recruitment, intervention delivery and data acquisition. The manuscript was drafted by LD and KM. All authors contributed to interpretation of the data, provided critical input into manuscript preparation and approved the final version to be published.

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Authors and Affiliations

  1. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia

    L A Daniels, K M Mallan & D Battistutta

  2. School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia

    L A Daniels, K M Mallan & A Magarey

  3. Department of Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia

    L A Daniels, R Perry & A Magarey

  4. Parenting Research Centre, Melbourne, VIC, Australia

    J M Nicholson

  5. Centre for Learning Innovation, Queensland University of Technology, Brisbane, QLD, Australia

    J M Nicholson

Authors
  1. L A Daniels
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Correspondence to L A Daniels.

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Daniels, L., Mallan, K., Battistutta, D. et al. 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. Int J Obes 36, 1292–1298 (2012). https://doi.org/10.1038/ijo.2012.96

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