Obesity. 2014 May;22(5):E104-11.

Child eating behavior outcomes of an early feeding intervention to reduce risk indicators for child obesity: the NOURISH RCT.

Daniels LA, Mallan KM, Battistutta D, Nicholson JM, Meedeniya JE, Bayer JK, Magarey A.

Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia; School of Exercise and Nutrition Sciences, Queensland University of Technology, Queensland, Australia; Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.

 

Abstract

Objective: The objective was to describe parent-reported child eating behavior and maternal parenting impact outcomes of an infant feeding intervention to reduce child obesity risk.

Methods: An assessor masked Randomized Controlled Trial (RCT) with concealed allocation of individual mother–infant dyads. The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD = 5.3) with healthy term infants (51% female) aged 4.3 months (SD = 1.0) at baseline. Outcomes were assessed 6 months post-intervention when the children were 2 years old. Mothers reported on child eating behaviors using the Children’s Eating Behavior Questionnaire (CEBQ), food preferences, and dietary intake using a 24-hour telephone recall. Parenting was assessed using five scales validated for use in Australia.

Results: Intervention effects were evident on the CEBQ overall (MANOVA P = 0.002) and 4/8 subscales: child satiety responsiveness (P = 0.03), fussiness (P = 0.01), emotional overeating (P < 0.01), and food responsiveness (P = 0.06). Intervention children “liked” more fruits (P < 0.01) and fewer non-core foods and beverages (P = 0.06, 0.03). The intervention mothers reported greater “autonomy encouragement” (P = 0.002).

Conclusions: Anticipatory guidance on protective feeding practices appears to have modest positive impacts on child eating behaviors that are postulated to reduce future obesity risk.

PMID: 24415390

 

Summary

fig1Childhood obesity has emerged as a major public health issue with negative short and long term consequences. In Australia around a quarter of children are overweight or obese. The NOURISH Randomized Controlled Trial (INSERT REF) evaluated an intervention designed to target feeding and parenting behaviours of first-time mothers in Australia. The intervention provided anticipatory guidance in two modules delivered in a group-based format when infants were around 4 and 14 months of age. Key messages focussed on introduction of solids (module 1: ‘learning to like, liking to eat’) and responsive feeding practices (module 2: ‘parent provides, child decides’). Interim outcomes at 14 months (INSERT REF) included lower age and gender adjusted BMI Z score in the intervention compared to the control group and lower use of nonresponsive feeding practices by intervention group mothers compared to those in the control ‘usual care’ condition. Although significant intervention effects on BMI Z score were not apparent at 2 years of age (INSERT REF) the impact of the intervention on maternal feeding practices was consistently in the expected direction. The current paper reports secondary outcomes at child age 2 years on eating behaviours, food preferences, intake and general parenting practices. Modest impact on child eating behaviours and food preferences were observed with children in the intervention condition scoring lower on maternal-report of a range of obesogenic eating behaviours and healthier food preferences. The absence of differences in child intake assessed via a 24 hour recall was consistent with the absence of an intervention effect on weight status at this age. Follow up at 3.5 and 5 years of age has been conducted and results will reveal whether intervening early in life can have longer term impacts on feeding/parenting practices and children’s eating behaviours, intake and weight.

 

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