(P20-003-25) Family Nutrition and Physical Activity Score Is Associated With Preschool Children’s Body Mass Index at 1-Year Follow-Up: Secondary Analyses From the ENCIRCLE Trial

Objectives: Parent completion of the Family Nutrition and Physical Activity (FNPA) questionnaire at well-child visits (WCV) has shown benefit on healthier weight outcomes. FNPA screening produces a score but the utility of the score on body mass index z-score (BMIz) at 1-year follow-up is unknown.

Methods: This is a secondary analysis of a subset of participants from the ENCIRCLE cluster-randomized controlled trial. Participants included parents and their children (aged 20-59 months with a BMI-for-age and -sex ≥50^thpercentile [BMI%tile], World Health Organization [WHO] Growth Standards) from lower-income households. This analysis included children with parent-completed FNPA screening and BMI measurements at the baseline WCV and 1-year follow-up. FNPA is a 20-item measure that produces a score (range=20 to 80) that is inversely associated with obesity risk. Groups of children were evaluated by FNPA score tertile. Mixed linear regression, accounting for repeated measures within individuals, clustering by clinician and baseline patient characteristics, was used to test for differences in 1-year BMIz change between the FNPA tertile groups.

Results: Among a total of 545 participants, 50% were male, mean (SD) age 34.1 (10.8) months, 7% were Black, and 11% Hispanic. At baseline, 24% of children had overweight (BMI%tile≥85-95^th), 19% had obesity (BMI%tile≥95t^h-120% of 95^th), and 3% had severe obesity (BMI%tile≥120% of 95^th). By FNPA score tertile, n=201 children were low (≤64), n=215 were mid (65-69), and n=159 were high (70+). There were no differences in child BMIz at baseline but those in the low FNPA tertile (obesogenic) compared to others were slightly older, less likely to be White and non-Hispanic, and the child’s parent was more likely to be obese and from a minoritized racial or ethnic group. At 1-year follow-up, change in BMIz was -0.160 (SE=0.064) for the low; -0.091 (SE=0.063) mid; and +0.036 (SE=0.073) high FNPA tertile groups. Change in BMIz was significantly lower in the low group versus the high group (Δ=-0.196, SE=0.097, p< 0.05).

Conclusions: These findings support the recommended practice of FNPA screening during WCVs and suggest that children with low FNPA scores, indicating obesogenic risk, experience significant protective benefit from parent answering of the screening questionnaire.

Funding Sources: Patient-Centered Outcomes Research Institute