MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Int J Obes (Lond). 2022 Apr;46(4):758-766. doi: 10.1038/s41366-021-01047-2. Epub 2021 Dec 16.
Rates of childhood obesity are increasing globally, with poor dietary quality an important contributory factor. Evaluation of longitudinal diet quality across early life could identify timepoints and subgroups for nutritional interventions as part of effective public health strategies.
This research aimed to: (1) define latent classes of mother-offspring diet quality trajectories from pre-pregnancy to child age 8-9 years, (2) identify early life factors associated with these trajectories, and (3) describe the association between the trajectories and childhood adiposity outcomes.
Dietary data from 2963 UK Southampton Women's Survey mother-offspring dyads were analysed using group-based trajectory modelling of a diet quality index (DQI). Maternal diet was assessed pre-pregnancy and at 11- and 34-weeks' gestation, and offspring diet at ages 6 and 12 months, 3, 6-7- and 8-9-years using interviewer-administered food frequency questionnaires. At each timepoint, a standardised DQI was derived using principal component analysis. Adiposity age 8-9 years was assessed using dual-energy X-ray absorptiometry (DXA) and BMI z-scores.
A five-trajectory group model was identified as optimal. The diet quality trajectories were characterised as stable, horizontal lines and were categorised as poor (n = 142), poor-medium (n = 667), medium (n = 1146), medium-better (n = 818) and best (n = 163). A poorer dietary trajectory was associated with higher maternal pre-pregnancy BMI, smoking, multiparity, lower maternal age and lower educational attainment. Using linear regression adjusted for confounders, a 1-category decrease in the dietary trajectory was associated with higher DXA percentage body fat (0.08 SD (95% confidence interval 0.01, 0.15) and BMI z-score (0.08 SD (0.00, 0.16) in the 1216 children followed up at age 8-9 years.
Mother-offspring dietary trajectories are stable across early life, with poorer diet quality associated with maternal socio-demographic and other factors and childhood adiposity. The preconception period may be an important window to promote positive maternal dietary changes in order to improve childhood outcomes.
儿童肥胖率在全球范围内呈上升趋势，而饮食质量差是一个重要的促成因素。评估整个儿童早期的饮食质量变化轨迹可以确定营养干预的时间点和亚组，作为有效公共卫生策略的一部分。
本研究旨在：（1）从怀孕前到儿童 8-9 岁时，确定母婴饮食质量轨迹的潜在类别；（2）确定与这些轨迹相关的早期生活因素；（3）描述轨迹与儿童肥胖结果之间的关系。
使用基于群组的轨迹建模方法对来自 2963 对英国南安普敦妇女调查母婴的饮食质量指数（DQI）进行分析。在怀孕前和 11-34 周妊娠时评估母亲的饮食，在 6、12 个月、3、6-7 和 8-9 岁时使用访谈式食物频率问卷评估子女的饮食。在每个时间点，使用主成分分析得出一个标准化的 DQI。使用双能 X 射线吸收法（DXA）和 BMI z 评分评估 8-9 岁时的肥胖情况。
确定了一个五轨迹组模型作为最优模型。饮食质量轨迹表现为稳定的水平直线，并分为较差（n=142）、较差-中等（n=667）、中等（n=1146）、中等-较好（n=818）和最佳（n=163）。较差的饮食轨迹与母亲怀孕前 BMI 较高、吸烟、多胎、母亲年龄较低和教育程度较低有关。在调整混杂因素的线性回归中，饮食轨迹每降低一个类别，与 8-9 岁时 1216 名随访儿童的 DXA 体脂百分比（0.08SD（95%置信区间 0.01，0.15）和 BMI z 评分（0.08SD（0.00，0.16）增加有关。
母婴饮食轨迹在整个儿童早期是稳定的，较差的饮食质量与母亲的社会人口统计学和其他因素以及儿童肥胖有关。孕前阶段可能是促进母亲饮食积极变化的重要窗口，以改善儿童结局。
