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Coppola S, Paparo L, Bedogni G, Nocerino R, Costabile D, Cuomo M, Chiariotti L, Carucci L, Agangi A, Napolitano M, Messina F, Passariello A, Berni Canani R. Effects of Mediterranean diet during pregnancy on the onset of overweight or obesity in the offspring: a randomized trial. Int J Obes (Lond) 2024:10.1038/s41366-024-01626-z. [PMID: 39289583 DOI: 10.1038/s41366-024-01626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND/OBJECTIVES The PREMEDI study was designed to assess the efficacy of nutritional counseling aimed at promoting Mediterranean Diet (MD) during pregnancy on the incidence of overweight or obesity at 24 months in the offspring. METHODS PREMEDI was a parallel-arm randomized-controlled trial. 104 women in their first trimester of pregnancy were randomly assigned in a 1:1 ratio to standard obstetrical and gynecological care alone (CT) or with nutritional counseling promoting MD. Women enrolled in the MD arm were provided with 3 sessions of nutritional counseling (one session per trimester). The main outcome was the proportion of overweight or obesity among the offspring at the age of 24 months. Maternal MD-adherence and weight gain during pregnancy were also evaluated. Lastly, the evaluation of epigenetic modulation of metabolic pathways in the offspring was analyzed in cord blood. RESULTS Five women in the MD arm and 2 in the CT arm were lost to follow-up, so a total of 97 completed the study. At 24 months, children of MD mothers were less likely to have overweight or obesity than those of the CT mothers (6% vs. 33%, absolute risk difference = -27%, 95% CI -41% to -12%, p < 0.001; number needed to treat 3, 95% CI 2 to 8, intention to treat analysis). A significantly higher increase of MD-adherence during the trial was observed in the MD arm compared to the CT arm. A similar body weight gain at the end of pregnancy was observed in the two arms. The mean (SD) methylation rate of the leptin gene in cord blood was 30.4 (1.02) % and 16.9 (2.99) % in the CT and MD mothers, respectively (p < 0.0001). CONCLUSIONS MD during pregnancy could be an effective strategy for preventing pediatric overweight or obesity at 24 months. This effect involves, at least in part, an epigenetic modification of leptin expression.
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Affiliation(s)
- Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, S. Maria delle Croci Hospital, AUSL Romagna, Viale Randi 5, 48121, Ravenna, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
| | - Davide Costabile
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
| | - Mariella Cuomo
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Lorenzo Chiariotti
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy
| | - Annalisa Agangi
- Neonatal Intensive Care Unit, Villa Betania Evangelical Hospital, Via Argine 604, 80147, Naples, Italy
| | - Marcello Napolitano
- Neonatal Intensive Care Unit, Villa Betania Evangelical Hospital, Via Argine 604, 80147, Naples, Italy
| | - Francesco Messina
- Neonatal Intensive Care Unit, Villa Betania Evangelical Hospital, Via Argine 604, 80147, Naples, Italy
| | - Annalisa Passariello
- Department of Pediatric Cardiology, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Via Gaetano Salvatore 486, 80131, Naples, Italy.
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Pervin S, Emmett P, Northstone K, Townsend N, Fatima Y, Huda MM, David McIntyre H, Al Mamun A. Trajectories of dietary patterns from pregnancy to 12 years post-pregnancy and associated maternal characteristics: evidence from the Avon Longitudinal Study of Parents and Children. Eur J Nutr 2023; 62:2763-2777. [PMID: 37294362 PMCID: PMC10468914 DOI: 10.1007/s00394-023-03185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Dietary patterns (DPs) during pregnancy have been well researched. However, little is known about maternal diet after pregnancy. The aim of the study was to explore maternal DPs longitudinally, examine trajectories over 12 years after pregnancy and identify associated factors. METHODS Of 14,541 pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) complete dietary information was available for 5336 women. Principal components analysis (PCA) was used to derive DPs. DP scores at each time point were used to create DP trajectories using group-based trajectory modelling (GBTM). Multinomial logistic regression assessed the association with maternal factors. RESULTS A total of six distinct DPs were identified over time with different numbers of DPs at each time point. The "healthy" and "processed" DPs persisted over the 12-year post-pregnancy. Three trajectories of "healthy" and "processed" DPs were identified from GBTM. Half the women were on the moderately healthy DP trajectory with 37% on the lower trajectory and 9% on the higher healthy DP trajectory. 59% of women were on the lower processed DP trajectory with 38% on the moderate trajectory and 3.3% on the higher processed DP trajectory. Low educational attainment, low social class and smoking in pregnancy were independently associated with being on a less favourable DP trajectory over the 12 years. CONCLUSION Health professionals should provide support on smoking cessation along with healthy eating advice during ante-natal counselling. Continued support on eating healthily after pregnancy would be beneficial for mothers and families.
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Affiliation(s)
- Sonia Pervin
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Long Pocket Precinct, Indooroopilly, Brisbane, QLD, 4068, Australia.
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, Australia.
| | - Pauline Emmett
- Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Rd, Bristol, BS8 1TZ, UK
| | - Yaqoot Fatima
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, Australia
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, 74 High St, Toowong, QLD, 4066, Brisbane, Australia
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - M Mamun Huda
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, Australia
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, 74 High St, Toowong, QLD, 4066, Brisbane, Australia
| | - H David McIntyre
- Mater Clinical Unit and Mater Research, Faculty of Medicine, The University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Abdullah Al Mamun
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, Brisbane, Australia
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, 74 High St, Toowong, QLD, 4066, Brisbane, Australia
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Ter Borg S, Koopman N, Verkaik-Kloosterman J. An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review. Nutrients 2023; 15:3071. [PMID: 37447397 DOI: 10.3390/nu15133071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.
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Affiliation(s)
- Sovianne Ter Borg
- National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands
| | - Nynke Koopman
- National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands
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Zhu L, Chen Y, Miao M, Liang H, Xi J, Wang Y, Yang K, Wang Z, Yuan W. Prenatal exposures to isoflavones and neurobehavioral development in children at 2 and 4 years of age: A birth cohort study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115176. [PMID: 37393818 DOI: 10.1016/j.ecoenv.2023.115176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
Isoflavones (ISOs) are plant-derived estrogen-like compounds, which were already proved with cognition benefits on elderly people. However, studies assessing the associations between prenatal ISOs exposure and children's neurodevelopment are scarce. This study aimed to examine the associations between maternal urinary ISOs concentrations, including genistein (GEN), daidzein (DAD), glycitein (GLY), and metabolite equol (EQU), and children's neurodevelopment, based on a Chinese cohort study. Participants in this study were pregnant women recruited at 12-16 weeks of gestation, and they provided a single spot urine sample for the ISOs assay. Neurodevelopment was measured using the Child Behavior Checklist (CBCL) at 2 and 4 years of age. Negative binomial regression analysis and Generalized Estimating Equation (GEE) were performed to examine the associations between maternal urinary ISOs concentrations and CBCL scores. Associations were observed between moderate levels of prenatal ISOs exposure and decreased risks of childhood neurobehavioral problems, while the highest level of prenatal ISOs exposure was associated with increased risks of neurobehavioral problems among children. The neuroprotective effects were consistently between moderate DAD exposure and specific neurobehavioral problems, across different ages and sexes. For example, compared with the lowest exposure level, the third quartile group was associated with less Anxious/Depressed problems in boys at 2 years of age (RR=0.72 (95%CI: 0.52, 0.99)), girls at 2 years of age (RR=0.70 (95%CI: 0.46, 1.06)), boys at 4 years of age (RR=0.73 (95%CI: 0.55, 0.96)), and girls at 4 years of age (RR=0.95 (95%CI: 0.68, 1.31)).
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Affiliation(s)
- Lin Zhu
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
| | - Yao Chen
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
| | - Maohua Miao
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
| | - Hong Liang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
| | - Jianya Xi
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
| | - Yan Wang
- School of Pharmacy, Shanghai Jiaotong University, Shanghai, China
| | - Kaige Yang
- School of Pharmacy, Shanghai Jiaotong University, Shanghai, China
| | - Ziliang Wang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China.
| | - Wei Yuan
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, China
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Monthé-Drèze C, Aris IM, Rifas-Shiman SL, Shivappa N, Hebert JR, Oken E, Sen S. The Role of Prenatal Psychosocial Stress in the Associations of a Proinflammatory Diet in Pregnancy With Child Adiposity and Growth Trajectories. JAMA Netw Open 2023; 6:e2251367. [PMID: 36662527 PMCID: PMC9860526 DOI: 10.1001/jamanetworkopen.2022.51367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/23/2022] [Indexed: 01/21/2023] Open
Abstract
Importance Prenatal psychosocial stress and nutrition may each program offspring adiposity, an important predictor of lifelong cardiometabolic health. Although increased stress and poor nutrition have been found to co-occur in pregnancy, little is known about their combined longitudinal associations in the offspring. Objective To investigate whether the associations of the Dietary Inflammatory Index (DII) with offspring adiposity differ by prenatal stress levels and whether these associations change with age. Design, Setting, and Participants Project Viva, a prospective prebirth cohort study of mother-child dyads in Massachusetts, included singleton children of mothers enrolled between April 1999 and July 2002, with follow-up visits at early childhood, midchildhood, and early adolescence. Data analysis was performed from October 31, 2020, to October 31, 2022. Exposures Food frequency-derived DII score in pregnancy was the exposure. Effect modifiers included stress-related measures in pregnancy; depressive symptoms assessed using the Edinburgh Postnatal Depression Scale (EPDS), dichotomized at scores greater than or equal to 13 vs less than 13; and census tract-level social vulnerability (overall Social Vulnerability Index and its 4 main subindices), dichotomized at the 75th percentile. Main Outcomes and Measures Overall adiposity, comprising sex- and age-standardized body mass index (BMI z), sum of subscapular and triceps skinfolds, fat mass index (FMI), and body fat percentage estimated using bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA); and central adiposity, comprising waist circumference, ratio of subscapular to triceps skinfolds, and DXA-derived trunk FMI. Results Among 1060 mother-child dyads, mean (SD) maternal age was 32.6 (4.6) years, and 811 (77%) mothers were non-Hispanic White. Mean (SD) DII score was -2.7 (1.3) units, Social Vulnerability Index level was 38th (27th) percentile, and 8% of mothers had depressive symptoms. Mean (SD) age of the children was 3.3 (0.3) years at the early childhood visit, 7.9 (0.8) years at the midchildhood visit, and 13.2 (0.9) years at the early adolescence visit. In adjusted analyses, children born to mothers in the highest (vs lowest) quartile of DII had slower decrease in BMI z scores (β, 0.03 SD units/y; 95% CI, 0.01-0.05 SD units/y), and faster adiposity gain (eg, BIA total FMI β, 0.11 kg/m2/y; 95% CI, 0.03-0.19 kg/m2/y) over time. Associations of prenatal DII quartiles with childhood adiposity were stronger (eg, BIA total FMI quartile 4 vs quartile 1 change in β, 1.40 kg/m2; 95% CI, 0.21-2.59 kg/m2) among children of mothers with high vs low EPDS scores in pregnancy, although EPDS scores did not modify the change over time. Associations of prenatal DII with adiposity change over time, however, were greater among children whose mothers lived in neighborhoods with a high (BIA percentage body fat: β, 0.55% per year; 95% CI, 0.04%-1.07% per year) vs low (β, 0.13% per year; 95% CI, -0.20 to 0.46% per year), percentage of racial and ethnic minorities, and residents with limited English-language proficiency. Conclusions and Relevance The findings of this cohort study suggest that it may be useful to simultaneously evaluate prenatal diet and psychosocial stress in women as targets for interventions intended to prevent excess childhood adiposity.
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Affiliation(s)
- Carmen Monthé-Drèze
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Nitin Shivappa
- South Carolina Statewide Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, South Carolina
| | - James R. Hebert
- South Carolina Statewide Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, South Carolina
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Callanan S, Yelverton CA, Geraghty AA, O'Brien EC, Donnelly JM, Larkin E, Horan MK, Mehegan J, McAuliffe FM. The association of a low glycaemic index diet in pregnancy with child body composition at 5 years of age: A secondary analysis of the ROLO study. Pediatr Obes 2021; 16:e12820. [PMID: 34080318 DOI: 10.1111/ijpo.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Childhood obesity remains a significant global health concern. Early intervention through maternal diet during pregnancy represents a possible mode of improving childhood adiposity. AIM To examine the impact of a low glycaemic index diet during pregnancy on offspring anthropometry at 5 years of age. METHODS This is a secondary analysis of 387 children from the ROLO pregnancy study 5 years' post-intervention. At the follow-up, BMI, circumferences and skinfold thickness were obtained. A subgroup of 103 children had a DXA scan completed. Statistical analyses included Independent sample t tests, Mann Whitney-U tests and chi-square tests to compare the intervention and control groups. Adjusted analysis using linear regression controlled for significant confounders between participants who returned at follow-up and those that did not. RESULTS There were no significant differences in BMI (16.05 kg/m2 vs 16.16 kg/m2 , P = 0.403), general adiposity (36.60 mm vs 36.00 mm, P = 0.920), central adiposity (0.61 mm vs 0.60 mm, P = 0.540), total fat mass (4.91 kg vs 4.71 kg, P = 0.377) or total lean mass (14.29 kg vs 14.56 kg, P = 0.386) between the intervention and control groups, respectively. No associations were observed in 5-year outcomes in adjusted analyses when controlling for maternal age at delivery, maternal early pregnancy BMI, maternal education and gestational age. CONCLUSION Our study found no evidence that a low glycaemic index diet in pregnancy impacts offspring anthropometry 5 years' post-intervention. Therefore, modulating maternal carbohydrate quality in pregnancy may not be an appropriate approach to improving weight status in childhood. Future research should investigate the impact of other dietary practices in pregnancy on child health.
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Affiliation(s)
- Sophie Callanan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cara A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Jean M Donnelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Elizabeth Larkin
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Mary K Horan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - John Mehegan
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Hu J, Aris IM, Lin PID, Wan N, Liu Y, Wang Y, Wen D. Association of Maternal Dietary Patterns during Pregnancy and Offspring Weight Status across Infancy: Results from a Prospective Birth Cohort in China. Nutrients 2021; 13:nu13062040. [PMID: 34203618 PMCID: PMC8232115 DOI: 10.3390/nu13062040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/22/2022] Open
Abstract
Literature on maternal dietary patterns during pregnancy and offspring weight status have been largely equivocal. We aimed to investigate the association of maternal dietary patterns with infant weight status among 937 mother–infant dyads in a Chinese birth cohort. We assessed maternal diet during pregnancy using food frequency questionnaires (FFQ) and three-day food diaries (TFD) and examined infants’ body weight and length at birth, 1, 3, 6, 8 and 12 months. Maternal adherence to the “protein-rich pattern (FFQ)” was associated with lower infant body mass index z-scores (BMIZ) at birth, 3 and 6 months and lower odds of overweight and obesity (OwOb) across infancy (quartile 3 (Q3) vs. quartile 1 (Q1): odds ratio (OR): 0.50, (95% confidence interval: 0.27, 0.93)). Maternal adherence to the “vegetable–fruit–rice pattern (FFQ)” was associated with higher BMIZ at birth, 3 and 6 months and higher odds of OwOb across infancy (Q3 vs. Q1: OR: 1.79, (1.03, 3.12)). Maternal adherence to the “fried food–bean–dairy pattern (TFD)” was associated with lower BMIZ at 3, 6, 8 and 12 months and lower odds of OwOb (Q3 vs. Q1: OR: 0.54, (0.31, 0.95)). The study results may help to develop interventions and to better define target populations for childhood obesity prevention.
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Affiliation(s)
- Jiajin Hu
- Health Sciences Institute, China Medical University, Shenyang 110122, China; (J.H.); (N.W.); (Y.L.); (Y.W.)
- Research Center of China Medical University Birth Cohort, China Medical University, Shenyang 110122, China
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA; (I.M.A.); (P.-I.D.L.)
| | - Izzuddin M. Aris
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA; (I.M.A.); (P.-I.D.L.)
| | - Pi-I D. Lin
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA; (I.M.A.); (P.-I.D.L.)
| | - Ningyu Wan
- Health Sciences Institute, China Medical University, Shenyang 110122, China; (J.H.); (N.W.); (Y.L.); (Y.W.)
- Research Center of China Medical University Birth Cohort, China Medical University, Shenyang 110122, China
| | - Yilin Liu
- Health Sciences Institute, China Medical University, Shenyang 110122, China; (J.H.); (N.W.); (Y.L.); (Y.W.)
- Research Center of China Medical University Birth Cohort, China Medical University, Shenyang 110122, China
| | - Yinuo Wang
- Health Sciences Institute, China Medical University, Shenyang 110122, China; (J.H.); (N.W.); (Y.L.); (Y.W.)
| | - Deliang Wen
- Health Sciences Institute, China Medical University, Shenyang 110122, China; (J.H.); (N.W.); (Y.L.); (Y.W.)
- Correspondence:
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Pre-Pregnancy Diet Quality Is Associated with Lowering the Risk of Offspring Obesity and Underweight: Finding from a Prospective Cohort Study. Nutrients 2021; 13:nu13041044. [PMID: 33804865 PMCID: PMC8063840 DOI: 10.3390/nu13041044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/11/2021] [Accepted: 03/20/2021] [Indexed: 12/16/2022] Open
Abstract
Maternal diet plays a critical role in epigenetic changes and the establishment of the gut microbiome in the fetus, which has been associated with weight outcomes in offspring. This study examined the association between maternal diet quality before pregnancy and childhood body mass index (BMI) in offspring. There were 1936 mothers with 3391 children included from the Australian Longitudinal Study on Women’s Health (ALSWH) and the Mothers and their Children’s Health (MatCH) study. Maternal dietary intakes were assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). The healthy eating index (HEI-2015) score was used to explore preconception diet quality. Childhood BMI was categorized as underweight, normal, overweight, and obese based on sex and age-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses. Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring being underweight after adjustment for potential confounders, highest vs. lowest quartile (relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.49, 0.96). Higher adherence to preconception diet quality was also inversely linked with the risk of childhood obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, no longer significant after adjusting for pre-pregnancy BMI. Sodium intake was significantly associated with decreased risk of childhood overweight and obesity (RRR = 0.18, 95% CI: 0.14, 0.23) and (RRR = 0.21, 95% CI: 0.17, 0.26), respectively. No significant association was detected between preconception diet quality and offspring being overweight. This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity.
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Monthé-Drèze C, Rifas-Shiman SL, Aris IM, Shivappa N, Hebert JR, Sen S, Oken E. Maternal diet in pregnancy is associated with differences in child body mass index trajectories from birth to adolescence. Am J Clin Nutr 2021; 113:895-904. [PMID: 33721014 PMCID: PMC8023853 DOI: 10.1093/ajcn/nqaa398] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/24/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nutrition in pregnancy and accelerated childhood growth are important predictors of obesity risk. Yet, it is unknown which dietary patterns in pregnancy are associated with accelerated growth and whether there are specific periods from birth to adolescence that are most sensitive to these associations. OBJECTIVES To examine the extent to which 3 dietary indices in pregnancy [Dietary Inflammatory Index (DII), Alternate Healthy Eating Index for Pregnancy (AHEI-P), and Mediterranean Diet Score (MDS)] are associated with child BMI z-score (BMI-z) trajectories from birth to adolescence. METHODS We examined 1459 mother-child dyads from Project Viva that had FFQ data in pregnancy and ≥3 child BMI-z measurements between birth and adolescence. We used linear spline mixed-effects models to examine whether BMI-z growth rates and BMI z-scores differed by quartile of each dietary index from birth to 1 mo, 1-6 mo, 6 mo to 3 y, 3-10 y, and >10 y. RESULTS The means ± SDs for DII (range, -9 to +8 units), AHEI-P (range, 0-90 points), and MDS (range, 0-9 points) were -2.6 ± 1.4 units, 61 ± 10 points, and 4.6 ± 2.0 points, respectively. In adjusted models, children of women in the highest (vs. lowest) DII quartile had higher BMI-z growth rates between 3-10 y (β, 0.03 SD units/y; 95% CI: 0.00-0.06) and higher BMI z-scores from 7 y through 10 y. Children of women with low adherence to a Mediterranean diet had higher BMI z-scores from 3 y through 15 y. Associations of AHEI-P with growth rates and BMI z-scores from birth through adolescence were null. CONCLUSIONS A higher DII and a lower MDS in pregnancy, but not AHEI-P results, are associated with higher BMI-z trajectories during distinct growth periods from birth through adolescence. Identifying the specific dietary patterns in pregnancy associated with rapid weight gain in children could inform strategies to reduce child obesity.
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Affiliation(s)
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Nitin Shivappa
- South Carolina Statewide Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - James R Hebert
- South Carolina Statewide Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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10
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Daneshzad E, Moradi M, Maracy MR, Brett NR, Bellissimo N, Azadbakht L. The association of maternal plant-based diets and the growth of breastfed infants. Health Promot Perspect 2020; 10:152-161. [PMID: 32296629 PMCID: PMC7146038 DOI: 10.34172/hpp.2020.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/01/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Studies are needed to further understand how different plant-based dietary patterns of mothers relate to infant growth. Thus, we investigated the association between maternal plant-based diets and infant growth in breastfed infants during the first 4 months of life. Methods: This cross-sectional study included 290 Iranian mothers and infants. Maternal dietary intake was assessed using a 168-question validated semi-quantitative food frequency questionnaire (FFQ). Three plant-based diet indices (PDIs) were then created to evaluate dietary intakes. Eighteen food groups were classified in three main categories by scoring method: wholeplant diet, healthy plant diet, and animal and unhealthy plant diet. Results: Participants in the top tertile of unhealthy PDI (uPDI) had a lower intake of potassium,phosphorus, zinc, magnesium, calcium, folate and vitamin C, B1, B2, and B3. The upper tertileof uPDI was associated with stunting at 4-month in infants (uPDI: odds ratio [OR] = 3.27, 95%CI= 1.32, 8.10). There were no significant associations between plant-based diet scores and anthropometric indices, including weight, weight status and head circumference (P > 0.05). Conclusion: In conclusion, higher adherence to uPDI may be associated with stuntingamong Iranian infants. Other PDIs were not associated with anthropometric measures. Future studies are needed to further understand the association between plant-based diets and infant growth.
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Affiliation(s)
- Elnaz Daneshzad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maedeh Moradi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad R Maracy
- Department of Epidemiology & Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neil R Brett
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Nick Bellissimo
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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11
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A low intensity dietary intervention for reducing excessive gestational weight gain in an overweight and obese pregnant cohort. Eat Weight Disord 2020; 25:257-263. [PMID: 30155856 DOI: 10.1007/s40519-018-0566-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Excessive gestational weight gain is associated with detrimental outcomes to both the mother and baby. Currently, the best approach to prevent excessive gestational weight gain in overweight and obese women is undetermined. The present study aimed to evaluate the effectiveness of a group-based outpatient dietary intervention in pregnancy to reduce excessive gestational weight gain. METHODS In this retrospective study, overweight and obese pregnant women who attended a single 90-min group education session were compared to women who received standard care alone. Total gestational weight gain, maternal and neonatal outcomes were compared between the intervention and control groups. Data were analysed using Student t, Mann-Whitney and Chi-squared tests as appropriate. A 24-h dietary recall was analysed and compared to the Australian National Nutrition Survey. RESULTS A significant reduction in gestational weight gain was observed with this intervention (P = 0.010), as well as in the rate of small for gestational age births (P = 0.043). Those who attended the intervention had saturated fat and sodium intake levels that exceeded recommendations. Intake of pregnancy-specific micronutrients including folate, calcium and iron were poor from diet alone. CONCLUSIONS A low-intensity antenatal dietary intervention may be effective in reducing excessive gestational weight gain, although multi-disciplinary interventions yield the best success. Further research is required to identify the optimal modality and frequency to limit excessive gestational weight gain. Dietary interventions tailored to ethnicity should also be explored. LEVEL OF EVIDENCE Level II, controlled trial without randomization.
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12
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Maternal healthful dietary patterns during peripregnancy and long-term overweight risk in their offspring. Eur J Epidemiol 2020; 35:283-293. [PMID: 32185575 PMCID: PMC7154013 DOI: 10.1007/s10654-020-00621-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022]
Abstract
Adherence to healthful dietary patterns is associated with lower body mass index (BMI) in adults; however, whether maternal diet quality during peripregnancy is related to a lower overweight risk in the offspring remains to be elucidated. We investigated the associations between the Alternate Healthy Eating Index (AHEI), Alternate Mediterranean Diet (aMED) and Dietary Approach to Stop Hypertension (DASH) during peripregnancy and offspring weight outcomes in a study including 2729 mother–child pairs from the Nurses’ Health Study II and offspring cohort Growing Up Today Study II. Children, 12–14 years at baseline were 21–23 years at the last follow-up. Overweight or obesity was defined according to International Obesity Task Force (< 18 years) and World-Health-Organization guidelines (18 + years). Maternal dietary patterns were calculated from food frequency questionnaires. Log-binomial models were used to estimate relative risks (RR) and 95% confidence intervals. In models adjusted for sex, gestational age at delivery and maternal total energy intake, greater maternal adherence to aMED and DASH, but not AHEI, was associated with lower overweight risk in the offspring (RRQ5 vs Q1 = 0.82 [0.70–0.97] for aMED and 0.86 [0.72–1.04] for DASH, P for trend < 0.05 for both). After additional adjustment for maternal pre-pregnancy lifestyle factors and socio-demographic characteristic, none of the diet quality scores were significantly associated with offspring overweight risk. Maternal pre-pregnancy BMI did not modify any of these associations. In this population of generally well-nourished women, maternal healthful dietary patterns during the period surrounding pregnancy were not independently associated with offspring overweight risk at ages 12–23 years.
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13
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Zhu Y, Hedderson MM, Sridhar S, Xu F, Feng J, Ferrara A. Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study. Int J Epidemiol 2020; 48:423-432. [PMID: 30590563 DOI: 10.1093/ije/dyy285] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nutritional perturbations during pregnancy may impact fetal and long-term childhood growth, although there are limited data on overall diet quality. We investigated whether diet quality, measured by the Healthy Eating Index-2010 (HEI-2010), during pregnancy was related to birthweight z-score (BWZ) and the clinically relevant birth outcomes of large- and small-for-gestational age (LGA and SGA). METHODS In a prospective cohort of 2269 multi-racial/ethnic women from the Pregnancy Environment and Lifestyle Study (2014-2017), dietary intake was assessed by a food frequency questionnaire during early pregnancy. Offspring BWZ and LGA or SGA were derived based on gestational age-, sex-, and racial/ethnic-specific birthweight distributions. Multivariable linear and Poisson regression with robust standard errors were used. RESULTS About 80% of women did not achieve good diet quality (HEI-2010 < 80). After adjusting for covariates, infants born to women in the lowest vs highest quartile of HEI-2010 (37.5-64.4 vs 78.7-94.2) had a 0.12 standard-deviation [95% confidence interval (CI) 0.01-0.23, P-for-trend = 0.023] greater BWZ and 1.76-fold (1.08-2.87, P-for-trend = 0.037) increased risk of LGA. No association was observed between HEI-2010 and SGA. Per-5-point substitution of the reversely coded empty calories component score with the whole grains component score in the HEI-2010 was related to a 25% (95% CI 0.66-0.86) lower risk of LGA. CONCLUSIONS Poor diet quality in pregnancy was associated with higher birthweight and increased risk of LGA independent of maternal obesity and other covariates. Substitution of empty calories with whole grains may mitigate the risk of excess fetal growth. Our findings may inform potential prevention strategies and dietary guidelines for pregnant women.
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Affiliation(s)
- Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sneha Sridhar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Fei Xu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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14
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Litvak J, Parekh N, Deierlein A. Prenatal dietary exposures and offspring body size from 6 months to 18 years: A systematic review. Paediatr Perinat Epidemiol 2020; 34:171-189. [PMID: 32011754 DOI: 10.1111/ppe.12629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND In utero dietary exposures may influence childhood obesity. OBJECTIVES To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years. DATA SOURCES Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews. STUDY SELECTION Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields. SYNTHESIS One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool. RESULTS A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size. CONCLUSIONS Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.
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Affiliation(s)
- Jacqueline Litvak
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, USA
| | - Niyati Parekh
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, USA.,Department of Population Health Sciences, School of Medicine, New York University, New York, NY, USA
| | - Andrea Deierlein
- Department of Epidemiology, College of Global Public Health, New York University, New York, NY, USA.,Department of Population Health Sciences, School of Medicine, New York University, New York, NY, USA
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15
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Hu Z, Tylavsky FA, Kocak M, Fowke JH, Han JC, Davis RL, LeWinn KZ, Bush NR, Sathyanarayana S, Karr CJ, Zhao Q. Effects of Maternal Dietary Patterns during Pregnancy on Early Childhood Growth Trajectories and Obesity Risk: The CANDLE Study. Nutrients 2020; 12:E465. [PMID: 32069778 PMCID: PMC7071328 DOI: 10.3390/nu12020465] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 01/01/2023] Open
Abstract
We investigated the associations between maternal dietary patterns during pregnancy and early childhood growth trajectories and overweight/obesity risk in offspring. Maternal diet was assessed using a food frequency questionnaire during the second trimester, and dietary patterns were derived by reduced rank regression. The associations between maternal dietary pattern scores and body mass index (BMI) trajectories from birth to age four (rising-high, moderate, and low BMI trajectories) as well as overweight/obesity risk at age four were analyzed (n = 1257). Two maternal dietary patterns were identified. The fast food pattern included a higher intake of fried chicken and fish, fruit juices, mayonnaise, and sugar-sweetened beverages, while the processed food pattern included a higher intake of dairy, salad dressing, processed meat, and cold breakfast cereal. Women with greater adherence to the fast food pattern were more likely to have children in the rising-high BMI trajectory group [OR (95% CI) = 1.32 (1.07-1.62); p = 0.008] or having overweight/obesity at age four [OR (95% CI) = 1.31 (1.11-1.54); p = 0.001]. The processed food pattern was not associated with these outcomes. The maternal dietary pattern during pregnancy represented by fried foods and sugar-sweetened beverages may contribute to rapid early childhood growth and increased risk for obesity in offspring.
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Affiliation(s)
- Zunsong Hu
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (Z.H.); (F.A.T.); (M.K.); (J.H.F.)
| | - Frances A. Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (Z.H.); (F.A.T.); (M.K.); (J.H.F.)
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (Z.H.); (F.A.T.); (M.K.); (J.H.F.)
| | - Jay H. Fowke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (Z.H.); (F.A.T.); (M.K.); (J.H.F.)
| | - Joan C. Han
- Departments of Pediatrics and Physiology, University of Tennessee Health Science Center, and Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN 38103, USA;
| | - Robert L. Davis
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA;
| | - Kaja Z. LeWinn
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94118, USA;
| | - Nicole R. Bush
- Departments of Pediatrics and Psychiatry, University of California San Francisco, San Francisco, CA 94118, USA;
| | - Sheela Sathyanarayana
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Seattle, WA 98121, USA;
- Department of Pediatrics, University of Washington, Seattle, WA 98121, USA;
| | - Catherine J. Karr
- Department of Pediatrics, University of Washington, Seattle, WA 98121, USA;
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (Z.H.); (F.A.T.); (M.K.); (J.H.F.)
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16
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Tovar A, Kaar JL, McCurdy K, Field AE, Dabelea D, Vadiveloo M. Maternal vegetable intake during and after pregnancy. BMC Pregnancy Childbirth 2019; 19:267. [PMID: 31349808 PMCID: PMC6660649 DOI: 10.1186/s12884-019-2353-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Improved understanding of vegetable intake changes between pregnancy and postpartum may inform future intervention targets to establish healthy home food environments. Therefore, the goal of this study was to explore the changes in vegetable intake between pregnancy and the postnatal period and explore maternal and sociodemographic factors that are associated with these changes. Methods We examined sociodemographic, dietary, and health characteristics of healthy mothers 18-43y from the prospective Infant Feeding Practices II cohort (n = 847) (2005–2012). Mothers completed a modified version of the diet history questionnaire, a food-frequency measure, developed by the National Cancer Institute. We created four categories of mothers, those that were: meeting vegetable recommendations post- but not prenatally (n = 121; improved intake), not meeting vegetable recommendations during pregnancy and postnatally (n = 370; stable inadequate), meeting recommendations pre- but not postnatally (n = 123; reduced intake), and meeting recommendations at both time points (n = 233; stable adequate). To make our results more relevant to public health recommendations, we were interested in comparing the improved vegetable intake group vs. stable inadequate vegetable intake group, as well as those that reduced their vegetable intake compared to the stable adequate vegetable intake group. Separate multivariable-adjusted logistic regression were used to examine sociodemographic predictors of improved vs. stable inadequate and reduced vs. stable adequate vegetable intake. Results Women with improved vegetable intake vs. stable inadequate smoked fewer cigarettes while women with reduced vegetable intake vs. stable adequate were more likely to experience less pregnancy weight gain. In adjusted models, employed women had greater odds of reduced vegetable intake (OR = 1.64 95% CI 1.14–2.36). In exploratory analyses, employment was associated with greater odds of reduced vegetable intake among low-income (OR = 1.79; 95% CI 1.03–3.1), but not higher income women (OR = 1.31; 95% CI 0.94–1.84). After further adjustment for paid maternity leave, employment was no longer associated with vegetable intake among lower income women (OR: 1.53; 95% CI: 0.76–3.05). Conclusions More women with reduced vs. stable adequate vegetable intake were lower income and worked full time. Improved access to paid maternity leave may help reduce disparities in vegetable quality between lower and higher income women.
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Affiliation(s)
- Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Road, Kingston, RI, 02881, USA.
| | - Jill L Kaar
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen McCurdy
- Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Alison E Field
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Road, Kingston, RI, 02881, USA
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17
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Ter Borg S, Koopman N, Verkaik-Kloosterman J. Food Consumption, Nutrient Intake and Status during the First 1000 days of Life in the Netherlands: a Systematic Review. Nutrients 2019; 11:E860. [PMID: 30995816 PMCID: PMC6520769 DOI: 10.3390/nu11040860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 12/25/2022] Open
Abstract
Adequate nutrition is essential for growth and development in early life. Nutritional data serves as a basis for national nutritional guidelines and policies. Currently, there is no insight into the availability of such data during the first 1000 days of life. Therefore, a systematic review was performed, following the PRISMA reporting guideline, to identify studies on food consumption, nutrient intake or status in the Netherlands. Potential gaps were identified, and the quality of the studies is discussed. The databases Embase and Medline were used, as well as databases from national institutes. Articles published in 2008-2018 were screened by two independent reviewers. In total 601 articles were identified, of which 173 were included. For pregnant women, 32 studies were available with nutritional data, for young children 40 studies were identified. No studies were available for breastfeeding women. A large variety of foods and nutrients were assessed, however certain nutrients were lacking (e.g., vitamin K). Overall, the studies had methodological limitations, making the data unsuitable to assess nutrient inadequacies. There is a need for recent, high quality nutritional research to strengthen the understanding of the nutritional needs and deficiencies during early life, and is fundamental for national guidelines and policies.
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Affiliation(s)
- Sovianne Ter Borg
- National Institute for Public Health and the Environment, 3721 MA, Bilthoven, The Netherlands.
| | - Nynke Koopman
- National Institute for Public Health and the Environment, 3721 MA, Bilthoven, The Netherlands.
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18
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Tahir MJ, Haapala JL, Foster LP, Duncan KM, Teague AM, Kharbanda EO, McGovern PM, Whitaker KM, Rasmussen KM, Fields DA, Jacobs DR, Harnack LJ, Demerath EW. Higher Maternal Diet Quality during Pregnancy and Lactation Is Associated with Lower Infant Weight-For-Length, Body Fat Percent, and Fat Mass in Early Postnatal Life. Nutrients 2019; 11:E632. [PMID: 30875943 PMCID: PMC6471184 DOI: 10.3390/nu11030632] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Maternal pregnancy nutrition influences fetal growth. Evidence is limited, however, on the relationship of maternal diet during pregnancy and lactation on infant postnatal growth and adiposity. Our purpose was to examine associations between maternal diet quality during pregnancy and lactation with offspring growth and body composition from birth to six months. Maternal diet quality was serially assessed in pregnancy and at one and three months postpartum, using the Healthy Eating Index⁻2015 in a cohort of 354 fully breastfeeding mother⁻infant dyads. Infant length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores were assessed at birth, one, three, and six months. Infant body fat percent (BF%), fat mass (FM), and fat-free mass (FFM) were measured at six months using dual-energy X-ray absorptiometry. Higher maternal diet quality from pregnancy through three months postpartum was associated with lower infant WLZ from birth to six months (p = 0.02) and BF% at six months (p ≤ 0.05). Higher maternal diet quality at one and three months postpartum was also associated with lower infant FM at six months (p < 0.01). In summary, maternal diet quality during pregnancy and lactation was inversely associated with infant relative weight and adiposity in early postnatal life. Additional research is needed to explore whether associations persist across the life course.
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Affiliation(s)
- Muna J Tahir
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Jacob L Haapala
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Laurie P Foster
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Katy M Duncan
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - April M Teague
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | | | - Patricia M McGovern
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
- Department of Epidemiology, University of Iowa, Iowa City, IA 52246, USA.
| | | | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
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19
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Developmental Origins of Disease: Emerging Prenatal Risk Factors and Future Disease Risk. CURR EPIDEMIOL REP 2018; 5:293-302. [PMID: 30687591 DOI: 10.1007/s40471-018-0161-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose of review Many of the diseases and dysfunctions described in the paradigm of the developmental origins of health and disease have been studied in relation to prenatal nutrition or environmental toxicant exposures. Here, we selectively review the current research on four exposures-two nutritional and two environmental-that have recently emerged as prenatal risk factors for long-term health outcomes. Recent findings Recent studies have provided strong evidence that prenatal exposure to (1) excessive intake of sugar-sweetened beverages, (2) unhealthy dietary patterns, (3) perfluoroalkyl substances, and (4) fine particulate matter, may increase risk of adverse health outcomes, such as obesity, cardiometabolic dysfunction, and allergy/asthma. Summary Emerging prenatal nutritional factors and environmental toxicants influence offspring long-term health. More work is needed to identify the role of paternal exposures and maternal exposures during the preconception period and to further elucidate causality through intervention studies. The ubiquity of these emerging nutritional and environmental exposures makes this area of inquiry of considerable public health importance.
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Impact of Dietary Macronutrient Intake during Early and Late Gestation on Offspring Body Composition at Birth, 1, 3, and 5 Years of Age. Nutrients 2018; 10:nu10050579. [PMID: 29738502 PMCID: PMC5986459 DOI: 10.3390/nu10050579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/19/2022] Open
Abstract
Dietary intake during pregnancy as a possible modifiable risk factor for childhood obesity is poorly explored. In a prospective observational study, two multivariable regression models were therefore used to associate maternal diet at 15 and 32 weeks’ gestation with offsprings’ body composition and fat distribution at birth, 1, 3, and 5 years. Mean energy intake was 2157 ± 375 kcal (n = 186) in early and 2208 ± 460 kcal (n = 167) in late gestation. The partition model showed mostly no significant associations between maternal diet in early pregnancy and offspring body composition. In late pregnancy, higher fat intake was negatively associated with clinical outcomes at birth, 1, and 5 years. Protein intake was negatively associated with BMI z score (zBMI) at 3 and 5 years. A 10 g increase in fiber was associated with an increase of 3.50 mm2 abdominal subcutaneous fat at 1, 172.49 g fat mass at 3, and 0.23 zBMI at 5 years. Results were largely comparable in the substitution model. An incremental increase in fat and protein at the expense of carbohydrates in late but not early pregnancy may be associated with lower fat mass up to 5 years. Findings require confirmation by additional prospective studies.
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21
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Clarke MA, Joshu CE. Early Life Exposures and Adult Cancer Risk. Epidemiol Rev 2018; 39:11-27. [PMID: 28407101 DOI: 10.1093/epirev/mxx004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/19/2017] [Indexed: 12/14/2022] Open
Abstract
Very little is known about the influence of early life exposures on adult cancer risk. The purpose of this narrative review was to summarize the epidemiologic evidence relating early life tobacco use, obesity, diet, and physical activity to adult cancer risk; describe relevant theoretical frameworks and methodological strategies for studying early life exposures; and discuss policies and research initiatives focused on early life. Our findings suggest that in utero exposures may indirectly influence cancer risk by modifying biological pathways associated with carcinogenesis; however, more research is needed to firmly establish these associations. Initiation of exposures during childhood and adolescence may impact cancer risk by increasing duration and lifetime exposure to carcinogens and/or by acting during critical developmental periods. To expand the evidence base, we encourage the use of life course frameworks, causal inference methods such as Mendelian randomization, and statistical approaches such as group-based trajectory modeling in future studies. Further, we emphasize the need for objective exposure biomarkers and valid surrogate endpoints to reduce misclassification. With the exception of tobacco use, there is insufficient evidence to support the development of new cancer prevention policies; however, we highlight existing policies that may reduce the burden of these modifiable risk factors in early life.
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Lifestyle of women before pregnancy and the risk of offspring obesity during childhood through early adulthood. Int J Obes (Lond) 2018; 42:1275-1284. [PMID: 29568108 DOI: 10.1038/s41366-018-0052-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/13/2017] [Accepted: 01/22/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In women, adhering to an overall healthy lifestyle is associated with a dramatically reduced risk of cardio-metabolic disorders. Whether such a healthy lifestyle exerts an intergenerational effects on child health deserves examination. METHODS We included 5701 children (9-14 years old at baseline) of the Growing Up Today Study 2, and their mothers, who are participants in the Nurses' Health Study II. Pre-pregnancy healthy lifestyle was defined as a normal body mass index, no smoking, physical activity ≥150 min/week, and diet in the top 40% of the Alternative Healthy Eating Index-2010. Obesity during childhood and adolescence was defined using the International Obesity Task Force age- and sex-specific cutoffs. Multivariable log-binominal regression models with generalized estimating equations were used to evaluate the association of pre-pregnancy healthy lifestyle and offspring obesity. RESULTS We identified 520 (9.1%) offspring who became obese during follow-up. A healthy body weight of mothers and no smoking before pregnancy was significantly associated with a lower risk of obesity among offspring: the relative risks [RRs; 95% confidence intervals (CIs)] were 0.37 (0.31-0.43) and 0.64 (0.49-0.84), respectively. Eating a healthy diet and regular moderate-to-vigorous physical activities were inversely related to offspring obesity risk, but these relations were not statistically significant. Compared to children of mothers who did not meet any low-risk lifestyle factors, offspring of women who adhered to all four healthy lifestyle factors had 75% lower risk of obesity (RR: 0.25, 95% CI: 0.14-0.43). CONCLUSION Adherence to an overall healthy lifestyle before pregnancy is strongly associated with a low risk of offspring obesity in childhood, adolescence, and early adulthood. These findings highlight the importance of an overall healthy lifestyle before pregnancy as a potential strategy to prevent obesity in future generations.
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Epigenetic effects of the pregnancy Mediterranean diet adherence on the offspring metabolic syndrome markers. J Physiol Biochem 2017; 73:495-510. [PMID: 28921259 DOI: 10.1007/s13105-017-0592-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/07/2017] [Indexed: 02/06/2023]
Abstract
Metabolic syndrome (MS) has a multifactorial and not yet fully clarified origin. Insulin resistance is a key element that connects all the accepted components of MS (obesity, dyslipemia, high blood pressure, and hyperglycemia). There is strong evidence that epigenetic changes during fetal development are key factors in the development of MS. These changes are induced by maternal nutrition, among different factors, affecting the intrauterine environment. The Mediterranean diet has been shown to be a healthy eating pattern that protects against the development of MS in adults. Similarly, the Mediterranean diet could have a similar action during pregnancy, protecting the fetus against the development of MS throughout life. This review assembles studies carried out, both in animals and humans, on the epigenetic modifications associated with the consumption, during pregnancy, of Mediterranean diet main components. The relationship between these modifications and the occurrence of factors involved in development of MS is also explained. In addition, the results of our group relating adherence to the Mediterranean diet with MS markers are discussed. The paper ends suggesting future actuation lines in order to increase knowledge on Mediterranean diet adherence as a prevention tool of MS development.
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Chatzi L, Rifas-Shiman SL, Georgiou V, Joung KE, Koinaki S, Chalkiadaki G, Margioris A, Sarri K, Vassilaki M, Vafeiadi M, Kogevinas M, Mantzoros C, Gillman MW, Oken E. Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood. Pediatr Obes 2017; 12 Suppl 1:47-56. [PMID: 28160450 PMCID: PMC5697744 DOI: 10.1111/ijpo.12191] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 07/21/2016] [Accepted: 08/26/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND In adults, adherence to the Mediterranean diet has been inversely associated with cardiovascular risk, but the extent to which diet in pregnancy is associated with offspring adiposity is unclear. We aimed to investigate the association between adherence to Mediterranean diet in pregnancy and offspring cardiometabolic traits in two pregnancy cohorts. METHODS We studied 997 mother-child pairs from Project Viva in Massachusetts, USA, and 569 pairs from the Rhea study in Crete, Greece. We estimated adherence to the Mediterranean diet with an a priori defined score (MDS) of nine foods and nutrients (0 to 9). We measured child weight, height, waist circumference, skin-fold thicknesses, blood pressure, and blood levels of lipids, c-reactive protein and adipokines in mid-childhood (median 7.7 years) in Viva, and in early childhood (median 4.2 years) in Rhea. We calculated cohort-specific effects and pooled effects estimates with random-effects models for cohort and child age. RESULTS In Project Viva, the mean (SD, standard deviation) MDS was 2.7 (1.6); in Rhea it was 3.8 (1.7). In the pooled analysis, for each 3-point increment in the MDS, offspring BMI z-score was lower by 0.14 units (95% CI, -0.15 to -0.13), waist circumference by 0.39 cm (95% CI, -0.64 to -0.14), and the sum of skin-fold thicknesses by 0.63 mm (95% CI, -0.98 to -0.28). We also observed lower offspring systolic (-1.03 mmHg; 95% CI, -1.65 to -0.42) and diastolic blood pressure (-0.57 mmHg; 95% CI, -0.98 to -0.16). CONCLUSION Greater adherence to Mediterranean diet during pregnancy may protect against excess offspring cardiometabolic risk.
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Affiliation(s)
- Leda Chatzi
- Department of Social Medicine, University of Crete, Greece
| | - Sheryl L. Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Kyoung Eun Joung
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stella Koinaki
- Department of Social Medicine, University of Crete, Greece
| | | | | | - Katerina Sarri
- Department of Social Medicine, University of Crete, Greece
| | | | | | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology, CREAL, Barcelona, Spain
| | - Christos Mantzoros
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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Attini R, Leone F, Montersino B, Fassio F, Minelli F, Colla L, Rossetti M, Rollino C, Alemanno MG, Barreca A, Todros T, Piccoli GB. Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature. Nutrients 2017; 9:E770. [PMID: 28753930 PMCID: PMC5537884 DOI: 10.3390/nu9070770] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is increasingly recognized in pregnant patients. Three characteristics are associated with a risk of preterm delivery or small for gestational age babies; kidney function reduction, hypertension, and proteinuria. In pregnancy, the anti-proteinuric agents (ACE-angiotensin converting enzyme-inhibitors or ARBS -angiotensin receptor blockers) have to be discontinued for their potential teratogenicity, and there is no validated approach to control proteinuria. Furthermore, proteinuria usually increases as an effect of therapeutic changes and pregnancy-induced hyperfiltration. Based on a favourable effect of low-protein diets on proteinuria and advanced CKD, our group developed a moderately protein-restricted vegan-vegetarian diet tsupplemented with ketoacids and aminoacids for pregnant patients. This report describes the results obtained in three pregnant patients with normal renal function, nephrotic or sub-nephrotic proteinuria, and biopsy proven diagnosis of focal segmental glomerulosclerosis, a renal lesion in which hyperfiltration is considered of pivotal importance (case 1: GFR (glomerular filtration rate): 103 mL/min; proteinuria 2.1 g/day; albumin 3.2 g/dL; case 2: GFR 86 mL/min, proteinuria 3.03 g/day, albumin 3.4 g/dL; case 3: GFR 142 mL/min, proteinuria 6.3 g/day, albumin 3.23 g/dL). The moderately restricted diet allowed a stabilisation of proteinuria in two cases and a decrease in one. No significant changes in serum creatinine and serum albumin were observed. The three babies were born at term (38 weeks + 3 days, female, weight 3180 g-62th centile; 38 weeks + 2 days, female, weight 3300 g-75th centile; male, 38 weeks + 1 day; 2770 g-8th centile), thus reassuring us of the safety of the diet. In summary, based on these three cases studies and a review of the literature, we suggest that a moderately protein-restricted, supplemented, plant-based diet might contribute to controlling proteinuria in pregnant CKD women with focal segmental glomerulosclerosis. However further studies are warranted to confirm the potential value of such a treatment strategy.
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Affiliation(s)
- Rossella Attini
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Filomena Leone
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Benedetta Montersino
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Federica Fassio
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Fosca Minelli
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Loredana Colla
- SCDU Nephrology, Città della Salute e della Scienza, University of Torino, 10100 Turin, Italy.
| | - Maura Rossetti
- SCDU Nephrology, Città della Salute e della Scienza, University of Torino, 10100 Turin, Italy.
| | - Cristiana Rollino
- SCDU Nephrology, Giovanni Bosco Hospital, University of Torino, 10100 Turin, Italy.
| | - Maria Grazia Alemanno
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Antonella Barreca
- Department of Medical Sciences, University of Torino, 10100 Turin, Italy.
| | - Tullia Todros
- Materno-Foetal Unit, Department of Surgery, University of Torino, 10100 Turin, Italy.
| | - Giorgina Barbara Piccoli
- Department of Biological and Clinical Sciences, University of Torino, 10100 Turin, Italy.
- Nephrology, Centre Hospitalier Le Mans, 72000 Le Mans, France.
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26
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Starling AP, Sauder KA, Kaar JL, Shapiro AL, Siega-Riz AM, Dabelea D. Maternal Dietary Patterns during Pregnancy Are Associated with Newborn Body Composition. J Nutr 2017; 147:1334-1339. [PMID: 28539412 DOI: 10.3945/jn.117.248948] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/11/2017] [Accepted: 04/26/2017] [Indexed: 01/04/2023] Open
Abstract
Background: Maternal dietary intake during pregnancy may influence offspring growth and adiposity. Specific dietary patterns associated with newborn adiposity have not been identified.Objective: We aimed to identify patterns of maternal dietary intake associated with gestational weight gain (GWG) and fasting glucose during pregnancy and to evaluate whether adherence to these patterns is associated with newborn adiposity.Methods: In the Healthy Start prospective cohort, dietary intake during pregnancy was assessed via 24-h recalls. Reduced-rank regression identified dietary patterns predictive of GWG and fasting glucose. Associations between dietary patterns and newborn fat mass, fat-free mass, and adiposity were estimated by using linear regression models among 764 ethnically diverse mother-infant pairs.Results: Two dietary patterns were identified. Pattern 1, correlated with greater GWG (r = 0.22, P < 0.01), was characterized by a higher consumption of poultry, nuts, cheese, fruits, whole grains, added sugars, and solid fats. Greater adherence to pattern 1 (upper compared with lower tertile) predicted a greater newborn fat-free mass (61 g; 95% CI: 12, 110 g) but no difference in fat mass or adiposity. Pattern 2, correlated with greater maternal fasting glucose (r = 0.16, P < 0.01), was characterized by a higher consumption of eggs, starchy vegetables, solid fats, fruits, and nonwhole grains and a lower consumption of dairy foods, dark-green vegetables, and whole grains. Greater adherence to pattern 2 was associated with a greater newborn birth weight (80 g; 95% CI: 15, 145 g), fat mass (33 g; 95% CI: 8, 59 g), and adiposity (0.9%; 95% CI: 0.3%, 1.6%).Conclusions: Among pregnant women, adherence to a dietary pattern characterized by an intake of poultry, nuts, cheese, and whole grains was associated with greater GWG but not maternal fasting glucose or newborn adiposity. Adherence to a pattern characterized by an intake of eggs, starchy vegetables, and nonwhole grains was associated with higher maternal fasting glucose and greater newborn adiposity. Maternal dietary patterns during pregnancy may influence newborn body composition.
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Affiliation(s)
| | - Katherine A Sauder
- Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | - Jill L Kaar
- Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | | | - Anna Maria Siega-Riz
- Departments of Public Health Sciences and Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA
| | - Dana Dabelea
- Departments of Epidemiology and.,Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; and
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27
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Voortman T, Tielemans MJ, Stroobant W, Schoufour JD, Kiefte-de Jong JC, Steenweg-de Graaff J, van den Hooven EH, Tiemeier H, Jaddoe VWV, Franco OH. Plasma fatty acid patterns during pregnancy and child's growth, body composition, and cardiometabolic health: The Generation R Study. Clin Nutr 2017; 37:984-992. [PMID: 28456538 DOI: 10.1016/j.clnu.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/27/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Exposure to different concentrations of fatty acids during fetal life may affect growth and metabolism. However, most studies examined individual fatty acids, whereas concentrations highly correlate and may interact with each other. We aimed to evaluate patterns of plasma fatty acids during pregnancy and their associations with growth, body composition, and cardiometabolic health of the 6-year-old offspring. METHODS This study was performed in 4830 mother-child pairs participating in a population-based cohort in the Netherlands. Around 20 weeks of gestation, we measured plasma phospholipid concentrations of 22 fatty acids, in which we identified three fatty acid patterns using principal component analysis: a 'high n-6 polyunsaturated fatty acid (PUFA)' pattern, a 'monounsaturated and saturated fatty acid (MUFA and SFA)' pattern, and a 'high n-3 PUFA' pattern. When the children were 6 years old, we measured their anthropometrics and detailed body composition (using dual-energy X-ray absorptiometry), and we calculated their body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI). At the same age, children's blood pressure, and serum insulin, HDL-cholesterol, and triacylglycerol were measured. RESULTS After adjustment for confounders and the other patterns, a higher score for the 'high n-6 PUFA' pattern during pregnancy was associated with a higher height, BMI, and FFMI in the offspring at 6 years, but not independently with cardiometabolic outcomes. The 'MUFA and SFA' pattern was not consistently associated with child body composition or cardiometabolic health. A higher score for the 'high n-3 PUFA' pattern was associated with a lower FMI, higher FFMI, higher HDL-cholesterol, and lower triacylglycerol. CONCLUSIONS Our results suggest that plasma fatty acid patterns during pregnancy may affect offspring's body composition and cardiometabolic health. Specifically, a pattern characterized by high n-3 PUFA levels was associated with a more favorable body composition and blood lipid profile.
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Affiliation(s)
- Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Myrte J Tielemans
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wendy Stroobant
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Leiden University College, The Hague, The Netherlands
| | | | - Edith H van den Hooven
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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28
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Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 2017; 356:j1. [PMID: 28179267 PMCID: PMC6888512 DOI: 10.1136/bmj.j1] [Citation(s) in RCA: 654] [Impact Index Per Article: 93.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates of obese women have increased body fat at birth, which increases the risk of childhood obesity. Although there is no unifying mechanism responsible for the adverse perinatal outcomes associated with maternal obesity, on the basis of the available data, increased prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation, and oxidative stress seem to contribute to early placental and fetal dysfunction. We will review the pathophysiology underlying these data and try to shed light on the specific underlying mechanisms.
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Affiliation(s)
- Patrick M Catalano
- Department of Obstetrics and Gynecology, Center for Reproductive Health/MetroHealth Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Kartik Shankar
- Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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29
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Parental heights and maternal education as predictors of length/height of children at birth, age 3 and 19 years, independently on diet: the ELSPAC study. Eur J Clin Nutr 2017; 71:1193-1199. [PMID: 28176773 DOI: 10.1038/ejcn.2016.244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/24/2016] [Accepted: 09/30/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND/OBJECTIVES Little is currently known about the relationship between the parental diet during pregnancy and the growth of the child from early childhood until early adulthood. This study was designed to examine whether the dietary patterns of the parents during a pregnancy and of the respective child at 3 years are associated with the length/height-for-age z-score of child at birth, 3 years of age and at 19 years of age. SUBJECTS/METHODS Dietary patterns of pregnant women and their partners, and offspring at 3 years that were enroled in the 1990-1991 period in the Czech part of the European Longitudinal Study of Pregnancy and Childhood. Multivariable linear regression models were used to estimate the relationship between the dietary patterns of parents (835 child-mother-father trios) during pregnancy and the length/height-for-age z-score of their offspring at birth, 3 years and 19 years. RESULTS The maternal health-conscious food pattern was found to predict lower child height at 3 years, but not at birth nor at 19 years of age. An increase in the health-conscious pattern score of the maternal diet was associated with significantly lower height-for-age z-score at 3 years; however, the observed effect lost its significance after the adjustment for diet of the child at 3 years. CONCLUSIONS After full adjustment, the only significant predictors of the height-for-age z-score of the child at 3 years were the heights of both parents and maternal education. More research into the association of maternal diet in pregnancy and height of child is necessary.
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30
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Chen LW, Aris IM, Bernard JY, Tint MT, Chia A, Colega M, Gluckman PD, Shek LPC, Saw SM, Chong YS, Yap F, Godfrey KM, van Dam RM, Chong MFF, Lee YS. Associations of Maternal Dietary Patterns during Pregnancy with Offspring Adiposity from Birth Until 54 Months of Age. Nutrients 2016; 9:nu9010002. [PMID: 28025503 PMCID: PMC5295046 DOI: 10.3390/nu9010002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 02/07/2023] Open
Abstract
Most studies linking maternal diet with offspring adiposity have focused on single nutrients or foods, but a dietary pattern approach is more representative of the overall diet. We thus aimed to investigate the relations between maternal dietary patterns and offspring adiposity in a multi-ethnic Asian mother–offspring cohort in Singapore. We derived maternal dietary patterns using maternal dietary intake information at 26–28 weeks of gestation, of which associations with offspring body mass index (BMI), abdominal circumference (AC), subscapular skinfold (SS), and triceps skinfold (TS) were assessed using longitudinal data analysis (linear mixed effects (LME)) and multiple linear regression at ages 0, 3, 6, 9, 12, 15, 18, 24, 36, 48, and 54 months. Three dietary patterns were derived: (1) vegetables-fruit-and-white rice (VFR); (2) seafood-and-noodles (SfN); and (3) pasta-cheese-and-bread (PCB). In the LME model adjusting for potential confounders, each standard deviation (SD) increase in maternal VFR pattern score was associated with 0.09 mm lower offspring TS. Individual time-point analysis additionally revealed that higher VFR score was generally associated with lower postnatal offspring BMI z-score, TS, SS, and sum of skinfolds (SS + TS) at ages 18 months and older. Maternal adherence to a dietary pattern characterized by higher intakes of fruit and vegetables and lower intakes of fast food was associated with lower offspring adiposity.
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Affiliation(s)
- Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
| | - Mya-Thway Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Airu Chia
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Fabian Yap
- Department of Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore.
- Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore 169857, Singapore.
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore 117599, Singapore.
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119228, Singapore.
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31
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Wu L, Shi A, Zhu D, Bo L, Zhong Y, Wang J, Xu Z, Mao C. High sucrose intake during gestation increases angiotensin II type 1 receptor-mediated vascular contractility associated with epigenetic alterations in aged offspring rats. Peptides 2016; 86:133-144. [PMID: 27818235 DOI: 10.1016/j.peptides.2016.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/10/2016] [Accepted: 11/01/2016] [Indexed: 12/31/2022]
Abstract
Accruing evidence have confirmed that the fetal programming in response to adverse environmental in utero factors plays essential roles in the pathogenesis of hypertension in later life. High sugar intake has been accepted worldwide in everyday life diet and becomes the critical public health issue. Our previous studies indicated that intake of high sucrose (HS) during pregnancy could change the vascular reactivity and dipsogenic behavior closely associated with abnormal renin-angiotensin system (RAS), to increase the risk of hypertension in adult offspring. In the present study, we tested the hypothesis that maternal HS intake in pregnancy may further deteriorate the Ang II-induced cardiovascular responses in the aged offspring. HS intake was provided to pregnant rats throughout the gestation. Blood pressure (BP) in conscious state and vascular contractility in vitro were measured in 22-month-old aged offspring rats. In addition, mRNA and protein expressions and epigenetic changes of Ang II type 1 receptor (AT1R) gene in blood vessels were determined with the methods of real-time RT-PCR, Western blotting, and Chromatin Immunoprecipitation Assay (CHIP). Results showed that, in the aged offspring, maternal HS intake during gestation would cause the elevation of basal BP which could be diminished by losartan. Although the circulatory Ang II was not changed, levels of local Ang II were significantly increased in blood vessels. In addition, prenatal HS exposure would significantly enhance the AT1R-mediated vasoconstrictions in both aorta and mesenteric arteries of the aged offspring. Moreover, in the aged offspring of prenatal HS exposure, mRNA and protein expressions of AT1R gene in both large and small blood vessels were significantly increased, which should be closely associated with the changes of epigenetic mechanisms such as histone modifications. Collectively, we proposed that maternal HS intake during gestation would cause abnormal BP responses mediated via the enhancement of vascular RAS, together with the increased expression of AT1R gene related to the its epigenetic changes, which would actually lead to the overt phenotype of hypertension in the aged offspring.
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MESH Headings
- Angiotensin II/pharmacology
- Angiotensin II/physiology
- Animals
- Aorta/drug effects
- Aorta/physiopathology
- Epigenesis, Genetic/drug effects
- Female
- Fetal Development
- Histones/metabolism
- Mesenteric Arteries/drug effects
- Mesenteric Arteries/physiopathology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiopathology
- Pregnancy
- Prenatal Exposure Delayed Effects/chemically induced
- Prenatal Exposure Delayed Effects/genetics
- Prenatal Exposure Delayed Effects/metabolism
- Promoter Regions, Genetic
- Protein Binding
- Protein Processing, Post-Translational
- Rats, Sprague-Dawley
- Receptor, Angiotensin, Type 1/physiology
- Sucrose/toxicity
- TATA-Box Binding Protein/metabolism
- Transcriptome
- Vasoconstriction
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Affiliation(s)
- Lei Wu
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China; Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, China
| | - Aiping Shi
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China; Zhangjiagang Centers for Disease Control and Prevention, Suzhou, China
| | - Di Zhu
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China
| | - Le Bo
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China
| | - Yuan Zhong
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China
| | - Juan Wang
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China
| | - Zhice Xu
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China
| | - Caiping Mao
- Institute for Fetology and Reproductive Medicine Center, First Hospital of Soochow University, Suzhou, 215006, China.
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32
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Martin CL, Siega-Riz AM, Sotres-Alvarez D, Robinson WR, Daniels JL, Perrin EM, Stuebe AM. Maternal Dietary Patterns during Pregnancy Are Associated with Child Growth in the First 3 Years of Life. J Nutr 2016; 146:2281-2288. [PMID: 27683873 PMCID: PMC5086788 DOI: 10.3945/jn.116.234336] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/18/2016] [Accepted: 08/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Child obesity is a major problem in the United States. Identifying early-life risk factors is necessary for prevention. Maternal diet during pregnancy is a primary source of fetal energy and might influence risk of child obesity. OBJECTIVE We prospectively investigated the influence of maternal dietary patterns during pregnancy on child growth in the first 3 y of life in 389 mother-child pairs from the Pregnancy, Infection, and Nutrition study. METHODS Dietary patterns were derived with the use of latent class analysis (LCA) based on maternal diet, collected with the use of a food-frequency questionnaire at 26-29 wk gestation. Associations between maternal dietary patterns and child body mass index (BMI)-for-age z score and overweight or obesity were assessed with the use of linear regression and log-binomial regression, respectively. We used linear mixed models to estimate childhood growth patterns in relation to maternal dietary patterns. RESULTS Three patterns were identified from LCA: 1) fruits, vegetables, refined grains, red and processed meats, pizza, french fries, sweets, salty snacks, and soft drinks (latent class 1); 2) fruits, vegetables, baked chicken, whole-wheat bread, low-fat dairy, and water (latent class 2); and 3) white bread, red and processed meats, fried chicken, french fries, and vitamin C-rich drinks (latent class 3). In crude analyses, the latent class 3 diet was associated with a higher BMI-for-age z score at 1 and 3 y of age and a higher risk of overweight or obesity at 3 y of age than was the latent class 2 diet. These associations were not detectable after adjustment for confounding factors. We observed an inverse association between the latent class 3 diet and BMI-for-age z score at birth after adjustment for confounding factors that was not evident in the crude analysis (latent class 3 compared with latent class 2-β: -0.41; 95% CI: -0.79, -0.03). CONCLUSION In this prospective study, a less-healthy maternal dietary pattern was associated with early childhood weight patterns.
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Affiliation(s)
| | - Anna Maria Siega-Riz
- Department of Epidemiology and
- Department of Nutrition, Gillings School of Global Public Health
| | | | | | | | - Eliana M Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, and
| | - Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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33
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Toemen L, Jaddoe VWV. Response to 'Maternal obesity, gestational weight gain and childhood cardiac outcome at age 6 years'. Int J Obes (Lond) 2016; 41:94. [PMID: 27748742 DOI: 10.1038/ijo.2016.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L Toemen
- From the Generation R Study Group, Departments of Epidemiology and Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - V W V Jaddoe
- From the Generation R Study Group, Departments of Epidemiology and Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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34
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Comparison of maternal isocaloric high carbohydrate and high fat diets on osteogenic and adipogenic genes expression in adolescent mice offspring. Nutr Metab (Lond) 2016; 13:69. [PMID: 27777604 PMCID: PMC5069891 DOI: 10.1186/s12986-016-0130-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/06/2016] [Indexed: 01/12/2023] Open
Abstract
Background Maternal high fat/high calorie diet leads to adiposity and bone fracture in offspring. However, the effects of macronutrient distribution in maternal isocaloric diet have not been studied. The present study was designed to test the hypothesis that maternal isocaloric pair-fed high-carbohydrate diet will increase osteoblastic and decrease osteoclastic and adipogenic gene expression compared with high-fat diet in adolescent mice offspring. Methods Virgin female C57BL/6 mice were impregnated and fed either the AIN 93G isocaloric pair-fed high-carbohydrate (LF-HCD) or a high fat (HF-LCD) diet from the time of vaginal plug confirmation until the offspring was weaned. Results After adjusting for the sex of offspring, osteoprotegrin (OPG) and Ctnnb1 (beta-catenin) genes expression were significantly reduced by 98 % and 97 % in the bone of offspring born from the HF-LCD compared with the LF-HCD-fed mothers (p < 0.001 and p < 0.001, respectively). Peroxisome proliferator-activated receptor gamma-2 (PPAR γ2) gene expression in the bone of offspring born from the HF-LCD was 7.1-folds higher than the LF-HCD-fed mothers (p = 0.004). In the retroperitoneal fat mass of offspring born from HF-LCD, AdipoQ and LPL genes expression were respectively up-regulated 15.8 and 4.2-folds compared with the LF-HCD-fed mothers (p < 0.001 and p = 0.03, respectively). Conclusions Maternal isocaloric pair-fed high-carbohydrate diet enhances osteoblastogenesis and inhibits adipogenesis compared with high-fat diet in adolescent mice offspring.
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35
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Attini R, Leone F, Parisi S, Fassio F, Capizzi I, Loi V, Colla L, Rossetti M, Gerbino M, Maxia S, Alemanno MG, Minelli F, Piccoli E, Versino E, Biolcati M, Avagnina P, Pani A, Cabiddu G, Todros T, Piccoli GB. Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience. BMC Nephrol 2016; 17:132. [PMID: 27649693 PMCID: PMC5029029 DOI: 10.1186/s12882-016-0339-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited. Aim of this study is to review the results obtained over the last 15 years with moderately restricted low-protein diets in pregnant CKD women (combining: CKD stages 3-5, proteinuria: nephrotic at any time, or > =1 g/24 at start or referral; nephrotic in previous pregnancy). CKD patients on unrestricted diets were employed for comparison. METHODS STUDY PERIOD January, 2000 to September, 2015: 36 on-diet pregnancies (31 singleton deliveries, 3 twin deliveries, 1 pregnancy termination, 1 miscarriage); 47 controls (42 singleton deliveries, 5 miscarriages). The diet is basically vegan; since occasional milk and yoghurt are allowed, we defined it vegan-vegetarian; protein intake (0.6-0.8 g/Kg/day), keto-acid supplementation, protein-unrestricted meals (1-3/week) are prescribed according to CKD stage and nutritional status. Statistical analysis was performed as implemented on SPSS. RESULTS Patients and controls were similar (p: ns) at baseline with regard to age (33 vs 33.5), referral week (7 vs 9), kidney function (CKD 3-5: 48.4 % vs 64.3 %); prevalence of hypertension (51.6 % vs 40.5 %) and proteinuria >3 g/24 h (16.1 % vs 12.2 %). There were more diabetic nephropathies in on-diet patients (on diet: 31.0 % vs controls 5.3 %; p 0.007 (Fisher)) while lupus nephropathies were non-significantly higher in controls (on diet: 10.3 % vs controls 23.7 %; p 0.28 (Fisher)). The incidence of preterm delivery was similar (<37 weeks: on-diet singletons 77.4 %; controls: 71.4 %). The incidence of other adverse pregnancy related outcomes was non-significantly lower in on-diet patients (early preterm delivery: on diet: 32.3 % vs controls 35.7 %; birth-weight = <1.500 g: on diet: 9.7 % vs controls 23.8 %). None of the singletons in the on-diet series died, while two perinatal deaths occurred among the controls (p = 0.505). The incidence of small for gestational age (SGA <10th centile) and/or extremely preterm babies (<28th week) was significantly lower in singletons from on-diet mothers than in controls (on diet: 12.9 % vs controls: 33.3 %; p: 0.04 (Fisher)). CONCLUSION Moderate protein restriction in the context of a vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.
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Affiliation(s)
- Rossella Attini
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Filomena Leone
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Silvia Parisi
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Federica Fassio
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Irene Capizzi
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
| | | | - Loredana Colla
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Maura Rossetti
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Martina Gerbino
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | | | - Maria Grazia Alemanno
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Fosca Minelli
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Ettore Piccoli
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Elisabetta Versino
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Marilisa Biolcati
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Paolo Avagnina
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | | | | | - Tullia Todros
- SS Nephrology, SCDU Urology, AOU San Luigi, Orbassano, Italy
- SS Epidemiology, University of Torino, Torino, Italy
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- SCD Nephrology, Brotzu Hospital, Cagliari, Italy
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
| | - Giorgina B. Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, Orbassano, Torino 10100 Italy
- Nèphrologie, CH du Mans, Le Mans, France
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Fu Q, Olson P, Rasmussen D, Keith B, Williamson M, Zhang KK, Xie L. A short-term transition from a high-fat diet to a normal-fat diet before pregnancy exacerbates female mouse offspring obesity. Int J Obes (Lond) 2015; 40:564-72. [PMID: 26607040 DOI: 10.1038/ijo.2015.236] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 10/19/2015] [Accepted: 11/01/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Recent findings have highlighted the detrimental influence of maternal overnutrition and obesity on fetal development and early life development. However, there are no evidence-based guidelines regarding the optimal strategy for dietary intervention before pregnancy. SUBJECTS/METHODS We used a murine model to study whether switching from a high-fat (HF) diet to a normal-fat (NF) diet (H1N group) 1 week before pregnancy could lead to in utero reprogramming of female offspring obesity; comparator groups were offspring given a consistent maternal HF group or NF group until weaning. After weaning, all female offspring were given the HF diet for either 9 or 12 weeks before being killed humanely. RESULTS H1N treatment did not result in maternal weight loss before pregnancy. NF offsprings were neither obese nor glucose intolerant during the entire experimental period. H1N offsprings were most obese after the 12-week postweaning HF diet and displayed glucose intolerance earlier than HF offsprings. Our mechanistic study showed reduced adipocyte insulin receptor substrate 1 (IRS1) and hepatic IRS2 expression and increased adipocyte p-Ser(636/639) and p-Ser(612) of H1N or HF offspring compared with that in the NF offspring. Among all groups, the H1N offspring had lowest level of IRS1 and the highest levels of p-Ser(636/639) and p-Ser(612) in gonadal adipocyte. In addition, the H1N offspring further reduced the expression of Glut4 and Glut2, vs those of the HF offspring, which was lower compared with the NF offspring. There were also enhanced expression of genes inhibiting glycogenesis and decreased hepatic glycogen in H1N vs HF or NF offspring. Furthermore, we showed extremely higher expression of lipogenesis and adipogenesis genes in gonadal adipocytes of H1N offspring compared with all other groups. CONCLUSIONS Our results suggest that a transition from an HF diet to an NF diet shortly before pregnancy, without resulting in maternal weight loss, is not necessarily beneficial and may have deleterious effects on offspring.
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Affiliation(s)
- Q Fu
- Department of Basic Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA.,Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA
| | - P Olson
- Department of Basic Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - D Rasmussen
- Department of Basic Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - B Keith
- Department of Basic Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - M Williamson
- Department of Basic Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - K K Zhang
- Department of Pathology, University of North Dakota, Grand Forks, ND, USA
| | - L Xie
- Department of Basic Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA.,Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA
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37
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Tielemans MJ, Erler NS, Leermakers ETM, van den Broek M, Jaddoe VWV, Steegers EAP, Kiefte-de Jong JC, Franco OH. A Priori and a Posteriori Dietary Patterns during Pregnancy and Gestational Weight Gain: The Generation R Study. Nutrients 2015; 7:9383-99. [PMID: 26569303 PMCID: PMC4663604 DOI: 10.3390/nu7115476] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/29/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023] Open
Abstract
Abnormal gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We examined whether dietary patterns are associated with GWG. Participants included 3374 pregnant women from a population-based cohort in the Netherlands. Dietary intake during pregnancy was assessed with food-frequency questionnaires. Three a posteriori-derived dietary patterns were identified using principal component analysis: a "Vegetable, oil and fish", a "Nuts, high-fiber cereals and soy", and a "Margarine, sugar and snacks" pattern. The a priori-defined dietary pattern was based on national dietary recommendations. Weight was repeatedly measured around 13, 20 and 30 weeks of pregnancy; pre-pregnancy and maximum weight were self-reported. Normal weight women with high adherence to the "Vegetable, oil and fish" pattern had higher early-pregnancy GWG than those with low adherence (43 g/week (95% CI 16; 69) for highest vs. lowest quartile (Q)). Adherence to the "Margarine, sugar and snacks" pattern was associated with a higher prevalence of excessive GWG (OR 1.45 (95% CI 1.06; 1.99) Q4 vs. Q1). Normal weight women with higher scores on the "Nuts, high-fiber cereals and soy" pattern had more moderate GWG than women with lower scores (-0.01 (95% CI -0.02; -0.00) per SD). The a priori-defined pattern was not associated with GWG. To conclude, specific dietary patterns may play a role in early pregnancy but are not consistently associated with GWG.
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Affiliation(s)
- Myrte J Tielemans
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Nicole S Erler
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Elisabeth T M Leermakers
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Marion van den Broek
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- Department of Global Public Health, Leiden University College the Hague, P.O. Box 13228, 2501 EE the Hague, The Netherlands.
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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