Association of infant diet with subsequent obesity at 2-5 years among children exposed to gestational diabetes: the SWIFT study

Abstract

Aims/hypotheses: This longitudinal analysis evaluated the independent and joint associations of any breastfeeding (BF) or exclusive BF (EBF) and intake of sugar-sweetened beverages (SSBs) and 100% fruit juice from birth to 1 year with subsequent overweight and obesity among young children exposed to gestational diabetes (GDM).

Methods: The analysis utilised prospectively collected data from participants enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes after GDM (SWIFT); 1035 pregnant women (20-45 years) diagnosed with GDM, of whom 75% were of Black, Hispanic or Asian race and ethnicity. Mother-infant dyad characteristics and infant dietary intake were assessed via research protocols at in-person examinations, telephone interviews and monthly mailed surveys from birth to 1 year. Child weight, length and height were obtained from electronic health records at birth (2008-2011) and ages 2-5 years (2010-2016) to classify BMI percentile groups (n = 835).

Results: Adequate BF (≥6 months), adequate EBF duration (≥6 months), and SSB and 100% fruit juice intake in the first year were independently associated with child obesity at ages 2-5 years (all p < 0.05). Compared with children with adequate EBF and no intake of SSB or 100% fruit juice, those with adequate EBF and intake of 100% fruit juice and/or SSBs had a four- to fivefold higher odds of obesity (aOR 4.2, 95% CI:1.6, 11.2 for 100% fruit juice; aOR 4.5, 95% CI:1.4, 8.5 for fruit juice or SSBs; and aOR 4.7, 95% CI:1.4, 15 for SSBs; all p < 0.01), while those with inadequate EBF (<6 months) and intake of 100% fruit juice and/or SSBs had a six- to 12-fold higher odds of obesity (aOR 6.4, 95% CI:2.4, 17.2 for fruit juice; aOR 6.6, 95% CI:2.7, 14.8 for fruit juice or SSBs; and aOR 12.2, 95% CI:4.3, 25 for SSBs; all p < 0.001). Compared with children with adequate BF and no intake of SSB or 100% fruit juice, those with adequate BF and intake of 100% fruit juice and/or SSBs had a threefold higher odds of obesity (aOR 3.1, 95% CI:1.1, 7.3 for fruit juice; aOR 3.3, 95% CI:1.3, 8.3 for fruit juice or SSBs; and aOR 3.4, 95% CI:1.3, 8.5 for SSBs; all p < 0.05), while those with inadequate BF (<6 months) and intake of 100% fruit juice and/or SSB were associated with five- to tenfold higher odds of obesity (aOR 4.8, 95% CI:2.3, 12.2 for fruit juice; aOR 6.0, 95% CI:2.5, 12.8 for fruit juice or SSBs; aOR 9.5, 95% CI:3.7, 15.1 for SSBs; all p < 0.05).

Conclusions/interpretation: This is the first study to prospectively evaluate the relation of BF or EBF duration and intake of SSB and 100% fruit juice during the first year of life with subsequent obesity in children exposed to GDM. Adequate BF or EBF combined with avoidance of SSB and 100% fruit juice during early infancy may ameliorate future child obesity in this high-risk population.

Keywords: 100% fruit juice; BMI; Childhood obesity; Exclusive breastfeeding; Gestational diabetes mellitus; Infant diet; Sugar-sweetened beverages.

Fig. 1

aORs (95% CIs) for obesity among children aged 2–5 years exposed to GDM associated with SSB intake and/or 100% fruit juice during infancy and stratified by BF duration. *p<0.05, **p<0.01, ***p<0.001: significantly higher odds compared with referent; ^RReferent: adequate BF, no SSBs, no 100% fruit juice; adequate BF: BF ≥6 months; inadequate BF: no BF or <6 months BF. Adjusted covariates: child sex, race/ethnicity, parity, WIC participation, maternal education level, prenatal 3 h OGTT sum of four z scores (GDM severity), GDM treatment type, gestational weight gain, gestational age at GDM diagnosis, and child age at BMI measurement

Fig. 2

aORs (95% CIs) for obesity among children aged 2–5 years exposed to GDM associated with SSB and 100% fruit juice intake during infancy and stratified by EBF duration. **p<0.01, ***p<0.001: significantly higher odds compared with referent; ^RReferent: adequate EBF, no SSB, no 100% fruit juice; adequate EBF: exclusive BF ≥6 months; inadequate EBF: no EBF or <6 months EBF. Adjusted covariates: child sex, race/ethnicity, parity, WIC participation, maternal education level, prenatal 3 h OGTT sum of four z scores (GDM severity), GDM treatment type, gestational weight gain, gestational age at GDM diagnosis, and child age at BMI measurement