Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United StatesBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2486 (Published 04 July 2018) Cite this as: BMJ 2018;362:k2486
- Klodian Dhana, postdoctoral fellow1,
- Jess Haines, associate professor2,
- Gang Liu, postdoctoral fellow1,
- Cuilin Zhang, senior investigator3,
- Xiaobin Wang, professor4,
- Alison E Field, professor5,
- Jorge E Chavarro, associate professor16,
- Qi Sun, associate professor16
- 1Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA 02115, 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
- Correspondence to: Q Sun
- Accepted 8 May 2018
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 1282 (5.3%) offspring became obese during a median of five 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 to 0.50), engaged in at least 150 min/week of moderate/vigorous physical activities (0.79, 0.69 to 0.91), did not smoke (0.69, 0.56 to 0.86), and consumed alcohol in moderation (1.0-14.9 g/day; 0.88, 0.79 to 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 to 1.12). When all healthy lifestyle factors were considered simultaneously, offspring of women who adhered to all five 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 to 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 to 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.
Contributors: KD and QS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. KD and QS planned and designed the study, and analyzed and interpreted the data. KD drafted the manuscript. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. KD and QS are the guarantors of this investigation. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: This study was supported by grants UM1-CA176726, P30-DK046200, U54-CA155626, T32-DK007703-16, HD066963, HL096905, DK084001, OH009803, and MH087786 from the US National Institutes of Health. QS is supported by grants ES021372, ES022981, and HL34594 from the National Institutes of Health.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the National Institutes of Health for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The Nurses’ Health Study II and Growing Up Today Study were approved by the institutional review board at Brigham and Women’s Hospital and Harvard T H Chan School of Public Health. The return of the completed self administrated questionnaire was considered to imply informed consent.
Data sharing: No additional data available.
The lead authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
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