Maternal dietary quality, inflammatory potential and childhood adiposity: an individual participant data pooled analysis of seven European cohorts in the ALPHABET consortium

Abstract

Background: Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity.

Methods: We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity (OWOB) (age-and-sex-specific BMI z-score > 85th percentile). Secondary outcomes were sum of skinfold thickness (SST), fat mass index (FMI) and fat-free mass index (FFMI). We used multivariable regression analyses (adjusting for maternal lifestyle and sociodemographic factors) to assess the associations of maternal DASH and E-DII scores with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effect meta-analyses.

Results: The study mothers had a mean (SD) age of 30.2 (4.6) years and a mean BMI of 23.4 (4.2) kg/m². Higher early-pregnancy E-DII scores (more pro-inflammatory diet) tended to be associated with a higher odds of late-childhood [10.6 (1.2) years] OWOB [OR (95% CI) 1.09 (1.00, 1.19) per 1-SD E-DII score increase], whereas an inverse association was observed for late-pregnancy E-DII score and early-childhood [2.8 (0.3) years] OWOB [0.91 (0.83, 1.00)]. Higher maternal whole pregnancy DASH score (higher dietary quality) was associated with a lower odds of late-childhood OWOB [OR (95% CI) 0.92 (0.87, 0.98) per 1-SD DASH score increase]; associations were of similar magnitude for early and late-pregnancy [0.86 (0.72, 1.04) and 0.91 (0.85, 0.98), respectively]. These associations were robust in several sensitivity analyses and further adjustment for birth weight and childhood diet did not meaningfully alter the associations and conclusions. In two cohorts with available data, a higher whole pregnancy E-DII and lower DASH scores were associated with a lower late-childhood FFMI in males and a higher mid-childhood FMI in females (P interactions < 0.10).

Conclusions: A pro-inflammatory, low-quality maternal antenatal diet may adversely influence offspring body composition and OWOB risk, especially during late-childhood. Promoting an overall healthy and anti-inflammatory maternal dietary pattern may contribute to the prevention of childhood obesity, a complex health issue requiring multifaceted strategy.

Keywords: Childhood obesity; Developmental origin of health and diseases; Diet; Dietary approaches to stop hypertension; Dietary inflammatory index; Inflammation; Maternal; Pregnancy; Quality.

Fig. 1

Associations between maternal pregnancy E-DII and DASH scores and late-childhood [10.6 (1.2) years] OWOB. Black dots indicate study-specific point effect estimates with corresponding 95% CIs indicated by horizontal lines, and diamonds indicate the pooled estimates with their corresponding 95% CIs. When studies were omitted one at a time for pregnancy E-DII and DASH meta-analysis, the overall pooled estimates were largely the same: for E-DII, pooled estimates ranged from 1.05 (0.98, 1.12) when excluding EDEN to 1.12 (1.02, 1.22) when excluding ALSPAC; for DASH, the pooled estimates ranged from 0.93 (0.88, 0.99) when excluding SWS to 0.90 (0.84, 0.97) when excluding GEN R. Effect estimates were adjusted for maternal education, ethnicity, pre-pregnancy BMI, maternal height, parity, energy intake (for DASH analysis only), cigarette smoking and alcohol consumption during pregnancy and (intrinsically adjusted for the outcome) child sex and age at measurement. E-DII, energy-adjusted Dietary Inflammatory Index; DASH, Dietary Approach to Stop Hypertension; OWOB, overweight and obesity

Fig. 2

a Associations of maternal E-DII and DASH scores with children’s FMI during mid-childhood by child sex and exposure time-point (only adjusted pooled estimates shown; all P-interactions < 0.10). Black dots indicate pooled point effect estimates with corresponding 95% CIs indicated by horizontal lines. Effect estimates were adjusted for maternal education, ethnicity, pre-pregnancy BMI, maternal height, parity, energy intake (for DASH analysis only), cigarette smoking and alcohol consumption during pregnancy and child sex and age at measurement. E-DII, energy-adjusted Dietary Inflammatory Index; DASH, Dietary Approaches to Stop Hypertension; FMI, fat mass index. b Associations of maternal E-DII and DASH scores with children’s FFMI during late-childhood by child sex and exposure time-point (only adjusted pooled estimates shown; all P-interactions < 0.10). Black dots indicate pooled point effect estimates with corresponding 95% CIs indicated by horizontal lines. Effect estimates were adjusted for maternal education, ethnicity, pre-pregnancy BMI, maternal height, parity, energy intake (for DASH analysis only), cigarette smoking and alcohol consumption during pregnancy and child sex and age at measurement. E-DII, energy-adjusted Dietary Inflammatory Index; DASH, Dietary Approaches to Stop Hypertension; FFMI, fat-free mass index