Sahariah Sirazul Ameen, Gandhi Meera, Chopra Harsha, Kehoe Sarah H, Johnson Matthew J, di Gravio Chiara, Patkar Deepak, Sane Harshad, Coakley Patsy J, Karkera Aarti H, Bhat Dattatray S, Brown Nick, Margetts Barrie M, Jackson Alan A, Kumaran Kalyanaraman, Potdar Ramesh D, Fall Caroline H D
Centre for the Study of Social Change, Mumbai, India.
Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
J Nutr. 2022 Apr;152(4):1070-1081. doi: 10.1093/jn/nxab443. Epub 2023 Feb 18.
Maternal nutrition influences fetal development and may permanently alter ("program") offspring body composition and metabolism, thereby influencing later risk of diabetes and cardiovascular (cardiometabolic) disease. The prevalence of cardiometabolic disease is rising rapidly in India.
To test the hypothesis that supplementing low-income Indian women with micronutrient-rich foods preconceptionally and during pregnancy has a beneficial impact on the children's body composition and cardiometabolic risk marker profiles.
Follow-up of 1255 children aged 5-10 y whose mothers took part in the Mumbai Maternal Nutrition Project [Project "SARAS"; International Standard Randomised Controlled Trial Number (ISRCTN)62811278]. Mothers were randomly assigned to receive a daily micronutrient-rich snack or a control snack of lower micronutrient content, both made from local foods, in addition to normal diet, from before pregnancy until delivery. Children's body composition was assessed using anthropometry and DXA. Their blood pressure, plasma glucose, insulin, and lipid concentrations were measured. Outcomes were compared between allocation groups with and without adjustment for confounding factors.
Overall, 15% of children were stunted, 34% were wasted, and 3% were overweight. In the intention-to-treat analysis, there were no differences in body composition or risk markers between children in the intervention and control groups. Among children whose mothers started supplementation ≥3 mo before conception (the "per protocol" sample) the intervention increased adiposity among girls, but not boys. BMI in girls was increased relative to controls by 2% (95% CI: 1, 4; P = 0.01); fat mass index by 10% (95% CI: 3, 18; P = 0.004); and percent fat by 7% (95% CI: 1, 13; P = 0.01) unadjusted, with similar results in adjusted models.
Overall, supplementing women with micronutrient-rich foods from before pregnancy until delivery did not alter body composition or cardiometabolic risk markers in the children. Subgroup analyses showed that, if started ≥3 mo before conception, supplementation may increase adiposity among female children.
孕产妇营养会影响胎儿发育，并可能永久性改变（“编程”）后代的身体组成和新陈代谢，从而影响日后患糖尿病和心血管（心脏代谢）疾病的风险。印度心脏代谢疾病的患病率正在迅速上升。
检验如下假设：在孕前和孕期为低收入印度女性补充富含微量营养素的食物，会对儿童的身体组成和心脏代谢风险标志物谱产生有益影响。
对1255名5至10岁儿童进行随访，这些儿童的母亲参与了孟买孕产妇营养项目[“萨拉斯”项目；国际标准随机对照试验编号（ISRCTN）62811278]。母亲们被随机分配，除正常饮食外，从怀孕前到分娩期间每天接受一份富含微量营养素的零食或一份微量营养素含量较低的对照零食，两者均由当地食物制成。使用人体测量法和双能X线吸收法评估儿童的身体组成。测量他们的血压、血浆葡萄糖、胰岛素和血脂浓度。在调整和未调整混杂因素的情况下，比较分配组之间的结果。
总体而言，15%的儿童发育迟缓，34%的儿童消瘦，3%的儿童超重。在意向性分析中，干预组和对照组儿童的身体组成或风险标志物没有差异。在母亲在受孕前≥3个月开始补充营养的儿童中（“符合方案”样本），干预增加了女孩的肥胖程度，但对男孩没有影响。与对照组相比，女孩的BMI未经调整增加了2%（95%CI：1，4；P = 0.01）；脂肪量指数增加了10%（95%CI：3，18；P = 0.004）；体脂百分比增加了7%（95%CI：1，13；P = 0.01），调整模型的结果相似。
总体而言，从怀孕前到分娩期间为女性补充富含微量营养素的食物，并没有改变儿童的身体组成或心脏代谢风险标志物。亚组分析表明，如果在受孕前≥3个月开始补充营养，可能会增加女童的肥胖程度。
