This article is more than 5 years old. Information may no longer be current.

Complementary feeding education promotes protective feeding practices

Guidance on complementary feeding to prevent childhood obesity correlated with an increased use of protective feeding practices among first-time mothers, according to results of the NOURISH trial.

The benefits of these intervention effects extended up to 5 years of age, the study also found.

“The early life environment has a profound life-course effect on social, cognitive, behavioral and health outcomes, including obesity,” Lynne Allison Daniels, PhD, head of the School of Exercise and Nutrition Sciences at the Queensland University of Technology in Brisbane, Australia, and colleagues wrote. “In the fetal and early life periods, interactions between biology and environmental exposures produce epigenetic effects that influence the risk of childhood obesity.”

Daniels and colleague sought to determine whether providing guidance to first-time mothers on “protective” complementary feeding practices — such as those that promote self-regulation of intake and development of healthy food preferences — would reduce the risk for childhood obesity.

The randomized, controlled NOURISH trial included 698 first-time mothers (mean age, 30.1 years; SD = 5.3) with healthy, full-term infants (51% girls). Daniels and colleagues randomly assigned mothers to usual care or to attend two 6-session, 12-week group education sessions.

The education sessions included two modules — one that commenced when the children were aged 4 months to 7 months and the other at 13 months to 16 months — led by a dietician and a psychologist. The sessions aimed to increase exposure to healthy foods and limiting exposure to unhealthy foods to promote the development of healthy food preferences; develop responsive feeding that recognized hunger cues to promote self-regulation of intake; and encourage positive parenting.

Mothers self-reported feeding practices using five scales from the Child Feeding Questionnaire and four scales from the Parental Feeding Style Questionnaire. Outcome assessments occurred at baseline (infant age, 4.3 months), 6 months following the first educational session (infant age, 14 months), 6 months following the second educational session (infant age, 2 years), and at 3.5 and 5 years of age.

Researchers calculated BMI Z-scores from measured child height and weight and used linear modules to evaluated intervention effect over time.

Sixty-one percent of participants (control arm, n = 211; intervention arm, n = 213) were evaluable at the 5-year assessment. Compared with participants who chose not to continue, mothers who remained in the study tended to be older (mean age, 30.8 years; P < .001), married or in a relationship (97% vs. 92%; P = .01), university-educated (68% vs. 42%; P < .001) and reported that they did not smoke during pregnancy (90% vs. 84%; P = .02).

Across ages 2 to 5 years, mothers in the intervention arm reported less frequent use of nonresponsive feeding practices on six of nine scales (P ˂ .05).

Additionally, they reported more appropriate responses to food refusal on seven out of 12 items at age 5 years (Ps ≤ .05). When children refused to eat unfamiliar foods, mothers in the intervention arm were also less likely to disguise the food and more likely to continue to reoffer new foods.

Although children in the intervention arm tended to have lower BMI Z-scores at all post-intervention time points, researchers did not observe a statistically significant group effect on BMI Z-scores or in the prevalence of overweight/obesity in the control vs. intervention arms (13.3% vs. 11.4%).

The researchers acknowledged selection and retention biases — along with considerably low attendance of the second educational session — as limitations to their study.

“The increasing prevalence of nonresponsive feeding strategies with age in both groups suggests that additional guidance regarding protective feeding practices is required beyond toddlerhood,” Daniels and colleagues concluded. “Overall, the results suggest that investing in early advice on the ‘how’ of responsive complementary feeding can improve maternal feeding practices and may have positive effects on obesity risk up to 5 years of age.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.