Michele E. Marini

Repeated exposure and associative conditioning promote preschool children’s liking of vegetables ☆

Most young children do not meet current dietary recommendations, consuming too many energy-dense foods and too few nutrient-dense foods like vegetables. We compared two approaches to increasing childrens liking of vegetables by having them repeatedly taste small portions of vegetables that were initially not liked, presented either alone (repeated exposure; RE) or with a liked dip (associative conditioning; AC). We first conducted a between-subjects experiment, where classrooms at a childcare center were each assigned a vegetable that most children did not like, and individual children were assigned to either the RE or AC condition. A second experiment was conducted to test whether the same results would be obtained using a within-subjects design, in which each child was assigned to repeatedly taste two vegetables that were not liked, one presented with dip and one without. In both experiments, vegetable liking was assessed before, during, and after a series of eight tasting trials, and vegetable intake was measured before and after the tasting trials in Experiment 1. In both experiments, childrens vegetable liking increased from pre- to post-test, but there was no evidence of associative conditioning effects. Increases in vegetable liking, as well as intake, were similar across conditions. Although the addition of the liked dip did not augment overall effects on vegetable liking, there was some evidence that the liked dips could be used to encourage initial tasting of vegetables. In both experiments and both conditions, increases in liking were detected by the sixth exposure to the vegetable. Additional tasting trials did not produce additional increases in liking, but the increases in liking were sustained throughout the experiments. The current evidence suggests that administering few small tastes of vegetables that are initially not liked can have a lasting impact on preschool childrens liking and intake of those vegetables.

Parent overweight predicts daughters' increase in BMI and disinhibited overeating from 5 to 13 years.

Objective: To assess whether parental overweight status and disinhibited overeating are predictive of daughters’ accelerated weight gain and disinhibited overeating.

Girls' early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence.

BACKGROUND Information is limited on persistence of early beverage patterns throughout childhood and adolescence and their influence on long-term dietary intake. OBJECTIVE To describe changes in beverage intake during childhood and assess beverage and nutrient intake from ages 5 to 15 years among girls who were consuming or not consuming sweetened carbonated beverages (soda) at age 5 years. DESIGN/SUBJECTS Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n=170) assessed biennially from age 5 to 15 years starting fall 1996. STATISTICAL ANALYSES At each assessment, intakes of beverages (milk, fruit juice, fruit drinks, soda, and tea/coffee), energy, macronutrients, and micronutrients were assessed using three 24-hour recalls. Analyses of longitudinal changes and the interaction between beverage type and age were conducted using a mixed modeling approach. Girls were categorized as either soda consumers or nonconsumers at age 5 years. A mixed modeling approach was used to assess longitudinal differences and patterns of change in beverage and nutrient intake between soda consumption groups. RESULTS Early differences in soda intake were predictive of later soda and milk intake and of differences in selected nutrients. Relative to girls who were not consuming soda beverages at age 5 years, soda consumers at age 5 years had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years. CONCLUSIONS Soda consumption at age 5 years predicted patterns of nutrient intake that persisted during childhood and into adolescence. Diets of soda consumers were higher in added sugars and lower in protein, fiber, calcium, vitamin D, magnesium, phosphorous, and potassium. Findings provide a more complex picture regarding the emergence of early beverage patterns and their predictive effects on nutrient intake across childhood and adolescence.

Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial

IMPORTANCE Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking. OBJECTIVE To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year. DESIGN, SETTING, AND PARTICIPANTS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015. INTERVENTIONS At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participants home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors. MAIN OUTCOMES AND MEASURES Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The interventions effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain. RESULTS Of the mothers included in the study, 246 were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full time (72%) at time of enrollment. The mean conditional weight gain score was lower among infants in the RP group compared with the control group (-0.18; 95% CI, -0.36 to -0.001), reflecting that the RP infants gained weight more slowly than control group infants (0.18; 95% CI, 0.02-0.34); this effect did not differ by feeding mode (predominantly fed breast milk or not). Infants in the RP group also had lower mean weight-for-length percentiles at 1 year than infants in the control group (57.5%; 95% CI, 52.56%-62.37% vs 64.4%; 95% CI, 59.94%-69.26%; P = .04) and were less likely to be overweight at age 1 year (5.5% vs 12.7%; P = .05). CONCLUSIONS AND RELEVANCE An RP intervention is associated with reduced rapid weight gain during the first 6 months after birth and overweight status at age 1 year. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01167270.

Serving smaller age-appropriate entrée portions to children aged 3–5 y increases fruit and vegetable intake and reduces energy density and energy intake at lunch

BACKGROUND Previous portion size research in children has focused on the impact of large entrée portions on childrens intake, but less attention has been given to how intake at a meal is affected across a broader range of entrée portions. OBJECTIVE The objective was to assess the effect of serving a range of entrée portions on childrens ad libitum intake and energy density consumed at the meal. DESIGN A within-subject design was used to examine the effect of varying entrée portions (ie, 100, 160, 220, 280, 340, and 400 g) on childrens ad libitum energy intake of macaroni and cheese and fixed portions of unsweetened applesauce, green beans, and whole-wheat roll served with the entree. Seventeen children (10 girls), aged 3 to 6 y, were served a series of 6 lunches, which varied only in entrée portion size, once per week. Weight, height, and weighed food intake were measured. RESULTS Increasing portion size increased childrens entrée intake (P < 0.01) and decreased intake of other foods served with the entrée, including fruit and vegetables (P < 0.0001). As a result, children consumed a more-energy-dense (kcal/g) lunch as portion size increased (P < 0.0001). Further examination showed that BMI percentile moderated the positive association between portion size and entrée intake (P < 0.01); overweight children showed greater increases in entree intake with increasing entrée portion. CONCLUSION Serving smaller age-appropriate entrée portions may be one strategy to improve childrens nutritional profile by decreasing intake of energy-dense foods and by promoting intake of fruit and vegetables served with the entree.

The Addition of a Plain or Herb-Flavored Reduced-Fat Dip Is Associated with Improved Preschoolers' Intake of Vegetables

This quasiexperimental study used a within-subjects experimental design to determine whether adding herbs and/or spices to a reduced-fat dip increased childrens willingness to taste, liking of, and consumption of vegetables. Participants were preschool children aged 3 to 5 years who attended a child-care center in Central Pennsylvania in late 2008 and early 2009. First, childrens familiarity with and liking of six raw vegetables and five dips (reduced-fat plain, herb, garlic, pizza, and ranch) were assessed. In Experiment 1 (n=34), children tasted a vegetable they liked, one they disliked, and one they refused, with a reduced-fat plain dip and their favorite reduced-fat herb-flavored dip. In Experiment 2 (n=26 or n=27), they rated their liking of celery and yellow squash, with and without their favorite reduced-fat herb dip (pizza or ranch), and their intake of those vegetable snacks was measured. In Experiment 1, the herb-flavored dip was preferred over the plain dip (P<0.01), and children were three times more likely to reject the vegetable alone, compared with eating the vegetable paired with an herb dip (P<0.001). In Experiment 2, children ate significantly more of a previously rejected or disliked vegetable (celery and squash) when offered with a preferred reduced-fat herb dip than when the vegetable was served alone (P<0.05). These findings suggest that offering vegetables with reduced-fat dips containing familiar herb and spice flavors can increase tasting and thereby promote liking, acceptance, and consumption of vegetables, including vegetables previously rejected or disliked.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study

BackgroundBecause early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight.Methods/Design316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings.DiscussionWith increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings.Trial registrationNCT01167270. Registered 21 July 2010.

Do children eat less at meals when allowed to serve themselves

BACKGROUND The effect of self-serving on young childrens energy intake is not well understood. OBJECTIVE The objective was to examine individual differences in the effects of plated and self-served entrée portions on childrens energy intake. DESIGN Two within-subjects experiments were used to examine ad libitum intake at meals in 63 children aged 3-5 y when 400 g of a pasta entrée was either plated or available for children to self-serve. Child age, sex, BMI, and responsiveness to increasing portion size (defined as individual slope estimates relating ad libitum intake of the entrée across a range of entrée portions) were evaluated as predictors of self-served portions. RESULTS Childrens entrée and meal intakes did not differ between the self-served and plated conditions for the total sample or by child weight status. However, larger self-served entrée portions were associated with greater entrée and meal intakes. Children who served themselves larger entrée portions tended to be overweight and more responsive to portion size (ie, greater increases in entrée intake as plated portion size increased). Last, self-served portion predicted both entrée and meal intake over and above BMI z score and responsiveness to portion. CONCLUSIONS Contrary to our hypothesis, relative to plated portions, allowing children to self-serve the entrée portion did not reduce energy intake. Children who were more responsive to portion-size effects were likely to self-serve and eat larger entrée portions. Self-serving is not a one-size-fits-all approach; some children may need guidance and rules to learn how to self-select appropriate portion sizes.

INSIGHT Responsive Parenting Intervention and Infant Sleep.

OBJECTIVES: Inadequate sleep during infancy is associated with adverse outcomes for infants and families. We sought to improve sleep behaviors and duration through a responsive parenting (RP) intervention designed for obesity prevention. METHODS: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control. Primiparous mother-newborn dyads were randomized after childbirth, and research nurses delivered intervention content at home visits at infant ages 3, 16, 28, and 40 weeks and at a research center visit at 1 year. The RP sleep component included developmentally appropriate messages about bedtime routines, sleep location and behaviors, and responses to wakings. Portions of the Brief Infant Sleep Questionnaire were administered 2, 8, and 52 weeks after birth with expanded sleep-related data collection at 16 and 40 weeks. RESULTS: Two hundred and seventy-nine dyads completed the first home visit; 90.7% completed the 1-year visit. Compared with controls, RP group infants were less likely to have prolonged bedtime routines >45 minutes and more likely to have earlier bedtimes at 16 and 40 weeks. They were less likely to be fed immediately before bed and more likely to self-soothe to sleep. At 8, 16, and 40 weeks, RP group nocturnal sleep duration was longer by 35, 25, and 22 minutes, respectively (P < .05 for all). Sleep duration at 1 year was similar between groups. CONCLUSIONS: The INSIGHT RP intervention positively influenced developmentally appropriate bedtime routines, sleep-related behaviors, and sleep duration for infants.

Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study

OBJECTIVES The American Academy of Pediatrics recommends infant-parent room-sharing until age 1. We assessed the association between room-sharing and sleep outcomes. METHODS The Intervention Nurses Start Infants Growing on Healthy Trajectories study is an obesity prevention trial comparing a responsive parenting intervention with a safety control among primiparous mother-infant dyads. Mothers completed the Brief Infant Sleep Questionnaire at 4, 9, 12, and 30 months. Reported sleep duration and overnight behaviors, adjusted for intervention group, were compared among early independent sleepers (own room <4 months), later independent sleepers (own room between 4 and 9 months), and room-sharers at 9 months. RESULTS At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, P = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers (P = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively (P = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months (P = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months (P < .01 for both). CONCLUSIONS Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.For prevention of SIDS, the AAP recommends infant-parent room-sharing until age 1. However, these new data show potential unintended consequences of room-sharing. OBJECTIVES: The American Academy of Pediatrics recommends infant-parent room-sharing until age 1. We assessed the association between room-sharing and sleep outcomes. METHODS: The Intervention Nurses Start Infants Growing on Healthy Trajectories study is an obesity prevention trial comparing a responsive parenting intervention with a safety control among primiparous mother-infant dyads. Mothers completed the Brief Infant Sleep Questionnaire at 4, 9, 12, and 30 months. Reported sleep duration and overnight behaviors, adjusted for intervention group, were compared among early independent sleepers (own room <4 months), later independent sleepers (own room between 4 and 9 months), and room-sharers at 9 months. RESULTS: At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, P = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers (P = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively (P = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months (P = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months (P < .01 for both). CONCLUSIONS: Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.