Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT

Abstract

The few existing early-life obesity prevention initiatives have concentrated on nutrition and physical activity, with little examination of sleep. METHODS:This community-based, randomized controlled trial allocated 802 pregnant women (≥16 years, <34 weeks' gestation) to: control, FAB (food, activity, and breastfeeding), sleep, or combination (both interventions) groups. All groups received standard well-child care. FAB participants received additional support (8 contacts) promoting breastfeeding, healthy eating, and physical activity (antenatal-18 months). Sleep participants received 2 sessions (antenatal, 3 weeks) targeting prevention of sleep problems, as well as a sleep treatment program if requested (6-24 months). Combination participants received both interventions (9 contacts). BMI was measured at 24 months by researchers blinded to group allocation, and secondary outcomes (diet, physical activity, sleep) were assessed by using a questionnaire or accelerometry at multiple time points. RESULTS:At 2 years, 686 women remained in the study (86%). No significant intervention effect was observed for BMI at 24 months (P = .086), but there was an overall group effect for the prevalence of obesity (P = .027). Exploratory analyses found a protective effect for obesity among those receiving the "sleep intervention" (sleep and combination compared with FAB and control: odds ratio, 0.54 [95% confidence interval, 0.35-0.82]). No effect was observed for the "FAB intervention" (FAB and combination compared with sleep and control: odds ratio, 1.20 [95% confidence interval, 0.80-1.81]). CONCLUSIONS:A well-developed food and activity intervention did not seem to affect children's weight status. However, further research on more intensive or longer running sleep interventions is warranted. Departments of a the Dean, Dunedin School of Medicine, b Preventive and Social Medicine, c Women's and Children's Health, d Human Nutrition, and e Medicine, University of Otago, Dunedin, New ZealandProf B Taylor is the co-principal investigator of the Prevention of Overweight in Infancy (POI) study, contributed to study design, co-led the sleep intervention, co-wrote the manuscript, and directed the statistical analyses; Mr Gray contributed to study design, designed and completed all statistical analyses, and wrote the relevant sections of the manuscript; Dr Galland contributed to study design, co-led the sleep intervention, and reviewed and revised the manuscript; Dr Heath contributed to study design, co-led the FAB (food, activity, and breastfeeding) intervention, and reviewed and revised the manuscript; Dr Lawrence contributed to study design, coordinated and led the management of the study, and reviewed and revised the manuscript; Ms Sayers delivered the sleep intervention, and reviewed and revised the manuscript; Drs Cameron, Hanna, and Dale contributed to data collection, and reviewed and revised the manuscript; Dr Coppell contributed to study design, and reviewed and revised the manuscript; and Prof R Taylor is the co-principal inves...

Interventions commenced by early infancy to prevent childhood obesity—The EPOCH Collaboration: An individual participant data prospective meta‐analysis of four randomized controlled trials

“…Data were available for 2196 of 2324 mother‐child dyads randomized across the four trials . Table illustrates the baseline sociodemographic variables of participants in the four individual trials and for the total combined dataset.…”

“…Abbreviations: AUS, Australia; BMI, Body Mass Index; EPOCH, Early Prevention of Obesity in CHildren Collaboration; HBT, Healthy Beginnings Trial; InFANT, Infant Feeding Activity and Nutrition Trial; N, number of participants with the event; Nourish, Nourish trial; NZ, New Zealand; POI, Prevention of Obesity in Infancy trial; SD, Standard Deviation; %, percentage.…”

“…Future research will need to address how best to implement these effective interventions at scale and cost implications and determine which factors characterize successful interventions. This may include the addition of a sleep component to early intervention obesity prevention programmes …”

Sleep during Infancy and Associations with Childhood Body Composition: A Systematic Review and Narrative Synthesis

“…Four studies were excluded after comparison with other publications from the same cohorts as they studied similar associations, but with binary outcomes or single outcomes vs. panel data. 7,[21][22][23] We included 19 studies in the systematic review (Tables 1 and 2). Two studies were based on analyses from the same cohort; project Viva, 24,25 presenting different followup times.…”

“…5 Curtailed infant sleep and bedtime routine have recently been under the attention of pediatricians and youth health care workers and healthy sleep is part of newly developed lifestyle interventions during infancy. 4,[6][7][8][9][10] Infant sleep problems can be problematic and include sleep latency and night awakenings, both leading to reduced sleep duration, quality, and efficiency (% of time spent in bed that the child really sleeps). Systematic reviews and meta-analysis so far have looked at the association and dose-response effects of sleep duration at age 0-4 years 11,12 and age 0-18 years [13][14][15] and concluded that there is an inverse association between sleep duration and weight gain.…”