In a recent study published in The Journal of Nutrition, researchers investigate the association between the quality of the maternal diet during pregnancy and hepatic fat in the offspring during early childhood.

Study: Maternal diet quality during pregnancy and offspring hepatic fat in early childhood: The Healthy Start Study. Image Credit: Evgeny Atamenenko / Shutterstock.com

Background

Non-alcoholic fatty liver disease (NAFLD) in the pediatric population is a growing concern, as it is associated with insulin resistance, childhood obesity, and various other metabolic disorders. During childhood, NAFLD can also lead to liver fibrosis and non-alcoholic steatohepatitis.

Previous studies have shown that exposure to obesogenic factors, such as suboptimal levels of lipids or glucose, as well as maternal obesity in utero during the developmental stages of the fetus, can increase the risk of hepatic fat in the offspring.

The activity levels of the mother and maternal diet could also influence the risk of NAFLD in the offspring. Research on animal models has shown that high-fat and high-sucrose-based diets are associated with liver fat in the offspring. Therefore, it is important to understand whether and how maternal diet quality influences the risk of NAFLD in offspring.

About the study

In the present study, researchers analyzed longitudinal data from the Health Start Study, a pre-birth cohort from Colorado, United States. The Healthy Start Study enrolled pregnant females above the age of 15 at less than 24 weeks of gestation with a singleton pregnancy and with no history of previous stillbirths or pre-existing chronic diseases such as diabetes, steroid-dependent asthma, psychiatric disease, or cancer.

The study recorded data from in-person visits with the mother-child dyad during early and mid-pregnancies, one day after delivery, twice during infancy when the offspring was at a median age of five and 22 months, and once during early childhood when the offspring was around five years old.

The researchers used the data for 1,131 mother-child dyads with complete information on the maternal diet during pregnancy. In addition, a subset of the children from these dyads underwent an assessment of hepatic fat during early childhood through magnetic resonance imaging (MRI).

The quality of the maternal diet was assessed using two distinct metrics. First, the typical maternal nutrient intake of carbohydrates, energy, fats, and protein was used to determine the macronutrient distribution.

Three indices, including the Healthy Eating Index-2010, relative Mediterranean Diet (rMED) score, and dietary inflammation index (DII®), were used to determine the maternal diet pattern scores to obtain insights into the combined impact of various foods consumed during pregnancy.

The researchers hypothesized that a maternal diet of poor quality with high fat and sugar content would correlate with a higher accumulation of hepatic fat in the offspring during early childhood.

Linear regression models were used to analyze associations between predictors of maternal diet during pregnancy and hepatic fat in the offspring. These models were also adjusted for perinatal or maternal confounding factors, the offspring's demographic characteristics, and the mother's total energy intake.

Study findings

Higher rMED scores, which indicated a relatively high Mediterranean Diet type with high fiber intake in the maternal diet during pregnancy, were associated with lower hepatic fat in the offspring during early childhood. Furthermore, a material diet with high DII scores, combined with increased sugar intake in the maternal diet and high levels of total sugar by the mother, was linked to higher hepatic fat in the offspring.

A sub-component analysis also revealed that the reduced intake of legumes and green vegetables in the diet by the mother and a higher intake of empty calories such as added sugar also increased the risk of hepatic fat accumulation in the offspring during early childhood.

These findings were consistent, even when the analyses were adjusted for factors such as total energy intake and body mass index (BMI) during pregnancy. Thus, the correlation between maternal diet and hepatic fat accumulation in the offspring was independent of the energy balance in the mother.

Increased intake of healthy dietary fibers and carbohydrates with a low glycemic index was linked to better weight control during pregnancy and enhanced metabolic homeostasis in the mother, which could reduce the susceptibility of the offspring to NAFLD. However, the study found that the levels of maternal triglycerides, previously linked to hepatic fat in the offspring, did not influence the associations between maternal diet and NAFLD risk in the offspring.

Conclusions

Overall, the current study reports that a maternal diet of poor quality that includes lower levels of healthy fiber and high sugar consumption increased the susceptibility of the offspring to NAFLD. Furthermore, pro-inflammatory maternal diets, as determined by high DII scores and dissimilar to the Mediterranean diet, were associated with hepatic fat accumulation in the offspring during early childhood.

These findings provide a target in the perinatal stage for preventing NAFLD in the pediatric population.

Journal reference:

• Cohen, C. C., Perng, W., Sauder, K. A., et al. (2023). Maternal diet quality during pregnancy and offspring hepatic fat in early childhood: The Healthy Start Study. The Journal of Nutrition. doi:10.1016/j.tjnut.2023.01.039