The Baby's First Bites RCT: Evaluating a Vegetable-Exposure and a Sensitive-Feeding Intervention in Terms of Child Health Outcomes and Maternal Feeding Behavior During Toddlerhood

Merel S van Vliet, Janneke M Schultink, Gerry Jager, Jeanne H M de Vries, Judi Mesman, Cees de Graaf, Carel M J L Vereijken, Hugo Weenen, Victoire W T de Wild, Vanessa E G Martens, Hovannouhi Houniet, Shelley M C van der Veek, Merel S van Vliet, Janneke M Schultink, Gerry Jager, Jeanne H M de Vries, Judi Mesman, Cees de Graaf, Carel M J L Vereijken, Hugo Weenen, Victoire W T de Wild, Vanessa E G Martens, Hovannouhi Houniet, Shelley M C van der Veek

Abstract

Background: Parenting interventions during the first years of life on what and/or how to feed infants during complementary feeding can promote healthy eating habits.

Objectives: An intervention promoting repeated exposure to a variety of vegetables [repeated vegetable exposure (RVE); what] and an intervention promoting responding sensitively to child signals during mealtime [video-feedback intervention to promote positive parenting-feeding infants (VIPP-FI); how] were compared, separately and combined (COMBI), with an attention control condition (AC). Primary outcomes were vegetable consumption and self-regulation of energy intake; secondary outcomes were child anthropometrics and maternal feeding practices (sensitive feeding, pressure to eat).

Methods: Our 4-arm randomized controlled trial included 246 first-time Dutch mothers and their infants. Interventions started when infants were 4-6 mo old and ended at age 16 mo. The present study evaluated effects at 18 (t18) and 24 (t24) mo of age. Vegetable acceptance was assessed using three 24-h dietary recalls, self-regulation of energy intake by an eating-in-the-absence-of-hunger experiment and mother-report, and maternal feeding behavior by observation and mother-report.

Results: Linear mixed model and ANOVA analyses revealed no follow-up group differences regarding child vegetable intake or self-regulatory behavior. The proportion of children with overweight was significantly lower in the COMBI group, compared with the VIPP-FI group at t18 (2% compared with 16%), and with the AC group at t24 (7% compared with 20%), although this finding needs to be interpreted cautiously due to the small number of infants with overweight and nonsignificant effects on the continuous BMI z-score measure (P values: 0.29-0.82). Finally, more sensitive feeding behavior and less pressure to eat was found in the VIPP-FI and COMBI groups, compared with the RVE and AC groups, mostly at t18 (significant effect sizes: d = 0.23-0.64).

Conclusions: Interventions were not effective in increasing vegetable intake or self-regulation of energy intake. Future research might usefully focus on risk groups such as families who already experience problems around feeding.This trial is registered at clinicaltrials.gov as NCT03348176.

Keywords: child; complementary feeding; infant; repeated exposure; responsive feeding; self-regulation of energy intake; sensitive feeding; toddler; vegetables.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Analysis of outcome measures comparing RVE, VIPP-FI, COMBI, and AC at t0, t18, and t24 on (A) child vegetable intake (n = 246), (B) maternal responsiveness to satiety cues (n = 246), (C) maternal self-reported responsive feeding (n = 212), and (D) maternal self-reported pressure to eat (n = 210). Means shown are absolute values. Linear mixed model analysis was used to identify main effects of treatment and time and their interaction (P < 0.05), followed by pairwise comparisons to identify mean differences between groups. Values are means ± SEs. Condition (n) per group in each figure: A and B, RVE (61), VIPP-FI (62), COMBI (60), AC (63); C, RVE (50), VIPP-FI (52), COMBI (54), AC (56); D, RVE (48), VIPP-FI (52), COMBI (54), AC (56). AC, attention-control condition; COMBI, combined condition of RVE and VIPP-FI; RVE, repeated vegetable exposure intervention; t0, baseline at child age 4–6 mo; t18, first follow-up measurement at child age 18 mo; t24, second follow-up measurement at child age 24 mo; VIPP-FI, video intervention to promote positive parenting–feeding infants intervention.

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