The Association of Mediterranean Diet during Pregnancy with Longitudinal Body Mass Index Trajectories and Cardiometabolic Risk in Early Childhood

Published:November 12, 2018DOI:https://doi.org/10.1016/j.jpeds.2018.10.005

      Objective

      To evaluate the associations between maternal adherence to the Mediterranean diet during pregnancy and their offspring's longitudinal body mass index (BMI) trajectories and cardiometabolic risk in early childhood.

      Study design

      We included mother-child pairs from the Infancia y Medio Ambiente (INMA) longitudinal cohort study in Spain. We measured dietary intake during pregnancy using a validated food frequency questionnaire and calculated the relative Mediterranean diet score (rMED). We estimated offspring's BMI z score trajectories from birth to age 4 years using latent class growth analyses (n = 2195 mother-child pairs). We measured blood pressure, waist circumference, and cardiometabolic biomarkers to construct a cardiometabolic risk score at 4 years (n = 697 mother-child pairs). We used multivariable adjusted linear and multinomial regression models.

      Results

      A higher maternal rMED in pregnancy was associated with a lower risk in offspring of larger birth size, followed by accelerated BMI gain (reference trajectory group: children with average birth size and subsequent slower BMI gain) (relative risk of high vs low rMED score, 0.68; 95% CI, 0.47-0.99). rMED score during pregnancy was not associated with the cardiometabolic risk score, its components, or related biomarkers.

      Conclusions

      Higher adherence to the Mediterranean diet in pregnancy was associated with lower risk of having offspring with an accelerated growth pattern. This dietary pattern was not associated with the offspring's cardiometabolic risk at 4 years.

      Keywords

      Abbreviations:

      apo ( Apolipoprotein), BMI ( Body mass index), BP ( Blood pressure), CRP ( C-reactive protein), DBP ( Diastolic blood pressure), FFQ ( Food-frequency questionnaire), HDL ( High-density lipoprotein), IDEFICS ( Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants ), INMA ( Infancia y Medio Ambiente), rMED ( Relative Mediterranean Diet Score), RR ( Relative risk), SBP ( Systolic blood pressure), TG ( Triglycerides), WC ( Waist circumference)
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      References

        • Salas-Salvadó J.
        • Guasch-Ferré M.
        • Lee C.H.
        • Estruch R.
        • Clish C.B.
        • Ros E.
        Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome.
        J Nutr. 2016; 146: 920S-927S
        • Tognon G.
        • Hebestreit A.
        • Lanfer A.
        • Moreno L.A.
        • Pala V.
        • Siani A.
        • et al.
        Mediterranean diet, overweight and body composition in children from eight European countries: cross-sectional and prospective results from the IDEFICS study.
        Nutr Metab Cardiovasc Dis. 2014; 24: 205-213
        • Velázquez-López L.
        • Santiago-Diaz G.
        • Nava-Hernández J.
        • Muñoz-Torres A.V.
        • Medina-Bravo P.
        • Torres-Tamayo M.
        Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity.
        BMC Pediatr. 2014; 14: 175
        • Gluckman P.D.
        • Hanson M.A.
        • Cooper C.
        • Thornburg K.L.
        Effect of in utero and early-life conditions on adult health and disease.
        N Engl J Med. 2008; 359: 61-73
        • Fernández-Barrés S.
        • Romaguera D.
        • Valvi D.
        • Martínez D.
        • Vioque J.
        • Navarrete-Muñoz E.M.
        • et al.
        Mediterranean dietary pattern in pregnant women and offspring risk of overweight and abdominal obesity in early childhood: the INMA birth cohort study.
        Pediatr Obes. 2016; 11: 491-499
        • Slining M.M.
        • Herring A.H.
        • Popkin B.M.
        • Mayer-Davis E.J.
        • Adair L.S.
        Infant BMI trajectories are associated with young adult body composition.
        J Dev Orig Health Dis. 2013; 4: 56-68
        • Ziyab A.H.
        • Karmaus W.
        • Kurukulaaratchy R.J.
        • Zhang H.
        • Arshad S.H.
        Developmental trajectories of Body Mass Index from infancy to 18 years of age: prenatal determinants and health consequences.
        J Epidemiol Community Health. 2014; 68: 934-941
        • Munthali R.J.
        • Kagura J.
        • Lombard Z.
        • Norris S.A.
        Childhood adiposity trajectories are associated with late adolescent blood pressure: birth to twenty cohort.
        BMC Public Health. 2016; 16: 665
        • Giles L.C.
        • Whitrow M.J.
        • Davies M.J.
        • Davies C.E.
        • Rumbold A.R.
        • Moore V.M.
        Growth trajectories in early childhood, their relationship with antenatal and postnatal factors, and development of obesity by age 9 years: results from an Australian birth cohort study.
        Int J Obes (Lond). 2015; 39: 1049-1056
        • Araújo J.
        • Severo M.
        • Barros H.
        • Mishra G.D.
        • Guimarães J.T.
        • Ramos E.
        Developmental trajectories of adiposity from birth until early adulthood and association with cardiometabolic risk factors.
        Int J Obes (Lond). 2015; 39: 1443-1449
        • Gesteiro E.
        • Bastida S.
        • Rodriguez Bernal B.
        • Sánchez-Muniz F.J.
        Adherence to Mediterranean diet during pregnancy and serum lipid, lipoprotein and homocysteine concentrations at birth.
        Eur J Nutr. 2015; 54: 1191-1199
        • Gesteiro E.
        • Rodríguez Bernal B.
        • Bastida S.
        • Sánchez-Muniz F.J.
        Maternal diets with low healthy eating index or Mediterranean diet adherence scores are associated with high cord-blood insulin levels and insulin resistance markers at birth.
        Eur J Clin Nutr. 2012; 66: 1008-1015
        • Mantzoros C.S.
        • Sweeney L.
        • Williams C.J.
        • Oken E.
        • Kelesidis T.
        • Rifas-Shiman S.L.
        • et al.
        Maternal diet and cord blood leptin and adiponectin concentrations at birth.
        Clin Nutr. 2010; 29: 622-626
        • Chatzi L.
        • Rifas-Shiman S.L.
        • Georgiou V.
        • Joung K.E.
        • Koinaki S.
        • Chalkiadaki G.
        • et al.
        Adherence to the Mediterranean diet during pregnancy and offspring adiposity and cardiometabolic traits in childhood.
        Pediatr Obes. 2017; 12: 47-56
        • Guxens M.
        • Ballester F.
        • Espada M.
        • Fernández M.F.
        • Grimalt J.O.
        • Ibarluzea J.
        • et al.
        Cohort profile: the INMA—INfancia y Medio Ambiente—(environment and childhood) project.
        Int J Epidemiol. 2012; 41: 930-940
        • Vioque J.
        • Navarrete-Muñoz E.M.
        • Gimenez-Monzó D.
        • Garcia-de-la-Hera M.
        • Granado F.
        • Young I.S.
        • et al.
        Reproducibility and validity of a food frequency questionnaire among pregnant women in a Mediterranean area.
        Nutr J. 2013; 12: 26
        • US Department of Agriculture, Agriculture Research Service
        USDA national nutrient database for standard reference.
        (Release 21, 2008; Available at:) (Accessed May 2, 2018)
        • Palma I.
        • Cantós D.F.A.
        Tablas de Composición de Alimentos por Medidas Caseras de Consumo Habitual en España. CESNID.
        McGraw-Hill Interamerican, Madrid2008
        • Buckland G.
        • González C.A.
        • Agudo A.
        • Vilardell M.
        • Berenguer A.
        • Amiano P.
        • et al.
        Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC cohort study.
        Am J Epidemiol. 2009; 170: 1518-1529
        • de Onis M.
        4.1 The WHO child growth standards.
        World Rev Nutr Diet. 2015; 113: 278-294
        • Meredith W.
        • Tisak J.
        Latent curve analysis.
        Psychometrika. 1990; 55: 107-122
        • Montazeri P.
        • Vrijheid M.
        • Martinez D.
        • Basterrechea M.
        • Fernandez-Somoano A.
        • Guxens M.
        • et al.
        Maternal metabolic health parameters during pregnancy in relation to early childhood BMI trajectories.
        Obesity (Silver Spring). 2018; 26: 588-596
        • Ahrens W.
        • Moreno L.A.
        • Mårild S.
        • Molnår D.
        • Siani A.
        • De Henauw S.
        • et al.
        Metabolic syndrome in young children: definitions and results of the IDEFICS study.
        Int J Obes (Lond). 2014; 38: S4-14
        • Valvi D.
        • Casas M.
        • Romaguera D.
        • Monfort N.
        • Ventura R.
        • Martinez D.
        • et al.
        Prenatal phthalate exposure and childhood growth and blood pressure: evidence from the Spanish INMA-Sabadell birth cohort study.
        Environ Health Perspect. 2015; 123: 1022-1029
        • Riaño-Galán I.
        • Fernández-Somoano A.
        • Rodríguez-Dehli C.
        • Valvi D.
        • Vrijheid M.
        • Tardón A.
        Proatherogenic lipid profile in early childhood: association with weight status at 4 years and parental obesity.
        J Pediatr. 2017; 187 (e2): 153-157
        • Manzano-Salgado C.
        • Casas M.
        • Lopez-Espinosa M.J.
        • Ballester F.
        • Iñiguez C.
        • Martinez D.
        • et al.
        Prenatal exposure to perfluoroalkyl substances and cardio-metabolic risk in children from the Spanish INMA birth cohort study.
        Environ Health Perspect. 2017; 125 (097018)
        • Switkowski K.M.
        • Jacques P.F.
        • Must A.
        • Kleinman K.P.
        • Gillman M.W.
        • Oken E.
        Maternal protein intake during pregnancy and linear growth in the offspring.
        Am J Clin Nutr. 2016; 104: 1128-1136
        • Willett W.C.
        • Howe G.R.
        • Kushi L.H.
        Adjustment for total energy intake in epidemiologic studies.
        Am J Clin Nutr. 1997; 65: 1220S-1228S
        • Huang T.T.
        • Roberts S.B.
        • Howarth N.C.
        • McCrory M.A.
        Effect of screening out implausible energy intake reports on relationships between diet and BMI.
        Obes Res. 2005; 13: 1205-1217
        • Institute of Medicine
        Dietary reference intakes for energy, carbohydrate. fiber, fat, fatty acids, cholesterol, protein, and amino acids.
        National Academies Press, Washington (DC)2005
        • Spratt M.
        • Carpenter J.
        • Sterne J.A.
        • Carlin J.B.
        • Heron J.
        • Henderson J.
        • et al.
        Strategies for multiple imputation in longitudinal studies.
        Am J Epidemiol. 2010; 172: 478-487
        • Haga C.
        • Kondo N.
        • Suzuki K.
        • Sato M.
        • Ando D.
        • Yokomichi H.
        • et al.
        Developmental trajectories of body mass index among Japanese children and impact of maternal factors during pregnancy.
        PLoS One. 2012; 7 (e51896)
        • Pryor L.E.
        • Brendgen M.
        • Tremblay R.E.
        • Pingault J.B.
        • Liu X.
        • Dubois L.
        • et al.
        Early risk factors of overweight developmental trajectories during middle childhood.
        PLoS One. 2015; 10 (e0131231)
        • Koletzko B.
        Childhood obesity: current situation and future opportunities.
        J Pediatr Gastroenterol Nutr. 2016; 63: S18-S21
        • Lampl M.
        • Lee W.
        • Koo W.
        • Frongillo E.A.
        • Barker D.J.
        • Romero R.
        Ethnic differences in the accumulation of fat and lean mass in late gestation.
        Am J Hum Biol. 2012; 24: 640-647
        • Sarr O.
        • Yang K.
        • Regnault T.R.
        In utero programming of later adiposity: the role of fetal growth restriction.
        J Pregnancy. 2012; 2012: 134758
        • Maslova E.
        • Rytter D.
        • Bech B.H.
        • Henriksen T.B.
        • Rasmussen M.A.
        • Olsen S.F.
        • et al.
        Maternal protein intake during pregnancy and offspring overweight 20 y later.
        Am J Clin Nutr. 2014; 100: 1139-1148
        • Danielsen I.
        • Granström C.
        • Haldorsson T.
        • Rytter D.
        • Hammer Bech B.
        • Henriksen T.B.
        • et al.
        Dietary glycemic index during pregnancy is associated with biomarkers of the metabolic syndrome in offspring at age 20 years.
        PLoS One. 2013; 8: e64887
        • Emmett P.M.
        • Jones L.R.
        • Golding J.
        Pregnancy diet and associated outcomes in the Avon Longitudinal Study of Parents and Children.
        Nutr Rev. 2015; 73: 154-174
        • van den Hil L.C.
        • Rob Taal H.
        • de Jonge L.L.
        • Heppe D.H.
        • Steegers E.A.
        • Hofman A.
        • et al.
        Maternal first-trimester dietary intake and childhood blood pressure: the Generation R Study.
        Br J Nutr. 2013; 110: 1454-1464
        • Blumfield M.L.
        • Nowson C.
        • Hure A.J.
        • Smith R.
        • Simpson S.J.
        • Raubenheimer D.
        • et al.
        Lower protein-to-carbohydrate ratio in maternal diet is associated with higher childhood systolic blood pressure up to age four years.
        Nutrients. 2015; 7: 3078-3093
        • Roseboom T.J.
        • van der Meulen J.H.
        • Osmond C.
        • Barker D.J.
        • Ravelli A.C.
        • Bleker O.P.
        Plasma lipid profiles in adults after prenatal exposure to the Dutch famine.
        Am J Clin Nutr. 2000; 72: 1101-1106
        • Roseboom T.
        • de Rooij S.
        • Painter R.
        The Dutch famine and its long-term consequences for adult health.
        Early Hum Dev. 2006; 82: 485-491
        • Ravelli A.C.
        • van der Meulen J.H.
        • Michels R.P.
        • Osmond C.
        • Barker D.J.
        • Hales C.N.
        • et al.
        Glucose tolerance in adults after prenatal exposure to famine.
        Lancet. 1998; 351: 173-177