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

Effects of Intermittent Fasting on Female Reproductive Function: A Review of Animal and Human Studies

PURPOSE OF REVIEW

Intermittent fasting has gained significant attention, yet a comprehensive understanding of its impact on female reproductive health is lacking. This review aims to fill this gap by examining various intermittent fasting regimens and their effects on female reproductive function, along with potential mechanisms.

RECENT FINDINGS

In healthy non-overweight/obese or pregnant animal models, alternate-day fasting (ADF) and an 8-h time-restricted feeding (TRF) window may have adverse effects on reproductive function. However, these regimens show potential to mitigate negative consequences induced by a high-fat diet (HFD) or environmental exposure. A 10-h TRF demonstrates benefits in improving fertility in both normal-weight and HFD-fed animal models. In women with overweight/obesity or polycystic ovary syndrome (PCOS), the 5:2 diet and TRF significantly reduce the free androgen index while elevating sex hormone binding globulin, promising improvements in menstrual regulation. For pregnant Muslim women, available data do not strongly indicate adverse effects of Ramadan fasting on preterm delivery, but potential downsides to maternal weight gain, neonatal birthweight, and long-term offspring health need consideration. Factors linking intermittent fasting to female reproductive health include the circadian clock, gut microbiota, metabolic regulators, and modifiable lifestyles. Drawing definitive conclusions remains challenging in this evolving area. Nonetheless, our findings underscore the potential utility of intermittent fasting regimens as a therapeutic approach for addressing menstruation irregularities and infertility in women with obesity and PCOS. On the other hand, pregnant women should remain cognizant of potential risks associated with intermittent fasting practices.

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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Nighttime eating during pregnancy and infant adiposity at 6 months of life

Introduction

Chrononutrition studies the relation between diet, circadian rhythms and metabolism, which may alter the metabolic intrauterine environment, influencing infant fat-mass (FM) development and possibly increasing obesity risk.

Aim

To evaluate the association of chrononutrition in pregnancy and infant FM at 6 months.

Methods

Healthy pregnant women and term-babies (n = 100pairs) from the OBESO cohort (2017-2023) were studied. Maternal registries included pregestational body-mass-index (BMI), gestational complications/medications, weight gain. Diet (three 24 h-recalls, 1 each trimester) and sleep-schedule (first and third trimesters) were evaluated computing fasting (hours from last-first meal), breakfast and dinner latencies (minutes between wake up-breakfast and dinner-sleep, respectively), number of main meals/day, meal skipping (≥1 main meal/d on three recalls) and nighttime eating (from 9:00 pm-5:59 am on three recalls). Neonatal weight, length, BMI/age were assessed. At 6 months, infant FM (kg, %; air-displacement plethysmography) was measured, and FM index (FMI-kgFM/length2) computed. Exclusive breastfeeding (EBF) was recorded. Multiple linear regression models evaluated the association between chrononutrition and 6 month infant FM.

Results

Mean fasting was 11.7 ± 1.3 h; breakfast, dinner latency were 87.3 ± 75.2, 99.6 ± 65.6 min, respectively. Average meals/day were 3.0 ± 0.5. Meal skipping was reported in 3% (n = 3) of women and nighttime eating in 35% (n = 35). Most neonates had normal BMI/age (88%, n = 88). Compared to those who did not, mothers engaged in nighttime-eating had infants with higher %FM (p = 0.019). Regression models (R 2 ≥ 0.308, p ≤ 0.001) showed that nighttime eating was positively associated with %FM (B: 2.7, 95%CI: 0.32-5.16). When analyzing women without complications/medications (n = 80), nighttime eating was associated with higher FM [%FM, B: 3.24 (95%CI: 0.59-5.88); kgFM, B: 0.20 (95%CI: 0.003-0.40); FMI, B: 0.54 (95%CI: 0.03-1.05)]. Infant sex and weight (6 months) were significant, while maternal obesity, pregnancy complications/medications, parity, energy intake, birth-BMI/age, and EBF were not.

Conclusion

Maternal nighttime eating is associated with higher adiposity in 6 month infants.

Association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy

To analyse the association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data collection occurred once during each gestational trimester. The assessment of sleep quality and duration was performed using the Pittsburgh Sleep Quality Index. Food intake was assessed using three 24-h recalls in each trimester. Body weight was measured during the three trimesters, and height was measured only once to calculate the BMI. Linear regression analyses were performed to associate sleep duration and quality with food consumption and weight gain variables. Longer sleep duration was associated with a later dinner in the first trimester (β = 0·228, P = 0·025) and earlier in the third trimester (β = -0·223, P = 0·026), in addition to a later morning snack in the second trimester (β = 0·315, P = 0·026). Worse sleep quality was associated with higher total energy intake (β = 0·243, P = 0·044), total fat (β = 0·291, P = 0·015) and the chrononutrition variables such as a higher number of meals (β = 0·252, P = 0·037), higher energetic midpoint (β = 0·243, P = 0·044) and shorter fasting time (β = -0·255, P = 0·034) in the third trimester. Sleep quality was also associated with a higher BMI in the first trimester of pregnancy (β = 0·420, P = < 0·001). Most of the associations found in the present study show that poor sleep is associated with higher energy and fat intake and higher BMI. Longer sleep duration was associated with a later dinner in early pregnancy and an earlier dinner in late pregnancy, as well as with a later morning snack in the second trimester of pregnancy.

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.