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Pediatr Obes. 2017 Oct;12(5):398-405. doi: 10.1111/ijpo.12157. Epub 2016 Jun 10.

Projecting the impact of hypothetical early life interventions on adiposity in children living in low-income households.

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Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA.
California Center for Population Research, UCLA, Los Angeles, USA.
Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, Los Angeles, USA.
Research and Evaluation Unit, Public Health Foundation Enterprises - Special Supplemental Nutrition Program for Women, Infants and Children (PHFE WIC), Irwindale, USA.
Department of Biostatistics, UCLA School of Public Health, Los Angeles, USA.
UCLA Center for Health Policy Research, California, USA.


It is difficult to evaluate the effectiveness of interventions aimed at reducing early childhood obesity using randomized trials. Objective To illustrate how observational data can be analysed using causal inference methods to estimate the potential impact of behavioural 'interventions' on early childhood adiposity. Methods We used longitudinal data from 1054 children 1-5 years old enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children and followed (WIC) from 2008 to 2010 for a mean duration of 23 months. The data came from a random sample of WIC families living in Los Angeles County in 2008. We used the parametric g-formula to estimate the impact of various hypothetical behavioural interventions. Results Adjusted mean weight-for-height Z score at the end of follow-up was 0.73 (95% CI 0.65, 0.81) under no intervention and 0.63 (95% CI 0.38, 0.87) for all interventions given jointly. Exclusive breastfeeding for 6 months or longer was the most effective intervention [population mean difference = -0.11 (95% CI -0.22, 0.01)]. Other interventions had little or no effect. Conclusions Compared with interventions promoting healthy eating and physical activity behaviours, breastfeeding was more effective in reducing obesity risk in children aged 1-5 years. When carefully applied, causal inference methods may offer viable alternatives to randomized trials in etiologic and evaluation research.


adiposity; breastfeeding; causal inference; childhood obesity

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