Stephanie Anzman-Frasca

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 use of food to soothe infant/toddler distress and child weight status. An exploratory study

The aim of the present study was to explore the parent feeding practice of using food to soothe infant/toddler distress and its relationship to child weight status. Seventy eight families with infants and toddlers (43 males) ranging in age from 3 to 34 months (M=14 mos, SD=9 mos) completed a survey which included questions on their use of food to soothe, questionnaires on parent feeding practices, parenting self-efficacy, child temperament and childs weight and length at the time of their last well-baby visit. Results revealed the use of food to soothe to be a valid construct. In addition, mothers who used food to soothe rated themselves lower in parenting self-efficacy and their children higher in temperamental negativity. Analyses examining weight status as the outcome variable revealed that mothers who reported the use of food to soothe had heavier children, however, this relationship was stronger for children rated as high in temperamental negativity.

Temperament and childhood obesity risk: a review of the literature.

Objective: Temperament, or individual differences in behavioral styles, could explain why many individuals are susceptible to childhood obesity in the current environment while others are not. The objective of this article is to review the growing body of literature linking weight outcomes with 2 aspects of temperament, negativity and self-regulation. Method: Studies conducted through 2011 and assessing at least 1 weight outcome and 1 aspect of early negativity or self-regulation in normally developing infants and young children were included. Results: Most studies suggest that greater levels of negative reactivity in early life may increase the risk of obesity, and greater self-regulation may be protective. While temperaments of individuals tend to be relatively stable over time, there is evidence that links between early temperament and weight outcomes are malleable. Conclusions: Relationships between temperament and weight outcomes are becoming well established. More research is needed to confirm the longitudinal nature of these relationships and to shed light on the mediators and moderators of these relationships and their implications for obesity interventions.

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.

Changes in children's meal orders following healthy menu modifications at a regional US restaurant chain

To examine changes in childrens meal orders, price, and revenue following the implementation of a healthier childrens menu in a full‐service restaurant chain.

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.

Infant temperament and maternal parenting self-efficacy predict child weight outcomes

Relationships between infant negative reactivity and self-regulation, parenting self-efficacy, and child weight outcomes were examined. Greater observed negative reactivity predicted more child weight gain when mothers had lower parenting self-efficacy. Lower mother-reported self-regulation predicted a greater child weight status. Results highlight potential early risk/protective factors.

Estimating impacts of a breakfast in the classroom program on school outcomes.

IMPORTANCE Short-term impacts of breakfast consumption on diet quality and cognitive functioning have been reported, but more evidence is needed to draw causal inferences about long-term impacts of school breakfast on indicators of school engagement and academic achievement. OBJECTIVE To estimate the impact of a Breakfast in the Classroom (BIC) program on School Breakfast Program participation, school attendance, and academic achievement. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental study included a sample of 446 public elementary schools from a large, urban US school district that served predominantly low-income, racial/ethnic minority students. INTERVENTIONS A total of 257 schools (57.6%) implemented a BIC program during the 2012-2013 academic year, whereas 189 (42.4%) did not. MAIN OUTCOMES AND MEASURES School- and grade-level data from 2012-2013 and grade-level achievement data from the prior year were collected from school district records across the elementary schools. Hypotheses that a BIC program would improve school breakfast participation at the school level, school attendance at the grade level (kindergarten through sixth grade), and academic achievement at the grade level (second through sixth grades) were tested using propensity score weights to adjust for demographic differences between the BIC and non-BIC schools. RESULTS The BIC program was linked with increased breakfast participation during the academic year (F10,414=136.90, P<.001), with mean participation rates of 73.7% in the BIC group vs 42.9% in the non-BIC group. The BIC program was also linked with greater overall school attendance rates (95.5% vs 95.3% in the non-BIC group; F1,2772=8.40, P = .004). When performing attendance analyses in the subset of grade levels for which achievement data were available, results were mostly consistent, although there was a group × time interaction (F10,1891=1.94, P=.04) such that differences between least squares means in the BIC vs non-BIC groups did not reach statistical significance at every month. There were no group differences in standardized test performance in math (57.9% in the BIC group vs 57.4% in the non-BIC group; F1,1890=0.41, P=.52) or reading (44.9% in the BIC group vs 44.7% in the non-BIC group; F1,1890=0.15, P=.70). CONCLUSIONS AND RELEVANCE Findings add to the evidence that BIC can increase school breakfast participation substantially and suggest that it has the potential to improve overall school attendance rates. Additional research is needed to explore the generalizability of these findings and the potential impacts on achievement for longer periods and on additional outcomes, such as weight status.

Breakfast consumption and adiposity among children and adolescents: an updated review of the literature.

Breakfast consumption has been associated with reduced risk of overweight and obesity among children, but previous evidence reviews fail to confirm a causal relationship.

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.