Maternal dietary intake during pregnancy and offspring body composition: The Healthy Start Study

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d2743590e143">Background</h5> <p id="P2">Consistent evidence of an influence of maternal dietary intake during pregnancy on infant body size and composition in human populations is lacking, despite robust evidence in animal models. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d2743590e148">Objective</h5> <p id="P3">To evaluate the influence of maternal macronutrient intake and balance during pregnancy on neonatal body size and composition, including fat mass and fat free mass. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d2743590e153">Study Design</h5> <p id="P4">The analysis was conducted among 1040 mother-offspring pairs enrolled in the prospective pre-birth observational cohort: The Healthy Start Study. Diet during pregnancy was collected using repeated 24 hour dietary recalls (up to 8). Direct measures of body composition were obtained using air displacement plethysmography. The National Cancer Institute measurement error model was used to estimate usual dietary intake during pregnancy. Multivariable partition (non-isocaloric) and nutrient density (isocaloric) linear regression models were used to test the associations between maternal dietary intake and neonatal body composition. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d2743590e158">Results</h5> <p id="P5">The median macronutrient composition during pregnancy was 32.2% from fat, 15.0% from protein and 47.8% from carbohydrates. In the partition multivariate regression model, individual macronutrient intake values were not associated with birth weight or fat free mass, but were associated with fat mass. Respectively, 100 kilocalorie increases in total fat, saturated fat, unsaturated fat and total carbohydrates were associated with 4.2 gram (p=0.03), 11.1 gram (p=0.003), 5.9 gram (p=0.04) and 2.9 gram (p=0.02) increases in neonatal fat mass, independent of pre-pregnancy BMI. In the nutrient density multivariate regression model, macronutrient balance was not associated with fat mass, fat free mass or birth weight after adjustment for pre-pregnancy BMI. </p> </div><div class="section"> <a class="named-anchor" id="S5">  </a> <h5 class="section-title" id="d2743590e163">Conclusions</h5> <p id="P6">Neonatal adiposity, but not birth weight, is independently associated with increased maternal intake of total fat, saturated fat, unsaturated fat, and total carbohydrates, but not protein, suggesting that most forms of increased caloric intake contribute to fetal fat accretion. </p> </div>

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Development and validation of a Pregnancy Physical Activity Questionnaire.

Lisa Chasan-Taber, Michael Schmidt, Dawn E Roberts … (2004)

The effect of physical activity during pregnancy on maternal and fetal health remains controversial and studies have yet to identify the optimal dose of physical activity associated with favorable pregnancy outcomes. The aim of this study was to develop and validate a pregnancy physical activity questionnaire (PPAQ). To ascertain the type, duration, and frequency of physical activities performed by pregnant women, three 24-h physical activity recalls were administered to 235 ethnically diverse prenatal care patients at a large tertiary care facility in western Massachusetts. The relative contribution of each activity to between-person variance in energy expenditure was used to establish the list of activities for the PPAQ. The PPAQ is self-administered and asks respondents to report the time spent participating in 32 activities including household/caregiving, occupational, sports/exercise, transportation, and inactivity. To validate the PPAQ, 54 pregnant women completed the PPAQ and then wore a Manufacturing Technology, Inc. actigraph for the following 7 d. At the end of the 7-d period, the PPAQ was repeated. Intraclass correlation coefficients used to measure reproducibility of the PPAQ were 0.78 for total activity, 0.82 for moderate activity, 0.81 for vigorous activity, and ranged from 0.83 for sports/exercise to 0.93 for occupational activity. Spearman correlations between the PPAQ and three published cut points used to classify actigraph data ranged from 0.08 to 0.43 for total activity, 0.25 to 0.34 for vigorous activity, 0.20 to 0.49 for moderate activity, and -0.08 to 0.22 for light-intensity activity. Correlations were higher for sports/exercise and occupational activities as compared to household/caregiving activities. household/caregiving activities. The PPAQ is a reliable instrument of physical activities during pregnancy.

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Associations of maternal BMI and gestational weight gain with neonatal adiposity in the Healthy Start study.

Anne Starling, John Brinton, Deborah Glueck … (2015)

Maternal obesity and weight gain during pregnancy are risk factors for child obesity. Associations may be attributable to causal effects of the intrauterine environment or genetic and postnatal environmental factors.

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Modeling data with excess zeros and measurement error: application to evaluating relationships between episodically consumed foods and health outcomes.

Dennis Buckman, W DODD, D Midthune … (2009)

Dietary assessment of episodically consumed foods gives rise to nonnegative data that have excess zeros and measurement error. Tooze et al. (2006, Journal of the American Dietetic Association 106, 1575-1587) describe a general statistical approach (National Cancer Institute method) for modeling such food intakes reported on two or more 24-hour recalls (24HRs) and demonstrate its use to estimate the distribution of the food's usual intake in the general population. In this article, we propose an extension of this method to predict individual usual intake of such foods and to evaluate the relationships of usual intakes with health outcomes. Following the regression calibration approach for measurement error correction, individual usual intake is generally predicted as the conditional mean intake given 24HR-reported intake and other covariates in the health model. One feature of the proposed method is that additional covariates potentially related to usual intake may be used to increase the precision of estimates of usual intake and of diet-health outcome associations. Applying the method to data from the Eating at America's Table Study, we quantify the increased precision obtained from including reported frequency of intake on a food frequency questionnaire (FFQ) as a covariate in the calibration model. We then demonstrate the method in evaluating the linear relationship between log blood mercury levels and fish intake in women by using data from the National Health and Nutrition Examination Survey, and show increased precision when including the FFQ information. Finally, we present simulation results evaluating the performance of the proposed method in this context.