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      Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy -the Norwegian randomized controlled trial Early Food for Future Health


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          Strategies to optimize early-life nutrition provide an important opportunity for primary prevention of childhood obesity. Interventions that can be efficiently scaled-up to the magnitude needed for sustainable childhood obesity prevention are needed. The objective of this study was to evaluate the effects of an eHealth intervention on parental feeding practices and infant eating behaviors.


          The Norwegian study Early Food for Future Health is a randomized controlled trial. Parents were recruited via social media and child health clinics during spring 2016 when their child was aged 3 to 5 months. In total 718 parents completed a web-based baseline questionnaire at child age 5.5 months. The intervention group had access to a webpage with monthly short video clips addressing specific infant feeding topics and age-appropriate baby food recipes from child age 6 to 12 months. The control group received routine care. The primary outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. The secondary outcomes were child anthropometry. This paper reports outcomes at child age 12 months.


          More than 80% of the intervention group reported viewing all/most of the video clips addressing infant feeding topics and indicated that the films were well adapted to the child’s age and easy to understand. Children in the intervention group were served vegetables/fruits more frequently ( p = 0.035) and had tasted a wider variety of vegetables ( p = 0.015) compared to controls. They were also more likely to eat family breakfast ( p = 0.035) and dinner ( p = 0.011) and less likely to be playing or watching TV/tablet during meals ( p = 0.009) compared to control-group children. We found no group differences for child anthropometry or maternal feeding practices.


          Our findings suggest that the eHealth intervention is an appropriate and feasible tool to propagate information on healthy infant feeding to Norwegian mothers. Our study also suggests that anticipatory guidance on early protective feeding practices by such a tool may increase young children’s daily vegetable/fruit intake and promote beneficial mealtime routines.

          Trial registration

          ISRCTN, ISRCTN13601567. Registered 29 February 2016, http://www.isrctn.com/ISRCTN13601567

          Electronic supplementary material

          The online version of this article (10.1186/s12966-018-0763-4) contains supplementary material, which is available to authorized users.

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          Most cited references39

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          The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes

          Background A primary focus of self-care interventions for chronic illness is the encouragement of an individual's behavior change necessitating knowledge sharing, education, and understanding of the condition. The use of the Internet to deliver Web-based interventions to patients is increasing rapidly. In a 7-year period (1996 to 2003), there was a 12-fold increase in MEDLINE citations for “Web-based therapies.” The use and effectiveness of Web-based interventions to encourage an individual's change in behavior compared to non-Web-based interventions have not been substantially reviewed. Objective This meta-analysis was undertaken to provide further information on patient/client knowledge and behavioral change outcomes after Web-based interventions as compared to outcomes seen after implementation of non-Web-based interventions. Methods The MEDLINE, CINAHL, Cochrane Library, EMBASE, ERIC, and PSYCHInfo databases were searched for relevant citations between the years 1996 and 2003. Identified articles were retrieved, reviewed, and assessed according to established criteria for quality and inclusion/exclusion in the study. Twenty-two articles were deemed appropriate for the study and selected for analysis. Effect sizes were calculated to ascertain a standardized difference between the intervention (Web-based) and control (non-Web-based) groups by applying the appropriate meta-analytic technique. Homogeneity analysis, forest plot review, and sensitivity analyses were performed to ascertain the comparability of the studies. Results Aggregation of participant data revealed a total of 11,754 participants (5,841 women and 5,729 men). The average age of participants was 41.5 years. In those studies reporting attrition rates, the average drop out rate was 21% for both the intervention and control groups. For the five Web-based studies that reported usage statistics, time spent/session/person ranged from 4.5 to 45 minutes. Session logons/person/week ranged from 2.6 logons/person over 32 weeks to 1008 logons/person over 36 weeks. The intervention designs included one-time Web-participant health outcome studies compared to non-Web participant health outcomes, self-paced interventions, and longitudinal, repeated measure intervention studies. Longitudinal studies ranged from 3 weeks to 78 weeks in duration. The effect sizes for the studied outcomes ranged from -.01 to .75. Broad variability in the focus of the studied outcomes precluded the calculation of an overall effect size for the compared outcome variables in the Web-based compared to the non-Web-based interventions. Homogeneity statistic estimation also revealed widely differing study parameters (Qw16 = 49.993, P ≤ .001). There was no significant difference between study length and effect size. Sixteen of the 17 studied effect outcomes revealed improved knowledge and/or improved behavioral outcomes for participants using the Web-based interventions. Five studies provided group information to compare the validity of Web-based vs. non-Web-based instruments using one-time cross-sectional studies. These studies revealed effect sizes ranging from -.25 to +.29. Homogeneity statistic estimation again revealed widely differing study parameters (Qw4 = 18.238, P ≤ .001). Conclusions The effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables. These outcomes included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, increased participation in healthcare, slower health decline, improved body shape perception, and 18-month weight loss maintenance.
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            Influence of parental attitudes in the development of children eating behaviour.

            The present paper is a review of available data on effects of parental feeding attitudes and styles on child nutritional behaviour. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. There is evidence for existence of some innate, automatic mechanism that regulate appetite. However, from birth genetic predispositions are modified by experience. There are mechanisms of taste development: mere exposure, medicine effect, flavour learning, flavour nutrient learning. Parents play a pivotal role in the development of their child's food preferences and energy intake, with research indicating that certain child feeding practices, such as exerting excessive control over what and how much children eat, may contribute to childhood overweight. Mothers are of particular interest on children's eating behaviour, as they have been shown to spend significantly more time than fathers in direct interactions with their children across several familial situations.A recent paper describes two primary aspects of control: restriction, which involves restricting children's access to junk foods and restricting the total amount of food, and pressure, which involves pressuring children to eat healthy foods (usually fruits and vegetables) and pressuring to eat more in general. The results showed significant correlations between parent and child for reported nutritional behaviour like food intake, eating motivations, and body dis- and satisfaction. Parents create environments for children that may foster the development of healthy eating behaviours and weight, or that may promote overweight and aspects of disordered eating. In conclusion positive parental role model may be a better method for improving a child's diet than attempts at dietary control.
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              A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial.

              To assess the effectiveness of a parent-focused intervention on infants' obesity-risk behaviors and BMI. This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes; all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 × 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age. Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = -4.45; 95% confidence interval [CI]: -7.92 to -0.99; P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48; 95% CI: 0.24 to 0.95; P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = -3.69; 95% CI: -6.41 to -0.96; P = .008) and viewed fewer daily minutes of television (mean difference = -15.97: 95% CI: -25.97 to -5.96; P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity. This intervention resulted in reductions in sweet snack consumption and television viewing in 20-month-old children.

                Author and article information

                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                3 January 2019
                3 January 2019
                : 16
                [1 ]ISNI 0000 0004 0417 6230, GRID grid.23048.3d, Department of Public Health, , Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, ; PO Box 422, 4604 Kristiansand, Norway
                [2 ]ISNI 0000 0004 1936 7603, GRID grid.5337.2, Faculty of Health Sciences, , University of Bristol, ; Bristol, BS8 1TH UK
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: The Eckbo foundation https://www.eckbos-legat.no/
                Funded by: University of Agder
                Custom metadata
                © The Author(s) 2019

                Nutrition & Dietetics
                infant nutrition,maternal feeding practices,child eating behavior,childhood obesity,ehealth,public health


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