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Philippe K, Teo SM, Perrotta C, McAuliffe FM, Phillips CM. Why do preconception and pregnancy lifestyle interventions demonstrate limited success in preventing overweight and obesity in children? A scoping review investigating intervention complexity, process evaluation components, and author interpretations. Obes Rev 2024:e13822. [PMID: 39198996 DOI: 10.1111/obr.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 07/08/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024]
Abstract
Preventing childhood obesity from early life is considered essential. However, evidence from recent systematic reviews has highlighted inconsistent results and limited effectiveness of preconception and pregnancy lifestyle interventions regarding offspring weight outcomes and adiposity. Therefore, to improve our understanding regarding the mixed success of these early life interventions, we conducted a scoping review examining intervention complexity, process evaluation components, and authors' statements. Eligible articles (preconception or pregnancy lifestyle trials with offspring data beyond 1 month of age) were identified by searching databases (PubMed, Embase, and CENTRAL), previous reviews, and performing CLUSTER searches. The Intervention Complexity Assessment Tool for Systematic Reviews (iCAT_SR) was used to evaluate intervention complexity. A thematic analysis provided insight into process evaluation components and authors' interpretations. Finally, an expert consultation on the results was conducted. We identified 40 eligible publications corresponding to 27 trials. Only two trials started before conception. Potential reasons for interventions' limited success included the late intervention initiation, short intervention duration, and insufficient sample size. Few studies reported process evaluations and included stakeholder involvement, which are essential according to the expert group. We discuss current limitations and outline suggestions for future interventions in this field of research.
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Affiliation(s)
- Kaat Philippe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Shevaun M Teo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Carla Perrotta
- 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
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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2
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Burden SJ, Alshehri R, Lamata P, Poston L, Taylor PD. Maternal obesity and offspring cardiovascular remodelling - the effect of preconception and antenatal lifestyle interventions: a systematic review. Int J Obes (Lond) 2024; 48:1045-1064. [PMID: 38898228 PMCID: PMC11281905 DOI: 10.1038/s41366-024-01536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Preconception or antenatal lifestyle interventions in women with obesity may prevent adverse cardiovascular outcomes in the child, including cardiac remodelling. We undertook a systematic review of the existing data to examine the impact of randomised controlled trials of lifestyle interventions in pregnant women with obesity on offspring cardiac remodelling and related parameters of cardiovascular health. METHODS This review was registered with PROSPERO (CRD42023454762) and aligns with PRISMA guidelines. PubMed, Embase, and previous reviews were systematically searched. Follow-up studies from randomised trials of lifestyle interventions in pregnant women with obesity, which included offspring cardiac remodelling or related cardiovascular parameters as outcome measures, were included based on pre-defined inclusion criteria. RESULTS Eight studies from five randomised controlled trials were included after screening 3252 articles. Interventions included antenatal exercise (n = 2), diet and physical activity (n = 2), and preconception diet and physical activity (n = 1). Children were <2-months to 3-7-years-old, with sample sizes ranging between n = 18-404. Reduced cardiac remodelling, with reduced interventricular septal wall thickness, was consistently reported. Some studies identified improved systolic and diastolic function and a reduced resting heart rate. Risk of bias analyses rated all studies as 'fair' (some risk of bias). A high loss-to-follow-up was a common limitation. CONCLUSION Although there is some evidence to suggest that lifestyle interventions in women with obesity may limit offspring cardiac remodelling, further high-quality longitudinal studies with larger sample sizes are required to confirm these observations and to determine whether these changes persist to adulthood. Child offspring cardiovascular health benefits of preconception and antenatal lifestyle interventions in women with obesity.
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Affiliation(s)
- Samuel J Burden
- Department of Women and Children's Health, School of Life Course & Population Sciences, King's College London, London, UK.
| | - Rahaf Alshehri
- Cardiovascular Medicine and Science Research, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
| | - Pablo Lamata
- Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
| | - Paul D Taylor
- Department of Women and Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
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Lavelle F, McKernan C, Shrewsbury V, Wolfson JA, Taylor RM, Duncanson K, Martins CA, Elliott C, Collins CE. An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland. J Hum Nutr Diet 2024; 37:927-942. [PMID: 38606553 DOI: 10.1111/jhn.13307] [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: 08/09/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. RESULTS Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. CONCLUSIONS Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.
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Affiliation(s)
- Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - Claire McKernan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachael M Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Carla A Martins
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
- Institute of Food and Nutrition, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Christopher Elliott
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Dalrymple KV, Briley AL, Tydeman FAS, Seed PT, Singh CM, Flynn AC, White SL, Poston L. Breastfeeding behaviours in women with obesity; associations with weight retention and the serum metabolome: a secondary analysis of UPBEAT. Int J Obes (Lond) 2024:10.1038/s41366-024-01576-6. [PMID: 39048696 DOI: 10.1038/s41366-024-01576-6] [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: 02/20/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND/OBJECTIVES Maternal obesity is associated with a decreased intention and initiation of breastfeeding as well as a shortened duration of breastfeeding. This analysis was undertaken to identify breastfeeding behaviours, and relationships with maternal anthropometry and the serum metabolome at 6-months postpartum in an ethnically diverse cohort of women with obesity. SUBJECTS/METHODS A cohort analysis of 715 women from the UK Pregnancies Better Eating and Activity Trial (UPBEAT); a multi-centre randomised controlled trial of an antenatal lifestyle intervention in women with obesity. Maternal data were collected in early pregnancy and included body mass index (BMI), socio-demographic characteristics and anthropometry. At 6-months postpartum, breastfeeding behaviours, anthropometry and 158 maternal metabolic measures from blood samples were recorded. Kaplan-Meier curves of breastfeeding duration were constructed and were stratified by obesity class (I: BMI 30.0-34.9 kg/m2, II: 35.0-39.9 kg/m2, III: ≥40.0 kg/m2). Relationships between breastfeeding behaviours, socio-demographic characteristics, the metabolome, and anthropometry were determined using regression analyses. RESULTS Eighty-two percent (591/715) of the cohort-initiated breastfeeding and at the 6-month follow-up 40% (283/715) were breastfeeding exclusively or partially. Duration of exclusive breastfeeding decreased with increasing BMI: Compared to BMI class I (mean 90.4 ± 64 days) the difference in mean for classes II and III were -15.8 days (95% confidence interval: -28.5, -3.1, p < 0.05) and -16.7 (95% CI: -32.0 to -1.35, p < 0.05), respectively. Compared to no breastfeeding, any breastfeeding at 6-months postpartum was associated with improvements in metabolites towards a healthier profile, reduced weight retention by -1.81 kg (95% CI -0.75, -2.88, p < 0.05 ) and reduced anthropometric measures, including mid-upper arm and hip circumferences. The breastfeeding related changes in anthropometry were not evident in women of Black ethnicity. CONCLUSIONS Greater emphasis on enabling breastfeeding for women with obesity could improve duration, women's weight management and metabolic health. The lack of breastfeeding related anthropometric effects in Black women requires further investigation. CLINICAL TRIAL REGISTRY ISRCTN reference 89971375.
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Affiliation(s)
- Kathryn V Dalrymple
- Department of Nutritional Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
| | - Annette L Briley
- Caring Futures Institute, CHNS, Flinders University, Adelaide, SA, Australia
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Florence A S Tydeman
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Claire M Singh
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Angela C Flynn
- Department of Nutritional Sciences, School of Life Course and Population Sciences, King's College London, London, UK
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sara L White
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
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Santos IS, Carvalho MR, Baroni NF, Crivellenti LC, Sartorelli DS. Effectiveness of nutritional counseling with overweight pregnant women on child growth at 6 months: A randomized controlled trial. Nutrition 2024; 123:112426. [PMID: 38581846 DOI: 10.1016/j.nut.2024.112426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Studies that have investigated the effect of nutritional counseling during the prenatal period on the follow-up outcomes of children at 6 mo have produced inconclusive results. The present study aimed to investigate the effect of nutritional counseling, based on the NOVA food classification, encouraging the consumption of fresh and minimally processed foods, with overweight adult pregnant women on infant growth at 6 mo of age. METHODS A randomized controlled trial with 195 pairs of pregnant overweight women and their infants at 6 mo of age was conducted in a Brazilian municipality. The pregnant women were allocated to the control group (CG) or intervention group (IG) at the beginning of the pregnancy. The IG received three sessions of nutrition counseling throughout the pregnancy. Linear regression models were used to investigate the effect of the nutritional counseling on infant growth. RESULTS One hundred ninety-five mother-infant pairs with complete data were included (96 CG, and 99 IG). The mean ± SD infant weight (g) at 6 mo was 7856.1 ± 1.1, and length (cm) was 67.0 ± 2.9. There were no differences in maternal and newborn characteristics between the groups. In the linear regression models, the counseling had no effect on anthropometric parameters of the infants at 6 mo of age: weight-for-length Z-score (β 0.089 [95% CI -0.250; 0.427], P = 0.61); length-for-age Z-score (β 0.032 [95% CI -0.299; 0.363], P = 0.85); weight-for-age Z-score (β 0.070 [95% CI -0.260; 0.400], P = 0.68); BMI-age Z-score (β 0.072 [95% CI -0.270; 0.414], P = 0.68). CONCLUSIONS There was no effect on infant growth at 6 mo of age after the nutritional counseling during pregnancy. Future studies are needed to confirm this hypothesis.
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Affiliation(s)
- Izabela S Santos
- Programa de Pós-Graduação em Nutrição e Metabolismo, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mariana R Carvalho
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Naiara F Baroni
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lívia C Crivellenti
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela S Sartorelli
- Programa de Pós-Graduação em Nutrição e Metabolismo, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil; Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil; Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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Barakat R, Silva-José C, Sánchez-Polán M, Zhang D, Lobo P, De Roia G, Montejo R. Physical Activity during Pregnancy and Childhood Obesity: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3726. [PMID: 38999292 PMCID: PMC11242316 DOI: 10.3390/jcm13133726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/03/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
Background and Objectives: The repercussions of childhood overweight and obesity are multifaceted, extending beyond the realm of physiology and giving rise to psychological and emotional disturbances in affected children. The precise effects of gestational physical activity (PA) on parameters related to childhood overweight and obesity remain inadequately understood. The aim of this study (Registration CRD42022372490) was to evaluate the literature regarding the influence of PA during pregnancy on the risk of childhood overweight and obesity. Materials and Methods: Only randomized controlled trials (RCTs) were considered for inclusion. Determinant parameters of childhood obesity were analyzed. A total of 30 studies involving 16,137 pregnant women were examined. Five meta-analyses about the effects of PA during pregnancy on determinants of childhood overweight and obesity were conducted. Results: Although favorable trends were observed, Meta-Analyses showed no statistical differences in the effects of PA on weight at birth (Z = 0.03, p = 0.97), Ponderal Index at birth (Z = 0.64, p = 0.52), Macrosomia and Large for Gestational Age at birth (Z = 0.93, p = 0.35), children's BMI (Z = 0.78, p = 0.44), weight (Z = 0.50, p = 0.62), and skinfold thicknesses (Z = 0.45, p = 0.65). Conclusions: The engagement in physical activity during pregnancy exhibits a favorable trend in parameters associated with childhood overweight and obesity while presenting no adverse effects on such outcomes.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miguel Sánchez-Polán
- GICAF Research Group, Department of Education, Research and Evaluation Methods, Universidad Pontificia Comillas, 28049 Madrid, Spain
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Pablo Lobo
- Laboratorio de Estudios en Actividad Física (LEAF), Universidad de Flores (UFLO), Buenos Aires C1406, Argentina
| | - Gabriela De Roia
- Laboratorio de Estudios en Actividad Física (LEAF), Universidad de Flores (UFLO), Buenos Aires C1406, Argentina
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Wagner KA, Whitcomb BW, Marcus B, Pekow P, Rosal MC, Leidy Sievert L, Tucker KL, Manson JE, Chasan-Taber L. The impact of a lifestyle intervention on postpartum weight retention among US Hispanic women with overweight and obesity. Prev Med Rep 2024; 38:102633. [PMID: 38375164 PMCID: PMC10874874 DOI: 10.1016/j.pmedr.2024.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction To evaluate the effect of a culturally-modified, motivationally-targeted, individually-tailored lifestyle intervention on postpartum weight retention among Hispanic women with overweight/obesity. Materials and methods Proyecto Mamá was a randomized controlled trial conducted in western Massachusetts (2014-2020). Hispanic women with overweight/obese pre-pregnancy BMI (n = 148) were randomized in early pregnancy to a Lifestyle Intervention (LI) or a Health & Wellness (HW) comparison arm. The LI was based upon theoretical concepts, used a low-cost, high-reach strategy, and focused on healthy exercise and diet with follow-up through 12-months postpartum. The primary outcome of change in weight was calculated as the difference between pre-pregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of 5 % weight reduction from pre-pregnancy weight. Retention was 68.2 % in the overall postpartum period and 31.0 % at 12-months. Results In intent-to-treat analyses, compared to the HW arm, there was no difference in postpartum weight retention at 6-weeks (0.0 kg, 95 % CI: -3.4, 3.5), 6-months (-1.8 kg, 95 % CI: -5.6, 2.0), or 12-months (-2.0 kg, 95 % CI: -7.0, 3.1). In a secondary complete case analysis, compared to the HW arm, the LI arm had 5.5 times higher odds of meeting the postpartum weight reduction goal (aOR = 5.5, 95 % CI: 1.7, 17.9) adjusting for pre-pregnancy weight. Conclusions A lifestyle intervention among at-risk Hispanic women with overweight/obesity had no overall impact on postpartum weight, but a beneficial impact among those who completed the trial. Future studies should focus on increasing the feasibility and acceptability of the intervention in this at-risk population.
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Affiliation(s)
- Kathryn A. Wagner
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Brian W. Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Lynnette Leidy Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States of America
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
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Lyons-Reid J, Derraik JGB, Kenealy T, Albert BB, Ramos Nieves JM, Monnard CR, Titcombe P, Nield H, Barton SJ, El-Heis S, Tham E, Godfrey KM, Chan SY, Cutfield WS. Impact of preconception and antenatal supplementation with myo-inositol, probiotics, and micronutrients on offspring BMI and weight gain over the first 2 years. BMC Med 2024; 22:39. [PMID: 38287349 PMCID: PMC10826220 DOI: 10.1186/s12916-024-03246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Nutritional intervention preconception and throughout pregnancy has been proposed as an approach to promoting healthy postnatal weight gain in the offspring but few randomised trials have examined this. METHODS Measurements of weight and length were obtained at multiple time points from birth to 2 years among 576 offspring of women randomised to receive preconception and antenatally either a supplement containing myo-inositol, probiotics, and additional micronutrients (intervention) or a standard micronutrient supplement (control). We examined the influence on age- and sex-standardised BMI at 2 years (WHO standards, adjusting for study site, sex, maternal parity, smoking and pre-pregnancy BMI, and gestational age), together with the change in weight, length, BMI from birth, and weight gain trajectories using latent class growth analysis. RESULTS At 2 years, there was a trend towards lower mean BMI among intervention offspring (adjusted mean difference [aMD] - 0.14 SD [95% CI 0.30, 0.02], p = 0.09), and fewer had a BMI > 95th percentile (i.e. > 1.65 SD, 9.2% vs 18.0%, adjusted risk ratio [aRR] 0.51 [95% CI 0.31, 0.82], p = 0.006). Longitudinal data revealed that intervention offspring had a 24% reduced risk of experiencing rapid weight gain > 0.67 SD in the first year of life (21.9% vs 31.1%, aRR 0.76 [95% CI 0.58, 1.00], p = 0.047). The risk was likewise decreased for sustained weight gain > 1.34 SD in the first 2 years of life (7.7% vs 17.1%, aRR 0.55 [95% CI 0.34, 0.88], p = 0.014). From five weight gain trajectories identified, there were more intervention offspring in the "normal" weight gain trajectory characterised by stable weight SDS around 0 SD from birth to 2 years (38.8% vs 30.1%, RR 1.29 [95% CI 1.03, 1.62], p = 0.029). CONCLUSIONS Supplementation with myo-inositol, probiotics, and additional micronutrients preconception and in pregnancy reduced the incidence of rapid weight gain and obesity at 2 years among offspring. Previous reports suggest these effects will likely translate to health benefits, but longer-term follow-up is needed to evaluate this. TRIAL REGISTRATION ClinicalTrials.gov, NCT02509988 (Universal Trial Number U1111-1171-8056). Registered on 16 July 2015.
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Affiliation(s)
- Jaz Lyons-Reid
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Timothy Kenealy
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Medicine and Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | - Benjamin B Albert
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - J Manuel Ramos Nieves
- Nestlé Institute of Health Sciences, Nestlé Research, Société Des Produits Nestlé S.A, Lausanne, Switzerland
| | - Cathriona R Monnard
- Nestlé Institute of Health Sciences, Nestlé Research, Société Des Produits Nestlé S.A, Lausanne, Switzerland
| | - Phil Titcombe
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Heidi Nield
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Tham
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University of Singapore, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University of Singapore, Singapore, Singapore
| | - Wayne S Cutfield
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
- A Better Start - National Science Challenge, The University of Auckland, Auckland, New Zealand.
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Díaz-Rodríguez M, Pérez-Muñoz C, Carretero-Bravo J, Santi-Cano MJ, Carrasco-Sánchez P, Barroso-Chirino C, Ferriz-Mas BC. Impact of an early 1000-day intervention for obesity prevention on adiposity and BMI at two years of age: A quasi-experimental study. J Glob Health 2023; 13:04145. [PMID: 38085237 PMCID: PMC10715455 DOI: 10.7189/jogh.13.04145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background The 1000-day period encompassing pregnancy and the first two years of postnatal life is critical for preventing childhood obesity. Existing interventions targeting this period have been characterised by great variability in duration, objectives, and evaluation indicators. We aimed to evaluate the impact of an intervention developed during the entire 1000-day period on body mass index and body fat percentage at two years of age. Methods We designed a prospective, interventional, quasi-experimental study (ie, without randomisation or blinding of both groups) targeting mother-child pairs from the beginning of pregnancy up to two years of age belonging to the basic health area of Puerto Real (Cádiz). We developed and delivered an intervention from pregnancy to two years and assessed its effect. Results The duration of breastfeeding and vitamin D supplementation increased significantly after the intervention. The intervention group showed lowed skinfolds values, a significantly lower body fat percentage, as well as a lower accumulation of factor at two years than the control group. Conclusions The intervention has had an impact on body fat percentage at two years, potentially justified through its overall effect and the lower accumulation of early risk factors.
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Affiliation(s)
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
| | - Jesús Carretero-Bravo
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
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10
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Sainty R, Silver MJ, Prentice AM, Monk D. The influence of early environment and micronutrient availability on developmental epigenetic programming: lessons from the placenta. Front Cell Dev Biol 2023; 11:1212199. [PMID: 37484911 PMCID: PMC10358779 DOI: 10.3389/fcell.2023.1212199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
DNA methylation is the most commonly studied epigenetic mark in humans, as it is well recognised as a stable, heritable mark that can affect genome function and influence gene expression. Somatic DNA methylation patterns that can persist throughout life are established shortly after fertilisation when the majority of epigenetic marks, including DNA methylation, are erased from the pre-implantation embryo. Therefore, the period around conception is potentially critical for influencing DNA methylation, including methylation at imprinted alleles and metastable epialleles (MEs), loci where methylation varies between individuals but is correlated across tissues. Exposures before and during conception can affect pregnancy outcomes and health throughout life. Retrospective studies of the survivors of famines, such as those exposed to the Dutch Hunger Winter of 1944-45, have linked exposures around conception to later disease outcomes, some of which correlate with DNA methylation changes at certain genes. Animal models have shown more directly that DNA methylation can be affected by dietary supplements that act as cofactors in one-carbon metabolism, and in humans, methylation at birth has been associated with peri-conceptional micronutrient supplementation. However, directly showing a role of micronutrients in shaping the epigenome has proven difficult. Recently, the placenta, a tissue with a unique hypomethylated methylome, has been shown to possess great inter-individual variability, which we highlight as a promising target tissue for studying MEs and mixed environmental exposures. The placenta has a critical role shaping the health of the fetus. Placenta-associated pregnancy complications, such as preeclampsia and intrauterine growth restriction, are all associated with aberrant patterns of DNA methylation and expression which are only now being linked to disease risk later in life.
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Affiliation(s)
- Rebecca Sainty
- Biomedical Research Centre, School of Biological Sciences, University of East Anglia, Norwich, United Kingdom
| | - Matt J. Silver
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - David Monk
- Biomedical Research Centre, School of Biological Sciences, University of East Anglia, Norwich, United Kingdom
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11
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Fortin-Miller S, Plonka B, Gibbs H, Christifano D, Hull H. Prenatal interventions and the development of childhood obesity. Pediatr Obes 2023; 18:e12981. [PMID: 36104864 DOI: 10.1111/ijpo.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Excess maternal adiposity during pregnancy has lasting effects on child outcomes including increased risk of overweight/obesity, which drives disease development. Prenatal interventions are a potential avenue to curb childhood obesity rates, but little is known on their long-term influence on offspring adiposity. OBJECTIVE Review the evidence for lasting effects of prenatal interventions on child adiposity. METHODS Three databases were searched for follow-up studies of completed prenatal RCTs that involved a diet, exercise, or combined (diet and exercise) intervention, and assessed offspring adiposity-related outcomes beyond birth. RESULTS A total of 18 follow-up studies describing 4277 offspring were included. Anthropometrics were collected in all studies while body composition was measured in 15 of the studies. Diet or exercise interventions did not have a consistent significant effect on child adiposity. Three combined interventions resulted in lower levels of child adiposity at 3, 6, and 12 months. CONCLUSIONS No strong association was found between prenatal diet, exercise, or combined interventions and child adiposity. Data are limited due to 63.6% overall retention rate for the follow-up studies and heterogeneity of intervention approach and child adiposity measures. Findings suggest combined interventions initiated early in pregnancy may decrease offspring adiposity in the first year of life.
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Affiliation(s)
- Sara Fortin-Miller
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brendel Plonka
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Heather Gibbs
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Danielle Christifano
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Holly Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
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12
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Eagleton SG, Shriver LH, Buehler C, Wideman L, Leerkes EM. Longitudinal Associations Among Food Insecurity During Pregnancy, Parental Mental Health Symptoms, Controlling Feeding Styles, and Infant Food Responsiveness. J Nutr 2023; 152:2659-2668. [PMID: 36166350 PMCID: PMC9840003 DOI: 10.1093/jn/nxac225] [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: 03/24/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood. OBJECTIVES This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive). METHODS Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness. RESULTS Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness. CONCLUSIONS Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.
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Affiliation(s)
- Sally G Eagleton
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Lenka H Shriver
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Cheryl Buehler
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Esther M Leerkes
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
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13
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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14
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Michońska I, Łuszczki E, Zielińska M, Oleksy Ł, Stolarczyk A, Dereń K. Nutritional Programming: History, Hypotheses, and the Role of Prenatal Factors in the Prevention of Metabolic Diseases-A Narrative Review. Nutrients 2022; 14:4422. [PMID: 36297106 PMCID: PMC9607048 DOI: 10.3390/nu14204422] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Childhood obesity and the numerous lifestyle diseases associated with it are undoubtedly among the key problems in modern medicine and public health. However, this problem concerns not only the present or immediate future, but also the longer term. Adult health is fundamentally shaped in the first years of life and in the fetal period. The preconceptual period, which is responsible for the proper preparation of the internal environment for the life and development of the fetus during pregnancy, is also significant. A special role in describing the phenomenon of conditioning the metabolism of the new human being is now attributed to the theory of nutritional programming. Research in this area was pioneered by David Barker, who put forward the theory of the "stunted phenotype" and described the relationship between a child's birth weight, which is largely a consequence of the mother's feeding behaviour, and diseases such as ischaemic heart disease, type 2 diabetes (T2D), dyslipidemia, or high blood pressure. This narrative review aims to provide an overview of the history, theory, and prenatal mechanisms involved in nutritional programming and its relationship to childhood obesity and other metabolic diseases.
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Affiliation(s)
- Izabela Michońska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Edyta Łuszczki
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Magdalena Zielińska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Łukasz Oleksy
- Faculty of Health Sciences, Department of Physiotherapy, Jagiellonian University Medical College Krakow, 31-008 Krakow, Poland
| | - Artur Stolarczyk
- Orthopedic and Rehabilitation Department, Medical Faculty, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Katarzyna Dereń
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
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15
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Programming by maternal obesity: a pathway to poor cardiometabolic health in the offspring. Proc Nutr Soc 2022; 81:227-242. [DOI: 10.1017/s0029665122001914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an ever increasing prevalence of maternal obesity worldwide such that in many populations over half of women enter pregnancy either overweight or obese. This review aims to summarise the impact of maternal obesity on offspring cardiometabolic outcomes. Maternal obesity is associated with increased risk of adverse maternal and pregnancy outcomes. However, beyond this exposure to maternal obesity during development also increases the risk of her offspring developing long-term adverse cardiometabolic outcomes throughout their adult life. Both human studies and those in experimental animal models have shown that maternal obesity can programme increased risk of offspring developing obesity and adipose tissue dysfunction; type 2 diabetes with peripheral insulin resistance and β-cell dysfunction; CVD with impaired cardiac structure and function and hypertension via impaired vascular and kidney function. As female offspring themselves are therefore likely to enter pregnancy with poor cardiometabolic health this can lead to an inter-generational cycle perpetuating the transmission of poor cardiometabolic health across generations. Maternal exercise interventions have the potential to mitigate some of the adverse effects of maternal obesity on offspring health, although further studies into long-term outcomes and how these translate to a clinical context are still required.
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16
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Iglesia Altaba I, Larqué E, Mesa MD, Blanco-Carnero JE, Gomez-Llorente C, Rodríguez-Martínez G, Moreno LA. Early Nutrition and Later Excess Adiposity during Childhood: A Narrative Review. Horm Res Paediatr 2022; 95:112-119. [PMID: 34758469 DOI: 10.1159/000520811] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies on childhood obesity mainly focus on the genetic component and on the lifestyle that may be associated with the development of obesity. However, the study of perinatal factors in their programming effect toward future obesity in children or adults is somewhat more recent, and there are still mechanisms to be disentangled. SUMMARY In this narrative review, a comprehensive route based on the influence of some early factors in life in the contribution to later obesity development is presented. Maternal pre-pregnancy BMI and gestational weight gain have been pointed out as independent determinants of infant later adiposity. Lifestyle interventions could have an impact on pregnant mothers through epigenetic mechanisms capable of redirecting the genetic expression of their children toward a future healthy weight and body composition and dietary-related microbiome modifications in mothers and newborns might also be related. After birth, infant feeding during the first months of life is directly associated with its body composition and nutritional status. From this point of view, all the expert committees in the world are committed to promote exclusive breastfeeding up to 6 months of age and to continue at least until the first year of life together with complementary feeding based on healthy dietary patterns such as Mediterranean Diet. KEY MESSAGES To develop future effective programs to tackle early obesity, it is necessary not only by controlling lifestyle behaviors like infant feeding but also understanding the role of other mechanisms like the effect of perinatal factors such as maternal diet during pregnancy, epigenetics, or microbiome.
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Affiliation(s)
- Iris Iglesia Altaba
- Aragon Health Research Institute, University of Zaragoza, Zaragoza, Spain.,Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Growth, Exercise, Nutrition and Development (GENUD), Faculty of Health Sciences, University of Zaragoza, and Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Elvira Larqué
- Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Department of Physiology, Murcia University, Murcia, Spain
| | - María Dolores Mesa
- Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Department of Biochemistry and Molecular Biology II, School of Pharmacy. Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Granada, Spain.,ibs.GRANADA, Biosanitary Research Institute, Granada, Spain
| | | | - Carolina Gomez-Llorente
- Department of Biochemistry and Molecular Biology II, School of Pharmacy. Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Granada, Spain.,ibs.GRANADA, Biosanitary Research Institute, Granada, Spain.,Center for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerardo Rodríguez-Martínez
- Aragon Health Research Institute, University of Zaragoza, Zaragoza, Spain.,Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Growth, Exercise, Nutrition and Development (GENUD), Faculty of Health Sciences, University of Zaragoza, and Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Department of Pediatrics, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Luis A Moreno
- Aragon Health Research Institute, University of Zaragoza, Zaragoza, Spain.,Growth, Exercise, Nutrition and Development (GENUD), Faculty of Health Sciences, University of Zaragoza, and Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Center for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
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Alves-Wagner AB, Kusuyama J, Nigro P, Ramachandran K, Makarewicz N, Hirshman MF, Goodyear LJ. Grandmaternal exercise improves metabolic health of second-generation offspring. Mol Metab 2022; 60:101490. [PMID: 35398278 PMCID: PMC9036117 DOI: 10.1016/j.molmet.2022.101490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/11/2022] [Accepted: 03/28/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE A major factor in the growing world-wide epidemic of obesity and type 2 diabetes is the increased risk of transmission of metabolic disease from obese mothers to both first (F1) and second (F2) generation offspring. Fortunately, recent pre-clinical studies demonstrate that exercise before and during pregnancy improves F1 metabolic health, providing a potential means to disrupt this cycle of disease. Whether the beneficial effects of maternal exercise can also be transmitted to the F2 generation has not been investigated. METHODS C57BL/6 female mice were fed a chow or high-fat diet (HFD) and housed in individual cages with or without running wheels for 2 wks before breeding and during gestation. Male F1 offspring were sedentary and chow-fed, and at 8-weeks of age were bred with age-matched females from untreated parents. This resulted in 4 F2 groups based on grandmaternal treatment: chow sedentary; chow trained; HFD sedentary; HFD trained. F2 were sedentary and chow-fed and studied up to 52-weeks of age. RESULTS We find that grandmaternal exercise improves glucose tolerance and decreases fat mass in adult F2 males and females, in the absence of any treatment intervention of the F1 after birth. Grandmaternal exercise also improves F2 liver metabolic function, including favorable effects on gene and miRNA expression, triglyceride concentrations and hepatocyte glucose production. CONCLUSION Grandmaternal exercise has beneficial effects on the metabolic health of grandoffspring, demonstrating an important means by which exercise during pregnancy could help reduce the worldwide incidence of obesity and type 2 diabetes.
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Affiliation(s)
| | | | | | | | | | | | - Laurie J. Goodyear
- Corresponding author. Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
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18
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Haby K, Gyllensten H, Hanas R, Berg M, Premberg Å. A Lifestyle Intervention During Pregnancy and Its Effects on Child Weight 2.5 Years Later. Matern Child Health J 2022; 26:1881-1890. [PMID: 35253077 PMCID: PMC9374787 DOI: 10.1007/s10995-022-03395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
Aim The aim of this study was to evaluate if overweight and obesity in the offspring is reduced by a low-intensity antenatal primary care intervention with focus on diet and physical activity for pregnant women with obesity, comparing children to mothers receiving the intervention with children to mothers who did not. Methods This study is a follow-up of children 2.5 years of age after their mothers’ participation in a non-randomised controlled intervention intending to limit gestational weight gain. All study participants received standard antenatal care. The intervention group received lifestyle support via motivational talks with midwife and support from dietician. Data on child weight were collected by medical records, letter and phone. Results There was no significant difference between the groups 2.5 years after intervention (International Obesity Task Force ISO-BMI 25 (child BMI corresponding to adult BMI of 25): 20% vs. 21%; ISO-BMI 30: 4.6% vs. 1.3%). The mother’s BMI at the beginning of pregnancy significantly influenced child BMI at 2.5 years (r = 0.13, p = 0.014, r2 = 0.017). For each unit of increase in maternal BMI at enrollment, the probability of child ISO-BMI ≥ 25 increased by 7.5% (p = 0.021) and of ≥ 30, by 12.9% (p = 0.017). Conclusion The frequency of overweight and obesity of the children at 2.5 years of age was significantly correlated to the mother’s BMI, but not correlated to the mothers’ participation in the antenatal lifestyle intervention. Thus, it seems important to address obesity and lifestyle issues before and between pregnancies. Trial registration The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03395-5.
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Affiliation(s)
- Karin Haby
- Antenatal Health Care, Primary Health Care, Research and Development Unit, Regionhälsan, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Primary Health Care and Research and Development Unit, Regionhälsan, Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ragnar Hanas
- Department of Paediatrics, NU Hospital Group, Uddevalla, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Premberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Health Care and Research and Development Unit, Regionhälsan, Gothenburg, Region Västra Götaland, Sweden
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19
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Stevanović-Silva J, Beleza J, Coxito P, Costa RC, Ascensão A, Magalhães J. Fit mothers for a healthy future: Breaking the intergenerational cycle of non-alcoholic fatty liver disease with maternal exercise. Eur J Clin Invest 2022; 52:e13596. [PMID: 34120338 DOI: 10.1111/eci.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED SPECIAL ISSUE: 'FOIEGRAS-Bioenergetic Remodelling in the Pathophysiology and Treatment of Non-Alcoholic Fatty Liver Disease'. BACKGROUND Non-alcoholic fatty liver disease (NAFLD) emerges as significant health burden worldwide. Lifestyle changes, unhealthy dietary habits and physical inactivity, can trigger NAFLD development. Persisting on these habits during pregnancy affects in utero environment and prompts a specific metabolic response in foetus resulting in offspring metabolic maladjustments potentially critical for developing NAFLD later in life. The increasing prevalence of NAFLD, particularly in children, has shifted the research focus towards preventive and therapeutic strategies. Yet, designing effective approaches that can break the NAFLD intergenerational cycle becomes even more complicated. Regular physical exercise (PE) is a powerful non-pharmacological strategy known to counteract deleterious metabolic outcomes. In this narrative review, we aimed to briefly describe NAFLD pathogenesis focusing on maternal nutritional challenge and foetal programming, and to provide potential mechanisms behind the putative intergenerational effect of PE against metabolic diseases, including liver diseases. METHODS Following detailed electronic database search, recent existing evidence about NAFLD development, intergenerational programming and gestational exercise effects was critically analysed and discussed. RESULTS PE during pregnancy could have a great potential to counteract intergenerational transmission of metabolic burden. The interplay between different PE roles-metabolic, endocrine and epigenetic-could offer a more stable in utero environment to the foetus, thus rescuing offspring vulnerability to metabolic disturbances. CONCLUSIONS The better understanding of maternal PE beneficial consequences on offspring metabolism could reinforce the importance of PE during pregnancy as an indispensable strategy in improving offspring health.
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Affiliation(s)
- Jelena Stevanović-Silva
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - Jorge Beleza
- Department of Cell Biology, Physiology & Immunology, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Pedro Coxito
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - Rui Carlos Costa
- Department of Communication and Art, Research Institute for Design, Media and Culture (ID+), Aveiro University, Aveiro, Portugal
| | - António Ascensão
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
| | - José Magalhães
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal
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20
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Sarni ROS, Kochi C, Suano-Souza FI. Childhood obesity: an ecological perspective. J Pediatr (Rio J) 2022; 98 Suppl 1:S38-S46. [PMID: 34780713 PMCID: PMC9510906 DOI: 10.1016/j.jped.2021.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence worldwide, including in Brazil. DATA SOURCE Survey of articles published in the last 10 years in PubMed, evaluating the interface between the environment and childhood obesity. DATA SYNTHESIS Recent studies show that the environment is very important in the etiopathogenesis of obesity and its comorbidities. Therefore, factors such as air pollution, exposure to chemical substances that interfere with the metabolism, excessive consumption of ultra-processed foods, changes in the intestinal microbiota, and sedentary lifestyle are associated with increased obesity, insulin resistance, type 2 diabetes, and changes in lipid metabolism. These factors have a greater impact on some stages of life, such as the first thousand days, as they affect the expression of genes that control the adipogenesis, energy expenditure, and the mechanisms for hunger/satiety control. CONCLUSIONS Environmental aspects must be taken into account in the prevention and treatment of childhood obesity, both from the individual and the population point of view, with adequate and comprehensive public health policies.
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Affiliation(s)
- Roseli Oselka Saccardo Sarni
- Centro Universitário Faculdade de Medicina do ABC (FMABC), Departamento de Pediatria, Santo André, SP, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Cristiane Kochi
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Departamento de Medicina Interna-Pediatria, São Paulo, SP, Brazil
| | - Fabiola Isabel Suano-Souza
- Centro Universitário Faculdade de Medicina do ABC (FMABC), Departamento de Pediatria, Santo André, SP, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina, Departamento de Pediatria, São Paulo, SP, Brazil.
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21
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Liney T, Shah NM, Singh N. Recurrent gestational diabetes : Breaking the transgenerational cycle with lifestyle modification. Wien Klin Wochenschr 2022; 134:788-798. [PMID: 35147773 DOI: 10.1007/s00508-022-02004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This literature review is aimed at examining the benefits of lifestyle modifications in preventing recurrent gestational diabetes (GDM). Worldwide GDM affects approximately 16.2% of all pregnancies with significant maternal, fetal and neonatal complications. Almost two thirds of pregnant women with GDM will develop type 2 diabetes mellitus (T2DM) in the years following pregnancy. The proportion of women affected by GDM is on the rise and reflects increasing trends in T2DM as well as adult and childhood obesity. METHODS Using predefined subject headings, we searched for relevant articles from the PubMed, Scopus, and Cochrane databases. RESULTS For high-risk women lifestyle modifications, such as dietary and exercise changes, are the mainstay of treatment to reduce negative outcomes for both women and their pregnancies. This includes reducing the incidence of recurrent GDM and future T2DM by intervening during pregnancy and in the postnatal period. CONCLUSION This review provides an overview of the literature to date, discusses different targeted approaches and how these interventions can optimise their benefits, and where further research is required.
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Affiliation(s)
- Thomas Liney
- The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, UB8 3NN, Uxbridge, UK
| | - Nishel M Shah
- Imperial College London, Academic Department of Obstetrics & Gynaecology, Level 3, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK
| | - Natasha Singh
- Imperial College London, Academic Department of Obstetrics & Gynaecology, Level 3, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
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22
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The Effects of a Preconception Lifestyle Intervention on Childhood Cardiometabolic Health—Follow-Up of a Randomized Controlled Trial. Cells 2021; 11:cells11010041. [PMID: 35011603 PMCID: PMC8750944 DOI: 10.3390/cells11010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Maternal obesity is associated with adverse metabolic outcomes in her offspring, from the earliest stages of development leading to obesity and poorer cardiometabolic health in her offspring. We investigated whether an effective preconception lifestyle intervention in obese women affected cardiometabolic health of their offspring. We randomly allocated 577 infertile women with obesity to a 6-month lifestyle intervention, or to prompt infertility management. Of the 305 eligible children, despite intensive efforts, 17 in the intervention and 29 in the control group were available for follow-up at age 3–6 years. We compared the child’s Body Mass Index (BMI) Z score, waist and hip circumference, body-fat percentage, blood pressure Z scores, pulse wave velocity and serum lipids, glucose and insulin concentrations. Between the intervention and control groups, the mean (±SD) offspring BMI Z score (0.69 (±1.17) vs. 0.62 (±1.04)) and systolic and diastolic blood pressure Z scores (0.45 (±0.65) vs. 0.54 (±0.57); 0.91 (±0.66) vs. 0.96 (±0.57)) were similar, although elevated compared to the norm population. We also did not detect any differences between the groups in the other outcomes. In this study, we could not detect effects of a preconception lifestyle intervention in obese infertile women on the cardiometabolic health of their offspring. Low follow-up rates, perhaps due to the children’s age or the subject matter, combined with selection bias abating contrast in periconceptional weight between participating mothers, hampered the detection of potential effects. Future studies that account for these factors are needed to confirm whether a preconception lifestyle intervention may improve the cardiometabolic health of children of obese mothers.
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23
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Ventura AK, Phelan S, Silva Garcia K. Maternal Diet During Pregnancy and Lactation and Child Food Preferences, Dietary Patterns, and Weight Outcomes: a Review of Recent Research. Curr Nutr Rep 2021; 10:413-426. [PMID: 34383279 DOI: 10.1007/s13668-021-00366-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Efforts to promote children's preferences for healthy foods hold much potential for improving diet quality and preventing obesity. The purpose of this review was to summarize recent evidence for associations between maternal diet during pregnancy and lactation and child food preferences, dietary patterns, and weight outcomes. RECENT FINDINGS Recent research illustrates greater maternal vegetable intakes during pregnancy and lactation predict greater child preferences for and intakes of vegetables. Recent randomized clinical trials to improve maternal weight outcomes during the perinatal period via behavioral lifestyle interventions that included dietary components have yielded mixed findings for effects on child weight outcomes. There is strong evidence that maternal diet during pregnancy and lactation shapes flavor preferences during infancy; more research is needed to understand factors that facilitate versus hinder the translation of these preferences to later dietary patterns and weight outcomes.
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Affiliation(s)
- Alison K Ventura
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, One Grand Ave, San Luis Obispo, CA, 93407, USA.
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, One Grand Ave, San Luis Obispo, CA, 93407, USA
| | - Karina Silva Garcia
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, One Grand Ave, San Luis Obispo, CA, 93407, USA
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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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25
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The role of maternal diet on offspring hyperinsulinaemia and adiposity after birth: a systematic review of randomised controlled trials. J Dev Orig Health Dis 2021; 13:527-540. [PMID: 34725018 DOI: 10.1017/s2040174421000623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In utero diet may be directly related to the risk of fetal hyperinsulinaemia and offspring metabolic health. This review examines the relationship between maternal dietary exposures and sub-clinical fetal hyperinsulinaemia and neonatal adiposity. Articles were identified in MEDLINE, Web of Science, Cochrane Controlled Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SCOPUS, and SPORTDiscus (September 2019-March 2021) using the preferred reporting items for systematic reviews and meta-analyses guidelines. PROSPERO registration ID CRD42020146453. Studies were selected by two independent reviewers. Randomised controlled trials (RCT) involving a dietary intervention with pregnant women (healthy pregnancy, gestational diabetes mellitus and obesity) and reporting fetal cord-blood insulin, c-peptide, glucose or adiposity estimates were included. One author extracted all information on main study characteristics and outcomes. Risk of bias was assessed using the Cochrane Collaboration's bias risk assessment tool. A total of 733 articles were identified. Fourteen articles from 11 RCTs (3614 participants) were included. Studies reviewed showed no specific effect of maternal diet on neonatal cord blood insulin, c-peptide or glucose levels. Infants born to mothers who followed a low glycaemic load (GL) had lower skin fold thickness compared to controls. Interventions that provided individualised nutrition counselling to women with obesity or previous infant born > 4 kg were also associated with lower adiposity. The studies reviewed suggest that lifestyle-based dietary interventions to improve glycaemia (low GL) have a protective effect against excess adiposity. Future studies should incorporate multi-modal interventions with dietary counselling to support lifestyle changes throughout gestation and include assessments of maternal insulin resistance at recruitment.
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26
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Harris RG, Batterham M, Neale EP, Ferreira I. Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum weight retention: An overview of systematic reviews with meta-analyses and additional sensitivity analyses. Obes Rev 2021; 22:e13318. [PMID: 34477276 DOI: 10.1111/obr.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022]
Abstract
High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR) casts doubt on whether such interventions can be relied upon as truly effective. This systematic overview of three MAs (19 RCTs), each with high MOD rates in the subset of RCTs included, examined how MOD were addressed in the estimation of summary intervention effects. All MAs reported beneficial and statistically significant intervention effects estimated based on complete case analyses, deemed valid if MOD was missing at random (MAR). Therefore, we conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption. In plausible scenarios where the response in intervention group participants with versus without MOD was worse (by just 0.5 kg), effect estimates were attenuated in all MAs and no longer statistically significant in two MAs. Statistical significance was retained when all 19 RCTs identified across MAs were examined together in a broader meta-analysis: -0.63 kg (95%CI -0.17, -0.08), but the clinical relevancy of effects of this magnitude remains unclear.
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Affiliation(s)
- Rebecca G Harris
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Isabel Ferreira
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Public Health Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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27
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Whyte K, Johnson J, Kelly K, Horowitz M, Widen EM, Toro-Ramos T, Gidwani S, Paley C, Crane J, Lin S, Rosenn B, Thornton J, Pi-Sunyer FX, Gallagher D. No sustained effects of an intervention to prevent excessive GWG on offspring fat and lean mass at 54 weeks: Yet a greater head circumference persists. Pediatr Obes 2021; 16:e12767. [PMID: 33394566 PMCID: PMC8178185 DOI: 10.1111/ijpo.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND LIFT (Lifestyle Intervention for Two) trial found that intervening in women with overweight and obesity through promoting healthy diet and physical activity to control gestational weight gain (GWG) resulted in neonates with greater weight, lean mass and head circumference and similar fat mass at birth. Whether these neonate outcomes are sustained at 1-year was the focus of this investigation. METHODS Measures included body composition by PEA POD air displacement plethysmography (ADP) and Echo Infant quantitative magnetic resonance (QMR) and head circumference at birth (n = 169), 14 (n = 136) and 54 weeks (n = 137). Differences in fat and lean mass between lifestyle intervention (LI) and Usual care (UC) groups were examined using ANCOVA adjusting for maternal age and BMI, GWG, offspring sex and age. RESULTS Compared to UC, LI infants had similar weight (112 ± 131 g; P = .40), fat mass (14 ± 80 g; P = .86), lean mass (100 ± 63 g; P = .12) at 14 weeks and similar weight (168 ± 183 g; P = .36), fat mass (148 ± 124 g; P = .24), lean mass (117 ± 92 g; P = .21) at 54 weeks. Head circumference was greater in LI at 54 weeks (0.46 ± 2.1 cm P = .03). CONCLUSIONS Greater lean mass observed at birth in LI offspring was not sustained at 14 and 54 weeks, whereas the greater head circumference in LI offspring persisted at 54 weeks.
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Affiliation(s)
- Kathryn Whyte
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jill Johnson
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kim Kelly
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Michelle Horowitz
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth M. Widen
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York,Department of Nutritional Sciences, University of Texas at Austin, New York, New York
| | - Tatiana Toro-Ramos
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sonia Gidwani
- Department Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine, New York, New York
| | - Charles Paley
- Department Pediatrics, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine, New York, New York
| | - Janet Crane
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Susan Lin
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York,Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York
| | - Barak Rosenn
- Department of Obstetrics and Gynecology, Mount Sinai West Hospital, Mount Sinai Health System, Icahn School of Medicine, New York, New York
| | | | - F. Xavier Pi-Sunyer
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Dympna Gallagher
- New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York
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28
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Chen Y, Ma G, Hu Y, Yang Q, Deavila JM, Zhu MJ, Du M. Effects of Maternal Exercise During Pregnancy on Perinatal Growth and Childhood Obesity Outcomes: A Meta-analysis and Meta-regression. Sports Med 2021; 51:2329-2347. [PMID: 34143412 DOI: 10.1007/s40279-021-01499-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perinatal growth abnormalities program susceptibility to childhood obesity, which is further exaggerated by maternal overweight and obesity (MO) during pregnancy. Exercise is highly accessible, but reports about the benefits of maternal exercise on fetal growth and childhood obesity outcomes are inconsistent, reducing the incentives for pregnant women to participate in exercise to improve children's perinatal growth. OBJECTIVE This systematic review and meta-analysis aims to establish evidence-based efficacy of exercise in mothers with normal weight (MNW) and MO during pregnancy in reducing the risks of perinatal growth abnormalities and childhood obesity. In addition, the impacts of exercise volume are also assessed. METHODS The PubMed, ScienceDirect, Web of Science, and Cochrane Library databases were searched from inception to February 15, 2020. We included randomized controlled trials with exercise-only intervention or exercise with other confounders in pregnant MNW (body mass index, BMI 18.5-24.9 kg/m2) and MO (BMI ≥ 25 kg/m2), which were further subgrouped in the meta-analysis. Primary outcomes included birth weight, preterm birth, small for gestational age (SGA), large for gestational age (LGA), infant and childhood weight, and childhood obesity. A linear meta-regression analysis was also used to explore the effects of exercise volume on outcomes. RESULTS 99 studies were included in the meta-analysis (n = 596,876), and individual study quality ranged from fair to good according to the Newcastle-Ottawa scale assessment. Exercise only interventions in MNW reduced preterm birth by 15% (26 studies, n = 76,132; odds ratio [OR] 0.85; 95% CI 0.72, 1.01; I2 = 83.3%), SGA by 17% (33 studies, n = 92,351; OR 0.83; 95% CI 0.71, 0.98; I2 = 74.5%) and LGA by 17% (29 studies, n = 84,310; OR 0.83; 95% CI 0.74, 0.95; I2 = 60.4%). Exercise only interventions in MO reduced preterm birth by 33% (2 studies, n = 3,050; OR 0.67; 95% CI 0.70, 0.96; I2 = 0%), SGA by 27% (8 studies, n = 3,909; OR 0.73; 95% CI 0.50, 1.05; I2 = 40.4%) and LGA by 55% (9 studies, n = 81,581; OR 0.45; 95% CI 0.18, 1.11; I2 = 98.3%). Exercise only interventions in MNW reduced childhood obesity by 53% (3 studies, n = 6,920; OR 0.47; 95% CI 0.36, 0.63; I2 = 77.0%). However, no significant effect was observed in outcomes from exercise confounders in either MNW or MO. In the meta-regression, the volume of exercise-only intervention in MNW was negatively associated with birth weight, greatly driven by volumes more than 810 metabolic equivalents (MET)-min per week. Other outcomes were not associated with exercise volume. CONCLUSIONS This systematic review and meta-analysis suggests that exercise during pregnancy in both MNW and MO safely and effectively reduce the risks of preterm birth, SGA, and LGA. Furthermore, MNW exercise also reduces the risk of childhood obesity. Overall, regardless of prepregnancy BMI, maternal exercise during pregnancy provides an excellent opportunity to mitigate the high prevalence of adverse birth outcomes and childhood obesity.
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Affiliation(s)
- Yanting Chen
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA.,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA
| | - Guiling Ma
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, People's Republic of China
| | - Yun Hu
- College of Animal Science and Technology, Yangzhou University, Yangzhou, 225009, People's Republic of China
| | - Qiyuan Yang
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Jeanene M Deavila
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA.,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA
| | - Mei-Jun Zhu
- School of Food Science, Washington State University, Pullman, WA, 99164, USA
| | - Min Du
- Center for Reproductive Biology, School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA. .,Nutrigenoimics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA, 99164, USA.
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29
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Dalrymple KV, Uwhubetine O, Flynn AC, Pasupathy D, Briley AL, Relph SA, Seed PT, O’Keeffe M, Poston L. Modifiable Determinants of Postpartum Weight Loss in Women with Obesity: A Secondary Analysis of the UPBEAT Trial. Nutrients 2021; 13:nu13061979. [PMID: 34207523 PMCID: PMC8227672 DOI: 10.3390/nu13061979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Pregnancy can alter a woman's weight gain trajectory across the life course and contribute to the development of obesity through retention of weight gained during pregnancy. This study aimed to identify modifiable determinants associated with postpartum weight retention (PPWR; calculated by the difference in pre-pregnancy and 6 month postpartum weight) in 667 women with obesity from the UPBEAT study. We examined the relationship between PPWR and reported glycaemic load, energy intake, and smoking status in pregnancy, excessive gestational weight gain (GWG), mode of delivery, self-reported postpartum physical activity (low, moderate, and high), and mode of infant feeding (breast, formula, and mixed). At the 6 month visit, 48% (n = 320) of women were at or above pre-pregnancy weight. Overall, PPWR was negative (-0.06 kg (-42.0, 40.4)). Breastfeeding for ≥4 months, moderate or high levels of physical activity, and GWG ≤9 kg were associated with negative PPWR. These three determinants were combined to provide a modifiable factor score (range 0-3); for each added variable, a further reduction in PPWR of 3.0 kg (95% confidence interval 3.76, 2.25) occurred compared to women with no modifiable factors. This study identified three additive determinants of PPWR loss. These provide modifiable targets during pregnancy and the postnatal period to enable women with obesity to return to their pre-pregnancy weight.
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Affiliation(s)
- Kathryn V. Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- Correspondence:
| | - Onome Uwhubetine
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
| | - Angela C. Flynn
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London SE1 9NH, UK;
| | - Dharmintra Pasupathy
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Annette L. Briley
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
- College of Nursing & Health Sciences, Flinders University, Adelaide 5042, Australia
| | - Sophie A. Relph
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
| | - Majella O’Keeffe
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London SE1 9NH, UK;
- School of Food and Nutritional Sciences, University College Cork, T12 K8AF Cork, Ireland
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE1 7EH, UK; (O.U.); (A.C.F.); (D.P.); (A.L.B.); (S.A.R.); (P.T.S.); (L.P.)
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Louise J, Poprzeczny AJ, Deussen AR, Vinter C, Tanvig M, Jensen DM, Bogaerts A, Devlieger R, McAuliffe FM, Renault KM, Carlsen E, Geiker N, Poston L, Briley A, Thangaratinam S, Dodd JM. The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials. BMC Med 2021; 19:128. [PMID: 34074261 PMCID: PMC8170974 DOI: 10.1186/s12916-021-01995-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of maternal obesity extends beyond birth, being independently associated with an increased risk of child obesity. Current evidence demonstrates that women provided with a dietary intervention during pregnancy improve their dietary quality and have a modest reduction in gestational weight gain. However, the effect of this on longer-term childhood obesity-related outcomes is unknown. METHODS We conducted an individual participant data meta-analysis from RCTs in which women with a singleton, live gestation between 10+0 and 20+0 weeks and body mass index (BMI) ≥ 25 kg/m2 in early pregnancy were randomised to a diet and/or lifestyle intervention or continued standard antenatal care and in which longer-term maternal and child follow-up at 3-5 years of age had been undertaken. The primary childhood outcome was BMI z-score above the 90th percentile. Secondary childhood outcomes included skinfold thickness measurements and body circumferences, fat-free mass, dietary and physical activity patterns, blood pressure, and neurodevelopment. RESULTS Seven primary trials where follow-up of participants occurred were identified by a systematic literature search within the International Weight Management in Pregnancy (i-WIP) Collaborative Group collaboration, with six providing individual participant data. No additional studies were identified after a systematic literature search. A total of 2529 children and 2383 women contributed data. Approximately 30% of all child participants had a BMI z-score above the 90th percentile, with no significant difference between the intervention and control groups (aRR 0.97; 95% CI 0.87, 1.08; p=0.610). There were no statistically significant differences identified for any of the secondary outcome measures. CONCLUSIONS In overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions. TRIAL REGISTRATION PROSPERO, CRD42016047165.
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Affiliation(s)
- Jennie Louise
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda J Poprzeczny
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia
| | - Andrea R Deussen
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christina Vinter
- Institute of Clinical Research University of Southern Denmark, 5230, Odense M, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Mette Tanvig
- Institute of Clinical Research University of Southern Denmark, 5230, Odense M, Denmark
| | - Dorte Moller Jensen
- Institute of Clinical Research University of Southern Denmark, 5230, Odense M, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Steno Diabetes Center, Odense University Hospital, 5000, Odense C, Denmark
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - Roland Devlieger
- Division of Mother and Child, Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine & Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Kristina M Renault
- Obstetric Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Emma Carlsen
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Nina Geiker
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Hvidovre, Denmark
| | - Lucilla Poston
- School of Life Course Sciences, Division of Women and Children's Health, King's College London, St. Thomas' Hospital, London, UK
| | - Annette Briley
- School of Life Course Sciences, Division of Women and Children's Health, King's College London, St. Thomas' Hospital, London, UK.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jodie M Dodd
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia. .,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia.
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31
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Do Lifestyle Interventions in Pregnant Women with Overweight or Obesity Have an Effect on Neonatal Adiposity? A Systematic Review with Meta-Analysis. Nutrients 2021; 13:nu13061903. [PMID: 34205875 PMCID: PMC8228378 DOI: 10.3390/nu13061903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 12/18/2022] Open
Abstract
Excessive body fat at birth is a risk factor for the development of childhood obesity. The aim of the present systematic review with meta-analysis was to evaluate the effect of lifestyle interventions in pregnant women with overweight or obesity on neonatal adiposity. The PubMed, Embase, Web of Science, Scopus, and LILACS databases were used as information sources. Original articles from randomized clinical trials of lifestyle intervention studies on pregnant women with excessive body weight and the effect on neonatal adiposity were considered eligible. The risk of bias was assessed using Cochrane criteria. The meta-analysis was calculated using the inverse variance for continuous data expressed as mean difference (MD), using the random effect model with a 95% confidence interval (CI). The outcomes were submitted to the GRADE evaluation. Of 2877 studies, four were included in the qualitative and quantitative synthesis (n = 1494). All studies were conducted in developed countries, with three including pregnant women with overweight or obesity, and one only pregnant women with obesity. The interventions had no effect on neonatal adiposity [Heterogeneity = 56%, MD = −0.21, CI = (−0.92, 0.50)] with low confidence in the evidence, according to GRADE. Studies are needed in low- and medium-developed countries with different ethnic-racial populations. PROSPERO (CRD42020152489).
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Kininmonth A, Smith A, Carnell S, Steinsbekk S, Fildes A, Llewellyn C. The association between childhood adiposity and appetite assessed using the Child Eating Behavior Questionnaire and Baby Eating Behavior Questionnaire: A systematic review and meta-analysis. Obes Rev 2021; 22:e13169. [PMID: 33554425 DOI: 10.1111/obr.13169] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
This systematic review and meta-analysis aimed to quantify associations between Child Eating Behavior Questionnaire (CEBQ) and Baby Eating Behavior Questionnaire (BEBQ) appetitive traits (food approach: Food Responsiveness [FR], Enjoyment of Food [EF], Emotional Overeating [EOE], and Desire to Drink [DD]; food avoidant: Satiety Responsiveness [SR], Slowness in Eating [SE], Emotional Undereating [EUE], Food Fussiness [FF]) and measures of child adiposity. Searches of six databases up to February 2019 identified 72 studies (CEBQ, n = 67; BEBQ, n = 5), and 27 met the meta-analysis criteria. For cross-sectional studies reporting unadjusted correlations with body mass index z-scores (BMIz) (n = 19), all traits were associated with BMIz in expected directions (positive: FR, EF, EOE, and DD; negative: SR, SE, EUE, and FF). Pooled estimates ranged from r = 0.22 (FR) to r = -0.21 (SR). For cross-sectional studies reporting regression coefficients (n = 10), three traits (FR, EF, and EOE) associated positively, and three traits (SR, SE, and EUE) negatively, with BMIz (β = -0.31 [SR] to β = 0.22 [FR]). Eleven studies reported prospective relationships from appetite to adiposity measures for six scales (positive: FR, EF, EOE, and DD; negative: SR and SE). Five studies reported relationships from adiposity measures to appetite for five traits (positive: FR, EF, and EOE; negative: SR). All BEBQ traits were consistently cross-sectionally associated with adiposity measures. Overall, CEBQ/BEBQ-assessed appetitive traits show consistent cross-sectional relationships with measures of child adiposity.
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Affiliation(s)
- Alice Kininmonth
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Andrea Smith
- Obesity Group, Research Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Carnell
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Silje Steinsbekk
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alison Fildes
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Clare Llewellyn
- Obesity Group, Research Department of Behavioural Science and Health, University College London, London, UK
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33
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Phelan S, Hart CN, Jelalian E, Muñoz-Christian K, Alarcon N, McHugh A, Ventura AK, Wing RR. Effect of prenatal lifestyle intervention on maternal postpartum weight retention and child body mass index z-score at 36 months. Int J Obes (Lond) 2021; 45:1133-1142. [PMID: 33627776 PMCID: PMC8081654 DOI: 10.1038/s41366-021-00784-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES We previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months. SUBJECTS/METHODS Pregnant women (N = 264; 13.7 weeks' gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks' gestation and after delivery at 6, 12, 18, 24, and 36 months. RESULTS At 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [-3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [-1.7, 1.0] units in the intervention group and 1.6 [-1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [-0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77). CONCLUSIONS Compared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.
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Affiliation(s)
- Suzanne Phelan
- California Polytechnic State University, Department of Kinesiology & Public Health, Center for Health Research, San Luis Obispo, CA, USA.
| | - Chantelle N Hart
- Temple University Center for Obesity Research and Education Department of Social and Behavioral Sciences, Philadelphia, PA, USA
| | - Elissa Jelalian
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Karen Muñoz-Christian
- California Polytechnic State University World Languages & Cultures Department, San Luis Obispo, CA, USA
| | - Noemi Alarcon
- California Polytechnic State University, Department of Kinesiology & Public Health, Center for Health Research, San Luis Obispo, CA, USA
| | - Angelica McHugh
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Alison K Ventura
- California Polytechnic State University, Department of Kinesiology & Public Health, Center for Health Research, San Luis Obispo, CA, USA
| | - Rena R Wing
- Warren Alpert Medical School at Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
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Huvinen E, Tuomaala AK, Bergman PH, Meinilä J, Tammelin T, Kulmala J, Engberg E, Koivusalo SB. Ascending Growth is Associated with Offspring Adiposity in Pregnancies Complicated with Obesity or Gestational Diabetes. J Clin Endocrinol Metab 2021; 106:e1993-e2004. [PMID: 33524144 DOI: 10.1210/clinem/dgaa979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Early growth is associated with childhood adiposity, but the influence of lifestyle remains unknown. OBJECTIVE This work aimed to investigate the association of growth profiles from high-risk pregnancies with adiposity at age 5 years, taking into account lifestyle and several antenatal/postnatal exposures. METHODS This prospective cohort study. INCLUDED 609 children born during the Finnish Gestational Diabetes Prevention Study (RADIEL), recruiting women with body mass index (BMI) greater than or equal to 30 and/or prior gestational diabetes mellitus (GDM) (2008-2013). Altogether 332 children attended the 5-year follow-up (2014-2017). Main outcome measures included growth profiles based on ponderal index (PI = weight/height3), investigated using latent class mixed models. Adiposity was assessed with anthropometrics and body composition (InBody720). RESULTS We identified 3 growth profiles: ascending (n = 82), intermediate (n = 351), and descending (n = 149). Children with ascending growth had a higher body fat percentage, ISO-BMI, and waist circumference (P < .05) at age 5 years. Ascending (β 4.09; CI, 1.60-6.58) and intermediate (β 2.27; CI, 0.50-4.03) profiles were associated with higher fat percentage, even after adjustment for age, sex, gestational age, diet, physical activity, education, and prepregnancy BMI. Similar associations existed with ISO-BMI. After adjusting for age and education, ascending growth was associated with prepregnancy BMI (odds ratio [OR] 1.06; CI, 1.01-1.12), primiparity (OR 3.07; CI, 1.68-5.62), cesarean delivery (OR 2.23; CI, 1.18-4.21), and lifestyle intervention (OR 2.56; CI, 1.44-4.57). However, meeting the intervention goals and exclusive breastfeeding for 3 months or more were associated with lower odds of ascending growth. CONCLUSION Accelerated early growth was associated with higher adiposity in 5-year-old children from high-risk pregnancies, even when adjusted for lifestyle. Reducing cesarean deliveries and promoting breastfeeding may be beneficial for postnatal growth.
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Affiliation(s)
- Emilia Huvinen
- Teratology Information Service, Emergency Medicine, Department of Prehospital Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paula H Bergman
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jelena Meinilä
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Tuija Tammelin
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Janne Kulmala
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Elina Engberg
- Folkhälsan Research Center, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Geyer K, Spies M, Günther J, Hoffmann J, Raab R, Meyer D, Rauh K, Hauner H. Effects of a Prenatal Lifestyle Intervention in Routine Care on Maternal Health Behaviour in the First Year Postpartum-Secondary Findings of the Cluster-Randomised GeliS Trial. Nutrients 2021; 13:1310. [PMID: 33921063 PMCID: PMC8071441 DOI: 10.3390/nu13041310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
Lifestyle interventions during pregnancy were shown to beneficially influence maternal dietary behaviour and physical activity, but their effect on health behaviour after delivery is unclear. The objective of this secondary analysis was to investigate the sustained effect of a lifestyle intervention in routine care on maternal health behaviour during the first year postpartum. The cluster-randomised controlled "Healthy living in pregnancy" (GeliS) study included 2286 pregnant women. Data on maternal health behaviour were collected at 6-8 weeks (T1pp) and one year postpartum (T2pp) using validated questionnaires. The intervention group showed a lower mean intake of fast food (T1pp: p = 0.016; T2pp: p < 0.001) and soft drinks (T1pp: p < 0.001), a higher mean intake of vegetables (T2pp: p = 0.015) and was more likely to use healthy oils for meal preparation than the control group. Dietary quality rated by a healthy eating index was higher in the intervention group (T1pp: p = 0.093; T2pp: p = 0.043). There were minor trends towards an intervention effect on physical activity behaviour. The proportion of smokers was lower in the intervention group (p < 0.001, both time points). The lifestyle intervention within routine care modestly improved maternal postpartum dietary and smoking behaviours.
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Affiliation(s)
- Kristina Geyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Roxana Raab
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
- Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354 Freising, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany; (K.G.); (M.S.); (J.G.); (J.H.); (R.R.); (D.M.); (K.R.)
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Tinius RA, Blankenship MM, Furgal KE, Cade WT, Duchette C, Pearson KJ, Maples JM. Metabolic flexibility during late pregnancy is associated with neonatal adiposity. Appl Physiol Nutr Metab 2021; 46:404-407. [PMID: 33544662 PMCID: PMC8158655 DOI: 10.1139/apnm-2020-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to determine the relationships between maternal metabolic flexibility during pregnancy and neonatal health outcomes. Percent change in lipid oxidation (before and after a high-fat meal) was calculated as the measure of "metabolic flexibility". Neonatal adiposity was assessed within 48 h of delivery by skinfold anthropometry. Metabolic flexibility (r = -0.271, p = 0.034), maternal HOMA-IR (r = 0.280, p = 0.030), and maternal body mass index (r = 0.299, p = 0.018) were correlated with neonatal subscapular skinfold (i.e., measure of neonatal adiposity). Clinical Trail Registration Number: NCT03504319. Novelty: This is the first study to link maternal metabolic flexibility, body mass index, and insulin resistance during pregnancy to neonatal adiposity at parturition.
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Affiliation(s)
- Rachel A Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Maire M Blankenship
- School of Nursing and Allied Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Karen E Furgal
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY 42101, USA
| | - W Todd Cade
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC 27710, USA
| | - Cathryn Duchette
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Kevin J Pearson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - Jill M Maples
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
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Rossiter C, Cheng H, Appleton J, Campbell KJ, Denney-Wilson E. Addressing obesity in the first 1000 days in high risk infants: Systematic review. MATERNAL AND CHILD NUTRITION 2021; 17:e13178. [PMID: 33780128 PMCID: PMC8189222 DOI: 10.1111/mcn.13178] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
Early intervention is critical for addressing the challenge of childhood obesity. Yet many preventive interventions do not target infants most at risk of future overweight or obesity. This systematic review examines interventions delivered before 2 years that aim to ameliorate excess weight gain among infants at high risk of overweight or obesity, due to sociodemographic characteristics, parental weight or health status, infant feeding or health behaviours. We searched six databases for interventions: (a) delivered before age two, (b) specifically aimed at infants at high risk of childhood obesity and (c) that reported outcomes by weight status beyond 28 days. The search identified over 27,000 titles, and 49 papers from 38 studies met inclusion criteria: 10 antenatal interventions, 16 postnatal and 12 conducted both before and after birth. Nearly all targeted infant and/or maternal nutrition. Studies varied widely in design, obesity risk factors, outcomes and quality. Overall, nine interventions of varying quality reported some evidence of significantly improved child weight trajectory, although effects tended to diminish over time. Interventions that improved weight outcomes tended to engage parents for a longer period, and most offered health professional input and support. Two studies of limited quality reported significantly worse weight outcomes in the intervention group.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Appleton
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia.,Tresillian Family Care Centres, Belmore, New South Wales, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia
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Abstract
To address the intergenerational transmission of obesity and diabetes, strategies promoting the health of women of reproductive age appear to be urgently needed. In this narrative review, we summarise what has been learned from many prenatal clinical trials, discuss the emerging evidence from preconception clinical trials and highlight persistent gaps and critical future directions. Most trials tested prenatal interventions that resulted in a limited gestational weight gain of ~1 kg and reduced gestational diabetes by 20-30%. These interventions also reduced macrosomia by 20-40% but had little-to-no impact on other offspring outcomes at birth or beyond. Far fewer trials tested preconception interventions, with almost all designed to improve conception or live-birth rates in overweight or obese women with infertility rather than reduce intergenerational risks in diverse populations. Preconception trials have successfully reduced weight by 3-9 kg and improved markers of glucose homeostasis and insulin resistance by the end of the intervention but whether effects were sustained to conception is unclear. Very few studies have reported offspring outcomes at birth and beyond, with no evidence thus far of beneficial effects on offspring obesity or diabetes risks. Further efforts to develop effective and scalable strategies to reduce risk of obesity and diabetes before conception should be prioritised, especially for diverse and under-resourced populations at disparately high risk of obesity and diabetes. Future clinical trials should include interventions with high potential for dissemination, diverse populations, thorough maternal phenotyping from enrolment through to conception and pregnancy, and rigorous assessment of offspring obesity and diabetes risks from birth onwards, including into the third generation.
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Affiliation(s)
- Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO, USA
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Dalrymple KV, Tydeman FAS, Taylor PD, Flynn AC, O’Keeffe M, Briley AL, Santosh P, Hayes L, Robson SC, Nelson SM, Sattar N, Whitworth MK, Mills HL, Singh C, Seed CStat PT, White SL, Lawlor DA, Godfrey KM, Poston L. Adiposity and cardiovascular outcomes in three-year-old children of participants in UPBEAT, an RCT of a complex intervention in pregnant women with obesity. Pediatr Obes 2021; 16:e12725. [PMID: 32914569 PMCID: PMC7116719 DOI: 10.1111/ijpo.12725] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Maternal obesity is associated with offspring cardiometabolic risk. UPBEAT was a randomised controlled trial of an antenatal diet and physical activity intervention in 1555 women with obesity. The intervention was associated with lower gestational weight gain, healthier diet and metabolic profile in pregnancy, and reduced infant adiposity at six months. OBJECTIVE We have investigated whether the UPBEAT intervention influenced childhood cardiometabolic outcomes or was associated with sustained improvements in maternal lifestyle 3-years after delivery. METHODS In UPBEAT mother-child dyads at the 3-year follow-up, we assessed childhood blood pressure, resting pulse rate, and adiposity (body mass index, skinfold thicknesses, body fat, waist and arm circumferences) and maternal diet, physical activity, and anthropometry. RESULTS 514 three-year-old children attended the appointment (49% intervention, 51% standard care). There was no difference in the main outcome of interest, subscapular skinfold thickness, between the trial arms (-0.30 mm, 95% confidence interval: -0.92, 0.31). However, the intervention was associated with a lower resting pulse rate (-5 bpm [-8.41, -1.07]). There was also a non-significant lower odds of overweight/obesity (OR 0.73; 0.50, 1.08). Maternal dietary improvements observed in the UPBEAT trial, including glycaemic load and saturated fat were maintained 3-years postpartum. CONCLUSION This study has demonstrated that an antenatal dietary and physical activity intervention in women with obesity is associated with lower offspring pulse rate and sustained improvement in maternal diet. Whilst larger than previous cohorts, there remains potential for bias from attrition and these findings require validation in future cohorts.
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Affiliation(s)
- Kathryn V Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Florence AS Tydeman
- Department of Mathematics and Statistics, Faculty of Science, University of Strathclyde, Glasgow, UK
| | - Paul D Taylor
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Angela C Flynn
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Majella O’Keeffe
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Annette L Briley
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Uterine Cell Signalling Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK, NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation, Glasgow, Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Melissa K Whitworth
- Maternity Services, Central Manchester University Hospitals NHS Foundation Trust, St Mary’s Hospital, Manchester, UK
| | - Harriet L Mills
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK, Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Singh
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Paul T Seed CStat
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Sara L White
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | - Deborah A Lawlor
- NIHR Bristol Biomedical Research Centre, Bristol, UK, MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK, Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
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Hoffmann J, Günther J, Stecher L, Spies M, Geyer K, Raab R, Meyer D, Rauh K, Hauner H. Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care-Findings from the cluster-randomised GeliS trial. Pediatr Obes 2021; 16:e12705. [PMID: 32725809 DOI: 10.1111/ijpo.12705] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lifestyle interventions in pregnancy may influence postpartum development and obesity risk in offspring. The impact of lifestyle interventions as health system-based approaches is unclear. OBJECTIVE To evaluate the effect of an antenatal lifestyle intervention conducted as public health approach on infant development and feeding practices. METHODS We followed offspring born to women participating in the cluster-randomised GeliS trial who received usual care (CG) or repeated lifestyle counselling (IG). We collected data on offspring development and complementary feeding until the 12th month postpartum. RESULTS Of the 1998 mother-child pairs, 1783 completed the follow-up. Mean infant weight at 12 months was comparable between groups (IG: 9497.9 ± 1137.0 g; CG: 9433.4 ± 1055.2 g; P = .177). There was no significant evidence of differences in sex- and age-adjusted z-scores or in the odds of offspring being overweight. More infants in the IG received whole-grain products compared to the CG (95.6% vs. 90.8%; P = .003). Despite small differences in the timing of introducing solid foods, there were no further significant differences in the pattern of complementary feeding. CONCLUSIONS The antenatal lifestyle intervention embedded in routine care did not substantially influence infant anthropometrics and is thus unlikely to impact future development.
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Affiliation(s)
- Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kristina Geyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roxana Raab
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Competence Centre for Nutrition, Freising, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Raab R, Michel S, Günther J, Hoffmann J, Stecher L, Hauner H. Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:8. [PMID: 33413486 PMCID: PMC7792105 DOI: 10.1186/s12966-020-01075-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal health and lifestyle during pregnancy may be critical for the onset and progression of childhood obesity. Prenatal lifestyle interventions have been shown to positively affect maternal behaviors, gestational weight gain, and anthropometric outcomes in infants at birth. The influence of such interventions on child weight or growth beyond birth is unknown. We therefore examined the association between lifestyle interventions during pregnancy and anthropometric outcomes during childhood. METHODS A systematic literature search was conducted in three electronic databases, two clinical trial registers and further sources, without language or publication status restrictions. Additionally, 110 study authors were contacted to obtain unpublished data. Randomized controlled trials comparing any antenatal lifestyle or behavioral intervention to standard prenatal care, in women of any body mass index (BMI), with offspring anthropometric data at 1 month of age or older, were considered. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration's updated tool. Data on weight, length, and BMI, and corresponding z-scores, were stratified into six age ranges and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated in univariate and multivariate random-effects meta-analytical models. RESULTS Twenty trials comprising 11,385 women were included in this systematic review, of which 19 were combined in meta-analyses. Overall, lifestyle interventions during pregnancy were not associated with differences in weight, length, BMI, or corresponding z-scores, in children aged 1 month to 7 years (e.g. weight in 5 to 6 month old children, WMD: 0.02 kg; 95% CI: - 0.05 to 0.10 kg, I2 = 38%; 13 studies, 6667 participants). Findings remained consistent when studies were stratified by maternal baseline BMI or other risk factors, and intervention content and duration. Based on the GRADE criteria, the strength of the body of evidence was considered moderate. CONCLUSION Prenatal lifestyle interventions were not shown to influence childhood weight or growth. Nevertheless, women should be encouraged to pursue a healthy lifestyle during pregnancy. Further efforts to establish early prevention strategies for childhood obesity are urgently needed. Thus, large, high-quality studies with pre-planned, long-term follow-ups are warranted. TRIAL REGISTRATION PROSPERO CRD42018118678 .
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Sophie Michel
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Julia Günther
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Julia Hoffmann
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Lynne Stecher
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
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Yang Z, Jiang J, Huang J, Zhao Y, Luo X, Song L. [Effect of high-fat diet and exercise on asprosin and CTRP6 expression in subcutaneous and retroperitoneal adipose tissues in rats during mid-gestation]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1406-1414. [PMID: 33118513 DOI: 10.12122/j.issn.1673-4254.2020.10.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To study the effects of high-fat (HF) diet and exercise on the expressions of asprosin and CTRP6 in adipose tissues in different regions of rats during mid-gestation. METHODS Pregnant SD rats were fed on a standard chow diet or a high-fat (60% fat content) diet for 14 days starting on gestation day (GD) 1. Starting from GD3, the rats fed either on normal or high-fat diet in the exercise groups (CH-RW and HF-RW groups) were allowed access to the running wheels for voluntary running, and those in sedentary groups (CH-SD and HF-SD groups) remained sedentary. At the end of the 14 days, adipose tissues were sampled from different regions of the rats for detecting the mRNA and protein expressions of asprosin and CTRP6 using RT-qPCR and Western blotting. RESULTS The mRNA expression of asprosin in retroperitoneal adipose tissues was significantly higher in HF-RW group than in the other 3 groups (P < 0.0001). Asprosin mRNA expression in subcutaneous adipose tissues was significantly higher in HF-SD group than in CH-SD group (P=0.0234) and comparable between HF-RW and CH-SD groups (P=0.0494). CTRP6 mRNA expression in retroperitoneal adipose tissues was also significantly higher in HF-RW group than in the other groups (P < 0.0001), and CTRP6 protein expression was signficiantly higher in HF-RW group than in CH-RW and HF-SD groups (P < 0.05). In subcutaneous adipose tissues, CTRP6 mRNA expression was significantly higher in CH-RW group than in HF-SD and HF-RW groups (P < 0.05). The protein expression level of CTRP6 in subcutaneous adipose tissues showed a significant negative correlation with blood glucose (r=-0.6038, P=0.0172), while its expression in retroperitoneal adipose tissues was positively correlated with blood glucose (r=0.5305, P= 0.0285); the mRNA expression levels of asprosin and CTRP6 were significantly lower in subcutaneous than in retroperitoneal adipose tissues (P < 0.0001). CONCLUSIONS High-fat diet and exercise during mid-gedtation can affect the expression levels of asprosin and CTRP6 in adipose tissues of rats in a site-specific manner.
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Affiliation(s)
- Zhao Yang
- Department of Physiology and Pathophysiology, School of Basic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an 710061, China.,Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710061, China
| | - Jianan Jiang
- Department of Physiology and Pathophysiology, School of Basic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an 710061, China
| | - Jiaqi Huang
- Department of Physiology and Pathophysiology, School of Basic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yujia Zhao
- Department of Physiology and Pathophysiology, School of Basic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an 710061, China
| | - Xiao Luo
- Department of Physiology and Pathophysiology, School of Basic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an 710061, China
| | - Lin Song
- Department of Physiology and Pathophysiology, School of Basic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University, Xi'an 710061, China
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Antoun E, Kitaba NT, Titcombe P, Dalrymple KV, Garratt ES, Barton SJ, Murray R, Seed PT, Holbrook JD, Kobor MS, Lin DTS, MacIsaac JL, Burdge GC, White SL, Poston L, Godfrey KM, Lillycrop KA. Maternal dysglycaemia, changes in the infant's epigenome modified with a diet and physical activity intervention in pregnancy: Secondary analysis of a randomised control trial. PLoS Med 2020; 17:e1003229. [PMID: 33151971 PMCID: PMC7643947 DOI: 10.1371/journal.pmed.1003229] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Higher maternal plasma glucose (PG) concentrations, even below gestational diabetes mellitus (GDM) thresholds, are associated with adverse offspring outcomes, with DNA methylation proposed as a mediating mechanism. Here, we examined the relationships between maternal dysglycaemia at 24 to 28 weeks' gestation and DNA methylation in neonates and whether a dietary and physical activity intervention in pregnant women with obesity modified the methylation signatures associated with maternal dysglycaemia. METHODS AND FINDINGS We investigated 557 women, recruited between 2009 and 2014 from the UK Pregnancies Better Eating and Activity Trial (UPBEAT), a randomised controlled trial (RCT), of a lifestyle intervention (low glycaemic index (GI) diet plus physical activity) in pregnant women with obesity (294 contol, 263 intervention). Between 27 and 28 weeks of pregnancy, participants had an oral glucose (75 g) tolerance test (OGTT), and GDM diagnosis was based on diagnostic criteria recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), with 159 women having a diagnosis of GDM. Cord blood DNA samples from the infants were interrogated for genome-wide DNA methylation levels using the Infinium Human MethylationEPIC BeadChip array. Robust regression was carried out, adjusting for maternal age, smoking, parity, ethnicity, neonate sex, and predicted cell-type composition. Maternal GDM, fasting glucose, 1-h, and 2-h glucose concentrations following an OGTT were associated with 242, 1, 592, and 17 differentially methylated cytosine-phosphate-guanine (dmCpG) sites (false discovery rate (FDR) ≤ 0.05), respectively, in the infant's cord blood DNA. The most significantly GDM-associated CpG was cg03566881 located within the leucine-rich repeat-containing G-protein coupled receptor 6 (LGR6) (FDR = 0.0002). Moreover, we show that the GDM and 1-h glucose-associated methylation signatures in the cord blood of the infant appeared to be attenuated by the dietary and physical activity intervention during pregnancy; in the intervention arm, there were no GDM and two 1-h glucose-associated dmCpGs, whereas in the standard care arm, there were 41 GDM and 160 1-h glucose-associated dmCpGs. A total of 87% of the GDM and 77% of the 1-h glucose-associated dmCpGs had smaller effect sizes in the intervention compared to the standard care arm; the adjusted r2 for the association of LGR6 cg03566881 with GDM was 0.317 (95% confidence interval (CI) 0.012, 0.022) in the standard care and 0.240 (95% CI 0.001, 0.015) in the intervention arm. Limitations included measurement of DNA methylation in cord blood, where the functional significance of such changes are unclear, and because of the strong collinearity between treatment modality and severity of hyperglycaemia, we cannot exclude that treatment-related differences are potential confounders. CONCLUSIONS Maternal dysglycaemia was associated with significant changes in the epigenome of the infants. Moreover, we found that the epigenetic impact of a dysglycaemic prenatal maternal environment appeared to be modified by a lifestyle intervention in pregnancy. Further research will be needed to investigate possible medical implications of the findings. TRIAL REGISTRATION ISRCTN89971375.
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Affiliation(s)
- Elie Antoun
- Biological Sciences, Institute of Developmental Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Negusse T. Kitaba
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Philip Titcombe
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kathryn V. Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Emma S. Garratt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Sheila J. Barton
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Robert Murray
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Joanna D. Holbrook
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael S. Kobor
- BC Childrens Hospital Research Institute, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - David TS Lin
- BC Childrens Hospital Research Institute, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Julia L. MacIsaac
- BC Childrens Hospital Research Institute, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Graham C. Burdge
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sara L. White
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Keith M. Godfrey
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Karen A. Lillycrop
- Biological Sciences, Institute of Developmental Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, United Kingdom
- * E-mail:
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Holme AM, Sitras V. Developmental origin of health and disease-Evidence and time for action. Acta Obstet Gynecol Scand 2020; 99:961-962. [PMID: 32683681 DOI: 10.1111/aogs.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ane Moe Holme
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Vasilis Sitras
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
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Kusuyama J, Alves-Wagner AB, Makarewicz NS, Goodyear LJ. Effects of maternal and paternal exercise on offspring metabolism. Nat Metab 2020; 2:858-872. [PMID: 32929233 PMCID: PMC7643050 DOI: 10.1038/s42255-020-00274-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
Maternal and paternal obesity and type 2 diabetes are recognized risk factors for the development of metabolic dysfunction in offspring, even when the offspring follow a healthful lifestyle. Multiple studies have demonstrated that regular physical activity in mothers and fathers has striking beneficial effects on offspring health, including preventing the development of metabolic disease in rodent offspring as they age. Here, we review the benefits of maternal and paternal exercise in combating the development of metabolic dysfunction in adult offspring, focusing on offspring glucose homeostasis and adaptations to metabolic tissues. We discuss recent findings regarding the roles of the placenta and sperm in mediating the effects of parental exercise on offspring metabolic health, as well as the mechanisms hypothesized to underlie these beneficial changes. Given the worldwide epidemics of obesity and type 2 diabetes, if these findings translate to humans, regular exercise during the reproductive years might limit the vicious cycles in which increased metabolic risk propagates across generations.
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Affiliation(s)
- Joji Kusuyama
- Integrative Physiology and Metabolism Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Ana Barbara Alves-Wagner
- Integrative Physiology and Metabolism Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Nathan S Makarewicz
- Integrative Physiology and Metabolism Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Laurie J Goodyear
- Integrative Physiology and Metabolism Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
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Dalrymple KV, Flynn AC, Seed PT, Briley AL, O'Keeffe M, Godfrey KM, Poston L. Associations between dietary patterns, eating behaviours, and body composition and adiposity in 3-year-old children of mothers with obesity. Pediatr Obes 2020; 15:e12608. [PMID: 31883218 PMCID: PMC7124886 DOI: 10.1111/ijpo.12608] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The relationships between eating habits, behaviours, and the development of obesity in preschool children is not well established. OBJECTIVE As children of mothers with obesity are themselves at risk of obesity, we examined these relationships in a cohort of 482 three-year-old children of mothers with obesity from the UK Pregnancy Better Eating and Activity Trial (UPBEAT). METHOD Dietary patterns were derived using factor analysis of an 85-item food frequency questionnaire (FFQ). Eating behaviours were assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Measures of body composition included age-specific BMI cut-offs, WHO z scores, sum of skinfolds, waist and arm circumferences, and body fat percentage. Using adjusted regression analysis, we examined associations between dietary patterns, eating behaviours, and measures of body composition. RESULTS Three distinct dietary patterns were defined: "healthy/prudent," "African/Caribbean," and "processed/snacking." The "processed/snacking" pattern was associated with greater odds of obesity; OR 1.53 (95% CI, 1.07-2.19). The "African/Caribbean" and the "healthy/prudent" patterns were associated with a lower arm circumference (β = -0.23 cm [-0.45 to -0.01]) and sum of skinfolds (β = -1.36 cm [-2.88 to -0.37]), respectively. Lower enjoyment of food and food responsiveness, and greater slowness in eating and satiety, were associated with lower arm and waist circumferences, WHO z scores, and obesity (all P < .05). CONCLUSION In children of mothers with obesity, those who had higher scores on a "processed/snacking" dietary pattern had greater odds of obesity. In contrast, slowness in eating was associated with lower measures of body composition. These novel findings highlight modifiable behaviours in high-risk preschool children which could contribute to public health strategies for prevention of childhood obesity.
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Affiliation(s)
- Kathryn V Dalrymple
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Angela C Flynn
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Annette L Briley
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Majella O'Keeffe
- Department of Nutritional Sciences, School of Life Course Sciences, King's College London, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Zheng J, Alves-Wagner AB, Stanford KI, Prince NB, So K, Mul JD, Dirice E, Hirshman MF, Kulkarni RN, Goodyear LJ. Maternal and paternal exercise regulate offspring metabolic health and beta cell phenotype. BMJ Open Diabetes Res Care 2020; 8:8/1/e000890. [PMID: 32111717 PMCID: PMC7050345 DOI: 10.1136/bmjdrc-2019-000890] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/20/2019] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Poor maternal and paternal environments increase the risk for obesity and diabetes in offspring, whereas maternal and paternal exercise in mice can improve offspring metabolic health. We determined the effects of combined maternal and paternal exercise on offspring health and the effects of parental exercise on offspring pancreas phenotype, a major tissue regulating glucose homeostasis. RESEARCH DESIGN AND METHODS Breeders were high fat fed and housed±running wheels before breeding (males) and before and during gestation (females). Offspring groups were: both parents sedentary (Sed); maternal exercise only (Mat Ex); paternal exercise only (Pat Ex); and maternal+paternal exercise (Mat+Pat Ex). Offspring were sedentary, chow fed, and studied at weaning, 12, 20 and 52 weeks. RESULTS While there was no effect of parental exercise on glucose tolerance at younger ages, at 52 weeks, offspring of Mat Ex, Pat Ex and Mat+Pat Ex displayed lower glycemia and improved glucose tolerance. The greatest effects were in offspring from parents that both exercised (Mat+Pat Ex). Offspring from Mat Ex, Pat Ex, and Mat+Pat Ex had decreased beta cell size, whereas islet size and beta cell mass only decreased in Mat+Pat Ex offspring. CONCLUSIONS Maternal and paternal exercise have additive effects to improve glucose tolerance in offspring as they age, accompanied by changes in the offspring endocrine pancreas. These findings have important implications for the prevention and treatment of type 2 diabetes.
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Affiliation(s)
- Jia Zheng
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Ana Barbara Alves-Wagner
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin I Stanford
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Noah B Prince
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Kawai So
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Joram D Mul
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Ercument Dirice
- Section on Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Michael F Hirshman
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Rohit N Kulkarni
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Section on Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, Massachusetts, USA
- Harvard Stem Cell Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Laurie J Goodyear
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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48
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Menting MD, van de Beek C, Rono K, Hoek A, Groen H, Painter RC, Girchenko P, Lahti‐Pulkkinen M, Koivusalo SB, Räikkönen K, Eriksson JG, Roseboom TJ, Heinonen K. Effects of maternal lifestyle interventions on child neurobehavioral development: Follow-up of randomized controlled trials. Scand J Psychol 2019; 60:548-558. [PMID: 31498898 PMCID: PMC6899471 DOI: 10.1111/sjop.12575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Obesity is a major public health problem. Children of women who were obese before or during pregnancy are at increased risk for neurobehavioral developmental problems. Whether a maternal lifestyle intervention conducted before and during pregnancy in obese women affects child neurobehavioral development is unknown. This study reports on the follow-up of a subsample of two randomized controlled trials, the Finnish RADIEL (n = 216) and Dutch LIFEstyle (n = 305) trial. Women with a pre-pregnancy BMI ≥29 kg/m2 wishing to conceive or who were already pregnant (<20 weeks) were allocated to a lifestyle intervention or to care as usual. Child neurodevelopment was measured with the Ages and Stages Questionnaire and child behavioral problems were measured with the Childhood Behavior Checklist (RADIEL) or the Strengths and Difficulties Questionnaire (LIFEstyle) at age 3-6 years. We used linear and binary logistic regression analyses to assess the effects of the lifestyle interventions on children's neurobehavioral developmental scores. Follow-up data was available from 161(38%) RADIEL and 96(32%) LIFEstyle children. Child neurodevelopmental scores did not differ significantly between children in the intervention and the control group (RADIEL:median = 275 vs. 280; LIFEstyle:median = 270 vs 267). Child behavioral problem scores did not differ significantly between children in the intervention and the control group (RADIEL:median = 22 vs. 21; LIFEstyle:median = 8 vs. 8). We did not observe considerable effects of the lifestyle interventions before or during pregnancy in obese women on child neurobehavioral development. With our sample sizes, we were not able to detect subtle differences in neurobehavioral development however.
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Affiliation(s)
- Malou D. Menting
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Kristiina Rono
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Annemieke Hoek
- University of GroningenUniversity Medical Centre GroningenDepartment of Obstetrics and GynecologyGroningenthe Netherlands
| | - Henk Groen
- University of GroningenUniversity Medical Centre GroningenDepartment of EpidemiologyGroningenthe Netherlands
| | - Rebecca C. Painter
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Polina Girchenko
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Marius Lahti‐Pulkkinen
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
- University/British Heart Foundation Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of EdinburghUK
| | - Saila B. Koivusalo
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Katri Räikkönen
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Johan G. Eriksson
- Department of General Practice and Primary Health CareUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Folkhälsan Research CenterHelsinkiFinland
| | - Tessa J. Roseboom
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamthe Netherlands
| | - Kati Heinonen
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
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Larqué E, Labayen I, Flodmark CE, Lissau I, Czernin S, Moreno LA, Pietrobelli A, Widhalm K. From conception to infancy - early risk factors for childhood obesity. Nat Rev Endocrinol 2019; 15:456-478. [PMID: 31270440 DOI: 10.1038/s41574-019-0219-1] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/25/2022]
Abstract
Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.
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Affiliation(s)
- Elvira Larqué
- Department of Physiology, University of Murcia, Murcia, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD) and Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carl-Erik Flodmark
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
| | - Inge Lissau
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
- Clinical Research Centre, University Hospital Copenhagen, Hvidovre, Denmark
| | - Sarah Czernin
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kurt Widhalm
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
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50
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Musial B, Fernandez‐Twinn DS, Duque‐Guimaraes D, Carr SK, Fowden AL, Ozanne SE, Sferruzzi‐Perri AN. Exercise alters the molecular pathways of insulin signaling and lipid handling in maternal tissues of obese pregnant mice. Physiol Rep 2019; 7:e14202. [PMID: 31466137 PMCID: PMC6715452 DOI: 10.14814/phy2.14202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023] Open
Abstract
Obesity during gestation adversely affects maternal and infant health both during pregnancy and for long afterwards. However, recent work suggests that a period of maternal exercise during pregnancy can improve metabolic health of the obese mother and her offspring. This study aimed to identify the physiological and molecular impact of exercise on the obese mother during pregnancy that may lead to improved metabolic outcomes. To achieve this, a 20-min treadmill exercise intervention was performed 5 days a week in diet-induced obese female mice from 1 week before and up to day 17 of pregnancy. Biometric, biochemical and molecular analyses of maternal tissues and/or plasma were performed on day 19 of pregnancy. We found exercise prevented some of the adverse changes in insulin signaling and lipid metabolic pathways seen in the liver, skeletal muscle and white adipose tissue of sedentary-obese pregnant dams (p110β, p110α, AKT, SREBP). Exercise also induced changes in the insulin and lipid signaling pathways in obese dams that were different from those observed in control and sedentary-obese dams. The changes induced by obesity and exercise were tissue-specific and related to alterations in tissue lipid, protein and glycogen content and plasma insulin, leptin and triglyceride concentrations. We conclude that the beneficial effects of exercise on metabolic outcomes in obese mothers may be related to specific molecular signatures in metabolically active maternal tissues during pregnancy. These findings highlight potential metabolic targets for therapeutic intervention and the importance of lifestyle in reducing the burden of the current obesity epidemic on healthcare systems.
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Affiliation(s)
- Barbara Musial
- Centre for Trophoblast Research, Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUnited Kingdom
| | - Denise S. Fernandez‐Twinn
- MRC Metabolic Disease UnitUniversity of Cambridge Metabolic Research Laboratories, Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke’s HospitalCambridgeUnited Kingdom
| | - Daniella Duque‐Guimaraes
- MRC Metabolic Disease UnitUniversity of Cambridge Metabolic Research Laboratories, Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke’s HospitalCambridgeUnited Kingdom
| | - Sarah K. Carr
- MRC Metabolic Disease UnitUniversity of Cambridge Metabolic Research Laboratories, Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke’s HospitalCambridgeUnited Kingdom
| | - Abigail L. Fowden
- Centre for Trophoblast Research, Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUnited Kingdom
| | - Susan E. Ozanne
- MRC Metabolic Disease UnitUniversity of Cambridge Metabolic Research Laboratories, Wellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke’s HospitalCambridgeUnited Kingdom
| | - Amanda N. Sferruzzi‐Perri
- Centre for Trophoblast Research, Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUnited Kingdom
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