Early Childhood Obesity Research Articles

Neonatal overfeeding during lactation rapidly and permanently misaligns the hepatic circadian rhythm and programmes adult NAFLD

Childhood obesity is a strong risk factor for adult obesity, type 2 diabetes, and cardiovascular disease. The mechanisms that link early adiposity with late-onset chronic diseases are poorly characterised. We developed a mouse model of early adiposity through litter size reduction. Mice reared in small litters (SLs) developed obesity, insulin resistance, and hepatic steatosis during adulthood. The liver played a major role in the development of the disease. ObjectiveTo gain insight into the molecular mechanisms that link early development and childhood obesity with adult hepatic steatosis and insulin resistance. MethodsWe analysed the hepatic transcriptome (Affymetrix) of control and SL mice to uncover potential pathways involved in the long-term programming of disease in our model. ResultsThe circadian rhythm was the most significantly deregulated Gene Ontology term in the liver of adult SL mice. Several core clock genes, such as period 1–3 and cryptochrome 1–2, were altered in two-week-old SL mice and remained altered throughout their life course until they reached 4–6 months of age. Defective circadian rhythm was restricted to the periphery since the expression of clock genes in the hypothalamus, the central pacemaker, was normal. The period-cryptochrome genes were primarily entrained by dietary signals. Hence, restricting food availability during the light cycle only uncoupled the central rhythm from the peripheral and completely normalised hepatic triglyceride content in adult SL mice. This effect was accompanied by better re-alignment of the hepatic period genes, suggesting that they might have played a causal role in mediating hepatic steatosis in the adult SL mice. Functional downregulation of Per2 in hepatocytes in vitro confirmed that the period genes regulated lipid-related genes in part through peroxisome proliferator-activated receptor alpha (Ppara). ConclusionsThe hepatic circadian rhythm matures during early development, from birth to postnatal day 30. Hence, nutritional challenges during early life may misalign the hepatic circadian rhythm and secondarily lead to metabolic derangements. Specific time-restricted feeding interventions improve metabolic health in the context of childhood obesity by partially re-aligning the peripheral circadian rhythm.

Redox Imbalance and Methylation Disturbances in Early Childhood Obesity.

Obesity is increasing worldwide in prepubertal children, reducing the age of onset of associated comorbidities, including type 2 diabetes. Sulfur-containing amino acids, methionine, cysteine, and their derivatives play important roles in the transmethylation and transsulfuration pathways. Dysregulation of these pathways leads to alterations in the cellular methylation patterns and an imbalanced redox state. Therefore, we tested the hypothesis that one-carbon metabolism is already dysregulated in prepubertal children with obesity. Peripheral blood was collected from 64 children, and the plasma metabolites from transmethylation and transsulfuration pathways were quantified by HPLC. The cohort was stratified by BMI z-scores and HOMA-IR indices into healthy lean (HL), healthy obese (HO), and unhealthy obese (UHO). Fasting insulin levels were higher in the HO group compared to the HL, while the UHO had the highest. All groups presented normal fasting glycemia. Furthermore, high-density lipoprotein (HDL) was lower while triglycerides and lactate levels were higher in the UHO compared to HO subjects. S-adenosylhomocysteine (SAH) and total homocysteine levels were increased in the HO group compared to HL. Additionally, glutathione metabolism was also altered. Free cystine and oxidized glutathione (GSSG) were increased in the HO as compared to HL subjects. Importantly, the adipocyte secretory function was already compromised at this young age. Elevated circulating leptin and decreased adiponectin levels were observed in the UHO as compared to the HO subjects. Some of these alterations were concomitant with alterations in the DNA methylation patterns in the obese group, independent of the impaired insulin levels. In conclusion, our study informs on novel and important metabolic alterations in the transmethylation and the transsulfuration pathways in the early stages of obesity. Moreover, the altered secretory function of the adipocyte very early in life may be relevant in identifying early metabolic markers of disease that may inform on the increased risk for specific future comorbidities in this population.

Socioeconomic settings and food consumption patterns of 2–5-year-old children in developed countries: a scoping review

Introduction: Early childhood overweight and obesity, as a result of unhealthy dietary habits and sedentary life, is a growing global public health concern, particularly in Canada. There are limited data on how socioeconomic factors influence dietary habits of young children living in developed countries. Methods: We conducted a scoping review to examine the existing literature on how socioeconomic settings influence food consumption patterns of children 2–5 years old in developed countries. The inclusion criteria were relevant articles in the English language between 2007 and 2019. Results: From the initial 1854 articles, only 12 articles from Europe, Canada, and the United States met the inclusion criteria. There are differences in eating patterns of preschool-aged children based on parental education, whereas income level did not have a clear influence on dietary patterns. The existing studies suffer from a variety of limitations that limit a cohesive conclusion. Conclusion: Studies with children 2–5 years old are scarce. Parental education seems to influence the dietary habits of young children, whereas the role of income is not clear. There is a need for further high-quality research, preferably longitudinal studies, to inform health promotion initiatives and preventive strategies to facilitate healthy growth and development in young children.

Fathers and Child Health Behaviors: Assessing Father Engagement, Early Childhood Diet, and Screen Time in a National Sample of US Children

The impact of father-child engagement on early childhood obesity risk has not been thoroughly investigated. In response to this gap, relationships between father-child engagement at age 2 years and multiple obesity risk factors at preschool were estimated in 4,500 families belonging to the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B). Early childhood obesity risk factors were prevalent in this US national sample, including weekly fast-food consumption (76%), excess juice (73%) and sugar-sweetened beverage (31%) use, and screen time above national recommendations (26%). Multivariable regression models revealed a mix of positive, negative, and null impacts of father engagement on pre-school obesity risk factors. Father engagement through both caregiving and play decreased juice consumption (Adjusted Relative Risk [aRR] = 0.87; 95% CI: 0.83, 0.98 and aRR = 0.82; 95% CI: 0.79, 0.91, respectively). On the other hand, father engagement in caregiving increased the risk of excess screen time (aRR = 1.06; 95% CI: 1.02, 1.12) and father engagement in play predicted lower fresh fruit consumption (aRR = 1.06; 95% CI: 1.01, 1.23). Finally, engagement through father-child shared breakfast decreased the risk of excess screen time (aRR = 0.95; 95% CI: 0.93, 0.98). These findings suggest that father-child engagement has both positive and negative impacts on early childhood obesity risk factors. The findings from this study, like prior ones, also reflect how underdeveloped this line of research is and how strong the need is for additional works that will provide us with actionable evidence on which to base policy.

Obesity Prevention within the Early Childhood Education and Care Setting: A Systematic Review of Dietary Behavior and Physical Activity Policies and Guidelines in High Income Countries.

As a strategy for early childhood obesity prevention, a variety of dietary behavior and physical activity policies and guidelines published by leading health agencies and early childhood education and care (ECEC) licensing and accreditation bodies exist. Given the potential diversity in recommendations from these policies, this narrative review sought to synthesize, appraise and describe the various policies and guidelines made by organizational and professional bodies to highlight consistent recommendations and identify opportunities to strengthen such policies. An electronic bibliographic search of seven online databases and grey literature sources was undertaken. Records were included if they were policies or guidelines with specific recommendations addressing dietary behavior and/or physical activity practice implementation within the ECEC setting; included children aged >12 months and <6 years and were developed for high income countries. Recommended dietary behavior and physical activity policies and practices were synthesized into broad themes using the Analysis Grid for Environments Linked to Obesity framework, and the quality of included guidelines appraised. Our search identified 38 eligible publications mostly from the US and Australia. Identified guidelines were largely consistent in their recommendation and frequently addressed the physical and sociocultural environment and were well-aligned with research evidence. Broader consideration of policy and economic environments may be needed to increase the impact of such policies and guidelines within the ECEC setting.

Collecting Early Childhood Obesity Measurements Through a Home Visiting Program: A Proof-of-Concept Study.

Community-based home visiting programs are recommended vehicles for early life-course interventions to prevent childhood obesity. We developed and implemented a proof-of-concept protocol for collecting child weight and length or height data for children aged 6 months to 5 years through Parents as Teachers (PAT) affiliates that were geographically dispersed throughout the United States. We implemented our protocol with 1 affiliate in each of 4 states. We assessed formative measures of the implementation from parent educators and site leaders and reviewed delivery process measures. Findings suggest that collecting data on child measurements through an existing home visiting program is 1) feasible (91% of estimated measurements achieved); 2) does not require much time (median, 0.5 hours spent per child); 3) is a positive experience for families (71% of parent educators indicated that families enjoyed the experience); and 4) is fairly accurate (82% of collected data met eligibility and quality standards).

Statistical analysis of children with disabilities with obesity for 2018-2019 in the Republic of Mordovia

Background. Disability is one of the most important medical and social problems. According to the latest data, more than 1 billion people in the world are disabled according to WHO data in 2016, more than 1.9 billion adults aged 18 and older were overweight, of which more than 650 million were obese (11% of men and 15% of women). According to WHO, it is expected that children with obesity will increase to 70 million by 2025. Obesity in early childhood it is most severe and less treatable, and can also lead to serious complications: hypertension, diabetes, metabolic syndrome, and other diseases. The aim: we believe that the study of the population of disabled people due to various diseases with obesity in various nosologies is important for the development of comprehensive measures for the prevention of morbidity, early diagnosis and rehabilitation of this group of people. Materials and methods. We conducted a comprehensive study of children with the status of disabled child and initially examined in the ITU Bureau No. 4 for the Republic of Mordovia. The study group included overweight and obese children with various diseases. Information from the statistical collections of Rosstat and approved forms of state statistics No. 7-Sobes for 2019 were also included. Results. In 2019, 1065 children were examined in 4 bureaus of the ITU RM; of these, 730 children were examined to determine the category of disabled child, which was 68.5% (first: 262; 35.9%, second: 468; 64.1%). The largest proportion of children recognized as disabled for the first time is young children from 0 to 3 years (45,2%). In the structure of primary disability of this age category, congenital malformations account for 31% (28 people out of 90). The proportion of disabled people in the age category from 4 to 7 years is 16.5%. The proportion of disabled people in the age group 15 years and older is 9.5%. The first place is occupied by diseases of the endocrine system (42.1%), the second by diseases of the musculoskeletal system (26.3%). The largest number of patients with primary examination are obese with disorders of neuromuscular, skeletal and movement-related (statodynamic) functions ― 10 children (5%); with disorders of the cardiovascular system ― 8 children (4%); and disorders of the endocrine system ― 7 children (3.5%). When re-examining children with various pathologies, the ranking places are occupied by violations of the same functions ― neuromuscular (6.1%), cardiovascular (3.7%), endocrine (2.5%). In other persistent disorders of body functions, there are also obese patients in both groups, but their number is very small. Conclusions. When monitoring for 20182019, we see an increase in the number of obese children with various functional disorders. Most often, obese children recognized as disabled are found in groups with impaired statodynamic and cardiovascular functions, most likely this is due to restricted movement. And such patients are recommended to follow the principles of a healthy diet more carefully, no matter what aggravates the existing condition. And thus, in a short time to carry out all the necessary rehabilitation measures and in some cases reduce the period of disability.

The role of parental depression during early childhood obesity treatment-Secondary findings from a randomized controlled trial.

SummaryBackgroundParental depression is a risk factor for childhood obesity.ObjectivesTo examine the influence of parental depression on child weight status, eating behaviours, and parental feeding practices during childhood obesity treatment.MethodsHundred and twenty eight children with obesity aged 4 to 6 years and their parents were randomized to a parent support program or to standard treatment. At baseline and after 12 months, children's heights and weights were measured. Parents reported levels of depression (Beck's Depression Inventory‐II), feeding practices (Child Feeding Questionnaire), and children's eating behaviors (Child Eating Behavior Questionnaire). Independent and dependent paired sample t‐tests and linear regressions were used to analyze data.ResultsAfter obesity treatment, mothers reported lower levels of depression, whereas fathers did not. No associations were found between parental level of depression and child weight status, or between baseline level of parental depression and feeding practices. Associations were found between baseline parental depression and children's food responsiveness (β = .03; P = .01; 95% CI [0.01, 0.05]), emotional overeating (β = .02; P = .02; 95% CI [0.004, 0.04]), and desire to drink (β = .02; P = .03; 95% CI [0.002, 0.04]) (adjusted for background variables).ConclusionsParental depression did not influence child weight status or parental feeding practices but was associated with obesity‐related child eating behaviors.

Opportunities for Impact: Health Promotion in Rural Early Care and Education Environments

Early care and education settings are essential partners in the battle against childhood obesity. We describe an Extension-facilitated early childhood obesity prevention intervention conducted in 25 rural early care and education settings. A total of 148 policy, systems, or environmental changes were achieved, reaching approximately 450 young children. Systems changes were the most prevalent outcome achieved. The experiences of Extension professionals in promoting policy, systems, and environmental changes are highlighted as are implications for other Extension systems and professionals promoting policy, systems, or environmental changes in early care and education settings.

When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity

• Children with obesity face increased biopsychosocial risks during COVID-19. • Stress exacerbates inflammation and immune response in obesity and COVID-19. • The COVID-19 pandemic has significantly interrupted children's daily routines. • The health effects of the obesogenic environment are exacerbated by COVID-19. • Access to timely, comprehensive healthcare is critical during COVID-19.

Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children

Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population. To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum. This study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted. The 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons. Primary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs). A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, -0.67; 95% CI, -0.04 to -1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, -0.54; 95% CI, -0.94 to -0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, -0.46; 95% CI, -0.92 to 0.01). Infants of Native American mothers who participated in a home-visiting intervention had substantially lower SSB consumption and improvements in responsive feeding practices and infant zBMI scores, suggesting the intervention is effective for promoting healthy infant feeding and growth. ClinicalTrials.gov Identifier: NCT03101943.

A Practical Screening Tool to Predict Early Childhood Obesity Risk: Examining a Birth Cohort.

Children obese at the age of 5 years are at greater risk of lifelong obesity. Because certain risks of obesity can be identified in early infancy, a tool for obesity risk prediction in early life would be clinically useful. We investigated predictors of obesity risk in a novel, prospectively collected healthy birth cohort recruited for demographic risks to develop iron deficiency at 1 year, a cohort leveraged because risk factors for iron deficiency and obesity overlap. Obesity at the age of 5 years was defined as age- and sex-specific body mass index Z-score (zBMI) >2SD. For each child, obesity risk factors were summed. Of 10 total risk factors, the following 4 key risks were identified: maternal obesity, maternal diabetes, large for gestational age, or breastfeeding <6 months. Childhood obesity was predicted by either ≥3 total number of risks (P < .033), any key risk (P < .002), or summing key risks (P < .0001). In clinical practice, summing early life risk factors may be a useful strategy for preemptive counseling.

Maternal Gestational Diabetes and Early Childhood Obesity: A Retrospective Cohort Study.

Background: Recently, childhood obesity has become one of the most serious public health problems in the world. Gestational diabetes mellitus (GDM) is considered a risk factor for childhood overweight and obesity. The study aimed at investigating the relationship between maternal GDM and childhood obesity in children aged from 1 to 3 years. Methods: In this retrospective cohort study, 237 GDM and 296 non-GDM mothers and their offspring who were followed up by Family Medicine Clinics in Rize province of Turkey were assessed. World Health Organization (WHO) criteria were used for the diagnosis of maternal GDM. Crude and adjusted logistic regression models were calculated for the association of gestational diabetes and childhood overweight/obesity. Gender and age-specific percentile tables were used for the categorization of BMI. Results: Statistical analysis carried out with adjustment for potential confounders (mother's age, educational status, smoking status, BMI, gestational weight gain, children's gender, and gestational birth weight) provided results with an odds ratio of 2.99; 95% CI 1.14-7.94 and 7.77; 95% CI 1.92-31.37 for the impact of gestational diabetes on childhood overweight and obesity at 2 and 3 years of age, respectively. Conclusions: This study found evidence for maternal GDM to cause the risk of early childhood obesity. Therefore, proper intervention strategies are required for this high-risk population.

Childhood obesity: Is it related to feeding type of the infant?

Aim: The prevalence of childhood obesity has risen currently, and the relationship between feeding types in the infancy period and childhood obesity remains controversial. It is aimed to investigate the impact of feeding practices in the first six months of life on early childhood obesity in exclusively breast-fed, exclusively formula-fed, and mixed (breast milk and formula) fed Turkish infants. Methods: This study was conducted in the Department of Pediatrics at Haydarpasa Numune Training and Research Hospital with 545 children aged between 2-5 years. We asked the parents various questions to determine the feeding patterns during infancy. Three groups were formed: Exclusively breastfeed, exclusively formula-fed and the mixed (breast milk and formula) fed group. Obesity rates were determined according to body mass index (BMI) and compared. Results: Among a total of 545 children, with a mean age of 3.4 years, there were 285 (52,3%) females. Evaluation based on BMI revealed that the obesity (≥95th percentile) rate was 8.8% and the percentage of overweight children was significantly higher in the only formula-fed group (28.2%) compared to those who were only breast-fed (16.8%) (P=0.009). Conclusions: Our findings showed that feeding the child exclusively with formula during the first six months of life may increase body weight during early childhood more than feeding solely breast milk. Therefore, it is necessary to promote breastfeeding to prevent childhood obesity.

Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Obesity in Early Childhood

Per- and polyfluoroalkyl substances (PFAS) are commonly found in firefighting foams, textiles, Teflon, and consumer products, with major sources including fire training sites, industrial sites, and wastewater treatment plants. We assessed the association between maternal serum PFAS concentrations during pregnancy and child obesity between the ages of 2 and 6 years in 165 mother-child pairs from the TESIE Study (2009-2011). We used multivariate logistic regression models to estimate the association between maternal serum PFAS concentrations and child obesity, and directed acyclic graphs to identify confounders. Linear regression models were used to assess the linear relationship between each maternal PFAS concentration and child body mass index. There was not a statistically significant association between maternal serum PFAS concentrations and body mass index. There was a positive trend observed between maternal serum concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorooctane sulfonamide (PFDeA) and the odds of child obesity, and a negative trend for perfluorohexane sulfonic acid (PFHxS). Each log increase in maternal serum PFNA concentration was marginally associated with a 15% increased odds of child obesity (95% confidence interval 0.99, 1.32). These findings suggest that prenatal exposure to PFAS may increase the odds of obesity in children in early childhood, and risk may differ by type of PFAS exposure.

Changes in Early Childhood Obesity from 2016 to 2019 and Effective Factors

Objective: Aim of our study is showing the changes of factors that affecting early childhood obesity from 2016 to 2019 and to ensure that necessary measures are taken about this regard. Method: 3 years follow-up information of 388 babies whom born in 2013 and 2016 and registered at the Family Health Centers of Rize (Turkey) included to our study. The family doctors participating in this study examined these babies who were registered to them during their 1st, 3rd, 7th, 9th, 12th, 18th, 24th, 30th, 36th months at the family health centers in accordance with Turkish Health Ministry protocols and recorded their height, weight, head circumference, and BMI (Body Mass Index). Results: 388 babies included in study, 177 of them were born in 2013 and 211 of them were born in 2016. Percentage of being overweight or obese was 19.2% in babies born in 2013 and this rate decreased to 18.2% in babies born in 2016. Percentage of being overweight or obese was 16% in girls and 21.2% in boys. We observed that high birth weight (&amp;gt;4000 gr) and excess gestational weight gain are risk factors for being overweight or obese at the age of three. (p=0,048) Conclusion: Result of our study showed us that although prevalence of early childhood obesity decreased, but prevalence is still at critical level. We found that gestational weight gain and high birth weight are risk factors for early childhood obesity. In future obesity prevention studies, taking these risk factors into account will be beneficial.

Reframing the early childhood obesity prevention narrative through an equitable nurturing approach.

High‐quality mother–child interactions during the first 2,000 days, from conception to age 5 years, are considered crucial for preventing obesity development during early life stages. However, mother–child dyads interact within and are influenced by broader socio‐ecological contexts involved in shaping child development outcomes, including nutrition. Hence, the coexistence of both undernutrition and obesity has been noted in inequitable social conditions, with drivers of undernutrition and overnutrition in children sharing common elements, such as poverty and food insecurity. To date, a holistic life‐course approach to childhood obesity prevention that includes an equitable developmental perspective has not emerged. The World Health Organization (WHO) Nurturing Care Framework provides the foundation for reframing the narrative to understand childhood obesity through the lens of an equitable nurturing care approach to child development from a life‐course perspective. In this perspective, we outline our rationale for reframing the childhood narrative by integrating an equitable nurturing care approach to childhood obesity prevention. Four key elements of reframing the narrative include: (a) extending the focus from the current 1,000 to 2,000 days (conception to 5 years); (b) highlighting the importance of nurturing mutually responsive child‐caregiver connections to age 5; (c) recognition of racism and related stressors, not solely race/ethnicity, as part of adverse child experiences and social determinants of obesity; and (d) addressing equity by codesigning interventions with socially marginalized families and communities. An equitable, asset‐based engagement of families and communities could drive the transformation of policies, systems and social conditions to prevent childhood obesity.

An exploration of constructs related to dissemination and implementation of an early childhood systems-level intervention.

Obesity and overweight in early childhood have detrimental impacts on children's health and development. Changing policy, system and environmental features focused on physical activity and healthy eating behaviors as part of health promotion interventions can play a key role in prevention strategies in early childhood education settings. These types of changes can have broad reach and are often sustained over time, which allows for impact on children who enter the early childhood education setting year after year. However, there is currently a gap between the generation of evidence for health promotion programs and their application into practice. This study used qualitative methods to evaluate intervention-, organizational- and individual-level factors within a dissemination and implementation framework that may be related to the implementation of a health-promoting intervention in early childhood education settings. Intervention-level factors, including feasibility and adaptability, organizational-level factors, including staff and leadership engagement, and individual-level factors, including attitudes, skills and knowledge, were identified as constructs that impacted the successful implementation of the intervention. These findings provide insight into core dissemination and implementation constructs that should be targeted by obesity prevention interventions in early childhood education settings to ensure maximum impact on sustainable behavior change.

Development of a Dissemination and Implementation Framework for an Early Childhood Obesity Prevention Program

Dissemination and implementation (D&I) science addresses the disconnect between evidence-based research and practical application in community settings. Early childhood education settings are ideal for the application of D&I research because of their widespread use for implementing health promotion interventions. A D&I framework was applied to the Culture of Wellness in Preschools program, a comprehensive early childhood obesity prevention program. The development and application of the Culture of Wellness in Preschools D&I framework can lead to a more comprehensive approach to program evaluation and quality improvement and can contribute more broadly to the body of evidence of nutrition-related health promotion programs.

Grow well/Crecer bien: a protocol for research on infant feeding practices in low-income families

BackgroundThe prevalence of obesity among children remains high. Given obesity’s significant lifelong consequences, there is great interest in preventing obesity early in life. There is a need to better understand the relation of common infant feeding styles and practices to obesity in infants using longitudinal study designs. There is also an urgent need to understand the role of caregivers other than mothers in feeding. A better understanding of variation in feeding styles and practices can inform the identification of risk groups and the tailoring of interventions to them.MethodsIn partnership with Early Head Start programs across four counties in southern California, mothers and infants will be enrolled in a two-year longitudinal study collecting survey and anthropometric data. A subsample of mothers and their selected other caregivers will participate in qualitative research involving feeding diaries and dyadic interviews. The results will be used to develop and test an enhanced nutrition education program.DiscussionWe outline a study methodology to examine feeding styles and practices and their association with early childhood obesity risk and enhance an existing intervention to promote healthy infant feeding and growth among children in low-income families.