Maternal Weight Status Research Articles

Maternal influences on the glucocorticoid concentrations of human milk: The STEPS study

Human milk (HM) contains a wide array of non-nutritive bioactive elements, including glucocorticoid hormones (glucocorticoid; cortisol and cortisone). The relationship between milk-borne glucocorticoids, measures of maternal health and patterns of breast-feeding is not yet established. This study was conducted to determine the influence of maternal and infant related biological and socio-demographic factors on the levels of glucocorticoids hormones in HM. Samples were obtained from lactating mothers (n=656) participating in the Finnish cohort the STEPS study (Steps to the Healthy Development and Well-being of Children) when the infants were 11.29 (±2.6) weeks of age. Glucocorticoids (both cortisol and cortisone) concentrations were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Maternal demographics, biological and social factors were obtained using hospital records and self-reported diaries and questionnaires. The majority of women reported that they were exclusively breastfeeding at the time of sample donation (51.2%). For all collected samples, cortisone (9.55±3.44ng/ml) was the predominant hormone and cortisol (7.39±5.97ng/ml) was present in all samples. Strong and positive correlation was found between cortisol and cortisone (r=0.60, p=<0.0001). Cortisone was statistically different between overweight, normal and underweight women (p=0.01) for cortisol no difference was seen (p=0.96). Whilst, preterm birth (born before 37 week gestation) was positively associated with both cortisol (p=0.04) and cortisone (p=0.01). There was also a significant but weaker negative relationship between mothers educational status and cortisol (p=0.05) and no effect was seen for cortisone (p=0.82). Interestingly, no significant differences was found in glucocorticoid concentrations between exclusive and partial breastfeeding women. HM contains glucocorticoids hormones. The concentrations are influenced by the varying maternal factors including maternal weight, preterm birth and maternal educational status, suggesting the possible role of maternal biological and social influences on milk hormonal composition. Interestingly, there was no influence of feeding patterns on HM glucocorticoids. Further analysis is required to fully explore the relationship with measures of maternal stress, including mother's glucocorticoid status.

Associations between maternal lifestyle factors and neonatal body composition in the screening for pregnancy endpoints (CORK) cohort study

Background A person's chronic disease risk can be influenced during their fetal development in ways that are likely mediated by their body composition at birth. A better understanding of how maternal lifestyle is related to newborn body composition could thus inform intervention efforts. Methods Using Cork participant data (n = 1754) from the Screening for Pregnancy Endpoints (SCOPE) cohort study (ECM5(10)05/02/08), we estimated how pre-pregnancy body size, gestational weight gain, exercise, alcohol, smoking and diet were related to neonatal fat and fat-free mass, as well as length and gestational age at birth, using quantile regression. Maternal factors were measured by a trained research midwife at 15 gestational weeks, in addition to a 3rd trimester weight measurement used to calculate weight gain. Infant body composition was measured using air-displacement plethysmography. Results Healthy (versus excess) gestational weight gain was associated with lower median fat-free mass (−112 g, 95%CI: −47 to −176) and fat mass (−33 g, 95%CI: −1 to −65) in the offspring and a 103 g decrease in the 95th centile of fat mass (95%CI: −33 to −174). Maternal normal weight status (versus obesity) was associated with lower median fat mass (−48 g, 95%CI: −12 to −84). At the highest centiles, fat mass was lower among infants of women who engaged in frequent moderate-intensity exercise early in the pregnancy (−92 g at the 95th centile, 95%CI: −168 to −16). No other lifestyle factors were strongly related to infant body composition. Conclusions These results suggest that supporting healthy maternal lifestyles could reduce the risk of excess fat accumulation in the offspring, without increasing the risk of low body fat, or adversely affecting fat-free mass development, length or gestational age.

Maternal Prepregnancy Weight Status and Adolescent Eating Disorder Behaviors: A Longitudinal Study of Risk Pathways.

Maternal characteristics and childhood growth have been identified as risk factors for eating disorders. Most studies to date have been unable to investigate these factors prospectively while accounting for their interdependencies. We address this by investigating whether the association of maternal prepregnancy body mass index (ppBMI) with adolescent eating disorder behaviors can be explained by childhood growth and/or a concurrent environmental pathway captured by maternal eating habits. We analyzed data from girls participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective UK cohort. The study had information on parentally and self-reported eating disorder behaviors at age 13/14 years (n = 3,529), maternal ppBMI and eating habits at age 8, child's birth weight, BMI from age 7 to 12, pubertal development at 11, and relevant confounders. We quantified contributions of childhood growth and concomitant maternal eating habits to the association of maternal ppBMI with eating disorder behaviors in terms of interventional disparity effects for multiple mediators. Maternal prepregnancy underweight was negatively associated with eating disorder behaviors (-0.18; 95% confidence interval: -0.29, -0.06), whereas overweight/obesity had the opposite relationship (0.25; 0.18, 0.32). Both were nearly fully explained by childhood growth. Although maternal ppBMI is associated with developing eating disorders, its role needs to be understood in the context of childhood factors, in particular childhood growth. The relatively small size of the remaining associations, once growth factors are hypothetically equalized across levels of maternal ppBMI, suggests that childhood growth is a potential area for prevention.

An Exploratory Study Examining Obesity Risk in Non-Obese Mothers of Young Children Using a Socioecological Approach.

This cross-sectional, exploratory study aimed to (1) develop an obesity risk score using a comprehensive set of variables assessing mothers’ intrapersonal weight-related characteristics and those of their homes’ interpersonal and physical environments, and (2) determine how weight-related characteristics differ by obesity risk level. U.S. mothers (N = 550) of preschool-aged children completed an online survey that assessed maternal self-report weight status, sociodemographics, health-related characteristics, and maternal intrapersonal and their homes’ interpersonal and physical environment weight-related characteristics. Binomial logistic regression analysis identified variables significantly associated with obesity. Scores for all obesity risk variables were summed to create a weighted obesity risk score for non-obese participants (n = 386). Analysis of variance and Tukey post-hoc tests determined how non-obese mothers’ sociodemographic, health-related, and intrapersonal and their homes’ interpersonal and physical environment characteristics differed among obesity risk score tertiles. Results revealed that eight variables explained 53 percent of maternal obesity risk, including African American race, lower education level, more children in household, poorer maternal health, higher weight teasing history, higher body dissatisfaction, primary relative with obesity, and greater concern about children’s overweight risk. Non-obese mothers in the highest obesity risk tertile had greater food insecurity risk, lower family affluence, worse sleep quality, less fruit/vegetable availability, and reported less frequent modeling of healthy behaviors and more family conflict. In conclusion, eight characteristics that explained more than half of the risk for obesity in non-obese mothers of young children, may help healthcare professionals identify mothers at increased risk of obesity and offer preventive care early.

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed by commercially available ELISA kits for all maternal samples.Results: Lower levels of irisin were seen in serum, colostrum and mature breast milk of GDM females (p < .01). SREBP-1c profile showed a similar trend of low serum levels in GDM, however, they were undetectable in colostrum and mature breast milk. Weak to moderate correlations of serum irisin with BMI (r = 0.439; p < .001), GTT 0 hours (r = 0.403; p = .01), HbA1c (r = −0.312; p = .011), Fasting blood glucose (r = 0.992; p = .008), and baby weight at birth (r = 0.486; p < .001). Colostrum and mature breast milk irisin showed positive associations with baby weight at 6 weeks (r = 0.325; p = .017; r = 0.296; p = .022, respectively). Serum SREBP-1c at 6 weeks correlated with random blood glucose (r = 0.318; p = .009), and HbA1c (r= −0.292; p = .011). All correlations were lost once we adjusted for maternal BMI.Conclusions: Low irisin and SREBP1-c levels may favor development of GDM in pregnant subjects. Further, low mature breast milk levels may act as a continued stressor from fetal to infant life as long as breast-feeding is continued. Further studies are required to identify the mechanistic relationship between these biomarkers and GDM.

Pengaruh Pemberian Makanan Tambahan (PMT) Pemulihan terhadap Status Gizi pada Ibu Hamil di Kabupaten Sleman

Latar Belakang : Ibu hamil rentan terhadap masalah gizi antara lain Kurang Energi Kronis (KEK). Masalah gizi tersebut dapat menyebabkan kematian pada ibu hamil dan berdampak pada pertumbuhan serta perkembangan janin. Salah satu cara untuk menanggulangi masalah KEK pada ibu hamil adalah dengan pemberian PMT pemulihan (PMT-P). Namun, fakta yang terjadi belum bisa memberikan hasil peningkatan asupan dan status gizi yang sesuai harapan. Tujuan : Tujuan penelitian ini mengetahui pengaruh kontribusi PMT-P terhadap status gizi pada ibu hamil. Metode : Jenis penelitian analitik dengan pendekatan quasi eksperimen dan menggunakan rancangan penelitian pre post test without control yang dilaksanakan di wilayah kerja Kabupaten Sleman pada bulan November 2016 - Januari 2017. Subjek penelitian adalah ibu hamil KEK dengan LILA &lt; 23,5 sejumlah 20 subjek. Variabel bebas yaitu asupan zat gizi total, asupan makan sehari, dan asupan PMT-P serta variabel terikat adalah lingkar lengan atas (LILA). Analisis data menggunakan uji paired sample t-test. Hasil : Hasil penelitian menunjukkan adanya peningkatan rerata berat badan, LILA, dan rerata asupan energi total pada akhir perlakuan. Terdapat pengaruh yang bermakna pemberian PMT pemulihan selama 3 bulan terhadap peningkatan status gizi ibu hamil dengan KEK berdasarkan pengukuran LILA (p=0,000).Kesimpulan : Kesimpulan penelitian; Program intervensi PMT pemulihan selama 90 hari pada ibu hamil dengan KEK terbukti mampu meningkatkan asupan energi total, berat badan ibu, dan status gizi ibu hamil dengan KEK berdasarkan LILA.

Maternal smoking during pregnancy and offspring overweight: is there a dose-response relationship? An individual patient data meta-analysis.

A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose-response relationship across number of cigarettes and whether this differs by sex remains unclear. Studies reporting number of cigarettes smoked during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex. Of 26 identified studies, 16 authors provided data on a total of 238,340 mother-child-pairs. A linear positive association was observed between the number of cigarettes smoked and offspring overweight for up to 15 cigarettes per day with an OR increase per cigarette of 1.03, 95% CI = [1.02-1.03]. The OR flattened with higher cigarette use. Associations were similar in males and females. Sensitivity analyses supported these results. A linear dose-response relationship of maternal smoking was observed in the range of 1-15 cigarettes per day equally in boys and girls with no further risk increase for doses above 15 cigarettes.

Maternal prepregnancy nutritional status influences newborn size and mode of delivery

The coexistence of underweight and obesity is commonly called the double burden of malnutrition, a phenomenon which can be found in most countries worldwide. During pregnancy maternal underweight as well as obesity have a profound impact on fetal growth patterns and consequently pregnancy outcome. In the present study the effects of maternal underweight as well as obesity on fetal growth and consequently newborn size were tested in a sample of 9214 term births which took place at Vienna Austria. It could be shown that maternal prepregnancy weight status was significantly positively associated with maternal age. Furthermore maternal prepregnancy weight status has a marked influence on fetal growth. With increasing maternal weight status birth weight, birth length, newborn head dimensions and acromial circumference increased significantly. Maternal obesity enhances fetal growth and increases the risk of giving birth to a large for gestational age offspring. In contrast underweight increases the risk of giving birth to a small for gestational age offspring. Additionally morbid obesity was positively associated with risk of caesarean section.

Key Clinical Factors Predicting Adipokine and Oxidative Stress Marker Concentrations among Normal, Overweight and Obese Pregnant Women Using Artificial Neural Networks.

Maternal obesity has been related to adverse neonatal outcomes and fetal programming. Oxidative stress and adipokines are potential biomarkers in such pregnancies; thus, the measurement of these molecules has been considered critical. Therefore, we developed artificial neural network (ANN) models based on maternal weight status and clinical data to predict reliable maternal blood concentrations of these biomarkers at the end of pregnancy. Adipokines (adiponectin, leptin, and resistin), and DNA, lipid and protein oxidative markers (8-oxo-2′-deoxyguanosine, malondialdehyde and carbonylated proteins, respectively) were assessed in blood of normal weight, overweight and obese women in the third trimester of pregnancy. A Back-propagation algorithm was used to train ANN models with four input variables (age, pre-gestational body mass index (p-BMI), weight status and gestational age). ANN models were able to accurately predict all biomarkers with regression coefficients greater than R2 = 0.945. P-BMI was the most significant variable for estimating adiponectin and carbonylated proteins concentrations (37%), while gestational age was the most relevant variable to predict resistin and malondialdehyde (34%). Age, gestational age and p-BMI had the same significance for leptin values. Finally, for 8-oxo-2′-deoxyguanosine prediction, the most significant variable was age (37%). These models become relevant to improve clinical and nutrition interventions in prenatal care.

Perinatal and lifestyle factors mediate the association between maternal education and preschool children's weight status: the ToyBox study.

This study aimed to explore the associations among perinatal, sociodemographic, and behavioral factors and preschool overweight/obesity. Data were collected from 7541 European preschoolers in May/June 2012. Children's anthropometrics were measured, and parents self-reported all other data via questionnaires. Level of statistical significance was set at P ≤ 0.05. Certain perinatal factors (i.e., maternal prepregnancy overweight/obesity, maternal excess gestational weight gain, excess birth weight, and "rapid growth velocity"), children's energy balance-related behaviors (i.e., high sugar-sweetened beverage consumption, increased screen time, reduced active-play time), family sociodemographic characteristics (i.e., Eastern or Southern Europe, low maternal and paternal education), and parental overweight/obesity were identified as correlates of preschoolers' overweight/obesity. Furthermore, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time mediated by 21.2%, 12.5%, and 5.7%, respectively, the association between maternal education and preschoolers' body mass index. This study highlighted positive associations of preschooler's overweight/obesity with excess maternal prepregnancy and gestational weight gain, excess birth weight and "rapid growth velocity," Southern or Eastern European region, and parental overweight/obesity. Moreover, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time partially mediated the association between maternal education and preschoolers' body mass index. The findings of the present study may support childhood obesity prevention initiatives, because vulnerable population groups and most specifically low-educated families should be prioritized. Among other fields, these intervention initiatives should also focus on the importance of normal prepregnancy maternal weight status, normal growth velocity during infancy, and retaining preschool children's screen time within recommendations.

Effect of maternal glycemia and weight status on offspring birth measures and BMI-z among Chinese population in the first year

To investigate the effects of maternal fasting plasma glucose (FPG) and pre-pregnancy weight status (PPWS) on offspring birth measures and body mass index z-score (BMI-z) in the first year, we conducted a prospective study of 1,096 mother-infant dyads in Guangdong, China, 2014–2015. Multivariate logistic regression was used to test independent/interaction associations of maternal FPG and PPWS with macrosomia/large for gestational age (LGA). Association of PPWS and FPG with offspring BMI-z in the first year was assessed by the linear mixed effects models. For each 1-mmol/L increase in FPG, the risk of macrosomia and LGA was elevated by 2.74 and 2.01 (95% CI: 1.85, 7.60 and 1.54, 5.88), respectively. No main effect of PPWS or interaction association of FPG and PPWS on macrosomia/LGA was observed (P > 0.05). A relation between maternal FPG and PPWS was detected (P < 0.05). Infants of Q5 FPG mothers, those who were born to OWO mothers, had a 0.35 increase in the BMI-z (95% CI: 0.16, 0.55) compared with infants of NW mothers. In conclusion, maternal FPG is positively associated with macrosomia/LGA. Maternal PPWS and FPG considerably interacted for the association with the risk of offspring high BMI-z in the first year.

Microbial Mechanistic Insight into the Role of Inulin in Improving Maternal Health in a Pregnant Sow Model.

General consumption of “western diet” characterized by high refined carbohydrates, fat and energy intake has resulted in a global obesity epidemics and related metabolic disturbance even for pregnant women. Pregnancy process is accompanied by substantial hormonal, metabolic and immunological changes during which gut microbiota is also remarkably remodeled. Dietary fiber has been demonstrated to have a striking role in shifting the microbial composition so as to improve host metabolism and health in non-pregnant individuals. The present study was conducted to investigate effects of adding a soluble dietary fiber inulin (0 or 1.5%) to low- or high- fat (0 or 5% fat addition) gestational diet on maternal and neonatal health and fecal microbial composition in a sow model. Results showed that inulin addition decreased the gestational body weight gain and fat accumulation induced by fat addition. Circulating concentrations of pro-inflammatory cytokine IL-6, adipokine leptin and chemerin were decreased by inulin supplementation. Inulin addition remarkably reduced the average BMI of newborn piglets and the within litter BMI distributions (%) ranging between 17 and 20 kg/m2, and increased the BMI distribution ranging between 14 and 17 kg/m2. 16S rRNA gene sequencing of the V3-V4 region showed that fecal microbial changes at different taxonomic levels triggered by inulin addition predisposed the pregnant sow to be thinner and lower inflammatory. Meanwhile, fecal microbial composition was also profoundly altered by gestation stage with distinct changes occurring at perinatal period. Most representative volatile fatty acid (VFA) producing-related genera changed dramatically when reaching the perinatal period and varied degrees of increases were detected with inulin addition. Fecal VFA concentrations failed to show any significant effect with dietary intervention, however, were markedly increased at perinatal period. Our findings indicate that positive microbial changes resulted by 1.5% soluble fiber inulin addition would possibly be the potential mechanisms under which maternal body weight, metabolic and inflammatory status and neonatal BMI were improved. Besides, distinct changes of microbial community at perinatal period indicated the mother sow is undergoing a catabolic state with increased energy loss and inflammation response at that period compared with other stages of gestation.

Associations between maternal lifestyle factors and neonatal body composition in the Screening for Pregnancy Endpoints (Cork) cohort study.

Neonatal body composition likely mediates fetal influences on life long chronic disease risk. A better understanding of how maternal lifestyle is related to newborn body composition could thus inform intervention efforts. Using Cork participant data (n = 1754) from the Screening for Pregnancy Endpoints (SCOPE) cohort study [ECM5(10)05/02/08], we estimated how pre-pregnancy body size, gestational weight gain, exercise, alcohol, smoking and diet were related to neonatal fat and fat-free mass, as well as length and gestational age at birth, using quantile regression. Maternal factors were measured by a trained research midwife at 15 gestational weeks, in addition to a 3rd trimester weight measurement used to calculate weight gain. Infant body composition was measured using air-displacement plethysmography. Healthy (versus excess) gestational weight gain was associated with lower median fat-free mass [-112 g, 95% confidence interval (CI): -47 to -176) and fat mass (-33 g, 95% CI: -1 to -65) in the offspring; and a 103 g decrease in the 95th centile of fat mass (95% CI: -33 to -174). Maternal normal weight status (versus obesity) was associated with lower median fat mass (-48 g, 95% CI: -12 to -84). At the highest centiles, fat mass was lower among infants of women who engaged in frequent moderate-intensity exercise early in the pregnancy (-92 g at the 95th centile, 95% CI: -168 to -16). Lastly, women who never smoked tended to have longer babies with more fat mass and fat-free mass. No other lifestyle factors were strongly related to infant body composition. These results suggest that supporting healthy maternal lifestyles could reduce the risk of excess fat accumulation in the offspring, without adversely affecting fat-free mass development, length or gestational age.

Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil.

The present study aimed to identify food patterns among 2-9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns. Cross-sectional study. Parents of 2-9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices. Participants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014. Parents of 2-9-year-olds (n 929). Two dietary patterns emerged: 'traditional food' and 'ultra-processed food'. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of 'Healthy Eating Guidance' (OR=1·83, P<0·001) and 'Monitoring' (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child's screen use during mealtimes (OR=1·61, P=0·004). The present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2-9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.

Associations of Maternal Weight Status Before, During, and After Pregnancy with Inflammatory Markers in Breast Milk.

ObjectiveTo examine the associations of maternal weight status before, during, and after pregnancy with breast milk C-Reactive Protein (CRP) and Interleukin-6 (IL-6), two bioactive markers of inflammation, measured at one and three months postpartum.MethodsParticipants were 134 exclusively breastfeeding mother-infant dyads taking part in the Mothers and Infants LinKed for Health (MILK) study, who provided breast milk samples. Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) were assessed by chart abstraction; postpartum weight loss was measured at the one and three month study visits. Linear regression was used to examine the associations of maternal weight status with repeated measures of breast milk CRP and IL-6 at one and three months, after adjustment for potential confounders.ResultsPre-pregnancy BMI and excessive GWG, but not total GWG or postpartum weight loss, were independently associated with breast milk CRP after adjustment (β=0.49, p<0.001 and β=0.51, p=0.011, respectively). No associations were observed for IL-6.ConclusionsHigh pre-pregnancy BMI and excessive GWG are associated with elevated levels of breast milk CRP. The consequences of infants receiving varying concentrations of breast milk inflammatory markers are unknown; however, we speculate that there are implications for the intergenerational transmission of disease risk.

Associations between bottle-feeding intensity and maternal encouragement of bottle-emptying.

To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy. Mothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying. The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration. Mothers (n 1776). Repeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001). More frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed.

The Intestinal Microbiome and Childhood Obesity

Pediatric obesity has reached epidemic proportions worldwide. The community of microbes inhabiting the human intestine affects differential nutrient absorption, metabolism, and weight status. However, the majority of our knowledge is derived from animal models and adults with obesity. This review discusses the role of the intestinal microbiome in the development and modification of pediatric obesity, with a focus on opportunities for modification of the microbiome through alteration of environmental factors. Recent evidence suggests that obesity is associated with phylogenetic changes in the gut microbiome, yet most of what we know about the role of the microbiome and obesity is from research on adults. A vast number of variables influence the gut microbial ecology early in life, including maternal weight status, breastfeeding, dietary manipulation, antibiotic exposure, and pre/probiotic use. Both in experimental animal and human studies, advances in genomic, proteomic, and metabolomics technologies have expanded our capacity to understand the composition and phenotype of the gut microbiome and mechanistic factors that modulate human health. The human intestinal microbiome is associated with both the environment and child obesity. Understanding the mechanisms behind microbial regulation of human metabolism during infancy and childhood is key to developing effective prevention and treatment of obesity.

Metabolic markers during pregnancy and their association with maternal and newborn weight status.

Background/AimsObesity during pregnancy increases the risk of adverse clinical outcomes and is associated with low-grade chronic inflammation. We describe maternal metabolic risk and inflammation by maternal weight status, and evaluate the association of metabolic and inflammatory markers with birthweight in a group of pregnant Mexican women.MethodsThis study derived from a prospective cohort of healthy pregnant women <14 weeks of gestation, receiving prenatal care at National Institute of Perinatology (Mexico, 2009–2013). Metabolic and inflammatory markers were measured in maternal serum in all three pregnancy trimesters (1st: 11.42±1.7; 2nd: 21.06±2.4; 3rd: 32.74±2.3 weeks). Pregestational weight was self-reported, and body mass index (BMI) was calculated. Gestational weight gain was evaluated in the third trimester. Newborn´s weight was measured at birth. We carried out correlations, general mixed linear model and regression analyses, based on pregestational weight (self-reported), body mass index (BMI), gestational weight gain (evaluated in the third trimester) and newborn weight (measured at birth).ResultsOf the 177 women included in the study (mean age = 26.93±8.49), thirty-eight percent (n = 67) were overweight or had obesity, and 32.8% (n = 58) showed excessive gestational weight gain. We found insulin, lipids (including total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides-TG), leptin and interleukin 1b (IL-1b) all increased significantly (p<0.05) during pregnancy. Pregestational maternal weight status altered longitudinal concentrations of insulin, leptin, adiponectin, TG and C reactive protein. Excessive gestational weight gain was associated with higher maternal insulin in the third trimester (p<0.05). Early pregnancy leptin and TNFα were determinants of birthweight in women with normal weight, but not in overweight or obese women.ConclusionsMaternal weight status affected the concentrations of insulin, leptin, adiponectin, triglycerides and C reactive protein throughout pregnancy. The role of early leptin and TNFα in fetal growth need further study given the association was only observed in normal weight women. This study presents data distribution of metabolic and inflammatory markers of normal weight and overweight/obese women that did not develop GDM, preeclampsia nor macrosomia.

A prospective study of breastfeeding intentions of healthy weight and overweight women as predictors of breastfeeding outcomes

ObjectiveWomen with a higher BMI are at increased risk of breastfeeding for a shorter duration, however it is unclear if weight status itself or other factors such as feeding intentions are responsible for early breastfeeding cessation. The aim of this study was determine the influence of maternal pre-pregnancy weight status on infant feeding intentions during pregnancy using a validated scale and assess whether high intentions to exclusively breastfeed measured during pregnancy predicted feeding mode at discharge and at 4 months postpartum in both healthy weight (Hwt) (BMI< 25kg/m2) and overweight (Owt)(BMI > 25kg/m2) women. DesignThis prospective, observational study commenced when participants were <20 weeks gestation, continuing until four months post partum. Self-administered questionnaires assessed pre-pregnancy weight, infant feeding intentions at 36 weeks gestation, and breastfeeding practices at hospital discharge and 4 months postpartum. Hospital records provided details of delivery mode, gestation and breastfeeding during hospital stay. Binary logistic regression analyses were used to compare weight groups on the breastfeeding beliefs and practices adjusting for selected covariates Participants and settingA consecutive sample of pregnant women (n = 715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks gestation were eligible unless they had pre-existing Type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. Measurements and findingsOf 715 women recruited, 402 had complete data at 4 months post-partum. There were no differences in high breastfeeding intentions (66% vs 53%, p = 0.10) or initiation (96% vs. 98%, p = 0.33) between Hwt and Owt women. Owt women were less likely to be exclusively breastfeeding at hospital discharge AOR [95%CI] 0.57 [0.33,0.98] and 4 months post-partum 0.62 [0.40,0.97]. High intention to breastfeed was positively associated with exclusively/fully breastfeeding at hospital discharge in Hwt 3.24 [1.52,6.89] but not Owt women 1.73 [0.75,4.00] and 4 months post partum in both weight groups (Hwt 4.1 [2.4–7.2], Owt 6.5 [2.9–14.3]). Key conclusionsHealthy and overweight women appear to have similar antenatal intentions for infant feeding but overweight mothers are less likely to be exclusive breastfeeding at hospital discharge. High antenatal intentions for breastfeeding are related to exclusively/fully breastfeeding at 4 months post partum in both healthy and overweight women. Implications for practiceInvestigation of early hospital practices that support and hinder the establishment of successful breastfeeding in overweight mothers may help to identify effective strategies to protect breastfeeding relationships between mother-infant dyads, particularly those who have experienced a caesarean delivery.

Risk Characteristics and Behaviors for Ultra-processed Food Consumption in a Sample of Brazilian Children

Identify food patterns among 2-9 year olds, and explore potential associations among less healthy dietary patterns, parental feeding practices and parent and child characteristics. Cross-sectional study. Participants were parents of 2-9 year old children enrolled in private schools of São Paulo and Campinas, Brazil (n=929). Parents completed a Food Frequency Questionnaire, feeding practices measured using a validated Brazilian version of the Comprehensive Feeding Practices Questionnaire and questionnaires regarding parent and child characteristics. First, we conducted a factor analysis on the Food Frequency Questionnaire to derive food patterns, followed by a univariate and a multivariate logistic regression model to identify predictors of less healthy dietary patterns. Two dietary patterns emerged: traditional foods, and ultra-processed foods. ‘Healthy Eating Guidance’ and ‘Monitoring’, factors of the Comprehensive Feeding Practices Questionnaire, were negatively associated with the ultra-processed food pattern, while the screen use during mealtimes, lower perceived parental responsibility for adequacy of food groups’ intake, lower maternal education, and higher maternal weight status were positively associated with this pattern. This is the first study to evaluate associations between less healthy dietary patterns of Brazilian 2-9 year olds, parental feeding practices and other risk characteristics. Our findings highlight demographic and behavioral factors within families that could be used to target tailored policies and interventions in risk populations for obesity and its consequences.