Associations of Circadian Eating Pattern and Diet Quality with Substantial Postpartum Weight Retention

Association between timing of maternal energy consumption and adiposity in breastfeeding infants: A prospective cohort study

BACKGROUND

Lactating women's food intake timing may play a critical role in maternal and infant nutrition health. We aimed to examine associations of breastfeeding mothers' diet quantity and circadian timing of food intake with subsequent weight status of exclusively breastfed infants over a 6-month period.

METHODS

This prospective observational study comprised pairs of healthy singleton breastfed infants and their corresponding healthy lactating mothers. Reported food intake times and diet content were used to define maternal eating patterns infant body mass index-for-age z scores (BAZs) at birth, 2 and 6 months. Association of maternal eating pattern with alterations in infant BAZ gain and nutritional status at age 6 months were investigated in multiple regression analyses.

RESULTS

Compared with maternal daytime eating, maternal nighttime eating was linked to a greater increase in infantile BAZ from ages 2 to 6 months (adjusted β = 0.49; 95% CI, 0.05-0.92; P = 0.03) and a heightened likelihood of being overweight at age 6 months (adjusted odds ratio = 3.81; 95% CI, 1.41-6.63; P = 0.01) after adjusting for factors including maternal age, education level, household income, parity, pregestational body mass index, BAZ at 2 months, total daily energy consumption, and the percentages of energy derived from macronutrients.

CONCLUSION

Disruption of rhythmic physiology from irregular eating habits can lead to circadian misalignment, which may result in abnormal weight gain in infants and an increased likelihood of being overweight in the early postnatal period. Circadian alignment is fundamental for regulating women-infant dyads health.

Maternal pregnancy diet quality, night eating, and offspring metabolic health: the GUSTO study

BACKGROUND

We investigated the understudied influence of maternal diet quality, food timing, and their interactions during pregnancy on offspring metabolic health.

METHODS

Maternal diet at 26-28 weeks' gestation was assessed using a 24-h recall and adherence to the modified-healthy-eating-index (HEI-SGP) reflects diet quality. Predominant night-eating (PNE) was defined as consuming >50% of total daily energy intake from 19:00 to 06:59. Outcomes were offspring composite metabolic syndrome score and its components measured at age 6 years. Multivariable linear regressions adjusted for relevant maternal and child covariates assessed associations of diet quality and PNE with these outcomes.

RESULTS

Up to 758 mother-child pairs were included. The mean(SD) maternal HEI-SGP score was 52.3(13.7) points (theoretical range: 0-100) and 15% of the mothers demonstrated PNE. Maternal diet quality showed inverse relationship with offspring Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) [β(95% CI): -0.08(-0.15, -0.02) per-10-point HEI-SGP increment; P = 0.012]. Maternal PNE was associated with a higher offspring HOMA-IR [0.28(0.06, 0.50); P = 0.012], with similar estimates after adjustment for children's BMI and diet quality; the association was stronger for boys (P-interaction<0.001) and among mothers with lower diet quality (

CONCLUSIONS

Maternal PNE and low dietary quality were associated with a higher level of insulin resistance in early childhood, especially among boys.

IMPACT

We demonstrated that maternal predominant night-eating behavior and low-quality diet are associated with higher offspring insulin resistance. Maternal low-quality diet and predominant night-eating behavior synergistically interact to influence offspring insulin resistance, particularly among boys. While maternal diet quality and food timing impact the mother's health, their influence on offspring long-term health outcomes through developmental programming is not well understood. Our findings highlight the significance of maternal food timing and calls for further studies on its influence on child health through developmental programming. Targeting both dietary quality and food timing during pregnancy could be a promising intervention strategy.

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Affiliation(s)

Ling-Wei Chen Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan. Master of Public Health Program, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan. A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore.
See Ling Loy Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
Mya Thway Tint A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Navin Michael A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore
Yi Ying Ong Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Jia Ying Toh A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore
Peter D Gluckman Liggins Institute, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
Kok Hian Tan Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
Yap-Seng Chong A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
Keith M Godfrey MRC Lifecourse Epidemiology Centre & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 6YD, Southampton, UK
Johan G Eriksson A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore Department of General Practice and Primary Health Care, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland Folkhälsan Research Center, Topeliusgatan 20, 00250, Helsinki, Finland
Fabian Yap Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore Department of Pediatric Endocrinology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
Yung Seng Lee A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore Khoo Teck Puat- National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
Mary F F Chong A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore

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Breastfeeding Practices and Postpartum Weight Retention in an Asian Cohort

This study examines relationships between breastfeeding practices and postpartum weight retention (PPWR) at 6 and 12 months postpartum among 379 first-time mothers participating in a clinical trial in Singapore. We categorized feeding modes at 6 months into exclusive breastfeeding, mixed feeding, and exclusive formula feeding. Participants were analyzed in two groups based on their PPWR assessment at 6 and 12 months postpartum, with complete datasets available for each assessment. We calculated PPWR by subtracting pre-pregnancy weight from self-reported weight at 6 and 12 months postpartum, defining substantial PPWR as ≥5 kg retention. Modified Poisson regression models adjusted for potential confounders were performed. At 6 and 12 months, 35% (n = 132/379) and 31% (n = 109/347) of women experienced substantial PPWR, respectively. Compared to exclusive breastfeeding, mixed feeding (risk ratio 1.85; 95% confidence interval 1.15, 2.99) and exclusive formula feeding (2.11; 1.32, 3.28) were associated with a higher risk of substantial PPWR at 6 months. These associations were slightly attenuated at 12 months and appeared stronger in women with pre-pregnancy overweight or obesity. This study suggests that breastfeeding by 6 months postpartum may help mitigate PPWR, particularly with exclusive breastfeeding. It also draws attention to targeted interventions to promote breastfeeding among women with overweight or obesity.

Eating Patterns, Chronotypes, and Their Relationship with Metabolic Health in the Early Postpartum Period in Women after Gestational Diabetes Mellitus

Observational studies have shown a relationship between eating patterns and chronotypes with metabolic health in the general population and in healthy pregnancies. Data are lacking in the postpartum period, which is characterized by an externally driven misalignment of sleep and food intake. We investigated the associations between eating patterns, chronotypes, and metabolic health in the early postpartum period in women who had gestational diabetes mellitus (GDM). We prospectively included 313 women who completed their 6-8 weeks postpartum visit between January 2021 and March 2023 at the Lausanne University Hospital. Women filled questionnaires on the timing of food intake, sleep (a shortened Pittsburgh Sleep Quality Questionnaire), and the chronotype (the Morningness-Eveningness Questionnaire) and underwent HbA1c and fasting plasma glucose measurements. After adjustments for weight, sleep quality, or breastfeeding, the later timing of the first and last food intake were associated with higher fasting plasma glucose and HbA1c levels 6-8 weeks postpartum (all p ≤ 0.046). A higher number of breakfasts per week and longer eating durations were associated with lower fasting plasma glucose levels (all p ≤ 0.028). The chronotype was not associated with metabolic health outcomes. Eating patterns, but not the chronotype, were associated with worsened metabolic health in the early postpartum period in women with previous GDM.

Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis

OBJECTIVE

Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention.

METHODS

Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies.

FINDINGS

A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible.

CONCLUSION

Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.

Associations of predominant night-eating with plasma glycemic status and continuous glucose monitoring measures among pregnant women

BACKGROUND & AIMS

To examine whether predominant night-eating, defined as more than 50% of total daily energy intake consumed between 1900 and 0659 h, is associated with glycemic outcomes in pregnancy.

METHODS

This was a prospective cohort study of 277 healthy pregnant women with complete 4-day dietary intake records at 18-24 weeks gestation, recruited from KK Women's and Children's Hospital, Singapore. Primary outcomes were fasting, 1-h, and 2-h plasma glucose after a 75-g oral glucose tolerance test at 24-28 weeks gestation. Secondary outcomes were gestational diabetes mellitus (GDM), fasting insulin, homeostasis model assessment of insulin resistance (HOMA2-IR), β-cell function (HOMA2-%B), and continuous glucose monitoring (CGM) measures. Glucose variables in continuous form were loge-transformed before analyses.

RESULTS

Predominant night-eating (11.6%) was associated with higher fasting glucose (geometric mean ratio (95% confidence interval) 1.05 (1.01, 1.08)) and 1-h glucose (1.11 (1.01, 1.21)), but not with 2-h glucose or GDM risk. Predominant night-eating women had lower fasting insulin (0.77 (0.63, 0.95)), lower HOMA2-IR (0.78 (0.64, 0.97)), and lower HOMA2-%B (0.77 (0.67, 0.89)) than their predominant day-eating counterparts. For CGM measures, predominant night-eating was associated with higher mean glucose (1.07 (1.00, 1.15)), higher glucose management indicator (1.05 (1.00, 1.10)), and higher overall glucose levels throughout 24 h (1.10 (1.02, 1.19)). All these associations were adjusted for socio-demographic, lifestyle factors, and diet composition.

CONCLUSION

Predominant night-eating was mainly associated with less desirable glycemic outcomes during pregnancy. Future studies should explore dietary interventions aimed at reducing consumption of relatively more calories at night than day during pregnancy.

Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies

Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregnant women's and their offspring's health outcomes. Therefore, we systematically reviewed and integrated all emerging evidence on chrononutrition during pregnancy (including meal skipping, meal frequency, night eating, and (Ramadan) fasting) and their relationships with maternal and offspring outcomes. The results suggest that meal skipping and night eating during pregnancy were generally associated with adverse pregnancy and birth outcomes, whereas no strong conclusion could be reached for meal frequency. In our meta-analysis, Ramadan fasting did not seem to be related with birth weight or gestational age at birth, but evidence for other mother-offspring outcomes was inconsistent. To further elucidate the effect of chrononutrition factors on maternal and offspring health outcomes, larger and well-conducted prospective cohort and interventional studies are needed. In addition, information on covariates such as physical activity, sleep, diet quality and quantity, fasting days, fasting period per day, and trimester exposure should also be collected and considered during analysis.

Assessing patterns of change in lifestyle behaviours by parity: a longitudinal cohort study

BACKGROUND

The time constraints and reprioritization of personal health associated with having children may lead women to adopt less healthy lifestyles. We assessed the patterns of change in weight and lifestyle behaviours associated with having children and whether these differ between primiparous and multiparous women.

METHODS

Data were from Surveys 3 and 5 of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health. In women who were nulliparous at Survey 3, we assessed changes in weight, energy intake, diet (diet quality, macronutrients and micronutrients), physical activity and sitting time by parity status at Survey 5 using one-way analysis of covariance.

RESULTS

Of 4927 eligible women, 2503 gave birth (1090 primiparous and 1413 multiparous) by Survey 5. Women who had given birth 6 years later increased weight (1.0 kg; 95% CI 0.5, 1.5), energy intake (833.9 kJ/day; 95% CI 706.7, 961.1) and diet quality (1.5 units; 95% CI 0.8, 2.1), but decreased physical activity [-405.0 Metabolic Equivalent of Task.min/week; 95% CI -464.2, -345.8] and sitting time (-1.8 h/day; 95% CI -1.9, -1.6) (adjusted mean differences) relative to those who remained nulliparous. In subgroup analysis involving further stratification by parity, the increase in diet quality was only seen in women who became primiparous and the decrease in sitting time was more marked in multiparous women.

CONCLUSION

Childbearing is associated with increased weight and energy intake, decreased physical activity, increased diet quality and decreased sitting time. More research targeting weight, energy intake and physical activity for improvement in women during the childbearing years is warranted.

Reducing Postpartum Weight Retention: A Review of the Implementation Challenges of Postpartum Lifestyle Interventions

Postpartum weight retention (PPWR) is a strong predictor of obesity in later life with long term health consequences in women. Suboptimal lifestyle behaviours (e.g., diet and physical activity) contribute to PPWR. Postpartum lifestyle interventions are known to be efficacious in reducing PPWR; however, there are challenges to their successful implementation. To inform implementation, this narrative review provides an overview of the factors that contribute to PPWR, the efficacy of existing postpartum lifestyle interventions and key determinants of effective implementation using the Consolidated Framework for Implementation Research (CFIR) across intervention characteristics, implementation process, individual characteristics and outer and inner setting. We then suggest strategies to improve the translation of evidence into large-scale interventions that deliver on health impact in postpartum women. We have identified gaps that need to be addressed to advance postpartum lifestyle research, including the involvement of postpartum women and community members as key stakeholders for optimal reach and engagement, more complete reporting of intervention characteristics to optimize translation of evidence into practice, capacity building of health professionals and guidelines for postpartum lifestyle management.

Chrononutrition during Pregnancy: A Review on Maternal Night-Time Eating

Evidence from women working night shifts during pregnancy indicates that circadian rhythm disruption has the potential to adversely influence pregnancy outcomes. In the general population, chronodisruption with the potential to affect pregnancy outcomes may also be seen in those with high energy intakes in the evening or at night. However, maternal night eating during pregnancy remains understudied. This narrative review provides an overview of the prevalence, contributing factors, nutritional aspects and health implications of night eating during pregnancy. We derived evidence based on cross-sectional studies and longitudinal cohorts. Overall, night eating is common during pregnancy, with the estimated prevalence in different populations ranging from 15% to 45%. The modern lifestyle and the presence of pregnancy symptoms contribute to night eating during pregnancy, which is likely to coexist and may interact with multiple undesirable lifestyle behaviors. Unfavorable nutritional characteristics associated with night eating have the potential to induce aberrant circadian rhythms in pregnant women, resulting in adverse metabolic and pregnancy outcomes. More research, particularly intervention studies, are needed to provide more definite information on the implications of night eating for mother-offspring health.