Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI1–3

Abstract

Background: Infant body mass index (BMI) peak characteristics and early childhood BMI are emerging markers of future obesity and cardiometabolic disease risk, but little is known about their maternal nutritional determinants. Objective: We investigated the associations of maternal macronutrient intake with infant BMI peak characteristics and childhood BMI in the Growing Up in Singapore Towards healthy Outcomes study. Design: With the use of infant BMI data from birth to age 18 mo, infant BMI peak characteristics [age (in months) and magnitude (BMI peak ; in kg/m 2 ) at peak and prepeak velocities] were derived from subjectspecific BMI curves that were fitted with the use of mixed-effects model with a natural cubic spline function. Associations of maternal macronutrient intake (assessed by using a 24-h recall during late gestation) with infant BMI peak characteristics (n = 910) and BMI z scores at ages 2, 3, and 4 y were examined with the use of multivariable linear regression. Results: Mean absolute maternal macronutrient intakes (percentages of energy) were 72 g protein (15.6%), 69 g fat (32.6%), and 238 g carbohydrate (51.8%). A 25-g (w100-kcal) increase in maternal carbohydrate intake was associated with a 0.01/mo (95% CI: 0.0003, 0.01/mo) higher prepeak velocity and a 0.04 (95% CI: 0.01, 0.08) higher BMI peak . These associations were mainly driven by sugar intake, whereby a 25-g increment of maternal sugar intake was associated with a 0.02/mo (95% CI: 0.01, 0.03/mo) higher infant prepeak velocity and a 0.07 (95% CI: 0.01, 0.13) higher BMI peak . Higher maternal carbohydrate and sugar intakes were associated with a higher offspring BMI z score at ages 2-4 y. Maternal protein and fat intakes were not consistently associated with the studied outcomes. Conclusion: Higher maternal carbohydrate and sugar intakes are associated with unfavorable infancy BMI peak characteristics and higher early childhood BMI. This trial was registered at clinicaltrials.gov as NCT01174875.Am J Clin Nutr 2017;105:705-13.

Prenatal dietary exposures and offspring body size from 6 months to 18 years: A systematic review

“…Brion et al found an inverse relationship between third‐trimester total carbohydrate intake and fat mass at ages 9 and 11 years; fat mass z‐score decreased by 0.07 (95% CI −0.12, −0.02) standard deviations for every 50 g increase in carbohydrates. Conversely, Chen et al observed positive associations between second‐ and third‐trimester total carbohydrate intake and offspring BMI z‐scores at ages 2‐4 years, peak BMI (the highest point on the BMI curve between birth and 18 months), and average pre‐peak BMI velocity (linear velocity from birth to peak BMI). The observed positive associations were partially explained by the type of carbohydrates being consumed, specifically sugar .…”

“…Conversely, Chen et al observed positive associations between second‐ and third‐trimester total carbohydrate intake and offspring BMI z‐scores at ages 2‐4 years, peak BMI (the highest point on the BMI curve between birth and 18 months), and average pre‐peak BMI velocity (linear velocity from birth to peak BMI). The observed positive associations were partially explained by the type of carbohydrates being consumed, specifically sugar . Other studies reported similar findings for prenatal sugar intakes.…”

“…Eleven studies assessed macronutrient or food intakes during pregnancy and offspring body size (Table ) . Within these studies, seven evaluated carbohydrates, seven assessed fat, eight assessed protein, and three evaluated intakes of specific foods …”

“…Among studies evaluating total carbohydrate intake, one study observed inverse associations (n = 5717), one study observed positive associations (n = 910), and three studies observed no associations (sample sizes ranging from 169 to 3807) . Brion et al found an inverse relationship between third‐trimester total carbohydrate intake and fat mass at ages 9 and 11 years; fat mass z‐score decreased by 0.07 (95% CI −0.12, −0.02) standard deviations for every 50 g increase in carbohydrates.…”

“…Among studies evaluating prenatal protein consumption and offspring body size, three studies observed inverse associations, two studies observed a positive association, and four studies observed no associations (sample sizes ranging from 264 to 3807) . In an analysis of the Avon Longitudinal Study of Parents and Children (n = 5717), a 20‐g increase of total protein consumption during the third trimester was associated with a slight increase in offspring lean mass z‐score at 11 years .…”