NP20 Starting Early: Expansion of a Primary Care-Based Early Child Obesity Prevention Program

Abstract

Objective Determine “Starting Early Program” (StEP) impacts on infant feeding practices and weight and develop expanded prenatal and pre-school StEP interventions. Description We conducted a randomized controlled trial testing the efficacy of StEP, a comprehensive early child obesity prevention program using prenatal and pediatric primary care to target low-income, Hispanic families. English/Spanish speaking pregnant Hispanic women were enrolled in the third trimester to standard primary care control group vs. StEP intervention group (prenatal/postpartum nutrition counseling, and nutrition and parenting support groups coordinated with well-child visits until child age three years). Expanded prenatal and preschool StEP curricula for women beginning in the first trimester and children aged 3-5 years were developed. Evaluation Intervention outcomes assessed at child age 3, 10, 19 months and 2, 3, 4 and 5 years. Maternal infant feeding and activity practices assessed using 24-hour diet recalls and validated surveys. Measured child weight for age z-scores (WFAz) determined from CDC growth charts. Intent to treat analyses and within group analyses for intervention dose impacts were conducted. We randomized 533 low-income women into the original trial. 88%, 78%, 74%, 76% and 75% of mother-infant pairs completed assessments at 3, 10, and 19 months, and 2 and 3 years. Intervention pairs had healthier feeding and activity practices (more exclusive breastfeeding, tummy time; less cereal in the bottle, excess milk intake and non-responsive feeding styles). By age two, intervention group infants had lower WFAz than controls (0.62(1.11) vs. 0.85(1.17); P = .046). Median number of sessions attended was 7.0(SD3.5)/12. High attendance reduced the odds of being overweight (AOR 0.42, P = .02). To date, a new expanded prenatal cohort is being enrolled in the 1st trimester (goal n = 200); 309 pairs from the original cohort enrolled for continuation, 4- and 5-year assessments on-going. Conclusion and Implications StEP intervention infants had healthier feeding practices and lower weight at two years, with dose dependent reduction in overweight. Findings demonstrate a scalable system to potentially augment obesity prevention in primary care for at-risk families.