Effect of supplemental nutrition in pregnancy on offspring’s risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India


Autoři: Sanjay Kinra aff001;  John Gregson aff001;  Poornima Prabhakaran aff002;  Vipin Gupta aff003;  Gagandeep Kaur Walia aff002;  Santhi Bhogadi aff004;  Ruby Gupta aff002;  Aastha Aggarwal aff002;  Poppy Alice Carson Mallinson aff001;  Bharati Kulkarni aff004;  Dorairaj Prabhakaran aff002;  George Davey Smith aff005;  K. V. Radha Krishna aff004;  Shah Ebrahim aff001;  Hannah Kuper aff001;  Yoav Ben-Shlomo aff006
Působiště autorů: Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom aff001;  Public Health Foundation of India, Delhi, India aff002;  Department of Anthropology, University of Delhi, Delhi, India aff003;  National Institute of Nutrition, Hyderabad, India aff004;  MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom aff005;  Population Health Sciences, University of Bristol, Bristol, United Kingdom aff006
Vyšlo v časopise: Effect of supplemental nutrition in pregnancy on offspring’s risk of cardiovascular disease in young adulthood: Long-term follow-up of a cluster trial from India. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003183
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003183

Souhrn

Background

Undernutrition during intrauterine life and early childhood is hypothesised to increase the risk of cardiovascular disease (Developmental Origins of Health and Disease Hypothesis), but experimental evidence from humans is limited. This hypothesis has major implications for control of the cardiovascular disease epidemic in South Asia (home to a quarter of world’s population), where a quarter of newborns have low birth weight. We investigated whether, in an area with prevalent undernutrition, supplemental nutrition offered to pregnant women and their offspring below the age of 6 years was associated with a lower risk of cardiovascular disease in the offspring when they were young adults.

Methods and findings

The Hyderabad Nutrition Trial was a community-based nonrandomised controlled intervention trial conducted in 29 villages near Hyderabad, India (1987–1990). Protein-calorie food supplement was offered daily to pregnant and lactating women (2.09 MJ energy and 20–25 g protein) and their offspring (1.25 MJ energy and 8–10 g protein) until the age of six years in the 15 intervention villages, but not in the 14 control villages. A total of 1,826 participants (949 from the intervention villages and 877 from the control villages, representing 70% of the cohort) at a mean age of 21.6 years (62% males) were examined between 2009 and 2012. The mean body mass index (BMI) of the participants was 20 kg/m2 and the mean systolic blood pressure was 115 mm Hg. The age, sex, socioeconomic position, and urbanisation-adjusted effects of intervention (beta coefficients and 95% confidence intervals) on outcomes were as follows: carotid intima-media thickness, 0.01 mm (−0.01 to 0.03), p = 0.36; arterial stiffness (augmentation index), −1.1% (−2.5 to 0.3), p = 0.097; systolic blood pressure, 0.5 mm Hg (−0.6 to 1.6), p = 0.36; BMI, −0.13 kg/m2 (−0.75 to 0.09), p = 0.093; low-density lipoprotein (LDL) cholesterol, 0.06 mmol/L (−0.07 to 0.2), p = 0.37; and fasting insulin (log), −0.06 mU/L (−0.19 to 0.07), p = 0.43. The limitations of this study include nonrandomised allocation of intervention and lack of data on compliance, and potential for selection bias due to incomplete follow-up.

Conclusions

Our results showed that in an area with prevalent undernutrition, protein-calorie food supplements offered to pregnant women and their offspring below the age of 6 years were not associated with lower levels of cardiovascular risk factors among offspring when they were young adults. Our findings, coupled with evidence from other intervention studies to date, suggest that policy makers should attach limited value to cardiovascular health benefits of maternal and child protein-calorie food supplementation programmes.

Klíčová slova:

Birth weight – Blood pressure – Cardiovascular diseases – Cholesterol – Insulin – Malnutrition – Nutrition – Pregnancy


Zdroje

1. Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390: 1151–1210. doi: 10.1016/S0140-6736(17)32152-9 28919116

2. Yusuf S, Reddy S, Ôunpuu S, Anand S. Global Burden of Cardiovascular Diseases: Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization. Circulation. 2001;104: 2746–2753. doi: 10.1161/hc4601.099487 11723030

3. Galobardes B, Lynch JW, Smith GD. Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review. J Epidemiol Community Health. 2008;62: 387–390. doi: 10.1136/jech.2007.065508 18413449

4. Godfrey KM, Barker DJP. Fetal nutrition and adult disease. Am J Clin Nutr. 2000;71: 1344S–52S. doi: 10.1093/ajcn/71.5.1344s 10799412

5. Barker DJP. Mother, babies and health in later life. 2nd ed. Edinburgh, United Kingdom: Churchill Livingstone; 1998.

6. Bateson P, Barker D, Clutton-Brock T, Deb D, D’Udine B, Foley RA, et al. Developmental plasticity and human health. Nature. 2004;430: 419–421. doi: 10.1038/nature02725 15269759

7. Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of In Utero and Early-Life Conditions on Adult Health and Disease. N Engl J Med. 2008;359: 61–73. doi: 10.1056/NEJMra0708473 18596274

8. Harding JE. The nutritional basis of the fetal origins of adult disease. Int J Epidemiol. 2001;30: 15–23. doi: 10.1093/ije/30.1.15 11171842

9. Kuh D, Power C, Blane D, Bartley M. Socioeconomic pathways between childhood and adult health. 2nd ed. A lifecourse approach to chronic disease epidemiology. 2nd ed. Oxford: Oxford University Press; 2004. pp. 371–95.

10. Hawkesworth S, Walker CG, Sawo Y, Fulford AJ, Jarjou LM, Goldberg GR, et al. Nutritional supplementation during pregnancy and offspring cardiovascular disease risk in The Gambia. Am J Clin Nutr. 2011;94: 1853S–1860S. doi: 10.3945/ajcn.110.000877 21677054

11. Stein AD, Wang M, Ramirez-Zea M, Flores R, Grajeda R, Melgar P, et al. Exposure to a Nutrition Supplementation Intervention in Early Childhood and Risk Factors for Cardiovascular Disease in Adulthood: Evidence from Guatemala. Am J Epidemiol. 2006;164: 1160–1170. doi: 10.1093/aje/kwj328 17018700

12. Kinra S, Rameshwar Sarma KV, Ghafoorunissa, Mendu VVR, Ravikumar R, Mohan V, et al. Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial. BMJ. 2008;337: a605–a605. doi: 10.1136/bmj.a605 18658189

13. Central Technical Committee. Integrated child development services: survey, evaluation and research, 1975–95. New Delhi; 1996.

14. The Director. Annual Report 1990–91. Hyderabad: National Institute of Nutrition (ICMR); 1991.

15. Kinra S, Radha Krishna K, Kuper H, Rameshwar Sarma K, Prabhakaran P, Gupta V, et al. Cohort Profile: Andhra Pradesh Children and Parents Study (APCAPS). Int J Epidemiol. 2014;43: 1417–1424. doi: 10.1093/ije/dyt128 24019421

16. Indian Institute of Population Sciences. National Family Health Survey 3. Mumbai: IIPS, 2006 [cited 2020 Apr 6]. http://rchiips.org/nfhs/volume_2.shtml

17. Bowen L, Bharathi AV, Kinra S, DeStavola B, Ness A, DM SE. Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and rural India. Asia Pac J Clin Nutr 2012;21:355–60. 22705424

18. Matsuzaki M, Sullivan R, Ekelund U, Krishna KR, Kulkarni B, Collier T, et al. Development and evaluation of the Andhra Pradesh Children and Parent Study Physical Activity Questionnaire (APCAPS-PAQ): a cross-sectional study. BMC Public Health. 2015;16.

19. Lane Kevin J., Stokes Eleanor C., Seto Karen C., Thanikachalam Sadagopan, Thanikachalam Mohan, Bell Michelle L. Associations between Greenness, Impervious Surface Area, and Nighttime Lights on Biomarkers of Vascular Aging in Chennai, India. Environ Health Perspect. 125: 087003. doi: 10.1289/EHP541 28886599

20. Ma T, Zhou C, Pei T, Haynie S, Fan J. Quantitative estimation of urbanization dynamics using time series of DMSP/OLS nighttime light data: A comparative case study from China’s cities. Remote Sens Environ. 2012;124: 99–107. doi: 10.1016/j.rse.2012.04.018

21. Ota E, Hori H, Mori R, Tobe-Gai R, Farrar D. Antenatal dietary education and supplementation to increase energy and protein intake. Cochrane Database Syst Rev. 2015; CD000032. doi: 10.1002/14651858.CD000032.pub3 26031211

22. Dorairaj Prabhakaran, Panniyammakal Jeemon, Ambuj Roy. Cardiovascular Diseases in India. Circulation. 2016;133: 1605–1620. doi: 10.1161/CIRCULATIONAHA.114.008729 27142605

23. Hawkesworth S, Wagatsuma Y, Kahn AI, Hawlader MDH, Fulford AJC, Arifeen S-E, et al. Combined food and micronutrient supplements during pregnancy have limited impact on child blood pressure and kidney function in rural Bangladesh. J Nutr. 2013;143: 728–734. doi: 10.3945/jn.112.168518 23514767

24. Carles Milà, Otavio Ranzani, Margaux Sanchez, Albert Ambrós, Santhi Bhogadi, Sanjay Kinra, et al. Land-Use Change and Cardiometabolic Risk Factors in an Urbanizing Area of South India: A Population-Based Cohort Study. Environ Health Perspect. 128: 047003. doi: 10.1289/EHP5445 32243204

25. Miranda JJ, Kinra S, Casas JP, Davey Smith G, Ebrahim S. Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Trop Med Int Health. 2008;13: 1225–1234. doi: 10.1111/j.1365-3156.2008.02116.x 18937743

26. Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in South Asia. BMJ. 2004;328: 807–810. doi: 10.1136/bmj.328.7443.807 15070638

27. Oken E, Gillman M. Fetal origins of obesity. Obes Res. 2003;11: 496–506. doi: 10.1038/oby.2003.69 12690076


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PLOS Medicine


2020 Číslo 7

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