Mary K. Horan

Methodologies to assess paediatric adiposity

IntroductionChildhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity.MethodsThe online databases PubMed, CINALH and EMBASE were searched and the abstracts identified were reviewed to determine appropriate studies. Their reference lists were also searched to identify further eligible studies. Publications were included if they described childhood measurement techniques or involved validation.Results and DiscussionThere are many body composition assessment tools available, none of which are direct. Each technique has limitations and a combination of methods may be used. The main clinical techniques are weight, height, body mass index (BMI) and circumferences which provide sufficient information to enable classification of overweight or obesity when growth centile charts and ratios are employed. Further investigation depends on resources available and examiner skill. Skinfold thicknesses are cost-effective but require technical training and only measure subcutaneous fat. Dual energy X-ray absorptiometry (DEXA), air displacement plethysmography (ADP), magnetic resonance imaging (MRI) and computed tomography (CT) are more costly and intensive, requiring the child to remain still for longer periods. DEXA and ADP are capable of accurately measuring adiposity but are unable to distinguish between fat depots. MRI and CT can distinguish intra-abdominal from subcutaneous adiposity and are considered gold standards, but CT is unsuitable for adiposity measurement in children due to high levels of radiation exposure. Ultrasound is a promising technique capable of measuring intra-abdominal adiposity in children but requires further validation.ConclusionThe core clinical measurements of weight, height, BMI and circumferences are sufficient to enable diagnosis of paediatric overweight and obesity while more technical tools provide further insight.

Maternal Diet and Weight at 3 Months Postpartum Following a Pregnancy Intervention with a Low Glycaemic Index Diet: Results from the ROLO Randomised Control Trial

Pregnancy increases the risk of being overweight at a later time period, particularly when there is excessive gestational weight gain. There remains a paucity of data into the effect of low glycaemic index (GI) pregnancy interventions postpartum. Aim: To examine the impact of a low glycaemic index diet during pregnancy on maternal diet 3 months postpartum. Methodology: This analysis examined the diet, weight and lifestyle of 460 participants of the ROLO study 3 months postpartum. Questionnaires on weight, physical activity, breastfeeding, supplement use, food label reading and dietary habits were completed. Results: The intervention group had significantly greater weight loss from pre-pregnancy to 3 months postpartum than the control group (1.3 vs. 0.1 kg, p = 0.022). The intervention group reported greater numbers following a low glycaemic index diet (p < 0.001) and reading food labels (p = 0.032) and had a lower glycaemic load (GL) (128 vs. 145, p = 0.014) but not GI (55 vs. 55, p = 0.809) than controls. Conclusions: Low GI dietary interventions in pregnancy result in improved health-behaviours and continued reported compliance at 3 months postpartum possibly through lower dietary GL as a result of portion control. Greater levels of weight loss from pre-pregnancy to 3 months postpartum in the intervention group may have important positive implications for overweight and obesity.

Maternal Nutrition and Glycaemic Index during Pregnancy Impacts on Offspring Adiposity at 6 Months of Age—Analysis from the ROLO Randomised Controlled Trial

Childhood obesity is associated with increased risk of adult obesity and metabolic disease. Diet and lifestyle in pregnancy influence fetal programming; however the influence of specific dietary components, including low glycaemic index (GI), remains complex. We examined the effect of a maternal low GI dietary intervention on offspring adiposity at 6 months and explored the association between diet and lifestyle factors in pregnancy and infant body composition at 6 months. 280 6-month old infant and mother pairs from the control (n = 142) and intervention group (n = 138), who received low GI dietary advice in pregnancy, in the ROLO study were analysed. Questionnaires (food diaries and lifestyle) were completed during pregnancy, followed by maternal lifestyle and infant feeding questionnaires at 6 months postpartum. Maternal anthropometry was measured throughout pregnancy and at 6 months post-delivery, along with infant anthropometry. No difference was found in 6 months infant adiposity between control and intervention groups. Maternal trimester three GI, trimester two saturated fats and trimester one and three sodium intake were positively associated with offspring adiposity, while trimester two and three vitamin C intake was negatively associated. In conclusion associations were observed between maternal dietary intake and GI during pregnancy and offspring adiposity at 6 months of age.

Fetal metabolic influences of neonatal anthropometry and adiposity

BackgroundLarge for gestational age infants have an increased risk of obesity, cardiovascular and metabolic complications during life. Knowledge of the key predictive factors of neonatal adiposity is required to devise targeted antenatal interventions. Our objective was to determine the fetal metabolic factors that influence regional neonatal adiposity in a cohort of women with previous large for gestational age offspring.MethodsData from the ROLO [Randomised COntrol Trial of LOw Glycaemic Index in Pregnancy] study were analysed in the ROLO Kids study. Neonatal anthropometric and skinfold measurements were compared with fetal leptin and C-peptide results from cord blood in 185 cases. Analyses were performed to examine the association between these metabolic factors and birthweight, anthropometry and markers of central and generalised adiposity.ResultsFetal leptin was found to correlate with birthweight, general adiposity and multiple anthropometric measurements. On multiple regression analysis, fetal leptin remained significantly associated with adiposity, independent of gender, maternal BMI, gestational age or study group assignment, while fetal C-peptide was no longer significant.ConclusionFetal leptin may be an important predictor of regional neonatal adiposity. Interventional studies are required to assess the impact of neonatal adiposity on the subsequent risk of childhood obesity and to determine whether interventions which reduce circulating leptin levels have a role to play in improving neonatal adiposity measures.

Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention.

Background/Objective:Well-being has been linked to the quality of diet and lifestyle in adults; however, there is a paucity of data in pregnancy. The aim of this study was to examine the relationship between well-being and socioeconomic status, diet and lifestyle during pregnancy and to consider the effect of intervention with low glycaemic index (GI) diet on well-being.Subjects/Methods:This was a cohort analysis of 619 participants of the ROLO study (Randomised cOntrol trial of LOw GI diet versus no dietary intervention to prevent recurrence of fetal macrosomia). The following data were collected: educational attainment, dietary intakes (food frequency questionnaire), physical activity (self-reported) and well-being (WHO-5-Item Wellbeing Index—expressed as a percentage).Results:Well-being was positively associated with education and physical activity. Third-level education was associated with a 3.07-point higher well-being percentage score, and each day that an individual achieved >30 min walking per week was associated with a 1.10-point increase in percentage well-being score, Radj2 2.4% (F=7.260, P=0.001). The intervention low GI group had a significantly lower percentage well-being score than the usual diet group (56.3% vs 59.9%, P=0.015). No correlation was noted between well-being and GI status calculated from food diaries (P=0.469). Well-being was not associated with micronutrient intake.Conclusions:Well-being in pregnancy was independently and positively associated with education and physical activity and negatively associated with low GI dietary intervention. These findings have significance not only for women at risk of low mood but also for healthcare professionals when counselling women about the importance of healthy lifestyle in pregnancy.

PMM.20 Maternal diet and weight at 3 months partum following a pregnancy intervention with a low glycaemic index diet: Results from the ROLO randomised control trial

Background There remains a paucity of data into the effect of low glycaemic index (GI) healthy eating pregnancy interventions postpartum. Aim: To examine the impact of a low glycaemic index diet during pregnancy on maternal diet and weight at 3 months postpartum, analysis from the ROLO (Randomised cOntrol trial of LOw glycaemic index (GI) diet versus no dietary intervention to prevent recurrence of fetal macrosomia) study. Methodology This was a postpartum analysis of 460 participants of the ROLO study 3 month postnatally. Questionnaires on weight, physical activity, breastfeeding, supplement use, food label reading and dietary change since the intervention were completed. Results The intervention group had significantly higher weight loss from pre-pregnancy to 3 months postpartum than the control group (1.314 vs 0.119 kg, p = 0.022). The intervention group reported higher levels of adherence to a low GI diet (p < 0.001) and food label reading (p = 0.032) and had a lower glycaemic load (GL) (128.22 vs 145.18, p = 0.014) but not GI intake (54.51 vs 54.66, p = 0.809) than the controls. Conclusions Low GI dietary intervention in pregnancy results in improved health-behaviours and continued reported compliance at 3 months postpartum possibly mediated through portion control. Reduced gestational weight gain in pregnancy persisted at 3 months postpartum which has important positive implications for overweight and obesity in later life.

8.1 The association of maternal characteristics and macronutrient intake in pregnancy with neonatal body composition

Background The in utero environment has been found to affect fetal development however many of the mechanisms by which this occurs remain unknown. The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle in pregnancy and neonatal body composition. Methods This was an analysis of 749 infants from the ROLO study (Randomised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia). Food diaries and food frequency, lifestyle and exercise questionnaires were completed during pregnancy. Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth. Results Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was gestational weight gain R2 adj 23.3% (F = 11.547, p < 0.001). The main maternal factor associated with increased birth length was non-smoking status R2 adj 27.8% (F = 6.193, p < 0.001). Neonatal central adiposity determined using waist:height ratio was negatively associated with maternal age, and positively associated with the following maternal parameters: smoking status, pre-pregnancy arm circumference, percentage energy from saturated fat in late pregnancy, postprandial glucose and control group membership. There was no association between neonatal anthropometry and maternal “healthy diet” clusters or adherence to a DASH diet. Conclusions Maternal low glycaemic index diet in pregnancy was found to have a beneficial effect on neonatal central adiposity. Additionally maternal dietary fat intake and late pregnancy postprandial glucose were positively associated with central adiposity, highlighting the important role of a healthy diet in pregnancy in promoting normal neonatal adiposity.

Impact of Maternal and Fetal Inflammatory Markers on Neonatal and Infant Adiposity

Aims To determine the association of maternal and fetal inflammatory factors with neonatal and infant adiposity Methods Data from 265 mother-child pairs at birth and 280 pairs at 6 months postnatal from a randomised control trial assessing the effect of a low glycaemic index diet on birth weight were analysed. Maternal TNF-alpha (TNFα) and Interleukin 6 (IL-6) were measured in early and late pregnancy and fetal levels from cord blood. Anthropometric measurements were recorded at birth and at 6 months. The sum of all skinfolds and the sum of Subscapular plus Triceps skinfolds [SS+TR] were used as markers of general adiposity and the ratio of SS/TR skinfolds as a marker of central adiposity. Results Maternal TNFα in early pregnancy was associated with neonatal anthropometry including biceps [p = 0.048], triceps [p = 0.027] and subscapular [p = 0.002] skinfold thicknesses. TNFα in early and late pregnancy correlated with general adiposity in the neonate [SS + TR p = 0.003, p = 0.008 respectively; Sum of skinfolds p = 0.011, p = 0.002 respectively] [Table 1]. Maternal early and late pregnancy TNFα was also associated with 6-month-old central adiposity [SS/TR ratio p = 0.002, p = 0.030, respectively]. Fetal TNFα did not exert a significant influence on neonatal anthropometry but was associated with infant triceps skinfold at 6 months. While fetal IL-6 was associated with birth length and waist:height ratio, maternal IL-6 was not significantly associated with adiposity. Abstract G313(P) Figure 1 Association of maternal and fetal TNF-α with infant adiposity at birth Simple linear regression On multiple linear regression analysis, TNFα contributed significantly to the majority of the final models for both neonatal and infant anthropometry, however, the models themselves were not significant. Any associations between maternal or fetal IL-6 with neonatal and infant anthropometry were no longer significant in the multiple regression models. Conclusion Maternal TNFα significantly correlates with greater offspring adiposity at birth and 6 months and therefore may act as a potential antenatal indicator of a predisposition towards early childhood obesity.

Perinatal inflammation and childhood adiposity – a gender effect?

Abstract Background: To determine the association of maternal and fetal inflammatory factors with gender-specific infant adiposity, independent of leptin. Methods: Analysis of anthropometry from 265 mother–infant pairs at birth and 280 pairs at 6 months from the randomised control trial of low glycaemic index diet in pregnancy (ROLO) study (Randomised control trial of low glycaemic index diet) and their association with Maternal TNF-alpha, interleukin 6 and leptin as measured in early and late pregnancy and fetal levels in cord blood. Results: No associations were noted in the male cohort. On multiple regression amongst the female neonatal cohort late pregnancy IL-6 was inversely associated with sum of skinfolds (p ≤ .001); at 6 months infant sum of skinfolds were positively associated with early pregnancy IL-6 (p = .046) and central adiposity positively associated with early pregnancy TNF alpha (p = .018) independent of leptin. Conclusion: Although maternal inflammatory cytokines were not associated with neonatal adiposity independent of leptin (as this association is known), both IL-6 and TNF-α were associated with female infant anthropometry at 6 months of age independent of leptin. These results suggest inflammatory cytokines may exert an in-utero influence on later infant adiposity with a tendency to influence female adiposity more than male. Further research is required to ascertain whether these cytokines may be used as reliable early predictors of infant adiposity.

Five Year Follow-Up of a Low GI Dietary Randomised Controlled Trial in Pregnancy - No Long-Term Maternal Effects of a Dietary Intervention

To determine whether a dietary intervention in pregnancy had a lasting effect on maternal outcomes of diet, HbA1c and weight retention 5 years post‐intervention; and to establish whether modifiable maternal behaviours were associated with these outcomes.