A pragmatic controlled trial to prevent childhood obesity within a risk group at maternity and child health-care clinics: results up to six years of age (the VACOPP study)

Taina Mustila, Jani Raitanen, Päivi Keskinen, Riitta Luoto, Taina Mustila, Jani Raitanen, Päivi Keskinen, Riitta Luoto

Abstract

Background: Obesity in childhood appears often during the toddler years. The prenatal environment influences obesity risk. Maternal gestational diabetes, the child's diet, and physical activity in the first few years have an important role in subsequent weight gain. A study was conducted to evaluate effectiveness of a primary health-care lifestyle counselling intervention in prevention of childhood obesity up to 6 years of age.

Methods: The study was a controlled pragmatic trial to prevent childhood obesity and was implemented at maternity and child health-care clinics. The participants (n = 185) were mothers at risk of gestational diabetes mellitus with their offspring born between 2008 and 2010. The prenatal intervention, started at the end of the first trimester of pregnancy, consisted of counselling on diet and physical activity by municipal health-care staff. The intervention continued at yearly appointments with a public health-nurse at child health-care clinics. The paper reports the offspring weight gain results for 2-6 years of age. Weight gain up to 6 years of age was assessed as BMI standard deviation scores (SDS) via a mixed-effect linear regression model. The proportion of children at 6 years with overweight/obesity was assessed as weight-for-height percentage and ISO-BMI. Priority was not given to power calculations, because of the study's pragmatic nature.

Results: One hundred forty seven children's (control n = 76/85% and intervention n = 71/56%) weight and height scores were available for analysis at 6 years of age. There was no significant difference in weight gain or overweight/obesity proportions between the groups at 6 years of age, but the proportion of children with obesity in both groups was high (assessed as ISO-BMI 9.9% and 11.8%) relative to prevalence in this age group in Finland.

Conclusion: As the authors previously reported, the intervention-group mothers had lower prevalence of gestational diabetes mellitus, but a decrease in obesity incidence before school age among their offspring was not found. The authors believe that an effective intervention should start before conception, continuing during pregnancy and the postpartum period through the developmentally unique child's first years.

Trial registration: ClinicalTrials.gov NCT00970710 . Registered 1 September 2009. Retrospectively registered.

Keywords: Childhood obesity; Diet; Gestational diabetes mellitus; Intervention; Physical activity; Pragmatic; Prevention.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for the study was granted by the ethics committee of the Hospital District of Vaasa. Informed written consent was provided by all participating mothers prior to the baseline assessments.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
BMI-SDS in whole group (N = 171) from two years to six years of age. Non-linear model including age of child, mother’s pre-pregnancy weight, and group × age interaction. Obs., observed; Est., estimated

References

    1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384:766–781. doi: 10.1016/S0140-6736(14)60460-8.
    1. Vuorela N, Saha MT, Salo MK. Change in prevalence of overweight and obesity in Finnish children – comparison between 1974 and 2001. Acta Paediatr. 2011;100:109–115. doi: 10.1111/j.1651-2227.2010.01980.x.
    1. Ip EH, Marshall SA, Saldana S, Skelton JA, Suerken CK, Arcury TA, Quandt SA. Determinants of adiposity rebound timing in children. J Pediatr. 2017;24(17):30161–30160.
    1. Hughes AR, Sherriff A, Ness AR, Reilly JJ. Timing of adiposity rebound and adiposity in adolescence. Pediatrics. 2014;134:e1354–e1361. doi: 10.1542/peds.2014-1908.
    1. Gardner DS, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ. Contribution of early weight gain to childhood overweight and metabolic health: a longitudinal study (EarlyBird 36) Pediatrics. 2009;123:e67–e73. doi: 10.1542/peds.2008-1292.
    1. Juhola J, Magnussen CG, Viikari JS, Kähönen M, Hutri-Kähönen N, Jula A, et al. Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the cardiovascular risk in young Finns study. J Pediatr. 2011;159:584–590. doi: 10.1016/j.jpeds.2011.03.021.
    1. Katzmarzyk PT, Barlow S, Bouchard C, Catalano PM, Hsia DS, Inge TH, et al. An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obes. 2014;38:887–905. doi: 10.1038/ijo.2014.49.
    1. Blake-Lamb T, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for childhood obesity in the first 1,000 days. A systematic review. Am J Prev Med. 2016;50:780–789. doi: 10.1016/j.amepre.2015.11.010.
    1. Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196:322.e 1–322.e 8. doi: 10.1016/j.ajog.2006.11.027.
    1. The HAPO Study Cooperative Research Group Hyperglycaemias and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002. doi: 10.1056/NEJMoa0707943.
    1. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycaemia. Diabetes Care. 2007;30:2287–2292. doi: 10.2337/dc06-2361.
    1. Chandler-Laney PC, Bush NC, Rouse DJ, Mancuso MS, Gower BA. Maternal glucose concentration during pregnancy predicts fat and lean mass of pre-pubertal offspring. Diabetes Care. 2011;34:741–745. doi: 10.2337/dc10-1503.
    1. Wen X, Shenassa ED, Paradis AD. Maternal smoking, breastfeeding, and risk of childhood overweight: findings from a national cohort. Matern Child Health J. 2013;17:746–755. doi: 10.1007/s10995-012-1059-y.
    1. Bammann K, Peplies J, De Henauw S, Hunsberger M, Molnar D, Moreno LA, et al. Early life course risk factors for childhood obesity: the IDEFICS case-control study. PLoS One. 2014;13:e86914. doi: 10.1371/journal.pone.0086914.
    1. Baptiste-Roberts K, Nicholson WK, Wang NY, Brancati FL. Gestational diabetes and subsequent growth patterns of offspring: the National Collaborative Perinatal Project. Matern Child Health J. 2012;16:125–132. doi: 10.1007/s10995-011-0756-2.
    1. Zhu Y, Olsen SF, Mendola P, Yeung EH, Vaag A, Bowers K, et al. Growth and obesity through the first 7 y of life in association with levels of maternal glycemia during pregnancy: a prospective cohort study. Am J Clin Nutr. 2016;103:794–800. doi: 10.3945/ajcn.115.121780.
    1. Gillman MW, Rifas-Shiman S, Berkey S, Field AE, Colditz GA. Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics. 2003;111:221–226. doi: 10.1542/peds.111.3.e221.
    1. Zhang J, Himes JH, Guo Y, Jiang J, Yang L, Lu Q, et al. Birth weight, growth and feeding pattern in early infancy predict overweight/obesity status at two years of age: a birth cohort study of Chinese infants. PLoS One. 2013;8:e64542. doi: 10.1371/journal.pone.0064542.
    1. Rogers IS, Ness AR, Steer CD, Wells JC, Emmett PM, Reilly JR, et al. Associations of size at birth and dual-energy X-ray absorptiometry measures of lean and fat mass at 9 to 10 y of age. Am J Clin Nutr. 2006;84:739–747. doi: 10.1093/ajcn/84.4.739.
    1. Griffiths LJ, Smeeth L, Hawkins SS, Cole TJ, Dezateux C. Effects of infant feeding practice on weight gain from birth to 3 years. Arch Dis Child. 2009;94:577–582. doi: 10.1136/adc.2008.137554.
    1. Moorcroft KE, Marshall JL, McCormick FM. Association between timing of introducing solid foods and obesity in infancy and childhood: a systematic review. Matern Child Nutr. 2011;7:3–26. doi: 10.1111/j.1740-8709.2010.00284.x.
    1. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr. 2006;95(8):904. doi: 10.1080/08035250600719754.
    1. Willers SM, Brunekreef B, Smit HA, van der Beek EM, Gehring U, de Jongste C, et al. BMI development of normal weight and overweight children in the PIAMA study. PLoS One. 2012;7:e39517. doi: 10.1371/journal.pone.0039517.
    1. Glavin K, Roelants M, Strand BH, Júlíusson PB, Lie KK, Helseth S, Hovengen R. Important periods of weight development in childhood: a population-based longitudinal study. BMC Public Health. 2014;14:160. doi: 10.1186/1471-2458-14-160.
    1. Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD, et al. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol. 2012;26:19–26. doi: 10.1111/j.1365-3016.2011.01213.x.
    1. Buyken AE, Karaolis-Danckert N, Remer T, Bolzenius K, Landsberg B, Kroke A. Effects of breastfeeding on trajectories of body fat and BMI throughout childhood. Obesity (Silver Spring) 2008;16:389–395. doi: 10.1038/oby.2007.57.
    1. Taveras EM, Rifas-Shiman SL, Oken E, Gunderson EP, Gillman MW. Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med. 2008;162:305–311. doi: 10.1001/archpedi.162.4.305.
    1. Godwin M, Ruhland L, Casson I, MacDonald S, Delva D, Birtwhistle R, Lam M, Seguin R. Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity. BMC Med Res Methodol. 2003;3:28. doi: 10.1186/1471-2288-3-28.
    1. Timmons BW, Leblanc AG, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of physical activity and health in the early years (aged 0–4 years) Appl Physiol Nutr Metab. 2012;37:773–792. doi: 10.1139/h2012-070.
    1. Patrick H, Nicklas TA. A review of family and social determinants of children’s eating patterns and diet quality. J Am Coll Nutr. 2005;24:83–92. doi: 10.1080/07315724.2005.10719448.
    1. Farrar D, Duley L, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev. 2011;5:CD007122.
    1. Waters E, De Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;7:CD001871.
    1. Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015;16:547–565. doi: 10.1111/obr.12277.
    1. Wen LM, Baur LA, Simpson JM, Rissel C, Wardle K, Flood VM. Effectiveness of home based early intervention on children's BMI at age 2: randomised controlled trial. BMJ. 2012;344:e3732. doi: 10.1136/bmj.e3732.
    1. Daniels LA, Mallan KM, Nicholson JM, Thorpe K, Nambiar S, Mauch CE, et al. An early feeding practices intervention for obesity prevention. Pediatrics. 2015;136:e40–e49. doi: 10.1542/peds.2014-4108.
    1. Hakanen M, Lagström H, Kaitosaari T, Niinikoski H, Näntö-Salonen K, Jokinen E, et al. Development of overweight in an atherosclerosis prevention trial starting in early childhood: the STRIP study. Int J Obes. 2006;30:618–626. doi: 10.1038/sj.ijo.0803249.
    1. Wen LM, Rissel C, Baur LA, Hayes AJ, Xu H, Whelan A, et al. A 3-arm randomised controlled trial of communicating healthy beginnings advice by telephone (CHAT) to mothers with infants to prevent childhood obesity. BMC Public Health. 2017;17:79. doi: 10.1186/s12889-016-4005-x.
    1. Campbell KJ, Hesketh KD, McNaughton SA, Ball K, McCallum Z, Lynch J, Crawford DA. The extended infant feeding, activity and nutrition trial (InFANT extend) program: a cluster-randomized controlled trial of an early intervention to prevent childhood obesity. BMC Public Health. 2016;16:166. doi: 10.1186/s12889-016-2836-0.
    1. T S, Svensson V, Ek A, Ekstedt M, Karlsson H, Johansson E, et al. A randomised controlled trial for overweight and obese parents to prevent childhood obesityEarly STOPP (STockholm obesity prevention program) BMC Public Health. 2011;11:336. doi: 10.1186/1471-2458-11-336.
    1. Gillman MW, Oakey H, Baghurst PA, Volkmer RE, Robinson JS, Crowther CA. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care. 2010;33:964–968. doi: 10.2337/dc09-1810.
    1. Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Lifestyle counselling during pregnancy and offspring weight development until four years of age: follow-up study of a controlled trial. J Negat Results Biomed. 2012;11:11. doi: 10.1186/1477-5751-11-11.
    1. Kolu P, Raitanen J, Puhkala J, Tuominen P, Husu P, Luoto R. Effectiveness and cost-effectiveness of a cluster-randomized prenatal lifestyle counseling trial: a seven-year follow-up. PLoS One. 2016;11:e0167759. doi: 10.1371/journal.pone.0167759.
    1. Tanvig M, Vinter CA, Jørgensen JS, Wehberg S, Ovesen PG, Beck-Nielsen H, et al. Effects of lifestyle intervention in pregnancy and anthropometrics at birth on offspring metabolic profile at 2.8 years: results from the lifestyle in pregnancy and offspring (LiPO) study. J Clin Endocrinol Metab. 2015;100:175–183. doi: 10.1210/jc.2014-2675.
    1. Vesco KK, Leo MC, Karanja N, Gillman MW, McEvoy CT, King JC, et al. One-year postpartum outcomes following a weight management intervention in pregnant women with obesity. Obesity (Silver Spring) 2016;24:2042–2049. doi: 10.1002/oby.21597.
    1. Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Lifestyle counselling targeting infant’s mother during the child’s first year and offspring weight development until 4 years of age: a follow-up study of a cluster RCT. BMJ Open. 2012;2:e000624. doi: 10.1136/bmjopen-2011-000624.
    1. Mustila T, Keskinen P, Luoto R. Behavioural counselling to prevent childhood obesity – study protocol of a pragmatic trial in maternity and child health care. BMC Pediatr. 2012;12:93. doi: 10.1186/1471-2431-12-93.
    1. Schulz KF, Grimes DA. Sample size calculations in randomised trials: mandatory and mystical. Lancet. 2005;365:1348–1353. doi: 10.1016/S0140-6736(05)61034-3.
    1. Hasunen K, Kalavainen M, Keinonen H, Lagström H, Lyytikäinen A, Nurttila A, et al. The child, family and food: nutrition recommendations for infants and young children as well as pregnant and breastfeeding mothers. Helsinki: Publications of the Ministry of Social Affairs and Health; 2004.
    1. Aittasalo M, Pasanen M, Fogelholm M, Kinnunen TI, Ojala K, Luoto R. Physical activity counselling in maternity and child health care – a controlled trial. BMC Womens Health. 2008;8:14. doi: 10.1186/1472-6874-8-14.
    1. Saari A, Sankilampi U, Hannila ML, Kiviniemi V, Kesseli K, Dunkel L. Finnish growth references for children and adolescents aged 0 to 20 years: length/height-for-age, weight-for-length/height, and body mass index-for-age. Ann Med. 2011;43:235–248. doi: 10.3109/07853890.2010.515603.
    1. Mustila T, Raitanen J, Keskinen P, Saari A, Luoto R. Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (the VACOPP study) BMC Pediatr. 2013;13:80. doi: 10.1186/1471-2431-13-80.
    1. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857–872. doi: 10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>;2-E.
    1. González L, Corvalán C, Pereira A, Kain J, Garmendia ML, Uauy R. Early adiposity rebound is associated with metabolic risk in 7-year-old children. Int J Obes. 2014;38:1299–1304. doi: 10.1038/ijo.2014.97.
    1. Leibowitz KL, Moore RH, Ahima RS, Stunkard AJ, Stallings VA, Berkowitz RI, et al. Maternal obesity associated with inflammation in their children. World J Pediatr. 2012;8:76–79. doi: 10.1007/s12519-011-0292-6.

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