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Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 YearA Randomized Clinical Trial

Educational Objective
To examine the effect of a responsive parenting intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year.
1 Credit CME
Key Points

Question  Can rapid weight gain and overweight status at 1 year be prevented by a responsive parenting intervention that is delivered by nurse home visitors?

Findings  In this randomized clinical trial that included 279 mother-infant dyads, the responsive parenting intervention was associated with reduced rapid weight gain, and fewer than 6% of infants in the responsive parenting group were overweight at age 1 year compared with 13% of control group infants, a significant difference.

Meaning  A multicomponent intervention that promotes responsive parenting behaviors is associated with healthy growth trajectories in infancy.


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 participant’s 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 intervention’s 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.

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Article Information

Corresponding Author: Jennifer Savage, PhD, Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA 16802 (jfs195@psu.edu).

Accepted for Publication: February 11, 2016.

Correction: There were errors in the Discussion section, the Conclusions section, and in the legend of Figure 3. In the first sentence of the second paragraph of the Discussion section, “Nourishing Our Understanding of Role-modeling to Increase Support and Health” should be replaced with “NOURISH-RCT.” In the third sentence of the fourth paragraph of the Discussion section, “with the exception of NOURISH34” should be deleted. In the second sentence of the Conclusions section, reference 34 should be added following references 14 and 33. Finally, the legend of Figure 3 should be replaced with the following: “Infants in the responsive parenting group have lower weight-for-length percentiles at age 1 year compared with control group infants (ANOVA P = .04). Among responsive parenting group infants, 5.5% were overweight at age 1 year compared with 12.7% of control group infants.” This article was corrected on October 10, 2016.

Published Online: June 6, 2016. doi:10.1001/jamapediatrics.2016.0445

Author Contributions: Dr Savage had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: Savage, Birch, Marini, Paul.

Drafting of the manuscript: Savage, Marini, Paul.

Critical revision of the manuscript for important intellectual content: Savage, Birch, Anzman-Frasca, Paul.

Statistical analysis: Savage, Marini, Paul.

Obtained funding: Savage, Birch, Paul.

Administrative, technical, or material support: Marini, Anzman-Frasca, Paul.

Study supervision: Birch, Marini, Paul.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported by grant R01DK088244 from the National Institute of Diabetes and Digestive and Kidney Diseases. Additional support was received from the Children’s Miracle Network at Penn State Children’s Hospital. US Department of Agriculture grant 2011-67001-30117 supported graduate students. Research Electronic Data Capture support was received from The Penn State Clinical and Translational Research Institute, Pennsylvania State University Clinical and Translational Science Award, and National Institutes of Health/National Center for Advancing Translational Sciences grant number UL1 TR000127.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We acknowledge Jodi Mindell, PhD, for contributing to the sleep curriculum development (Saint Joseph’s University, Philadelphia, Pennsylvania), Jessica Beiler, MPH, Jennifer Stokes, RN, Patricia Carper, RN, Amy Shelly, LPN, Gabrielle Murray, RN, Heather Stokes, and Nicole Verdiglione for their assistance in recruiting and retaining participants, intervention delivery, and data collection (Pennsylvania State College of Health and Human Development), Susan Rzucidlo, MSN, RN, for contributing to the safety control curriculum development (Pennsylvania State College of Health and Human Development), Lindsey Hess, MS, Emily Hohman, PhD, Chelsea Rose, PhD, Katherine Balantekin, PhD, RD, and Julia Bleser, MS, for assisting with data collection and data management (The Center for Childhood Obesity Research, Pennsylvania State University), and Eric Loken, PhD, for statistical advising (Pennsylvania State University). Drs Birch and Paul are principal investigators on the National Institutes of Health grant R01DK088244 that supported the study.

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