Bottle-weaning intervention and toddler overweight
Karen Bonuck1, Sivan Ben Avraham1, Yungtai Lo1
1Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
Insights
A WIC-based counseling intervention effectively reduced bottle use and calorie intake in toddlers. However, it did not significantly decrease the risk of overweight, possibly due to increased sippy cup consumption.
Area of Science:
- Pediatric Nutrition
- Public Health Interventions
- Childhood Obesity Prevention
Background:
- Excessive bottle feeding in early childhood is linked to increased calorie intake and potential overweight.
- The Women, Infants, and Children (WIC) program provides a platform for nutritional counseling.
- Understanding the impact of interventions on bottle use and weight status is crucial for public health.
Purpose of the Study:
- To assess if a WIC-based counseling intervention reduces bottle use and energy intake from bottles.
- To determine if this intervention lowers the risk of children exceeding the 85th percentile for weight-for-length.
- To evaluate the effectiveness of a brief, WIC-integrated intervention in modifying early childhood feeding practices.
Main Methods:
- A randomized controlled trial involving 300 12-month-olds consuming over two bottles daily.
- Intervention group received counseling from nutritionists at WIC sites; control group did not.
- Dietary intake, beverage container use, and anthropometrics were assessed at multiple time points up to 24 months.
Main Results:
- The intervention group showed significantly reduced use of bottles (OR=0.23) and lower calorie intake from milk bottles (OR=0.36) at 1-year follow-up.
- Total calorie intake was also reduced in the intervention group (β=-1.15, P=.043).
- No significant difference was observed in the risk of being overweight (OR=1.02) between groups; sippy cup use increased in the intervention group.
Conclusions:
- A brief WIC-based counseling intervention successfully reduced bottle use and associated energy intake in young children.
- The intervention did not significantly impact the risk of overweight, potentially due to a compensatory increase in sippy cup consumption.
- WIC settings are effective for delivering interventions aimed at reducing early childhood risk factors for overweight.
Objective:
To evaluate 3 research questions: (1) Does a Women, Infants, and Children (WIC)-based counseling intervention reduce (milk) bottle use?; (2) Does this intervention reduce energy intake from bottles?; and (3) Does this intervention reduce the risk of a child being >85th percentile weight-for-length?
Study Design:
Parents of n = 300 12-month-olds consuming >2 bottles/d were randomized to a bottle-weaning intervention or control group. Nutritionists at WIC Supplemental Feeding Program sites delivered the intervention. Researchers assessed dietary intake and beverage container use via computer-guided 24-hour recalls, and anthropometrics at 15, 18, 21, and 24 months old. Intent-to-treat analyses controlled for baseline measures of outcomes and months post-baseline.
Results:
At 1 year follow-up, the intervention group had reduced use of any bottles (OR = 0.23, 95% CI = 0.08-0.61), calories from milk bottles (OR = 0.36, 95% CI = 0.18-0.74), and total calories (β = -1.15, P = .043), but did not differ from controls in risk of overweight status (ie, >85th percentile weight-for-length (OR = 1.02, 95% CI = 0.5-2.0). The intervention group's decreased bottle usage at 15 and 18 months was paralleled by increased "sippy cup" usage.
Conclusion:
A brief intervention, during WIC routine care, reduced early childhood risk factors for overweight-bottle use and energy intake--but not risk of overweight. The intervention group's increased use of sippy cups may have attenuated an intervention effect upon risk of overweight. Toddlers consume a high proportion of their calories as liquid. Parents should be counseled about excess intake from bottles and sippy cups. WIC is an ideal setting for such interventions.
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