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Dhana K¹, Haines J², Liu G¹, Zhang C³, Wang X⁴, Field AE⁵, Chavarro JE^1,6, Sun Q^1,6

¹Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; ²Department of Family Relations and Applied Nutrition at the University of Guelph in Guelph, Canada; ³Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA; ⁴Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; ⁵Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; ⁶Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA

BMJ 2018;362:k2486

Objective: To examine the association between an overall maternal healthy lifestyle (characterized by a healthy body mass index, high quality diet, regular exercise, no smoking, and light to moderate alcohol intake) and the risk of developing obesity in offspring.

Design: Prospective cohort studies of mother-child pairs.

Setting: Nurses’ Health Study II (NHSII) and Growing Up Today Study (GUTS) in the United States.

Participants: 24,289 GUTS participants aged 9–14 years at baseline who were free of obesity and born to 16,945 NHSII women.

Main Outcome Measure: Obesity in childhood and adolescence, defined by age and sex specific cutoff points from the International Obesity Task Force. Risk of offspring obesity was evaluated by multivariable log-binomial regression models with generalized estimating equations and an exchangeable correlation structure.

Results: 1,282 (5.3%) offspring became obese during a median of 5 years of follow-up. Risk of incident obesity was lower among offspring whose mothers maintained a healthy body mass index of 18.5–24.9 (relative risk 0.44, 95% confidence interval 0.39–0.50), engaged in at least 150 min/week of moderate/vigorous physical activities (0.79, 0.69–0.91), did not smoke (0.69, 0.56–0.86), and consumed alcohol in moderation (1.0–14.9 g/day; 0.88, 0.79–0.99), compared with the rest. Maternal high quality diet (top 40% of the Alternate Healthy Eating Index 2010 diet score) was not significantly associated with the risk of obesity in offspring (0.97, 0.83–1.12). When all healthy lifestyle factors were considered simultaneously, offspring of women who adhered to all 5 low risk lifestyle factors had a 75% lower risk of obesity than offspring of mothers who did not adhere to any low risk factor (0.25, 0.14– 0.47). This association was similar across sex and age groups and persisted in subgroups of children with various risk profiles defined by factors such as pregnancy complications, birth weight, gestational age, and gestational weight gain. Children’s lifestyle did not significantly account for the association between maternal lifestyle and offspring obesity risk, but when both mothers and offspring adhered to a healthy lifestyle, the risk of developing obesity fell further (0.18, 0.09–0.37).

Conclusion: Our study indicates that adherence to a healthy lifestyle in mothers during their offspring’s childhood and adolescence is associated with a substantially reduced risk of obesity in the children. These findings highlight the potential benefits of implementing family or parental based multifactorial interventions to curb the risk of childhood obesity.

Reprinted with permission from BMJ Publishing Group Ltd.

Comments

Identifying modifiable risk factors for the prevention of childhood obesity has become a public health priority. Previous studies have shown that children’s lifestyle choices are largely influenced by their mothers, and maternal behaviors are also associated with offspring’s body mass index [3, 4]. Therefore, maternal lifestyle choices could exert health effects among offspring, probably through modulating the living environment and lifestyle of children.This large study demonstrated that offspring of women adhering to an overall healthy lifestyle had a substantially lower risk of obesity than children of mothers who did not practice these lifestyle choices. Offspring of women who adhered to 5 low-risk lifestyle factors (high-quality diet, normal body weight, regular physical activities, light to moderate intake of alcohol, and non-smoking) had a 75% lower risk of developing incident obesity than children of mothers who did not adhere to any of the low-risk lifestyle factors. The risk of incident offspring obesity was 82% lower when both mothers and their offspring followed a healthy lifestyle. These associations were independent of other established and potential risk factors of childhood obesity and persisted among participants who had different baseline risk profiles defined by pregnancy complications and other maternal factors.We have to remember that a maternal healthy lifestyle can have an impact both on the intra-uterine metabolic environment that is important for the prenatal fetal programming and can prevent obesity and metabolic comorbidities in the next generations [5, 6] and also on the children’s lifestyle choices.The strengths of the study are the large sample size, the detailed information of lifestyle factors in both mothers and offspring, and its prospective study design with long-term follow-up, which allowed to examine the impact of maternal factors before the occurrence of offspring obesity in childhood and adolescence.The study is limited by the self-reported data of the lifestyle characteristics, including children’s lifestyle assessments (patients with obesity tend to under-report their energy intake and over-report their amount of physical activities) and body weight of mothers and their offspring, which are known to be subject to measurement errors.Second, the participants belonged to the Nurses’ Health Study II (NHSII) and Growing Up Today Study (GUTS) that are relatively of homogeneous socioeconomic status. Therefore, it can limit the generalizability of the findings to other populations with different socioeconomic status. Also, the study only examined maternal lifestyle, and the potentially crucial role of paternal lifestyle in the development of obesity in offspring was not investigated.Overall, the study results highlight the potentially critical role of maternal lifestyle choices in the etiology of childhood obesity and show that adherence to a healthy lifestyle in both mothers and their children can result in an even further reduction in the risk of offspring obesity.

Breastfeeding and Nutrition During Early Life and Risk of Childhood Obesity and Metabolic Comorbidities

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