Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada3George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winni.
JAMA Pediatr. 2016 Jul 1;170(7):662-70. doi: 10.1001/jamapediatrics.2016.0301.
The consumption of artificial sweeteners has increased substantially in recent decades, including among pregnant women. Animal studies suggest that exposure to artificial sweeteners in utero may predispose offspring to develop obesity; however, to our knowledge, this has never been studied in humans.
To determine whether maternal consumption of artificially sweetened beverages during pregnancy is associated with infant body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 3033 mother-infant dyads from the Canadian Healthy Infant Longitudinal Development (CHILD) Study, a population-based birth cohort that recruited healthy pregnant women from 2009 to 2012. Women completed dietary assessments during pregnancy, and their infants' BMI was measured at 1 year of age (n = 2686; 89% follow-up). Statistical analysis for this study used data collected after the first year of follow-up, which was completed in October 2013. The data analysis was conducted in August 2015.
Maternal consumption of artificially sweetened beverages and sugar-sweetened beverages during pregnancy, determined by a food frequency questionnaire.
Infant BMI z score and risk of overweight at 1 year of age, determined from objective anthropometric measurements and defined according to World Health Organization reference standards.
The mean (SD) age of the 3033 pregnant women was 32.4 (4.7) years, and their mean (SD) BMI was 24.8 (5.4). The mean (SD) infant BMI z score at 1 year of age was 0.19 (1.05), and 5.1% of infants were overweight. More than a quarter of women (29.5%) consumed artificially sweetened beverages during pregnancy, including 5.1% who reported daily consumption. Compared with no consumption, daily consumption of artificially sweetened beverages was associated with a 0.20-unit increase in infant BMI z score (adjusted 95% CI, 0.02-0.38) and a 2-fold higher risk of infant overweight at 1 year of age (adjusted odds ratio, 2.19; 95% CI, 1.23-3.88). These effects were not explained by maternal BMI, diet quality, total energy intake, or other obesity risk factors. There were no comparable associations for sugar-sweetened beverages.
To our knowledge, we provide the first human evidence that maternal consumption of artificial sweeteners during pregnancy may influence infant BMI. Given the current epidemic of childhood obesity and widespread use of artificial sweeteners, further research is warranted to confirm our findings and investigate the underlying biological mechanisms, with the ultimate goal of informing evidence-based dietary recommendations for pregnant women.
近几十年来，人工甜味剂的消费大幅增加，包括孕妇在内。动物研究表明，胎儿暴露于人工甜味剂可能使后代更容易肥胖；然而，据我们所知，这在人类中从未被研究过。
确定孕妇在怀孕期间饮用人工加糖饮料是否与婴儿的体重指数（BMI[体重以千克为单位除以身高以米为单位的平方]）有关。
设计、地点和参与者：这项队列研究包括来自加拿大健康婴儿纵向发展（CHILD）研究的 3033 对母婴对，这是一项基于人群的出生队列，2009 年至 2012 年期间招募了健康孕妇。女性在怀孕期间完成了饮食评估，她们的婴儿在 1 岁时测量了 BMI（n=2686；89%随访）。这项研究的统计分析使用了随访第一年之后收集的数据，该数据于 2013 年 10 月完成。数据分析于 2015 年 8 月进行。
孕妇在怀孕期间人工加糖饮料和含糖饮料的摄入量，通过食物频率问卷确定。
婴儿的 BMI z 分数和 1 岁时超重的风险，通过客观的人体测量学测量并根据世界卫生组织参考标准确定。
3033 名孕妇的平均（SD）年龄为 32.4（4.7）岁，平均（SD）BMI 为 24.8（5.4）。1 岁时婴儿 BMI z 分数的平均值（SD）为 0.19（1.05），5.1%的婴儿超重。超过四分之一的女性（29.5%）在怀孕期间饮用人工加糖饮料，其中 5.1%的人报告每天饮用。与不饮用相比，每天饮用人工加糖饮料与婴儿 BMI z 分数增加 0.20 个单位（调整后的 95%置信区间，0.02-0.38）和 1 岁时婴儿超重的风险增加 2 倍（调整后的优势比，2.19；95%置信区间，1.23-3.88）相关。这些影响不能用母亲的 BMI、饮食质量、总能量摄入或其他肥胖风险因素来解释。含糖饮料没有类似的关联。
据我们所知，我们提供了第一个人类证据，表明孕妇在怀孕期间摄入人工甜味剂可能会影响婴儿的 BMI。鉴于当前儿童肥胖的流行和人工甜味剂的广泛使用，有必要进一步研究以证实我们的发现并研究潜在的生物学机制，最终目标是为孕妇提供基于证据的饮食建议。
