Early life nutrition disparities: where the problem begins?

Abstract

Empirical evidence continues to accumulate indicating that early life nutrition disparities are likely to explain, at least in part, higher risks for maternal disease (e.g., gestational diabetes) and childhood obesity among ethnic/racial minority groups. Minority women are more likely to be overweight or obese when they become pregnant. This condition may trigger a series of events including excessive weight gain during pregnancy compared with the Institute of Medicine recommendations (1), altered glucose and lipid metabolism, suboptimal infant feeding outcomes, and postpartum weight retention that, when combined, may explain, at least in part, a higher obesity risk among their offspring. This supplement from Advances in Nutrition follows a life cycle approach to first understanding disparities, if any, in prepregnancy BMI, weight gain during pregnancy, gestational diabetes, and infancy/early childhood risk factors for childhood obesity including suboptimal infant feeding practices. Second, each article attempts to provide possible solutions for addressing documented disparities. The collection of 5 review articles that follows this introduction represents an important advance in synthesizing the knowledge in an area that is critical to better understanding how to improve public health in the United States and beyond. Three of these articles focus on maternal outcome disparities before, during, and after pregnancy (2–4), and 2 focus primarily on the infancy/early childhood period (5,6). Whenever possible, the authors of the articles included in this special issue examine the effectiveness of local community programs and federal food assistance programs in reversing health disparities in maternal and infant health. As reported by Siega-Riz (2) in this supplement, minority women are not only more likely to be overweight/obese when becoming pregnant for the first time, but they are also more likely to become pregnant at younger ages and have more children than their white counterparts. Thus, they are also more likely to go through the mother-child obesity cycle (Fig. 1) more times during their reproductive life than white women. Therefore, their increased risk of excessive body fat accumulation, in relation to that of their white counterparts, may also be the result of more “exposures” to the obesity cycle and not only to the weight differentials when becoming pregnant for the first time. Headen et al. (3) confirm in their review that minority women are more likely to experience inadequate weight gain during pregnancy and that there are no disparities with regard to excessive gestational weight in relation to their white counterparts. The authors found that black women were more likely to retain excessive weight postpartum compared with Hispanic and white women. Headen et al. also document that interventions seeking to improve gestational weight gain and postpartum weight retention outcomes have thus far yielded mixed results. A major finding from their review is the lack of studies that explicitly address reasons for racial/ethnic differences in pregnancy-related weight. Studies in this area are urgently needed to develop effective pregnancy-related weight-control interventions among minority women. Chasan-Taber (4) reviewed the literature to determine whether physical activity, diet, and excessive weight gain during pregnancy are associated with impaired glucose tolerance/gestational diabetes among pregnant Latinas. This review provides support for an inverse association between exercise during pregnancy and risk of gestational diabetes among Latinas. Based on limited evidence, it also found support for an association between certain nutrient intakes (fewer saturated fatty acids and energy-dense foods, higher intakes of fiber, and a higher polyunsaturated:saturated fatty acid ratio) and lower risk of abnormal glucose tolerance, independent of gestational 1