Goiuri Alberdi

Nutrition During Pregnancy Impacts Offspring's Epigenetic Status-Evidence from Human and Animal Studies.

Pregnancy is a vital time of growth and development during which maternal nutrition significantly influences the future health of both mother and baby. During pregnancy, the fetus experiences a critical period of plasticity. Epigenetics, specifically DNA methylation, plays an important role here. As nutrition is influential for DNA methylation, this review aims to determine if maternal nutrition during pregnancy can modify the offsprings epigenome at birth. Research focuses on micronutrients and methyl donors such as folate and B vitamins. Evidence suggests that maternal nutrition does not largely influence global methylation patterns, particularly in nutrient-replete populations; however, an important impact on gene-specific methylation is observed. A link is shown between maternal nutrition and the methylome of the offspring; however, there remains a paucity of research. With the potential to use DNA methylation patterns at birth to predict health of the child in later life, it is vital that further research be carried out.

Maternal Blood Lipid Profile during Pregnancy and Associations with Child Adiposity: Findings from the ROLO Study

Background The in-utero environment affects fetal development; it is vital to understand how maternal diet during pregnancy influences childhood body composition. While research indicates that triglycerides in hyperglycaemic women may increase birth weight, little is known about this relationship in euglycemic women. This study examines the relationship between maternal blood lipid status and infant adiposity up to 2 years of age. Methods Data from 331 mother-child pairs from the ROLO longitudinal birth cohort study was analysed. Maternal dietary intakes were recorded and fasting blood lipids, leptin and HOMA were measured in early and late pregnancy and cord blood. Infant anthropometric measurements and skin-fold thicknesses were recorded at birth, 6 months and 2 years. Correlation and regression analyses were used to explore associations between maternal blood lipid status and infant adiposity. Results All maternal blood lipids increased significantly during pregnancy. Maternal dietary fat intake was positively associated with total cholesterol levels in early pregnancy. Late pregnancy triglycerides were positively associated with birth weight (P = 0.03) while cord blood triglycerides were negatively associated with birth weight (P = 0.01). Cord HDL-C was negatively associated with infant weight at 6 months (P = 0.005). No other maternal blood lipids were associated with infant weight or adiposity up to 2 years of age. Conclusion Maternal and fetal triglycerides were associated with birth weight and cord HDL-C with weight at 6 months. Thus, maternal lipid concentrations may exert in-utero influences on infant body composition. There may be potential to modulate infant body composition through alteration of maternal diet during pregnancy.

The association between childcare and risk of childhood overweight and obesity in children aged 5 years and under: a systematic review.

AbstractThe aim of this paper was to systematically review the published evidence on the relationship between the type of childcare and risk of childhood overweight or obesity. The databases PubMed, MEDLINE, Cochrane Library and EMBASE were searched using combinations of the various search terms to identify eligible observational studies published between 2000 and May 2016 in English. Fifteen publications from 7 countries matched the inclusion criteria. The most commonly reported childcare arrangements were centre-based (e.g. crèche) and informal care (e.g. relatives, neighbours, friends). Informal care was most frequently associated with an increased risk of childhood overweight and obesity. Associations were also found for other lifestyle variables such as low maternal education, high birth-weight, maternal employment, ethnicity, maternal overweight/obesity and father’s Body Mass Index (BMI). Conclusion: The relationship between childcare and childhood overweight/obesity is multi-faceted with many aspects linked to childhood adiposity, in particular the age of initiation to care, type of care (i.e. informal care) and shorter breastfeeding duration were related with infant adiposity.What is known:• Lifestyle factors during early years affect health outcomes in adulthood, particularly in children with low birth weight.• Pre-school stage influences children’s body composition and growth.What is new:• This is the first systematic review of observational studies examining the association between childcare and childhood overweight and obesity in preschool children.• ‘Informal’ care is linked to early introduction to solid foods, less physical activity and obesity.

Metabolic programming of a beige adipocyte phenotype by genistein

Scope Promoting the development of brown or beige adipose tissue may protect against obesity and related metabolic features, and potentially underlies protective effects of genistein in mice. Methods and results We observed that application of genistein to 3T3‐L1 adipocytes changed the lipid distribution from large droplets to a multilocular distribution, reduced mRNAs indicative of white adipocytes (ACC, Fasn, Fabp4, HSL, chemerin, and resistin) and increased mRNAs that are a characteristic feature of brown/beige adipocytes (CD‐137 and UCP1). Transcripts with a role in adipocyte differentiation (Cebpβ, Pgc1α, Sirt1) peaked at different times after application of genistein. These responses were not affected by the estrogen receptor (ER) antagonist fulvestrant, revealing that this action of genistein is not through the classical ER pathway. The Sirt1 inhibitor Ex‐527 curtailed the genistein‐mediated increase in UCP1 and Cebpβ mRNA, revealing a role for Sirt1 in mediating the effect. Baseline oxygen consumption and the proportional contribution of proton leak to maximal respiratory capacity was greater for cells exposed to genistein, demonstrating greater mitochondrial uncoupling. Conclusions We conclude that genistein acts directly on adipocytes or on adipocyte progenitor cells to programme the cells metabolically to adopt features of beige adipocytes. Thus, this natural dietary agent may protect against obesity and related metabolic disease.

A Low Glycaemic Index Diet in Pregnancy Induces DNA Methylation Variation in Blood of Newborns: Results from the ROLO Randomised Controlled Trial

The epigenetic profile of the developing fetus is sensitive to environmental influence. Maternal diet has been shown to influence DNA methylation patterns in offspring, but research in humans is limited. We investigated the impact of a low glycaemic index dietary intervention during pregnancy on offspring DNA methylation patterns using a genome-wide methylation approach. Sixty neonates were selected from the ROLO (Randomised cOntrol trial of LOw glycaemic index diet to prevent macrosomia) study: 30 neonates from the low glycaemic index intervention arm and 30 from the control, whose mothers received no specific dietary advice. DNA methylation was investigated in 771,484 CpG sites in free DNA from cord blood serum. Principal component analysis and linear regression were carried out comparing the intervention and control groups. Gene clustering and pathway analysis were also explored. Widespread variation was identified in the newborns exposed to the dietary intervention, accounting for 11% of the total level of DNA methylation variation within the dataset. No association was found with maternal early-pregnancy body mass index (BMI), infant sex, or birthweight. Pathway analysis identified common influences of the intervention on gene clusters plausibly linked to pathways targeted by the intervention, including cardiac and immune functioning. Analysis in 60 additional samples from the ROLO study failed to replicate the original findings. Using a modest-sized discovery sample, we identified preliminary evidence of differential methylation in progeny of mothers exposed to a dietary intervention during pregnancy.

A feasibility study of a multidimensional breastfeeding-support intervention in Ireland

BACKGROUND Breastfeeding is the optimum mode of infant feeding. Despite this, most global populations do not achieve the World Health Organisations recommendation of exclusive breast milk for the first 6 months of life. Irish breastfeeding rates are among the lowest in Europe, necessitating a well-designed breastfeeding-support intervention. AIM To evaluate the feasibility and acceptability of a multidimensional breastfeeding intervention in a rural and an urban maternity setting in Ireland. DESIGN A feasibility study of a breastfeeding-support intervention. SETTING Participants were recruited from The National Maternity Hospital (Dublin, urban) and Wexford General Hospital (Wexford, rural). Questionnaires were completed antenatally, at 6 weeks postpartum and at 3 months postpartum to assess acceptability of the intervention and determine breastfeeding status. PARTICIPANTS Pregnant women were recruited in the 3rd trimester, alongside a support partner. INTERVENTION The intervention consisted of an antenatal class (including the physiology and practical approaches to breastfeeding), a one-to-one breastfeeding consultation with a lactation consultant after birth, access to a breastfeeding helpline, online resources, and a postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant. RESULTS One hundred women from The National Maternity Hospital, Dublin and 27 women from Wexford General Hospital were recruited. The antenatal class was attended by 77 women in Dublin and 23 in Wexford; thus, 100 women participated in the intervention. Seventy-six women had a one-to-one postnatal consultation with a lactation consultant in Dublin and 23 in Wexford. Fifty and 45 women in Dublin, and 15 and 15 in Wexford responded to the 6-week and 3-month questionnaires, respectively. At 3 months postpartum, 70% of respondents from Dublin and 60% from Wexford were breastfeeding. Mothers perceived the one-to-one consultation with the lactation consultant during postnatal hospitalization as the most helpful part of the intervention. Inclusion of a support partner was universally viewed positively as a means to support the mothers decision to initiate and continue breastfeeding. CONCLUSION This multidimensional intervention is well-accepted and feasible to carry out within an Irish cohort, in both urban and rural areas. Data from this feasibility study will be used to design a randomized controlled trial of a breastfeeding-support intervention.

The influence of socioeconomic status on gestational weight gain: a systematic review

Background Despite a large number of publications regarding the association between socioeconomic status (SES) and gestational weight gain (GWG), the literature is inconsistent. We conducted a systematic review of current evidence relating to the association between SES and GWG, according to the Institute of Medicine (IOM) 2009 guidelines. Methods Six electronic databases were searched, with the final search run on first July 2016. The PRISMA Statement guidelines were followed and a modified version of the RTI Item Bank was used to assess risk of bias within studies. The primary outcome was inadequate, adequate or excessive GWG, as per the IOM guidelines. Results Sixteen studies were included. There was a positive skew in the number of studies that indicated that those who are less well educated are most at risk of gaining weight outside of the recommendations. Other measures of SES were not significantly associated with GWG. Conclusions Low educational attainment is likely to be associated with women gaining outside the IOM recommendations for GWG. Healthcare providers should provide additional support to pregnant women who are most at risk of gaining outside the recommendations, thus reducing the gap in health inequalities between those of high and low SES.

Lower education predicts poor response to dietary intervention in pregnancy, regardless of neighbourhood affluence: secondary analysis from the ROLO randomised control trial

OBJECTIVE To determine if response to a low glycaemic index (GI) dietary intervention, measured by changes in dietary intake and gestational weight gain, differed across women of varying socio-economic status (SES). DESIGN Secondary data analysis of the ROLO randomised control trial. The intervention consisted of a two-hour low-GI dietary education session in early pregnancy. Change in GI was measured using 3 d food diaries pre- and post-intervention. Gestational weight gain was categorised as per the 2009 Institute of Medicine guidelines. SES was measured using education and neighbourhood deprivation. SETTING The National Maternity Hospital, Dublin, Ireland. SUBJECTS Women (n 625) recruited to the ROLO randomised control trial. RESULTS The intervention significantly reduced GI and excess gestational weight gain (EGWG) among women with third level education residing in both disadvantaged (GI, mean (sd), intervention v. control: -3·30 (5·15) v. -0·32 (4·22), P=0·024; EGWG, n (%), intervention v. control: 7 (33·6) v. 22 (67·9); P=0·022) and advantaged areas (GI: -1·13 (3·88) v. 0·06 (3·75), P=0·020; EGWG: 41 (34·1) v. 58 (52·6); P=0·006). Neither GI nor gestational weight gain differed between the intervention and control group among women with less than third level education, regardless of neighbourhood deprivation. CONCLUSIONS A single dietary education session was not effective in reducing GI or gestational weight gain among less educated women. Multifaceted, appropriate and practical approaches are required in pregnancy interventions to improve pregnancy outcomes for less educated women.

Low education predicts poor response to dietary intervention in pregnancy, regardless of neighbourhood affluence – secondary analysis from the ROLO randomised control trial

This abstract was awarded the student prize for best poster original communication. Low socioeconomic status (SES) is associated with reduced diet quality, gestational weight gain (GWG) outside of Institute of Medicine (IOM) guidelines and poorer pregnancy outcomes. A paucity of data exists regarding the response of women of low SES to interventions in pregnancy. We aimed to determine if response to a low glycaemic index (GI) dietary intervention, measured by changes in diet and excess GWG, differed across women of high/low educational attainment and neighbourhood deprivation. This was secondary data analysis of 754 women recruited to the ROLO study (Randomised cOntrol trial of a LOw glycaemic index diet in pregnancy to prevent macrosomia) between 2007 and 2011. The intervention consisted of a 2-hour low GI education session with a dietitian. Change in GI and nutrient intakes were measured using 3-day food diaries preand post-intervention. Weight, height and BMI (kg/m) were measured at the first antenatal visit. GWG was recorded throughout pregnancy. Excess GWG was categorised as per the 2009 IOM guidelines. Neighbourhood deprivation indices were assigned using an Irish census data index, and categorised as advantaged or disadvantaged. Self-reported education was categorised as achieved or did not achieve 3 level education. The mean changes in nutrient intakes from pre-intervention to post-intervention are shown in the table below. The intervention significantly reduced GI in both the “advantaged & ⩾3 level” and “disadvantaged & ⩾3 level” groups. The intervention did not significantly change any of the nutrient intakes from pre-intervention to post-intervention in the “disadvantaged and <3 level” group. The intervention significantly reduced excess GWG, compared to the control, only among those in the “disadvantaged and ⩾3 level” (31·8 % vs. 69·7 %, respectively; P= 0·006) and “advantaged and ⩾3 level” (34·5 % vs. 55·5 %, respectively; P= 0·001). There were no significant differences in excess GWG between the intervention and control in the “disadvantaged and <3 level” and “advantaged and <3 level”.

Effects of resveratrol on the methylation of lipogenic enzyme genes in 3T3-L1 adipocytes

Abstract of paper that presented at 20th International Congress of Nutrition, Granada, September 2013.Background and Objectives: Indonesia is one of the countries facing nutrition transition with an increased proportion of the middle-class population. Few studies explored young child feeding practice amongst middle class families in developing countries. This study aims to assess child feeding practices and their associations with child nutritional status in urban area of Indonesia. Methods: The study was designed as a mixed-method study in an urban middle-class community, comprising of a qualitative study amongst 26 families of young children and a case-control study involving 288 (109 cases and 179 controls) children aged 12-36 months. Cases were mild to moderately underweight children, while controls were normal weight children. The data collection methods consisted of in-depth interview for the qualitative phase and anthropometry measurements, structured interviews pertaining to child feeding practices and 24-hours recall for the quantitative phase. Results: The qualitative study suggested that mothers appeared to have positive attitude and were familiar with many brands of toddler formula milk. Mothers reported challenges in encouraging their children to eat and relied on formula milk to increase child’s food intake.The results of the case-control study showed that only 10.4% children received six-month exclusive breastfeeding and there was a significantly higher proportion of control than case children who were offered formula milk within their first month of life. Almost all children (91.7%, CI = 87.7 – 94.5) had low dietary diversity (consumed 1-3 food groups) in the last 24 hours. Formula milk was the largest contributor to child’s energy intake amongst the control children. Conclusions: The low dietary diversity warn potential problems for the health of Indonesian children. A large government strategy on complementary feeding practices including controlling the marketing activities of formula milk need to be enhanced.