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. 2022 Oct 5:379:e071767.
doi: 10.1136/bmj-2022-071767.

Maternal consumption of ultra-processed foods and subsequent risk of offspring overweight or obesity: results from three prospective cohort studies

Yiqing Wang  1   2 , Kai Wang  3 , Mengxi Du  4 , Neha Khandpur  5   6   7 , Sinara Laurini Rossato  7   8 , Chun-Han Lo  1   2   3 , Hannah VanEvery  1   2 , Daniel Y Kim  1   2 , Fang Fang Zhang  4   9 , Jorge E Chavarro  3   7   10 , Qi Sun  3   7   10 , Curtis Huttenhower  11   12 , Mingyang Song  1   2   3   7 , Long H Nguyen  1   2   11 , Andrew T Chan  1   2   7   10
Affiliations

Maternal consumption of ultra-processed foods and subsequent risk of offspring overweight or obesity: results from three prospective cohort studies

Yiqing Wang et al. BMJ. .

Abstract

Objective: To assess whether maternal ultra-processed food intake during peripregnancy and during the child rearing period is associated with offspring risk of overweight or obesity during childhood and adolescence.

Design: Population based prospective cohort study.

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

Participants: 19 958 mother-child (45% boys, aged 7-17 years at study enrollment) pairs with a median follow-up of 4 years (interquartile range 2-5 years) until age 18 or the onset of overweight or obesity, including a subsample of 2925 mother-child pairs with information on peripregnancy diet.

Main outcome measures: Multivariable adjusted, log binomial models with generalized estimating equations and an exchangeable correlation structure were used to account for correlations between siblings and to estimate the relative risk of offspring overweight or obesity defined by the International Obesity Task Force.

Results: 2471 (12.4%) offspring developed overweight or obesity in the full analytic cohort. After adjusting for established maternal risk factors and offspring's ultra-processed food intake, physical activity, and sedentary time, maternal consumption of ultra-processed foods during the child rearing period was associated with overweight or obesity in offspring, with a 26% higher risk in the group with the highest maternal ultra-processed food consumption (group 5) versus the lowest consumption group (group 1; relative risk 1.26, 95% confidence interval 1.08 to 1.47, P for trend<0.001). In the subsample with information on peripregnancy diet, while rates were higher, peripregnancy ultra-processed food intake was not significantly associated with an increased risk of offspring overweight or obesity (n=845 (28.9%); group 5 v group 1: relative risk 1.17, 95% confidence interval 0.89 to 1.53, P fortrend=0.07). These associations were not modified by age, sex, birth weight, and gestational age of offspring or maternal body weight.

Conclusions: Maternal consumption of ultra-processed food during the child rearing period was associated with an increased risk of overweight or obesity in offspring, independent of maternal and offspring lifestyle risk factors. Further study is needed to confirm these findings and to understand the underlying biological mechanisms and environmental determinants. These data support the importance of refining dietary recommendations and the development of programs to improve nutrition for women of reproductive age to promote offspring health.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from National Institutes of Health, American Gastroenterological Association, the Crohn’s and Colitis Foundation, American Cancer Society, and Massachusetts General Hospital for the submitted work; ATC serves as a consultant for Pfizer, Boehringer Ingelheim, Bayer Pharma AG outside 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.

Figures

Fig 1
Fig 1
Study design. Each number in the process chart indicates the year questionnaire was administered. BMI=body mass index, FFQ=food frequency questionnaire; GUTS=Growing Up Today Study; NHS=Nurses’ Health Study
Fig 2
Fig 2
Association between maternal consumption of individual types of ultra-processed foods during child rearing period and risk of overweight or obesity in offspring. Relative risks and 95% confidence intervals were estimated for each one standard deviation increase in ultra-processed food intake using generalized estimating equation adjusted for maternal risk factors (baseline age, race, smoking, physical activity, total energy intake, Alternative Healthy Eating Index 2010, body mass index, personal history of chronic disease, living status, household income, spouse’s education), and offspring’s risk factors (sex, consumption of ultra-processed foods, physical activity, sedentary time). Individual types of ultra-processed foods were mutually adjusted
Fig 3
Fig 3
Association between maternal consumption of ultra-processed foods during child rearing period and risk of overweight or obesity in offspring by risk factors. Relative risks and 95% confidence intervals for group with highest consumption of ultra-processed food (group 5) compared with group with lowest consumption (group 1) estimated using generalized estimating equation adjusted for maternal risk factors (baseline age, race, smoking, physical activity, total energy intake, 2010 Alternative Healthy Eating Index, body mass index (BMI), personal history of chronic disease, living status, household income, spouse’s education), and offspring’s risk factors (sex, consumption of ultra-processed foods, physical activity, sedentary time). Information for gestational weight gain is only available in GUTS I. P for heterogeneity was calculated using Cochran’s Q test
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