In Nutrition Now, we aim to improve dietary care in the first 1000 days of life. We will do so by implementing existing evaluated interventions in the community where people live and work, in collaboration with stakeholders and end-users.
Poor diet quality is a leading cause of non-communicable diseases, with large negative societal impacts well beyond the health sector. Over the past 40 years it has become clear that nutrition in early life strongly influences health throughout life. Still, there is a lack of public health action and response to these insights. There is also a lack of action on the existing evidence-to-practice gap; that successful interventions are not being implemented at scale for the benefit of population health and community resilience.
We have previously developed e-learning interventions targeting nutrition, that have been evaluated with promising results in controlled settings. The interventions address diet during pregnancy, infancy, and toddlerhood, respectively, and include kindergarten educational tools. In this project we will scale up and implement the interventions in a community setting tailored to contnext and users’ needs, especially those from less advantaged groups. Real-life effectiveness will be assessed in one municipality vs control before moving on to a fully scaled-up program at county-level.
We will also investigate potential cumulative health effects of this lifecourse intervention approach of implementing multiple, low-cost, equitable, evidence-based e-learning resources at scale. The project harnesses an untapped potential for improving nutrition in early life through improved dietary guidance in primary health care and better feeding practices in kindergartens. Time is not on our side for reducing the NCD burden; we need to act to improve nutrition now.
Funding: Norwegian Research Council and University of Agder
Early interventions to prevent childhood obesity are usually extensive and complex, cover multiple lifestyle behaviours, and use a range of strategies.
Currently, there is a gap in understanding which parts of early interventions are effective in reducing childhood obesity, and whether certain components are particularly effective for key population groups.
The aims of TOPCHILD are:
To deconstruct childhood obesity interventions into their components (i.e. delivery features and behaviour change techniques) using a systematic, internationally recognised framework
To assess each discrete intervention component, establishing their relative impact on child obesity outcomes
To assess which intervention components are particularly effective for specific populations (e.g. by socioeconomic position)
No individual trial alone can answer these questions, hence we are establishing the TOPCHILD Collaboration to bring together planned, ongoing and completed trials from around the world. Three of Lifecourse Nutrition’s studies are included in this collaboration.
Collaborators: Nina Øverby, Christine Helle and Margrethe Røed
Early Food for Future Health
The early feeding environment is critical for establishing eating habits that may influence weight development and healthy growth. The aim of this study is to develop, implement and evaluate the effects of an eHealth intervention designed for parents of infants between 6 and 12 months of age, aiming to promote beneficial feeding practices in parents and early healthy eating habits in their children.
During springtime 2016, 900 parents of children between 3 and 5 months were recruited through social media (Facebook). In total 715 mothers were included in the study and randomly assigned to an intervention- or control group. Parents in the intervention group were given access to the intervention`s website when the child`s age was between 6 and 12 months. Here, short monthly videos provided information regarding beneficial parental feeding practices, diet quality and how to make healthy and age-appropriate homemade baby food. Parents randomized to the control group received usual treatment at the municipal child-health centers.
The intervention-period ended April 2017. Outcomes at child age 12 months indicated that the eHealth intervention increased daily vegetable/fruit intake and promoted more beneficial mealtime routines https://rdcu.be/bflrU . Autumn 2019, we published a follow-up study evaluating potential long-term effects of the intervention at child age 24 months.
This project is included in the TOPCHILD-collaboration.
Funding: University of Agder
Project leader: Nina Øverby, PhD: Christine Helle, Co-supervisor: Elisabet Hillesund
Food4toddlers (Mat til minsten)
Background and aim: The aim of Food4toddlers is to foster healthy dietary habits through an e-health intervention targeting toddlers' food and eating environment. The intervention was presented for parents when the child was in the important developmental stage between 12-18 months. The parents in the intervention group, got access to a website for 6 months with information, films and recipes and got reminders regularly. We focused on availability of food that is good for the child and how parents can be good role models.
The project is a randomized controlled trial. Today, most parents are e-technology users. With an e-health approach we hoped to recruit a broad part of the target population toddlers and their parents. We recruited through Facebook. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9).
At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group.
We also found that the Food4toddlers intervention website was found to be relevant by most participants in the intervention group, although usage of the website differed according to educational level and family composition. For eHealth interventions to be effective, intervention materials such as websites must be used by the target group. Our results highlight the need to include users from different groups when developing interventions.
PhD: Margrethe Røed, co-supervisors: Frøydis Vik and Elisabet Hillesund
A healthy and sustainable diet during pregnancy and beyond (SEED)
Nutrition during pregnancy and the early years of life represent a vulnerable phase for adverse exposures and nutritional imbalances. Studies show that a healthy diet during this phase may especially be beneficial for the long-term development. In this project, we are therefore investigating the association between compliance to a potentially healthy and sustainable Nordic diet during infancy and childhood and the future risk of overweight, cognitive development and mental health development in children up to eight years of age. The project is based on data from the Norwegian Mother and Child Cohort Study (MoBa) which is a large prospective population-based cohort study conducted by the Norwegian Institute of Public Health. Pregnant mothers were recruited from all over Norway from 1999-2008, and the cohort now includes more than 114 000 children, 95 000 mothers and 75 000 fathers. Food frequency data from n = 89 715 at child age 6 months, n = 76 432 at 18 months, n = 58 884 at 3 years, and n = 35 978 at 7 years were used to construct subscales in accordance with the maternal diet score. Subscales were composed of responses to a selection of food and drink items or other questions and were dichotomized by the median, yielding four age-specific diet scores where the possible scoring ranged from 0 to 6 at 6 months and 3 years and from 0 to 9 at 18 months and 7 years. The developed scores will be used to examine associations with childhood overweight and cognitive and mental development in future studies. We have reported on the associations between the diet scores and overweight. In crude analyses, adherence to the NND at 6 months was inversely associated with odds of overweight at 8 years in the continuous score (odds ratio = 0.95, 95% CI [0.91, 0.98]) and when comparing high versus low NND adherence (odds ratio = 0.81, 95% CI [0.70, 0.94]). The association was almost entirely attenuated in the adjusted models. In conclusion, child NND adherence up to 7 years of age was not associated with odds of overweight at 8 years in adjusted analyses.
Funding: University of Agder
PhD: Neha Agnihotri
Project leader: Nina Øverby, co-supervisors: Elisabet R Hillesund, Elling Bere