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Randomized Controlled Trial
. 2010 Dec;35(6):667-75.
doi: 10.1007/s10900-010-9270-5.

The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: a feasibility and efficacy study

Njeri Karanja  1 , Tam Lutz, Cheryl Ritenbaugh, Gerardo Maupome, Joshua Jones, Thomas Becker, Mikel Aickin
Affiliations
Randomized Controlled Trial

The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: a feasibility and efficacy study

Njeri Karanja et al. J Community Health. 2010 Dec.

Abstract

Excess weight gain in American Indian/Alaskan native (AI/AN) children is a public health concern. This study tested (1) the feasibility of delivering community-wide interventions, alone or in combination with family-based interventions, to promote breastfeeding and reduce the consumption of sugar-sweetened beverages; and (2) whether these interventions decrease Body Mass Index (BMI)-Z scores in children 18-24 months of age. Three AI/AN tribes were randomly assigned to two active interventions; a community-wide intervention alone (tribe A; n = 63 families) or community-wide intervention containing a family component (tribes B and C; n = 142 families). Tribal staff and the research team designed community-tailored interventions and trained community health workers to deliver the family intervention through home visits. Feasibility and acceptability of the intervention and BMI-Z scores at 18-24 months were compared between tribe A and tribes B & C combined using a separate sample pretest, posttest design. Eighty-six percent of enrolled families completed the study. Breastfeeding initiation and 6-month duration increased 14 and 15%, respectively, in all tribes compared to national rates for American Indians. Breastfeeding at 12 months was comparable to national data. Parents expressed confidence in their ability to curtail family consumption of sugar-sweetened beverages. Compared to a pretest sample of children of a similar age 2 years before the study begun, BMI-Z scores increased in all tribes. However, the increase was less in tribes B & C compared to tribe A (-0.75, P = 0.016). Family, plus community-wide interventions to increase breastfeeding and curtail sugar-sweetened beverages attenuate BMI rise in AI/AN toddlers more than community-wide interventions alone.

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Figures

Figure 1
Figure 1
PedNSSa BMI Z-Score distribution in 24-month old children a study initiation compared to WHOb standards aPedNSS=Pediatric Nutrition Surveillance System. bWHO=World Health Organization
Figure 2
Figure 2
Growth patterns comparing TOTS children to WHO standards for A and B+C tribes
See this image and copyright information in PMC

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