Effectiveness of an Early Nutrition Program on Promoting Breastfeeding and Optimizing Infant Growth and Diet Quality
Effectiveness of an Early Nutrition Program on Promoting Breastfeeding and Optimizing Infant Growth and Diet Quality
Effective early life programs that reduce the long-term non-communicable diseases (NCDs) risk
 could bring great economic benefits to the society. However, there is a lack of local data on
 the effect of nutrition on child growth and most research on early life intervention focus on
 disease models such as obese women to improve offspring health outcomes. There is limited
 research on postpartum interventions in the community that optimize maternal and infant
 nutrition through improving success of breastfeeding, infant growth diet quality and
 microbiota to enhance health in the adulthood.

 In this study, it is hypothesized that our early nutrition program could promote
 breastfeeding successful rate (increase the number of months the mothers breastfed their
 infants) and improve growth status, diet quality and microbiota of the infants which may
 reduce the risk of NCDs in the adulthood. The planned project proposal would like to include
 240 pairs of mothers and infants. In order to test the protocol in the planned proposal, the
 investigators hope to run a pilot study to set up this community based early nutrition
 program including breastfeeding workshops and supports, healthy lifestyle courses, parenting
 education, introduction of solid foods for infants, child development and cooking classes of
 infant foods. the investigators will evaluate the effectiveness of this early nutrition
 program and determine its impacts on breastfeeding, infant growth (by comparing infants'
 biomarkers and microbiota in different stages) , diet quality and microbiota, as well as the
 benefits to the postpartum mothers such as reducing the postpartum weight retention so that
 to generate pilot result and facilitate the up scale study that the investigators proposed in
 the planned proposal.

 The ultimate goal is that a long term follow up with the children in this project could also
 be arranged to determine the long term health effects of this early nutrition program.
Study background:

 Effective early life programs that reduce the long-term non-communicable diseases (NCDs) risk
 could bring great economic benefits to the society. NCDs are responsible for roughly
 two-thirds of worldwide death and cause large burden of health care cost. Most policies
 nowadays that combat disease focus on treatment after disease occurs and on reducing risk
 factors in adult life. Early life interventions are an unexplored and promising new avenue of
 health policy . One of the oldest US early life intervention programs, the Carolina
 Abecedarian Project, started from 1970s has been shown to have substantial benefits in
 boosting adult health. However, most research on early life intervention focus on disease
 models such as obese women to improve offspring health outcomes. There is limited research on
 postpartum interventions in the community that optimize maternal and infant nutrition through
 improving success of breastfeeding, infant growth, diet quality and microbiota to enhance
 health in the adulthood

 Aim of study:

 To evaluate the effects of postpartum nutrition program on i) success of breastfeeding by
 comparing the average duration of breastfeeding between intervention group and control group
 (primary outcome) ii) diet quality of the infants and mothers (secondary outcome) The diet
 quality will be measured by 3-day dietary records using Diet Quality Index-International
 (DQI-I).

 Briefly, the DQI-I assesses four categories (variety, adequacy, moderation, and overall
 balance) and contains six food items and 11 nutrient items. This scoring scale is complex.
 The maximum possible score for each category ranges from 10 to 40 points, and the full score
 is 100 points.

 Paired t-tests will be used to compare the difference between intervention group and control
 group.

 iii) the infant growth by comparing the Z-scores of weight-for-age, length-for-age,
 BMI-for-age and head circumference-for-age at 2, 4, 6, 8, 10 and 12 month old between
 intervention group and control group (secondary outcome) Z-score (or SD-score) = (observed
 value - median value of the reference population) / standard deviation value of reference
 population

 iv) the microbiota profiles (secondary outcome)

 Method of Investigation:

 In this project, a randomized controlled trial will be conducted which subjects will be 40
 pairs of local Chinese healthy postpartum mothers aged 18-40 years old and their infants. The
 participants will be randomly assigned into 1:1 ratio to the control group or the
 intervention group. A study coordinator will randomize subjects by means of a
 computer-generated list of random numbers in blocks of 4. Treatment assignments will be
 concealed in consecutively-numbered sealed envelopes, which will be opened sequentially upon
 subject enrollment.
Inclusion Criteria for mothers:

 -  Postpartum mothers: Aged 18-40 years old

 -  Hong Kong residents having resided in Hong Kong for a continuous period of not less
 than 18 months

 -  vaginal delivery at full term (>37 gestation weeks)

 -  first pregnancy and give birth to singleton infant

 Inclusion Criteria for Infants:

 -  Full term

 -  Born by vaginal delivery (>37 gestation weeks)

 -  singleton infant with no known abnormality.

 Exclusion Criteria:

 -  Concurrent participation in any clinical trial or study

 -  Complicated pregnancy such as preeclampsia and gestational diabetes

 -  Special dietary restrictions for examples gluten-free diets, vegan or any restrictions
 due to food allergies;

 -  Suffer from renal, liver or thyroid dysfunction, cognitive impairment, or any other
 indication of a major medical or psychological illness, as judged by the investigators
 as ineligible to participate the study.