A Method for Estimating Self-Regulation of Energy Intake in Infants

• In Event: Physical and mental health across the lifecourse

Abstract

Because of the clear, established link between obesity during infancy and a lifelong risk of excess weight and its associated health problems, a child’s early years are a critical period for obesity prevention (Birch, Parker, & Burns, 2011; Blake-Lamb et al., 2016). Self-regulation of energy intake (SREI) aligned with physiologic need is essential for obesity prevention (Herman & Polivy, 2011). Evidence suggests feeding interactions with caregivers shape both infants’ energy intake (Lumeng, Patil, & Blass, 2007) and interpretation of internal states of hunger and satiety (Atzil & Barrett, 2017; Fotopoulou & Tsakiris, 2017; Harshaw, 2008). Several studies have included efforts to increase caregiver responsiveness to infants’ hunger and satiety cues and have reported outcomes related to infants’ anthropometric markers of body mass and, to a lesser extent, body fat, yet measurement of changes in the precision of SREI has been lacking.
In our recent infant obesity prevention clinical trial, Enhancing Caregiver-Infant Communication to Prevent Obesity (R21HD082707; PI: Hodges), we developed a method for estimating SREI. This trial involved healthy infants (N = 71) and their primary caregiving parent who were randomized to either intervention or control. Families entered the study when infants were between 4-9 months of age. Data collection occurred in families’ homes and included two 24-hour dietary recalls for infants at three timepoints (baseline [4-9 months], 3 months post-baseline, and 6 months post-baseline). Estimated energy requirements (EER) were calculated for each infant based on their age at the time of the 24-hour recalls. EER values were calculated according to the mathematical formulas published by the Institute of Medicine (now National Academy of Medicine) in 2002. At each timepoint, these EER values were then compared to reported energy intake values based on the mean energy intake across the two 24-hour dietary recalls, as derived within the Nutrition Data System for Research (NDSR). In reviewing the reported energy intake values, we discovered the NDSR records self-reported instances of breastfeeding as 1 gram of breastmilk (0.7 kcal). Therefore, an infant who exclusively breastfed 10 times in a day would only have total energy intake of 7 kcal per NDSR calculations. In order to recalculate total energy intake for exclusively and partially breast-fed infants to compare with infants consuming complementary foods, we used the approach published by Briefel et al. (2008). Precision of SREI was estimated by creating difference scores between EER and mean total daily reported energy intake, with smaller values indicating greater precision. We found our intervention group demonstrated greater precision in their caloric intake compared to their estimated energy requirements than the control group by the third timepoint (difference in kcal: 121 vs. 242, p=.04, 1-sided)
This method for measuring precision of SREI, though a gross estimate, could be useful for other researchers interested in obesity prevention or intervention studies during infancy. Given that intervention effects on obesity status and growth may become evident later in development (Hayes et al., 2019), a measure of precision of SREI may be a useful indicator of intervention effects.

Authors

• Eric Hodges, University of North Carolina at Chapel Hill
  Presenting Author

• Cathi Propper, University of North Carolina at Chapel Hill
  Non-Presenting Author

• Todd Schwartz, The University of North Carolina at Chapel Hill
  Non-Presenting Author